THE Compleat Surgeon: OR, The whole Art of Surgery explain'd in a most familiar Method.

Containing An exact Account of its Principles and several Parts, viz. Of the Bones, Muscles, Tu­mours, Ʋlcers, and Wounds simple and complicated, or those by Gun-shot; as al­so of Venereal Diseases, the Scurvy, Fra­ctures, Luxations, and all sorts of Chirur­gical Operations; together with their pro­per Bandages and Dressings.

To which is added, A Chirurgical Dispensatory; shewing the man­ner how to prepare all such Medicines as are most necessary for a Surgeon, and par­ticularly the Mercurial Panacaea.

Written in French by M. le Clerc, Physician in Ordinary, and Privy-Counsellor to the French King; and faithfully translated into English.

LONDON, Printed for M. Gillyflower, in Westminster-Hall; T. Goodwin, and M. Wotton, in Fleet-street; J. Walthoe, in the Middle-Temple Cloysters; and R. Parker, under the Royal-Exchange, in Cornhill, 1696.

THE PREFACE.

SO great a number of Trea­tises of Surgery, as well Ancient as Modern, have been already publish'd, that a plenary Satisfaction seems to have been long since given on this Sub­ject, even to the Judgment of the most curious Inquirers: But if it be consider'd that a young Sur­geon ought always to have in view the first Principles of this Noble Art explain'd after a fa­miliar and intelligible manner, it will be soon acknowledg'd that there is good reason to set about [Page]the Work anew: For besides that the Writings of the Anci­ents being so voluminous, are not portable, they are also very in­tricate and confus'd; nay the whole Art has been so far im­prov'd and brought to perfection by able Masters in the present Age, that they are now almost be­come unprofitable.

Some Modern Authors have set forth certain small Tracts, which only explain a few Chi­rurgical Operations, and on that account deserve only the Name of Fragments. Indeed the Works of some others seem to be suffici­ently compleat, but are printed in so large Volumes, and contain so many Discourses altogether fo­reign from the principal Sub­ject, [Page]that they have almost the same Inconveniences with those of the Ancients. Therefore the Reader is here presented with a small Treatise of Surgery, yet very plain and perspicuous, in a portable Volume; being free from a Multiplicity of impertinent Words, and containing every thing of moment that has been produc'd by the most approv'd Authors both Ancient and Modern.

An Introduction is made into the Matter by small Colloquies or Dialogues, to the end that the young Student may be at first lead as it were by the Hand; but as soon as he has attain'd to a con­siderable Progress in these Stu­dies, this innocent and puerile manner of speaking is abandon'd, [Page]to conduct him in good earnest to the most sublime Heights of so admirable an Art; to which pur­pose, after having penetrated in­to its first Rudiments and Grounds, he is well instructed in Anatomy, and furnish'd with a general Idea of Wounds and Tumours, which are afterward treated of in particular: He is also taught a good Method of curing Wounds made by Gun­shot, the Scurvy, and all sorts of Venereal Diseases: From thence he is introduc'd into the Practice of all manner of Chirurgical O­perations in Fractures and Luxa­tions; together with the use of their respective Dressings and Bandages.

At the end of the Work is ad­ded a compleat Chirurgical Dispensatory, shewing the Me­thod of preparing such Medici­nal Compositions as are chiefly us'd in the Art of Surgery; so that upon the whole Matter; it may be justly affirm'd, that this little Manual has all the Ad­vantages of the Ancient and Mo­dern Writings on the same Sub­ject, and is altogether free from their Superfluities and Defects.

THE Compleat Surgeon: OR, THE Whole ART OF SURGERY Explain'd, &c.

CHAP. I. Of the Qualifications of a Surgeon, and of the Art of Surgery.

WHO is a Surgeon?

A Person skill'd in curing Diseases in­cident to Humane Bodies by a metho­dical Application of the Hand.

What are the Qualifications of a good Surgeon in general?

[...]
[...]

They are three in Number: viz. Skill in the Theory, Experience in the Practical part, and a gentle Application of the Hand.

Why ought a Surgeon to be skilful?

Because without a discerning Faculty he ca [...] have no certainty in what he doth.

Why must he be experienc'd?

Because Knowledge alone doth not endue hi [...] with a dexterity of Hand requisite in such [...] Person, which cannot be acquir'd but by Expe­rience, and repeated Manual Operations.

Why must he be tender-handed?

To the End that by fit Applications he ma [...] asswage those Pains which he is oblig'd to cau [...] his Patients to endure.

What is Chirurgery or Surgery?

It is an Art which shews how to cure th [...] Diseases of Humane Bodies by a methodic [...] Manual Application. The Term being deriv [...] from the Greek Word [...], signifying a Ha [...] and [...], a Work or Operation.

After how many manners are Chirurgical O [...] rations usually perform'd?

Four several ways.

Which be they?

I. Synthesis, whereby the divided Parts [...] re-united; as in Wounds. II. Diaeresis, t [...] divides and separates those Parts, which, [...] their Union, hinder the Cure of Diseases, s [...] is the continuity of Abscesses or Impostu [...] which must be open'd to let out the pu [...] lent Matter. III. Exaeresis, which draws ou [...] the Body whatsoever is noxious or hurt [...] as Bullets, Arrows, &c. IV. Pros [...] ­sis adds some Instrument or Body to sup [...] [Page 3]the defect of those that are wanting; such are Artificial Legs and Arms, when the Natural ones are lost. It also furnishes us with cer­tain Instruments to help and strengthen weak Parts, such as Pessaries, which retain the Matrix in its proper place when it is fallen, Crutches to assist feeble Persons in going, &c.

What ought to be chiefly observed before the under­taking an Operation?

Four things; viz.

  • 1. What the Operation to be perform'd is?
  • 2. Why it is perform'd?
  • 3. Whether it be necessary or possible? And
  • 4. The manner of performing it.

How may we discern these?

The Operation to be perform'd may be known by its Definition; that is to say, by explaining what it is in it self: We may discover whether it ought to be done, by examining whether the Distemper cannot be cur'd otherwise: We may also judge whether it be possible or necessary, by a competent Knowledge of the Nature of the Disease, the Strength of the Patient, and the Part affected: Lastly, the manner of performing it may be found out, by being well vers'd in the Practice of Surgery.

What are the Fundamental Principles of Sur­gery?

They are Three in number: viz.

  • 1. The knowledge of Man's Body.
  • 2. That of the Diseases which require a Manual Operation.
  • 3. That of proper Remedies and Helps upon every Occasion.

How may one attain to the Knowledge of Humane Bodies?

By the study of Anatomy.

How may one learn to know the Distempers re­lating to Surgery, and the Remedies appropria­ted for them?

Two several ways; viz.

  • 1. By the reading of good Books, and Instructions receiv'd from able Masters of that Art.
  • 2. By practice and the Observation of what is perform'd b [...] others upon the Bodies of their Patients.

What are the Diseases in general that belong [...] Surgery?

They are Tumours, Impostumes, Wound [...] Ulcers, Fractures, Dislocations, and generall [...] all sorts of Distempers whereto Manual Operati­ons may be applyed.

What are the Instruments in general which a [...] commonly used in Surgery for the curing of Di­seases?

They are Five; viz. the Hand, Bandages Medicines, the Incision-Knife, and Fire.

What is the general Practice which ought to be observ'd in the Application of these different helps?

Hippocrates teacheth us, in saying, that whe [...] Medicines are not sufficient, recourse may b [...] had to the Incision-Knife, and afterward t [...] Fire; intimating that we must proceed by de­grees.

Are there any Distempers that may be cured [...] the Surgeon's Hand alone?

Yes, as when a simple and small Dislocation [...] only to be reduced.

CHAP. II. Of Chirurgical Instruments, portable and not portable.

WHAT do you call portable and not portable Instruments?

Portable Instruments are those which the Surgeon carries in his Lancet-Case with his Plaister-Box; and not portable are those that he doth not carry about him, but is oblig'd to keep at home; the former being appointed for the ready help which he daily administers to his Patients, and the others for greater Ope­rations.

What are the Instruments which a Surgeon ought to have in his Plaister-Box?

These Instruments are a good pair of Sizzers, a Razor, an Incision-Knife streight and crooked, a Spatula, a greater Lancet to open Impostumes, and lesser for letting Blood. They likewise car­ry separately in very near Lancet-Cases, a hol­low Probe made of Silver or fine Steel; as also many other Probes, streight, crooked, folding, and of different thickness; a Pipe of Silver or fine Steel, to convey the cauterizing Button to a remote Part, without running the hazard of burning those that are near it; another Pipe or Tube serving instead of a Case for Needles, which have Eyes at one end for sowing; a Carlet, or thick triangular Needle; a small File; a Steel Instrument to cleanse the Teeth; a [Page 6] Fleam; a pair of crooked Forceps to draw a Tooth; a Pelican; a Crow's Bill; several sorts of Raspatories; a Hook to hold up the Skin in cutting, &c.

What are the Instruments which a Surgeon ought to keep in his Repository to perform the greater Operations?

Some of them are peculiar to certain Opera­tions, and others are common to all. The In­struments appropriated to particular Operations, are the Trepan for opening the Bones in the Head or elsewhere: The Catheters or Probes for Men and Women afflicted with the Stone, or difficulty of making Water. Extractors, to lay hold on the Stone in Lithotomy, and to gather together the Gravel; large crooked In­cision-Knives, and a Saw, to make Amputations of the Arms or Legs; great Needles with three Edges, to be used in making Setons; small Needles to couch Cataracts; other Needles; thin Plates and Buckles to close a Hair-Lip, &c.

May not the Salvatory be reckon'd among the por­table Instruments?

Yes, because the Balsams, Ointments, and Plaisters contain'd therein, are means where­of the Surgeon makes use to restore Health.

CHAP. III. Of Anatomy in general; and in parti­cular of all the Parts whereof the Humane Body is compos'd.

WHAT is Anatomy?

It is the Analysis or exact Division of all the Parts of a Body, to discover their Nature and Original.

What is requisite to be observ'd by a Surgeon before he goes about to dissect a Body?

Two things; viz. The external Structure of the Body, and the Proportion or Correspondence between the outward Parts, and those that are within.

Why so?

Because without this exterior and general Knowledge, the Surgeon wou'd be often mi­staken in the Judgment he is to pass concerning a Dislocation or Wound, inasmuch as it is by the Deformity which he perceives in the Mem­ber, that he knows the Dislocation, as it is also by the means of the Correspondence which the outward Parts have with the inward, that he is enabled to draw any certain Consequences rela­ting to a Wound, which penetrates into the Body.

What is a Part?

It is that whereof the whole Body is com­pos'd, and which partakes of a common Life or Sensation with it.

How many sorts of Parts are there in a Humane Body?

We may well reckon up Fifteen distinct Parts, which are the Bone, the Cartilage, the Ligament, the Tendon, the Membrane, the Fibre, the Nerve, the Vein, the Artery, the Flesh, the Fat, the Skin, the Scarf-Skin, the Hair, and the Nails.

What is a Bone?

It is the hardest and driest Part of the whole Body, and that which constitutes its principal Sup­port.

What is a Cartilage or Gristle?

It is a yielding and supple Part, which par­takes of the Nature of a Bone, and is always fasten'd to its Extremities, to mollifie and facili­tate its Motion.

What is a Ligament?

It is a Membranous Contexture usually stick­ing to the Bones to contain them; as also sometimes to other Parts, to suspend, and re­tain them in their proper place.

What is a Tendon?

It is the Tail or Extremity of the Muscles, made by the re-union of all the Fibres of their Body, which serves to corroborate it in its Acti­on, and to give Motion to the Part.

What is a Membrane?

It is a Nervous Part, the use whereof is to a­dorn and secure the Cavities of the Body on the inside, and to wrap up or cover the Parts.

What is a Fibre?

They are fleshy Lines of which the Body of a Muscle is compos'd.

What is a Nerve?

It is a long, white, and thin Body, consisting [Page 9]of many Fibres, enclos'd within a double Tu­nick, and design'd to carry the Animal Spirits into all the Parts, to give them Sense and Mo­tion.

What is an Artery?

It is a Canal compos'd of Four Coats, that carryeth with a kind of Beating or Pulse even to the very Extremity of the Parts, the Blood full of Spirits, which proceeds from the Heart, to distribute to them at the same time both Life and Nourishment.

What is a Vein?

It is a Canal made likewise of Four Tunicles, which receives the Arterial Blood, to carry it back to the Heart.

What is Flesh?

It is a Part which is form'd of Blood thicken'd by the natural Heat; and that constitutes the Body of a Muscle.

What is Fat?

It is a soft Body made of the Unctuous and Sulphurous part of the Blood.

What is the Derma or Skin?

It is a Net compos'd of Fibres, Veins, Arte­ries, Lymphatick Vessels and Nerves, which co­vers the whole Body, to defend it from the In­juries of the Air, and to serve as an universal Emunctory: It is very thin in the Face, stick­ing close to the Flesh, and is pierc'd with an in­finite number of imperceptible Pores, affording a Passage to insensible Transpiration.

What is the Epiderma, or Scarf-Skin?

It is a small fine Skin, transparent and insensi­ble, having also innumerable Pores for the dis­charging of Sweat, and other Humours by im­perceptible [Page 10]Transpiration: It is extended over the whole inner Skin, to dull its too exquisite Sense, by covering the Extremities of the Nerves which are there terminated. It also renders the same Skin even and smooth, and so contributes very much to Beauty.

What is the Hair?

The Hairs are certain hollow Filaments plant­ed in the Glandules of the Skin, from whence their Nourishment is deriv'd. They constitute the Ornament of some Parts, cover those which Modesty requires to be conceal'd, and defend o­thers from the injury of the Weather.

What is a Nail?

The Nails are a Continuity of the Skin har­den'd at the end of the Fingers, to strengthen and render them fit for Work.

CHAP. IV. Of the general Division of a Hu­mane Body.

HOW is the Humane Body divided before it is dissected, in order to Anatomical Demonstra­tion?

Some Anatomists distinguish it into Similar and Dissimilar Parts, appropriating the former Deno­mination to all the simple Parts of the Body taken separately, as a Bone, a Vein, a Nerve, &c. but they attribute the Name of Dissimilar to all those Members that are compos'd of many Simi­lar or Simple Parts together; such are the Arms, [Page 11]Legs, Eyes, &c. wherein are contain'd all at once, Bones, Veins, Nerves, and other parts.

Others divide it into containing and contained Parts, the former enclosing the others, as the Skull includes the Brain, and the Breast the Lungs; whereas the contained Parts are shut up within others; as the Entrails within the Belly, the Brain within the Skull, &c.

Others again divide the whole Body into Spermatick and Sanguineous Parts; the former being those which are made at the time of Formation; and the latter all those that are grown afterward by the Nourishment of the Blood.

Are there not also other Methods of dividing the Humane Body?

Yes: Many Persons consider it as a Contex­ture of Bones, Flesh, Vessels and Entrails, which they explain in four several Treatises, whereof the first is call'd Osteology, for the Bones; the second Myology, for the Muscles; the third An­giology, for the Veins, Arteries, and Nerves, which are the Vessels; and the fourth Splanch­nology, for the Entrails.

But lastly, the most clear and perspicuous of all the Divisions of the Body of Man, is that which compares it to a Tree, whereof the Trunk is the Body, and the Branches are the Arms and Legs. The Body is divided into three Venters, or great Cavities, viz. the Up­per, the Middle, and the Lower, which are the Head, the Breast, and the lower Belly. The Arms are distributed into the Arms pro­perly so called, the Elbow and Hands; and the Legs in like manner into Thighs, Shanks, [Page 12]and Feet: The Hands being also subdivided in­to the Carpus or Wrist, Metacarpium or Back of the Hand, and the Fingers; as the Feet in­to the Tarsus, Metatarsus, and Toes. This Di­vision is at present follow'd in the Anatomical Schools.

CHAP. V. Of the Skeleton.

WHY is Anatomy usually begun with the De­monstration of the Skeleton, or Contexture of Bones?

Because the Bones serve for the Foundation, Connexion, and Support of all other Parts of the Body.

What is the Skeleton?

It is a gathering together, or Conjunction of all the Bones of the Body almost in their Na­tural Situation.

From whence are the principal differences of the Bones derived?

They are taken from their Substance, Figure, Articulation, and Use.

How is all this to be understood?

First then, with respect to their Substance, there are some Bones harder than others; as those of the Legs compared with those of the Back-Bone. Again, in regard of their Figure, some are long, as those of the Arm; and others short, as those of the Metacarpium. Some are also broad, as those of the Skull and Omo­platae [Page 13]or Shoulder-Blades; and others narrow, as the Ribbs. But with respect to their Articulation, some are joined by thick Heads, which are re­ceived into large Cavities, as the Huckle-Bones with those of the Hips; and others are united by the means of a simple Line, as the Chin-Bones. Lastly, with relation to their Use; some serve to support and carry the whole Bo­dy, as the Leg-Bones, and others are appoint­ed to grind the Meat; as the Teeth; or else to form some Cavity, as the Skull-Bone, and those of the Ribs.

What are the Parts to be distinguished in the Bones?

They are the Body, the Ends, the Heads, the Neck, the Apophyses, the Epiphyses, the Con­dyli or Productions, the Cavities, the Supercilia or Lips, and the Ridges.

The Body is the greatest Part, and the middle of the Bone; the Ends are the two Extremities; the Heads are the great Protuberances at the Ex­tremities; the Neck is that Part which lies im­mediately under the Head; the Apophyses or Pro­cesses are certain Bunches or Knobs at the Ends of the Bones, which constitute a Part of them; the Epiphyses are Bones added to the Extremities of o­ther Bones; the Condyli or Productions are the small Elevations or Extuberances of the Bones; the Cavities are certain Holes or hollow places; the Supercilia or Lips are the Extremities of the Sides of a Cavity, which is at the End of a Bone; the Ridges are the prominent and saliant Parts in the length of the Body of the Bone.

How are the Bones join'd together?

Two several ways, viz. by Articulation and Symphysis.

How many sorts of Articulations are there in the Bones?

There are generally two kinds, viz. Diarthrosis and Synarthrosis.

What is Diarthrosis?

Diarthrosis is a kind of Articulation which serves for sensible Motions.

How many kinds of Diarthroses, or great Motions are there?

There are Three, viz. Enarthrosis, Arthrodia, and Ginglymus.

Enarthrosis is a kind of Articulation which u­nites two Bones with a great Head on one side, and a large Cavity on the other; as the Head of the Thigh-Bone in the Cavity of the Ischion or Huckle-Bone.

Arthrodia is a sort of Articulation, by the means whereof two Bones are join'd together with a flat Head receiv'd into a Cavity of a small depth. Such is the Head of the Shoul­der-Bone with the Cavity of the Omoplata or Shoulder-Blade; and that of the Twelfth Vertebra of the Back with the first of the Loins.

Ginglymus is a kind of Articulation which u­nites two Bones, each whereof hath at their Ends a Head and a Cavity, whereby they both receive and are received at the same time, such is the Articulation in the Bones of the Elbow and the Vertebrae.

What is Synarthrosis?

Synarthrosis being opposite to Diarthrosis, is a [Page 15]close or compacted Articulation, destitute of any sensible Motion.

How many sorts of Synarthroses, or close Articu­lations are there?

There are Three, viz. Sutura, Harmonia, and Gomphosis.

A Suture is that which joins together two Bones by a kind of Seam or Stitch, or by a Connexion of their Extremities dispos'd in form of a Saw, the Teeth whereof are recipro­cally let one into another: Such are the Sutures of the Skull-Bones.

Harmonia is the uniting of two Bones by a simple Line; as the Bone of the Cheek with that of the Jaw.

Gomphosis is a kind of close Articulation, which unites two Bones after the manner of Nails or Wooden Pins fixt in the Holes made to receive them: Such is that of the Teeth in their Soc­kets.

What is Symphysis?

Symphysis is the uniting of two Bones by the interposition of a Medium, which ties them very streight together, being also threefold: Such is the Connexion of the Knee-Pan or Whirl-Bone of the Knee, and the Omoplata or Shoul­der-Blade.

Are not these three kinds of Articulations or Sym­physes distinguish'd one from another?

Yes; for tho' they are all made by the means of a third Body intervening, which joins them together; nevertheless every one of these va­rious Bodies gives a different Denomination to its respectivé Articulation: Thus the Articula­tion which is caus'd by a Glutinous and Car­tilaginous [Page 16]Substance, is properly call'd Syn­chondrosis; as that of the Nose, Chin, Os Pu­bis, &c. But an Articulation which is made by a Ligament is termed Synneurosis, as that of the Knee-Pan. Lastly, that which is wrought by the means of Flesh, bears the Name of Syssar­cosis; as the Jaw-Bones, the Os Hyoides, and the Omoplata or Shoulder-Blade.

Have the Bones any sense of Feeling or Moti­on?

They have neither; for their sense of Pain proceeds from nothing else but their Periostium, or the Membrane with which they are cover'd, and their Motion is perform'd only by the Muscles that draw them.

Doth the Marrow afford any Nutriment to the Bones?

No, all the Bones are nourish'd by the Blood, as the other Parts; but the Marrow is to the Bones what the Fat is to the Flesh; that is to say, it is a kind of Oil or Unctuous Substance, which moistens, and renders them less brittle.

Are all the Bones of the same Colour?

No, they follow the Temperament and Con­stitution of the Persons.

How many in number are the Bones of the Hu­mane Skeleton?

There are two hundred and fifty usually rec­kon'd, viz. 61 in the Head, 67 in the Trunk or Chest, 62 in the Arms and Hands, and 60 in the Legs and Feet; but the true Number can­not be exactly determin'd, by reason that some Persons have more, and others fewer; for some have more Ossa Sesamoidea, Teeth and Breast-Bones [Page 17]than others: Again, some have many in­dentings in the Lambdoidal Suture, and others have none at all.

Can you rehearse the Number of the Bones of the Head?

There are Fifteen in the Skull, and Forty six in the Face.

The Fifteen of the Skull are the Coronal for the fore-part of the Head; the Occipital for the hin­der-part; the two Parietals for the upper-part and each side; the two Temporals for the Tem­ples; the Os Sphenoides or Cuneiforme, which clo­seth the Basis or bottom of the Skull; the Os Ethmoides, or Cribriforme, situated at the Root of the Nose; and the four little Bones of the Ear on each side, viz. the Incus or Anvil; the Stapes or Stirrup; the Malleolus or Hammer; and the Orbiculare or Orbicular Bone.

Of the Forty six of the Face, Twenty seven are counted in the Upper-Jaw, viz. the two Zy­gomatick, or the two Bones of the Cheek-Knots; the two Lachrymal in the great Corners of the Eyes toward the Nose; the two Maxillar, that receive the Upper-Teeth, and which form part of the Palate of the Mouth, and the Orbits of the Eyes; the two Bones of the Nose; the two Palate-Bones which are at its end, and behind the Nostrils; the last being single is the Vomer, which makes the Division of the lower part of the Nostrils; and there are generally Sixteen Upper-Teeth. The Lower-Jaw contains Nine­teen Bones, viz. sixteen Teeth; two Bones that receive them; and the Os Hyoides, which is single, and fix'd at the Root of the Tongue.

How are the Teeth usually divided with respect to their Qualities?

Into Incisive or Cutters, Canine or Dog-Teeth, and Molar or Grinders: There are eight Inci­sive, and four Canine, which have only one single Root; as also twenty Molar, every one whereof hath one, two, or three Roots.

Can you recite the Number of the Bones of the Trunk or Chest?

There are generally thirty and three in the Spine or Chine-Bone of the Back, viz. seven Ver­tebra's in the Neck, twelve in the Back, five in the Legs, five, six, and sometimes seven in the Os Sacrum, three or four in the Coccyx, and two Cartilages at its end.

There are twenty nine in the Breast, viz. twenty four Ribs, two Clavicles or Channel-Bones, and commonly three Bones in the Ster­num. The Hip-Bones are likewise divided into three, viz. Ilion, Ischion, and Os Pubis.

Do you know the Number of the Bones of the Arms?

There are thirty and one Bones in each Arm, that is to say, the Omoplata or Shoulder-Blade; the Humerus or Shoulder-Bone; the two Bones of the Elbow call'd Ʋlna, and Radius; eight little Bones in the Carpus or Wrist; five in the Metacarpium or Back of the Hand; and fourteen in the Fingers, three to e­very one except the Thumb, which hath only two.

Can you give us a List of the Bones of the Leg in their Order?

There are thirty Bones in each Leg, viz. the Femur or great Thigh-Bone, the Knee-Pan or [Page 19]Whirl-Bone on the top of the Knee; the Tibia, greater Focile, or Shin-Bone; and the Perone or Fibula, or lesser Focile, which are the two as­sociated Bones of the Leg; seven little Bones in the Tarsus; five in the Metatarsus; and fourteen in the Toes; that is to say, three to every one, except the great Toe, which hath only two.

Thus the Number of Bones of the Humane Skeleton amounts to two hundred and Fifty, without reckoning the Sesamoides, the Indent­ings of the Skull, and some others which are not always to be found.

CHAP. VI. Of Myology, or the Anatomy of the Muscles of a Humane Body.

WHAT is a Muscle?

It is the principal Organ or Instrument of Motion; or it is a Portion of Flesh, wherein there are Veins, Arteries, Nerves, and Fibres, and which is cover'd with a Membrane.

How many parts are there in a Muscle?

Three, viz. the Head, the Belly, and the Tail: The Head is that part thro' which the Nerve enters; the Belly is the Body or Mid­dle of the Muscle; and the Tail is the Extre­mity, where all the Fibres of the Muscle are terminated to make the Tendon or String which is fasten'd to the Part whereto it gives Moti­on.

Have all the Muscles their Fibres streight from the Head to the Tail?

No, some have them streight, others trans­verse, and others oblique or circular, accor­ding to the several Motions to which they are appropriated.

How many sorts of Muscles are there with respect to their Action?

There are two different kinds, viz. the An­tagonists and the Congenerate; the former are those that produce opposite Motions; as a Flexor and an Extensor, a Depressor and a Leva­tor. The Congenerate are those that contri­bute to one and the same Action; as when there are two Flexors or two Extensors, and then one supplies the defect of the other; whereas when one of the Antagonist Muscles is cut, the other becomes useless, and void of Action.

How is the Action of a Musole perform'd?

It is done by Contraction and Extension; the former causeth the Anargonist to swell, and the other compels it to stretch forth in length.

What is Aponeurosis?

It is the continuity of the Fibres of a Tendon which makes a Connexion that serves to strength­en the Muscle in its Motion.

CHAP VII. Of the Myology, or Anatomy of the Muscles of the Head.

HOW many Muscles are there appointed to move the Head, and which be they?

The Head is mov'd by the means of four­teen Muscles, seven on each side; of these, two serve to depress it, eight to lift it up, and four to turn it round about.

The two Depressors are call'd Sternoclinoma­stoidei; they take their Rise in the Sternum, at the Clavicles, and proceed obliquely to join the Apophysis Mastoides.

Of the four Elevators on each, side the first is the Splenius, which begins at the five Vertebrae of the Back and the three lower ones of the Neck, and ascending obliquely, cleaves to the hinder part of the Head. The second, named Complexus or Trigeminus, having its beginning as the Splenius', sticks in like manner to the hinder part of the Head, and they form together a figure resembling that of S. Andrew's Cross. The third is the Rectus Major, which proceeding from the second Vertebra of the Neck, shoots forward to join the hinder part of the Head. The fourth is the Rectus Minor, which begins at the first Vertebra of the Neck, and ends likewise in the hinder part of the Head.

The two Muscles on each side, which move the Head circularly, are the Obliquus Major and [Page 22] Minor; the greater Oblique taking its rise from the second Vertebra of the Neck, goes to meet the first; but the lesser Oblique hath its Origine in the hinder part of the Head, and proceeds to join the other obliquely in the first Vertebra.

How many Muscles are there in the Lower-Jaw, and which be they?

The Lower-Jaw hath twelve Muscles which cause it to move; that is to say, six on each side, whereof four serve to close and two to open it.

The first of the Openers is the Latus which beginning at the top of the Sternum, Cla­vicle, and Acromion, cleaves on the outside to the bottom of the Lower-Jaw-Bone. The second of the Openers is the Digastricus, which takes its rise in a Fissure lying between the Occipital-Bone and the Apophysis Mastoides, from whence it passeth to the bottom of the Chin on the inside.

The first of the Shutters is the Crotaphites or Temporal Muscle, which hath its Origine at the bottom, and on the side of the Os Coronale, the Os Parietale, and the Os Petrosum, from whence it is extended till it cleaves to the Apophysis Coro­noides of the Lower-Jaw, after having passed a­bove the Apophysis of the Zygoma: Its Fibres are spread from the Circumference to the Center and it is covered again with the Pericranium, which renders its Wounds very dangerous; so that the least Incisions as can be, ought to be made therein.

The second is the Pterygoideus or Aliformis Ex­ternus, whose rise is in the Apophysis Pterygoides, from whence it sets forward till it stick between the Condylus and the Coronal of the Lower-Jaw.

The third is the Masseter, which hath two [Page 23]Sources or Beginnings, and as many Insertions; the first Source thereof is at the Cheek-Knot or Ball of the Cheek, and the second at the lower part of the Zygoma. The first Insertion is at the outer Corner of the Jaw, and the second in the middle part, by that means forming the Figure of the Letter X.

The fourth is the Pterygoideus or Aliformis Intern­us, which hath its beginning in the Apophysis Pte­rygoides, and is terminated in the inner Corner of the Jaw; so that Mastication or Chewing is per­form'd by the means of these four Muscles.

How many Muscles are there in the Face, and which be they?

There are two for the Forehead, call'd Fron­tal, whose Origine is in the upper part of the Head, from whence they descend by streight Fibres, until they are fasten'd in the Skin of the Forehead near the Eye-Brows, where they are re-united: Their Action or Office is to draw the Skin of the Forehead upward, whereto they stick very close.

There are also two others call'd Occipital, which have their Beginning in the same place with the preceeding, but they descend backward, and cleave to the Skin of the hinder part of the Head, which they draw upward.

There are two Muscles to each Eye-Lid, one whereof is termed the Attoll [...]ns or Elevator and the other the Depressor. The Elevator takes its rise in the bottom of the Orbit of the Eye, and is fastned by a large Aponeurosis to the edge of the upper Eye-Lid. The Shutter or Depressor, call'd also the Orbicular, hath its Origine in the great Canthus, or Corner of the Eye, passeth over the [Page 24]Eye-Lid upward, and is join'd to the lesser Cor­ner of the same Eye, being extended along its whole Compass.

The Eyes have each six Muscles, viz. four Recti and two Obliqui; the Recti, or streight Mu­scles are the Elevator, the Depressor, the Adductor, and the Abductor. The first of these call'd Elevator, or Superbus, draws the Eye upward, as it is pull'd downward by the Depressor or Humilis; the Adductor or Bibitorius draws it toward the Nose, and the Abductor or Indignarorius toward the Shoulder: All these small Muscles have their O­riginals and Insertions in the bottom of the Orbit through which the Optick Nerve passeth, and are terminated in the Corneous Tunicle, by a very large Tendon.

The first of the Oblique ones is term'd the Obliquus Major, and the other Obliquus Minor, be­cause they draw the Eye obliquely. These Mu­scles cause Children to squint when they do not act together. The Obliquus Minor is fasten'd to the outward part of the Orbit near the great Corner, and draws the Eye obliquely toward the Nose: But the Obliquus Major is fixt in the inner part of the Orbit, and ascends along the Bone to the upper part of the great Corner, where its Tendon passeth thro' a small Cartilage nam'd Trochlea, and is inserted in the little Cor­ner with the lesser Obliquus Minor, to draw the Eye obliquely toward the lesser Corner.

The Ear, altho' not usually endu'd with any sensible Motion, nevertheless hath four Muscles, viz. one above, and three behind; the first being situated over the Temporal, and fasten'd to the Ear to draw it upward: The three others have [Page 25]their beginning in the Mammillary Apophysis, and are terminated in the Root of the Ear, to draw it backward.

There are also three Muscles in the inner part of the Ear, whereof the external belonging to the Malleus or Hammer lies under the exterior part of the Bony Passage which reacheth from the Ear to the Palate of the Mouth, being fixt in a very oblique Sinuosity which is made im­mediately above the Bone that bears the Furrow, into which is let the Skin of the Tympanum or Drum. The internal Muscle lies hid in a Bony Semi-Canal, in the Os Petrosum; one part of which Semi-Canal is without the Drum, and clos'd on the top with a Passage that leads from the Ear into the Palate. But the other part within the Drum advanceth to the Fenestra Ova­lis, and is inserted in the hinder part of the Handle of the Malleus. The Muscle of the Stapes or Stirrup is also hid in a Bony Tube, almost at the bottom of the Drum, and fixt in the Head of the Stapes.

The Nose hath seven Muscles, that is to say, one common and six proper; the common con­stitutes part of the orbicular Muscle of the Lips, and draws the Nose downward with the Lip. Of the six proper Muscles of the Nose, four serve to dilate it, being situated on the outside, and two to contract it, which are placed in the inside.

The two first Dilatators of a Pyramidal Fi­gure, take their rise in the Suture of the Fore­head, and are fasten'd by a large Filament to the Alae of the Nose. The two other Dilatators resembling a Myrtle-Leaf have their Source in [Page 26]the Bone of the Nose, and are inserted in the middle of the Ala.

The two Restrictors are Membranous, begin­ning in the internal part of the Bone of the Nose and adhering to the inner Ala of the Nostril.

The Lips have thirteen Muscles, viz. eight proper, and five common: Of the proper there ar [...] four for the Upper-Lip, and as many for the [...] Lower; with two common for each, and th [...] odd one.

The first of the proper of the Upper-Lip [...] bears the Name of the Incisivus, its Origine be­ing in the Jaw, in the place of the Incisive Teeth and its Insertion is in the Upper-Lip.

The second is the Triangularis, Antagonist t [...] the former; its Rise is on the outside, at th [...] bottom of the Lower-Jaw; and it is implanted in the Upper-Lip, near the Corner of the Mouth.

The third being the Quadratus, springs fro [...] the bottom of the Chin before, and cleav [...] to the edge of the Lower-Lip.

The fourth is the Caninus, Antagonist to th [...] Quadratus, beginning in the Upper-Jaw-Bo [...] and being terminated in the Lower-Lip near t [...] Corner of the Mouth.

The first of the common is the Zygoma [...] ­cus, the Origine whereof is in the Zygoma, a [...] its Insertion in the Corner of the Mouth, [...] draw it toward the Ears; so that it is th [...] Muscle which acts when we laugh.

The second of the common is the Buccina [...] or Trumpeter, which is swell'd when one sounds Trumpet. It hath its rise at the Root of [...] Molar Teeth of both the Jaws, and is extend [...] quite round about the Lips.

The odd Muscle, or the thirteenth in number, is the Orbicular, which makes a Sphincter round about the Lips to close or shut them up.

The Ʋvula or Palate of the Mouth hath four Muscles, whereof the two first are the Perista­phylini Externi, taking their rise from the Up­per-Jaw, above the last Molar Tooth, and be­ing ty'd to the Palate by a thin T [...]don.

The two others are the Peri [...]phy [...]ini Interni, which have their beginning in the Apophysis Pte­rygoides on the inside, and likewise [...]ck [...] th [...] Palate.

The Tongue, altho' all over Musculous and Fibrous, yet doth not cease to have its peculi [...] Muscles, which are eight in Number.

The first of these is call'd Genioglossus, taking its rise in the lower part of the Chin, from whence it is extended till it cleave to the Root of the Tongue before, to cause it to go out of the Mouth.

The second is term'd Styloglossus, its Rise being in the Apophysis Styloides, from whence it passeth to the side above the Tongue, to lift it up.

The third bearing the Name of Basiglossus, commenceth in the Basis or Root of the Os Hyoides, and thence insinuates it self into the Root of the Tongue, to draw it back to the bottom of the Mouth.

The fourth is the Ceratoglossus, deriving its Original from the Horn of the Os Hyoides, and cleaving to the side of the Tongue to draw it on one side: The Action of these Muscles of both sides together, causeth an Orbicular Moti­on in the Tongue. To these some add a fifth [Page 28]Pair of Muscles, call'd Myloglossus, which serves to draw it obliquely upward.

What is the Action of the Os Hyoides in the Throat, and how many Muscles hath it?

The use of the Os Hyoides is to consolidate the Root of the Tongue; and it hath five Muscles on each side, which keep it as it were hung up.

The first of these, call'd the Geniohyoideus hath its beginning in the Chin on the inside, and ad­heres to the top of the Os Hyoides, which it draws upward.

The second is the Mylohyoideus, whose Origine is in the inner side of the Jaw, from whence i [...] cleaves side-ways to the Root of the Os Hyoi­des, which it draws upward, and to one side.

The third is the Stylohyoideus, which after it hath taken its rise in the Apophysis Styloides, is fasten'd to the Horn of the Os Hyoides, to draw it toward the side.

The fourth is the Coracohyoideus, which spring­ing up from the Apophysis Coracoides of the Omo­plata, cleaves to the Root and side of the Os Hyoides, to draw it downward and to the side.

The fifth is the Sternomohyoideus, that hath its beginning in the Bone of the Sternum on the inside and is inserted in the Root of the Os Hyoides, which it draws downward.

How many Muscles hath the Larynx?

There are fourteen, viz. four Common, and ten Proper. The first Pair of the Common is the Sternothyroideus or Bronchycus, which proceed­ing from the inside, and the top of the Sternum, ascends along the Cartilages of the Wind-Pipe, and is terminated in the bottom of the Scuti­formis [Page 29]or Buckler-like Cartilage, which it draws downward. The second is the Hyothyroideus, which ariseth from the Root of the Os Hyoides, and is inserted in that of the Scutiforme. This Muscle serves to lift up the Larynx, as also to dilate the bottom of the Scutiformis, and to close its top.

The first Pair of the Proper is the Cricothyroi­deus Anticus, which deriving its Original from the hinder and upper part of the Cricoides, or Ring-like Cartilage, is fixt in the upper and lateral part of the Scutiformis, to close or shut it up.

The second is the Thyroides.

The third is the Crioarytenoideus Lateralis, which proceeds from the side of the Cricoides within, and is fasten'd to the bottom and side of the Arytenoides, which it removes to dilate the Mouth of the Larynx.

The fourth is the Thyroarytenoideus, which ari­rising from the fore-part on the inside of the Scu­tiformis, is terminated on the side of the Aryte­noides, to close the Orifice of the Larynx.

The fifth is the Arytenoideus, which having its Source in that place where the Cricoides is uni­ted to the Arytenoides is inserted in its upper and lateral part, to close the Larynx.

How many Muscles hath the Pharynx?

It hath seven, the first whereof is the Oeso­phagieus, which takes its rise from the side of the Scutiformis or Buckler-like Cartilage, and passing behind the Oesophagus or Gullet, is fasten'd to the other side of the Cartilage. It thrusts the Meat down by locking up the Pharynx as a Sphincter.

The second named Stylopharingaeus, springs from within the Acute Apophysis of the Os Sphe­noides, or Cuneiforme, and is inserted obliquely [Page 30]in the side of the Pharynx, which it dilates by drawing it upward.

The third, call'd Sphenopharyngaeus, proceed [...] from the Apophysis Styliformis, and is terminate [...] in the side of the Pharynx, which it dilates by drawing its sides.

The fourth Pair is the Cephalopharyngaem. which ariseth from the articulation of the. Head with the first Vertebra, and closeth the Larynx.

How many Muscles are there in the Neck, a [...] which be they?

There are four Muscles in the Neck [...] each side, viz. two Flexors, and two Exte [...] ­sors. The Flexors are the Scalenus and th [...] Rectus or Longus; and the Extenders are th [...] Spinatus and the Transversalis.

The Scalenu or Triangularis hath two remo [...] Sources, viz. one in the first Rib, and the oth [...] in the Clavicle, and is fasten'd to the third an [...] fourth Vertebra of the Neck.

The Rectus or Longus begins in the side of th [...] four upper Vertebra's of the Back, and is join [...] to the upper Vertebra's of the Neck, and the hin­der part of the Head.

The Spinatus hath its Origine in the fourth an fifth upper Vertebra's of the Back, and is fasten [...] to all the six lower Vertebra's of the Neck.

The Transversalis springs forth out of the upp [...] Vertebra's of the Back, and cleaves to the Ext [...] ­mity of the four Vertebra's of the Neck.

CHAP. VIII. Of the Myology or Anatomy of the Muscles of the Chest; or of the Breast Belly, and Back.

HOW many Muscles are there in the Breast, and which be they?

The Breast hath fifty seven Muscles, that is to say, thirty that serve to dilate it, twenty six whose Office is to contract it, and the Diaphragm or Midriff, which partakes of both Actions.

The thirty which dilate the Breast are equal­ly plac'd to the number of Fifteen, viz. the Subelavius, the Serratus Major Anticus, the two Serrati Postici, and the eleven external Inter­costals.

The twenty six which contract the Breast are likewise equally rank'd to the Number of thirteen on each side, viz. the Triangula­ris, the Sacrolumbus, and eleven internal Inter­costals.

The Subclavian takes up the whole space be­tween the Clavicle and the first Rib: Its Ori­ginal being in the internal and lower part of the Clavicula, and its insertion in the upper part of the first Rib.

The Serratus Major is a large Muscle having seven or eight Indentings or Jaggs. It takes its rise in the interior Basis of the Omoplata or Shoulder-Blade, and its Jaggings are inserted in [Page 32]the five lower true Ribs, as also in the two up­per spurious Ribs.

The Serratus Posticus Superior, begins wi [...] a large Aponeurosis in the Apophyses of the th [...] lower Vertebrae of the Neck, and of the first [...] those of the Back; then passing under the Rhom­boid, it is join'd obliquely by four Indentings [...] the four upper Ribs.

The Serratus Posticus Inferior, commence [...] in like manner with a large Aponeurosis in the Apophyses of the three lower Vertebra's of the Back, and of the first of those of the Loins, an [...] is afterwards fasten'd by four Digitations to th [...] four lower Ribs.

The eleven External Intercostal Muscles are situated in the spaces between the twelve Ribs passing obliquely and on the outside from the bad part to the fore part. They take their rise be­low the Upper Rib, and have their Insertion a­bove the lower Rib.

The Triangularis is the first of those that con­tract the Breast, and possesseth the inward part of the Sternum: Its Original is in its lower part and its Insertion in the top of the Cartilages of the two upper Ribs.

The Sacrolumbus hath its Source in the hin­der part of the Os Sacrum, as also in the Verte­bra's of the Loins, and ascending from thence, insinuates it self into the hinder part of the Ribs to every one of which it imparts two Tendons one whereof sticks on the outside, and the other on the inside. This Muscle is fleshy within, and fibrous without.

The Eleven Internal Intercostals, contrary to the External, derive their Original from the [Page 33]top of every lower Rib, and ascend obliquely from the back-part to the fore-part, till they are join'd to the lower Lip of every upper Rib: Thus these Internal Muscles, with the Exter­nal, form, by the opposition of their Fi­bres, a Figure resembling a Burgundian Cross.

The Diaphragm or Midriff is esteem'd as the fifty seventh Muscle of the Breast, and serves as well for its dilatation as contraction. It separates the Thorax or Chest from the lower Belly, and is tied circularly to all the Extre­mities of the Bastard Ribs, immediately un­der the Xiphoides, or Sword-like Cartilage.

Modern Anatomists have discover'd that the Diaphragm is compos'd of two Muscles, viz. one Upper, and the other Lower; so that the Upper cleaves to the Extremities of the Spuri­ous Ribs, and is terminated in a flat Tendon in the middle, which hath been always taken for its Nervous part. The Lower begins with two Productions, the longest whereof being on the right side, ariseth from the three upper Ver­tebra's of the Loins, and the other on the Left from the two Vertebra's of the Back, till it is lost in the Aponeurosis of the Upper Muscle.

How many Muscles are there in the Back and the Loins, and which be they?

There are three in each side, viz. one for Fle­ction, and the other for Extension.

The Triangularis is the Flexor, taking its rise in the hinder part of the Rib of the Os Ilion, and the inner part of the Os Sacrum, in passing from whence it is joined to the last of the Ba­stard [Page 34]Ribs, and to the transverse Productions of the Vertebra's of the Loins.

The Extensors are the Sacer, and the Semi­spinatus, which make the Waste streight, and are so interwoven along the Back-Bone, that one would imagine that there were as many Pairs of Muscles as Vertebra's, affording Tendons to all.

The Sacer springs from behind the Os Sa­crum, as also from the hinder and upper Ex­tremity of the Os Ilium, and is inserted in the Spines of the Vertebra's of the Loins and Back.

The Semi-spinatus hath its Source in the Spines of the Os Sacrum, and is join'd to all the trans­verse Productions of the Vertebra's from the Back to the Neck, being exactly situated between the Sacer and the Sacrolumbus

CHAP. IX. Of the Myology, or Anatomy of the Muscles of the lower Belly.

HOW many Muscles are there in the lower Belly, and which be they?

There are generally ten, five on each side, that is to say, two Obliqui, one ascending, and the other descending; one Transversus, one Rectus, and two Pyramidal, of which last, nevertheless, there is sometimes only one, and sometimes none at all.

The Obliquus Descendens, which is the first, hath its Original by digitation in the sixth and seventh of the true Ribs, in all the spurious Ribs, and in the transverse Apophyses of the Ver­tebra's of the Loins, and comes near to the Ser­ratus Major Anticus of the Breast; from whence it proceeds to the external Rib of the Os Ilion, and is terminated by a large Aponeurosis in the Linea Alba or White Line, which separates the Muscles that are on each side of the Abdomen or lower Belly.

The Obliquus Ascendens ariseth from its Source in the upper part of the Os Pubis, and in the Ridge of the Hip-Bone, till it cleaves to the Apophyses of the Vertebra's of the Loins in the Extremities of all the Ribs, and in the Xi­phoides or Sword-like Cartilage, and is ter­minated in the White Line by a large Aponeu­rosis.

The Rectus being situated between the Apo­neuroses of the Obliquus, takes its rise in the Cartilages of the Ribs, in the Xiphoides and the Sternum, and enters into the Os Pubis, having many nervous parts to corroborate it in its length.

The Transversus having its beginning in the transverse Apophyses of the Vertebra's of the Loins, is fasten'd to the internal Rib of the Os Ilium, and within the Cartilages of the lower Ribs, and is terminated by a large Aponeurosis in the Linea Alba, passing over the Re [...]lus, and sticking to the Peritonaeum.

The Oblique Muscles, and the Transverse, have Holes toward the Groin, to give Passage to the Spermatick Vessels of Men, and to a round [Page 36]of the Matrix in Women; so that Rup­tures or Burstenness happen through these par [...] in both Sexes, although the Holes of thes [...] three Muscles are not situated one over-again [...] another.

The Pyramidal, so named by reason of its Fi­gure, is situated in the lower Tendon of th [...] Rectus, its Origine being in the upper and ex­ternal part of the Os Pubis; but it is terminate in the White Line, three Fingers breadth abo [...] the Pubes, and sometimes even in the Navel felf. These Muscles are not found in all Bodies for there are sometimes two, sometimes only one and sometimes none.

The use of the Muscles of the lower Belly to compress all the contain'd parts, in order [...] assist them in expelling the Excrements.

How many Muscles are there in the Testicles?

They have each of them one, call'd Cremaster this Muscle takes its rise from the Ligaments of the Os Pubis, and by the dilatation of i [...] Tendon covers the Testicle, which it draws up­ward.

How many Muscles hath the Penis?

