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Title: 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, Ulcers, 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


Author: Charles Gabriel Le Clerc



Release Date: October 28, 2010  [eBook #34157]

Language: English

Character set encoding: ISO-8859-1


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Transcriber's note:

      A few typographical errors have been corrected; they are
      listed at the end of the text.

      Page numbers enclosed by curly braces (e.g., {125}) are
      included in the text to enable the reader to use the
      "Table of the Chapters" [Table of Contents] which is
      located at the end of the book.





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_, _Ulcers_, 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 Panacæa_.

       *       *       *       *       *

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_ _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, 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
producd 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, 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 Gun-shot, the
Scurvy, and all sorts of Venereal Diseases: From thence he is introduced
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._

       *       *       *       *       *


{1}

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?_

{2}

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 can have no certainty in what he
doth.

_Why must he be experienc'd?_

Because Knowledge alone doth not endue him with a dexterity of Hand
requisite in such a 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 may asswage those Pains which he is
oblig'd to cause his Patients to endure.

_What is Chirurgery or Surgery?_

It is an Art which shews how to cure the Diseases of Humane Bodies by a
methodical Manual Application. The Term being derived from the _Greek_ Word
[Greek: Cheir], signifying a Hand and [Greek: Ergon], a _Work_ or
_Operation_.

_After how many manners are Chirurgical Operations usually perform'd?_

Four several ways.

_Which be they?_

I. _Synthesis_, whereby the divided Parts are re-united; as in Wounds. II.
_Diæresis_, that divides and separates those Parts, which, by their Union,
hinder the Cure of Diseases, such is the continuity of Abscesses or
Impostumes which must be open'd to let out the purulent Matter. III.
_Exæresis_, which draws out of the Body whatsoever is noxious or hurtful,
as Bullets, Arrows, _&c._ IV. _Prosthesis_ adds some Instrument or Body to
supply {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?_ {4}

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 by others upon the Bodies of their Patients.

_What are the Diseases in general that belong to Surgery?_

They are Tumours, Impostumes, Wounds, Ulcers, Fractures, Dislocations, and
generally all sorts of Distempers whereto Manual Operations may be applyed.

_What are the Instruments in general which are 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 when Medicines are not
sufficient, recourse may be had to the Incision-Knife, and afterward to
Fire; intimating that we must proceed by degrees.

_Are there any Distempers that may be cured by the Surgeon's Hand alone?_

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

       *       *       *       *       *


{5}

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 neat 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 {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.

       *       *       *       *       *


{7}

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. {8}

_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 {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 carreyth 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 a 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 {10}
imperceptible 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, {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, {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 vision 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 {13} _Omoplatæ_ 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. {14}

_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 _Vertebræ_.

_What is _Synarthrosis_?_

_Synarthrosis_ being opposite to _Diarthrosis_, is a {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 respective Articulation: Thus the
Articulation which is caus'd by a Glutinous and {16} Cartilaginous
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
_Synncurosis_, 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 {17} Breast-Bones 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.
{18}

_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 _Ulna_, 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 {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. {20}

_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 respecting 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 Muscle perform'd?_

It is done by Contraction and Extension; the former causeth the Antagonist
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.

       *       *       *       *       *


{21}

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 _Vertebræ_ 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 {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 {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
_Attollens_ 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 {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 at 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 {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 _Alæ_
of the Nose. The two other Dilatators resembling a Myrtle-Leaf have their
Source in {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 are four for the Upper-Lip, and as many for the Lower:
with two common for each, and the 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 _Triangulis_, Antagonist to the former; its Rise is on
the outside, at the 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 from the bottom of the Chin
before, and cleaves to the edge of the Lower-Lip.

The fourth is the _Caninus_, Antagonist to the _Quadratus_, beginning in
the Upper-Jaw-Bone and being terminated in the Lower-Lip near the Corner of
the Mouth.

The first of the common is the _Zygomaticus_, the Origine whereof is in the
_Zygoma_ and its Insertion in the Corner of the Mouth, to draw it toward
the Ears; so that it is the Muscle which acts when we laugh.

The second of the common is the _Buccinator_ or Trumpeter, which is swell'd
when one sounds a Trumpet. It hath its rise at the Root of the Molar Teeth
of both the Jaws, and is extended quite round about the Lips. {27}

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 _Uvula_ 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 Left Molar Tooth, and being ty'd to the Palate by a thin
_Tendon_.

The two others are the _Peristaphylini Interni_, which have their beginning
in the _Apophysis Pterygoides_ on the inside, and likewise stick to the
Palate.

The Tongue, altho' all over Musculous and Fibrous, yet doth not cease to
have its peculiar 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 {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 it 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 {29} _Scutiformis_ 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 _Cricoarytenoideus 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 arising 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 _Stylopharingæus_, springs from within the Acute
_Apophysis_ of the _Os Sphenoides_, or _Cuneiforme_, and is inserted
obliquely {30} in the side of the _Pharynx_, which it dilates by drawing it
upward.

The third, call'd _Sphenopharyngæus_, proceeds from the _Apophysis
Styliformis_, and is terminated in the side of the _Pharynx_, which it
dilates by drawing its sides.