It hath two Pair, viz. the Erectores or Di [...] ­ctores, and the Dilatantes: The Erectores ari [...] from the internal part of the Os Ischion, und [...] the beginning of the Corpora Cavernosa, whe [...] they are inserted, and retake their Fibres i [...] their Membranes. The Dilatantes or Acceler [...]tores have their Source in the Sphincter of th [...] Anus, and slipping from thence obliquely under the Ʋreter, are join'd to the Membrane of th [...] Nervous Bodies.

How many Muscles are there in the Clitoris?

It hath two Erectors which spring forth from the Protuberance of the Os Ischion, and are in­serted in the Nervous Bodies of the Clitoris. There are also two others suppos'd to be its Elevators, which proceed from the Sphincter of the Anus, and are terminated in the Cli­toris.

How many Muscles are there in the Anus?

There are three, viz. the Sphincter, and two Levatores. The Sphincter is two Fingers broad, to open and close the Rectum. This Muscle being double, is fasten'd in the fore-part to the Penis in Men, and to the Neck of the Matrix in Women, as also behind to the Coccyx, and laterally to the Ligaments of the Os Sacrum, and the Hips.

The two Levatores arise from the inner and lateral part of the Os Ischion, and are fasten'd to the Sphincter of the Anus, to lift it up after the expulsion of the Excrements.

The Bladder hath also a Sphincter Muscle to open and shut its Orifice.

CHAP. X. Of the Muscles of the Omoplatae, or Shoulder-Blades, Arms, and Hands.

HOW many ways doth the Omoplata or Shoulder-Blade move, and what are its Mus­cles?

The Omoplata moves upward, downward, forward, and backward, by the means of four proper Muscles, which are the Trapezius, the [Page 38] Rhomboides, the proper Levator, and the lesse [...] Pectoral, or Serratus Minor Anticus.

The Trapezius or Cucullaris hath its beginning in the back part of the Occiput, or hinder part of the Head, in the Spines of the six lower Ver­tebra's of the Neck, and of the nine upper of the Back, in passing from whence it is implant­ed in the Spine of the Omoplata or Shoulder-Blade, and the external part of the Clavicula, as far as the Acromion. This Muscle produceth ma­ny Motions by reason of its different Fibres drawing the Shoulder-Blade obliquely upward downward, and forward.

The Rhomboides is situated over the Trapezius its rise being in the Apophyses of the three lower Vertebra's of the Neck, and of the three upper of the Back, but it is afterward join'd to the whole Basis or Root of the Omoplata, which it draws backward.

The proper Levator commenceth in the Tr [...] ­verse Apophyses of the four first Vertebra's of the Neck, by different Progressions, but is after­ward re-united, and inserted in the upper Corner of the Omoplata, which it draws up­ward.

The lesser Pectoral, or Serratus Minor Anticus, is situated under the great Pectoral, its rise be­ing by Digitation or Indenting in the second, third, and fourth of the upper Ribs, and its In­sertion in the Apophysis Coracoides of the Shoul­der-Blade, which it draws forward.

How many Motions are there in the Humerus, or Arm; which be they, and what are its Muscles?

The Arm performs all sorts of Motions by the help of nine Muscles: For it is lifted up by the Deltoides and the Infra-Spinatus; it is depress'd by the Largissimus, and the Rotundus Major; it is drawn forward by the Pectoralis Major, and the Coracoideus; it is drawn back­ward by the Infra-Spinatus, and the Rotundus Minor: It is drawn near the Ribs by the Subsca­pularis, and its circular Motion is performed when all these Muscles act together succes­sively.

The Deltoides or Triangular hath its beginning in the whole Spine of the Omoplata, the Acro­mion, and half the Clavicula, and by its point cleaves with a strong Tendon to the middle of the Arm.

The Infra-Spinatus takes its rise in the Cavi­ty that lies above the Spine of the Omoplata, which it sill [...]ssing over the Acromion, until it is join'd to the Neck of the Shoulder-Bone, which it surrounds with a large Tendon.

The Largissimus, otherwise call'd Ani-scalptor, covers almost the whole Back, proceeding from a large and Nervous Stock, in the third and fourth lower Vertebra of the Back, the five Ver­tebra's of the Loins, the Spine of the Os Sacrum, the hinder part of the Lip of the Hip-Bone, and the external part of the lower Bastard-Ribs, in passing from whence it insinuates it self into the lower Corner of the Omoplata, as also into the upper and inner part of the Humerus.

The Rotundus Major, or Teres Major, having its Origin in the external Cavity of the low­er Corner of the Omoplata, is confounded with the Largissimus, and adheres with it by the same [Page 40] Tendon to the upper and inner part of the Hu­merus, a little below the Head.

The greater Pectoral hath its Source in hal [...] the Clavicula, on the side of the Sternum; covers the fore-part of the Breast, and is fasten'd by a short, broad, and nervous Tendon, to the to [...] of the Shoulder-Bone, on the inside, between the Biceps and the Deltoides.

The Coracoideus or Coracobrachyaeus, beginning in the Apophysis Coracoides of the Omoplata o [...] Shoulder-Blade, adheres to the middle of the Arm on the inside, which with the Pectoral [...] draws forward.

The Infra-Spinatus fills the Cavity which lies below the Spine of the Omoplata, its Origine being in the lower Rib of the Omoplata, from whence it passeth between the Spine and the Rotundus Minor, to cleave to the Neck of the Shoulder-Bone, which it embraceth, and draw backward.

The Rotundus Minor, or Teres Minor, proceed from the lower Rib of the Omoplata, and ad­heres to the Neck of the Shoulder-Bone with the Infra-Spinatus to draw it in like manne [...] backward.

The Sub-scapularis or Immersus is situated en­tirely under the Omaplata, proceeding from th [...] internal Lip of the Basis or Root of the same Omoplata, and being terminated in the Neck [...] the Arm-Bone, which it causeth to lie close [...] the Ribs.

How many Motions are there in the Cubitus [...] Elbow, and what are its Muscles?

The Cubitus or Ʋlna is endu'd with two sor [...] of Motions, viz. that of Flection and that [...] [Page 41]Extension, the former being perform'd by the help of two Muscles, that is to say, the Biceps, and the Brachiaeus Internus; and the later by eight others, which are the Longus, the Brevis, the Brachiaeus Externus, and the Anconcus.

The Biceps is a Muscle with two Heads, one whereof proceeds from the Apophysis Coracoides, and the other from the Cartilaginous edge of the Glenoid Cavity of the Omoplata or Shoulder-Blade: These two Heads descend along the fore-part of the Arm, and are united in one and the same Body, from whence springs forth a Ligament, which is inserted in a tuberosity situated in the upper and fore-part of the Ra­dius.

The Brachiaeus Internus is a small fleshy Mu­scle, lying hid under the Biceps, which takes its rise in the upper and fore-part of the Hume­rus, and is implanted in the upper and inner­part of the Radius, to bend the Elbow with the Biceps.

The first of the four Extenders is the Longus having two Sources, viz. one situated in the lower Rib of the Omoplata, near its Neck, and the other descending to the hinder-part of the Arm, till it is tyed to the Olecranum or Ancon, by a strong Aponeurosis, which is common thereto, with the Brevis, and the Brachiaeus Ex­ternus.

The Brevis or short Muscle of the Elbow ari­sing from the hinder and upper-part of the Hu­merus, is fasten'd to the Olecranum with the Longus.

The Brachiaeus Externus is a fleshy Muscle which proceeds from the hinder part of the Hu­merus, [Page 42]and adheres to the Olecranum with th [...] Brevis and the Longus.

The Anconeus or Cubitalis being situated behind the Fold of the Cubitus, is the least Mus­cle of all; it springs from the Extremity of th [...] Arm-Bone, at the end of the Brevis and the Lon­gus, and in descending is inserted between th [...] Radius and the Cubitus or Ʋlna, three or four Fin­gers breadth below the Olecranum.

How many Muscles hath the Radius, and wh [...] are its Motions?

The Radius is endu'd with a twofold Motion by the means of four Muscles: Of the [...] the Rotundus and Quadratus cause that of Pro­nation, as the Longus and the Brevis that of Su­pination.

The Pronator Superior Rotundus, or round Muscle of the Radius, commenceth from the inne [...] Apophysis of the Shoulder-Bone, in a very fleshy Stock, and is terminated obliquely by a Mem­branous Tendon in the middle and exterior part [...] the Radius.

The Pronator Inferior Quadratus; springing fort [...] from the bottom and inside of the Cubitus, i [...] fixt in the lower and outward part of the Radius by a Tail as large as its Head. This Muscle lying hid under the others near the Wrist, [...] that which jointly with the Rotundus, turns th [...] Arm with the Palm of the Hand downward, which is the Motion of Pronation.

The Longus is the first of the Supinators, whose Origine is three or four Fingers breadth above th [...] external Apophysis of the Arm-Bone; from whence it passeth along the Radius, and cleaves to the inner-part of its lower Apophysis.

The Brevis, or the second of the Spinators a­rising from the lower part of the Inferior Condy­lus, and the external of the Humerus, is twisted round about the Radius, going forward from the hinder-part till it is united to its upper and fore-part. This Muscle, with the Longus, serves to turn the Arm and the Palm of the Hand upward, and produceth the Motion of Supination.

How many sorts of Motions belong to the Wrist, and what are its Muscles?

Two several Motions are perform'd by the Wrist, viz. one of Flection, and the other of Extension, three Muscles being appropriated to the former, and as many to the later: But it ought to be observed, that a strong Ligament, call'd the Annular, appears here, which, surroun­ding all the Tendons of the Muscles as it were a Bracelet, holds them together, and else­where serves to unite the two Bones of the El­bow. The three Flexors or Bending Muscles of the Wrist are the Cubitaeus Internus, the Radiaeus Internus, and the Palmaris.

The Cubitaus Internus derives its Original from the part of the Arm-Bone, passeth under the Annular Ligament, and is ty'd by a thick Tendon to the small Bone of the Wrist, which is plac'd above the others.

The Radiaeus Internus proceeds from the same place with the Cubitaeus, and is fasten'd to the first Wrist-Bone which supports the Thumb. It lies along the Radius, and passeth under the An­nular Ligament.

The Palmaris is reckon'd among the Flexors of the Wrist, although situated in the Palm of the Hand. It ariseth from the inner Process or Knob [Page 44]of the Arm-Bone, and is united by a large Ten­don to the first Phalanges of the Fingers, sli [...] ­ping under the Transverse or Annular Ligame [...] and sticking under the Skin of the Palm of the Hand.

The three extending Muscles of the Wrist [...] the Cubitaeus Externus, and the Radiaeus Extenus or the Longus, and the Brevis.

The Cubitaeus Externus taking its rise from [...] hinder-part of the Elbow, passeth under the An­nular Ligament, and adheres to the upper a [...] outward-part of the Bone of the Metacarpus th [...] stayeth the little Finger.

The Radiaeus Externus, or the Longus, havin [...] its Origine in the edge of the lower part of th [...] Arm-Bone, slides from thence along the Rad [...] on the outside, extends it self under the Annul [...] Ligament, and cleaves to the Wrist-Bone, whi [...] stayeth the Fore-Finger.

The Brevis or short Muscle of the Wrist spring from the lower part of the same Edge; afterwa [...] it runs along the Radius, passeth under the An [...] ­lar Ligament, and is terminated in the Bone [...] the Carpus or Wrist, which stayeth the Middle Finger. But we must take notice, that beside these six Muscles, there is also Caro quaedam qu [...] ­drata, or a square piece of Flesh under the P [...] ­maris, which seems to arise from the Thenar, an [...] sticks to the eighth Wrist-Bone. It is suppo [...] that this Musculous piece of Flesh serves with the Hypothenar of the little Finger, to make th [...] which is call'd Diogenes's Cup.

How many Motions are there in the Fingers, a [...] what are their Muscles?

The Fingers are bent, extended, and turn'd from one side to the other by the means of twen­ty three Muscles, whereof ten are proper, and thirteen common: The former are those that serve all the Fingers in general, and the other those that are particularly serviceable to some of them: The Common are the Sublimis, the Pro­fundus, the common Extensor, the four Lumbri­cales, and the six Interossei.

The Sublimis or Perforatus, arising from the internal part of the lower Process of the Hume­rus or Shoulder-Bone is divided into four Ten­dons, which run below the Annular Ligament of the Wrist, and are inserted in the second Phalanx of the Bones of the four Fingers, after having stuck in passing to those of the first Phalanx, to help to bend it. It is also observ'd that every one of these Tendons hath a small cleft in its length, to let in the Tendons of the Pro­fundus.

The Profundus or Perforans lies under the Sub­limis, deriving its Original from the top of the Cubitus and Radius. It creeps along these two Bones, and is divided into four Tendons, which pass under the Annular Ligament, and slip into the Fissures of the Tendons of the Sublimis, to adhere to the third Phalanx of the Fingers, which they bend with the Sublimis: So that these two Muscles make together the bending of the Fingers.

The Extensor Magnus is that which ex­tends the four Fingers. It springs from the external and lower Process of the Arm-Bone, and is divided into four flat Tendons, which pass under the Annular Ligament, and cleave [Page 46]to the second and third Phalanx of the Fin­gers.

The four Lumbricales or Vermiculares are [...] the Palm of the Hand, to draw the Fingers [...] the Thumb: They proceed from the Tend [...] of the Profundus, and the Annular Ligamen [...] extend themselves along the sides of the Finge [...] and are inserted in their second Articulation, [...] cause the drawing toward the Thumb.

The three Interossei Interni, and the three E [...] ­terni, are situated between the four Bones of t [...] Metacarpium, as well on the inside of the Ha [...] as without: They have their beginning in [...] Intervals or Spaces between the Bones of th [...] Metacarpium, are united with the Lumbrical, a [...] fixt in the last Articulation of the Bones of [...] Fingers, to produce the Motion of drawing ba [...] or removing from the Thumb.

The Thumb is mov'd by five particular M [...] ­cles; one whereof serves to bend it, two to [...] ­tend it, one to remove it from the Fingers, a [...] another to draw it to them.

The Flexor of the Thumb takes its rise fro [...] the upper and inner part of the Radius, passe [...] under the Annular Ligament, as also under [...] Thenar, and adheres to the first and second Bo [...] of the same Thumb to bend it.

The two Extensors of the Thumb are [...] Longior and the Brevior: The former proceed [...] from the upper and outward part of the C [...] ­tus, ascends above the Radius, and is ty'd w [...] a forked Tendon to the second Bone of [...] Thumb. The Brevior hath the same Orig [...] with the Longior, keeps the same Track, pass [...] under the Annular Ligament, and is terminated [...] the third Thumb-Bone.

The Thenar removes the Thumb from the Fin­gers, and forms that part which is call'd the Mount of Venus: It hath its Source in the first Bone of the Carpus or Wrist, and the Annular Ligament, and is inserted in its second Bone.

The Antithenar draws the Thumb to the o­ther Fingers, having its Origine in the Bone of the Metacarpus, that stayeth the middle Fin­ger, and its Insertion is in the first Bone of the Thumb.

The Muscle which serves to extend the Fore-Finger, is call'd Indicator: It proceeds from the middle and outer part of the Cubitus, and is fixt by a double Tendon in the second Articulation of the Fore-Finger, as also in the Tendon of the great Extensor of the Fingers.

That which draws the Fore-Finger to the Thumb is term'd Adductor: It commenceth in the fore-part of the first Thumb-Bone, and is terminated in the Bones of the Fore-Finger.

That which removes the Fore-Finger from the Thumb is known by the Name of Abductor, which arising out of the external and middle part of the Bone of the Elbow, and passing un­der the Annular Ligament, cleaves to the La­teral and outward part of the Bones of the Fore-Finger.

The Little-Finger hath two proper Muscles, viz. an Extensor and an Abductor.

The Extensor springs from the lower part of the Condylus of the Arm-Bone, and is fasten'd by a double Tendon in the second Articulation of the Little-Finger, and in the Tendon of the Ex­tensor of all the others.

The Abductor, call'd also Hypothenar, hath [...] beginning in the small Bone of the Wrist, whic [...] is situated over the others, and is terminated [...] the first Bone of the Little-Finger on the ou [...] side.

CHAP. XI. Of the Muscles of the Thighs, Legs, and Feet.

WHAT are the Motions of the Thighs? The Thigh performs five kinds of Mo [...] ­ons; for it is bent, extended, drawn within si [...] and without, and turn'd round: All these Mo [...] ­ons are produc'd by the means of fourteen Mu [...] ­cles, viz. three Flexors, three Extensors, thr [...] Adductors, three Abductors, and two Obturat [...] for the Circular Motion.

The Flexors of the Thigh are the Psoas, Ili [...] ­cus, and Pectineus.

The Psoas or Lumbaris is situated inwardly the Abdomen, on the side of the Vertebra's. proceeds from the transverse Apophyses of [...] two lower Vertebra's of the Back, and of [...] upper of the Loins, and lying on the inner Fa [...] of the Os Ilion, sticks to the lesser Trochanter [...] Rotator.

The Iliacus Internus hath its Origine in all [...] Lips of the inner Cavity of the Os Ilion, and b [...] ­ing joyn'd by a Tendon to the Lumbaris, is inse [...] ­ed with it in the lesser Trochanter.

The Pectineus takes its rise from the fore-part of the Os Pubis, and is united before to the Thigh-Bone a little below the lesser Trochanter.

The Extensors of the Thigh are the Glutaeus Major, Medius, and Minimus.

The Glutaeus Major springs forth out of the la­teral part of the Os Sacrum, as also the hinder and outer part of the Os Ilion and Coccyx, and e [...]ters into the Thigh-Bone, four Fingers breadth below the great Trochanter or Rotator, being the thickest of all the Muscles of the Body.

The Glutaeus Medius, deducing its Original from the hinder and outward part of the Os Ili­on, is inserted three Fingers breadth below the great Trochanter.

The Glutaeus Minimus ariseth from the bottom of the Cavity of the Os Ilion, and is fasten'd to a small Hole near the great Trochanter.

The Adductors of the Thigh are the Triceps Superior, Medius, and Inferior.

The Triceps Superior hath its beginning in the top of the Os Pubis, and is terminated in the top of a Line, which is on the inside of the Thigh.

The Triceps Medius proceeding from the mid­dle of the Os Pubis, is inserted in the Thigh-Bone a little lower than the Triceps Superior.

The Triceps Inferior hath its Source in the bottom of the Os Pubis, and is implanted in the Thigh-Bone, a little lower than the Triceps Me­dius. Some Anatomists make only one Muscle of these three, attributing thereto three Originals and three Insertions. These Muscles serve to draw the Thighs one against another.

The Abductors of the Thigh are the Iliacus Ex­ternus, or Pyriformis, the Quadratus, and the Ge­melli.

The Pyriformis arising from the upper and la­teral part of the Os Sacrum, and the Os Ilio [...] cleaves to the Neck of the great Trochanter.

The Quadratus or square Muscle of the Thig [...] takes its Origine from the external Promine [...] of the Os Ischion, and adheres to the outward p [...] of the great Trochanter.

The Gemelli or Twin Muscles arise from t [...] small Knobs in the hinder-part of the Ischi [...] and insinuate themselves into a small Cavity [...] the Neck of the great Trochanter.

The Circular Motion of the Thigh is pers [...] ­med by the means of two Muscles, named [...] Obturatores Externi and Interni.

The Obturator Internus springs from the i [...] Circumference of the Oval Hole of the Ischi [...] and its Tendons passing between the two Gem [...] are inserted in a small Cavity at the Root of [...] great Trochanter or Rotator.

The Obturator Externus ariseth from the o [...] ward Circumference of the same Hole of [...] Ischion, and is terminated in the side of the oth [...] near the great Trochanter.

What are the Motions of the Leg, and what [...] its Muscles?

The Leg is mov'd four several ways, that [...] to say, it is bent, extended, and drawn inwa [...] and outward, by the means of eleven Mus [...] viz. three Flexors, four Extensors, two Adduc [...] and two Abductors.

The three Flexors of the Leg are the [...] ­ceps, the Semi-nervosus, and the Semi-mem [...] ­nosus.

The Biceps hath two Heads, the longer wh [...] of cometh out of the bottom of the Promin [...] [Page 51]of the Ischion, and the other from the middle and exterior part of the Femur, and is termina­ted in the outward and upper part of the Epiphy­sis of the Perone or Fibula.

The Semi-nervosus hath its Origine in the Knob of the Ischion, and is join'd backward to the top of the Epiphysis of the Tibia. These three Muscles are plac'd in the back-part of the Thigh below the Buttocks.

The four Extensors of the Leg are the Re­ctus, the Vastus Internus, the Vastus Externus, and the Crureus.

The Rectus or streight Muscle of the Leg takes its rise from the fore-part and the bottom of the Ilion, and descends in a right Line: It covers with its Tendon, which is common to the three following, the whole Knee-Pan, and adheres to the top of the Tibia, on the fore-part.

The Vastus Internus, being situated on the inside of the Thigh, hath its beginning in the top of the Thigh inwardly, and a little below the lesser Trochanter or Rotator: Afterward it is ty'd to the Tibia by a large Tendon, common thereto with the preceeding.

The Vastus Externus is plac'd on the outside of the Thigh, springing from the top and the fore-part of the Femur, being united by the same Tendon with the two preceeding.

The Crureus proceeds from the top, and the fore-part of the Thigh-Bone, between the two Trochanters; then covering the whole Bone, it is also fasten'd to the Leg-Bone with the three preceeding Muscles, after having cover'd the Knee-Pan with their common Ten­don, [Page 52]which serves likewise as a Ligament the Knee.

The two Adductors of the Leg are the S [...] torius and the Gracilis.

The Sartorius or the Longissimus draws the [...] inward, deriving its Original from the upp [...] Spine of the Ischion; from whence it desce [...] obliquely thro' the inside of the Thigh, a [...] cleaves to the top on the inside of the Tibia.

The Gracilis hath its Origine in the sore-pe [...] at the bottom of the Os Pubis, and its Inse [...] in the top of the Tibia on the inside.

The two Abductors of the Leg are the Fas [...] lata, and the Poplitaeus.

The Fascia lata, or the Membranosus, is as were a kind of large Band, which covers [...] the Muscles of the Thigh. It proceeds from [...] outward Lip of the Os Ilion, is ty'd by a la [...] Membrane to the top of the Perone or Fi [...] and sometimes descends to the end of the Fo [...]

The Poplitaeus, or Sub-poplitaeus, ari [...] from the lower and external Condylus of [...] Thigh-Bone, passeth obliquely from the ou [...] to the inside, till it is lost in the upper and in [...] part of the Leg-Bone under the Ham.

What are the Motions of the Foot, and [...] are its Muscles?

The Foot performs two Motions by the [...] of nine Muscles, as being bent by two, and [...] tended by seven.

The two Flexors are the Crureus Anticus, [...] the Peronaeus Antieus.

The Crureus or Tibiaeus Anticus, is plac'd long the Tibia, and takes its rise from its up [...] and fore-part: Afterward it is bound by [...] [Page 53] Tendons to the first Os Cuneiforme, or Wedge­like Bone, and to that of the Metatarsus or In­step, which stayeth the great Toe, after having pass'd under the annular Ligament.

The Peronaeus Anticus springs from the mid­dle and outward-part of the Perone or Fibula, and insinuating it self thro' the Cleft which is under the external Malleolus before, sticks to the Bone of the Metatarsus that supports the lit­tle Toe.

The seven Extensors of the Foot are the two Gemelli, or the Soleus, the Planta [...]s, the Cru­reus Posticus, and the two Peronaei Postici.

The Gemelli are the Interior and the Exterior; the former having its Source in the inner Con­dylus, and the other in the outward and lower of the Thigh-Bone; from whence they extend themselves till they are fasten'd to the Talus or Ankle-Bone by a Tendon common to them, with the two following.

The Soleus ariseth from the top on the back­part of the Leg-Bone and Perone, and confound­ing its Tendon with that of the Gemelli, sticks close to the Talus.

The Plantaris, which lies hid between the Gemelli and the Soleus, hath its Origine from the Exterior Condylus of the Thigh-Bone; then uniting its Tendon with the preceeding, it adheres to them; and this common Tendon is call'd Chorda Achillis.

The Crureus or Tibiaeus Posticus, springs from the back-part of the Leg-Bone, from whence extending it self downward, it passeth thro' the Fissure in the Internal Malleolus, and cleaves to the inner-part of the Os Scaphoides.

The Peronaei, or Fibulaei Postici, are otherwi [...] call'd the Longus and the Brevis, whereof o [...] proceeds from the upper and almost fore-part [...] the Perone, terminating in the upper-part of [...] Bone, that supports the great Toe in the M [...] tatarsus, and the other from the lower p [...] of the Perone, adhering in like manner to [...] Bone with which the little Toe is sustain'd.

With what Motions are the Toes endu'd, how m [...] ny Muscles have they, and which be they?

The Toes are bent and extended, as al [...] drawn inward and outward, by the means [...] twenty two Muscles, of which sixteen are Co [...] mon, and six Proper. The former are t [...] Flexors, two Extensors, four Lumbricales, a [...] eight Interossei. The first Flexor is nam'd S [...] limis, and the other Profundus.

The Sublimis or Perforatus derives its Orig [...] nal from the lower and inner-part of the Ta [...] and is fixt in its proper place by four c [...] Tendons, which are inserted in the upper-part [...] the Bones of the first Phalanx of the four To [...] It is situated under the Sole of the Feet.

The Profundus or Perforans hath its begining in the top and back-part of the Leg-Bo [...] and Perone, slips under the Malleolus Inte [...] thro' the Sinus Calcaris, and makes four Tend [...] which pass thro' the Fissures of the Tendon of [...] Sublimis, and cleaves to the Bones of the [...] Phalanx of the Toes, to bow them.

The first Extensor is call'd the Common, [...] the other the Pediaeus.

The Common Extensor, or the Longus, ta [...] its rise from the top and fore-part of the Ti [...] in the place of its joyning with the Perone [Page 55]Fibula, and divides it self into four Tendons, which after having pass'd under the Annular Ligament, are inserted in the Articulations of every Toe.

The Pediaeus or the Brevis, being plac'd over the Foot, proceeds from the Annular Ligament, and the lower-part of the Perone, and sends forth four Tendons, which are sixt to the first Articulation of the four Toes on the outside, Thus this Muscle, together with the Longus, causeth their Extension.

The four Lumbrical Muscles of the Toes a­rise from the Tendons of the Prosundus, and a Mass of Flesh at the Sole of the Feet. They are joyn'd by their Tendons with those of the In­terossei Interni, and adhere inwardly to the side of the first Bones of the four Toes, to incline them toward the great Toe.

The Abductors, or those Muscles that re­move the Toes from the great Toe, are the eight Interossei, whereof four are call'd Exter­ni, and as many Interni. The former take their rise in the Spaces between the Bones of the Metatarsus, and are terminated outwardly in the side of the first Bones of the Toes. The Internal lie in the bottom of the Foot, and take up the Spaces between the five Bones of the Metatarsus. They arise from the Bones of the Tarsus, and the Intervals between those of the Metatarsus, and are implanted with the four Lumbricales inwardly, in the upper-part of the Bones of the first Phalanx of the four Toes.

Of the six Proper Muscles of the Toes, there are four appointed for the great Toe, which cause it to perform the Motions of Flexion, Ex­tension, [Page 56]and drawing forward or backward The two others are the Adductor of the second Toe to the great Toe, and the Abductor of the little toe, call'd Hypothenar.

The Proper Flexor of the great Toe, arising from the top of the Perone or Fibula, on the ba [...] part, passeth thro' the Ancle-Bone on the inside to the sole of the Foot, and is fasten'd to the Bone of the last Phalanx.

The Proper Extensor of the great Toe spring from the middle of the fore-part of the P [...] rone, passeth over the Foot, and hath its Insertion in the upper-part of the Bone of th [...] great Toe.

The Proper Adductor of the great Toe, [...] the Thenar, taking its rise inwardly on the side of the Talus, the Ossa Schaphoidea and Innomin [...] ta, extends it self over the outward-part of the Bone of the Metatarsus, which stayeth the great Toe, and adheres to the top of the se­cond Bone of the great Toe, which it draw inward.

The proper Abductor of the great Toe, o [...] the Antithenar, draws it toward the other Toes. It derives its Origine from the Bone of the Metatarsus, which supports the little Toe, slides obliquely over the other Bones, and cleaves to the first Bone of the great Toe on the inside.

The Adductor appropriated to the second Toe hath its Source in the first Bone of the great Toe, on the inside, and sticks close to the Bones of the second Toe, which it draws to the great Toe.

The Abductor of the little Toe, or the Hypo­thenar, proceeds from the outward part of the Bone of the Metatarsus, that stayeth the little Toe, and is inserted in the top of the little Toe, on the outside, to remove it from the others.

A List of all the Muscles in the Humane Body.
  • The Fore-head hath two Muscles 2
  • The hinder-part of the Head 2
  • The Eye-Lids 4
  • The Eyes 12
  • The Nose 7
  • The Ears on the outside 8
  • The Ears on the inside 6
  • The Lips 13
  • The Tongue 8
  • The Ʋvula, or Palate of the Mouth 4
  • The Larynx 13
  • The Pharynx 7
  • The Os Hyoides 10
  • The Lower Jaw 12
  • The Head 14
  • The Neck 8
  • The Omoplatae or Shoulder-Blades 8
  • The Arms 18
  • The Elbows 12
  • The Radii 8
  • The Wrists 12
  • The Fingers 48
  • The Breast, or the Parts of Respiration 57
  • The Loins 6
  • The Abdomen or lower Belly 10
  • The Testicles 2
  • The Bladder 1
  • [Page 58]The Penis 4
  • The Clitoris 4
  • The Anus 3
  • The Thighs 30
  • The Legs 22
  • The Feet 18
  • The Toes 44
  • Total 425

CHAP. XII. Of the Anatomy of the Nerves, Arteries, and Veins in general.

WHAT is the Structure of the Nerves?

The Nerves are round white Bodies en­clos'd in a double Membrane, communicated to them from the two Meninges of the Brain: Their Office is to convey the Animal Spirits into all the Parts.

Where is the Root and first beginning of all the Nerves?

All the Nerves take their Original from the Medulla Oblongata, and that of the Spine.

How is the distribution of them made thro' th [...] whole Body?

It is directly perform'd by Conjugations o [...] Pairs, whereof one goes to the Right-hand, and the other to the Left: There are nine Pairs o [...] them that proceed from the Medulla Oblongata and enter into the Skull; and a Tenth that comes from the Marrow which lies between the Occipital and the first Vertebra of the Neck. It [Page 59]passeth thro' the Hole of the Dura Mater, thro' which the Vertebral Artery enters, to distribute its Branches into several Parts.

To what Ʋse are the nine Pairs of Nerves appropriated, which proceed from the Root of the Brain?

They are chiefly design'd for the Senses, and also for the Motion of their Organs, of which the Ancients discover'd only seven.

The first Pair of Nerves is call'd the Olfactory, and serves for the Smelling.

The second Pair is the Optici or Visorii Nervi, and bestows upon the Eyes the Faculty of seeing.

The third is term'd Motorii Oculorum, being serviceable for the Motion of the Eyes.

The fourth Pair is nam'd Oculorum Pathetici, which shews the Passion of the Mind in the Eyes, whereto it imparts a String as well as to the Lips.

The fifth is call'd the Gustative, and appropri­ated to the Taste, because it sends Twigs more especially to the Tongue, as also to the Fore­head, Temples, Face, Nostrils, Teeth, and Privy-Parts.

The Sixth is likewise for the Taste, and goes to the Palate.

The seventh is the Auditive Nerve, that enters into the Os Petrosum, where it divides it self into many Branches, which when gone forth, are di­stributed to the Muscles of the Tongue, Lips▪ Mouth, Face, Fore-head, Eye-Lids, &c.

The eighth is the Os Vagum, or wandering Pair, which is united to the Intercostal Nerve, as also to the Recurrent, Diaphragmatick, Me­senterick, &c.

The ninth Pair, after having form'd a True with the eighth, disperseth its Twigs sever ways, whereof one is join'd with the Twig [...] the tenth, to be distributed together into [...] Muscle Stern [...]hyoideus, and into the Tongue.

The Intercostal and Spinal are not Pairs Nerves, but only Branches or Twigs of othe [...] Pairs.

What is the Distribution and Ʋse of the th [...] Pairs of Nerves that proceed from the Spinal M [...] ­row?

There are seven that go forth from the sev [...] vertebra's of the Neck, twelve from those [...] the Back, five from the Loins, and six fro [...] the Os Sacrum, according to the following Pr [...] ­gression.

The first of the seven Pairs of Nerves of [...] Neck proceeds from between the Occipital Bo [...] and the first Vertebra, nam'd Atlas, its Fibres b [...] ­ing lost in the Muscles of the hinder-part of [...] Head and Neck.

The second Pair springs from between the f [...] and second Vertebra of the Neck; the Fibr [...] whereof are lost in the Muscles of the Head, a [...] in the Skin of the Face.

The third Pair issueth from between the seco [...] and third Vertebra of the Neck; and its Fib [...] are lost in the Flexor Muscles and Extensors [...] of the Neck.

The fourth, fifth, sixth, and seventh Pairs p [...] ­ceed from between the Vertebra's, as before, [...] their Fibres are lost in the Neck of the Omo [...] ­ta, in the Arm, and in the Diaphragme or M [...] ­riff. Here it ought to be observ'd by the w [...] that the Arms receive Branches not only from [...] [Page 61]four last Pairs of the Nerves of the Neck, but also from the two first Pairs of the Back, which are extended even to the end of the Fingers: Whence it happens that in the Palsie of the Arms, Remedies are usually apply'd to the Vertebra's of the Neck; and that in Phlebotomy or letting Blood, care must be taken to avoid pricking the Nerve, which accompanies the Basilick Vein in the Elbow.

The twelve Pairs of Nerves that have their Beginning from between the Vertebra's of the Back, are each of them divided into two Bran­ches, as the others; and their Branches are di­stributed in like manner to the Muscles of the Breast, and to those of the Back and Abdomen.

The five Pairs which take their Rise from between the Vertebra's of the Loins, have thick­er Branches than the others, and the distribution of them is made to the Muscles of the Loins, Hypogastrium, and Thighs.

Of the six Pairs of Nerves that proceed from the Os Sacrum, the four Upper with the three Lower of the Loins, send forth Fibres of Nerves to the Thigh, Leg, and Foot; and the two last Pairs impart Nerves to the Anus, Bladder, and privy Parts.

What is the Structure of the Arteries?

The Arteries are long and round Canals, con­sisting of four sorts of Tunicks or Membranes, which have their Rise from the left Ventricle of the Heart, from whence they receive the Blood, and convey it to all the Parts of the Body for their Nourishment.

What is the Construction of these four Tunicks or Membranes of the Arteries?

The first being thin and Nervous in its out­ward Superficies, is in the Inside a Plexus or In­terlacement of small Veins and Arteries, and Fi­bres of Nerves, which enter into the other fol­lowing Tunicks, to nourish them.

The second sticking close to the former, is al­together full of whitish Glandules, that serve to separate the serous Particles of the Blood.

The third is intirely Musculous, and inter­woven with Annular Fibres.

The fourth is very thin, and hath its Fibres all streight.

Whence proceeds the Pulse or beating of the Ar­teries?

It is deriv'd from the Heart, and exactly an­swers to its Motion of Diastole and Systole.

By what Name is the first Trunk of the Arteries call'd, and what is the Effect of the Distribution made thence to the whole Body?

The first Trunk of the Arteries is nam'd Aor­ta, or the thick Artery, which proceeds immedi­ately from the left Ventricle of the Heart, where­to it communicates before its departure from the Pericardium, one or two small Branches call'd the Coronary: Afterward it is divided into two Branches, whereof one goes upward, and is term'd the Ascending Artery; and the other downward, under the Denomination of the De­scending Artery.

The Ascending Artery ariseth upward along the Aspera Arteria or Wind-Pipe, to the Clavicles, and is there divided into two Branches, call'd the Subclavian Arteries, one whereof goes for­ward to the Right side, and the other to the Left; and they both send forth on each side di­vers [Page 63]Branches, which take their Names from the several Parts, whereto they are distributed; such are the Carotides or Soporales Interni & Ex­terni, which pass to the Head; the Mediastina; the Intercostal; the Axillar, and others.

The Descending Artery, before its departure from the Breast, affords certain Branches to the Pericardium, Diaphragm, and lower Ribs; af­terward it penetrates the Diaphragm, and consti­tutes seven double Branches. The first is of those that are call'd Coeliack, and which go to the Li­ver and Spleen. The second Branch contains the Ʋpper Mesenterick. The third the Emulgent, which pass to the Reins. The fourth the Sper­matick, which are extended to the Genitals. The fifth the Lower Mesenterick. The sixth the Lum­bar. And the seventh the Muscular. But assoon as the great Trunk is come downward to the Os Sacrum, it divides it self into two thick Arteries nam'd the Iliack, which are distributed on both sides, each of them making two Internal and External Branches, which likewise impart Sprigs or lesser Arteries, to the Bladder, Anus, Matrix, and other adjacent Parts: Then the Master-Branch forms the Crural Arteries on the inside of the Thighs, which are communicated by mul­tiplying their Number even to the ends of the Toes, in passing over the External Ancle-Bones of the Feet.

What is the Structure of the Veins?

The Veins are long and round Canals made of four kinds of Tunicks or Membranes, whose Of­fice it is to receive the Blood that remains after the Nourishment is taken, and to carry it back to the Heart to be reviv'd.

What is the Form of the four Tunicks that make the Canals of the Veins?

The first is a Contexture of Nervous and streight Fibres. The second is a Plexus of small Vessels that carry the Nourishment. The third is all over beset with Glandules thro' which are filtrated the serous Particles of the Blood con­tain'd in the Vessels of the second Tunicle. The fourth is a Series of Annular and Musculous or Fleshy Fibres.

Which are the-most numerous, the Arteries or the Veins?

The Number of the Veins exceeds that of the Arteries; and there are scarce any Arteries with­out Veins accompanying them.

Where is the Beginning and Original of all the Veins?

All the Veins have their Root in the Liver, and two of the three great Trunks that proceed from thence, are call'd Vena Portae, and Vena Ca­va; and the third is twofold, viz. the ascending and the descending.

The Vena Portae is distributed to all the Par [...] contain'd in the lower Belly, and terminated i [...] the Fundament; where it makes the Internal Haemorrhoidal Veins.

The Vena Cava is immediately divided into two thick Branches, one whereof ariseth upward to the Right Ventricle of the Heart, and form [...] the ascending Vena Cava; as the other goes down­ward to the Feet, and constitutes the descending.

What is the Distribution of the ascending Ven [...] Cava?

It perforates the Diaphragm, goes to the Heart, and ascends from thence to the Clavicles [Page 65]after having communicated to the Midriff in pas­sing, a small Branch call'd the Phrenicus; as also one or two to the Heart, nam'd the Coronary; and some others to the upper Ribs, besides the single Branch, term'd Azygos, only on the right side. But the Trunk of the ascending Vena Ca­va, being once come up to the Clavicles, is divi­ded into two Branches, well known by the Name of the Subclavian, one whereof Shoots forth toward the Right side, and the other to­ward the Left; and they both make various Ra­mifications like to those of the thick ascending Artery, by producing the Cervicalis or Soporalis, and the Internal and External Jugulars that go to the Head; as also the Axillars, which pass to the Arms and Shoulders, forming the Cepha­lick, the Median, and the Basilick on the inside of the Elbow.

The descending Vena Cava in like manner ac­companieth the Ramifications of the Aorta, or thick descending Artery, to the fourth Vertebra of the Loins, where it sends forth two Bran­ches, nam'd the Iliack, one whereof goes to the Right side, and the other to the Left, both in­wardly and outwardly; imparting divers Twigs or lesser Branches to all the Parts contain'd in the Abdomen or lower Belly, even as far as the Fundament, where it makes the External Hae­morrhoidal Veins. Afterward the outward Branch of the Iliack descends in the Thigh, to form the Crural, and others, as far as the Saphaena, toge­ther with those that are situated at the end of the Feet.

CHAP XII. Of the Anatomy of the Abdomen, o [...] lower Belly.

WHAT is the clearest Division of the Hum [...] Body into various Parts, and that which [...] most follow'd in the Anatomical Schools?

It is that which constitutes three Venters, tha [...] is to say, the Upper, the Middle, and the Lo [...] ­er, which are the Head, the Thorax or Breas [...] and the Abdomen or lower Belly, together wi [...] the Extremities, which are the Arms and Legs▪

What is the lower Belly?

It is a Cavity of the Body that contains th [...] nourishing parts, as the Reins, the Bladder, an [...] all those that are appropriated to Generation [...] both Sexes.

What is to be consider'd outwardly in the low [...] Belly?

Its different Regions, and the several pa [...] therein contain'd.

What are these Regions?

They are the Epigastrick, the Ʋmbilical, an [...] the Hypogastrick.

What is their Extent?

It is from the Xyphoides or Sword-like Carti­lage to the Os Pubis, the division whereof in [...] three equal Parts, constitutes the three diffe­rent Regions; the Epigastrium being the first up­ward, the Ʋmbilicus the second, and the Hyp [...] ­gastrium the third.

What are the Parts contain'd in the Epiga­strium, and what Place do they possess therein?

The Parts contain'd in the Epigastrium are the Liver, the Spleen, the Stomach, and the Pan­creas or Sweet-bread, which lies underneath: The Stomach takes up the middle before, the Liver being plac'd on the Right side, and the Spleen on the Left; so that these two sides of the Epi­gastrick Region, are call'd the Right and Left Hypochondria.

What Parts are there contain'd in the Ʋm­bilicál Region, and what is their situation?

They are the most part of the thin Intestines or small Guts, viz. the Duodenum, the Jejunum, and the Ileon, which have their Residence in the middle, where they are encircled with a Portion of the two great Guts, Coecum and Co­lon, that take possession of the Sides, otherwise call'd the Flanks. The Reins or Kidneys are also in this Place, above, and somewhat back­ward.

What Parts are there contain'd in the Hy­pogastrium, and of what Place are they pos­sest?

The greater part of the thick-Guts, Coecum, and Colon, are enclos'd therein, with the entire Rectum; there is also a Portion of the Ileon, which hides it self in the sides of the Ilia, or Hip-Bones: In the middle under the Os Pubis, the Bladder is situated on the Gut Rectum in Men, and the Matrix in Women lies between the Rectum and Bladder.

After what manner is the opening of a Corps or dead Body perform'd at a publick Dissection?

It is begun with a Crucial Incision in the Skin from underneath the Throat downward, tra­versing from one side to another in the Umbili­cal Region; then this Skin is pull'd off at the four Corners, and the Panicula Adiposa is imme­diately discover'd: Under this Fat lies a Fleshy Membrane, call'd Membrana Carnosa; and after that, the common Membrane of all the Muscle [...] of the lower Belly. Thus we have taken: View of what Anatomists commonly term the five Teguments, that is to say, the Epiderma o [...] Scarf-Skin, the Derma or true Skin, the Panicu­la Adiposa, the Panicula Carnosa or Membrane Carnosa, and the common Membrane of the Muscles.

The five Teguments being remov'd, we meet with as many Muscles on each side, viz. the de­scending Oblique, the ascending Oblique, the Transverse, the streight, and the Pyramidal, by the means whereof the Belly is extended and contracted. Afterwards appears a Membrane nam'd Peritonaeum, which contains all the Bow­els, and covers the whole lower Belly, being strongly fasten'd to the first and third Vertebra's of the Back. The Fat skinny Net which lies immediately under the Peritonaeum, is call'd Epi­ploon and Omentum, or the Caul; it floats over the Bowels, keeping them in a continual Sup­pleness necessary for their Functions, maintains the Heat of the Stomach, and contributes to Digestion.

It remains to take an Account of the Bowels viz. the Stomach, Mesentery, Liver, Spleen, Kidneys, Bladder, and Guts, together with the Parts appointed for Generation, which in Men [Page 69]are the Spermatick Vessels, the Testicles, and the Penis; and in Women, the Spermatick Ves­sels, the Testicles or Ovaries, the Matrix, and its Vagina or Neck.

What is the Stomach?

It is the Receptacle of the Aliments or Food convey'd thither thro' the Oesophagus or Gullet, which is a Canal, or kind of streight Gut that reacheth from the Throat to the Mouth of the Sto­mach. The Stomach it self is situated immediately under the Diaphragm or Midriff, between the Liver and the Spleen, having two Orifices, whereof the Left is properly call'd Stomachus, or the Up­per, and the Right (at its other Extremity) Py­lorus, or the lower Orifice. Its Figure resem­bleth that of a Bag-Pipe, and the greater part of its Body lies toward the Left side. It is com­pos'd of three Membranes, viz. one Common, which it receives from the Peritonaeum; and two Proper; the two uppermost being smooth, and the innermost altogether wrinkled.

What is the Pancreas or Sweet-bread?

It is a Fat Body, consisting of many Glan­dules wrapt up in the same Tunicle, being situa­ted under the Pylorus or lower Orifice of the Sto­mach: It helps Digestion, and hath divers other uses; but its principal Office is to separate the serous Particles of the Blood, to be convey'd af­terward into the Gut Duodenum, by a Canal or Passage, nam'd the Pancreatick. This Juice serves to cause the Chyle to ferment with the Choler, in order to remove the grosser Parti­cles from those that ought to enter into the Lacteal Vessels.

Into how many sorts are the Guts distinguish'd?

There are two sorts, viz. the thin and the thick.

How many thin or small Guts are there?

Three; that is to say, the Duodenum, the Je­junum, and the Ileon.

How many thick Guts are there?

Three likewise; viz. the Coecum, the Colon and the Rectum.

Why are some of them call'd thin Guts, and o­thers thick?

Because the thin are smaller, being appointed only to transport the Chyle out of the Sto­mach into the Reserver; whereas the thick are more large and stronger, serving to carry forth the gross Excrements out of the Belly.

Are the six Guts of an equal length?

No, the Duodenum, which is the first of the thin Guts, is only twelve Fingers breadth long▪ The Jejunum, being the second, so call'd because always empty, is five Foot long: The third is nam'd Ileon, by reason of its great Turnings which oblige it to pass to the Os Ilion, wher [...] it produceth a Rupture; it extends it self almost twenty Foot in length.

The first of the thick Guts, known by th [...] Name of Coecum, is very short, and properly on­ly an Appendix or Bag of a Finger's length That which follows is the Colon, being the lar­gest of all, and full of little Cells, which are fill'd sometimes with Wind and other Matters that excite the Pains of the Colick. It en­compasseth the thin Guts, in passing from the top to the bottom of the Belly, by the means o [...] its great Circumvolutions, and is from eight to nine Foot long. The last is the Rectum o [...] [Page 71]streight Gut, so nam'd, because it goes directly to the Fundament: It is no longer than ones Hand, but it is fleshy, and situated upon the Os Sacrum, and the Coccyx or Rump-Bone.

What is the Peristaltick Motion of the Guts?

It is the successive Motion and Undulation, whereby the Guts insensibly push forward from the top to the bottom, the Matters contain'd in them; and that Motion which on the contrary is perform'd from the bottom to the top, is term'd the Antiperistaltick, as it happens in the Iliack Passion, or twisting of the Guts, call'd Domine Miserere, by reason of its intolerable Pain.

What is the Mesentery?