The fourth Pair is the _Cephalopharyngæus_ which ariseth from the
articulation of the Head with the first _Vertebra_, and closeth the
_Larynx_.

_How many Muscles are there in the Neck, and which be they?_

There are four Muscles in the Neck on each side, _viz._ two Flexors, and
two Extensors. The _Flexors_ are the _Scalenus_ and the _Rectus_ or
_Longus_; and the Extenders are the _Spinatus_ and the _Transversalis_.

The _Scalenus_ or _Triangularis_ hath two remote Sources, _viz._ one in the
first Rib, and the other in the Clavicle, and is fasten'd to the third and
fourth _Vertebra_ of the Neck.

The _Rectus_ or _Longus_ begins in the side of the four upper _Vertebra's_
of the Back, and is join'd to the upper _Vertebra's_ of the Neck, and the
hinder part of the Head.

The _Spinatus_ hath its Origine in the fourth and fifth upper _Vertebra's_
of the Back, and is fasten'd to all the six lower _Vertebra's_ of the Neck.

The _Transversalis_ springs forth out of the upper _Vertebra's_ of the
Back, and cleaves to the Extremity of the four _Vertebra's_ of the Neck.

       *       *       *       *       *


{31}

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 _Subclavius_, 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 {32} the five lower true
Ribs, as also in the two upper spurious Ribs.

The _Serratus Posticus Superior_, begins with a large _Aponeurosis_ in the
_Apophyses_ of the three lower _Vertebræ_ of the Neck, and of the first of
those of the Back; then passing under the _Rhomboid_, it is join'd
obliquely by four Indentings to the four upper Ribs.

The _Serratus Posticus Inferior_, commences 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, and is afterwards fasten'd by
four Digitations to the 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 back
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 {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 {34} Bastard Ribs, and
to the transverse Productions of the _Vertebra's_ of the Loins.

The _Extensors_ are the _Sacer_, and the _Semi-spinatus_, 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. {35}

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 _Rectus_, and
sticking to the _Peritonæum_.

The Oblique Muscles, and the Transverse, have Holes toward the Groin, to
give Passage to the Spermatick Vessels of Men, and to a round {36} ligament
of the _Matrix_ in Women; so that Ruptures or Burstenness happen through
these parts in both Sexes, although the Holes of these three Muscles are
not situated one over-against another.

The Pyramidal, so named by reason of its Figure, is situated in the lower
_Tendon_ of the _Rectus_, its Origine being in the upper and external part
of the _Os Pubis_; but it is terminated in the White Line, three Fingers
breadth above the _Pubes_, and sometimes even in the Navel itself. 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 is to compress all the contain'd
parts, in order to 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 its Tendon
covers the Testicle, which it draws upward.

_How many Muscles hath the _Penis_?_

It hath two Pair, _viz._ the _Erectores_ or _Directores_, and the
_Dilatantes_: The _Erectores_ arise from the internal part of the _Os
Ischion_, under the beginning of the _Corpora Cavernosa_, where they are
inserted, and retake their Fibres in their Membranes. The _Dilatantes_ or
_Acceleratores_ have their Source in the _Sphincter_ of the _Anus_ and
slipping from thence obliquely under the _Ureter_, are join'd to the
Membrane of the Nervous Bodies.

_How many Muscles are there in the _Clitoris_?_ {37}

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 _Omoplatæ_, 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 {38} _Rhomboides_,
the proper _Levator_, and the lesser _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 _Transverse 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?_ {39}

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 fills, passing 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 {40} _Tendon_ to the upper
and inner part of the _Humerus_, a little below the Head.

The greater _Pectoral_ hath its Source in half 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 top of the Shoulder-Bone, on the
inside, between the _Biceps_ and the _Deltoides_.

The _Coracoideus_ or _Coracobrachyæus_, beginning in the _Apophysis
Coracoides_ of the _Omoplata_ or Shoulder-Blade, adheres to the middle of
the Arm on the inside, which with the _Pectoral_ it 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 draws backward.

The _Rotundus Minor_, or _Teres Minor_, proceeds 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 manner backward.

The _Sub-scapularis_ or _Immersus_ is situated entirely under the
_Omaplata_, proceeding from the internal Lip of the _Basis_ or Root of the
same _Omoplata_, and being terminated in the Neck of the Arm-Bone, which it
causeth to lie close to the Ribs.

_How many Motions are there in the_ Cubitus _or Elbow, and what are its
Muscles?_

The _Cubitus_ or _Ulna_ is endu'd with two sorts of Motions, _viz._ that of
Flection and that of {41} Extension, the former being perform'd by the help
of two Muscles, that is to say, the _Biceps_, and the _Brachiæus Internus_;
and the later by eight others, which are the _Longus_, the _Brevis_, the
_Brachiæus Externus_, and the _Anconeus_.

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 _Brachiæus 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 inner-part 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 _Brachiæus 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 _Brachiæus Externus_ is a fleshy Muscle which proceeds from the hinder
part of the {42} _Humerus_, and adheres to the _Olecranum_ with the
_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 the
Arm-Bone, at the end of the _Brevis_ and the _Longus_, and in descending is
inserted between the _Radius_ and the _Cubitus_ or _Ulna_, three or four
Fingers breadth below the _Olecranum_.