It is a kind of Membrane somewhat fleshy, which is join'd to the Spine in the bottom and middle of the Belly, and by its folding, keeps all the Guts steady in their place; it is all over beset with red, white, and Lymphatick Vessels; that is to say, those that carry the Blood, Chyle, and Lympha, which serves to cause this last to run more freely, and to fer­ment. Three notable Glandules are also ob­serv'd therein, the greatest whereof lies in the middle, and is nam'd Asellius's Pancreas; the two other lesser are call'd Lumbar Glandules, as be­ing situated near the Left Kidney. From each of these Glandules proceeds a small Branch; and both are united together to make the great Lacteal Vein, or Thoracick Canal. This Tube conveys the Chyle along the Vertebra's of the Back to the Left Subclavian. Vein; from whence it passeth into the ascending Vena Cava, and descends in the Right Ventricle of the Heart, [Page 72]where it assumes the form of Blood; fro [...] whence it passeth to the Lungs thro' the Pul­monary Artery; then it returns to the Hear thro' the Pulmonary Vein, and goes forth agai [...] thro' the Left Ventricle of the Heart, between the Aorta or great Artery, to be afterward di­stributed to all the Parts of the Body. This i [...] the ordinary Passage for the Circulation of th [...] Chyle, and the Sanguification of the Heart.

What is the Liver?

The Liver, being the thickest of all the Bo [...] ­els, is plac'd in the Right Hypochondrium, at th [...] distance only of a Fingers breadth from the Dia­phragm; its Figure much resembling that of [...] thick piece of Beef: It is Convex on the out­side, and Concave within; its Substance is so [...] and tender, its Colour and Consistence being lik [...] coagulated Blood: It is cleft at bottom, and di­vided into two Lobes, viz. one greater, an [...] the other less: Its Office is to purifie the Ma [...] of Blood by Filtration; and it is bound by two strong Ligaments, the first whereof adheres [...] the Diaphragm, and the second to the Xiphoid [...] or Sword-like Cartilage. Two great Veins tak [...] their Rise from hence, viz. the Vena Portae, an [...] the Vena Cava, which form innumerable Bra [...] ­ches, as it were Roots in the Body of th [...] Liver. The Gall-Bladder is fasten'd to the ho [...] ­low part thereof, and dischargeth its Chole [...] into the Gut Duodenum, thro' the Vessels that be [...] the Name of Meatus Choledochi, or Ductus Bi [...] ­ares. This Choler is not a meer Excremen [...] but on the contrary of singular Use in causin [...] the Fermentation of the Chyle, and bringing to perfection.

What is the Spleen?

The Spleen is a Bowel resembling a Hart's Tongue in shape, and situated in the Left Hypo­chondrium, over-against the Liver: Its length is about half a Foot, and its breadth equal to that of three Fingers; its Substance being soft, as that of the Liver, and its Colour like dark co­agulated Blood: It is fasten'd to the Peritonae­um, Left Kidney, Diaphragm, and to the Caul on the inside; as also to the Stomach by cer­tain Veins, call'd Vasa Brevia; nevertheless these Ligatures do not hinder it from wandering here and there in the lower Belly, where it often changeth its place, and causeth many dreadful Symptoms by its irregular Motions. Its Office is to Subtilize the Blood by cleansing and re­fining it.

What are the Reins?

The Reins or Kidneys are Parts of a Fleshy Consistence, harder and more firm than that of the Liver and Spleen: They are both situa­ted in the sides of the Umbilical Region, up­on the Muscle Psoas, between the two Tunicks of the Peritonoeum; but the Right is lower than the Left: Their Shape resembleth that of a French Bean, and they receive Nerves from the Stomach, whence Vomitings are frequently oc­casion'd in the Nephritical Colicks: They are [...] asten'd to the Midriff, Loins, and Aorta, by the Emulgent Arteries; as also to the Bladder by the Ʋreters. The Right Kidney likewise adheres to the Gut Caecum, and the Left to the Colon. Their Office is to filtrate or strain the Urine in the Pelves or Basons, which they have in the middle of their Body on the inside, and [Page 74]to cause it to run thro' the Vessels call'd Ʋreters into the Bladder.

Immediately above the Reins on each side, is a flat and soft Glandule, of the thickness of [...] Nut; they are nam'd Renal Glandules, or Ca [...] ­sulae Atribiliariae, because they contain a black­ish Liquor, which (as they say) serves as i [...] were Leaven for the Blood, to set it a fer­menting.

What is the Bladder?

It is the Bason or Reserver of Urines, of a Membranous Substance as the Stomach, bei [...] plac'd in the middle of the Hypogastrick Re­gion; so that it is guarded by the Os Sacr [...] behind, and by the Os Pubis before: Two Par [...] are to be distinguish'd therein, viz. its Botto [...] and Top; by its Membranous Bottom it [...] join'd to the Navel, and suspended by the mea [...] of the Ʋrachus, and the two Umbilical Arter [...] which degenerate into Ligaments in adult P [...] ­sons: As by its fleshy Neck, longer and crooke [...] in Men, and shorter and streight in Wom [...] it cleaves to the Intestinum Rectum in the for­mer, and to the Neck of the Womb in the la­ter. Lastly, its Office is to receive the Uri [...] to keep them, and to discharge them fr [...] time to time.

What are the Genitals in Men?

They are the Spermatick Vessels, the Tes [...] ­cles, and the Penis. The Spermatick Vessels a [...] a Vein and an Artery on each side; the form proceeding from the Aorta, or thick Artery the Heart; and the other from the Branches the Vena Cava of the Liver. These Arte [...] and Veins are terminated in the Body of [...] [Page 75]Testicles, which are two in Number, enclos'd within the Scrotum

The Office of the Testicles is to filtrate the Seed, which is brought thither from all the parts of the Body, thro' the Spermatick Vessels, cal­led Praeparantia, and afterwards to cause it to pass thro' others nam'd Deferentia, to the Ve­siculae Seminales, from whence it is forc'd into the Ʋreter, thro' two small and very short Canals.

The Penis or Yard is a Nervous and Mem­branous Part, well furnish'd with Veins and Ar­teries, containing in the middle the Canal of the Ʋreter: Its Extremity, which consists of a very delicate and spongy sort of Flesh, is call'd Balanus, or Glans, and the Nut, the Skin that covers it being nam'd the Praeputium, or the Fore-Skin. Thus by the means of this swell'd Part, and stiff thro' the affluence of the Spirits, the Male injects his Seed into the Matrix of the Female, to propagate his Kind.

What are the Parts appropriated to Generation in Women?

They are the Spermatick Vessels, the Ovaries or Testicles, and the Matrix. The Spermatick Vessels are a Vein and an Artery on each side, as in Men: The Ovaries or Testicles, situated on the side of the bottom of the Matrix, are almost of the same bigness with those of Men, but of a round and flat Figure. The Vesiculae, or lit­tle Bladders which they contain, are usually term'd Ova or Eggs by Modern Anatomists; and the Vessels that pass from these Testicles or Ova­ries to the Cornua of the Ʋterus, are call'd Defe­rentia or Ejaculatoria.

The Matrix, Ʋterus or Womb, is the princi­pal Organ of Generation, and the place where it is perform'd, resembling the Figure of a Peat with its Head upward, and being situated be­tween the Gut Rectum and the Bladder: It is of a fleshy and membranous Substance, retain'd in its place by four Ligaments, fasten'd to the bot­tom; whereof the two upper are large ones, proceeding from the Loins, and the two lower round, taking their Rise from the Groin, where they form a kind of Goose-Foot, which is ex­tended to the Os Pubis, and the flat part of the Thighs; which is the cause that Women are in danger of Miscarrying when they fall upon their Knees.

The Exterior Neck of the Womb, call'd Va­gina, is made almost in form of a Throat or Gul­let, extending it self outwardly to the sides of the Lips of the Pudendum, and being terminated inwardly at the internal Orifice of the Matrix, the shape whereof resembleth that of the Muz­zle or Nose of a little Dog. The outward Neck of the womb is fasten'd to the Bladder and the Os Pubis before, and in the hinder part to the Os Sacrum: Between the Lips of the Pudendum lie the Nymphae, which are plac'd at the Extre­mity of the Canal of the Bladder, to convey the Urines; and somewhat farther appear four Caruncles, or small pieces of Flesh, at the En­trance of the Vagina, which when join'd toge­ther make the thin Membrane call'd Hymen.

CHAP. XIV. Of the Anatomy of the Thorax, Breast, or middle Venter.

WHAT is the Breast?

It is a Cavity in which the Heart and the Lungs are principally enclos'd.

What is to be consider'd outwardly in the Breast?

Its extent, and the situation of the Parts there­in contain'd.

What is its extent?

It is extended from the Clavicles to the Xiphoi­des, or Sword-like Cartilage on the fore-part, and bounded on the hinder by the twelfth Ver­tebra of the Back, having all the Ribs to form its Circumference, and the Diaphragm for its Bounds at bottom, separating it from the Abdo­men or lower Belly.

What is the situation of the Parts contain'd in the Breast?

The Lungs take up the upper Region, and fill almost the whole Space, descending at the di­stance of two Fingers breadth from the Dia­phragm; the Heart is situated in the middle, bearing its Point somewhat towards the Left side, under the Lobes of the Lungs, which are divided by the Mediastinum that distinguishes them into the Right and Left Parts.

How is the Breast Anatomiz'd or open'd?

After the dissection of the five Teguments, and the removal of the Muscles, as in the lower Belly, the Anatomist proceeds to lift up the Sternum or Breast-Bone, by separating it from the Ribs; then it is laid upon the Face, or else entirely taken away to the end that the internal Parts of the Breast may be more clearly dis­cover'd; whereupon immediately appear, the Heart, the Lungs, the Diaphragm, and the Me­diastinum, which sticks to the Sternum throughout its whole length.

What is the Heart?

It is a most noble Part, being the Fountain of Life, and the first Original of the Motion of a [...] the others; on which account it is call'd Prim [...] vivens, & ultimum moriens; that is to say, the first Member that begins to live, and the la [...] that dies.

What Parts are to be consider'd in the Heart?

Its fleshy Substance, with all its Fibres turn [...] round like the Skrews of a Vice; its Basis, Poin [...] Auricles, Ventricles, large Vessels, Pericardium and Ligatures or Tyes: The Basis is the upper­most and broadest part; the Point is the lower­most and narrowest part; the two Auricles [...] small Ears being as it were little Cisterns [...] Reservers, that pour the Blood by degrees it to the Heart, are situated on each side abo [...] the Ventricles. The Ventricles, which are like­wise two in Number, are certain Cavities [...] its Right and Left Sides. The large Vessels [...] the Aorta or great Artery, and the Vena Ca [...] together with the Pulmonary Artery and Ve [...] The Pericardium is a kind of Bag fill'd wi [...] Water, wherein the Heart is kept; which [...] [Page 79]fasten'd to the Mediastinum by its Basis, and to the large Vessels that enter and go out of its Ventricles.

What are the Terms appropriated to the continual beating of the Heart?

They are Diastole and Systole, from whence proceed two several Motions, the first whereof is that of Dilatation, and the other of Contra­ction, communicated to all the Arteries which have the same Pulse.

To what use serves the Water contain'd in the Pericardium?

It prevents the drying of the Heart by its perpetual Motion.

What are the Lungs?

They are an Organ serving for Respiration, of a soft Substance, and porous as a Spunge, being all over beset with Arteries, Veins, Nerves, and Lymphatick Vessels, and perforated with small Cartilaginous Tubes, that are imparted to it from the Wind-Pipe, and are call'd Bronchia. Their Natural Colour is a pale Red, and marbl'd dark Brown; and their whole Bo­dy is wrapt up in a fine smooth Membrane, which they receive from the Pleuron. They are sus­pended by the Wind-Pipe, by their proper Ar­tery and Vein, and by the Ligatures that fasten them to the Sternum, Mediastinum, and frequent­ly to the Pleuron it self: They are also divided into the Right and Left Parts by the Mediasti­num; having four or five Lobes, whereof those on the Left side cover the Heart. Their con­tinual Motion consists in Inspiration, to take in the Air, and Expiration, to drive it out. The Larynx makes the Entrance of the Wind-Pipe [Page 80]into the Lungs, and the Pharynx that of the O [...] ­sophagus or Gullet, at the bottom of the Mouth to pass into the Stomach.

CHAP. XV. Of the Anatomy of the Head, or upper Venter.

WHAT is the Head?

It is a bony Part, that contains and en­closeth the Brain within its Cavity.

What is most remarkable in the outward parts of the Head?

The Temporal Arteries, the Crotaphitae, of Temporal Muscles, and the Sutures of the Skull.

Why are these things considerable?

The Temporal Arteries are of good Note because they are expos'd on the outside, lying even with the Skin. The Crotophite Muscles are so likewise, in regard that they cannot be hurt without danger of Convulsions, by reason of the Pericranium with which they are cover'd. And the Sutures, because the Meninges of the Brain proceed from thence to form the Pericranium.

What is the Pericranium?

It is a Membrane that lies under the thick hairy Skin of the Head, and immediately covers the Skull.

What are the Meninges?

They are two Membranes that enclose the Substance or Marrow of the Brain.

What is a Suture?

It is a kind of thick Seam or Stitch, that serves to unite the Bones of the Skull.

How many sorts of Sutures are there?

There are two sorts, viz. the true, and the false or Bastard.

What are the true Sutures?

They are three in number, namely the Sagit­tal, the Coronal, and the Lambdoidal.

What is the disposition or situation of the true Sutures?

The Sagittal is streight, beginning in the middle of the Fore-head, and sometimes at the root of the Nose, and being terminated behind, at the joining of the two Branches of the Lambdoidal Suture?

The Coronal appears in form of a Crown, passing to the middle of the Head, and descend­ing thro' the Temples, to finish its Circumference in the Root of the Nose.

The Lambdoidal Suture is made like an open Pair of Compasses, the Legs whereof are ex­tended toward the Shoulders; and the Button is in the top of the Head backward.

What are the Bastard Sutures?

They are those that are call'd Squamous or scaly, What is the disposition or natural situation of these false Sutures?

They are plac'd at the two sides of the Head, and make a Semi-Circle of the bigness of the Ears, round the same Ears.

What difference is there between the true and spurious Sutures.

The true Sutures are made in form of the Teeth of a Saw, which enter one into the other; and the false or Bastard ones are those that resemble the Scales of Fishes, which [Page 82]are join'd together by passing one over the other.

What is the Ʋse of the Sutures?

The Ancients were of Opinion, that they were made to hinder the Fracture of one Skull-Bone from passing thro' the whole Head; but there is more reason to believe that they have the three following Uses, that is to say,

  • 1. To promote the transpiration of the Brain.
  • 2. To give Passage to the Vessels that go to the Di­ploe.
  • 3. To retain the Meninges, and to sup­port the Mass of the Brain, which is cover'd by them.

What are the Names of the Bones that compose the Skull?

The Bone of the fore-part of the Head is call'd Sinciput, or the Fore-head-Bone, as also the Frontal or Coronal Bone. The Bone of the hinder-part, enclos'd within the Lambdoidal Su­ture, is term'd the Occipital. The two Bones that form the upper-part, and are distinguish'd by the Sagittal Suture, bear the Name of Pa­rietals, one being on the Right side, and the other on the Left. And those behind the Ears are call'd Temporal, Squamosa, or Petrosa. These also are distinguish'd into the Right and Left Temporals, and are join'd to the bottom of the Par [...]etal by a bastard squamous Suture.

What is most remarkable in the thickness of the Skull-Bones?

The Diploe, which is nothing else but a Plex [...] or Contexture of small Vessels, that nourish the Bones, and in the middle of their thickness make the distinction of the first and second Ta­blature of the Bones; whence it sometimes hap­pens [Page 83]that an exfoliative Trepan, or Semi-Tre­pan, is sufficient, when the first of these two Tables is only broken, the other remaining entire.

Is the Brain which is preserv'd in the Skull all of one Piece, or one equal Mass?

No, it is distinguish'd by the means of the Meninges into the Brain it self, and the Cerebel­lum or little Brain; the Brain, properly so cal­led, takes up almost the whole Cavity of the Skull, and the Cerebellum is lodg'd altogether in the hinder-part, where it constitutes only one en­tire Body; whereas the former is divided in­to the Right and Left Parts by the Meninges, which cut it even to the bottom; whence these Foldings are call'd Falx; i. e. a Scythe or Sickle.

What is chiefly remarkable in the Substance of the Brain?

The Ventricles or Cavities which are found therein, together with the great Numbe of Veins, Arteries, Lymphatick Vessels, and Nerves, that carry Sense to all the Parts of the Body, and Spirits for their Motion.

An exact Historical Account of all the Holes of the Skull, and the Vessels that pass thro' them.

To attain to an exact Knowledge of all the Holes with which the inside of the Basis of the Skull is perforated, they are to be consider'd either with respect to the Nerves, or to the Sanguina­ry Vessels.

There are nine Pairs of Nerves that arise from the Medulla Oblongata, and go forth out of the Skull through many Holes hereafter nam'd.

The first Pair is that of the Olfactory Nerves, appropriated to the Sense of Smelling, which are divided below the Os Cribiforme, or Sieve-like Bone, into dive [...]s Threads, that passing into the Nose through many Holes with which this Bone is pierc'd, are distributed to the inner Tunick of the Nose.

The second Pair is that of the Optick or Vi­sual Nerves, that pass into 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 [Page 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-par [...] thro' which passeth a Portion of the Audito [...] Nerve. This is also the Entrance of another [...] made in the Os Petrosum, which is open'd b [...] [...] the Apophysis Mastoides and S [...]des: The other Holes afford a Passage to the Br [...] [...] of the soft Portion of the same Auditory [...].

Below this Ductus there is a remarkable Hole form'd by the meeting of two hollow Cuts the larger whereof is in the Occipital Bor [...] and the other in the lower-part of the Apophy­sis Petros [...]: From the middle of the upper-p [...] of this Hole issueth forth a small Prominence [...] bony Point, whereto is join'd an Appendix o [...] the Dura Mater, which divides the Hole in [...] two parts; so that thro' the foremost Orifice passeth the Nerve of the eighth Pair, and th [...] which is call'd the Spinal Nerve. We shal [...] have occasion hereafter to shew the Use of th [...] 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 Occipi [...] 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 sometime double, but its two Entrances are re-united [...] the outward-part of the Skull; and the tw [...] Branches that form the Origine of this Nerve and which pass thro' these two Holes, are like­wise re-united at their Departure, These a [...] the Passages of the nine Pairs of Nerves th [...] proceed from the Medulla Oblongata, and it re­mains only to show the Paths thro' which the Intercostal Nerve goes forth, as also that of the tenth Pair. The Intercostal runs out of th [...] Skull thro' the Ductus that gives Entrance [...] the Internal Carotick Artery. As for the ten [...] Pair, in regard that it ariseth from the Mar­row which is enclos'd between the Occipit [...] [Page 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.

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 i [...] 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 Oprick Nerve hath its Passage.

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 contain'd in the late­ral Sinus's is emptied thro' two places; the great­er Portion thereof descending in the Jugulars [Page 90]from the Neck, and the other in the Verteb [...] Sinus's: Sometimes those Ductus's are fou [...] only on one side, another while both are stop up, and then the Blood contain'd in the late­ral Sinus's is discharg'd into the Internal J [...] ­gulars.

Behind the Apophysis Mastoides on each sid [...] is a remarkable Hole, thro' which passeth thick Vein, which brings back part of th [...] Blood that hath been distributed to the T [...] ­guments and Muscles, which cover part of t [...] Occiput or hinder-side of the Head: This V [...] is open'd into the lateral Sinus's at the pla [...] where they begin to turn about. But in th [...] Heads of some Persons, this Hole is found [...] ­ly on one side, and even sometimes not at all in which case the Blood contain'd in th [...] Vessels falls into the External Jugulars, wi [...] which the Branches of this Vein have a Co [...] ­munication.

In each Parietal Bone on the side of the S [...] ­gittal Suture, at a little distance from the La [...] ­deidal, appears a Hole, thro' which passeth Vein, that brings back the Blood of the Teg­ments of the Head, and dischargeth it self in the upper Longitudinal Sinus. These Holes a [...] sometimes stopt up on one side, and some­times on both; and then the Blood contain in the Branches of this Vein runs into the E­ternal Jugulars.

In the middle of the Sella of the Os Sph [...] ­noides, we may observe one or two small Hole thro' which (according to the Opinion [...] some Modern Anatomists) the Lympha co [...] ­tain'd in the Glandula Pituitaria is thrown i [...] [Page 91]to 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 [Page 92]pull'd off and laid down the four Corners the bottom.

How is the Brain anatomiz'd?

It is done by cutting it Superficially, a [...] by Leaves, in order to discover by little [...] little the Ventricles, Vessels, and Nerves, w [...] their Original Sources, &c. Or else it is take entire out of the Skull, (the Nerves havi [...] been before examin'd) and laid down; so t [...] without cutting any thing, all the parts of [...] Brain may be set in their proper places, to f [...] out those that are sought for.

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, accord­ing [Page 94]to their several Uses, and often bear th [...] of their Inventer.

What is the Matter whereof these Straps are [...] ­pos'd?

They may be of divers sorts, but are usual made of Silk, Wooll, or Leather.

What is a Swathing-Band?

It is a long and broad Band, that serves [...] wrap up and contain the Parts with the Su [...] ­ons Dressings or Preparatives.

Of what Matter are these Swathing-Ba [...] made?

They are made at present of Linnen-Clo [...] but in the time of Hippocrates, were made Leather or Woollen-Stuff.

How many sorts of Swathing-Bands are there general?

There are two sorts, viz. the Simple [...] Compound; the former are those that [...] smooth, having only two ends; and the oth [...] are those which are trimm'd with Wooll, C [...] ­ton, or Felt, or that have many Heads, that to say, Ends, fasten'd or cut in divers place according as different Occasions require.

What are the Conditions requisite in the Lin­nen-Cloth, whereof the Swathing-Bands are ma [...]

It must be clean, and half worn out, no [...] ­ving any manner of Hem or List.

What are the Names of the different Swat [...] Bands?

There are innumerable, but the greater pa [...] them take their Denominations from their [...] ­gure or Shape; as the Long, Streight, Tri [...] ­gular, and those which have many Heads, are trimm'd.

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 Ideals 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?

There are many, viz.

  • 1. Care must be ta­ken that the Bands be roll'd firm, and th [...] 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 o [...] four Days, to be refitted.
  • 3. They must b [...] neatly and conveniently roll'd, that the Patien [...] may not be uneasie or disquieted.

What ought to be observ'd in fitting the Ba­sters?

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.

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.

What is the Setling by Congestion?

It is that which produceth the Tumour by lit­tle and little, and almost insensibly, by reas [...] of the slow Progress and thickness of the Ma [...]

Which are the most dangerous Tumours, th [...] that arise from Fluxion, or those that derive th [...] Original from Congestion?

They that proceed from Congestion, becau [...] their thick and gross Matter always renders [...] 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, the Phlegmon, which is made of Blood, and [...] Erysipelas of Choler: Mixt, as the Erysipelas Phlegmon, which consists of Blood mingl'd w [...] a Portion of Choler; or the Phlegmonous Erysipe­las, which proceeds from Choler intermixt [...] a Portion of Blood: Alter'd, as the Meli [...] which is compos'd of many Humours, that [...] not be any longer distinguish'd by reason of the too great Alteration. Secondly, the difference Tumours is taken from their likeness to some [...] ­ther thing, as the Carbuncle and the Talpa, [...] former resembling a burning Coal, and the o [...] a Mole, according to the Etymology of their [...] tin Names. Thirdly, From the Parts when they are situated; as the Ophthalmy in the E [...] and the Quinsey in the Throat. Fourthly, from Disease that causeth 'em, as Venereal and Pe­stilential Buboes. Fifthly, from certain Qual [...] found in some, and not in others; as the [...] ­sted Tumours, which have their Matter [...] clos'd within their proper Cystes or Membra [...] and so of many others.

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.

What are Impostumes or Abcesses, Breakings or and Pustules?

Indeed, it may be affirm'd, that all these kind of Tumours scarce differ one from another, [...] cept in their size or bigness; nevertheless, [...] speak properly, by the Names of Impostumes [...] Abcesses are understood gross Tumours that [...] suppurable, or may be dissolv'd, and by th [...] of Breakings out and Pustules, only simple Pust [...] Wheals, or small Tumours, that appear in gre [...] Numbers, and which frequently do not co [...] to Suppuration; some of them consisting of [...] ­ry few Humours, and others altogether of dry Matter.

What difference is there between a Tumour [...] an Impostume or Abcess?

They differ in this particular, that all T [...] mours are not Impostumes nor Abcesses; [...] there is no Impostume nor Abcess that is n [...] Tumour: As for Example, Wens and Gang [...] are Tumours, yet are not Abcesses nor Im [...] stumes; whereas these last are always Tumour in regard that they cause Bunches and Elevatio [...]

CHAP. II. Of the general Method to be observ'd the curing of Tumours.

WHAT ought a Surgeon chiefly to observe Tumours, before he undertake their Cu [...].

He ought to know three things, viz.

  • 1. [...] Nature or Quality of the Tumour.
  • 2. [...] [Page 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 E [...]thiomenus or Gangrene, two means that [...]etimes 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 [Page 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 son [...] of means, even by opening; which may be done upon this occasion, without waiting for their perfect Maturity.

What are the Precautions whereto a Surge [...] 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 iss [...] 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?

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.

How many general Causes are there of Tumours?

There are three. viz. the Primitive, the An­tecedent, and the Conjunct: The Primitive is that which gives occ [...]sion to the Tumours; as for Example, a Fall or a Blow receiv'd. The Antecedent is that which supplies it with Mat­ter, such is the Mass of Blood that thickens and maintains the Phlegmon. Lastly, the Conjunct Cause is the overflowing Blood or Matter, which immediately forms the Tumor.

What regard ought to be had to these three sorts of Causes in the Cure?

The Primitives Cause may be prevented by avoiding the Falls, Blows, or other Hurts, and the Antecedent by diminishing the Plethory of the Blood, and cooling the whole Mass by Phle­botomy. The Conjunct Cause, which is the overflowing of the Blood, may be also remov'd in dispersing it by dissolving, or else in dis­charging it by Suppuration.

What is a Crisis?

It is a sudden setling of Humors, which happens in Diseases, whereby they are usually terminated.

How are these Critical Setlings effected?

By the Strength of Nature, which either ex­pels the peccant Humours thro' the Belly, or car­ries them to the Habitude of the Body; for in the former she causeth Fluxes of Humours, U­rine and Blood; as in the other she excites Sweat­ings, Tumours, and even a Gangrene it self.

In what Parts do the Critical Tumours usu­ally arise?

In the Glandules, which the Ancients call'd the Emunctories of the Brain, Heart, and Liver; for they gave the Name of Emunctories of the Brain to the thick Glandules which lie under the Ears, that of the Emunctories of the Hean to those that are under the Arm-Pits; and that of the Emunctories of the Liver to those under the Groin. Now Malignant Tumours may arise in all these parts, but the Venereal happen only in the Groin.

CHAP. III. Of Natural Tumours.

ARTICLE I. Of the Phlegmon and its Dependancies.

WHAT is a Phlegmon?

It is a red Tumour occasion'd by the Blood diffus'd in some part, wherein it causeth extension, pain, and heat with beating.

Are Aneurisms and Varices, which are Tu­mours, made by the Blood, to be reckon'd among the Phlegmons?

No, because the Blood that forms the Aneruisms and Varices is not extravasated nor accompany'd with Inflammation, but only a Tumour of Blood proceeding from the Dilatation of the Arteries and Veins.

May Echymoses or Contusions consisting of extra­vasated Blood, be esteem'd as Phlegmons?

By no means, in regard that it is not suffici­ent that the Blood be extravasated for the producing of a Phlegmon; it must also cause Pain, Heat, and a Beating, with Inflam­mation, which is not to be found in the Echy­moses, except in great ones, after they have been neglected for a long time; where the corrupted Blood ought to be let out imme­diately, to prevent the Inflammation, over­much Suppuration, and many other ill Conse­quences.

Is the Phlegmon always compos'd of pure Blood?

No, it may happen sometimes to partake of Choler, Phlegm, or Melancholy; on which ac­count it is nam'd an Erysipelatous, Oedomatous, or Scirrhous Phlegmon, always retaining the Name of the predominant Humour, which is the Blood; and so of the others.

REMEDIES.

What are the Remedies proper for a Phlegmon?

They are of two sorts, viz. General and Particular; the former having regard to the an­tecedent cause, and the other to the conjunct. The Phlegmon is cur'd in its antecedent Cause, by Phlebotomy or letting Blood, by good Diet, and sometimes by Purgations, by which means the Plethory, Heat, and Alteration of the Blood is diminished; But Fomentations, Cataplasms and Plaisters facilitate the Cure in the conjunct cause, either by dissolving the Tumour, or bringing it to Suppuration.

At what time is the Opening of a Vein ne­cessary?

In the Beginning and Increase.

What are the Remedies proper to be us'd im­mediately upon the first appearing of the Tumour?

They are Resolvents and Anodynes; such as those that are prepar'd with Chervil boil'd in Whey, adding a little Saffron to wash the Tu­mour, and soak the Linnen Cloaths apply'd thereto, which are often renew'd, and may be laid on with the Chervil.

Or else take the Urine of a healthful Per­son, wherein is boil'd an Ounce of Saffron for a Glass, and bath the Tumour with it.

The Sperm of Frogs is also made use of to very good purpose, either alone, or with Lime-Water and Soap mixt together; or Oak-Leaves and Plantane beaten small, and apply'd. But Care must be more especially taken to avoid cooling Medicines, Oils, and Grease, which are pernicious in great Inflammations.

What ought to be done in the increase of the Tu­mour and Pain?

They are to be asswag'd by mollifying and dissolving; to which end a Cataplasm or Pul­tis is to be made with the Leaves of Elder, Wall-wort or Dwarf-Elder, Mallows, Violet-Plants, Camomile, and Melilot; whereto is ad­ded beaten Line-seed; causing the whole Mass to be boil'd in Whey, and allowing to every Pint, or thereabout, a Yolk of an Egg, twen­ty Grains of Saffron, a quarter of a Pound of Honey, and the Crum of [...] Bread, till it comes to a necessary Cons [...]ence. Or else take Cow's Dung instead of the above-mention'd [Page 107]Herbs, and mix with it all the other Ingre­dients, to make a Cataplasm, which must be renew'd at least every twelve Hours.

What is to be done in the State?

If the Tumour cannot be dissolv'd (as was intended) it must be brought to Suppuration by Cataplasms, consisting of these Ingredients, viz. Garlick, White Lillies roasted under Embers, Milk, and Ʋnguentum Basilicon.

Or else only take a Glass of Milk, in which an Ounce of Soap is dissolv'd, to wet the Lin­nen apply'd to the Tumour; and let it be of­ten reiterated: Otherwise make use of Sorrel boil'd with fresh Butter, and a little Leaven or Yeast. The Plaister Diasulphuris is also most excellent either alone, or, if you please, mixt with Diachylon and Basilicon.

What is to be done in the Declination after the Suppuration?

The Ulcer must be at first gently dry'd with a Plaister of Diasulphuris or Diachylon, and af­terward that of Diapalma may be us'd, and Ce­ruse or White Lead.

What Method is to be observ'd in case there be any Disposition toward a Gangrene?

It is requisite during the great Inflammation to make use of good Vinegar, in an Ounce whereof is dissolv'd a Dram of White Vitriol, with as much Sal Ammoniack, to bath the Tu­mour: Or else take the Tincture of Myrrh and Aloes, with a little Ʋnguentum Aegyptiacum, and afterward make a Digestive of Turpen­tine, the Yolk of an Egg, and Honey, ming­ling it with a little Spirit of Wine, or Brandy, if there remains any Putrifaction or Rottenness.

Remedies for Aneurisms and Varices.

What is to be done in order to cure an Aneurism?

When it is little, as that which happens after an Operation of Phlebotomy or letting Blood ill perform'd, it may be sufficient to lay upon the affected Part a thin Plate of Lead, or else a Piece of Money or Counter wrapt up in a Bol­ster, and to bind it on very streight: But a Piece of Paper chew'd is much better for that purpose.

If the Anuerism be considerable, an Astringent Plaister may be us'd, such as the following.

Take Bolus, Dragon's Blood, Frankincence, Aloes, and Hypocystis, of each a Dram; mingle the whole with two beaten Eggs, and add Wax to give it the consistence of a Plaister, which may be apply'd alone, or mixt with an equal Portion of Emplastrum contra Rupturam, always making a small Bandage to keep it on. Empla­strum de Cicuta hath also a wonderful effect.

When the Aneurism is excessive, it is abso­lutely necessary to proceed to a Manual Ope­ration, the manner whereof shall be shewn here­after in the Treatise of great Operations.

What is requisite to be done in the Varices?

Varices are not generally dangerous, but even conduce to the preservation of Health; ne­vertheless, if they become troublesome by rea­son of their greatness, and the Pains that ac­companie'em, they may be mollify'd with the following Remedy.

Take the Mucilages of the Seeds of Psyllium and Line, of each two Ounces; of Populeon [Page 109]two Ounces; Oleum Lumbricorum & Hyperici, of each one Ounce; and of the Meal of Whear one Ounce, adding Wax to make the Consi­stence of a Plaister; part of which spread upon Linnen or Leather, must be apply'd to the Va­rix, and ty'd thereto with a small Band.

If the Blood abound too much, it may be discharg'd by the Application of Leeches, or by a Puncture made with a Lancet: After­ward lay upon the Part a Piece of Lead sow'd up in a Cloth, and let it be kept close with a proper Bandage. Otherwise you may make use of an Astringent, such as this.

Take a Pomegranate, cut it in pieces, and boil it with as much Salt as may be taken up with the Tip of your Fingers, in a Gallon of strong Vinegar; then dip a Spunge in this Vi­negar, apply it to the Varix, bind it on, and continue the use of it twice a Day for a Month together.

Remedies for Echymoses, Contusions, or Bruises.

How are Echymoses to be treated?

All possible means must be us'd to dissolve 'em, by laying Slices of Beef upon the Part, renewing 'em very often, or applying Linnen Rags dipt in Spirit of Wine impregnated with Saffron.

They may be also dissolv'd with the Roots of Briony grated and apply'd thereto, or else with Plaister or Mortar, Soot, Oil of Olives and Ʋnguentum Divinum, a Mixture whereof being made, is to be put between two Rags, and laid upon the Tumour or Swelling.

If the Echymosis happens in a Nervous Part, Balsam of Peru may be us'd, or, for want there­of, Oleum Lumbricorum & Hyperici, with luke­warm Wine, with which the Bolsters must be soak'd, to be laid upon it.

When the Echymosis is great, and much Blood is diffus'd between the Skin and the Flesh, the safest way is to make an Opening to let it out, lest a too plentiful and dangerous Suppu­ration should ensue, or even a Gangrene it self. However, a Surgeon ought to proceed in the curing of an Echymosis in the Face with great Circumspection, which must be always prepar'd for Incision.

Of phlegmonous Tumors or Impostumes, and of Remedies proper for 'em.

What are the Tumours or Impostumes that par­take of a Phlegmon?

They are the Bubo, Carbuncle, Anthrax, Fu­runculus, Phyma, Phygeton, Panaritium or Par [...] ­nychia, Burn, Gangrene, and Kibe or Chil­blain.

What is a Bubo?

A Bubo is a Tumour which ariseth in the Groin, being accompany'd with Heat, Pain, Hardness, and sometimes a Feaver.

What is a Carbuncle?

A Carbuncle is a hard Swelling, red, burn­ing, and inseparable from a Fever: It is co­ver'd with a black Crust or Scab, that after­ward falls off at the Suppuration, leaving a deep and dangerous Ulcer, and which sometimes doth not suppurate at all.

What is an Anthrax?

The Anthrax is very near the same thing as the Carbuncle, only with this difference, that the latter always appears in the Glandulous Parts, and the Anthrax every where else.

What is a Furunculus?

It is a kind of Boil, or benign Carbuncle, which somewhat resembles the Head of a Nail, and is on that Account call'd Clou by the French, causing Pains, as if a Nail were driven into the Flesh.

What is a Phygeton?

The Phygeton is a small, red, and inflam'd Extuberance, situated in the Miliary Glandules of the Skin, where it causeth a pricking Pain, without Suppuration.

What is a Phyma?

The Phyma appears after the same manner as the Phygeton, and suppurates.

What are the Remedies proper for all these sorts of phlegmonous Tumours and Impostumes?

They are Cataplasms and Plaisters Anodyn, Emollient, Resolvent, and Suppurative, which are us'd proportionably as in the Phlegmons.

What is a Gangrene, Sphacelus, or Esthio­menus?

The Gangrene and Sphacelus signifie the same thing, nevertheless are commonly distinguish'd; the former being a Mortification begun, and the, Sphacelus an entire or perfect Mortificati­on; call'd also Nec [...]is and Si [...]ratio. An Est [...]om [...]nus is a Disposition to M [...] ­on, discover'd by the sof [...]ness of th [...] [...]art; and a Gangrene is defin'd to be a Morti­fication of a Part, occasion'd by the Interce­ption [Page 112]of the Spirits, and the Privation of the Natural Heat.

What are the causes of a Gangrene in general?

Every thing that can hinder the Natural Heat from exerting it self in a Part; as strong Li­gatures, astringent or resolvent Medicines, not conveniently us'd in great Inflammations; a violent Haemorrhage; or Old Age, whereby the Spirits are exhausted; the bitings of Mad Dogs; excessive Cold, &c.

By what Signs is the Gangrene known?

It is discover'd by the livid Colour of the Skin, which departs from the Flesh, the soft­ness, coldness, and insensibility of the part; and sometimes by its dryness and blackness, from whence exhales a cadaverous Stench, with Sanies issuing forth after Punctures or Scarifications made therein. Lastly, a Gangrene is perceiv'd by the cold Sweats, Swoonings, Syncope's, and Delirium's that invade the Patient, and which are all the Fore-runners of approaching Death.

Is a Gangrene only found in the Flesh, and soft Parts of the Body?

It happens also in the Bones; and is then call'd Caries.

How is this Caries or Gangrene of the Bone dis­cover'd, when it lies hid under the Flesh?

It is known by the black Colour of the Neigh­bouring Flesh, the Stink of the Sanies that comes forth, the intolerable Pains felt thereabouts, which are six'd and continual before the Im­postume and Ulcer appear; but when the Ul­cer is made, a kind of roughness may be per­ceiv'd in the Bone.

REMEDIES.

What are the Remedies proper for a Gangrene?

They are those that take away the morri­fy'd and corrupt Parts, and recall the Natu­ral Heat; both which Indications are exactly answer'd in the Extirpation of what is already corrupted, with the Incision-Knife; and the Restauration of the Natural Heat by the fol­lowing Remedies.

Take an Ounce of good Vinegar, steeping therein a Dram of White Vitriol, with as much Sal Ammoniack: Let it be us'd in bathing the Part; and apply thereto Bolsters well seak'd in the same Liquor. This remedy is convenient in the first Disposition toward a Gangrene: Or, if you please, you may make use of the Yellow Water, which is made with Corrosive Sublimate and Lime-Water; taking, for Ex­ample, half a Dram of Corrosive Sublimate to be infus'd in a Pint of Lime-Water.

But a Tincture of Myrrh and Aloes is more efficacious, wherein Ʋnguentum Aegyptiacum is steep'd; or else Lime-Water kept for that pur­pose, in which have been boil'd two Ounces of Sulphur or Brimstone, with two Drams of Mercurius Dulcis; adding four Ounces of Spi­rit of Wine, to make an excellent Phegedaenick Water, with which the Part may be bathed, and the Bolsters soak'd.

If the Gangrene passeth to the Bone, the Ul­cer must be immediately cleans'd with Bran­dy, and Euphorbium afterward put into it, lay­ing also some upon the Bolsters, and abstain­ing [Page 114]from all sorts of Oils and Greases. But if these Remedies prove unprositable, re­course is then to be had to the Incision-Knife, Fire, or Amputation; the manner of perform­ing which several Operations, is explain'd here­after.

What are Kibes or Chilblains?

They are painful Tumours, which are often accompany'd with Inflammation; they happen more especially in the nervous and outward Parts, as the Heel, and are so much the more sensibly selt, as the Air and Cold are more sharp and Ve [...]ement.

What is to be done in order to cure these Kibes or Chilblains?

The Heel or affected Part must be wash'd and dipt in Wine boil'd with Allum and Salt, whereof a Cataplasm may be afterward made, by adding Meal of Rye, Honey, and Brim­stone. The Juice of a hot Turnep apply'd with Ʋnguentum Rosatum, is also very good, or Petroleum alone.

What is a Panaritium.

Panaritium or Paronychia, is a Tumour which generally ariseth in the Extremity of the Fingers, at the Root of the Nails: It is red, and accompany'd with very great Pain, even so exquisite, that the whole Arm is sensi­ble thereof, insomuch that a Fever sometimes ensues, and a Gangrene; the Humour being contain'd between the Bone and the Perioste­um, or that little Membrane with which it is immediately invested.

What Remedies are convenient for the curing a Panaritium?

Anodyn Cataplasms are to be first apply'd, that is to say, such as serve to asswage ex­cessive Pain, as that which is compos'd of Milk, Line-seeds beaten, large Figs, the Yolk of an Egg, Saffron, Honey, and Oleum Lumbricorum, with the Crum of white Bread. Afterward you may endeavour to dissolve it, by applying Oil of Almonds, Saccharum Sa­turni, and Ear-Wax, or else Balsam of Sul­phur. The Plaister of Mucilages, and that of Sulphur or Brimstone, dissolv'd in Wine, is also a most excellent Resolvent and Anodyn

If it be requisite to bring this Tumour to Suppuration, white Lillies roasted under Em­bers may be added to the preceeding Cata­plasm; or else a new Cataplasm may be made with Sorrel boil'd, fresh Butter, and a little Leaven.

What is a Burn?

A Burn is an Impression of Fire made upon a Part, wherein remains a great deal of Heat, with Blisters full of serous Particles, or Scabs, ac­cordingly as the Fire hath taken more or less effect.

What are the Remedies proper for a Burn?

A Burn is cur'd by the speedy Application of fresh Mud re-iterated many times succes­sively; by that of peel'd Onions, Ʋnguentum Rosatum, and Populeon, mixt with the Yolk of an Egg and unslack'd-Lime: Cray-Fishes or Crabs pounded alive in a Leaden-Mortar; and a great Number of other things.

If the Burn be in the Face, you may more especially take the Mucilages of the Seeds of Quinces and Psyllium, and Frog's-Sperm, of [Page 116]each an equal quantity, adding to every four [...] Ounces twenty Grains of Saccharum S [...]tu [...]ni. This Composition may be spread on the Part with a Feather, and cover'd with fine Brown Paper. It is an admirable and approved Re­ceipt.

If the Burn hath made an Escar or Crust, it may be remov'd with fresh Butter spread up­on a Colewort or Cabbage Leaf, and apply'd hot. But in Case the Scab is too hard, and doth not fall off, it must be open'd, to give pas­sage to the Pus or corrupt Matter, the stay of which would occasion a deep Ulcer under­neath. The same Method is to be observ'd in the Pustules or Blisters, two Days after they are rais'd, applying also the Ointment of quick Lime, Oil of Roses, and Yolks of Eggs.

ARTICLE II. Of the Erysipelas and its Dependances.

WHat is an Erysipelas?

An Erysipelas, commonly call'd St. Antho­ny's Fire, is a small Elevation produc'd by a Flux of Choler dispers'd and running between the Skin and the Flesh. It is known by its yellowish Colour, great Heat and Prickings.

REMEDIES.

What are the Remedies proper for an Erysipelas?

An Erysipelas that ariseth in the Head and Breast is not without danger, and the Cure of [Page 117]it ought to be undertaken with great Care in the Application as well of internal as external Remedies: For it is requisite to take inwardly a Dose of the Diaphoretick Mineral, Crabs-Eyes, Egg-shels, Powder of Vipers, and other Medicines; as also Potions that have the like Virtues, such as the following. Take four Oun­ces of Elder-Flower-Water, adding thereto a Scruple of the volatile Salt of Vipers or Hart's-Horn, with an Ounce of Syrrup of red Poppies.

Phlebotomy or Blood-letting hath no place here, unless there be a great Plethory, but fre­quent Clysters are not to be rejected, viz. such as are made of Whay, Chervil, Succory, and Violet-Plants, adding a Dram of Mineral Crystal-dissolv'd with two Ounces of Honey of Violets.

As for outward Applications, Linnen-Rags dipt in the Spirit of Wine impregnated with Camphire and Saffron, are to be laid upon the Tumour, and renew'd as fast as they are dry'd. An equal quantity of Chalk and Myrrh beaten to Powder, may also be strew'd upon a Sheet of Cap-Paper over-spread with Honey, and ap­ply'd to the Part.

If the Heat and Pain grow excessive, take half a Dram of Saccharum Saturni, twenty Grains of Camphire, as much Opium, with two Drams of red Myrrh, to be infus'd in a Gal­lon of White-Wine: Let this Liquor be kept to soak the Cloaths that are laid upon the Ery­sipelas, ond often renew'd. But to dress the Face, a Canvass Cloth may be us'd, which hath been dipt in a Medicine prepar'd with a Gal­lon [Page 118]of Whey, two Yolks of Eggs, and a Dram of Saffron.

Moreover amidst all these Remedies, it is ne­cessary to oblige the Patient to keep to a good Diet, and to prescribe for his ordinary Drink a Diet-Drink made of Hart's-Horn, the Tops of the lesser Centory, Pippins cut in Slices with their Skins, and Liquorish; A little good Wine may be also allow'd, with the Advice of the Physician.

Of Erysipelatous Tumours or Impostumes, and their Remedies.

What are the Tumours or Impostumes that par­rake of the Nature of an Erysipelas?

They are the dry and moist Herpes, the for­mer being that which is call'd the Tetter or Ring-Worm; and the other a kind of yellow. Bladders, Pustules, or Wheals, that cause itch­ing, and raise small corroding, Ulcers in the Skin: To these may be added divers sorts of Scabs and Itch.

The Remedies prescrib'd for the Erysip [...]les may be us'd for both these kinds of Herpes; as also Lotions or Bathing-Liquors made of Lime-Water, and a Decoction of. Wormwood and Sal Ammoniack, allowing half a Dram to four Ounces of Liquor. Or else take half a Dram of Sal Sa [...]u [...]i, and put it into a Glass of the De­coction of Fumitory or Chervil. You may al­so make use of the Oil of Tartar per deliquium, to make a Liniment either alone, or ming'd with the above-mention'd Decoctions.

ARTICLE III. Of the Oedema.

WHat is the Oedema?

It is a white soft Tumour, with very lit­tle sense of Pain, which ariseth from the Set­tling of a pituitous Humour.

What are the Rumedies proper for an Oedema?

They are Fomentations, Cataplasms, Lini­ments, and Pla [...]sters.

The Fomen [...]a [...]ions are made with Bundles of Wall-Wort or Dwarf-Elder, thrown into a hot Oven after the Bread is bak'd, and sprink­led with Wine: Afterward being taken out smoaking, they are unty'd, open'd, and wrapt about the Part, putting a warm Linnen Cloth over 'em. This Operation is to be re-i [...]erated; and by this means the Humour is dissolv'd thro' Transpiration by Swear.

The Cataplasms are compos'd of Camomile, Melilot, St. John's-Wort, Sage, Wall-Wort, Pellitory of the Wall, Roots of Briony and O­nions, all boil'd together in White Wine with Honey, adding, if you please, a few Cummin or Fennel Seeds beaten. Cataplasms are also made of Horse-Dung and the Seeds of Cum­min beaten, which are boil'd in strong Vinegar, and mixt with Barly-Meal to the Consistence of Pap.

The Plaisters are prepar'd with an Ounce of Diapalma, half an Ounce of Martiatum, a Pint of Oil of Lillies, half an Ounce of Cum­min-Seeds [Page 120]powder'd, half a Dram of Sal Am­moniack, and an Ounce of yellow Wax to make a Consistence.

If any hardness remains, the Plaister of Mu­cilages may be apply'd▪ or that which is made of the Gums Bdellium, Ammoniack, and Galba­num, dissolv'd in Vinegar. Bu [...] Care must be taken not to omit the Purgatives of Jalap to the quantity of a Dram in a Glass of White-Wine; or of half an Ounce of Lozenges of Diacar­thamum, which are effectual in drawing out the bottom of pituitous and serous Humours that nourish the Oedema's.

Of Oedomatous Tumours and Impostumes.

What are the kinds of Tumours that partake of the Nature of an Oedema?

They are the Phlyctaena, the Emphysema, the Batrachos or Ranunculus, the Wen, the Talpa, the Bronchocele, the Ganglion, the Fungus, the Scurf, the Scrophula or King's-Evil, and all sorts of Dropsies both general and particular.

What are Phlyctaena's?

They are Pustules or Blisters fill'd with a white and somewhat yellowish Humour.

What is an Emphysema?

It is a kind of flatuous Tumour, wherein Wind is contain'd, with a little slimy Phlegm.

What is a Batrachos or Ranunculus?

It is a Blister fill'd with slimy Water, that ariseth under the Tongue near the String, and in French is call'd Grenouillette, or the little Frog; which is the same with its Greek and La­tin Names.

What is a Wen?

It is a Tumour consisting of thick plaistry Phlegm, which is reckon'd among the Encysted.

What is a Talpa?

It is a soft and very broad Tumour, which usually appears in the Head and Face, contain­ing a white, thick, and pituitous Matter.

What is a Bronchocele?

It is a bunch'd Tumour which ariseth in the Throat, and causeth it to swell extremely; being compos'd of thick Phlegm mix'd with a little Blood, and ranked among the Encysted Tumours.

What is a Ganglion?

It is a very hard Tumour, void of Pain and wavering, produc'd by thick Phlegm: But it is always found upon some Nerve or Ten­don.

What is a Fungus?

It is a spungy Tumour that grows upon Ten­dons bruis'd or weaken'd by some Hurt.

What is the Scurf?

It is a whitish and scaly Tumour rais'd in the Skin of the Head by a viscous and mixt Phlegm, having its Root in the bottom of the Skin.

What is the Scrophula or King's-Evil?

Scrophulae or Strumae, commonly call'd the King's-Evil, are Tumours that generally shew themselves in the Glandules of the Neck, and in all those Parts where there are any. They consist of a viscous, serous, and malignant Phlegm, the Source or Root whereof is suppos'd to be in the Glandules of the Mesentery. They are also of the number of the Encysted Tu­mours.

What is the Dropsie?

It is a soft Tumour occasion'd by the setling of abundance of serous Matter in the Parts where it appears.

How many sorts of Dropsies are there?

There are three general Species, viz. the Asci­tes, Tympanites, and Leucophlegmatia.

What is an Ascites?

It is a kind of Dropsy that forms the Tumour or Swelling of the Abdomen or lower Belly, by a Mass of Water,

What is a Tympanites?

It is a kind of Dropsy, which in like manner causeth a Tumour or Swelling in the lower Belly, with this difference, that a great deal of Wind is mixt with the Water, which renders the Tumour transparent, and sounding, as it were a Drum; whence this Disease hath taken its Name.

What is the Dropsy call'd Leucophlegmatia?

It is a Tumour, or, to speak more proper­ly; a general Swelling or Bloating of all the o­ther Parts of the Body, as well as of the lower Belly. It is produc'd by a viscous and mucilagi­nous sort of Phlegm; whence it happens that the Print of the Fingers remains in those places that have been press'd.

What are the particular kinds of Dropsies?

They are those that are incident to different Parts, of which they bear the Names; as the Hydrocephalus, which is the Dropsy of the Head; the Exomphalus, of the Navel, and the Hydre­cele of the Scrotum. There is also a Dropsy of the Breast, and that of the Matrix.

What are the Remedies proper for all these sorts of Tumours or Dropsies?

They are in general all those that are agree­able to the Oedema, which are variously us'd, as Liniments, Fomentations, Cataplasms, and Plaisters: Internal Medicines ought also to be much consider'd, as Diaphoreticks, Sudorificks, and Purgatives, when they are assisted by a regular Diet.

A Decoction of the Roots of Briony with Cinnamon and Liquorish, provokes Urine very much; as well as a Decoction of Turneps and Carrets, and an Infusion of Sage in White-Wine.

ARTICLE IV. Of a Scirrhus, and its peculiar Remedies.

WHat is a Scirrhus?

It is a hard unmoveable Tumour, almost altogether void of Pain, and of a livid dark Colour; which is form'd of a Melancholick Humour, frequently succeeding Phlegmons and Oedema's that have not been well dress'd with convenient Remedies.

How is a Scirrhus cur'd?

By mollifying or dissolving it, and seldom by bringing it to Suppuration.

It may be mollify'd by the application of a Cataplasm or Pultis, compos'd of the Leaves of Violet-Plants, Mallows, Beets, Elder, Rue, and Wormwood, with Camomile-Flowers, [Page 124]Horse-Dung, Cow-Dung, and White Lillies. The whole Mass is to be boil'd together in Wine, afterward adding Honey and Hogs-Lard, to make a Cataplasm thereof with the Crum of White Bread.

It is dissolv'd with Plaisters compos'd of those of Diachylon, Melilot, and Mucilages, to which is added Oleum Lumbricorum, and Flower of Brimstone. To render the Remedy more ef­fectual, Oil of Tobacco may be also mixt with it, and Gum Ammoniack dissolv'd in Vi­negar.

Furthermore, these Topical or outward Me­dicines are to be accompany'd with others ta­ken inwardly, which serve to prepare the Hu­mours for convenient Evacuations; Such are Crab's-Eyes, the Decoctions of Sarsaparilla, the use of good Wine, and light Meats of easie Digestion.

Of Scirrhous Tumours, and their Remedies.

What are the Tumours that partake of the Na­ture of a Scirrhus?

They are the Polypus, Carcinoma, Sarcoms, Natta, and Cancer.

What is a Polypus?

It is an Excrescence of fungous Flesh arising in the Nostrils: But Hippocrates confounds the Car­cinoma and Sarcoma with the Polypus, of which he says they are only a Species.

What is the Natta?

It is a Tumour or Excrescence of Flesh that appears in the Buttocks, Shoulders, Thighs, Face, and every where else, the various Figures [Page 125]of which cause it to be call'd by different Names. For one while it resembleth a Goose­berry, at another time a Mulberry, and at ano­ther time a Melon or Cherry. Sometimes also these Swellings are like Trees, Fishes, Birds, or other sorts of Animals, according to the ar­dent desire that Women with Child have had for things that they cou'd not obtain when they longed for 'em.

What are the Remedies proper for the Polypus, and other kinds of Excrescences of the like Na­ture?

The Polypus may be cur'd in the beginning, but it is to be fear'd lest it degenerate into an incurable Cancer, when it hath been neg­lected or ill dress'd.

Besides the general Remedies, which are let­ting Blood a little, and reiterated Purgations, with an exact Regulation of Diet, there are also particular Medicaments which dry up and insensibly consume the Excrescence; as a Deco­ction of B [...]stort, Plantain, and Pomegranate-Rinds in Claret-Wine, which is to be snuff [...]d up the Nose many times in a Day, and serves to soak the small Tents that are put up therein, as also often to cool the Part, adding a little Allum and Honey.

The Patient must sometimes likewise keep in his Mouth a Sage-Leaf, sometimes a piece of the Root of Pellitory of Spain; and at ano­ther time Tobacco or some other thing of this Nature, which causeth Salivation. If the Tu­mour continues too long, and doth not yield to the above-mention'd Remedies, it is ne­nessary to proceed to a Manual Operation, [Page 126]which is very often perform'd with good Suc­cess.

As for the Natta's, it is most expedient not to meddle with 'em at all; nevertheless these Marks which Infants bring along with 'em into the World, are frequently defac'd by an Application of the After-Burdens, whilst they are as yet warm, assoon as their Mothers are deliver'd.

What is a Cancer?

It is a hard, painful, and ulcerous Tumour, produc'd by an adust Humour, the Malignity whereof can scarce be suppress'd by any Re­medies.

How many sorts of Cancers are there?

There are two kinds, viz. The Primitive and the Degenerate; the Primitive Cancer is that which comes of it self, and appears at first a­bout the bigness of a Pea or Bean, which ne­vertheless doth not cease to cause an inward Pain, continual, and pricking by intervals; du­ring this time it is call'd an Occult Cancer; but when grown bigger, and open'd, it bears the Name of an Ulcerated Cancer; which is so much the less capable of being cur'd or as­swag'd, as it makes it self more conspicuous by its dreadful Symptoms, or concomitant Cir­cumstances.

The Degenerate Cancer is that which succeeds an obstinate and ill-dress'd Tumour or Impo­stume, and which becomes an Ulcerated Can­cer, without assuming the Nature of a blind or occult one.

What Remedies are requisite to be apply'd to a blind Cancer?

In regard that it cannot be known in this Condition without difficulty, it is often neglect­ed; nevertheless it is a Matter of great Mo­ment to prevent its Consequences, more espe­cially by a good Diet, and by general Reme­dies, which may gently rectifie the intempera­ture of the Bowels: Afterwards Baths may be prescrib'd, together with the use of Whey Asses-Milk, and Specificks in general, as Pow­ders of Crab's-Eyes, Vipers, Adders, and others. As for Topical Remedies, none are to be ad­minister'd, except it be judg'd convenient to apply to the Tumour a Piece of Lead rubb'd with Quick-silver; all others serving only to make the Skin tender, and apt to break. The Patient may also take for his Drink Water of Scorzonera and Hart's-Horn, with the Flowers of Bugloss or Borage, and Liquorice: Or else Quick-silver-Water alone, boiling an Ounce of it in a Quart of Water every time, the Quick-silver always remaining at the bottom of the Vessel.

What are the Remedies for an ulcerated Cancer?

Besides the general ones, that are the same with those of the blind Cancer, there are also Topical, which may take place here. The Powders of Toads, Moles, Frogs, and Crabs calcin'd, cleanse the Ulcers perfectly well. A Decoction of Vipers and Crabs may serve to bath 'em, and some of it may be taken in­wardly. Detersives made of Lime-Water, or Whey clarify'd, and boil'd with Chervil are ve­ry good; and (if you please) you may add Camphire or Saccharum Saturni.

If the Pains grow violent, recourse is to be had to Laudanum, one or two Grains whereof may be given in a little Conserve of Roses. When the Cancer is situated in the Glandules or Flesh, the Extirpation of it may also be undertaken with good Success.

As for the manner of handling Degenerate Cancers, respect must be always had to the kind of Tumour, from whence it deriv'd its Original.

CHAP. IV. Of Bastard or Encysted Tumours.

WHAT is an Encysted or Bastard Tumour or Impostume?

It is that which is made of a Setling of mixt and corrupt Humours, the Matter whereof is contain'd in certain proper Cystes or Membranous Bags.

What are the kinds of these Tumours?

They are the Steatoma, the Atheroma, the Me­liceris, the Wen, the Bronchocele, and the Scro­phula or King's-Evil.

How is the difference between these Tumours discern'd?

The Steatomá is known by its Matter resem­bling Suet; as that of the Atheroma resembleth Pap; and that of the Meliceris is like Honey: These three Tumours cannot be well distin­guish'd on the outside, in regard that they do not change the natural Colour of the Skin, which [Page 129]equally retains in all three the print of the Fin­gers that press it. But the Bronchocele is disco­ver'd by the Place and Part which it possesseth; that is to say, the Throat; as also by its some­what hard consistence without the Alteration of the Skin. The Scrophulae or King's-Evil Swel­lings are known by their unequal Hardness, and their situation in the Glandules, either in the Neck, Arm-pits or elsewhere, without alteration likewise of the Skin.

REMEDIES.

What is the Method to be observ'd in curing these sorts of Tumours?

An Attempt is to be made to dissolve 'em, as in all the others; nevertheless the safest way is to bring 'em to Suppuration, and to extirpate the Cystes, which are apt to be sill'd again after the Dissipation of the Humour.

What are the Medicines proper to dissolve these Tumours?

They are all such as may be us'd for the Oe­dema and Scirrhus; but the Specificks or particu­lar Remedies are these:

Take Rosemary, Sage, Wormwood, Elder, great Celandine, Camomile, Melilot, St. John's. Wort, and Tobacco; boil 'em in White-Wine with Soot and Mercurial Honey, adding, thereto Cummin-seeds beaten, and Olcum Lumbricorum, to make a Cataplasm, which is to be renew'd twice a Day. Afterward if the Tu­mour be not dispers'd, you may apply the fol­lowing Plaister, which hath an admirable Ef­fect.

Take an equal Portion of the Plaister of Dia­chylon, Devigo, and four times as much Mercury, and Emplastrum Divinum; let 'em be dissolv'd together; then intermix Saffron, and Oil of To­bacco, to make a Plaister with the whole Mass, which may be spread upon thin Leather, and ap­ply'd to the Tumour, without taking it off on­ly once every eighth Day, to cool it; so that it must be laid on again after having wash'd and bath'd the Part with warm Urine or Brine.

But it is to be always remember'd that exter­nal Remedies take effect only imperfectly, un­less they are assisted by internal, such as in this case are reirerated Purgations, join'd with a re­gular Diet.

What are the Remedies proper to excite Suppu­ration?

To this purpose those may be us'd that serve in other kinds of Tumours: But as for the ex­tirpation of the Cystis, it is done by dividing the Tumour into four Parts, by procuring Suppu­ration, and by consuming the Bag by little and little. The Bronchocele alone will not admit this Extirpation, by reason of the great Number of Nerves, Veins, and neighbouring Arteries amidst which the Tumour is settl'd. However Bron­chotomy, or opening the Throat, may be per­form'd; which is an Operation peculiar to this Tumour.

CHAP. V. Of Critical, Malignant, Pestilential, and Venereal Tumours and Impostumes.

WHAT difference is there between Critical, Malignant, Pestilential, and Venereal Tu­mours?

It consists in these particular circumstances, viz. that Critical Tumours or Impostumes are indifferently all such as are form'd at the End or Termination of Diseases, in whatsoever Place or Part they appear.

Malignant Impostumes or Tumours are those that are obstinate, and do not easily yield to the most efficacious Remedies.

Pestilential Impostumes or Tumours are those that are accompany'd with a Fever, Swooning, Head-ach, and Faintness: They usually arise in the time of a Plague or Pestilence, and are contagious.

Venereal Tumours or Impostumes are those that appear only at the bottom of the Groin, and are the product of an impure Coitus.

However, the Critical Impostume may be Malignant, Pestilential, and Venereal; the Ma­lignant Impostume may be neither Critical, nor Pestilential, nor Venereal: But the Pestilen­tial and Venereal Tumours are always Ma­lignant.

What are the ordinary kinds of Critical Tumours or Impostumes?

They are the Anthrax, the Boil, the Phlegmon, and the Parotides or Swellings in the Almonds of the Ears?

What are the kinds of Malignant Tumours or Impostumes?

They are the Cancer, the Scrophula or King's-Evil; and others of the like Nature.

What are the kinds of Pestilential Tumours or Impostumes?

They are Carbuncles that break out every where; a sort of Authrax which appears under the Arm-pits, and Bubo's in the Groin.

What are the kinds of Venereal Tumours or Im­postumes?

They are Botches or Bubo's and Cancers that arise in the Yard; as also Wens and Condyloma's in the Fundament.

What is the difference between a Pestilential and a Venereal Buboe?

They may be distinguish'd by their Situation, and respective Accidents; the Pestilential lying higher, and the Venereal lower: Besides, a Fe­ver, Sickness at the Heart, and an universal Faintness or Weakness, are the ordinary con­comitant Circumstances of the former; whereas the Venereal Buboe is always the consequence of an impure Coitus, and is attended with no other Symptoms than those of common Tumours, viz. Pain, Heat, Shootings or Prickings, &c.

As for the Remedies, they may be sought for among those that have been already prescrib'd for Tumours.

CHAP. VI. Of the Scurvy.

THIS Disease is known by the Ulcers of the Mouth, which are very stinking; as also by excessive Salivation, great Pains in the Head, Dizziness, frequent Epilepsies, Apoplexies, and Palsies. The Face, being of a pale red, and dark Colour, is sometimes puff'd up or bloated, inflam'd, and beset with Pustules: The Teeth are loose and [...]ake, the Gums are swell'd, itch, putrifie, exulcerate, and are eaten with the Canker; and the Jaw is almost unmoveable: The Members are bow'd, and cannot be ex­tended: The Patients become stupid and drow­sie, so that they fetch their Breath with diffi­culty, are obnoxious to Palpitations of the Heart and Coughs, and fall into Swoons: The Ulcers sometimes are so malignant, that their Cheeks are entirely eaten up, and their Teeth seen: They are also much inclin'd to Vomit­ting, Looseness, and Gripes; and their Entrails are swell'd: They have red and livid Pustules on their Belly and Privy-parts, which sometimes break out into Ulcers; their whole Body being dry'd, &c.

This Disease may be easily cur'd in the begin­ning; but when it is grown inveterate, and invades the Bowels, it becomes incurable; as well as when it is the Epidemical Disease of [Page 134]the Country, or the Persons afflicted with it, are old, or well advanc'd in Years.

In undertaking the Cure, it is requisite to be­gin with a good Diet, and to sweeten the Blood, let the Patient take the Broth of boil'd Fowl; eating Pullets and Eggs; in the Broth may also be put divers sorts of Antiscorbutick Herbs; viz. Cresses, Spinage, Parsly-Roots, Sparagus, Smallage, Scorzonera, Scurvy-Grass, &c. Let him eat nothing that is high season'd, nor acid or sharp; let him drink pure Claret, without any adulterate Mixture; let him use moderate Exercise and Rest; Lastly, let him keep his Mind sedate, and free from all manner of vio­lent Passion.

The following Remedies taken inwardly are very good for the Scurvy, viz. the Tincture of Flints from ten Grains to thirty; Diaphoretick Antimony, from six Grains to thirty; sweet Sub­limate, from six Grains to thirty; Mars Dia­phoreteus, from ten Grains to twenty; Crocus Martis Aperitivus, from ten Grains to two Scru­ples; prepar'd Coral, from ten Grains to one Dram; Volatile Spirit of Sal Ammoniack, from six Drops to twenty; Water of Cresses, from fifteen Drops to one Dram; Spirit of Scurvy­grass, from ten Drops to one Dram; Tincture of Antimony, from four Drops to twenty; Oily Volatile Sal Ammoniack, from four Grains to fifteen; Spirit of Guyacum, from half a Dram to a Dram and a half; Vitrioliz'd Tartar, from ten Grains to thirty; the Volatile Salt of Tar­tar, Urine, Vipers, and Hart's-Horn, of each from six Grains to fifteen; the Spirit of Gum Ammoniack, from eight Drops to sixteen; White [Page 135] Mercury Precipitate, from four to ten Grains; Mercurial Panacaea, from six Grains to two Scru­ples. We shall shew the manner of compound­ing 'em in our Treatise of Venereal Diseases.

It is also expedient to give Emollient and De­tersive Clysters to the Patient at Night going to bed, his Body being always kept open with convenient Diet-drinks: Afterward let him take gentle Sudorificks, such as are made of the De­coctions of Fumitory, wild Cicory, Dandelion, Hart's-Tongue, Scabious, the lesser House-Leek, Germander, Borage, Scorzonera-Root, and Poly­pody, with Flowers of Broom, Elder, and Ma­ry gold.

These are stronger for cold Constitutions, viz. Decoctions of Scurvy-Grass, Lepidium, Arse-smart, the lesser Celandine, Wormwood, little House-Leek, Trifolium Febrinum, Angelico, Ju­niper-Berries, &c.

Convenient Decoctions to wash the Mouth may be made with Sage, Rosemary, Hyssop, Oak-Leaves, Scurvy-Grass, Cresses, Tobacco, Roots of Bistort, Aristolochy or Birth-Wort, Tormen­til, Flower-de-Luce, Balaustia or Pomegranate-Flowers, Red Roses, &c.

To corroborate the Gums, Gargarisms are made of Anti-Scorbutick Plants; as of Spirit of Scurvy-Grass two Drams, one Scruple of Spirit of Vitriol, one Scruple of common Salt, four Ounces of Rose-Water and Plantane-Wa­ter. But if the Gums are putrefy'd, they are to be rubb'd with Honey of Roses, and some Drops of Spirit of Salt.

To asswage the Pains of the Members, Bath­ings and Fomentations are to be us'd; and a [Page 136]Decoction of Saxifrage taken inwardly, with some Grains of Laudanum is good for that Pur­pose.

To allay the Gripes, Clysters may be given with Whey, Sugar, Yolks of Eggs, Syrrop of Poppies, and Oils of Earth-Worms, Scurvy-Grass, Camomile, &c.

Against the Scorbutick Dropsy, take the Es­sence of Trifolium Febrinum and Elicampane, from twenty four Drops to thirty, and continue the use thereof.

Milk taken inwardly hinders Vomitting; and a Broth or Gelly of Crabs sweetens the Blood. The Looseness may be stopt with the Essence of Wormwood, and Spirit of Mastick; as also the Fever with Febrifuges and Anti-scorbuticks.

The Spots may be fomented with Decoctions of Aromatick and Anti-Scorbutick Herbs and Ni­tre. For the Ulcers of the Legs, pulverize an e­qual quantity of Saccharum Saturni, Crocus Martis, Myrrh, and Mercurius Dulcis, and lay it upon the Bolsters that are to be apply'd to the Sores.

To mollifie the sharpness of Acid Humours, this is a good Remedy: Prepare half an Ounce of Spirit of Scurvy-Grass, two Drams of tarta­riz'd Spirit Ammoniack, a Dram of the Tin­cture of Worms. Take thrice a Day fifteen or twenty Drops of this Liquor, in a Decoction of the Tops of Firr.

Against the Tubercles, take two Handfuls of the Flowers of Camomile and Elder, three Drams of Briony-Root, and an Handful of White-Bread Crum; Boil the whole Compositi­on in Milk, and make Cataplasms thereof.

To mitigate the Pains in the Head, take twenty or thirty five Drops of the Tincture of Amber, in Anti-scorbutick Spirits or Waters.

The difficulty of Respiration may be re­mov'd by a Medicinal Composition made of two Drams of an Anti-scorbutick Water, two Drams of the Essence of Elicampane, and half a Dram of the Spirit of Gum Ammoniack; take three or four Spoonfuls thereof several times in a Day.

To prevent the putrefaction of the Gums, take one Dram of the Tincture of Gum Lacca, three Drams of the Spirit of Scurvy-Grass, with fifteen or twenty Drops of Oil of Tartar made per De­liquium, and rub the Gums with this Composi­tion many times in a Day. Brandy in which Camphire is infus'd, or Spirit of Wine, is like­wise a most excellent Remedy; as also all Loti­ons or Washes made with the Waters or De­coctions of Anti-scorbutick Plants.

For Leanness, Goat's-Milk with the Spirit of Scurvy-Grass may be us'd, and other Waters drawn from Anti-scorbutick Plants. The Apo­zemes or Decoctions of Endive, Cicory, Sorrel, Becabunga, and Snail-Water, are in like manner very good for the same purpose.

Ointment of Styrax is frequently us'd in the Hospital call'd Hôtel-Dieu at Paris, and apply'd to Spots and callous Swellings that arise in the Legs.

A TREATISE OF Wounds, Ulcers, and Sutures.

CHAP. I. Of Sutures.

SUTURES or Stitches are made only in recent, and as yet bleeding Wounds, when they cannot be re-united by Bandage, as are the transverse; provided there be no Contusion, nor loss of Substance, nor great Hae­morrhages, as also that the Wounds were not made by the biting of venomous Beasts, that there be no violent Inflammations, and that the Bones are not laid open; because generally 'tis necessary to cause 'em to be exfoliated; nei­ther is this Operation to be perform'd in the Breast, by reason of its Motion.

The Instruments proper for the making of Stitches, are streight and crooked Needles, [Page 139]with waxed Thread; and these Sutures are of four sorts, viz. first the Intermittent Stitch for transverse Wounds; the second for the Hare-Lip; the third, commonly call'd the Dry Stitch, for superficial Wounds; and the fourth, term'd the Glover's Stitch.

The Intermittent Stitch is that which is made at certain separated Points, 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 [Page 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.

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.

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.

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 C [...]ol cothar, two Drams of Crocus Martis Astringens; beat the wh [...]e 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 Worm­eaten 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 porential 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 [Page 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 [...]en 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, persorms 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 Convulsin 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 [Page 145]Decoction of Wormweod 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 Baellium, 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.

How are Excrescences to be taken away?

They may be consum'd with Powder of Al­lom, Ʋnguentum 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 Hmp-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 [Page 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.

Take half an Ounce of Aloes and Myrth 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 Ʋnguentum Bas [...] ­con, and let the whole Mass be mingled together.

In fine, the whole Mystery consists in well clear­sing the Wounds with a Linnen Cloth, or with the Injections of the Tinctures of Myrrh and Aloes; or with simple Decoctions of Wormwood, Sc [...] ­dium 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 to­ken 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 Deco [...]ion [...] 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.

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 [Page 150]fall of the Splint, and to keep the Wound open; as in [...]he 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 tw [...] 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.

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 [Page 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 piered, 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-mention'd 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, for 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.

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 on 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 [Page 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 dilatation 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 [...] they were not made with Cross-Bar-Shot, or Quarter-Pieces.

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 Di­lacerations [Page 156]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 shatter'd, 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 ha [...]h 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 [Page 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.

If the Wound be in the Nerves, Tendons, or other Nervous Parts, it is requisite to use spi­rituous and drying Medicines, never applying any Ointments, which will not fail to cause Putrefaction in those Parts: But a Cataplasm may be made with Barley-Meal, Orobus, I u­pins and Lentils boil'd in Claret, adding some Oil of St. John's-Wort.

The Balsam of Peru, Oil of Turpentine de­still'd, Oil of Wax, destill'd Oil of Lavender, Oleum Phil [...]sophorum, Oil of Bays destill'd, Balsam of St. John's-Wort, Spirit of Wine, and Gum Elemi, are excelient Medicaments for the Nerves: Or else,

Take four Ounces of Ʋnguentum Althaeae with a Dram and a half of destill'd Bays; mingle the whole Composition, and apply it: Or else,

Take an Ounce of destill'd Oil of Turpen­tine, a Dram of Spirit of Wine, and half an Ounce of Camphire; let all be intermixt, and dropt into the Wound: Or else,

Take a Scruple of Euphorbium, half an Ounce of Colophonia, and a little Wax; let 'em be mingl'd together, and apply'd very hot to the Nervous Parts.

If the Wounds are deep, Injections may be made with this Vulnerary Water, which is ve­ry good for all sorts of Contusions, as also for the Gangrene and U [...]cers.

Take the lesser Sage, the greater Comfrey, and Mugwort, of each four Handfuls; Plantane, Tobacco, Meadowsweet, Betony, Agrimony, Vervein, St. John's-Wort, and Wormwood, of each three Handfuls; Fennel, Pilewort Bugle, Sanicle, Mouse-Ear, the lesser Dazy, the lesser Centory, and All-heal, of each three Handfuls; three Ounces of round Birth-Wort, and two Ounces of long: Let the whole Composition be digested during thirty Hours, in two Gallons of good White-Wine, and afterward destill'd in Balneo Mariae, till one third part be con­sum'd.

If a Gangrene happens in the Part, Spirit of Mother-Wort may be put into it, which is compounded with two Drams of Mastick, Myrrh, Olibanum, and Amber, and a Quart of recti­fy'd Wine, the whole being destill'd.

This Fomentation may be apply'd very hot to very good purpose, viz. an equal quantity of Camphirated Wine and Lime-Water, with three Drams of Camphire.

This is also an excellent Cataplasm: Take a Pint of Lye, and as much Spirit of Wine, half an Handful of Rue, Sage; Scordium, and Wormwood, a Dram of each of the Roots of both sorts of Birth-Wort, and two Drams of [Page 159] Sal Ammoniack. Let the whole Composition be boil'd till a third Part be consum'd; adding half a Dram of Myrrh and Aloes, and a little Brandy.

Of a Burn made by Gun-Powder.

If the Burn be recent, and the Skin not ex­ulcerated, Spirit of Wine or Brandy is to be immediately apply'd; or else an Ointment may be made with Oil of Olives, or bitter Almonds, Salt, the Juice of Onions, and Ver­juice.

If the Skin be ulcerated, and little Bladders or Pustules arise, an Ointment may be com­pounded with the second Bark of Elder boil'd in Oil of Olives. After it hath been strain'd, add two parts of Ceruse or White-Lead, and one of Burnt Lead, with as much Litharge, stirr'd about in a Leaden-Mortar, to make a Liniment. But it is not convenient to take out the Grains of Powder that remain in the Skin, because they are apt to break, and to be more confounded or spread abroad; so that they must be left to come forth in the Suppu­ration.

When the Wound is supersicial, and the Skin as yet whole, peel'd Onions with common Ho­ney are an excellent Remedy; but if the Skin be torn, it is not to be us'd, by reason that the Pain wou'd be too great; in which case Oil of Tartar per diliquium hath a very good ef­fect.

If the Burn be accompany'd with a Fever, it may be allay'd with fixt Nitre, Nitre pre­par'd [Page 160]with Antimony, and Gun-Powder taken inwardly, which are very effectual in their Operation. Crab's-Eyes prepar'd, and even some of 'em unprepar'd, are in like manner admirable Remedies.

As for external Medicaments, when the Burn is only superficial, take Onions and unslack'd Lime, quench'd in a Decoction of Rapes, and apply this Liquor very hot, with double Bol­sters dipt therein. Or else take what quan­tity you please of quick Lime well wash'd, and pound it throughtly in a Leaden-Mortar, with May-Butter without Salt, to make an Ointment, which may be be laid altogether liquid upon the affected Part: Or else,

Take as much quick Lime as you can get up between your Fingers at two several times; Milk-Cream and clarify'd Honey, of each about half the like quantity; let the whole be inter­mix'd to the Consistence of an Ointment, and apply'd: It is an approv'd Remedy; as also is the following;

Take unslack'd Lime, and put it into com­mon Water, so as the Water may appear four or five Finger's breadth above it. After the Ef­fervescence, pour in Oil of Roses; whereupon the whole Mass will be coagulated in form of Butter, and may be apply'd.

A good Lotion or Washing-Liquor may be prepar'd with the Juice of Garlick and Onions, in recent Burns; otherwise make use of this Ointment. Take an Ounce and an half of raw Onions, Salt, and Venice Soap, of each half an Ounce; mingle the whole Compositi­on in a Mortar, pouring upon it a sufficient [Page 161]quantity of Oil of Roses, to make a very good Ointment: Or else.

Dissolve Minium or Litharge in Venegar, filtrate this Liquor, and add thereto a quantity of Rape-Oil newly drawn off, sufficient to give it the Consistence of a liquid Liniment; then stir it about in a Leaden-Mortar till it be­come of a grey Colour, and keep it for Use as an excellent Liniment: Or else,

Pound Crey-Fishes or Crabs alive in a Mor­tar to get their Blood, and foment the Part with it hot; it is a good Remedy: Otherwise intermix the pounded Crabs with May-Butter without Salt, and let 'em be boil'd up toge­ther, and scumm'd, till a red Ointment be made, which may be drawn off, or strain'd for Use. And indeed, all manner of Ointments and o­ther Medicinal Compositions wherein Crabs are an Ingredient, are true specificks against Burns made by Gun-Powder.

The Mucilages of the Seeds of Psyllium, or rather those of Quince-Seeds prepar'd with Frog's Sperm, and a little Saccharum Saturni, spread with a Feather upon the affected Part, have a wonderful Operation in Burns.

A Medicament compounded with one third part of the Oil of Olives, and two of the Whites of Eggs well beaten and mixt together, is a very simple and singular Remedy. Other­wise take half an Ounce of Line-seed-Oil in­fus'd in Rose-Water, with four Yolks of Eggs; beat 'em together, and let the whole be ap­ply'd to the burnt Part.

If the Burn be very violent, and hath many Pustules, Etmullerus is of Opinion that they [Page 162]ought to be open'd, and that an Ointment shou'd be apply'd, which is made of Hen's-Dung boil'd in fresh Butter: Other­wise,

Take a handful of fresh Sage-Leaves, two handfuls of Plantane, six Ounces of fresh But­ter without Salt, three Ounces of Pullet's-Dung newly voided, and the whitest that can be found; then fry the whole Composition for a quarter of an Hour; squeeze it out, and keep it for use: Otherwise,

Take two Ounces of sweet Apples roasted under Embers, Barly-Meal, and Fenugreek, of each half an Ounce, and half a Scruple of Saffron; let the whole Mass be mingled to make a Liniment or soft Cataplasm, which may serve to asswage Pain, and mollifie the Skin.

If the Wound be yet larger, and hath a Scab, open all the Pustules, and endeavour the two first Days to cause the Escar to fall off by the Application of a Liniment made of the Mucilages of Quince-Seeds steept in Frog's-Sperm, with fresh Butter, the Oil of White Lillies, and the Yolk of an Egg: Otherwise,

Make a Liniment with fresh Butter well beaten in a Leaden-Mortar, with a Decocti­on of Mallows, which being spread upon hot Colewort-Leaves, and apply'd to the Escar, it will fall off.

But if the Escar be too hard and obstinate, it is requisite to proceed to Incisions to make way for the Sanies, lest a deep and putrid Ulcer shou'd be engender'd Underneath. As soon as the Humour is evacuated, the above-mention'd [Page 163]Emollient Medicines may be us'd, till the se­paration of the Escar; then the Ulcer may be consolidated with Digestives and Mundifica­tives; such as the Ointment of quick Lime with Oil of Roses, and the Yolks of Eggs. The white camphirated Ointments, and that of Alabaster, are also good for the same Pur­pose.

If a Gangrene ensueth, Sudorificks must be taken inwardly; such are camphirated Spirit of Treacle, the Essence and Spirit of Elder-Berries, the Spirit of Hart's-Horn with its own proper Salt, Treacle impregnated with the Spi­rit of camphirated Wine, Scorpion-Water, Hart's-Horn, Citron with Camphire, &c.

As for external Remedies in the beginning of the Gangrene, the Spirit of Wine apply'd hot is excellent; and yet better if Aloes, Frankin­cense, and Myrrh be intermixt therein. It ought also to be observ'd, that Camphire must always be mingled in the topical Medicines for the Cure of the Gangrene.

A Decoction of unslack'd Lime, in which Brimstone hath been boil'd, with Mercurius Dul­cis, and the Spirit of Wine, is a very efficacious Remedy.

In a considerable Gangrene, after having made deep Scarifications, let Horse-Dung be boil'd in Wine, and laid upon the Part in form of a Cataplasm. This is an approved Remedy.

If a Sphacelus be begun, scarifie the Part, and apply thereto abundance of Ʋnguentum Ae­gyptiacum over and above the Ointments and Cataplasms already describ'd; remembring al­ways [Page 164]that when the Gangrene degenerates in­to a Sphacelus, all the mortify'd Parts must be incontinently separated or cut off from the sound.

CHAP. VII. Of Ʋlcers in general.

WHAT is an Ʋlcer?

An Ulcer is a Rupture of the Natural Union of the Parts made a long while ago, which is maintain'd by the Sanies that runs out of its Cavity; or an Ulcer takes its Rise from a Wound that cou'd not be well cur'd in its proper time, by reason of the ill quality of its Pus or corrupt Matter.

What difference is there between a Wound and [...] Ʋlcer?

It is this, that a Wound always proceeds from an external Cause, and an Ulcer from an in­ternal, such as Humours that fall upon a Part; or else a Wound in growing inveterate degene­rates into an Ulcer

Whence is the difference of Ʋlcers deriv'd?

It is taken from the Causes that produce 'em, and the Symptoms or Accidents with which they are accompany'd. Thus upon Account of their Causes they are call'd Ben [...]gn or Malig­nant, Great, Little, Dangerous, or Mortal; and by reason of their Accidents, they are term'd Putrid, Corrosive, Cavernous, Fistulous, Can­cerous, &c.

Do Ʋlcers always proceed from external Causes, or from an outward Wound degenerated?

No they sometimes also derive their Origine from internal Causes, as the Acrimony of Hu­mours, or their Malignant Quality; the Reten­tion of a Splint of a Bone, and other things of the like Nature. These Ulcers are commonly call'd Primitive, and the others Degenerate.

What are Putrid, Corrosive, Cavernous, Fistu­lous and Cancerous Ʋlcers?

The Putrid Ulcer is that wherein the Flesh is soft and scabby, the Pus and Ichor being vis­cous, stinking, and of a cadaverous smell.

The Corrosive Ulcer is that which by the Acrimony and Malignity of its Sanies, cor­rodes, makes hollow, corrupts and mortifies the Flesh.

The Cavernous Ulcer is that the Entrance of which is streight and the bottom broad, where­in there are many Holes fill'd with malignant Sanies, without any callosity or hardness in its sides.

The Fistulous Ulcer is that which hath long, streight, and deep Holes, with much hardness in its sides; the Sanies whereof is sometimes vi­rulent, and sometimes not.

The Cancerous Ulcer is large, having its Lips bloated, hard, and knotty, of a brown Colour, with thick Veins round about, full of a livid and blackish sort of Blood. In the bottom a [...] divers round Cavities, which stink extremely, by reason of the ill Quality of the Sanies that runs out from thence.

Are there no other kinds of Ʋleers?

Yes, there are also Verminous, Chironian, Telephian, Pocky, Scorbutick, and others, which have much affinity with, and may well be reckon'd among the five Kinds already spe­cify'd.

What are the means to be us'd in the curing of Ʋcers?

Ulcers ought to be well mundify'd, dry'd and cicatriz'd; but with respect to the several Causes and Accidents that render 'em obstinate, and difficult to be cur'd, it is also requisite to make use of internal Medicines, which may re­strain and consume 'em. If their sides grow cal­lous, they are to be scarify'd, in order to bring 'em to Suppuration; and if there be any Ex­crescences, they must be eaten away with cor­roding Powders, such as that of Allom; or by the Infernal Cautery.

What are the Remedies proper to cleanse and dry up Ʋlcers?

To this Purpose divers sorts of Liquors may be us'd, as also Powders and Plaisters: The Liquors are usually made of Briony-Roots, the greater Celandine, Lime, and Yellow Water; a Tincture of Myrrh, Aloes and Saffron, and Whey, whereto is added Saccharum Saturni; so that the Ulcers may be wash'd or bath'd with these Liquors; and very good Injections may be compounded of 'em.

The Powders are those of Worm-eaten-Oak, Allom, and Cinoper, the last of these being us'd by burning it, to cause the Fume to be convey'd to the Ulcer thro' a Funnel. The Country People often make use of Potter's-Earth to dry up their Ulcers, with good Suc­cess; [Page 167]but then they must not be of a Malig­nant Nature.

The Plaisters are Emplastrum de Betonica, Dia­sulphuris, Dessiccativum Rubrum, and others; and the Ointments are such as these;

Take three Yolks of Eggs, half an Ounce of Honey, and a Glass of Wine, and make there­of a mundifying Ointment, according to Art: Otherwise.

Take Lime well wash'd and dry'd se­veral times, let it be mingled with the Oil of Line and Bolus, and it will make an excel­lent Ointment to mundifie and dry; a little Mercury Precipitate may be intermixt (if you please) to augment the drying Quality; and Mercurius Dulcis may be added in the Injections.

For Ulcers in the Legs, and Cancerous Ul­cers, take Plantain-Water and Allom-Water, or else Spirit of Wine, Ʋnguentum Aegyptiacum, and Treacle; or else an Extract of the Roots of round Birth-Wort made in the Spirit of Wine. Gun-Powder alone dissolv'd in Wine, is of singular Use to wash the Ulcers, and after­wards to wet the Pledgets which are to be apply'd to 'em. But here are two particu­lar and specifick Medicines to mollifie a Can­cer.

Take Saccharum Saturni, Camphire, and Soot; let 'em be incorporated with the Juice of House-Leek and Plantain, in a Leaden-Mor­tar; then make a Liniment thereof, and cover the Part affected as lightly as is possible to be done, as with a simple Canvass-Cloth, or a Sheet of Cap-Paper: Or else,

Take the destill'd Water of rotten Apples, and mingle it with the Extract of the Roots of round Birth-Wort made in Spirit of Wine; reserving this Liquor to wash the Part, and to make Injections.

CHAP. VIII. Of Venereal Diseases.

Of the Chaude-pisse or Gonorrhaea.

THE Signs of this Disease are a painful Distention of the Penis or Yard, and a scal­ding Pain in making Water, the Urine being pale, whitish, and full of Filaments or little Threads: Sometimes the Testicles are swell'd as well as the Glans and Praeputium; and some­times there is a Flux of a kind of Matter yel­lowish, Greenish, &c.

If there be a great Inflammation in the Yard, endeavours must be us'd to allay it by letting Blood; and afterward the Patient may take a cooling and diuretick Diet-Drink, as also Emul­sions made with cold Seeds in Whey. A very good Decoction may be prepar'd in all places, and without any trouble, by putting a Dram of Sal Prun [...]ll [...] into every Quart of Water, where­of the Patient is to drink as often as he can: This Decoction is very cooling and diuretick; and the use of it ought to be continu'd till the Inflammation be asswag'd. Then some gentle [Page 169]Purges are to be prescrib'd in the beginning; such as an Ounce of Cassia, and as much Man­na, infus'd in two Glasses of Whey, which are to be taken one or two Hours one after ano­ther.

Afterward the Patient must be often purg'd with twelve Grains of Scammony, and fifteen Grains of Mercurius Dulcis; and these Purgati­ons must be continu'd, till it appears that the Fluxes are neither yellowish nor greenish, nor of any other bad Colour. When they are become White, and grown Thready, they may be stopt with Astringents: Amber and dry'd Bones beat­en to Powder, eighteen Grains of each, with one Grain of Laudanum, the whole Compositi­on being taken in Conserve of Roses, are ve­ry good for this Purpose. Crocus Martis Astrin­gens, or else its Extract, taken from half a Dram to a whole Dram, in like manner per­forms the same Operation. As soon as the Gonorrhaea is stopt, to be certain of a perfect Cure, a Dram of the Mercurial Panacaea is to be taken, from fifteen to twenty Grains at a time, in Conserve of Roses. In the mean while, if a small Salivation shou'd happen, it must be let alone for the present, since it may be stopt at pleasure by the Purgations. When it is re­quisite to restrain the Gonorrhaea, Mercury must not be given any longer, in regard that it is a Dissolvent, which is only good when the Glan­dules of the Groin or Testicles are swell'd, or else when it is expedient to set the Chaude­pisse a running, after it hath been too sud­denly stopt. At the same time that the Astrin­gents are taken with the Mouth, Injecti­ons [Page 170]also are to be made into the Yard; such as are prepar'd with Lapis Medicamentosus, of which one Dram is put into eight Ounces of Plan­tane-Water. All Astringents that are not Causticks, are proper for the Syringe.

Of Shankers.

They are round Ulcers, and hollow in the middle, which appear upon the Glans and the Praeputium. To cure 'em, they must be touch'd with the Lapis Infernalis, and brought to Sup­puration by the means of red Precipitate mixt with the Ointment of Andreas Crucius. Oleum Mercurii laid on a Pledget or Bolster, is very efficacious to open Skankers, and consume their Flesh. The Patient must be well purg'd with Mercurius Dulcis and Scammony, taking twelve or fifteen Grains of each in Conserve of Roses; and after these Purgations are sufficiently re­iterated, he may take the Mercurial Pana­caea's. It is an excellent Remedy for all sorts of Pocky Distempers not yet consummated, or arriv'd at the greatest height of Malig­nity.

Of Bubo 's.

Bubo's are gross Tumours or Abcesses that a­rise in the Groin, the perfect Maturity of which is not to be waited for in order to open 'em; because it is to be fear'd lest the corrupt Mat­ter remaining therein too long, might be con­vey'd into the Blood by the Circulation, and so produce the grand Pox: Therefore it is necessa­ry [Page 171]to open 'em betimes with a Lancet, or else with a Train of potential Cauteries, if they are too hard. They ought to be Suppu­rated for a considerable time: The Patient must be well purg'd with Scammony and Mercurius Dulcis: He must also take the Mercurial Pa­nacaea's.

Of the Pox.

This loathsome Disease begins sometimes with a virulent Gonorrhaea, and a weariness or faintness at the same time seizeth on all the Members of the Body: It is usually accompany'd with Salivation and the Head-ach, which grows more violent at Night: Pricking Pains are also felt in the Arms and Legs, the Palate of the Mouth being sometimes ulcerated. If it be an inveterate Pox, the Bones are corrupted, and Exostoses happen therein; divers Spots with dry, round and red Pustules appear in the Skin; and the Cartilages or Gristles of the Nose are sometimes eaten up. But when this Disease is come to its greatest height of Malignity, the Hair falls off; the Gums are ulcerated; the Teeth are loose, and drop out; the whole Bo­dy is dry'd up; the Eyes are livid; the Ears tingle; the Nose becomes stinking; the Al­monds of the Ears swell; the Ʋvula or Pa­late is down; Ulcers break out in the Privy-Parts; Bubo's arise in the Groin; as also Warts in the Glans and Praeputium; and Condyloma's in the Anus,

Indeed the Pox may be easily cur'd in the beginning; but when it hath taken deep Root [Page 172]by a long Continuance, it is not extirpated with­out much difficulty, more especially if it be ac­company'd with Ulcers, Caries, and Exostoses; the Person afflicted with it being of an ill Con­stitution, and his Voice grown hoarse.

The Spring and Summer are the proper Sea­sons of the Year for undertaking the Cure of this Disease: In order to which, it is necessary that the Patient begin with a regular Diet, lodging in a warm place, and taking such Ali­ments as yield a good Juice; as Jelly-broath made with boil'd Fowl: Let him drink Sudo­rifick Decoctions, prepar'd with the Wood of Guayacum, China-Root, and Sarsaparella, and let him abstain from eating any thing that is high sea­son'd: Let him take Clysters to keep his Body open; sometimes also he may be let Blood, and purg'd with half a Dram of Jalap, and fifteen Grains of Mercurius Dulcis. The Purgations may be re-iterated as often as it shall be judg'd convenient; and then the Patient may be bath'd for nine or ten Days, every Morning and E­vening; during which time he may take vo­latile Salt of Vipers, the Dose being from six to sixteen Grains; or else Viper's-Grease from half a Dram to a whole Dram in Conserve of Roses.

Afterward it will be necessary to proceed to Fluxing, which is caus'd by the means of Fri­ctions with Ʋuguentum Mercurii, which is made of crude Mercury stirr'd about in a Mortar with Turpentine, and then the whole mingled with Hog's-Grease, one part of Mercury being usually put into two parts of Hog's-Grease. The Rubbing is begun at the Sole of the Feet, [Page 173]ascending to the Legs, and the inside of the Thighs; but the Back-Bone must not be rubb'd at all; When the Persons are tender, or of a weak Constitution, a single Friction may be sometimes sufficient. Thus the Patient must be rubb'd at the Fire, after he hath taken a good Mess of Broath; but I would not advise it to be done with more than one or two Drams of Mercury at a time, without reckoning the Grease. Then the Patient must be dress'd with a Pair of Linnen-Drawers or Pantaloons, and laid in his Bed, where his Mouth may be lookt into from time to time, to see whether the Mercury hath taken effect; which may be easily known, by reason that his Tongue, Gums, and Palate swell and grow thick, his Head akes, his Breath is strong, his Face red, and he can scarce swallow his Spittle; or else he begins to Salivate.

If none of these Signs appear, the Rubbing must be begun again in the Morning and E­vening; then if no Salivation be perceiv'd, for sometimes four or five Frictions are made suc­cessively, a little Mercurial Panacaea may be ta­ken inwardly, to promote it, During the Fri­ctions, the Patient is to be nourish'd with Eggs, Broaths, and Gellies; he must also keep his Bed in a warm Room, and never rise till it shall be thought fit to stop the Salivation, which continues twenty or twenty five Days; or ra­ther till it becomes Laudable; that is to say, till it be no longer stinking, nor colour'd, but clear and fluid.

If a Looseness shou'd happen during the Sa­livation, it wou'd cease, so that to renew it, [Page 174]the Looseness may be stay'd with Clysters made of Milk and the Yolks of Eggs; and in case the Salivation shou'd not begin afresh, it must be excited with a slight Friction: But if it shoul'd be too violent, it may be diminish'd by some gentle Purge, or with four or five Grains of Aurum Fulminans, taken in Conserve of Roses.

Three or four Pints of Rheum are com­monly salivated every Day in a Bason made for that purpose, which the Pati­ent holds in his Bed near his Mouth, so as the Spittle may run into it. But if the Fluxing shou'd not cease of it self at the time when it ought, he must be purg'd to put a stop thereto. If any Ulcers remain in his Mouth, to dry 'em up, Gargarisms are to be often us'd, which are made of Barley-Water, Honey of Roses, or luke-warm Wine.

The Warts are cur'd by binding 'em, if a Ligature be possible, or else they may be con­sum'd with Causticks, such as the Powder of Savine, or Aqua-fortis, by corroding the neigh­bouring Parts; sometimes they are cut, left to bleed for a while, and bath'd with warm Wine.

When the Patient begins to rise, he must be purg'd, his Linnen, Bed, and Chamber being chang'd; and afterward his Strength is to be re­cruited with good Victuals, and generous Wine. If he were too much weaken'd, let him take Cow's-Milk with Saccharum Rosatum.

If the Pox were not inveterate, the Fluxing might be excited by the Panacaea alone, with­out any Frictions: For after the Phlebotomy, [Page 175]Purgations, and Bathings duly administer'd, the Patient might take ten Grains of the Mercu­rial Panacaea in the Morning, and as many at Night; on the next Day fifteen Grains might be given, and the like quantity at Night; on the third Day twenty Grains might be given both Morning and Evening; on the fourth Day twenty five Grains in the Morning, and as many at Night; and on the fifth Day thir­ty Grains in the Morning, and the very same quantity in the Evening; continuing thus to aug­ment the Dose, till the Fluxing comes in abun­dance; and it may be maintain'd by giving every two or every three Days twelve Grains of the Panacaea. This Course must be continu­ally follow'd till the Salivation becomes Lau­dable, and the Symptoms cease.

The manner of making the Mercurial Panacaea.

To prepare this Panacaea, it is requisite to take Mercury reviv'd from Cinnabar, because it is more pure than Mercury which is immedi­ately dug out of the Mine. The Mercury is reviv'd with Cinnabar, after this manner: Take a Pound of artificial Cinnabar pulveriz'd, and mighled exactly with three Pounds of un­slack'd Lime, in like manner beaten to Powder: Let this Mixture be put into a Retort of Stone, or Glass luted, the third part of which at least remains empty; Let it be plac'd in a reverbera­ting Furnace; and after having fitted a Recipi­ent fill'd with Water, let the whole be left during twenty four Hours at least; then let the Fire be [Page 176]put under it by degrees, and at length let the Heat be very much augmented, whereupon the Mercury will run Drop by Drop into the Recipi­ent: Let the Fire be continu'd till nothing comes forth, and the Operation will be perform'd gene­rally in six or seven Hours: Then pour the Wa­ter out of the Recipient, and having wash'd the Mercury, to cleanse it from some small quantity of Earth that may stick thereto, let it be dry'd with Cloaths, or else with the Crum of Bread: Thus thirteen Ounces of Mer­cury may be drawn off from every Pound of artificial Cinnabar.

The Panacaea is made of sweet Sublimate, and the later of corrosive Sublimate: To make the corrosive Sublimate, put sixteen Ounces of Mercury reviv'd from Cinnabar, into a Matrass, pour upon it eighteen Ounces of Spirit of Nitre; place the Matras upon the Sand, which must be somewhat hot, and leave it there till the Disso­lution be effected: Then pour off this dissol­ [...]ed Liquor, which will be as clear as Water; into a Glass Vial, or into a S [...]one-Jug, and let its Moisture evaporate gently over the Sand-Fire, till a white Mass remains; which you may pulverize in a Glass Mortar, mingling it with sixteen Ounces of Vitriol calcin'd, and as much decrepited Salt: Put this Mixture into a Matras, two third parts of which remain empty, and the Neck of which hath been cut in the middle of its height; then fix the Matras in the Sand, and begin to kindle a gentle Fire under­neath, which may be continu'd for three Hours; afterwards let Coals be thrown upon it till the Fire burn very vehemently, and a Sublimate [Page 177]will arise on the top of the Matras; so that the Operation may be perform'd within the space of six or seven Hours. Let the Matras be cool'd, and afterward broken; avoiding a kind of Flower or light Powder, which flyes up into the Air as soon as this Matter is re­mov'd; whereupon you'll find nineteen Oun­ces of very good corrosive Sublimate; but the red Scoria or Dross which settleth at the bot­tom must be cast away as unprofitable. This Sublimate being a powerful Escaro­tick, eats away proud Flesh, and is of singular use in cleansing old Ulcers. if half a Dram thereof be dissolv'd in a Pint of Lime-Water, it gives a yellow Tincture; and this is that which is call'd the Phagae­donick-Water.

The sweet Sublimate, of which the Pana­caea is immediately compos'd, is made with sixteen Ounces of corrosive Sublimate, pulve­riz'd in a Marble or Glass-Mortar, intermix­ing with it by little and little, twelve Oun­ces of Mercury reviv'd from Cinnabar: Let this Mixture be stirr'd about with a Wooden Pestle, till the Quick-silver become imper­ceptible; then put the Powder, which will be of a grey Colour, into divers Glass-Vials, or into a Matras, of which two third parts re­main empty; place your Vessel on the Sand, and kindle a small Fire in the beginning, the Heat of which may be afterward encreas'd to the third Degree: Let it continue in this Condition till the Sublimate be made; and the Operation will be generally consummated [Page 178]in four or five Hours: whereupon you may break your Vial, and throw away as use­less, a little light Earth that lies at the bot­tom. You must also separate that which sticks to the Neck of the Vials, or of the Ma­tras, and keep it for Ointments against the Itch; but carefully gather together the white Matter which lies in the middle, and having pulveriz'd it, cause it to be sublimated in the Vials or Matras, as before. This Mat­ter must also be separated again (as we have already shown) and put into other Vials to be sublimated a third time. Lastly, the ter­restrial parts in the bottom, and the fuligi­nous in the Neck of the Vials, must be, in like manner, separated, still preserving the Sublimate in the middle, which will then be very well dulcify'd, and amount to the quan­tity of twenty five Ounces and an half: It is an Efficacious Remedy for all sorts of Venereal Diseases; removes Obstructions, kills Worms, and purgeth gently by stool, being taken in Pills from six Grains to thirty.

Of the proper Composition of the Mer­curial Panacaea.

Take what quantity you please of sweet Sublimate, reduce it to Powder in a Mar­ble or Glass-Mortar, and put it into a Ma­tras, three quarters whereof remain empty, and of which you have cut off the Neck in [Page 179]the middle of its Height: Then place this Matras in a Furnace or Balneum of Sand, and make a little Fire underneath for an Hour, to give a gentle Heat to the Matter, which may be augmented by little and little to the third degree: Let it continue in this state about five Hours, and the Matter will be sublimated within that space of time. Then let the Vessel cool, and break it, throwing a­way as unprofitable a little light sort of Earth, of a reddish Colour, which is found at the bot­tom, and separating all the Sublimate from the Glass. Afterward pulverize it a second time, and let it be sublimated in a Matras, as be­fore: Thus the Sublimations must be reitera­ted seven several times, changing the Ma­trasses every time, and casting away the light Earth. Then having reduc'd your Sublimate to a very sine impalpable Powder, by grinding it upon a Porphyry or Marble Stone, put it into a Glass Cucurbite or Gourd, pour into it alkaliz'd Spirit of Wine to the height of four Fingers; cover the Cucurbite with its Head, and leave the Matter in Infusion during fif­teen Days, stirring it about from time to time with an Ivory Spatula. Afterward set your Cucurbite in Balneo Mariae, or in a Va­porous Bath, make fit a Recipient to the Mouth of the Alembick; lute the Joints exactly with a moisten'd Bladder, and cause all the Spirit of Wine to be destill'd with a mode­rate Fire: Let the Vessels be cool'd, and un­luted, and the Panacaea will appear at the bottom of the Cucurbite. If it be not al­ready [Page 180]dry enough, you may dry it up with a gentle Fire in the Sand, stirring it with an Ivory or Wooden Spatula in the Cucurbite it self till it be reduc'd to Powder. It may be kept for use in a Glass-Vessel, as a Remedy of very great Efficacy for all sorts of Vene­nereal Diseases, as also for Obstructions, the Scurvy, Scrophula or King's-Evil, Tettar, Scab, Scurf, Worms, Ascarides, inveterate Ulcers, &c. The Dose is from six Grains to two Scruples, in Conserve of Roses.

A TREATISE OF THE DISEASES OF THE BONES.

CHAP. I. Of the Dislocation of the Bones.

WHAT are the Diseases incident to the Bones?

They are five in number, viz. Dislo­cation, Fracture, Caries or Ulcer, Exostosis, and Nodus.

What is a Dislocation or Luxation?

It is the starting of the Head of one Bone out of the Cavity of another, with an Inter­diction [Page 182]of the proper Motion of the Part: Or else it is the disjointing of two Bones united to­gether for the Motion of a Part.

How many causes are there of Dislocation in general?

Two, that is to say, one violent, and the o­ther gentle; thus the Dislocation is made vio­lently in Falls, Strains, Knocks, and Blows; but it is done gently and slowly in Deflucti­ons of Rheum; as also by an insensible gather­ing together of Humours between the Joints, and upon the Ligaments, the Relaxation or loosening of which gives occasion afterward to the Head of the Bone to go out of its place; whence this Consequence may well be drawn, viz. that a violent Dislocation usually depends upon an external Cause, and a gentle Dislocation upon an internal.

After how many manners doth a Dislocation happen?

Two several Ways; viz. the first is called compleat, total, and perfect; and the second in­compleat, partial, and imperfect: But both may happen before, behind, on the inside, and without; and may also be simple or com­plicated.

What are the signs of a perfect, total, and com­pleat Dislocation?

It is when a hard Tumour or Swelling is perceiv'd near a Hole in the place of the Joint, great pain being felt in the Part, and the Motion of it abolith'd.

What are the signs of an imperfect, partial, and incompleat Dislocation?

It is when the Motion is streighten'd, and weaker than ordinary, so that some Pain is felt in the Joynt, and a Deformity may be discern'd therein, by comparing the hurt Part with the opposite which is sound: This Dislo­cation is otherwise call'd a Sprain, when it pro­ceeds from an external Cause; or else it is termed a Relaxation, when it happens by an internal.

What is a simple, and what is a complicated Dislocation or Luxation?

The Dislocation is properly simple, when it hath no concomitant Accidents; and it is complicated when accompany'd with some ill Symptoms or Accidents, such as Swellings, In­flammations, Wounds, Fractures, &c.

What are the means proper to be us'd in a simple Dislocation?

A speedy and simple reducing thereof, which is perform'd by stretching out the dislocated or luxa­ted. Member, and thrusting back the Head of the Bone into its natural place. Afterward the Joynt must be strengthen'd with a Fomentation made with Provence Roses, the Leaves of Wormwood, Rosemary, Camomile, St. John's-Wort, and Oak-Moss boil'd in the Lees of Wine and Forge-Water, keeping the Part well bound up, and sustain'd in a convenient situa­tion. But if any ill Consequence is to be fear'd, apply Emplastrum Oxycroceum, or Diapalma dis­solv'd in Wine.

What is to be done in a complicated Disloca­tion?

The Accidents must be first remov'd, and then the Bone may be set, which is impossible to be done otherwise; it being dangerous even to make an Attempt before, by reason of the too great Violence with which it is effected, and which would infallibly produce a Convulsion or a Gangrene.

If the Dislocation be accompany'd with a Wound, must the Wound be cur'd before any Endeavours are us'd to reduce it?

No, but the Symptoms of the Wound, which hinder the Operation, must be taken away, as the Swelling, Inflammation, and others of the like Nature; and then it may be reduc'd, and the Wound may be dress'd according to the usu­al Method.

If the Dislocation be complicated with the Fra­cture, what is to be done then?

It is necessary to begin with reducing of the Dislocation, and afterward to perform that of the Fracture, by reason of the Extension which must be made to reduce the Dislocation, which would absolutely hinder the Setling of the Fracture.

How is the Inflammation and Swelling to be asswag'd?

With Linnen Cloaths dipt in Brandy and common Water, which must be often renew'd; or else with the Tops of Wormwood and Ca­momile, with Sage and Rosemary boil'd in the Lees of Wine, wherein the Bolsters and Bands are to be steep'd. But all Repereussives and A­stringents must be avoided.

How doth it appear that the Reduction is well perform'd?

By the Re-establishment of the Part in its na­tural State; by its being free from Pain; by its regular Motion; and by its conformity to the opposite Part which is sound.

What Dislocations of Parts are most difficult to be reduc'd?

They are those of the Thighs with the Huc­kle-Bones, which are almost never perfectly set; that of the first Vertebra's is extremely difficult to be reduc'd; and those of the Lower-Jaw and Soles of the Feet are mortal.

The reducing of Dislocations is perform'd with greate [...] facility in Infants than in Persons ad­vanc'd in Years; but it becomes most difficult when it is deferr'd for many Days, by reason of the overflowing of the Lympha and nutriti­ous Juice.

If an Inflammation shou'd happen before the Member is reduc'd, nothing can be done till it be allay'd, as we have already intimated; but to prevent and mitigate it, the dislocated Joynt, and the neighbouring Parts, may be bath'd with luke-warm Wine, in which hath been boil'd the Tops of St. John's-Wort, Camomile, Rosemary, Stoecas Arabica, and other Ingredients of the like Nature; the Bands must be also steept in the same Liquor.

If an Oedematous Tumour arise in the luxated Member after the Joint hath been set, it is re­quisite to take internal Sudorificks, and to apply Liniments made with the destill'd Oil of Tar­tar, and of Human Bones, which may be re­ctify'd with burnt Hart's Horn, or some other part of Animals, to take away its stink: Or else take yellow-Wax, and very white Rosin, [Page 186]melt the whole Mass, and put into it white Amber and Gum Elemi, a sufficient quantity of each to make a Composition to be incorpora­ted with Balsam of Peru; a Plaister of which may be prepar'd, and apply'd to the dislocated Member; but the Plaister must not be laid a cross, lest it shou'd contract the Part too much. The whole Member may be also a­nointed with Oil of St. John's-Wort, or with the destill'd Oil of Turpentine; or rather with a simple Decoction of Nervous Plants in Wine.

If the Bone be put out of its place by a co­agulated sort of Matter like Mortar or Plai­ster, Resolutives and Attenuants are to be us'd, such as the volatile Spirit of Tartar prepar'd with the Lees of Wine, volatile Spirit of Tartar destill'd with Nitre in a Retort with a long Neck, or Spirit of Tartar prepar'd by Fermentation with Tartar, and its proper Alkali: This last is the best of all, and the use thereof ought to be con­tinu'd. The volatile Salt of Human Bones is also very efficacious; but it is necessary to be­gin first with the taking of Laxative and Sudo­rifick Medicines, appropriated according to the respective Circumstances. The Spirit of Earth-Worms may be also apply'd outwardly, which is made by Fermentation, and may be often laid on the Part either alone, or with the Spirit of Sal Ammoniack.

If a dislocated Bone be not set in good time, a Coagulum or kind of curdled Substance is form'd in the Cavity, which hinders the redu­cing of it to its place; but this Coagulum may be dissolv'd with the following Medicament, before you attempt to set the Bone. Take one [Page 187]part of the destill'd Oil of Human Bones, two parts of foetid Oil of Tartar; mingle the whole, and add quick Lime to be destill'd in a Retort: Let the Parts be fomented with this Oil.

If the Dislocation happen'd by the Relaxa­tion of the Ligaments, recourse may be had to universal Sudorificks taken inwardly; as also to such Medicines as are full of an unctuous and volatile Salt, particularly Aromatick Oils, and Spirit of Sal Ammoniack. In the mean while A­romaticks, Resolutives, and moderate Astrin­gents may be apply'd outwardly.

CHAP II. Of the Fractures of Bones.

WHAT is the Fracture of a Bone?

It is the Division of the Continuity of its Parts.

After how many different manners may a Bone be broken?

Three several ways, viz. cross-wise, side-wise, in its length, and perhaps in Shatters or Splinters.

By what means may a Bone be fractur'd?

It may happen to be done by three sorts of Instruments, viz. such as are fit for brui­sing, cutting, or wresting; that is to say, a Bone may be divided in the Continuity of its proper Parts, by Contusion, Incision, or Contorsion.

How is the Fracture of a Bone discover'd?

Divers ways, viz. by the ill Disposition of the Part, which becomes shorter; by its want of Motion; by its flexibility or pliantness else [...] where than in its Articulations; by the uneven­ness that may be perceiv'd in its Continuity; by the cracking which is heard; sometimes also by the shooting forth of one of its ends thro' the Flesh which it hath open'd; and last­ly by a Comparison made thereof with the sound Part on the other side, as that of the Right Arm with the Left.

What kind of Fracture is most difficult to be discern'd?

It is that which happens in the length of the Bone, commonly call'd a Cleft or Fissur [...] which gives occasion to very great Symptoms when it is unknown: But it may be found out by the Pain and Swelling felt at the bottom of the Cleft in touching it; besides the Conjectures which may be made from the Relation of the Person who hath had a Fall, and might have heard the cracking of the Bone.

What sort of Fracture is most difficult to be cur'd?

The shattering or splitting of a Bone in Pie­ces, by reason of the great Number of Splints which daily cause new Pains and Suppura­tions.

What is a simple and what is a complicated Fracture?

The simple Fracture is that whereby the Bone is broken, without any other Accident; and the complicated Fracture is that which is follow'd by some Accident; as that in which there is a splitting of the Bone in pieces, or [Page 189]where the Bone is broken in two several pla­ces, or else when the Fracture is accompa­ny'd with a Luxation, a Wound, an Inflam­mation, or other Circumstances of the like Nature.

Are old Men or Children most subject to these Fractures of the Bones?

Old Men, because their Bones are dr [...]r; whereas those of Infants are almost Cartilagi­nous, and yield or give way to the violence offer'd to 'em; from whence proceed the [...]ink­ings and hollowness that happen in their Skulls, especially in the Mould of their Heads, or else­where; for which a Remedy is found out by the means of Plais [...]ers, Splints, and Bandages, fitted to the shape of the Parts. It is also on the same Account that Bones are more easily broken in the Winter than in the Summer.

In what Parts are the Fractures of Bones most dangerous?

They are those that happen in the Skull and Joints; in the former by reason of the Brain; and in the latter in regard of the Ner­vous Parts.

What Course is to be taken by a Surgeon who is sent for to cure a Fracture?

He ought to do three things, that is to say, at first he must incessantly endeavour to reduce it, to the end that Nature may re-unite the Parts with greater Facility, and that its Extre­mities may be brought together again with less trouble, before a Swelling, Inflammation, or Gangrene happen in the Part. After­ward he is to use means to retain the Parts in their proper Figure, and natu­ral [Page 190]Situation, and to prevent all sorts of Ac­cidents.

How is the setting of a broken Bone to be perform'd?

When the Fracture is Cross-wise, it must be reduc'd by Extension and contra-Extension; and when it is in length, the Coaptation or bring­ing together again of the Sides, is only ne­cessary.

What is to be done in a Fracture complicated with a Wound?

The Operator must first reduce it, and then administer the other Helps, as in a simple Fracture.

How may it be known that the reducing of the Fracture is well perform'd?

When the Pain ceaseth; when the Part hath resum'd its natural Shape; when no Uneven­ness is any longer perceiv'd therein; and when it is conformable to the sound Part on the o­ther side.

What are the Signs which shew that the Splints remain in the Fracture after it hath been re­duc'd?

They are the secret and continual Workings of the Fibres, or twitchings, that are felt by Intervals in the Part, with great Pains, which are the Indications of an Abcess arising therein; and when a Wound is join'd to the Fracture, the Lips of it are puff'd up, and become more soft and pale, the purulent Matter abounding also more than ordinary.

When the Splints appear, must they be drawn out by force?

By no means; for great care ought to be taken to avoid all manner of violent Operati­ons; it being requisite to wait for their going out with the purulent Matter; or at most to facilitate their Passage by the use of Injections of the Tincture of Myrth and Aloes; by the ap­plication of Emplastrum Andreae Crucii, and by the help of the Forceps.

How is a simple Fracture to be dress'd, after it hath been reduc'd?

The Parts are to be strengthen'd and conso­lidated with Liniments of Oleum Lumbricorum, or of Oil of St. John's-Wort mingled with Wine, Brandy, or Aqua-Vitae; with Fomentati­ons of Red Roses, Rosemary, and St. John's-Wort boil'd in Wine; and with Emplastrum contra Rupturam, or de Betonica, carefully wrap­ping up the broken Member, but after such a manner that the two Fxtremities may not cross one another; and that a small Space may remain open between both. Afterward the Splints and Bands are to be apply'd, taking care to avoid binding 'em too hard, and to take 'em off every three Days, in order to refit 'em, to abate troublesome Itchings, and to give Air to the Part; by these means pre­venting the Gangrene, which might happen by the Suffocation of the natural Heat. If the Thighs or Legs are broken, Scarves are to be us'd to support and stay 'em in the Bed.

What space of time may there be allow'd for cu­ring the Fracture of a Bone?

The Cure will take up more or less time, according to the variety of the Parts, or the different thickness of the Bones: Thus to form [Page 192]the Callus of the broken Jaw-Bone, twenty Days may well be allotted; for that of the Clavicle, or that of the Shoulder-Bone, twenty four; for that of the Bones of the Elbow, thirty; for that of the Arm-Bone, forty; for that of the Wrist-Bone, and those of the Fin­gers, twenty; for that of the Ribs, twenty; for that of the Thigh-Bone, fifty; for that of the Leg-Bone, forty; for that of the Bones of the Tarsus and Toes, twenty.

What ought to be done in particular to promote the formation of the Callus?

The fractur'd Part must be rubb'd with Oleum Lumbricorum and Spirit of Wine heated and min­gled together: The Decoctions of Agrimony, Savine, and Saxifrage are also to be us'd, and the Lapis Osteocolla is a Specifick: It is usually given in great Comphrey-Water, or in a Deco­ction of Perewinkle made with Wine, and is of­ten re-iterated.

CHAP. III. Of the particular Fractures of the Skull.

WHAT is a Fracture of the Cranium or Skull?

It is a Wound of the Head complicated with a Fracture of the Skull-Bone.

After how many manners may the Skull be fractur'd?

Three several ways, viz. by Contusion, by Incision, and by Puncture.

What is the most dangerous of these Fractures?

It is that which happens by Contusion; because the Concussion and Commotion is greater.

Do all the Fractures of the Skull require the use of the Trepan?

No, the Fractures must be deep which stand in need of the help of such an Instrument; for those that are superficial may be cur'd by a sim­ple Exfoliation.

What is that deep Fracture, wherein the use of the Trepan is absolutely necessary?

It is that which is made in the two Tables of the Skull, penetrating to the Meninges of the Brain; upon which at that time the Blood is diffus'd, and must be taken away by the Opera­tion of the Trepan.

How may it be discover'd that the [...]o Tables of the Skull are broken?

By the Eyes, and by Ratiocination.

Are not the Eyes sufficient alone, and are they not more certain than Ratiocination?

Yes; but forasmuch as things are not al­ways seen, there is often a necessity of making use of rational Deductions to find out that which the Eyes cannot discern.

When doth it happen that the Eyes alone discover the Eracture?

When the Wound is large and wide, so that it may be immediately view'd.

When doth it happen that Ratiocination supplies the defect of the Eyes?

When the Wound is so small that the Bone cannot be seen, and nothing appears but the Accidents.

What are the Accidents or Signs of the Fracture of the Skull?

They are a dimmness of the Sight, and loss of the Understanding, which happen at the ve­ry Moment when the Fall or Blow is receiv'd; with the Phlegmatick Vomittings that follow soon after: These Signs are call'd Ʋnivocal. And there are others that bear the Name of Equivocal, and which confirm the former; as a Flux of Blood thro' the Nose, Eyes, and Ears, redness of the Eyes, heaviness of the Head, and puffing up of the Face; as also afterward Drow­siness, Shivering of the whole Body, Fever, De­liriums, Convulsions, &c.

Must all these Signs appear before a Determi­nation can be made of the necessity of using the Trepan?

No, it is sufficient to have the Univocal Signs to make a Crucial Incision in the place of the Wound, and to lay bare the Bone, in order to observe the Fracture, which sometimes is so fine, that the Operator is oblig'd to make use of Ink, which insinuates it self into the Cleft, and of a particular Instrument, wi [...]h which the black Line that hath penetrated to the bot­tom, cannot be rubb'd out; whereas it may be easily defac'd when the Fracture is only super­ficial.

How long time is commonly spent before the appear­ing of the Accidents?

In the Summer Season they appear in three or four Days, and at the latest in seven; in Winter [Page 195]they are slower, and sometimes do not happen till the fourteenth Day: But at the end of this term, it may be affirm'd that the Tre­pan is often unprofitable.

What is requisite to be done in a doubtful Oc­casion; Must the Trepan be apply'd or omitted?

The Surgeon is to have recourse to his own conscientious Discretion, which ought to serve as a Guide, and requires that we should always act according to the known Rules of Art; inso­much that after having well consider'd the Ac­cidents, with all the Circumstances of the Wound, if there be no good grounds for the undertaking of the Operation, it is expedient to desist, and in this case to have deference to the Advice of other able Surgeons of the same So­ciety, rather than to rely too much upon his own Judgment, to the end that he may be always secure from all manner of Blame.

Is the Trepan apply'd upon the Fracture?

No; but on one side of it, and always in a firm place.

What Course is to be taken when a Fracture is found in a Suture?

A double Trepan is to be made, and apply'd on each side of the Suture, by reason of the overflowing of the Blood, which may happen therein.

What Method ought to be observ'd in the cu­ring of the Wounds of the Head, and Fractures of the Skull?

In simple Wounds of the Head, it is neces­sary only to make use of Balsams, and to lay over 'em Emplastrum de Betonica. When there is a Contusion either in the Pericra­nium, [Page 196]or in the Skull, the Wound must be kept open till after the Suppuration or Exfo­liation.

When there is only a Bunch without any Wound or Accident, it must speedily be dis­solv'd with Plaister or Mortar, Chimney-Soot, Oil of Olives, and Wine, laid upon the Part between two Linnen-Rags; or else with Soot, Spirit of Wine, and Oil of St. John's-Wort, wherein the Bolsters are soakt, to be in like manner apply'd with a Band.

Wounds of the Head accompany'd with a Fracture, absolutely require the application of the Trepan, wherein it is requisite to make use of Oil of Turpentine to be dropt upon the Membrane of the Brain; or else Spirit of Wine mingled with Oil of Almonds, and not with the Oil or Syrrup of Roses; and to endeavour to cause a plentiful outward Suppuration.

Besides, it must not be neglected to enjoyn the wounded Person to be let Blood both be­fore and after the Operation, if he hath a Fe­ver or a Plethory; and more especially it is to be remember'd to cause his Body to be kept o­pen at least every other Day, with Clysters, ob­liging h [...]m to keep a good Diet, and to avoid all violent Agitations both of Body and Mind, ab­staining from eating Flesh till the Fourteenth Day. All manner of Venery and Conjugal Em­braces, which prove fatal at this time, are to be prohibited during forty Days, to be count­ed from the Day of the Operation; as they are also in all other considerable Wounds.

CHAP. IV. Of the Caries or Ʋlcer of the Bones, Exostosis, and Nodus.

WHAT is Caries?

It is the Putrifaction of the Substance of the Bone, or else its Ulcer or Gangrene.

Whence doth the Caries of the Bone derive its Original?

It proceeds from an internal and external Cause; the former being that which hath been produc'd at first in the Substance of the Bone; and the other that which takes its Rise from an inveterate Ulcer in the Flesh, which hath communicated its Malignity to the Sub­stance of the Bone, and by that means cor­rupted it.

How is the Caries known which proceeds from an inward Cause?

By the continual and violent Pains which are felt before, and continue for a long time with­out diminution; as also afterward by the altera­tion of the Flesh that covers the Bone, and which becomes soft, spongy, and livid.

By what means is a Caries that derives its Ori­gine from an outward Cause, discover'd?

By the quality of the purulent Matter that is­sueth out of the Ulcer in the Flesh, which is blackish, Unctuous, and extremely stinking; as also by the help of the Probe, that discovereth [Page 198]asperity or roughness in the Bone when it is laid bare.

What Means are to be us'd in order to cure a Caries proceeding from an external Cause?

The Powder of Flower-de-luce may be us'd, and it is sufficient for that purpose, when the Caries is superficial; but it is necessary to take Oleum Guyaci, and to soak Bolsters therein, to be laid upon the Ulcer when it is deep; or else Aqua-Vitae or Brandy, in which have been in­fus'd the Roots of Flower-de-luce, Cinnamon, and Cloves. Lastly, the actual Cautery, which is Fire, must be apply'd thereto.

What is to be done when the Caries proceeds from an internal-Cause?

The Flesh must be open'd to give Passage to the Sanies that runs out of the ulcerated Bone, to the end that Exfoliation may be procur'd; and if the Ulcer hath not as yet laid open the Bone on the outside, the Trepan ought to be apply'd; but the Ulcer or Caries must be afterward handled, as we have even now de­clar'd.

What is Exostosis?

It is the Swelling of a Bone made by the settling of a corrupt Humour in its proper Substance.

What is Nodus?

It is a kind of gummy and wavering Tu­mour, which is form'd by the settling of a gross Humour between the Bone and the Periosteum.

Are Exostoses and Nodus 's suppurable Tu­mours?

Yes, because they sometimes produce Ulcers and Gangrenes in the Bone, which are call'd [Page 199] Caries, proceeding from an internal Cause; ne­vertheless they are generally dissolv'd by Fri­ctions with Ʋnguentum Griseum, or by the ap­plication of Plaisters of Tobacco, or Empla­strum de Vigo quadruplicato Mercurio; taking also to the same purpose internal Diaphoretick and Sudorisick Medicines, with convenient Pur­gatives.

CHAP. V. Of Cauteries, Vesicatories, Setons, Cup­ping-Glasses, ond Leeches.

WHAT is a Vesicatory?

The Name of Vesicatory may be attri­buted to every thing that is capable of raising Bladders of Blisters in the Skin; nevertheless in Surgery, by a Vesicatory is understood a Medicament prepar'd with Cantharides or Spa­nish Flies dried, which are beaten to Powder, and mingled with Turpentine, Plaisters, Lea­ven, and other Ingredients.

In what places, and after what manner are Ve­sicatories usually apply'd?

They are apply'd every where, accordingly as there is occasion to draw out or discharge some Humour from a Part: In Defluxions of Rheum upon the Eyes or Teeth, they are laid on the Neck and Temples; in Apoplexies, behind the Ears; and so of the rest, observing always to make Frictions on the places where the Ap­plication [Page 200]is to be made, to the end that the Ve­sicatory may sooner take effect.

How long time must the Vesicatory continue on the Part?

The Blisters are generally rais'd by 'em within the space of five or six Hours; yet this Operation depends more or less upon the fine­ness of the Skin; and when the Bladders or Blisters appear, it is requisite to deferr the o­penning of 'em for some time, to the end that Nature may have an Opportunity to introduce a new Scarf-Skin, by which means the Pain may be avoided that would be felt, if the Skin were too much expos'd to the Air.

What is a Cautery?

It is a Composition made of many Ingredi­ents, which corrode, burn, and make an Escar on the Part to which they are apply'd.

How many sorts of Cauteries are there in ge­neral?

There are two kinds, viz. the Actual and the Potential; the former are those that have an immediate Operation; as Fire, or a red-hot I­ron; and the others are those that produce the same Effect, but in a longer space of time; such are the ordinary Cauteries compos'd of Cau­stick Medicaments.

Which are the most safe, the Actual or the Po­tential Cauteries?

A distinction is to be made herein; for Actu­al Cauteries are safest in the Operation, be­cause they may be apply'd wheresoever one shall think fit, as also for as long a time, or for any purpose: Whereas the Potential cannot be [Page 201]guided after the same manner. But in Haemor­rhages the Potential Cauteries are most eligi­ble, by reason that the Escar produc'd by 'em not being so speedily form'd, the Vessels are bet­ter clos'd, and they are not so subject to open again when it falls off; as it often happens in the Fall of an Escar made by Fire.

In what places are Cauteries usually apply'd?

In all places where an Attraction is to be made, or an Intemperature to be corrected, or a Flux of Humours to be stopt, by inducing an Escar on the Part: However they are common­ly laid upon the Nape of the Neck, between the first and second Vertebra; on the outward Part of the Arm in a small Hole between the Muscle Deltoides and the Biceps; above the Thigh, between the Muscle Sartor, and the Vastus Internus; and on the inside of the Knee, below the Flexors of the Leg; observing every where that the Cautery be plac'd near the great Vessels, to the end that it may draw out and cleanse more abundantly.

What is the Composition of the Potential Cau­teries?

They may be made with quick Lime, Soap; and Chimney-Soot; or else take an Ounce of Sal Ammoniack, two Ounces of burnt Roman Vitriol, three Ounces of quick Lime, and as many of calcin'd Tartar; mingle the whole Mass together in a Lixivium of Bean-Cod Ashes, and cause it to evaporate gent­ly to a Consistence: Let this Paste be kept for use in a dry place, and in a well-stopt Vessel. Or else the Silver-Cautery, or Lapis Infernalis may be prepar'd after the following manner:

Take what quantity you please of Silver, let it be dissolv'd with thrice as much Spirit of Nitre in a Vial, and set the Vial upon the Sand-Fire, to the end that two third parts of its Moisture may evaporate: Then pour the rest scalding-hot into a good Crucible, plac'd over a gentle Fire, and the Ebullition being made, the heat of the Fire must be augment­ed, till the Matter sink to the bottom, which will become as it were an Oil: Afterward pour it into a somewhat thick and hot Mould, and it will coagulate, so as to be fit for Use, if it be kept in a well-stopt Vial. This Cau­tery is the best; and an Ounce of Silver will yield one Ounce and five Drams of Lapis In­fernalis.

What is a Seton?

It is a String of Silk, Thread, or Cotton, threaded thro' a kind of Pack-Needle, with which the Skin of a Part is to be pierc'd thro', to make an Ulcer therein, that hath almost the same effect as a Cautery.

What is most remarkable in the Application of a Seton?

It ought to be observ'd, that the String must be dipt in Oil of Roses, and that one end of it must always be kept longer than the other, to facilitate the running of the Humours.

In what Parts is the to Seton be apply'd?

The Nape of the Neck is the usual place of its Application, altho' it may be made in any part of the Body where it is necessary. It sometimes happens that a Surgeon is oblig'd to use a kind of Seton in such Wounds made with a Sword, or by Gun-shot, as pass quite [Page 203]thro' from one side to the other; then the String or Skain must be dipt in convenient Ointments or Medicinal Compositions; and as often as the Dressings are taken away, it will be re­quisite to cut off the Part soakt in the Puru­lent Matter, which must be taken out of the Ulcer.

What is a Cupping-Glass?

It is a Vessel or kind of Vial, made with Glass, the bottom whereof is somewhat broader than the top, which is apply'd to the Skin to cause an Attraction. There are two sorts of these Cupping-Glasses, viz, the Dry, and the Wet; the former are those that are laid upon the Skin without opening it; and the latter those that are apply'd with Scarification.

In what Diseases are Cupping-Glasses us'd?

In all kinds where it is necessary to make any Attraction; but more especially in Apo­plexies, Vapours in Women, Palsies, and other Distempers of the like Nature. But the Ap­plications of Cupping-Glasses are altogether dif­ferent; for in Apoplexes they are generally set upon the Shoulders or upon the Coccyx; in Va­pours upon the inside of the Thighs; and in Palsies upon the Paralytick Part it self.

What is a Leech?

It is an Animal like a little Worm which sucks the Blood, and is commonly apply'd to Children and weak Persons, to serve instead of Phlebotomy: Leeches are also us'd for the dis­charging of a Defluxion of Humours in any Part; as also in the Haemorrhoidal Veins when they are too full; in the Varices, and in several parts of the Face.

What choice ought to be made of Leeches?

It is requisite to take those that have their Backs greenish, and their Bellies red; as also to seek for 'em in a clear running Stream, and to cast away those that are black and hairy.

CHAP. VI. Of Phlebotomy.

WHAT is Phlebotomy?

It is an evacuation of Blood procur'd by the artificial Incision of a Vein or Artery, with a design to restore Health.

Which are the Vessels that are open'd in Phle­botomy or Blood-letting?

They are in general all the Veins and Ar­teries of the Body, nevertheless some of 'em are more especially appropriated to this Ope­ration; as the Vena Praeparata in the Forehead; the Ranulae under the Tongue; the Jugular Veins and Arteries in the Neck; the Tempo­ral Arteries in the Temples; the Cephalick, Me­dian, and Basilick Veins in the inside of the El­bow; the Salvatella between the Ring-Finger and the Little-Finger; the Poplitaea in the Ham; the Saphena in the internal Malleolus or Ankle; and the Ischiatica in the external.

What are the Conditions requisite in the due performing of the Operation of Phlebotomy?

They are these, viz. to make choice of a proper Vessel; not to open any at all Adven­tures; not to let Blood without necessity, nor [Page 205]without the Advice of a Physician; whose Of­fice it is to determine the Seasons or Times convenient for that purpose; as that of Inter­mission in an Intermitting Fever; that of Cool­ing in the Summer; and that of Noon-tide in the Winter; and lastly, to take away different quantities of Blood; for in the Heat of Sum­mer they ought to be lesser, and greater in the Winter.

What are the Accidents of Phlebotomy?

They are an Impostume, a Rhombus, an Echy­mosis, an Aneurism, Lipothymy, Swooning, and a Convulsion.

What is a Rhombus?

It is a small Tumour of the Blood which hap­pens in the place where the Operation is per­form'd either by making the Orifice too small, or larger than the Capaciousness of the Ves­sel will admit. The Rhombus is cur'd by lay­ing upon it a Bolster dipt in fair Water, be­tween the Folds of which must be put a lit­tle Salt, to dissolve and prevent the Sup­puration.

How may it be perceiv'd that an Artery hath been prickt or open'd in letting Blood?

The Puncture of an Artery produceth an Aneurism; and the Opening of it causeth a Flux of Vermilion Colour'd Blood, which is­sueth forth in abundance, and by Leaps.

Are the Leaps which the Blood makes in running, a certain Sign that it comes from an Artery?

No, because it may so happen, that the Ba­silick Vein lies directly upon an Artery, the beating of which may cause the Blood of the [Page 206] Basilica to run out leaping: Therefore these three Circumstances ought to be consider'd jointly, that is to say, the Vermilion Colour, the great quantity and the Leaps, in order to be assur'd that the Blood proceeds from an Artery.

How may it be discover'd that a Tendon hath been hurt in letting Blood?

It is known when in opening the Median Vein, the end of the Lancet hath met with some Resistance; when the Patient hath felt great Pain, and afterward when the Tendon apparently begins to be puff'd up, and the Arm to swell. A Remedy may be apply'd to this Accident thus; after having finish'd the O­peration, a Bolster steep'd in Oxycratum is to be laid upon the Vessel, a proper Bandage is to be made, and the Arm must be wrapt up in a Scarf: If the Inflammation that ariseth in the Part be follow'd with Suppuration, it must be dress'd with a small Tent; and if the Suppuration be considerable, it is necessary to dilate the Wound, and to make use of Oil of Eggs and Brandy, or Arcaeus's Liniment, with a good Digestive; as also to apply Empla­strum Ceratum; to make an Embrocation on the Arm with Oil of Roses; and to dip the Bolsters in Oxycratum to cover the whole Part.

Is it not to be fear'd that some Nerve may be wounded in letting Blood?

No, they lie so deep that they cannot be touch'd.

Ʋnder what Vein is the Artery of the Arm?

It is usually situated under the Basilica.

What Course is proper to be taken to a­void the Puncture of an Artery in letting Blood?

It must be felt with the Hand before the Ligature is made, observing well whether it be deep or superficial; for when it lies deep, there is nothing to be fear'd; and when it is superficial, it may be easily a­voided by pricking the Vein either higher or lower.

What is to be done when an Artery is open'd?

If it be well open'd, it is requisite to let the Blood run out till the Person falls in­to a Syncope or Swoon, by which means the Aneurism is prevented; and afterward the Blood will be more easily stopt: It re­mains only to make a good Bandage with many Bolsters, in the first of which is simply put a Counter or a Piece of Money; but a bit of Paper chew'd will serve much bet­ter, with Bolsters laid upon it in several Folds.

If the Arteries cause so much trouble when o­pen'd accidentally, why are those of the Temples sometimes open'd on purpose, to asswage vio­lent Pains in the Head?

By reason that in this place the Arte­ries are situated upon the Bones that press 'em behind; which very much facilitates their re-union.

Are not the Arteries of Persons advanc'd in Years more difficult to be clos'd than those of Children?

Yes.

Are there not Accidents to be fear'd in letting Blood in the Foot.

Much less than in the Arm; because the Veins of the Malleoli or Ankles are not ac­company'd either with Arteries or Tendons; which gave occasion to the Saying, That the Arm must be given to be let Blood only to an able Surgeon, but the Foot may be afforded to a young Practitioner.

A TREATISE OF Chirurgical Operations.

CHAP. I. Of the Operation of the Trepan.

THIS Operation is to be perform'd, when it is inferr'd from the Signs of which we have already given a par­ticular Account, that some Matter is diffus'd over the Dura Mater. The Trepan must not be us'd in the Sinus Superciliares, by reason of their Cavity; nor in the Sutures, in regard of the Vessels that pass thro' 'em; nor in the Temporal Bone without great necessity, e­specially in that part of it which is join'd to the Parietal-Bone, lest the end of this Bone shou'd fly out of its place, since it is only laid upon the Parietal; nor in the middle of the Coro­nal and Occipital-Bones, by reason of an inner [Page 210]Prominence wherein they adhere to the Dura Mater; nor in the Passage of the Lateral Si­nus's that are situated on the side of the Oc­cipital.

If the Fissure be very small, the Trepan may be apply'd upon it, altho' it is more expe­dient to use this Instrument on the side of the Fissure in the lower part; neither is the Trepan to be set upon the Sinkings; and if the Bones are loosen'd or separated, there needs no other trepanning than to take 'em away with the E­levatory

The Operation must be begun with Incision, which is usually made in form of a Cross, if the Wound be remote from the Sutures, and there are no Muscles to be cut, and in the shape of the Letter T. or of the Figure 7. if it be near the Sutures, so that the Foot of the 7. or of the T. ought to be parallel to the Suture, the top of the Letter descending toward the Tem­ples; it is also made in the middle of the Fore­head. If it be sufficient to make a longitudinal Incision in the Forehead; its Wrinkles may be follow'd, and there will be less Deformity in the Scar; but it is never done Crosswise in this Part, and the Lips of the Wound are not to be cut. If an Incision be made on the Mu­scle Crotaphites, and on those of the back-part of the Head, it may be done in form of the Letter V. the Point of which will stand at the bottom of the Muscles; nevertheless it is more convenient to make a longitudinal Incision, by which means fewer Fibres will be cut; and it is always requisite to begin at the lower part, to avoid being hindred by the Haemorrhage. [Page 211]The Incisions are to be made with the Incision-Knife, and that too boldly when there are no Sinkings; but if there be any, too much weight must not be laid upon 'em: Thus the In­cision being finish'd, the Lips of the Skull are to be separated either with the Fingers, or some convenient Instrument; Then if there be no urgent Occasion to apply the Trepan, it may be deferr'd till the next Day, the Wound be­ing dress'd in the mean time with Plaisters, Bolsters, Pledgets, and a large Kerchief or up­per Dressing, the use of which we shall shew hereafter.

The Operation is begun with the Perforative, to make a little Hole for the fixing of the Py­ramid or Pin which is in the Round; after­ward the Round is to be apply'd, holding the Handle of the Trepan with the Left-hand, and turning; but when the Round hath made its way, it is lifted up to remove the Pin, lest this Point shou'd hurt the Dura Mater: Thus the Round being taken off from time to time, to be cleans'd from the Filings that stick thereto, is set on again, and the Operator begins his Work of turning anew, which must be carry'd on gently when any Blood appears, to the end that the first Ta­ble of the piece of Bone which is remov'd may not fly from the second: When it comes near the Dura Mater, the Operator must pro­ceed, in like manner, gently, searching with a Feather round about the Bone, to observe whe­ther he still continueth his Course in the Skull. He must also often lift up the Trepan to search the Hole, to cleanse the Instrument, and to keep [Page 212]it from growing hot. As often as the Trepan is taken off, let him search with a Feather, to see whether the Bone be cut equally; and if it be not, he must lean more on that side which is least cut. If it be necessary to make use of the Terebella, the Hole must be made in the be­ginning, whilst the Bone is as yet firm; and when the Piece begins to move, the Terebella is to be put very gently into its Hole, without pressing the Bone, to draw it out; or else it may be taken away with the Myrtle-Leaf, which is an Instrument made of a firm Silver-Plate somewhat crooked. When the Piece is thus remov'd, the uneven Parts that remain at the bottom of the Hole, are to be cut with the Lenticula; and if there be any Sinkings, they may be rais'd with the Elevatory. Whereupon the Dura Mater may be compress'd a little with the Lenticula, to facilitate the running out of the Blood, the Wounded Person being oblig'd to stoop with his Head downward, stopping his Nose and Mouth, and holding his Breath for a while, to cause the Matter to run out: Then the Dura Mater may be wip'd with Lint; but if any Pus or corrupt Matter lies un­derneath, it must be pierc'd with a Lancet wrapt up in a Tent, that it may not be perceiv'd by the Assistants. Afterward a Sindon or very fine Linnen Rag dipt in a proper Medica­ment, is put between the Dura Mater and the Skull; the Hole is fill'd with small Bol­sters steept in convenient Medicinal Liquors; and the Wound is dress'd with Pledgers, a Plai­ster, and a Kerchief.

But the Hole ought to be well stopt with Bolsters, because the Dura Mater is sometimes so much inflam'd, that it bursts forth; so that if any Excrescences arise therein, and go our of the Hole, having small Roots, they may be bound and cut; but if their Roots be large, they must be press'd close with little Bolsters steept in Spirituous Medicines. Here it may not be improper to observe, that the Operati­on of the Trepan ought to be perform'd more gently in Children than in adult Persons, in re­gard that their Bones are more tender, and that Oily Medicines must not be us'd, but Spiritu­ous. The Exsoliation is made sometimes soon­er, and sometimes later; but the Callus usually covers the opening of the Skull within the space of forty or fifty Days, if no ill Accident happens. In great Fractures, where there is no longer any connexion between the Bones, it is requisite to take 'em away.

Of the Bandagè of the Trepan.

The proper Bandage to be us'd after the O­peration of the Trepan, is the great Kerchief, which is a large Napkin folded into two parts after such a manner that the side which toucheth the Head exceeds that which doth not touch it in the breadth of four Fingers; it is apply'd to the Head in the middle, whilst a Servant holds the Dressing with his Hand: Then the two upper ends of the Napkin being brought under the Chin, the Surgeon takes the two lower, and draws 'em streight by the sides, so as that side of the Napkin, which is four Fingers broader [Page 214]than the other, may be laid upon the Fore­head: Afterward the two ends of the Napkin are cross'd behind the Head, and fasten'd at their Extremities with Pins, without making a­ny Folds, that might hurt the Part; but the ends of the Napkin which fall upon the Shoul­ders, are rais'd up to the Head near the les­ser Corner of the Eyes; and the two ends un­der the Chin are fasten'd with Pins, or else tied in a Knot.

CHAP. II. Of the Operation of the Fistula Lachrymalis.

THIS Operation is perform'd when there is a Fistulous Ulcer in the great Corner of the Eye, after this manner: The Patient being pl [...]c'd in a convenient Posture, and having his sound Eye bound up, to take away the sight of the Instruments; the Operator causeth the other Eye to be kept steady with a Bolster held with an Instrument, and makes an Incision with a Lancer in form a Crescent upon the Tumour, taking care to avoid cutting the Eye-Lid and the little Cartilage which serves as a Pulley to the great Oblique Muscle. If the Bone be pu­trify'd with a Caries, an Actual Cautery may be apply'd thereto, using for that purpose a small Funnel or Tube, thro' the Canal of which the Cautery is convey'd to the Bone. [Page 215]But the Bone must not be pierc'd, for it is exfoliated entire by reason of its smallness; and so the Hole is made without any Per­foration.

The Dressing and Bandage of the Fistula Lachrymalis.

The Wound is fill'd with small dry Pled­gets, and cover'd with a Plaister and Bolster: The Bandage is made with an Handkerchief folder triangular-wise, the ends of which are fasten'd behind the Head. If the Flesh grows too fast, it may be consum'd with the Lapis Infernalis; and if there be occasion to dilate the Wound, to facilitate the Exsoliation, it may be done with little pieces of Spunge prepar'd, and put into it. Afterward Causticks are to be us'd, to eat away the Callous Parts, which may be mingled with Oily Medicines, to weak­en their Action, taking care, nevertheless, that the Eye receive no dammage by 'em. If the Bone be corrupted, a little Euphorbium may be apply'd; or else the small Pledgets steept in the Tincture of Myrrh and A­loes; then the Ulcer may be handled as all others.

CHAP. III. Of the Operation of the Cataract.

THIS Operation is perform'd when there is a small Body before the Apple of the Eye, which hinders the Sight from entring into it; but it is undertaken only in Blew, Green, and Pearl-colour'd Cataracts, or in those that are of the Colour of polish'd Steel; and not in Yellow, Black, or Lead-colour'd. To know whe­ther the Cataract be fit to be couch'd, the Pa­tient's Eye must be rubb'd; so that if the Ca­taract remains unmoveable, it is mature enough; but if it changeth its place, it is requisite to wait till it become more solid. The Spring and Au­tumn are the most proper Seasons for perform­ing the Operation.

To this purpose the Patient being set down with his Eyes turn'd toward the Light, and having his sound Eye bound up, the Surgeon must likewise sit on a higher Seat, whilst the Patient's Head is held by a Servant; and his Eye being turn'd toward his Nose, is kept steady with a Speculum Oculi, which is a little Iron-Instrument made like a Spoon, pierc'd in the middle, so that the Ball of the Eye may be let thro' this Hole: Then the Surgeon taking a a Steel-Needle either round or flat, according­ly as he shall judge convenient, perforates the Conjunctive at the end of the Corneous Tu­nicle, on the side of the little Corner of the [Page 217]Eye, and boldly thrusts his Needle into the middle of the Cataract, which he at first push­eth upward, to loosen it with the Point of the Needle; and then downward, holding it for some time with his Needle below the Apple of the Eye. If it ascend again after it is let go, it must be depress'd a second time; but the Operation is finish'd when it remains in the same place whereto it was thrust; neither is the Needle to be remov'd till this be done, and the Cataract entirely couch'd. In taking out the Needle, the Eye-Lid must be pull'd down, and press'd a little over the Eye.

The Dressing and Bandage,

Is to cause both the Patient's Eyes to be clos'd and bound up; then he must be oblig'd to keep his Bed during seven or eight Days, and some Defensative is to be laid upon the sore Eye, to hinder the Inflammation.

M. Dupré, Surgeon to the Hospital of Hôtel-Dieu at Paris, a Person well vers'd in these kinds of Operations, hath observ'd, that after the same manner as Cataracts were form'd in a ve­ry little space of time in perfect Maturity; it happen'd also very often, that the Cataracts which were suppos'd to have got up again, were not the very same with those that were couch'd, but rather a new Pellicula or little Skin, which sometimes hath its Origine in the top of the Ʋveous Tunicle, and is caus'd only by a very considerable Relaxation of the Excretory Vessels from the Sources of the Aqueous Hu­mour which in filtrating permits the running [Page 218]of many heterogeneous Parts, the Encrease of which produceth a new Cataract.

Of other Operations in the Eyes.

Sometimes a sort of purulent Matter is ga­ther'd together under the Corneous Tunicle; so that to draw it out, the Eye must be fixt in a Posture with the Speculum Oculi, and after a small Incision made therein with a fine Lan­cet, is to be press'd a little, to let out the Mat­ter; but if it be too thick, it may be drawn forth by sucking gently with a small Tube or Pipe, having a little Vial in the middle, into which the Matter will fall as it is suck'd out.

Sometimes a small Tumour ariseth in the Eye, which being ty'd at its Root with a Slip-Knot, to streighten it from time to time, will at length be dissolv'd: But if the Tumour lie in the Hole of the Apple of the Eye, this Operation must not be admitted, lest the Scar shou'd hinder the Passage of the Light. Sometimes also a some­what hard Membrane, call'd Ʋnguis, appears in the great Corner of the Eye, which when it sticks thereto, may be cut off by binding it; this is done with a Needle and Thread, which is pass'd thro' the Membrane, [...]nd afterward ty'd.

If the Eye-Lids are glu'd together, a crook­ed Needle without a Point may be threaded, and pass'd underneath 'em; then the ends of the Thread may be drawn, to lift up the Eye-Lids, and they may be separated with a Lan­cet.

If the Hairs of the Eye-Lids or Eye-Brows offend the Eye, they must be pull'd out with a Pair of Tweezers or Nippers; and when any small, hard, and transparent Tumours arise in the Eye-Lids, they are to be open'd, to let out the corrupt Matter.

CHAP. IV. Of the Operation of the Polypus.

THIS Operation is necessary, when there are any Excrescences of Flesh in the No­strils, which, nevertheless, when they are livid, stinking, hard, painful, and sticking very close, must not be tamper'd with, because they are Cancers. But if they are whitish, red, hang­ing, and free from Pain, the Cure may be un­dertaken after this manner: Take hold of the Polypus with a Pair of Forceps, as near its Root as is possible, and turn 'em first on one side, and then on another, till it be pull'd off. If the Polypus descends into the Throat, it may be drawn thro' the Mouth with crooked Forceps; and if an Haemorrhage shou'd happen after the Operation, it may be stopt by thrusting up in­to the Nostrils certain Tents soakt in some Styp­tick Liquor; or else by Syringing with the same Liquor.

CHAP. V. Of the Operation of the Hare-Lip.

THIS Operation is perform'd when the Upper-Lip is cleft; but if there be a great loss of Substance, it must not be undertaken; neither ought it to be practis'd upon old nor scorbutick Persons, nor upon young Children, by reason that their continual Crying wou'd hinder the re-union. But if any are desirous that it shou'd be done to these last, they are to be kept from taking any rest for a long time, to the end that they may fall a-sleep after the Ope­ration, which is thus effected:

If the Lip sticks to the Gums, it is to be se­parated with an Incision-Knife, without hurting 'em; then the Hare-Lip must be cut a little a­bout the edges with Sizzers, that it may more easily re-unite, the edges being held for that purpose with a Pair of Pincers, whilst the Ser­vant who supports the Patient's Head, presseth his Cheeks before, to draw together the sides of the Hare-Lip: Whereupon the Operator passeth a Needle with wax'd Thread, into the two sides of the Wound, from the outside to the inside at a Thread's distance from each. But care mu [...] be had that the two Lips of the Hare-Lip be well adjusted, and very even; the Thread be­ing twisted round the Needle by crossing it above.

The Dressing and Bandage.

After the Lips are wash'd with warm Wine, the Points of the Needles must be out off, small Bolsters being laid under their ends; then the Wound is to be dress'd with a little Pled­get cover'd with some proper Balsam, putting at the same time under the Gum a Linnen Rag steep'd in some desiccative Liquor, lest the Lip shou'd stick to the Gum, if it be necessary to keep 'em a-part. Lastly, upon the whole is to be laid an agglutinative Plaister, supported with the uniting Bandage, which is a small Band perforated in the middle; it is laid be­hind the Head, and afterward drawn forward, one of its ends being let into the Hole which lies upon the Sore: Then the two ends of the Band are turn'd behind the Head upon the same Folds where they are fasten'd, sticking therein a certain Number of Pins, proportionably to the length of the Wound.

The Patient must be dress'd three Days af­ter; and it is requisite at the first time only to untwist half the Needle, loosening the mid­dle Thread if there be three; to which pur­pose a Servant is to thrust the Cheeks somewhat forward. On the eighth Day the middle Nee­dle may be taken off, if it be a young Infant; nevertheless the Needles must not be remov'd till it appears that the sides are well join'd; nei­ther must they be left too long, because the Hoses wou'd scarce be brought to close.

CHAP VI. Of the Operation of Bronchotomy.

THIS Operation becomes necessary, when the Inflammation that happens in the Larynx hinders Respiration, and is perform'd after this manner:

The Wind-Pipe is open'd between the third and fourth Ring, above the Muscle Cricoides, or else in the middle of the Wind-Pipe; but in se­parating the Muscles call'd Sternohyodei, care must be had to avoid cutting the recurrent Nerves, lest the Voice shou'd be lost; as also the Glandules nam'd Thyroides. The Space be­tween the Rings is to be open'd with a streight Lancet, kept steady with a little Band, and a transverse Incision is to be made between 'em: Before the Lancet is taken out, a Stilet is put into the Opening, thro' which passeth a little Pipe, short, flat, and somewhat crooked at the end, which must not be thrust in too far, for fear of exciting a Cough. This Pipe hath two small Rings for the fastening of Ribbans, which are ty'd round about the Neck; and it must be left in the Wound till the Symptoms cease. Af­terward it is taken away, and the Wound is dress'd, the Lips of it being drawn together again with the uniting Bandage, which hath been already describ'd.

CHAP. VII. Of the Operation of the Uvula.

WHEN the Ʋvula or Palate of the Mouth is swell'd so as to hinder Respiration or Swallowing, or else is fallen into a Gangrene, it may be extirpated thus: The Tongue being first depress'd with an Instrument call'd Speculum Oris, the Palate is held with a Forceps, or cut with a Pair of Sizzers; or else a Ligature may be made before it is cut; and the Mouth may be afterward gargl'd with Astringent Liquors.

CHAP. VIII. Of the Operation of a Cancer in the Breast.

THE Cancer at first is not so big as a Pea, being a small, hard, blackish Swelling, sometimes livid, and very troublesome by rea­son of its Prickings; but when it is encreas'd, the Tumour appears hard, Lead-colour'd, and livid, causing in the beginning a Pain that may be pretty well endur'd, but in the increase it grows intolerable, and the Stink is extremely noisome. When it is ready to Ulcerate, the Heat is vehement, with a pricking Pulsation; and the Veins round about are turgid, being [Page 224]fill'd with black Blood, and extended as it were the Feet of a Crab or Crey-Fish, till Death happen. When this Tumour is not ulcerated, it is call'd an Occult Cancer; and an Appa­rent one when it breaks forth into an open Ulcer.

To palliate an Occult Cancer, and prevent its Ulceration, a Cataplasm or Pultis of Hem­lock very fresh may be apply'd to the Part. All the kinds of Succory, the Decoction of So­lanum or Night-shade; the Juices of these Plants, as also those of Scabious, Geranium or Stork-Bill, Herniaria or Rupture-Wort, Plantain, &c. are very good in the beginning. River-Crabs pounded in a Leaden-Mortar, and their Juice beaten in a like Mortar, are an excellent Re­medy; as also are Humane Excrements or Urine destill'd, and laid upon the Occult Con­cer: Or else,

Take an Ounce of calcin'd Lead, two Oun­ces of Oil of Roses, and six Drams of Saffron; let the whole Composition be beaten in a Mor­tar with a Leaden Pestle, and apply'd. The Amalgama of Mercury with Saturn is likewise a very efficacious Remedy.

In the mean while the Patient may be purg'd with black Hellebore and Mercurius Dulcis, ta­king also inwardly from one Scruple to half a Dram of the Powder of Adders, given to drink, with half the quantity of Crab's-Eyes: But very great care must be taken to avoid the Application of Maturatives or Emollients, which wou'd certainly bring the Tumour to Ulceration.

When the Cancer is already ulcerated, the Spirit of Chimney-Soot may be us'd with good Success; and the Oil of Sea-Crabs pour'd scalding hot into the Ulcer, is an ex­cellent Remedy. But if it be judg'd expedi­ent entirely to extirpate the Cancer, it may be done thus:

The sick Patient being laid in Bed, the Sur­geon takes the Arm on the side of the Cancer, and lifts it upward and backward, to give more room to the Tumour; then having pass'd a Needle with a very strong. Thread tho' the bottom of the Breast, he cuts the Thread to take away the Needle, and passeth the Needle again into the Breast, to cause the Threads to cross one another. Afterward these four ends of the Threads are ty'd together, to make a kind of Handle to take off the Tumour, which is cut quite round to the Ribs with a very sharp Ra­sor. The Cutting is usually begun in the low­er Part to end in the Vessels near the Arm-Pit, where a small Piece of Flesh is left, to stop the Blood with greater Facility: Then having laid a Piece of Vitriol upon the Vessels, or Bolsters soakt in styptick Water; the sides of the Breast are to be press'd with the Hand, to let out the Blood and Humours; and an Actual Cautery is to be lightly apply'd thereto.

The Dressing.

The Wound is to be dress'd with Pledgets strew'd with Astringent Powders, a Plaister, a Bolster, a Napkin round the Breast, and a Sca­pulary to support the whole Bandage.

But instead of passing Threads cross-wise, to form a Handle, with which the Breast may be taken off, it wou'd be more expedient to make use of a sort of Forceps turn'd at both ends in form of a Crescent, after such a manner that those ends may fall one upon another when the Forceps are shut. Thus the Surgeon may lay hold on the Breast with these Forceps, and draw it off, after having cut it at one single Stroak with a very flat, crooked, and sharp Knife. Neither is it convenient to apply the Actual Cau­tery to stop the Haemorrhage, because it is apt to break forth again anew, when the Escar, is fall'n off.

When the Tumour is not as yet ulcerated, a Crucial Incision may be made in the Skin, without penetrating into the Glandulous Bodies; then the four Pieces of the Glandules being separated, the Cancerous Tumour may be held with the Forceps, and, afterward cut off If there be any Vessels swell'd, they may be bound before the Tumour is taken away; but if the Tumour sticks close to the Ribs, the Operation is not usually undertaken.

CHAP. IX. Of the Operation of the Empyema.

THIS Operation is perform'd when it may be reasonably concluded that some corrupt Matter is lodg'd in the Breast, which may be perceiv'd by the weight that the Patient feels in fetching his Breath; being also sensible of the floating of the Matter when he turns himself from one side to another.

If the Tumour appears on the outside, the Abcess may be open'd between the Ribs; but if no external Signs are discern'd, the Surgeon may choose a more convenient place to make the Opening. Thus when the Patient is set upon his Bed, and conveniently supported, the Opening is to be made between the second and third of the Spurious Ribs, within four Fingers breadth of the Spine, and the lower Corner of the Omoplata; to this purpose the Skin is to be taken up a-cross, to cut it in its length, the Surgeon holding it on one side, and the Assi­stant on the other. The Incision is made with a streight Knife two or three Fingers breadth long, and the Fibres of the great Dorsal-Mus­cle are cut a-cross, that they may not stop the Opening. Then the Surgeon puts the Fore-Fin­ger of his Left-hand into the Incision, to remove the Fibres, and divides the Intercostal Muscles, guiding the Point of the Knife with his Fin­ger to pierce the Pleuron, for fear of wounding [Page 228]the Lungs, which sometimes adhere thereto, the Opening being thus finish'd, if the Matter runs well, it must be taken out; but if not, the Fore-Finger must be put into the Wound, to disjoyn those Parts of the Lungs that stick to the Pleuron.

To let out the Matter, the Patient must be oblig'd to lean on one side, stopping his Mouth and Nose, and puffing up his Cheeks, as if he were to blow vehemently; then if Blood ap­pears, a greater quantity of it may be taken away than if it were Matter, in regard that a Flux of Matter weakens more than that of Blood. It is also worth the while to observe, that in making the Incision, the Intercostal Mu­scles ought to be cut a-cross, that the side of the Ribs may not be laid bare, by which means the Wound will not so soon become Fistulous.

If it be judg'd that purulent Matter is con­tain'd in both sides of the Breast, it is requi­site that the Operation be done on each side; it being well known that the Breast is divided into two Parts by the Mediastinum: But in this case the two Holes made by the Incision must not be left open at the same time, for fear of suffocating the Patient.

The Dressing and Bandage.

The Wound is dress'd with a Tent of Lint arm'd with Balsam, being soft, and blunt at the end, which enters only between the Ribs, for fear of hurting the Lungs; but a good Pled­get of Lint is more convenient than a Linnen [Page 229]Tent, however a Thread must be ty'd to the Pledget or Tent, lest it shou'd fall into the Breast; and Bolsters are to be put into the Wound; as also a Plaister or Band over the whole. This Dressing is to be kepc close with a Napkin fasten'd round the Breast with Pins, and supported by a Scapulary, which is a sort of Band, the breadth of which is equal to that of six Fingers, having a Hole in the mid­dle to let in the Head: One of its ends falls behind and the other before; and they are both fasten'd to the Napkin. Thus the Patient is laid in Bed, and set half upright. If the Lungs hinder the running out of the Matter, a Pipe is us'd, and the Wound afterward dress'd ac­cording to Art.

CHAP. X. Of the Operation of the Paracentesis of the Lower-Belly.

THIS Manual Operation is sometimes ne­cessary in a Dropsie, when Watry Humours are contain'd in the Cavity of the Belly, or else between the Teguments. The Disease is manifest by the great Swelling; and the Ope­ration is perform'd with a Cane, or a Pipe made of Silver or Steel, with a sharp Stilet at the end; altho' the Ancients were wont to do it with a Lancet. The Patient being supported, sitting on a Bed, or in a great Elbow-Chair, to the end that the Water may run downward, [Page 230]a Servant must press the Belly with his Hands, that the Tumour may be extended, whilst the Surgeon perforates it three or four Fingers breadth below the Navel, and makes the Pun­cture on the side, to avoid the White-Line; but before the Opening is made, it is expedient that the Skin be a little lifted up. The pointed Stilet being accompany'd with its Pipe, remains in the Part after the Puncture; but it is remov'd to let out the Water; and a convenient quantity of it is taken away, accordingly as the Strength of the Patient will admit. The Stilet makes so small an Opening, that it is not to be fear'd lest the Water shoul'd run out, which might happen in making use of the Lancet, because there wou'd be occasion for a thicker Pipe. When a new Puncture is requisite, it must be begun beneath the former; but if the Waters cause the Navel to stand out, the Open­ing may be made therein, without seeking for any other place.

The Bandage and Dressing

Are prepar'd with a large four-double Bol­ster kept close with a Napkin folded into three or four Folds, which is in like manner support­ed by the Scapulary.

The Operation of the Paracentesis of the Scrotum

Is undertaken when those Parts are full of Water, after this manner: Assoon as the Pati­ent is plac'd in a convenient Posture, either [Page 231]standing or sitting, the Operator lays hold on the Scrotum with one Hand, presseth it a little to render the Tumour hard, and makes a Pun­cture, as in the Paracentesis of the Abdomen. In an Hydrocele that happens to young Infants, the Opening may be made with a Lancet, to take away all the Water at once: But in Men, e­specially when there is a great quantity thereof, it is more expedient to do it with the sharp-pointed Pipe; but the Testicles are to be drawn back, for fear of wounding 'em with the Point of the Instrument.

If the Hydrocele be apparently Encysted, the Membrane containing the Water is to be con­sum'd with Causticks, which is done by laying a Cautery in the place where the Incision shou'd be made, and afterward opening the Escar with a Lancet.

When the Puncture is made, it ought to be done in the upper-part of the Scrotum, because it is less painful than the lower, and less subject to Inflammation.

CHAP XI. Of the Operation of Gastroraphy.

THIS Operation is usually perform'd when there is a Wound in the Belly so 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 [Page 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 or 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 [Page 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 six 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 Peritoneaum, 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 Nee­dle [Page 234]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 [Page 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.

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 [Page 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 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 [Page 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 [Page 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 nearly, 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, are 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.

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 in the Ʋreter; 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 Ʋreter, 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.

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 Ʋteri 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 Ʋreter 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 staken 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 [Page 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 [Page 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 [Page 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 one to 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 Ʋteri, 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 Ʋreter, 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 Ʋreter.

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.

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 [Page 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 our the Instrument to cut the Fistula entirely at one Stroke.

If the Fistula hath an Opening into the In­restine, 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.

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 pu­trisie, but altogether Spirituous Medicaments; and that the Part must be bound up, lest the Ex­tension of it shou'd separate the Tendons.

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 boing 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.

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.

In order to cut off a Leg the Patient is to be set on the side of his Bed, or in a Chair; and supported by divers Assistants; one of 'em be­ing employ'd to hold the J [...]eg at the bottom, and another to draw the Skin upward above the Knee, to the end that the Flesh may cover the Bone again after the Operation. In the mean while a very thick Bolster is laid under the Ham, upon which are made two Ligatures, viz. the first above the Knee, to stop the Blood, by screwing it up with the Tourniquet or Gripe-Stick; and the second below the Knee, [...]o ren­der the Flesh firm for the Knife. Before the Ligature is drawn close with the Gripe-Stick, a little piece of Paste-board is to be put under­neath, for fear of pinching the Skin. Thus the Leg being well fixt, the Surgeon placeth him­self between both the Legs of the Patient, to make the Incision with a crooked Knife, turn­ing it circularly to the Bone, and laying one Hand upon the Back of the Knife, which must, have no Edge. Afterward the Periosteum is to [Page 250]scrap'd with an Incision-Knife, and the Flesh with the Vessels that lie between the two Bones are to be cut. When the Flesh is thus sepa­rated, a Cleft Band is to be laid upon it, with which the Heads are cross'd, to draw the Flesh upward, to the intent that the Bones may be cut farther, and that it may cover 'em after the Amputation, as also to facilitate the Passage of the Saw. Then the Surgeon holds the Leg with his Left-hand, and saweth with his Right, which he lets fall upon the two Bones, to divide 'em asunder at the same time, beginning with the Perone or Fibula, and end­ing with the Tibia. But it is necessary to in­cline the Saw, and to go gently in the begin­ning, to make way for it, and afterward to work it faster. The Leg being cut off, the Ligature must be unty'd below the Knee, loos­ening the Gripe-Stick, to let the Blood run a little, and to discern the Vessels with greater facility; and then the Gripe-Stick may be twisted again, to stop the Blood; which some Surgeons effect, by laying Pieces of Vitriol up­on the Opening of the Arteries, and Astringent Powders, on a large Bolster of Cotton or Tow, to be apply'd to the end of the Stump; but if such a method be us'd, it is requisite that some Person be employ'd to keep on the whole Dressing with his Hand during twenty four Hours. However this Custom hath prevail'd in the Hospital of Hôtel-Dieu at Paris.

Others make a Ligature of the Vessels, taking up the ends of 'em with a pair of Forceps, having a Spring; or with the Valet a Patin, which is a sort of Princers that are clos'd with a small [Page 251]Ring let down to the bottom of the Branches. These Pincers being held by a Servant, the Surgeon passeth a Needle with wax'd Thread, into the Flesh, below the Vessel, bringing it back again, and with the two ends of the Thread makes a good Ligature upon the same Vessel; then he looseth the Gripe-Stick and the Band, the Stump is to be somewhat bended, and the Flesh let down to cover the Bones.

The Dressing and Bandage.

After the Operation, it is requisite to lay small Bolsters upon the Vessels, and dry Pled­gets upon the two Bones, as also many other Folds of Linnen strew'd with Astringent Pow­ders; and over all another large Bolster or Pledget of Cotton or Tow, cover'd in like manner with Astringent Powders; then the whole Dressing is to be wrapt up with a Plai­ster and a Bolster, in form of a Malta Cross; so that there are three or four Longitudinal Bolsters, and one Circular.

The Surgeon usually begins to apply the Milta Cross and Bolster under the Ham, crossing the Heads or Ends upon the Stump, and causeth 'em to be held by a Servant that Supports the Part; then he likewise cros­seth the other Heads, and layeth on the two Longitudinal Bolsters that cross each other in the middle of the Stump, together with a third Longitudinal, which is brought round a­bout the Stump, to stay the two former: These Bolsters ought to be three Fingers broad, and ve­ry long, to pass over the Stump. Afterward he proceeds to apply,

The Bandage commonly call'd Capeline by French Surgeons, or the Head-Bandage.

Which is prepar'd with a Band four Ells long, and three Fingers broad, roll'd up with one Ball, three Circumvolutions being made on the side of the cut Part, the Band is to be car­ry'd upward with Rollers, passing obliquely a­bove the Knee; and is brought down again along its former Turns; If it be thought fit to make this Bandage with the same Band, it must be let down to the middle of the cut Part, and carry'd up again to the Knee, ma­ny back-folds being made, which are stay'd with the Circumvolutions, till the Stump be entirely cover'd, and the whole Bandage wrapt up with Rollers or Bolsters.

The Capeline or Head-Bandage, having two Heads, is made with a Band of the same breadth, but somewhat longer. This Band being at first apply'd to the middle of the cut Part or Wound, the Heads are carry'd up above the Knee; and one of the Ends are turn'd backward, to bring it down, and to pass it over the end of the Stump. At every back-fold which is form'd above and below the Knee, a Circumvolution is to be made with the other end of the Band, to strengthen the back-folds, continuing to bring the Band downward and upward, till the whole Stump be cover'd: Then Rollers are made round the about the Stump, and the Band is stay'd above the Knee. Afterward the Part may be brought to Suppuration, cleans'd and cicatriz'd.

CHAP. XXII. Of the Operation of the Aneurism.

THIS Operation is perform'd when the Surgeon hath prickt an Artery, or when a Tumour ariseth in an Artery.

To this purpose the Patient is set in a Chair, and a Servant employ'd in holding his Arm in a Posture proper for the Operation; then a Bolster is to be laid four double, following the Progress of the Artery, to the end that the Ligature may better press the Vessel; and the Arm may be also surrounded with another sin­gle Bolster, on which is made a Ligature screw'd up with a Gripe-Stick, provided the Arm be not too much swell'd; for in this Case it wou'd be more expedient to deferr the Ope­ration for fear of a Gangrene. The Artery being thus well stopt, the Surgeon lays hold on the Arm with one Hand, below the Tu­mour, and with the other makes an Incision with his Lancet, beginning at the bottom of the Tumour, and ending on the top along the Progress of the Artery. When the Tumour is open'd, the coagulated Blood may be dis­charg'd with a Finger; and if there are any Strings at the bottom, they may be cut with a crooked Pair of Sizzers, to the end that all the Clods of Blood, and other extraneous Bo­dies which are sometimes form'd in Aneurisms when they are very inveterate) may be more [Page 254]easily remov'd. But the Gripe-Stick must be loosen'd, to discover the Opening of the Arte­ry with greater facility, and the Artery se­parated from the Membranes with a Fleam; for it wou'd be dangerous to cut it with a streight Incision-Knife: The Artery must also be supported with a convenient Instrument to divide it from the Nerve and Membranes; and to be assur'd of the Place of its Opening, the Gripe-Stick may be somewhat loosen'd, and afterward screw'd up again. In the mean time the Surgeon gives the Instrument to a Servant to hold, whilst he passeth under the Artery a crooked Needle with a wax'd String, cuts the Thread, and takes away the Needle: The he begins to make the Ligature be­neath the Opening of the Artery, tying at first a single Knot, on which may be put (if you please) a small Bolster, that may be kept stea­dy with two other Knots: It is also necessa­ry that another Ligature be made in the lower part of the Artery, by reason that the little lateral Arteries might otherwise let out Blood.

The Artery ought not to be cut between the two Ligatures, lest the first Ligature shou'd be forc'd by the Impulsion of the Blood; but the Thread must be let fall, that it may rot with the Suppuration. Then the Wound may be dress'd with Pledgets, Bolsters strew'd with Astringent Powders and a Plaister; a Bolster being also laid in the Fold of the Elbow.

The Bandage

Is made with a Band six Ells long, and an Inch broad, roll'd with one end, being at first apply'd with divers Circumvolutions under the Elbow, and moderately bound. Many turns are to be made, and a thick and streight Bol­ster, is to be laid upon the Tumour, (as in the Bandage for Phlebotomy) along the Artery, till it pass under the Arm-Hole: The Arm and Bolster must be surrounded with the Band, which is brought up with small Rollers, to the Arm-Pit, and stay'd with Circumvolutions round about the Breast. Afterward the Patient is to be laid in his Bed, with the Arm lying some­what bended on the Pillow, and the Hand a little higher than the Elbow.

CHAP. XXIII. Of the Operation of Phlebotomy.

TO perform this Operation, the Surgeon holds the Lancet between his Thumb and Fore-finger, and three other Fingers lying upon the Patient's Arm, and thrusts the Point of the Lancet into the Vessel, carrying the same Point somewhat upward, to make the Orifice the greater. If a Tendon, which is known by its hardness; or an Artery, which is discover'd by Pulsation, appear beyond the Vein, and very near it, the Lancet must be only set very for­ward [Page 256]in the Vein, and drawn back again streight, without turning it up, otherwise the Artery of Tendon wou'd be certainly cut with the Point. If the Artery or Tendon lies immediately un­der the Vein, the later must be prickt some­what underneath, holding the Lancet inclin'd side-ways, and thrusting it very little forward; so that the Point will finish the Opening, by turning it upward.

If the Artery stick too close to the Vein, the later is to be prickt higher or lower than it is ordinarily done; and if the Vein be super­ficial, and lie close upon a hard Muscle, the Lancet must not be thrust downright into the Vein, but it is requisite to carry it somewhat obliquely, and to take the Vessel above, lest the Muscle and its Membrane shou'd be prickt, which wou'd cause a great deal of Pain, and perhaps a vehement Inflammation. It is well known that the Veins of the Right Arm are usually open'd with the Right-hand, and those of the Left-Arm with the Left-hand.

The Bandage

Is made thus: The Surgeon having laid a Bolster upon the Orifice, keeps it close with two Fingers, and holds the Band or Fillet with the other Hand; then taking one end of the Fillet with the Middle-Finger, Fore-Finger, and Thumb, and applying it to the Bolster, he makes with the longest end of the Fillet divers Figures in form of the Letters KY in the Fold of the Arm; as also a back-fold with the shorter end of the Fillet, held between three [Page 257]Fingers. Afterward both ends of the Fillet are ty'd beneath the Elbow.

If an Inflammation happens after the Opera­tion, The Bolsters are to be dipt in Oxycratum: but if the Orifice were so small as to produce a Rhombus, it wou'd be requisite to press the Wound often with two Fingers, and immedi­ately to apply a Bolster dipt in Oxycratum.

CHAP. XXIV. Of the Operation of Encysted Tumours.

IF the Tumours are small and hanging, and have a narrow bottom, a Ligature may be made with Horse-Hair or Silk, dipt in Aqua-Fortis, which will cause 'em to fall off of them­selves after some time; or else they may be cut above the Ligature.

If the Tumour or Wen be thick, and its bottom large, a Crucial Incision is to be made in the Skin, without impairing the Cystis or Bagg; and when the Incision is finish'd, the Bag may be torn off with the Nails, or with the Handle of a Pen-Knife; but sometimes it is necessary to dissect it. If there be any con­siderable Vessels at the Root, they may be bound, or else cut; and the Blood may be stopt with Astringents. If any parts of the Cy­stis remain, they are to be consum'd with Cor­rosives; and the Lips of the Wound are to be drawn together without a Stitch, making use [Page 258]only of an agglutinative Plaister. But if the Tumour adheres very close to the Pericranium, it is most expedient not to meddle with it at all.

Of Ganglions.

Ganglions are Tumours arising upon the Ten­dons and Nervous Parts, which may be cur'd by thrusting 'em violently, and making a ve­ry streight Bandage, provided they be very re­cent; a resolvent Plaister is to be also apply'd to the Part.

CHAP. XXV. Of the Operation of the Hydrocephalus.

THIS Operation is perform'd when it is necessary to discharge watry Humours out of the Head: If these Waters lie under the Skin, a very large Opening is to be made with a Lancet, and a small Tube or Pipe left therein to let 'em run out. If the Water be situated between the Brain and the Dura Mater, the Membrane is to be perforated with a Lancet, after the Trepan hath been apply'd, according to the usual Method, of which we have already given some account: Cauteries and Scarifications may be also us'd to very good purpose in this Disease.

CHAP. XXVI. Of the Operation of cutting the Tongue-String.

WHEN the Ligament of the Tongue in Infants is extended to its Extremity, they cannot suck without difficulty; and when grown up, they have an impediment in their Speech.

This Ligament may be cut with a little pair of Sizzers; to which purpose the Thumb of the Left-hand being laid upon the Gum of the lower Jaw, to keep the Mouth open, the Tongue may be rais'd upward with the Fore-Finger of the same Hand, and the Sizzers may be pass'd between the two Fingers, to divide the String as near as is possible, to the Root of the Tongue, avoiding the Vessels: If an Haemorrhage happens, recourse may be had to Styptick-Waters. Afterward the Nurse must take care to let a Finger be often put into the Child's Mouth, to prevent the re-uniting of the String.

CHAP. XXVII. Of the Operation of opening stopt Ductus's.

IF there be only one Membrane that stops the Entrance of the Vagina, an Incision may be made, and a Leaden Pipe put into it, ha­ving Rings to fasten it to the Waste, to hin­der the re-uniting of the Wound.

If the Lips of the Pudendum are conglutina­ted or clos'd up, the Patient must be laid up­on her Back, and her Knees rais'd up, in or­der to make an Incision with a crooked In­cision-Knife, beginning at the Top; and then a Leaden Pipe is to be put into the Opening.

If the Vagina be fill'd with a Fleshy Sub­stance, an Incision is to be made therein, till it be entirely perforated, putting at the same time a Leaden Tube into the Orifice.

If the Urinary Ductus as well in young Boys as in Virgins, be stopt up, an Incision is to be made therein with a very narrow Lancet; and if a small Leaden Pipe can be conveniently introduc'd, it may be done; but it is not ve­ry necessary, in regard that Children are al­most always making Water, which wou'd of it self hinder the closing of the Orifice.

If the Ductus of the Ear be stopt with a Membrane, it must be perforated, taking care not to go too far, for fear of piercing the Membrane of the Tympanum or Drum, and [Page 261]a small Leaden Pipe is to be put into the Open­ing.

If there be a carnous Exerescence on the out­side of the Ear, a Ligature ought to be made therein, or else it may be cut with a pair of Sizzers, to cause it to fall off; and the rest of the Fleshy Substance that remains in the Ear must be consum'd with Causticks, con­vey'd to the Part by the means of a small Tube, care being had, nevertheless, to avoid cauterizing the Tympanum.

CHAP. XXVIII. Of the Operation of the Phimosis and Paraphimosis.

WHEN the Praeputium is so streight that the Glans can be no longer uncover'd, this Indisposition is call'd Phimosis; but if the Praeputium be turn'd back above the Glans, af­ter such a manner that it can no longer co­ver the same Glans, it is a Paraphimosis. If in the Phimosis the Praeputium cleaves very close round about the Glans, it is most expedient to let it alone; but if in handling the Glans it be perceiv'd that it is moveable, or else that some parts of it only stick together, the Operation may be perform'd after this manner: The Pa­tient being set in a Chair, a Servant is em­ploy'd in pulling back the Skin to the Root of the Penis, to the end that the Incision may be [Page 262]made directly at the bottom of the Glans: Then the Surgeon having drawn out the bot­tom of the Praeputium, introduceth a small In­strument with a very sharp Point on its flat side, at the end of which is sixt a Button of Wax, pierceth the Praeputium at the bottom of the Glans on the side of the Thread, and fini­sheth the Incision by drawing the Instrument toward himself.

The Paraphimosis is cur'd by making Fomen­tations on the Part, to allay the Inflammation if there be any; and it is to be pull'd down with the Fingers. But if Medicinal Prepara­tions prove ineffectual, Scarifications are to be made round about the Praeputium; and after­ward convenient Remedies may be apply'd to remove the Inflammation, and prevent the Mor­tification of the Part; so that at length the Prae­putium may be drawn over the Glans.

CHAP. XXIX. Of the Operation of the Varix.

IN order to cure this Tumour, the Surgeon having first cut the Skin to discover the dila­ted Vein, separates it from the Membranes, and passeth underneath a crooked Neodle with a double wax'd Thread; then he makes a Li­gature both above and below the dilatation of the Vein, opens the dilared Part with a Lan­cet, to let out the Blood, and applie; a conve­nient Bandage: But without performing this [Page 263]Operation, the Vein might be open'd with a Lancet, to draw out a sufficient quantity of Blood; and then the Varix is to be press'd with [...] somewhat close Bandage.

CHAP. XXX. Of the Operation of the Panaritium.

THE Panaritium is an Abcess which ari­seth at the end of the Fingers; some of these Tumours are only superficial, and others penetrate even under the Periosteum; neverthe­ [...]ess after whatsoever manner the Panaritium may happen, it ought to be open'd on the side of the Finger, that the Tendons may not be [...]urt. If the Abcess be extended under the Pe­riosteum, the opening must be made on the side, and the Lancet thrust forward to the Bone: Afterward the Pus or corrupt Matter is to be discharg'd, which wou'd cause the Tendons to putrisie, if it shou'd remain too long up­on 'em.

The Dressing and Bandage

Are made with a Plaister cut in form of a Malta Cross, which is apply'd at the middle to the end of the Finger, the Heads being cross'd round about. The Bolsters must be also cut in the shape of the Malta Cross, or of a plain Cross only; the Band being a Finger's breadth [Page 264]wide, and long enough to be roll'd about the whole Dressing: It must be pierc'd at one of its ends, and cut the length of three Fin­gers at the other; so that the two Heads may pass thro' the Hole, to surround the Fin­ger with small Rollers.

CHAP. XXXI. Of the Reduction of the falling of the Anus.

TO reduce the Anus to its proper place when it is fallen, the Patient being laid upon his Belly, with his Buttocks higher than his Head, the Operator gently thrusts back the Roll that forms the Anus with his Fin­gers dipt in the Oil of Roses: Then he ap­plies the Bolsters steept in some Astringent Li­quor, and causeth 'em to be supported with a sort of Bandage, the Nature of which we shall shew in treating of the Fracture of the Coccyx, that is to say, the T. the double T. or else the Sling with four Heads.

CHAP. XXXII. Of the Reduction of the falling of the Matrix.

IN this Operation, the Patient being laid upon her Back, with her Buttocks rais'd up, somentations are to be apply'd to the Part; [...] Linnen Cloth is to be laid upon the Neck of the fallen Matrix; and it is to be thrust [...]ery gently with the Fingers, without using [...]uch force. If the Matrix shou'd fall out a­ [...]in, it wou'd be requisite to convey a Pessa­ [...] into it, after it hath been reduc'd; and to [...]njoyn the Patient to lie on her Back with her legs a-cross.

CHAP. XXXIII. Of the Application of the Cautery.

THE Cautery is an Ulcer which is made in the Skin, by applying Causticks to it, [...]er this manner:

The Surgeon having moisten'd the Skin [...] a while with Spittle, or else having caus'd [...] light Friction to be made with a warm [...]oth, applies a perforated Plaister to the Part, [...]d breaks the Cautery-Stone, to be laid in [Page 266]the little Hole, leaving it for a longer or short­er time, accordingly as he knows its Efficacy, or as the Skin is more or less Fine. After­ward he scarifieth the Burn with his Lan­cet, and puts a Suppurative, or piece of fresh Butter into the Part, till the Escar be fallen off.

The Dressing and Bandage.

After the Application of the Lapis Inferna­lis, or any other Cautery-Stone, it is necessary to lay over it a Plaister, a Bolster, and a Circular Bandage, which ought to be kept sufficiently close, to press the Stone, after, a Pea or little Piece of Orrice-Root, hath been put into the Ulcer to keep it open. Then the Patient is to make use of this Ban­dage, with which he may dress it himself. Take a piece of very strong Cloth, large e­nough to roll up the Part without crossing a­bove it: And let three or four Holes be made in one of its sides, as many small Ribbans or Pieces of Tape being sow'd to the other, which may be let into the Holes, as occasion serves, to close the Band.

CHAP. XXXIV. Of the Application of Leeches.

IT is requisite that the Leeches be taken in clear running Waters, and that they be long and slender, having a little Head, the Back green, with yellow Streaks, and the Belly some­what reddish. Before they are apply'd, it is also expedient to let 'em purge during some Days in fair Water, fast half a Day in a Box without Water. Afterward the Part be­ing rubb'd or chaf'd with warm Water, Milk, [...] the Blood of some Fowl, the Opening of the Box is to be set to the Part, or the Lee­thes themselves laid upon a Cloth; for they will not fasten when taken up with the Fin­gers. The end of their Tail may be cut with [...] Pair of Sizzers, to see the Blood run, and to determine its quantity, as also to facilitate their sucking. When you wou'd take 'em away, put Ashes, Salt, or any other sharp thing upon their Head, and they will suddenly desist from their Work; but they are not to be pull'd off by force, lest they shou'd leave their Head or St [...]ing in the Wound, which wou'd be of ve­ry dangerous consequence. When they are re­mov'd, let a little Blood run out, and wash the Part with salt Water.

Is made with a Bolster soakt in some Styp­tick Water, if the Blood will not otherwise stop; or in Brandy or aqua-Vitae, if there be an Inflammation; and it is to be supported with a Bandage proper for the Part.

CHAP. XXXV. Of the Application of the Seton.

TO perform this Operation, a Cotton or Silk Thread is to be taken, after it hath been dipt in Oil of Roses, and let into a kind of Pack-Needle; then the Patient sitting in a Chair, is to hold up his Head backward, whilst the Surgeon gripes the Skin transverse­ly in the Nape of the Neck with his Fingers, or else takes it up with a Pair of Forceps, and pas­seth the Needle thro' the Holes of the For­ceps, leaving the String in the Skin. As often as the Bolster that covers the Seton is taken off, that part of the String which lies in the Wound is to be drawn out, and cut off.

CHAP. XXXVI. Of Scarifications.

SCARIFICATIONS are to be made more or less deep, accordingly as necessity [...]quires, beginning at the bottom, and carrying [...] on upward, to avoid being hinder'd by [...]e Haemorrhage. They must also be let one to another, that Strings may not be left in [...]e Skin.

CHAP. XXXVII. Of the Application of Vesicatories.

VESICATORIES are compounded with the Powder of Cantharides or Spanish [...]es, mixt with very sower Leaven, or else [...]th Turpentine. Before they are apply'd, a light [...]tion is to be made on the Part with a wram [...]eth, and a greater or lesser quantity is to be [...]d on, accordingly as the Skin is more or [...]s fine, leaving 'em on the Part about seven or [...] Hours; then they are to be taken away, [...]d the Blisters are to be open'd, applying there­ [...]me sort of Spirituous Liquor.

CHAP. XXXVIII. Of the Application of Cupping-Glasses.

A Good Friction being first made with warm Clothes, lighted Toe is to be put into the Cupping-Glass, or else a Wax-Candle fasten'd to a Counter, and then it is to be apply'd to the Part till the Fire be extinguish'd, and the Skin swell'd, re-iterating the Operation as of­ten as it is necessary; and afterward laying on a Bolster steept in Spirit of Wine. These are call'd dry Cupping-Glasses: But if you wou'd draw Blood, every thing is to be observ'd that we have now mention'd, besides that Scarifica­tions are to be made, according to the [...] manner; and the Cupping-Glass is to be set up­on the Scarifications: But when the Cupping-Glass is half full of Blood, it must be taken off to be emptied, and the Application thereof is to be re-iterated, as often as it is requisite to take away any Blood. Lastly, the Incision [...] are to be wash'd with some Spirituous Li­quor; and a Bandage is to be made convenien [...] for the Part.

CHAP. XXXIX. Of the opening of Abcesses or Impostumes.

AN Abcess or Impostume ought to be open'd in its most mature part, and in the Bias of the Humours, endeavouring to preserve the Fibres of the Muscles from being cut, unless there be an absolute necessity, avoiding also the great Vessels, Tendons, and Nerves. The O­pening must be rather large than small, and not too much press'd in letting out the puru­lent Matter. If the Skin be thick, as it happens in the H [...]el, it may be par'd with a Razor; and if the Matter be lodg'd under the Nails, it wou'd be requisite to scrape 'em with Glass be­fore they are pierc'd.

A TREATISE OF THE OPERATIONS OF FRACTURES.

CHAP. I. Of the Fracture of the Nose.

WHEN the Fracture is considerable, the Nostrils are stopt up, and the Sense of Smelling is lost. In order to re­duce it, the Surgeon takes a little Stick wrapt up in Cotton, and introduceth it into the No­strils as gently as is possible, to raise up the Bones again, laying the Thumb of his Left-hand upon the Nose, to retain 'em in their place. The Bones being thus set, he proceeds to prepare

The Dressing and Bandage

By conveying into the Nostrils certain Leaden Pipes of a convenient Bigness and Figure, which serve to support the Bones, and to facilitate Re­spiration. But care is to be had to avoid thrust­ing 'em up too far, for fear of hurting the fides of the Nose; and they are to be anoint­ed with Oil of Turpentine mixt with Spirit of Wine: These Pipes are also to have little Han­dles, with which they may be fasten'd to the Cap. If there be no Wound in the Nose, there will be no need of a Bandage; but if the Fracture be accompany'd with a Wound, after having apply'd the proper Medicines, it wou'd be requisite to lay upon each side of the Nose a Triangular Bolster, cover'd with a little piece of Paste-board of the same Figure. This small Dressing is to be supported with a kind of Sling that hath four Heads; being a piece of Linnen-Cloath, two Fingers broad, and half an Ell long; it is slit at both ends, and all along, only leaving in the mid­dle a Plain of three Fingers, that is to say, a part which is not cut. The Plain of this Sling is to be laid upon the Fracture, causing the upper Heads to pass behind the Nape of the Neck, which are to be brought back again forward; the lower Heads are likewise to be carry'd behind, crossing above the upper, and afterward to be return'd forward. If the Bones of the Nose be not timely reduc'd, a great De­formity soon happens therein, and a Stink caus'd by the Excrescences and Polypus's.

CHAP. II. Of the Fracture of the lower Jaw.

THE Operator at first puts his Fingers in­to the Patient's Mouth, to press the Pro­minences of the Bones; and afterward doth the same thing on the outside, If the Bones pass one over another, a small Extension is to be made. If the Teeth be forc'd out of their Place, they are to be reduc'd, and fa­sten'd to the found Teeth with a wax'd Thread.

The Dressing and Bandage.

If the Fracture be only on one side, a Bol­ster sow'd to a piece of Paste-board is to be laid upon the flat side of the Jaw, both be­ing of the Figure and Size of the Jaw it self. The Bandage of this Fracture is call'd Cheve­stre, i. e. a Cord or Bridle, by the French Sur­geons, and is made by taking a Band roll'd with one Head or End, three Ells long, and two Fingers broad; the Application of it is be­gun with making a Circumvolution round a­bout the Head in passing over the Fore-head; then the Band is let down under the Chin, and carry'd up again upon the Cheek, near the lesser Corner of the Eye in passing over the Fracture; afterward it is rais'd up to the Head, and brought down again under the Chin, [Page 275]to form a Roller or Bolster upon the Fracture: Thus three or four Circumvolutions and Rollers being made upon the Fracture, the Band is let down under the Chin, to stay and strengthen its several Turns, and is terminated round the Head, in passing over the Fore-head.

If the Jaw be fractur'd on both sides, it wou'd be requisite to apply thereto a Bolster and Paste-board, perforated at the Chin, and of the Figure of the entire Jaw; the Bandage which we have even now describ'd, may be also pre­par'd in making Rollers on both sides of the Jaw: Or else the double Chevestre may be made with a Band of five Ells long, and two Fingers broad, roll'd up with two Balls, that is to say, with the two Ends. The Applicati­on of this Band is begun under the Chin, from whence it is carry'd up over the Cheek, cross'd upon the top of the Head, and brought down behind the Head, where it is cross'd a­gain; then it is let down under the Chin, cross'd there, and carry'd up over the Fracture; afterward the Band being pass'd three or four times over the same turns, in making Rollers upon the Jaws, is turn'd upon the Chin, and stay'd upon the Forehead round about the Head.

CHAP. III. Of the Fracture of the Clavicle.

THE Patient is to be set in a Chair, and his Arm is to be drawn backward, whilst an Assistant thrusts his Shoulder forward: In the mean time the Operator sets the Bones a­gain in their place, by thrusting the Protuberan­ces, and drawing out the sunk Bone.

Or else a Tennis-Ball may be taken, and put under the Patient's Arm-Pit, whose Elbow is then to be press'd against his Ribs, whilst the Surgeon reduceth the Fracture.

Otherwise, the Patient may be laid upon his Back, putting a Convex Body under both his Shoulders, as a Bowl, or large wooden Por­renger; and then the Shoulders may be prest, to raise up the two ends of the Bones, which the Surgeon must take care to reduce.

The Dressing and Bandage.

The Cavities which are above and below the Clavicle, are to be fill'd with Bolsters trimm'd with Paste-boards; another is to be also laid upon the Bone, which is almost of the same Figure with the Clavicle, and a large Bolster, to cover the three others: This Dressing is to be secur'd with the Bandage call'd the Cape­ [...]ine or Head-Bandage, provided the Fracture [...]e in the middle of the Clavicle. A Band be­ing [Page 277]taken about six Ells long, and four Fin­ [...]ers thick, roll'd with two Balls; it is apply'd is the middle to the Fracture; one of its Heads or Ends is let down upon the Breast, whilst the other is pass'd behind the Back, below the Arm-hole, opposite to the indispos'd Arm- [...]ole, and above the Breast, to be carry'd o­ [...]erthe other end of the Band, which is rais'd up, to make a Roller or Bolster upon the Fracture: The other end is pass'd under the indispos'd Arm­pit, and upon the Band that made the Roller, which is elevated by making a third Roller upon the Clavicle: These Circumvolutions [...]nd about the Body are continu'd, as also these Rollers upon the Clavicle, till it be en­ [...]irely cover'd. Some. Circumvolutions are also [...]de upon the upper part of the Arm, near is Head: The Space that lies between the Rol­ [...]s and the Circumvolutions of the Arm, and [...]hich bears the Name of Geranium or Stork's-Bill, is likewise cover'd with some Circumvo­ [...]tions, and the Band is stay'd by making Cir­ [...]mvolutions quite round about the Body.

If the Fracture were near the Head of the [...]merus or Arm-Bone, a sort of Bandage might be prepar'd, which is call'd Spica, with a Band [...]ll'd with one Ball five Ells long, and four fingers broad; one end of this Band is pass'd under the Arm-pit opposite to the indispos'd [...]e behind the Back: The other end is con­ [...]ey'd under the indispos'd Arm-pit; the Fi­gure of the Letters KY or X is made on the Shoulder; the Band is return'd below the [...]her Shoulder behind; it is brought back again before, to form a second KY upon the Fra­cture; [Page 278]three or four more KY's are wrought upon the Fracture; two Circumvolutions are made in the upper part of the Humerus, which con­stitute a Triangle call'd Geranium; this Tri­angle is cover'd with Rollers, and the Band is terminated round about the Breast.

CHAP. IV. Of the Fracture of the Omoplata or Shoulder-Blade.

THE Acromion is usually fractur'd, but it may be known that the middle of the O­moplata is broken by a Numness which is felt in the whole Arm: Whereupon the Surgeon, after having examin'd the place of the Fracture, thrusts back the Prominences of the Bones in­to their place; and if any Splints happen to prick the Part, he makes an Incision to take 'em out, or to cut off their Points.

The Dressing and Bandage.

A Bolster is laid upon the Omoplata, as also a large piece of Paste-board of the bigness and Figure of this Bone, and a sort of Bandage is prepar'd, known by the name of the Star, with a Band roll'd with one Head four Ells long, and as many Fingers broad. This Band is convey'd behind the Back, one of its ends ly­ing under the Arm-hole, opposite to the indis­pos'd one; but the other is pass'd under the [Page 279] [...]houlder, and afterward above it, to make a KY in the middle of the Back; then passing [...]der the other Arm-hole, it is brought up to [...] Shoulder, to be let down, and to form a [...]ond KY upon the middle of the Back: These Turns are continu'd in making Rollers, [...]ll the Omoplatae are all cover'd: Circumvolu­tions are also made round the upper part of [...]e Humerus, as in the Spica; and the Ba [...] ­ [...]ge is finish'd by Circumvolutions round about [...]e Breast.

CHAP. V. Of the Fracture of the Ribs.

WHEN a Rib is broken, one of the ends pusheth into the Breast, sometimes on the outside; and sometimes the Ends lie against each other. In order to reduce it, the Patient being laid upon the sound Rib, a Plaister of Mastick is apply'd to the Fracture; and it is drawn out violently; so that sometimes this Attraction brings back the Bone, which is ad­ [...]anc'd into the Breast; but the surest way is to make an Incision therein, to raise it up with the Finger.

If the Rib appear without, the Patient is to be set in a Chair, and oblig'd to bend his Body on the side opposite to the Fracture, holding his Breath, with which he must puff strongly, without letting it forth, in order to di­late the Breast, whilst the Surgeon thrusts the Rib into its place.

The Dressing and Bandage.

A Bolster is to be apply'd to the Fracture, with two little Pieces of Paste-board pass'd in form of a St. Andrew's Cross; and another Bol­ster upon the whole Dressing, on which is al­so laid a large square Paste-board cover'd with a Bolster. The Bandage is made with a Nap­kin folded into three Folds, which is put round the Breast, being sow'd and supported by the Scapulary; which is a Band six Fingers broad, perforated in the middle, to let in the Head. The two ends of the Scapulary are fasten'd be­fore and behind to the Napkin.

CHAP VI. Of the Fracture of the Sternum or Breast-Bone.

TO reduce this Fracture, the Patient is to be laid upon his Back, with a Convex Body underneath; both his Shoulders are to be press'd with some weight, to push 'em backward, and to raise up the Sternum, which is sunk down; or else an Incision may be made upon the [...] Bone, to discover it; and then a Vectis is to be apply'd thereto very gently, in order to heave it up into its place.

The Dressing and Bandage.

A Bolster and Paste-board are to be laid upon the Sternum, almost of the same Figure with the Part; and the Bandage is to be prepar'd with a Napkin supported with a Sca­pulary. Or else the Bandage call'd Quadriga may be made with a Band roll'd with two Heads, five Ells long, and four Fingers broad: The Application of this Band is begun under-the Arm-pit; the Figure of KY is form'd un­der the Shoulder; the Band is carry'd down­ward with the two Balls, one before, and the other behind; it is pass'd under the other Arm­hole; the Heads are cross'd upon the Shoulder, and it is brought down backward and forward, forming a KY before and behind. Afterward the Band is roll'd about the Breast in making Rollers or Bolsters; these Rollers are continu'd till the Band be terminated; and it is stay'd by [...] Circumvolution round the Breast.

CHAP. VII. Of the Fracture of the Vertebra's.

THE Apophyses of the Vertebra's are com­monly broken, and their Bodies but sel­dom: It may be known that the Body of the Vertebra of the Neck and Back is fractur'd by the Palsie of the Arm, accompany'd with the loss of Feeling; by the suppression of Urine; [Page 282]and by the Palsie of the Sphincter of the Anus; so that the Excrements cannot be any longer retain'd. If these Symptoms appear, it may well be conceiv'd that the Marrow is compress'd, and prickt with Points; for the removing of which, it is necessary to make an Incision upon the Body of the Vertebra in the fra­ctur'd Place.

If the Apophyses Spinosae are only fractur'd, these Accidents will not happen, only some Pain will be felt: To reduce 'em, the Patient is to be laid upon his Belly, and the Surgeon must use his utmost endeavours to raise up the Bone again, and to set it in its Natural Situation.

The Dressing and Bandage.

If the Apophysis Spinosa were fractur'd, it wou'd be requisite to apply to each side of it a small long Bolster, which is to be cover'd with a Paste-board of the same Figure with the Bolster; another Bolster lying upon each Paste-board. The Bandage is to be made with a Napkin sustain'd by its Scapulary; or else the Quadriga may be prepar'd, according to the manner we have already describ'd in the Fra­cture of the Sternum.

CHAP. VIII. Of the Fracture of the Os Sacrum.

IT is reduc'd as the other Vertebra's; but its Dressing and Bandage are made with the T perforated at the Anus, or else with the [...] or double T. It is made with a Band two Fingers broad, and long enough to encompass the Body above the Hips; so that to the mid­dle of this Band is fasten'd another Band of the same breadth, and of a sufficient length to pass over the Dressing of the Os Sacrum, as al­so between the Thighs, to be join'd in the fore-part to the first Cincture. The double T is made by fastening two Bands at a Finger's breadth distance one from another, to be Band which ought to be roll'd about the Body; and this sort of Bandage is to be supported with a Scapulary.

CHAP. IX. Of the Fracture of the Coccyx or Rump-Bone.

THIS Bone is usually broken by falls, and sinks into the inside; so that to reduce it, the Fore-finger of one Hand is to be put into the Anus or Fundament as far as the Fra­cture, [Page 284]to thrust it back again into its place, whilst the other Hand setleth it on the out­side.

The Dressing and Bandage

Are the same with those in the Fracture of the Os Sacrum; but the Patient must be ob­lig'd to lie on one side, and to sit in a per­forated Chair, when he hath a mind to rise.

If the Os Innominatum be broken, the Spica is to be us'd after it hath been dress'd, of which Bandage we have given an Account in the Fra­cture of the Clavicle.

CHAP. X. Of the Fracture of the Humerus or Arm-Bone.

TO set this Bone, a strong Extension is to be made, if the two ends cross one ano­ther, to which purpose the Patient is to be plac'd on a little Stool or Seat, and supported by a Servant, two other Assistants being em­ploy'd to draw, one at the upper-part, and the other at the lower, above the Elbow, and not beneath it. In the mean time the Operator re­duceth the two Bones, by closing 'em on all sides with the Palms of his Hands, and after­ward prepareth

The Dressing and Bandage.

It is necessary at first to lay round the Fra­cture a Bolster steept in some proper Liquor, as Claret or Oxycratum; then three several Bands are to be taken, three or four Fingers broad, and an Ell and a half long: The first of these is to be laid upon the Fracture, round which are to be made three very streight Circumvolutions; then it is to be carry'd up with small Rollers to the top of the Arm, and stay'd round the Bo­dy. The second Band being apply'd to the Fracture, on the side opposite to the first, two Circumvolutions are to be made upon the Fra­cture; so that the same Band may be brought down along the whole length of the Arm, making divers Rollers▪ and at last stay'd be­low the Elbow, which, nevertheless, it must not [...]over. Afterward four Longitudinal Bolsters must be laid upon the Fracture round about [...]he Arm, which are to be kept close with a [...]hird Band; it being of no great Importance whether the Application of this third Band be begun at the Top▪ or at the Bottom; but it [...]ay be stay'd round the Body, or else beneath [...]e Elbow. The Arm ought also to be en­compass'd with two thick pieces of Paste-board made round at the ends, and of the length of [...]e Arm; but they must not cross one another. These Paste-boards are to be fasten'd with [...]ee Ribbands, and the Arm is to be put in­ [...] a Scarf made with a large Napkin, which [...] to be first apply'd in the middle under [...]e Arm-pit, the Arm resting upon it, so that [Page 286]the four ends may be rais'd up, and fasten'd to the opposite Shoulder; but the Hand must lie higher than the Elbow.

CHAP. XI. Of the Fracture of the Bone of the Elbow.

IF both the Bones of the Elbow be broken, a stronger Extension is to be made than if on­ly one of 'em were so hurt; to which purpose a Servant is to be appointed to grasp the Arm above the Elbow with both his Hands, and another to hold it above the Wrist, whilst the Surgeon sets the Bones with the Palms of both his Hands, till no unevenness be any longer felt in the Part.

The Dressing and Bandage

Are the same with those in the Fracture of the Arm; but the Bands which are carry'd upward are to be stay'd above the Elbow. If the Patient be desirous to keep his Bed, it is re­quisite that his Arm be laid upon a Pil­low, the Elbow lying somewhat higher than the Hand.

CHAP. XII. Of the Fracture of the Carpus or Wrist-Bone.

[...]F the Bones of the Carpus, or those of the Metacarpium be fractur'd, a Servant must old the Arm above the Wrist, and ano­ [...]her the Fingers; whilst the Operator sets the [...]ones in their place, so as no unevenness may [...]pear in the Part.

The Dressing and Bandage.

Of the Fracture of the Wrist are to be pre­ [...]'d with a Band roll'd with one Head, be­ [...]g six Ells long, and two Fingers broad; so [...]at three Circumvolutions are to be made up­ [...] the Wrist; the Band is to be pass'd over [...]e Hand, between the Thumb and the Fore-fin­ [...]er, making the Figure of KY upon the [...]humb. Then after having made divers Rol­ [...]s upon the Carpus, a Bolster is to be ap­ [...]'d, with a little Piece of Paste-board of the [...]ne Shape with the Wrist; several Rollers [...] to be form'd on the top of the Elbow, [...] stay the Band above it; and the Arm is to [...] put into a Scarf.

CHAP. XIII. Of the Fracture of the Bone of the Metacarpium.

TWO Servants are to hold the Hand, af­ter the same manner as in the setting of the Carpus or Wrist-Bone, whilst the Surgeon reduceth the broken Bone by fixing it in its Natural Situation.

The Dressing and Bandage

Are made with a Band roll'd up with one Head, five Ells long, and two Fingers broad: This Band being fasten'd to the Wrist, with a Circumvolution, is to be laid on the Metacar­pium, between the Thumb and the Fore-fin­ger, and the Figure of KY is to be made upon the Hand: Then the forming of Rollers and KY's is to be continu'd till the Metacarpium be cover'd; a Bolster and Paste-board are to be laid upon the same Metacarpium; as also one in the Hand, of the Skape of the Part: The inside of the Hand is to be trimm'd; and the whole Contexture is to be cover'd as before, with Rollers; which are continu'd till above the Elbow, where the Band is stay'd.

CHAP. XIV. Of the Fracture of the Fingers.

A Light Extension is to be made in the Fin­gers to reduce 'em, and a small Dressing is to be prepar'd for every Finger, almost like that of the Arm. The Fingers are to be some­what bent, and the inside of the Hand is to be trimm'd with a Bolster, to retain 'em in this Situation. The Bolster is also to be day'd with a Band, and the Arm to be put [...]o a Scarf.

CHAP. XV. Of the Fracture of the Thigh.

IF the Thigh-Bone be broken near its Head, the Fracture is very difficult to be disco­ver'd; but if the Bones pass one over ano­ther, it may be soon known, because the hurt [...]eg will be shorter than the other. There­fore a very great Extension is to be made; and if the Hands are not sufficient for that purpose, recourse may be had to Straps and Engines. In the mean time the Operator is to [...]ay his Thumbs upon the fractur'd Bone, to thrust it back into its place, and afterward to apply

The Dressing and Bandage.

The Cavity of the Thigh is to be fill'd with a thick Bolster, of the length of its bending; and three Bands four Fingers broad are to be provided, the first being three Ells long, and the second four, as well as the third: Then three Circumvolutions are to be made upon the Fracture with the first Band, carrying it up with small Rollers, and it is to be stay'd round the Body. The second Band is to make two Circumvolutions upon the Fracture, and is to be brought down with small Rol­lers, which are terminated above the Knee; or else they may be continu'd all along the Leg; it is also to be pass'd under the Foot, and to be drawn up again upon the Leg: Then a Bolster is to be apply'd to the lower part of the Thigh, being thicker at bottom than at top, to render the Thigh everywhere even; and four Longitudinal Bolsters are to be added, on which are laid Splints of the same length and breadth, which are to be wrapt up with a single Bolster. The third Band is to be roll'd upon these Splints, beginning at the bottom, and ascending with Rollers. Then two large Paste-boards are to be us'd, which may embrace the whole Dressing, without crossing one another, being fasten'd with three Ribbands. Afterward a Pair of Pumps is to be put under the Foot, and the Heel to be supported with a small Roll, the Thigh and Leg being let into the Scarves, the inner of which is to extend to the Groin, and the [Page 291]outermost is to be somewhat longer: Two little Cushions are also to be laid on each side be­low the Knee, and two others below the An­kles, to fill up the Cavities. These Cushions or large Bolsters are to lie between the Scarves; and a thick Bolster is to be laid upon the Leg all along its length, as also one upon the Thigh. The Scarves are to be bound with three Rib­bands for the Legs, and as many for the Thighs; the Knots being ty'd without, and on the side.

CHAP. XVI. Of the Fracture of the Knee-Pan.

THE Knee-Pan is cleft or broken in divers pieces in its length, and cross-wise: If it be broken cross-wise or obliquely, the two Pie­ces fly out one from another; and on this oc­casion a strong Extension is to be made; whilst the Surgeon at the same time thrusts back again the upper-part of the Knee-Pan into its place.

If the Knee-Pan be fractur'd in its length, to Extension can be made, because the pieces of the Bones remain in their place.

The Dressing and Bandage.

If the Knee-Pan be broken cross-wise, a Band is to be provided three Ells long, and two Fingers broad, which may be roll'd with [Page 292]one or two Heads. The Application is to be be­gun above the Knee-Pan; the Figure of KY is to be made in the Ham, and a Circumvo­lution under the Knee; then the Band is to be continually carry'd up and down, till the Knee-Pan be entirely cover'd.

If the Knee-Pan be fractur'd in its length, that is to say, from the top to the bottom, the Uniting-Band must be us'd, being two or three Ells long, and two Fingers broad, per­forated in the middle. It is to be at first apply'd under the Knee, and one of the Balls is to be pass'd thro' the Hole; it must also be well clos'd, and divers Circumvolutions are to be made upon the Knee-Pan, so as it may be altoge­ther cover'd.

CHAP. XVII. Of the Fracture of the Leg.

IF the Tibia be only broken, it pushes into the Inside; but if both Bones be fractur'd they are sometimes separated on both sides, o [...] else they pass one upon another; and in thi [...] case the Leg is shorter than it ought to be If the Perone be broken, it pushes to the out­side.

If one Bone be only fractur'd, so strong a [...] Extension is not requisite as when they ar [...] both shatter'd, and it is to be drawn only o [...] one side; whereas the drawing ought to be equa [...] on both sides when both Bones are concern'd [Page 293]Thus whilst the Assistants are employ'd in drawing, the Surgeon performs the Operation, by laying the ends of the Bones exactly against one another; and they are known to be re­duc'd when the great Toe remains in its Natu­ral Situation.

The Dressing and Bandage.

A simple Bolster dipt in a convenient Liquor is at first apply'd, and three Bands three Fin­gers broad are prepar'd, the first being two [...]lls long, the second three, and the third three and an half. Three very streight Circumvo­lutions are to be made upon the Fracture; the Band is also to be carry'd up with Rollers, and [...]tay'd above the Knee. The Application of the second Band is to be begun upon the Fra­cture with two Circumvolutions; it is to be brought down with Rollers, to pass under the Foot, afterward carry'd up again, and stay'd where it is terminated. The Leg is to be fill'd with a Bolster thicker at the bottom than at the top; and then are to be laid on the four Longitudinal Bolsters, two Fingers broad, and as long as the Leg; to which are to be apply'd the Splints of a plyable and thin Wood: These are wrapt up with a simple Bolster, and strength­en'd with the third Band, which is apply'd in­differently either at the top or bottom, oppo­site to the former; so that it is carry'd up or else down in making Rollers, and stay'd at its end. The whole Contexture is to be encom­pass'd with large Paste-boards made round at the Ends, which are not to cross one another, [Page 294]but must be streighter at the bottom than at the top, and are to be ty'd with three Rib­bands or pieces of Tape, beginning at the mid­dle; so that the Knots be ty'd on the outside. Afterward the Leg is to be put into the Scarves, and the Heel is to be supported with a Lin­nen-Roll, to which are fasten'd two Ribbands that are ty'd upon the Scarves: These Rolls are made with a small piece of Cloth, which is doubl'd, and roll'd up with the ends, in which is contain'd some Straw, and a little Stick in the middle, to consolidate 'em. The Foot is supported with a Paste-board or Wood­en Sole, trimm'd with a Bolster, or small Quilt sow'd over it. Divers Strings are also fasten'd to the middle of the sides of the Sole or Pump, which are cross'd to be joyn'd to the Scarves; and another is sixt at the end of the Sole, which is ty'd to a Ribband that binds the middle of the Scarf. These Scarves are likewise fasten'd with three Ribbands, beginning with that in the middle, the Knots being without, and trimm'd with four Bolsters, that is to say, two on each side, to fill up the Cavities that are belo [...] the Knee, and above the Ankle. Last­ly, the Leg is to be plac'd somewhat high, and a Cradle to be laid upon it, to keep off the Bed-Cloaths, the Scarves passing over the Knee and Foot.

The Dressing of Complicated Fractures

Of the Arms, Legs, and Thighs is prepar'd with a Bandage having Eighteen Heads or Ends, in order to make which, a Linnen-Cloth is to [Page 295]be taken of the length of the Part, and broad [...]nough to cause it to be cross'd thereby: It is to be folded into three doubles, and cut in three places on each side, leaving the middle plain; so that eighteen Heads or small Bands [...]e form'd, every one of which will be four fingers broad, the upper Heads being a little [...]orter than the lower. This Band of eighteen Heads is to be laid upon the Scarves, and a Bol­ler is to be apply'd to it four Fingers broad, [...]s long as the Scarves. The Leg is laid upon [...]his Bolster, and it hinders the corrupt Matter [...]om falling on the Bandage.

When the Wound hath been dress'd, the fracture is to be incontinently surrounded with [...]ee of the Heads, which ought to cross one a­ [...]other: Then after the Leg hath been bound with the first Heads, two Longitudinal Bol­lers are to be apply'd to the side of it; and the other Heads are to be rais'd up, with all the rest of the Dressing, which hath been de­scrib'd in the simple Fracture.

CHAP. XVIII. Of the Fracture of the Bone of the Foot.

THE Reduction of the Bone of the Foot is perform'd after the same manner as that of the Hand.

The Dressing and Bandage

Are made with a Band roll'd with two Heads, being three Ells long, and two Fingers broad: The Application of it is begun with a Circumvolution above the Ankles; it is pass'd on the Foot, and in like manner makes a Cir­cumvolution round it: Afterward the same Band is cross'd over the Metatarsus, upon which are made some Folds in form of a Rhombus or Diamond; as also on the Toes, and it is stay'd above the Ankle-Bone; or else it is carry'd up along the Leg, to be stay'd above the Knee. This Bandage serves for all Fractures of the Bones of the Foot, and is call'd the Sandal.

A TREATISE OF THE OPERATIONS Which are perform'd in LUXATIONS.

CHAP. I. Of the Luxation of the Nose.

THE Bones of the Nose may be sepa­rated from that of the Fore-head by a Fall, or some violent Blow; and the Surgeon in order to set 'em, at first [...]s his Thumb upon the Root of the No [...] [...]en he introduceth a little Stick trimm'd [...] [...]otton, into the Nostrils, and by the [...] [...]hereof thrusts back the Bones in [...] [...]lace.

The Dressing and Bandage

Are the same with those that have been already describ'd in the Fracture of the Bones of the Nose.

CHAP. II. Of the Luxation of the lower-Jaw.

THE Jaw may be luxated either on both sides, or only on one. When the Disloca­tion happens on both sides, it hangs over the Sternum or Breast-Bone, and the Spittle runs abundantly out of the Mouth: To reduce it, the Patient must sit down, and his Head is to be supported by a Servant; then the Opera­tor or Surgeon having wrapt up his two Thumbs, puts 'em into the Mouth upon the Molar Teeth, his other Fingers lying under the Jaw, which is to be drawn down by raising it up, having before set two small Wooden Wedges upon the two Molar Teeth on both sides of the Jaw, lest the Surgeon's Fingers shou'd be hurt, as the Bone is returning to its place.

If the Luxation be forward, a Band or Strap is to be put under the Chin, an Assistant ha­ving his Knees upon the Patient's Shoulders, where he is to draw the Strap upward, to faci­litate the Extension; which the Surgeon makes with his Hands, at the same time thrusting the Bone back again into its place.

When the Jaw is luxated only on one side, the Chin stands a-cross, and the dislocated side is squash'd down, a small Cavity being perceiv'd in it, and a Rising on the other side; so that the Mouth cannot be shut close, but re­remains somewhat open, the lower Teeth ap­pear farther out than the upper; and the Ca­nine or Dog-Teeth lie under the Incisive. This Luxation is reduc'd by giving a blow with the Hand upon the luxated Bone which is suffici­ent to cause it to re-enter its Natural Place.

The Dressing and Bandage

Are altogether the same with those us'd in the Fracture of the Bones of the lower Jaw.

CHAP. III. Of the Luxation of the Clavicle.

THE Clavicle is oftner loosen'd from the A­cromion than from the Sternum; when it hath left the former the Arm cannot be lifted up; the Acromion makes a Prominence, and the Clavicle descends downward, a Cavity appear­ing in its place. To reduce this Luxation, the Patient is to be laid upon some Convex Body put between his Shoulders; both which are to be press'd backward, to raise up the Clavicle▪ Afterward he is to be set in a Chair, that his Arm may be drawn backward, whilst the Sur­geon [Page 300]is employ'd in pressing the Clavicle and Acromion, to join 'em together.

The Dressing and Bandage

Are the same with those that we have alrea­dy shewn, in treating of the Fracture of the Clavicle.

CHAP. IV. Of the Luxation of the Vertebra's.

IN the Luxation of the Vertebra's of the Neck, the Head stands to one side, and the Face is swell'd and livid, with a difficulty of Respiration.

To reduce this Dislocation, the Patient is to be set upon a low Seat, an Assistant leaning on his Shoulders, to keep his Body steady, whilst the Surgeon or Operator draws his Head up­ward, and turns it from one side to ano­ther: Then if the Accidents or Symptoms cease, the Cure is perform'd; so that Fomentations may be apply'd to the Part; and the Patient being laid in his Bed, must take care to avoid moving his Head.

When the Vertebra's of the Back or Loins are luxated on the inside, a sinking of the Bone is soon perceiv'd; whereupon the Patient be­ing laid on his Belly, the Extension is to be made with Napkins pass'd under the Arm-Pits, and upon the Os Ileum, whilst the Surgeon with [Page 301]a strong Extension makes some Efforts on the Spine, endeavouring to draw back the Verte­bra. If that be not sufficient, an Incision is to be made upon the Apophysis Spinosa of the Ver­tebra; so that after having laid open this Pro­cess of the Bone, it may be taken out with a Pair of Forceps. Then the Wound is to be dress'd with Pledgets, a Plaister, and a Nap­kin, which must not be bound too close, for [...]ear of pushing back the Spine.

When the Vertebra is luxated on the outside, a Prominence appears; so that to reduce this Dislocation, the Extension is to be made as be­fore, the Patient lying in like manner upon his Belly; but in order to push back the Vertebra, two little Sticks trimm'd with Linnen-Cloth are to be prepar'd, and laid along the two sides of the Spine of the Vertebra; yet these Sticks ought to be thick enough to remain more elevated than the Apophysis Spinosa; and a large Wooden Roller is to be often roll'd up­on 'em, which by its turning backward and for­ward, may thrust the Vertebra's inward; so that when all the Vertebra's are of an equal height, the Reduction is finish'd. If the Vertebra's are luxated on the side, the same Extensions are to be made, and the Prominence is to be push'd, to re-establish the Vertebra in its place.

The Dressing and Bandage.

The Dressing is prepar'd by laying two thin Plates of Lead on each side of the Spinous Process of the Vertebra, to maintain it in its Place, and a long Bolster over 'em. The [Page 302]proper Bandage is the Quadriga, which hath been before describ'd, in treating of the Fra­ctures of the Breast-Bone.

CHAP. V. Of the Luxation of the Coccyx or Rump-Bone.

IF the Coccyx be sunk on the inside, it is to be rais'd with the Fore-finger of the Right-hand put into the Anus; and if the Luxation be on the outside, it may be gently thrust back again. An Account of its proper Dressing and Bandage hath been already given in the Fra­cture of the Coccyx.

CHAP. VI. Of the Bunch.

THE Bunch is nothing else but an exterior Luxation of the Vertebra's, and for the Cure thereof, it wou'd be requisite lo keep E­mollients for a long time upon the Vertebra's, to loosen the Ligaments, and to wear Iron-Bo­dice; which in compressing the Vertebra's by lit­tle and little, might perhaps drive 'em back into their Natural Place.

CHAP. VII. Of the Luxation of the Ribs.

THE Ribs are luxated either on the out­side, or on the inside: If they be disloca­ted on the inside, a Cavity is perceiv'd near the Vertebra's, the Patient drawing his Breath with Pain, and not being able to bend his Body.

When the Luxation is on the outside, and happens in the upper Ribs, the Patient's Hands are to be hoisted upon the top of a Door, to raise up the Ribs, whilst the Surgeon pres­seth the Prominence of the Rib to restore it to its place.

When the lower Ribs are luxated, the Pati­ent must be oblig'd to stoop, laying his Hands upon his Knees, and the Prominence of the Bone is to be thrust back.

If a Rib be luxated on the inside, an In­cision is to be made to draw it out with the Fingers.

The Dressing and Bandage

Are the same with those that are us'd in the Fracture of the Ribs.

CHAP. VIII. Of the Sinking of the Xiphoides, or Sword-like Cartilage.

TO raise up the Xiphoid Cartilage, it must be fomented before for some time with Oil of Turpentine, or other Fomentations, made with Aromaticks; then the Patient is to be laid upon his Back, with a Convex Body underneath, and the Shoulders, and Sides of the Breast are to be press'd, to lift up the Cartilage. When this Operation is not sufficient, dry Cupping-Glasses are usually apply'd, till the Bart be ele­vated, and a strengthening Plaister is afterward laid upon it.

CHAP. IX. Of the Luxation of the Humerus, or Arm-Bone.

THE Head of the Humerus generally falls under the Arm-Pit, so that the luxated Arm becomes longer than the other, the Acro­mion appears pointed on the outside; the Elbow starts from the Ribs, and cannot be mov'd with­out great Pain. To reduce this Bone, the Pa­tient [Page 305]is to be set upon a low Seat, or else on the Ground, whilst some Person supports his Body with a Napkin: In the mean time the Surgeon is to lay hold on the upper-part of the Humerus, a Servant kneeling behind him, who is to hold the Patient's Arm above the Elbow, which is to pass between the Surgeon's Legs, and is to be drawn down by the Assistant as much as is possible, whilst the Surgeon in like manner draws the Arm, to remove the Head of the Bone out of the place where it was stopt; insomuch that the Bone sometimes makes a Noise in re-entring its Cavity.

Or else the Patient's Arm may be laid up­on the Shoulder of a taller Man than himself, who is strongly to draw the luxated Arm up­on the Fore-part of his Breast; during which time, the Operator is to push the Head of the Humerus, to cause it to re-enter its Ca­vity.

Otherwise the Patient may lie on the Ground, a Tennis-Ball being put under his Arm-Pit, which a Servant is to draw strongly with a Handkerchief pass'd under the Shoulder, whilst another Assistant stands behind the Patient, to thrust down the Shoulder with his Foot; at the same time the Surgeon sitting between the Patient's Legs, is to push strongly with his Heel the Ball that lies under the Arm-hole.

Or else, a thick Battoon or Leaver may be laid on the Shoulders of two Men, after a Tennis-Ball hath been nail'd on the middle of it; otherwise a Bunch▪ may be made therein, and cover'd with Linnen-Cloth; two Wooden Pins being also fixt on each side of the Ball: [Page 306]Then the Patient's Arm-Pit is to be set between those two Pins, and upon the Ball, where he is to remain hanging, whilst his Arm is pull'd down by main force. The same thing may be done by laying the Patient's Arm-Pit upon a Door, or else upon the Round of a Ladder.

The Dressing and Bandage

A little Ball of Linnen is to be laid under the Arm-Pit, and underneath a Bolster with four Heads, which are cross'd upon the Shoul­der; as also a Bolster under the sound Arm-Hole, that it may not be gall'd by the Bandage Spica, the Nature of which we have shewn in treating of the Fracture of the Cla­vicle.

CHAP. X. Of the Luxation of the Elbow.

WHEN the Elbow is luxated on the in­side, the Arm flies out, and the Hand is turn'd outward; but in the Luxation on the outside, the Arm is shortned: If the Luxa­tion be Lateral, a Prominence appears in the Dislocated, and a Cavity in the opposite Part.

To reduce the Internal Luxation, the Hume­rus and Cubitus are drawn, and at the same time the Surgeon bends the Elbow, by carrying [Page 307] [...]he Hand toward the Shoulder; or else a Ten­ [...]is-Ball may be laid in the Fold of the Elbow, [...]ed the Arm drawn toward the Shoulder.

For the External Luxation, the Extension is [...] be made, whilst the Surgeon thrusts back [...]e Elbow into its place: Or else a round Stick [...]ay be taken, and trimm'd with Linnen-Cloth, [...]ith which the Bone is to be push'd back into [...] place during the Extension. This Stick may [...]e also us'd in the reducing of the Internal Luxa­ [...]ion.

For the Lateral Luxations, the Extension may be made in like manner; the Surgeon at the [...]me time thrusting back the Bone into its Na­tural Situation.

The Bandage

Is made with a Band five Ells long, and two Fingers broad, roll'd with one Ball: The Ap­plication of it is begun with a Circumvolution at the lower part of the Humerus, it is pass'd over the Fold of the Arm; a Circumvolution is also form'd in the upper-part of the Elbow, and the Figure of KY in its Fold. Afterward the Roliers are continu'd upon the Elbow, and the KY's in the inside of the Arm, till the Elbow be entirely cover'd: The Band is like­wise carry'd up to the top of the Arm with Rollers, and stay'd round about the Body. The Patient must be oblig'd to keep his Bed, or else his Arm may be put in a Scarf, after the same manner as in the Fracture of the Arm.

CHAP. XI. Of the Luxation of the Wrist.

IF the Luxation be Internal, the Hand is turn'd back to the outside, so that for the Reducti­on thereof, it wou'd be requisite to cause the back of the Hand to be laid upon a Table, and the Extension to be made by drawing the Elbow and Hand, whilst the Surgeon takes care to press the Prominence.

If the Luxation be External, the Hand is bend­ed on the inside; so that to reduce it, the in­side of the Hand is to be laid upon a Table, and the Surgeon is to press it after the Extension.

If the Luxation be on the sides, the Hand is turn'd to one side; so that the Extension must be made, and the Hand turn'd on the side op­posite to the Luxation. But the Fingers are usually drawn one after another, to the end that the Tendons may be set again in their Place.

The eight Bones of the Canpus may be in like manner dislocated both on the inside and with­out; and to set 'em right, the Hand is to be laid upon a Table, and the Extension to be made, so as to press the Protuberances on the inside, if the Luxation be internal, and on the outside if it be external.

The Bandage

Is prepar'd with a Band six Ells long, and two Fingers broad; so that three Circumvolu­tions may be made upon the Luxation; as also divers Rollers in passing thro' the inside of the Hand between the Thumb and the Fore­finger, and in forming the Figure of KY upon the Thumb, after having made many Rollers upon the Wrist. Two Pieces of Paste-board are also to be laid on the sides of the Wrist, which are bound with the same Band in ma­king Rollers; and the Hand is to be trimm'd with a Linnen-Ball, to keep the Fingers in their mean Situation Then the Band is to be pass'd above, to strengthen it, and carry'd up with Rollers along the whole length of the El­bow, to be stay'd below the same Elbow.

CHAP. XII. Of the Luxation of the Fingers.

IF the Fingers be luxated, it is necessary to make an Extension to reduce 'em, and af­terward to use the following

Bandage.

If the Luxation be in the first Articulation or Joint, the Bandage Spica is to be apply'd, be­ing made of a Band roll'd with one Head, an [Page 310]Ell long, and an Inch broad: It is begun with Circumvolutions round about the Wrist, and brought over the Luxation in passing between the Fingers. These Circumvolutions are also continu'd to form a Spica upon the Luxation; and the Band is stay'd at the Wrist.

If all the first Phalanges were dislocated, it wou'd be requisite to make as many upon every Phalanx, and with the same Band: This sort of Bandage is call'd the Demi-Gantlet.

CHAP. XIII. Of the Luxation of the Thigh.

THE Luxation which most commonly hap­pens in this Part, is the Internal; so that a Protuberance appears on the Hole of the Os Pubis; the indispos'd Leg is longer than the o­ther, and the Knee and Foot turn outward; nei­ther can the Thigh be any longer bended, nor drawn near the other.

If the Luxation be External, the Leg be­comes shorter than the other, the Knee and Foot turning inward, and the Heel to the outside.

When the Luxation is on the fore-part, a Tumour ariseth in the Groin, so that the Patient cannot draw this Thigh toward the other, nor bend the Leg; his Body resting only upon the Heel.

If the Luxation be Posterior, a Tumour is selt in the Buttocks with great Pain, and the Legg is shorter than it ought to be: There al­so appears a sinking in the Groin, the Leg is [...]isted off from the Ground, and the hurt Person [...]s apt to fall backward.

To reduce the Internal Luxation, the Patient [...]s to be laid with his Back upon a Table, to which is fixt a thick Wooden Pin, about a Foot long, which is to be set between his Thighs, [...]o detain his Body when his Legs are drawn down; then a Strap is to be pass'd above the Joynt of the Thigh, to draw the Ischion up­ward; and the Thigh is to be drawn down with another Strap fasten'd above the Knee: In the mean while the Surgeon thrusts the Thigh upward, to cause it to re-enter its Ca­vity, the Straps being somewhat loosen'd in the time of the Reduction to facilitate the O­peration.

To reduce the External Luxation, the Pati­ent is to be laid upon his Belly; and the drawing to be perform'd after the same manner as we have even now shewn, whilst the Thigh is thrust from the outside inward, to cause the Bone to re-enter its Cavity.

In reducing the Anterior Luxation, the hurt Person is to be laid upon the side op­posite to the Luxation, and Extensions are to be made, by drawing both upward and down­ward, as before: Then the Head of the Bone is to be forc'd, by the means of a Ball thrust strongly with the Knee, in drawing the luxated Leg toward the other.

The Posterior Luxation is thus reduc'd: The Patient being laid upon his Belly, the double Extension is to be made, and his Knee drawn outward, to set the Bone in its place. After the Operation hath been perform'd, a Bolster is to be apply'd, steept in Spirituous Medicaments; and the Bandage call'd Spica, of which we have given an Account in treating of the Luxation of the Shoulder.

CHAP. XIV. Of the Luxation of the Knee.

WHEN the Tibia is luxated behind, its Prominences are in the Cavity of the Ham, and the Leg flies off, or is bended. If the same Tibia be dislocated on the side, a kind of Tumour appears in the luxated side, and a Sinking in the opposite. But if the Condylus of the Tibia remains in the inside, the Leg turns outward; and if it be in the outside, it turns inward.

The Posterior Luxation is reduc'd by obliging the Patient to lie upon his Belly, whilst the Surgeon during the Extensions bends the Leg, in drawing the Heel toward the top of the Thigh,

If the Tibia be luxated on the side, the usu­al Extensions are to be made, and the Bone is to be push'd with the Knee.

If the Luxation were in the fore-part, it wou'd be requisite to lay the Patient upon his Back, to make the Extensions, by drawing the Thigh and Leg; and to press the protuberant Parts.

The Bandage

Is prepar'd with a Band three Ells long, and two Fingers broad, roll'd with two Balls: A Circumvolution being at first made above the Knee, the Figure KY is form'd underneath, and a Circumvolution above it; then the Band [...]s carry'd up again over the Knee, in making Rollers and KY's underneath, till the Knee be entirely cover'd.

CHAP. XV. Of the Luxation of the Patella or Knee-Pan.

THE Knee-Pan is luxated by starting up­ward; and to reduce it, the Patient's Leg is to be held streight, whilst it is thrust back in­to its place with the Hands. Then he must be oblig'd to keep his Bed; and the same Bandage is to be apply'd with that which hath been de­scrib'd for the Luxation of the Knee.

If the Perone or Fibula be remov'd from the Tibia, the sides of the Foot are to be press'd, to draw it back again; and it may be kept close [Page 314]with the Bandage which is appropriated to the Fractures of the Tarsus.

The Astragalus may be also luxated in the fore-part; so that the Operator ought to thrust it back into its place, and to make use of the Bandage which we have prepar'd for the Fracture of the Foot.

The Calcaneum sometimes flies off from the Astragalus both in the inside and without; and the Bones of the Tarsus, Metatarsus, and Toes are likewise apt to be luxated. But a little Cir­cumspection is only requisite to reduce all these Dislocations.

A TREATISE OF Medicinal Compositions Necessary for a SURGEON.

CHAP. I. Of Balsams.

The Balsam of Arcaeus.

TAKE two Pounds of the Suet of a He-Goat, Venice Turpentine and Gum Elemi, a Pound and a half of each; and of Hogs-Lard one Pound. After the Gum Elemi, being cut into shall Pieces, [...]ath been melted over a very gentle Fire, and to it the Turpentine, Goats-Suet, and Swines-Grease; [Page 316]Grease; and when all these Ingredients are wel [...] dissolv'd, strain the Liquor thro' a new Linnen-Cloth, to separate the Scum and Dregs from it; then let the whole Mass cool, and the Bal­sam is made.

This Balsam serves to incarnate and consoli­date all sorts of Wounds and Ulcers: It is like­wise us'd in Fractures and Dislocations of the Bones; as also to cure the Contusions and Wounds of the Nerves.

The Balsam of Spain.

Take pure Wheat, the Roots of Valerian and Carduus Benedictus, of each one Ounce, and beat 'em well in a Mortar with a Pint of White-Wine; strain the whole Composition into an Earthen Vessel Leaded, having a narrow Mouth; stop up the Vessel, and set it upon hot Embers during twenty four Hours: Then add six Oun­ces of St. John's-Wort; set the whole Mass in Balneo Mariae, till the Wine be consum'd, and let it be strain'd and queez'd. Afterward add two Ounces of Frankincense well pulveriz'd, with eight Ounces of Venice Turpentine, mix­ing 'em together over a gentle Fire, and the Balsam will be made.

This is the Balsam which was always us'd by Hieronymus Fabritius ab Aquapendente, and no­ted Italian Surgeon, and is excellent for all kinds of Wounds, even for the Nervous, which (as it is avouch'd by some Persons) may be cur'd by it within the the space of twenty four Hours. But the Wound must be at first wash'd with good Wite-Wine cold, and afterward anointed [Page 317] [...]ith this Balsam well heated. If the Wound [...]e deep, it may be syringed with the same Balsam very hot, and the sides of it anointed [...]hen drawn together. Then a Bolster steep'd [...] the Balsam is to be apply'd to the Part, and [...]on that another Bolster soakt in the Lees of [...]ine; as also over this last another drie Bolster.

The Green Balsam.

Take Linseed-Oil and that of Olives, of each [...]e Pint; one Ounce of Oil of Bays; two Ounces of Venice Turpentine, half an Ounce of [...]e destill'd Oil of Juniper-Berries, three Drams [...]f Verdegrease, two Drams of Sucotrin Aloes, [...]o Drams and a half of White Vitriol, and [...]ne of the Oil of Cloves.

Having made choice of the best Olive and [...]inseed-Oil well purify'd and mingl'd together [...]n a Skillet or Pan over a very gentle Fire, [...]s the Turpentine and Oil of Bays be incor­ [...]orated in it; then having taken off the Pan from [...]e Fire, and left the Liquor to be well cool'd, [...] it be intermixt by little and little with the [...]erdegrease, the White Vitriol, and the Sucotrin [...]oes beaten to fine Powder: Afterward the [...]estill'd Oils of Cloves and Juniper-Berries be­ [...]g added, and the whole Composition well [...]ingl'd together, the Balsam will be entirely compounded according to Art.

This is the Balsam that hath been so much [...]lkt of at Paris, and which many Quack-Sal­ [...]ers, pretending to the Art of Physick and Sur­ [...]ery, keep as a great Secret. Indeed it is very [...]ood for all sorts of Wounds, whether they [Page 318]be made by the Sword, or other Iron Wea­pons, or by Gun-shot. But it wou'd be requi­site at first to wash the Wound with warm Wine, then to anoint it with this Balsam very hot, and to apply Bolsters that have been steept in it, as also a large Bolster over the other, dipt in some Styptick Liquor. This Balsam mundi­fies, incarnates, and cicatrizes Wounds; being likewise good against the Bitings of venomous Beasts, and fistulous and malignant Ulcers.

Samaritan Balsam.

Take an equal quantity of common Oil and good Wine; boil 'em together in a glaz'd Ear­then Vessel, till the Wine be wholly consum'd, and the Balsam will be made. I have produc'd this Balsam in particular, by reason of its simpli­city, and in regard that it may be readily pre­par'd at all times. It serves to mundifie and consolidate simple Wounds more especially those that are recent.

CHAP. II. Of Ointments.

Unguentum Althaeae.

TAKE of the Roots of Althaea or Marsh-Mallows, six Ounces, the Seeds of Line, and Fenugreek, and Squills, of each four Oun­ces; of yellow Wax one Pound; Colophony and Rosin, of each one Pound; Venice Tur­pentine, Galbanum, and Gum Hederae pulveriz'd, two Ounces of each. The Marsh-Mallow-Roots being newly gather'd, are to be well wash'd and slic'd, as well as the Squills. After they have been put into a Copper-Pan or Skil­let, tinn'd over on the inside, together with the Seeds of Line and Fenugreek, and a Gal­lon of fair Water pour'd upon 'em, the whole Mass is to be macerated during twenty four Hours, over a very gentle Fire, stirring the Ingredients from time to time with a Wooden Spatula: Thus they are to be boil'd slowly, often reiterating the stirring, till the Mucilages are sufficiently thicken'd; then, after having well squeez'd and strain'd 'em thro' a strong and very close Cloth, and mingl'd 'em with the prepar'd Oil, they are to be boil'd together a­gain over a very gentle Fire, till the Superflu­ous Moisture of the Mucilages be wholly con­sum'd: [Page 320]Afterward having strain'd the Oil again, the yellow Wax, Colophony, and Rosin cut into small pieces, are to be melted in it; and if any Dregs appear at the bottom of the Pan, when the whole Mass is dissolv'd, it is to be strain'd a-new, or at least the pure Liquor must be separated from the gross or impure by Inclination, whilst it is as yet very hot: The Ointment is to be stirr'd about with a Wood­en Pestle; and when it begins to grow thick, you may add the Turpentine, the Galbanum pu­rify'd and thicken'd, and the Gum Hederae beat­en to fine Powder, all which Ingredients were before incorporated together Then the Oint­ment is to be continually stirr'd, till it be alto­gether grown cold.

This Ointment serves to moisten, mollifie, and heat gently; it also allayes the Pains of the Side, and softens Tumours, particularly the Pa­rotides. It may be us'd either alone, or with other Ointments or Oils.

The mundificative Ointment of Smallage.

Take three handfuls of Smallage-Leaves; with Ground-Ivy, great Wormwood, great Cen­tory, Germander, Sage, St. John's-Wort, Plan­tain, Milfoil or Yarrow, Perewinkle, the great­er Comfrey, the lesser Comfrey, Betony, Ho­ney-suckle, Fluellin, Vervein, Knot-Grass, Ad­ders-Tongue, and Burnet, of every one of these Plants two handfuls; a Gallon of common Oil, white Pitch, Mutton-Suet, yellow Wax, and Turpentine, of each two Pounds.

Bruise all these Herbs in a Marble-Mortar; let the Wax, white Pitch, and Mutton-Suet cut into pieces, as also the Turpentine be melted in the Oil, in a Copper-Pan lin'd with Tin, over a moderate Fire; put the bruis'd Herbs in it, and cause the whole Mass to simmer together very slowly, stirring it about from time to time with a Wooden Spatula. As soon as it shall be perceiv'd that the Oil of the Herbs is almost quite consum'd, the whole Composition is to be strain'd, and strongly squeez'd. Then after having let the Ointment cool, to draw off all the Dregs and Moisture, it is to be dissolv'd o­ver a very gentle Fire; and after having left it a little while to cool again and thicken, you may add thereto Myrrh, Aloes, Florence Orris, and round Birth-Wort pulveriz'd very fine. When all these Ingredients are by this means well incorporated, the Ointment will be brought to perfection.

This Ointment is of singular Use to cleanse Ulcers; as also to mundifie, cicatrize, and con­solidate all sorts of Wounds.

The black or suppurative Ointment.

Take a Quart of common Oil, white and yellow Wax, Mutton-Suet that lies near the Kidneys, pure Rosin, Ship-Pitch, Venice Tur­pentine, of each half a Pound; and of Mastick beaten to fine Powder, two Ounces; let all that is capable of being dissolv'd, be liquify'd in the Oil; and add the Powder of Mastick to make in Ointment.

This Ointment searches and opens all sorts of Impostumes, as well as Carbuncles, and Pesti­lential and Venereal Bubo's. The use of the same Ointment is also to be continu'd after the opening of the Abcesses, till their perfect Cure be compleated.

Unguentum Rosatum.

Take Bore's-Grease well purify'd, and often wash'd, and Red Roses newly pickt, of each four Pounds, with the like quantity of White Roses.

The thin Membrane or Skin which lies upon the Bores-Grease, being taken away, it is to be cut into small pieces, well wash'd in fair Water, and melted in a glaz'd Earthen-Pot over a very gentle Fire: the first Grease that is dissolv'd is to be strain'd thro' a Cloth, well wash'd, and mixt with the same quantity of thick Rose-Buds well bruis'd. Then the whole Mass is to be put into a glaz'd Earthen-Pot with a narrow Mouth; the Pot is to be well stopt, and set du­ring six Hours in Water, which is between luke-warm and boiling hot. Afterward it is to be boil'd an Hour, strain'd and strongly squeez'd. In the mean while four Pounds of White Ro­ses newly blown are to be taken, well bruis'd, and mingl'd with the former Composition, the Pot being cover'd, which is likewise set for the space of fix Hours in Water, between luke-warm and boiling hot: Then the Liquor is to be strain'd and strongly squeez'd. Lastly, after the Ointment hath been cool'd, and separated from its Faeces or Dregs, it may be kept for use.

If it be desir'd to give a Rose-Colour to this Ointment, it wou'd be requisite a quarter of an Hour before it be strain'd the last time, to throw into it two or three Ounces of Orcanet, which is to be stirr'd into the Ointment. If it be thought fit to retain the White Colour, and to produce the smell of Roses, it may be done with Damask-Roses without Orcanet. If you are desirous to give it the Consistence of a Lini­ment, you may add Oil of sweet Almonds to the quantity of a sixth part of its weight.

This Ointment is a very good Remedy a­gainst all manner of external Inflammations, particularly against Phlegmons, Erysipelas's, and Tetters; as also against the Head-ach and Hae­morrhoids or Piles.

Unguentum Album, aut de Cerussa.

Take three Pints of Oil of Roses, nine Oun­ces of white Wax, one Pound of Venice Ce­ruse or white Lead, and a Dram and a half of Camphire.

The Ceruse being pulveriz'd by rubbing the pieces upon the Cloath of a Hair-Sieve turn'd upside-down; the Powder is to be receiv'd on [...] Sheet of Paper laid underneath, and to be of­ten wash'd with Water in a great Earthen-Pan, stirring it about with a Wooden Spatula, and pouring off the Water by Inclination as soon as the Powder is sunk to the Bottom. When the Water of these Washings grows insipid, the last Lotion is to be made with Rose-Water, leaving it for the space of five or six Hours, which being ex­pir'd, it is to be pour'd off by Inclination, and [Page 324]the Ceruse must be dry'd in the Shade, cover'd with Paper. Then the broken Wax and pre­par'd Oil is to put into a glaz'd Earthen-Pot, and the Pot into the boiling Bath. As soon as the Wax is melted, the Pot may be taker out of the Bath, and the dissolv'd Liquor stirr'd with a Wooden Pestle till it begins to grow thick. Afterward the pulveriz'd Ceruse is to be infus'd, and the Ointment stirr'd about till it be almost cold. If you shall think fit to add Camphire, let it be dissolv'd in a little Oil, and incorporated with the Ointment when it is cold. The Whites of Eggs may be also well mixt with the Ointment, by stirring it about, to make an exact union of the several Ingredi­ents.

This Ointment is good for Burns, Erysipelas's, the Itch, and many Distempers of the Skin; it allayes the Itchings and intemperature of Ul­cers; it dissipates the Chasings and Redness that happen in the Bodies of Infants; It is of great efficacy in the [...]ealing of Contusions, and it serves to consolidate and cool light Wounds.

Unguentum Aegyptiacum.

Take eleven Ounces of Verdegrease, fourteen Ounces of strong Vinegar, and twenty eight Ounces of good Honey.

Let the Verdegrease be put into a Copper-Pan or Skillet over a very gentle Fire; then bruise it with a Wooden Pestle; work it well in the Vinegar, and strain the whole thro' a Hair-Sieve. If a little Verdegrease remains on the Sieve, it is to be put again into the Skil­let, [Page 325]bruis'd and beaten small therein, as before, with a Portion of the same Vinegar, straining it thro' the Sieve, till the unprofitable drossy parts of the Copper be only left. Afterward this Liquor is to be boil'd over a gentle Fire, with the Honey, stirring it about from time to time till it hath acquir'd the Consistence of a softish Ointment, and a very red Co­lour.

This Ointment consumes putrify'd Flesh, and the Superfluities of Ulcers and Wounds.

Unguentum Basilicon, or Royal Ointment.

Take yellow Wax, Mutton-Suet, Rosin, Ship-Pitch, and Venice Turpentine, one Pound of each; with five Pints of common Oil.

Cut the Suet, Rosin, and black Pitch into small Pieces, and let 'em be melted together, with the Oil, in a Copper-Pan over a very moderate Fire; then after having strain'd the Liquor thro' a thick Cloth, let it be incorpo­rated with the Turpentine, and the Ointment will be made.

It promotes Suppuration, and cicatrizes Wounds when the purulent Matter is drawn forth. It is often laid alone upon the Bolsters, and sometimes mixt with the Yolks of Eggs, Turpentine, and other Ointments, or with Oils and Plaisters.

A cooling Cerate.

Take a Pint of Oil of Roses, and three Oun­ces of white Wax.

Let the whole Composition be put into a glaz'd Earthen-Pot, and the Pot set in Balneo Mariae, till the Wax be well dissolv'd in the Oil: Then take the Vessel out of the Bath, and stir the Ointment with a Wooden Pestle till it be cool'd; add two Ounces of Water, and stir it about with the Pestle till it be im­bib'd by the Cerate; let as much more Wa­ter be infus'd, and again the same quantity, till the Cerate becomes very white, and hath been well soakt with fresh Water. Afterward all the Water is to be pour'd off by Inclinati­on, and separated as much as is possible from the Cerate, which may then be kept for use; but some Surgeons cause an Ounce of Vinegar to be mingl'd with it.

This Cerate is usually laid outwardly upon all Parts that stand in need of cooling, and as­swages the Pains of the Haemorrhoids or Piles. It is also good for Chaps, sore Nipples, and other ill Accidents that happen in the Breast; and is us'd for Burns either alone, or mixt with other Ointments. Whensoever it is necessary to apply Desiccatives and Astringents to any Part, this Cerate may be mingl'd with Ʋn­guentum de Cerussa.

An Ointment for Burns.

Take a Pound of Bores-Grease, two Pints of White-Wine, the Leaves of the greater Sage, Ground- and Wall-Ivy, Sweet Mar­joram, or the Greater House-Leek, of each two handfuls.

Let the whole Mass be boil'd over a gen­tle Fire, and having afterward strain'd and squeez'd it, let the Ointment so made be kept for use.

CHAP. III. Of Plaisters.

The Plaister of Diapalma.

TAKE three Pounds of prepar'd Litharge of Gold, three Pints of common Oil, two Pounds of Hogs-Lard, a Quart of the Deco­ction of Palm-Tree or Oak-Tops; four Oun­ces of Vitriol calcin'd till it become red, and steept in the said Decoction. Having bruis'd or cut very small two handfuls of Palm-Tree or Oak-Tops, let 'em be boil'd slowly in three Quarts of Water till about half be consum'd; and after the whole Mass hath been well squeez'd, the strain'd Decoction is to be preserv'd. In the mean time the Litharge is to be pound­ed [Page 328]in a great Brass Mortar, and diluted with two or three Quarts of clear Water; but it will be requisite readily to pour out into ano­ther Vessel the muddly Water which is im­pregnated with the more subtil part of the Li­tharge, whilst the thicker remains at the bot­tom of the Mortar; whereupon this part of the Litharge will sink to the bottom of the Wa­ter, and the Litharge remaining in the Mortar is to be pounded again. Then having diluted it in the Water of the first Lotion, or in some other fresh Water, the muddy Liquor is to be pour'd by Inclination upon the subtil Litharge that remain'd in the bottom of the Vessel: Afterward you may continue to pound the Litharge, to bruise it in the Water, to pour it off by Inclination, and to let the Powder settle, till there by left only at the bottom a certain impure part of the Litharge, capable of being pulve­riz'd, and rais'd amidst the Water. As soon as the Lotions are well settl'd, and care hath been taken to separate by Inclination the Wa­ter which swims over the Powder of Litharge; this Powder is to be dry'd, and having weigh'd out the appointed Quantity, it is to be put as yet cold into a Copper-Pan lin'd with Tin, and stirr'd about to mingle it with the Oil, Lard, and Decoction of Palm-Tree-Tops. When these Ingredients have been well incor­porated together, a good Charcoal Fire must be kindl'd in a Furnace, over which they are to be boil'd, stirring 'em continually with a great Wooden Spatula, and constantly maintain­ing an equal Degree of Heat during the whole time of their boiling. At last you may add [Page 329]the rubify'd Vitriol dissolv'd in a Portion of the Liquor that hath been reserv'd, if you wou'd have the Plaister tinctur'd with a red Co­lour; or else white Vitriol melted in the same Decoction, if it shall be thought fit to retain the Whiteness of the Plaister, which may be form'd into Rolls, and wrapt up with Pa­per.

This Plaister is us'd for the cure of Wounds, Ulcers, Tumours, Burns, Contusions, Fractures, and Chilblains, and is also laid upon the Cau­teris. If you mingle with it the third or fourth part of its weight of some convenient Oil, it will attain to the Consistence of a Cerate; and this is that which is call'd Dissolved Diapal­ma, or Cerate of Diapalma.

The Plaister of simple Diachylum.

Take of Marsh-Mallow-Roots peel'd, three Drams; the Seeds of Line and Fenugreek, of each four Ounces; three Quarts of Spring-Wa­ter; two Quarts of common Oil, and two Pounds of Litharge of Gold.

Let the Mucilages of Marsh-Mallow-Roots, and of the Seeds of Line and Fenugreek be taken, as hath been shewn in the making of Ʋnguen­tum Althaeae, and let the Litharge be prepar'd after the same manner as for the Plaister of Diapalma. Having at first well mixt the Oil with the Litharge in a large Copper-Vessel or Pan, Tinn'd on the inside, being wide at the top, and tapering like a Cone toward the bot­tom, as also having afterward added and well incorporated the Mucilages, a moderate Char­coal [Page 330]Fire ts to be kindl'd in a Furnace, upon which the Vessel is to be set, and the whole Mass is to be stirr'd about incessantly with a Wooden Spatula; and as fast as is possible. A gentle Fire is to be maintain'd, and the Boil­ing and Agitation to be continu'd, till it be per­ceiv'd that the Plaister begins to sink in the Pan; then the Heat of the Fire must be di­minish'd one half at the least; and it will be requisite only to cause an Evaporation by little and little, of the Superfluous Moisture that might remain in the Plaister, which being consum'd, it will be sufficiently boil'd, having attain'd to its due Consistence and Whiteness.

This Plaister softens and dissolves hard Swel­lings, and even the Scirrhous Tumours of the Liver and Bowels; such are the Scrophulous or King's-Evil Tumours, the old remains of Abcesses, &c.

The Plaister of Andreas Crucius.

Take two Ounces of Rosin, four Ounces of Gum Elemi, Venice Turpentine and Oil of Bays, of each two Ounces.

After having beat in pieces the Rosin and Gum Elemi, they are to be melted together over a very gentle Fire, and then may be added the Turpentine and Oil of Bays. When the whole Mass hath been by this means well incorpora­ted, it must be strain'd thro' a Cloth, to sepa­rate it from the Dregs. The Plaister being af­terward cool'd, is to be made up in Rolls, and kept for use.

This Plaister is proper for Wounds of the Breast: It also mundifies and consolidates all sorts of Wounds and Ulcers, dissipates Contu­sions, strengthens the Parts in Fractures and Dislocations, and causeth the Serous Humours to pass away by Transpiration.

Emplastrum Divinum.

Take of Litharge of Gold prepar'd, one Pound and an half; three Pints of common Oil; one Quart of Spring-Water; six Ounces of prepar'd Load-Stone; Gum Ammoniack, Galba­num, Opoponax, and Bdellium, of each three Ounces; Myrrh, Olibanum, Mastick, Verde­grease, and round Birth-Wort, of every one of these an Ounce and an half; eight Oun­ces of Yellow Wax, and four Ounces of Tur­pentine.

Let the Gum Ammoniack, Galbanum, Bdelli­um, and Opoponax be dissolv'd in Vinegar, in a little Earthen Pipkin; strain 'em thro' a course Cloth, and let 'em be thicken'd by Evaporati­on, according to the Method before observ'd in other Plaisters: Then prepare the Load-Stone upon a Porphyry or Marble-Stone, and take care to bruise separately the Olibanum, the Mastick, the Myrrh, the round Birth-Wort, and the Verdegrease, which is to be kept to be added at last. In the mean while, having in­corporated cold the Oil with the Litharge, and mingl'd the Water with 'em, they are to be boil'd together over a very good Fire, stirring 'em incessantly, till the whole Composition hath acquir'd the Consistence of a somewhat solid [Page 332]Plaister, in which is to be dissolv'd the yellow Wax cut into small pieces. Afterward having taken off the Pan from the Fire, and left the Ingredients to be half cool'd, intermix the Gums, which have been already thicken'd and incorpo­rated with the Turpentine; then the Load-Stone mingl'd with the Birth-Wort, Myrrh, Mastick, and Olibanum; and last of all the Verdegrease. Thus when all these Ingredients are well stirr'd and mixt together, the Plaister will be entirely compounded; so that it may be made up in­to Rolls, and preserv'd to be us'd upon necessa­ry Occasions.

This Plaister is efficacious in curing of all kinds of Wounds, Ulcers, Tumours, and Contusions; for it mollifies, digestes, and brings to Suppuration such Matter as ought to be carry'd off this way. It also mundi­fies, cicatrizes, and entirely consolidates Wounds, &c.

CHAP. IV. Of Cataplasms or Pultisses.

CATAPLASMS are usually prepar'd to asswage Pain; as also to dissolve and dis­sipate recent Tumours, and are made thus:

Take four Ounces and a half of white Bread, one Pint of new Milk, three Yolks of Eggs, one Ounce of Oil of Roses, one Dram of Saffron, and two Drams of the Extract of Opium.

The Crum is to be taken out of the inside of a white Loaf newly drawn out of the O­ven, and to be boil'd with the Milk in a Skil­let over a little Fire, stirring it from time to time with a Spatula, till it be reduc'd to a thick Pap. After having taken the Vessel off from the Fire, the three Yolks of Eggs beaten are to be put into it, and the Dram of Saffron pulve­riz'd; to these Ingredients may be added two Drams of the Extract of Opium somewhat li­quid, if the Pain be great.

Here is another Cataplasm proper to molli­fie and to bring to Suppuration when it is necessary.

Take White-Lilly-Roots, and Marsh-Mallow-Roots, of each four Ounces; the Leaves of common Mallows, Marsh-Mallows, Groundsel, Violet-Plants, Brank-Ursin, of every one of these Herbs one handful; the Meal of Line, Fenugreek, and Oil of Lillies, of each three Ounces.

The Roots when wash'd and slic'd, are to be boil'd in Water, and the Leaves being ad­ded some time after, the Boiling is to be con­tinu'd till the whole Mass becomes perfectly tender and soft; at which time having strain'd the Decoction, beat the remaining gross Sub­stance in a Stone-Mortar, with a Wooden Pestle, and pass the Pulp thro' a Hair-Sieve turn'd upside-down: Then let the Decoction and Pulp so strain'd be put into a Skillet, and having intermixt the Meal of Line, Fenugreek, [Page 334]and Oil of Lillies; let 'em be boil'd together o­ver a gentle Fire, stirring about the Ingredients from time to time, till they be all sufficiently thicken'd. These two Cataplasms may serve as a Model for the making of many others.

CHAP. V. Of Oils.

OILS are made either by Infusion or Ex­pression.

Simple Oil of Roses made by Infusion.

Take two Pounds of Roses newly gather'd, and bruis'd in a Mortar; half a Pint of the Juice of Roses, and five Pints of common Oil: Let the whole Composition be put into a Earth­en-Vessel, Leaded and well stopt, and then let it be expos'd to the Sun during forty Days. Af­terward let it be boil'd in Balneo Mariae; and having strain'd and squeez'd the Roses, let the Oil be kept for use.

Compound Oil of Roses made by Infusion.

Take a Pound of Red Roses newly gather'd, and pound 'em in a Mortar; as also four Oun­ces of the Juice of Red Roses, and two Quarts of common Oil. Let the whole Composition be put into an Earthen-Vessel Leaded, the Mouth [Page 335]of which is narrow, and well stopt; and then having expos'd it to the Sun during four Days, let it be set in Balneo Mariae for an Hour, and then strain'd and squeez'd. Afterward let this Liquor be put into the same Vessel, adding to it the Juice of Roses, and Roses them­selves, in the same quantity as before: Let the Vessel be stopt; let the Maceration, Boil­ing, Straining, and Expression be made in like manner as before; and let the same Operation be once more re-iterated: Then let your Oil be depurated, and preserv'd for use.

These Oils qualifie and disperse Defluctions of Humours, suppress Inflammations, mitigate the Head-ach and Deliriums, and provoke to sleep. They must be warm'd before the Parts are anointed with 'em, and they may be given inwardly against the Bloody-flux and Worms, the Dose being from half an Ounce to a whole Ounce. The Parts are also anointed with 'em in Fractures and Dislocations of the Bones, and Oxyrodins are made of 'em with an equal quan­tity of Vinegar of Roses.

Oil of Sweet Almonds made by Expression.

Take new Almonds that are fat and very dry, without their Snells, and having shaken 'em in a somewhat thick Sieve, to cause the Dust to fall off; let 'em be put into hot Wa­ter till their Skins become tender, so that they may be separated by squeezing 'em with the Fingers: Afterward having taken off the Skin, they must be wip'd with a white Linnen-Cloth, and spread upon it to be dry'd: Then they are [Page 336]to be put into a Stone-Mortar, and pounded with a Wooden-Pestle, till the Paste grows very thin, and begins to give Oil: This Paste is to be put into a little Linnen-Bag, new and strong, the Mouth of which hath been well ty'd; and the Bag is to be plac'd between two Platines of Tin, or of Wood lin'd on the inside with a Leaf of Tin, squeezing the whole Mass gently at first; but afterward very strongly, and lea­ving it for a long while in the Press, that the Oil may have time to run out.

This Oil mitigates the Nephritick Colicks, remedies the Retension of Urine, facilitates Child-birth, allayes the After-Pains in Women after their delivery, and the Gripes in young In­fants: It is taken inwardly fasting from half an Ounce to two Ounces; and it is us'd in Lini­ments to asswage and mollifie. The Oils of common Wall-Nuts and Small-Nuts, may be also prepar'd after the same manner as that of Sweet-Almonds.

The Oil of Bayes.

Take as much as you please of Laurel or Bay-Berries, well cleans'd, perfectly ripe, and soundly bruis'd; let 'em be put into a Kettle, and boil'd with a sufficient quantity of Water during half an Hour; then strain and squeez 'em strongly; let the Liquor cool, and scum off the Fat that swims upon the Water: Afterward pound the remaining Substance in a Mortar, and cause it to be boil'd again for half an Hour, with some of the first Water which was left, adding a little fresh; then strain and squeez it, [Page 337]as before, and take off the Oil that swims on the Top. But the first Oil is better than the second, and therefore ought to be kept separate­ly. The Oils of Berries of Mastick, Myrtle, and other oleaginous Plants, may be extracted after the same manner.

The Oil of Bayes mollifies, attenuates, and [...]s opening and discussive: It is very good against the Palsie, and the Shiverings or cold Fits of a [...]eaver or Ague in anointing the Back; as also against Scabs. Tetters, &c.

The Oil of Eggs by Expression.

Take newly laid Eggs, and let 'em be har­ [...]en'd in Water; then separate the Yolks, and put 'em into a Frying-pan over a gentle Coal-fire, stirring 'em about from time to time, and a last without discontinuing, till they grow red­dish, and begin to yield their Oil: Then they are to be sprinkl'd with Spirit of Wine, and [...]our'd very hot into a little Linnen-Bag, which [...]s to be ty'd, and set in a Press between two [...]eated Platines; so that the Oil may be squeez'd [...]ut as readily as is possible.

This Oil mitigates the Pains of the Ears and Haemorrhoids, cures Scabs and Ring-Worms or Tetters; as also Chaps and Clefts in the Breast, Hands, Feet, and Fundament; and is made use of in Burns, &c.

CHAP VI. Of Collyrium 's.

COLLYRIƲM's are Medicines prepar'd for the Diseases of the Eyes: The following is that of Lanfrancus.

Take a Pint of White-Wine, three Pints of Plantain-Water, three Pounds of Roses, two Drams of Orpiment, one Dram of Verdegrease; Myrrh and Aloes, of each two Scruples.

The Orpiment, Verdegrease, Myrrh, and A­loes are to be beaten to a fine Powder before they are intermixt with the Liquors. This Collyrium is not only good for the Eyes, but is also of use to make Injections into the Privy-Parts of Men and Women; but before the In­jections are made, it ought to be sweeten'd with three or four times the quantity in weight of Rose, Plantain, or Morel-Water.

A dry Collyrium.

Take two Drams of Sugar-candy; prepar'd Tutty, Lizard's-Dung, of each one Dram; White Vitriol, Sucotrin Aloes, and Sal Saturni, of each half a Dram.

Let the whole Composition be reduc'd to a very fine Powder, and mixt together: Two or three Grains of this Powder may be blown at [Page 339]once into the Eye with a small Quill, Pipe of Straw, or Reed, as long as it is necessary; and the same Powder may also be steept in Ophthalmick Waters, to make a liquid Collyrium.

A Blue Collyrium.

Take a Pint of Water in which unslackt Lime has been quench'd, and a Dram of Sal Am­moniack pulveriz'd; mingle these Ingredients together in a Brass-Bason, and let 'em be insus'd during a whole Night; then filtrate the Liquor and keep it for use.

This Collyrium is one of the best Medicines that can be prepar'd for all manner of Diseases of the Eyes.

CHAP. VII. Of Powders.

A Powder against Madness or Frenzy.

TAKE the Leaves of Rue, Vervein, the lesser Sage, Plantain, Polypody, common Wormwood, Mint, Mother-Wort, Balm, Beto­ny, St. John's-Wort, and the lesser Centory; of every one an equal quantity.

These Plants must be gather'd in the Month of June, during the clear and serene Weather, [Page 340]and ty'd up in Nose-gays, or little Bundles; which are to be wrap'd up in Paper, and hung in the Air to be dry'd in the Shade. Af­terward they are to be pounded in a great Brass-Mortar, and the Powder is to be sifted thro' a Silk-Sieve.

The Dose of this Powder is from two to three Drams, mingl'd with half a Dram of the Powder of Vipers, in half a Glass of good White-Wine every Morning fasting, for fifty one Days successively. It has an admirable effect, provided the wounded Person be not bit in the Head nor Face, and that the Wound has not been wash'd with Water.

CHAP. VIII. Styptick-Water.

TAKE Colcothar or Red Vitriol that re­mains in the Retort after the Spirit has been drawn off, Burnt Allom, and Sugar-candy, of each thirty Grains; the Urine of a Young Person, and Rose-Water, of each half an Ounce; and two Ounces of Plantain-Wa­ter: Let the whole Mixture be stirr'd about for a long time, and then put into a Vial. But the Liquor must be pour'd off by Incli­nation when there shall be occasion to take any for use.

If a Bolster steept in this Water be laid upon an open Artery, and held close with the Hand, it will soon stop the Blood; a small Tent may be also soakt in it, and put up into the Nose for the same purpose. If it be taken inwardly, it stops the spitting of Blood, and the Dysentery or Bloody-Flux; as also the Haemorrhoidal and Menstruous Fluxes; the Dose being from half a Dram to two Drams, in Knot-Grass-Water.

FINIS.

A TABLE OF THE CHAPTERS And of the Principal Matters Which are contain'd in every Chapter.

  • CHAP. I. OF the Qualifications of a Surgeon, and the Art of Surgery, Page 1
  • CHAP. I. Of Synthesis, Diaeresis, Exaeresis, and Pros­thesis Page 2
  • CHAP. I. What ought to be observ'd before the underta­king of an Operation Page 3
  • CHAP. II. Of Chirurgical Instruments, portable and not port­able Page 5
  • [Page] CHAP. III. Of Anatomy in general, and in particular of all the Parts of which the Human Body is compos'd Page 7
  • CHAP. IV. Of the General Division of a Human Body Page 10
  • CHAP. V. Of the Skeleton Page 12
  • CHAP. V. Of the different kinds of Articulations, Page 14
  • CHAP. V. Of the Number of the Bones of the Human Skeleton Page 16
  • CHAP. VI. Of Myology, or the Description and Anatomy of the Muscles of the Human Body Page 19
  • CHAP. VII. Of the Myology or Anatomy of the Muscles of the Head Page 21
  • CHAP. VIII. Of the Myology or Anatomy of the Muscles of the Chest, or of the Breast, Belly, and Back Page 31
  • CHAP. IX. Of the Myology or Anatomy of the Muscles of the lower Belly Page 34
  • CHAP. IX. Of the Muscles of the Parts that serve for Ge­ration in both Sexes Page 36
  • CHAP. X. Of the Muscles of the Shoulder-Blades, Arms and Hands. Page 37
  • CHAP. XI. Of the Muscles of the Thighs, Legs, and Feet, Page 48
  • CHAP. XI. A List of all the Muscles of the Humane Body, Page 57
  • CHAP. XII. Of the Anatomy of the Nerves, Arteries, and Veins [Page]in general Page 58
  • CHAP. XII. Of the Structure of the four Tunicks of the Arteries Page 61
  • CHAP. XII. Of the Structure of the four Tunicks of the Veins Page 63
  • CHAP. XII. Of the Beginning and Origine of all the Veins Page 64
  • CHAP. XII. Of the Distribution of the ascending Vena Cava Ibid.
  • CHAP. XIII. Of the Anatomy of the Abdomen or lower Belly, Page 66
  • CHAP. XIII. Of the Opening of a dead Body at a publick Dissection Page 67
  • CHAP. XIII. Of the Peristaltick Motion of the Guts Page 71
  • CHAP. XIII. Of the Parts appointed for Generation in Men Page 74
  • CHAP. XIII. Of the Parts appropriated to Generation in Women Page 75
  • CHAP. XIV. Of the Anatomy of the Breast, or middle Venter, Page 77
  • CHAP. XIV. The manner of opening the Breast in order to dissect it Ibid.
  • CHAP. XV. Of the Anatomy of the Head or upper Venter, Page 80
  • CHAP. XV. An exact Historical Account of the Holes of the Skull, and the Vessels that pass thro' 'em Page 83
  • CHAP. XV. The manner of opening the Head, and Anato­mizing the Brain Page 91
  • CHAP. XVI. Of Straps, Swathing-Bands, Bandages, Bolsters, and Tents Page 93
A Treatise of Chirurgical Diseases.
  • CHAP. I. OF Tumours in general, Impostumes or Abcesses, Breakings out, Pustules, and Tubercles Page 97
  • CHAP. II. Of the general Method to be observ'd in the curing of Tumours Page 100
  • CHAP. II. How many several ways may all curable Tu­mours be terminated Page 101
  • CHAP. II. What are the best means of curing Impostumes, whether to dissolve, or to bring 'em to Sup­puration Ibid.
  • CHAP. II. Of the Circumstances, to be observ'd by a Surge­on in the opening of Tumours Page 102
  • CHAP. II. Of the general Causes of Tumours Page 103
  • CHAP. III. Of Natural Tumours, and first of the Phlegmon, and its Dependances Page 104
  • CHAP. III. Of Remedies proper for the Phlegmon Page 105
  • CHAP. III. Remedies for the curing of Aneurisms and Varices Page 108
  • CHAP. III. Remedies for Echymoses, Contusions, or Brui­ses Page 109
  • CHAP. III. Of Phlegmonous Tumours, and their Re­medies Page 110
  • CHAP. III. Of a Gangrene Page 111
  • CHAP. III. Remedies for a Gangrene Page 113
  • [Page] CHAP. III. Of Kibes and Chilblains, and their Remedies Page 114
  • CHAP. III. Of the Panaritium and its Remedies Ibid.
  • CHAP. III. Of a Burn and its Remedies Page 115
  • CHAP. III. Of the Erysipelas and its Dependances Page 116
  • CHAP. III. Remedies for the Erysipelas Ibid.
  • CHAP. III. Of Erysipelatous Tumours or Impostumes, and their Remedies Page 118
  • CHAP. III. Of the Oedema, and its proper Remedies, Page 119
  • CHAP. III. Of Oedomatous Tumours and Impostumes Page 120
  • CHAP. III. Of a Scirrhus and its Remedies Page 123
  • CHAP. III. Of Scirrhous Tumours Page 124
  • CHAP. III. Remedies for the Polypus Page 125
  • CHAP. III. Of Cancers Page 126
  • CHAP. III. Remedies for Cancers Ibid and Page 127
  • CHAP. IV. Of Bastard or Encysted Tumours Page 128
  • CHAP. IV. Of the Remedies for Encysted Tumours Page 129
  • CHAP. V. Of Critical, Malignant, Pestilential, and Vene­real Tumours and Impostumes Page 131
  • CHAP. VI. Of the Scurvy, Page 133
A Treatise of Wounds, Ulcers, and Sutures,
  • CHAP. I. OF Sutures or Stitches, Page 138
  • CHAP. II. Of Wounds in general Page 141
  • CHAP. II. Of Remedies proper to stop the Haemorrhage of a Wound Page 143
  • CHAP. II. What is to be done when a Convulsion happens in a Wound, by reason of a Wounded Nerve or Tendon Page 144
  • CHAP. II. What Course is to be taken to draw extraneous Bodies out of a Wound Page 145
  • CHAP. II. Of Vulnerary Decoctions to be taken inwardly Page 148
  • CHAP. III. Of the particular Wounds of the Head Page 149
  • CHAP. IV. Of the particular Wounds of the Breast Page 151
  • CHAP. V. Of the particular Wounds of the lower Belly Page 153
  • CHAP. VI. Of Wounds made by Guns or Fire-Arms Page 154
  • CHAP. VI. Of the Prognostick of Wounds by Gun-shot Page 155
  • CHAP. VI. Of the cure of Wounds by Gun-shot Ibid
  • CHAP. VI. Of a Burn made by Gun-powder Page 159
  • CHAP. VII. Of Ʋlcers in general Page 164
  • [Page] CHAP. VIII. Of Venereal Diseases Page 168
  • CHAP. VIII. Of the Chaude-Pisse or Gonorrhaea Ibid.
  • CHAP. VIII. Of Shankers Page 170
  • CHAP. VIII. Of Bubo's Ibid.
  • CHAP. VIII. Of the Pox Page 171
  • CHAP. VIII. The manner of making the Mercurial Pana­caea Page 175, &c.
A Treatise of the Diseases of the Bones.
  • CHAP. I. OF the Dislocation of Bones Page 181
  • CHAP. II. Of the Fractures of Bones Page 187
  • CHAP. III. Of the particular Fractures of the Skull Page 192
  • CHAP. IV. Of the Caries, Exostoses, and Nodus of the Bones Page 197
  • CHAP. V. Of Cauteries, Vesicatories, Setons, Cupping-Glasses, and Leeches Page 199
  • CHAP. V. Of the compounding of Potential Cauteries Page 201
  • CHAP. VI. Of Phlebotomy Page 204
A Treatise of Chirurgical Operations.
  • CHAP. I. Of the Operation of the Trepan Page 209
  • CHAP. I. Of the Bandage of the Trepan Page 213
  • CHAP. II. Of the Operation of the Fistula Lachrymalis Page 214
  • CHAP. II. The Dressing and Bandage of the Fistula La­chrymalis Page 215
  • CHAP. III. Of the Operation of the Cataract Page 216
  • CHAP. III. The Dressing and Bandage of the Operation of the Cataract Page 217
  • CHAP. III. Of purulent Matter gather'd under the Cor­neous Tunicle of the Eye Page 218
  • CHAP. III. Of a Tumour that ariseth in the Eye, Ibid.
  • CHAP. III. Of the Eye-Lids glu'd together Ibid.
  • CHAP. III. Of the Hairs of the Eye-Brows that offend the Eye Page 219
  • CHAP. III. Of hard and transparent Tumours on the Eye-Lids Ibid.
  • CHAP. IV. Of the Operation of the Polypus Ibid.
  • CHAP. V. Of the Operation of the Hare-Lip Page 220
  • CHAP. V. The Dressing and Bandage for the Hare-Lip Page 221
  • CHAP. VI. Of the Operation of Bronchotomy Page 222
  • [Page] CHAP. VII. Of the Operation of the Uvula Page 223
  • CHAP. VIII. Of the Operation of a Cancer in the Breast Ibid.
  • CHAP. VIII. The Dressing for a Cancer in the Breast Page 225
  • CHAP. IX. The Operation of the Empyema Page 227
  • CHAP. IX. The Dressing and Bandage for the Operation of the Empyema Page 228
  • CHAP. X. Of the Operation of the Paracentesis of the lower Belly Page 229
  • CHAP. X. The Dressing and Bandage for that Paracentesis Page 230
  • CHAP. X. The Operation of the Paracentesis of the Scro­tum Ibid.
  • CHAP. XI. Of the Operation of Gastroraphy Page 231
  • CHAP. XII. Of the Operation of Exomphalus Page 234
  • CHAP. XIII. Of the Operation of the Bubonocele, and of the compleat P [...]ture Page 236
  • CHAP. XIII. The Dressing and Bandage Page 237
  • CHAP. XIII. Of the compleat Rupture Ibid.
  • CHAP. XIV. Of the Operation of Castration Page 238
  • CHAP. XIV. Of the Dressing and Bandage for the Castra­tion Page 239
  • CHAP. XV. Of the Operation of the Stone [...]the Ureter Page 240
  • CHAP. XVI. Of the Operation of Lithotomy Page 241
  • CHAP. XVI. The Dressing and Bandage for the Operation of Lithotomy Page 243
  • [Page] CHAP. XVI. Of the Operation of Lithotomy in Women by the lesser Preparative Page 244
  • CHAP. XVII. Of the Operation of the Puncture of the Perinaeum Page 245
  • CHAP. XVIII. Of the Operation of the Fistula in Ano Ibid
  • CHAP. XIX. Of the Suture or Stitching of a Tendon Page 247
  • CHAP. XX. Of the Caesarian Operation Page 248
  • CHAP. XXI. Of the Operation of Amputation; with its proper Dressings and Bandages Page 249 and 251
  • CHAP. XXII. Of the Operation of the Aneurism Page 253
  • CHAP. XXII. The Bandage for the Aneurism Page 255
  • CHAP. XXIII. Of the Operation of Phlebotomy Ibid.
  • CHAP. XXIII. The Bandage in Phlebotomy Page 256
  • CHAP. XXIV. Of the Operation of Encysted Tumours Page 257
  • CHAP. XXIV. Of Ganglions Page 258
  • CHAP. XXV. Of the Operation of Hydrocephalus Ibid.
  • CHAP. XXVI. Of the Operation of cutting the Tongue-String Page 259
  • CHAP. XXVII. Of the Operation of opening stopt Ductus's Page 260
  • CHAP. XXVII. Of an Incision made to open the Vagina Ute­ri Ibid.
  • CHAP. XXVII. The manner of separating the Lips of the Pu­dendum when conglutinated Ibid.
  • CHAP. XXVII. The manner of opening the Vagina when stopt with a Fleshy Substance Ibid.
  • CHAP. XXVII. The Method of opening the Ʋrinary Ductus as well in Boys as in young Virgins Ibid.
  • [Page] CHAP. XXVII. The Method of opening the Ductus of the Ear, when stopt with a Membrane or a Carnous Substance Page 261
  • CHAP. XXVIII. Of the Operation of the Phimosis and Paraphi­mosis Ibid.
  • CHAP. XXIX. Of the Operation of the Varix Page 262
  • CHAP. XXX. Of the Operation of the Panaritium Page 263
  • CHAP. XXX. The Dressing and Bandage for this Operation Ibid.
  • CHAP. XXXI. Of the Reduction of the falling of the Anus Page 264
  • CHAP. XXXII. Of the reducing of the falling of the Matrix Page 265
  • CHAP. XXXIII. Of the application of the Cautery and its Bandage Ibid.
  • CHAP. XXXIV. Of the Application of Leeches, and the Dressing Page 267
  • CHAP. XXXV. Of the application of the Seton Page 268
  • CHAP. XXXVI. Of Scarifications Page 269
  • CHAP. XXXVII. Of the Application of Vesicatories Ibid.
  • CHAP. XXXVIII. Of the application of Cupping-Glasses Page 270
  • CHAP. XXXIX. Of the opening of Abscesses or Impostumes Page 271
A Treatise of the Operati­ons of Fractures.
  • CHAP. I. OF the Fracture of the Nose Page 272
  • CHAP. I. The Dressing and Bandage for the Fracture of the Nose Page 273
  • CHAP. II. Of the Fracture of the lower Jaw Page 274
  • CHAP. II. The Dressing and Bandage Ibid.
  • CHAP. III. Of the Fracture of the Clavicle Page 276
  • CHAP. III. The Dressing and Bandage Ibid.
  • CHAP. IV. Of the Fracture of the Omoplata or Shoulder-Blade Page 278
  • CHAP. IV. The Dressing Ibid.
  • CHAP. V. Of the Fracture of the Ribs Page 279
  • CHAP. V. The Dressing and Bandage Page 280
  • CHAP. VI. Of the Fracture of the Sternum or Breast-Bone Ibid.
  • CHAP. VI. The Dressing and Bandage Page 281
  • CHAP. VII. Of the Fracture of the Vertebra's Ibid.
  • CHAP. VIII. Of the Fracture of the Os Sacrum Page 283
  • CHAP. IX. Of the Fracture of the Coccyx or Rump-Bone Page Ibid.
  • CHAP. IX. The Dressing and Bandage for that Fracture Page 284
  • CHAP. X. Of the Fracture of the Humerus or Arm-Bone Page Ibid.
  • [Page] CHAP. X. Its proper Dressing and Bandage Page 285
  • CHAP. XI. Of the Fracture of the Bone of the Elbow Page 286
  • CHAP. XI. The Dressing and Bandage Page Ibid.
  • CHAP. XII. Of the Fracture of the Carpus or Wrist-Bone page 287
  • CHAP. XII. The Dressing and Bandage Page Ibid.
  • CHAP. XIII. Of the Fracture of the Bone of the Metacarpium or Back of the Hand Page 288
  • CHAP. XIII. The Dressing and Bandage Page Ibid.
  • CHAP. XIV. Of the Fracture of the Bones of the Fingers Page 289
  • CHAP. XV. Of the Fracture of the Thigh-Bone Page Ibid.
  • CHAP. XV. The Dressing and Bandage Page 290
  • CHAP. XVI. Of the Fracture of the Patella or Knee-Pan Page 291
  • CHAP. XVI. The Dressing anae Bandage Page Ibid.
  • CHAP. XVII. Of the Fracture of the Leg-Bone Page 292
  • CHAP. XVII. Its proper Dressing and Bandage Page 293
  • CHAP. XVII. The Dressing for complicated Fractures Page 294
  • CHAP. XVIII. Of the Fracture of the Bones of the Foot Page 295
  • CHAP. XVIII. The Dressing and Bandage Page 296
A Treatise of the Operati­ons which are perform'd in Luxations.
  • CHAP. I. OF the Luxation of the Bone of the Nose Page 297
  • CHAP. I. The Dressing and Bandage proper for such a Luxation Page 298
  • CHAP. II. Of the Luxation of the lower Jaw-Bone Page Ibid.
  • CHAP. II. The Dressing and Bandage Page 299
  • CHAP. III. Of the Luxation of the Clavicle Page Ibid.
  • CHAP. IV. Of the Luxation of the Vertebra's Page 300
  • CHAP. IV. The Dressing and Bandage Page 301
  • CHAP. V. Of the Luxation of the Coccyx or Rump-Bone Page 302
  • CHAP. VI. Of the Bunch Page Ibid.
  • CHAP. VII. Of the Luxation of the Ribs Page 303
  • CHAP. VII. The Dressing and Bandage Page Ibid.
  • CHAP. VIII. Of the sinking of the Xiphoider or Sword-like Cartilage Page 304
  • CHAP. IX. Of the Luxation of the Humerus or Arm-Bone, Page Ibid.
  • CHAP. IX. The Dressing and Bandage Page 306
  • [Page] CHAP. X. Of the Luxation of the Bone of the Elbow Page Ibid.
  • CHAP. X. The Bandage for the same Luxation Page 307
  • CHAP. XI. Of the Luxation of the Carpus or Wrist-Bone Page 308
  • CHAP. XI. The Bandage Page 309
  • CHAP. XII. Of the Luxation of the Bones of the Fingers Page Ibid.
  • CHAP. XII. The Bandage for that Luxation Page Ibid.
  • CHAP. XIII. Of the Luxation of the Thigh Page 310
  • CHAP. XIII. Its proper Dressing and Bandage Page 312
  • CHAP. XIV. Of the Luxation of the Knee Page Ibid.
  • CHAP. XIV. The Bandage Page 313
  • CHAP. XV. Of the Luxation of the Patella, Knee-Pan, or Whirl-Bone of the Knee Page Ibid.
  • CHAP. XV. Of the Separation of the Perone from the Ti­bia Page Ibid.
  • CHAP. XV. Of the Luxation of the Astragalus Page 314
  • CHAP. XV. Of the Separation of the Calcaneum from the Ast [...]aglus Page Ibid.
A Treatise of Medicinal Compositions necessary for a Surgeon.
  • CHAP. I. OF Balsams Page 315
  • CHAP. I. The Balsam of Arcaeus Ibid.
  • CHAP. I. The Balsam of Spain Page 316
  • CHAP. I. The Green Balsam Page 317
  • CHAP. I. The Samaritan Balsam Page 318
  • CHAP. II. Of Ointments Page 319
  • CHAP. II. Unguentum Althaeae Ibid.
  • CHAP. II. The mundificative Ointment of Smallage Page 320
  • CHAP. II. The black or suppurative Ointment Page 321
  • CHAP. II. Unguentum Rosatum Page 322
  • CHAP. II. Unguentum Album, aut de Cerussa Page 323
  • CHAP. II. Unguentum Aegyptiacum Page 324
  • CHAP. II. Unguentum Basilicon, or the Royal Ointment Page 325
  • CHAP. II. A cooling Cerate Page 326
  • CHAP. II. An Ointment for Burns Page 327
  • CHAP. III. Of Plaisters Page 328
  • CHAP. III. Of Plaister of Diapalma Ibid.
  • CHAP. III. The Plaister of simple Diachylum Page 329
  • CHAP. III. The Plaister of Andreas Crucius Page 330
  • CHAP. III. Emplastrum Divinum Page 331
  • CHAP. IV. Of Cataplasms or Pultisses Page 332
  • [Page] CHAP. V. Of Oils Page 334
  • CHAP. V. Simple Oil of Roses made by infusion Ibid.
  • CHAP. V. Compound Oil of Roses made be infusion Ibid.
  • CHAP. V. Oil of sweet Almonds made by expression Page 335
  • CHAP. V. Oil of Bayes Page 336
  • CHAP. V. Oil of Eggs made by expression Page 337
  • CHAP. VI. Of Collyriums Page 338
  • CHAP. VI. A dry Collyrium Ibid.
  • CHAP. VI. A blue Collyrium Page 339
  • CHAP. VII. Of Powders Ibid.
  • CHAP. VII. A Powder against Madness or Frenzy Ibid.
  • CHAP. VIII. A Styptick Water Page 340
The END of the TABLE.

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