_How many Muscles hath the _Radius_, and which are its Motions?_

The _Radius_ is endu'd with a twofold Motion by the means of four Muscles:
Of these 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 inner _Apophysis_ of the Shoulder-Bone, in a very
fleshy Stock, and is terminated obliquely by a Membranous _Tendon_ in the
middle and exterior part of the _Radius_.

The _Pronator Inferior Quadratus_, springing forth from the bottom and
inside of the _Cubitus_, is 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, is that which jointly with the _Rotundus_, turns the
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 the external _Apophysis_ of the Arm-Bone; from
whence it passeth along the _Radius_, and cleaves to the inner-part of its
lower _Apophysis_. {43}

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 forepart. 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 _Cubitæus Internus_, the _Radiæus Internus_,
and the _Palmaris_.

The _Cubitæus 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 _Radiæus Internus_ proceeds from the same place with the _Cubitæus_,
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
{44} of the Arm-Bone, and is united by a large _Tendon_ to the first
_Phalanges_ of the Fingers, slipping under the Transverse or _Annular_
Ligament and sticking under the Skin of the Palm of the Hand.

The three extending Muscles of the Wrist are the _Cubitæus Externus_, and
the _Radiæus Externus_ or the _Longus_, and the _Brevis_.

The _Cubitæus Externus_ taking its rise from the hinder-part of the Elbow,
passeth under the _Annular_ Ligament, and adheres to the upper and
outward-part of the Bone of the _Metacarpus_ that stayeth the little
Finger.

The _Radiæus Externus_, or the _Longus_, having its Origine in the edge of
the lower part of the Arm-Bone, slides from thence along the _Radius_ on
the outside, extends it self under the _Annular_ Ligament, and cleaves to
the Wrist-Bone, which stayeth the Fore-Finger.

The _Brevis_ or _short_ Muscle of the Wrist springs from the lower part of
the same Edge; afterwards it runs along the _Radius_, passeth under the
_Annular_ Ligament, and is terminated in the Bone of the _Carpus_ or Wrist,
which stayeth the Middle Finger. But we must take notice, that besides
these six Muscles, there is also _Caro quædam quadrata_, or a square piece
of Flesh under the _Palmaris_, which seems to arise from the _Thenar_, and
sticks to the eighth Wrist-Bone. It is supposed that this Musculous piece
of Flesh serves with the _Hypothenar_ of the little Finger, to make that
which is call'd _Diogenes's Cup_.

_How many Motions are there in the Fingers, and what are their Muscles_?
{45}

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
observed 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
{46} to the second and third _Phalanx_ of the Fingers.

The four _Lumbricales_ or _Vermiculares_ are in the Palm of the Hand, to
draw the Fingers to the Thumb: They proceed from the _Tendons_ of the
_Profundus_, and the _Annular_ Ligament, extend themselves along the sides
of the Fingers and are inserted in their second Articulation, to cause the
drawing toward the Thumb.

The three _Interossei Interni_, and the three _Externi_, are situated
between the four Bones of the _Metacarpium_, as well on the inside of the
Hand as without: They have their beginning in the Intervals or Spaces
between the Bones of the _Metacarpium_, are united with the _Lumbrical_,
and fixt in the last Articulation of the Bones of the Fingers, to produce
the Motion of drawing back or removing from the Thumb.

The Thumb is mov'd by five particular Muscles; one whereof serves to bend
it, two to extend it, one to remove it from the Fingers, and another to
draw it to them.

The _Flexor_ of the Thumb takes its rise from the upper and inner part of
the _Radius_, passes under the _Annular_ Ligament, as also under the
_Thenar_, and adheres to the first and second Bones of the same Thumb to
bend it.

The two _Extensors_ of the Thumb are the _Longior_ and the _Brevior_: The
former proceeding from the upper and outward part of the _Cubitus_, ascends
above the _Radius_, and is ty'd with a forked _Tendon_ to the second Bone
of the Thumb. The _Brevior_ hath the same Origin with the _Longior_, keeps
the same Track, passes under the _Annular_ Ligament, and is terminated in
the third Thumb-Bone. {47}

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. {48}

The _Abductor_, call'd also _Hypothenar_, hath its beginning in the small
Bone of the Wrist, which is situated over the others, and is terminated in
the first Bone of the Little-Finger on the outside.

       *       *       *       *       *


CHAP. XI.

_Of the Muscles of the Thighs, Legs, and Feet._

_What are the Motions of the Thighs?_

The Thigh performs five kinds of Motions; for it is bent, extended, drawn
within side and without, and turn'd round: All these Motions are produc'd
by the means of fourteen Muscles, _viz._ three _Flexors_, three
_Extensors_, three _Adductors_, three _Abductors_, and two _Obturators_ for
the Circular Motion.

The _Flexors_ of the Thigh are the _Psoas_, _Iliacus_, and _Pectineus_.

The _Psoas_ or _Lumbaris_ is situated inwardly in the _Abdomen_, on the
side of the _Vertebra's_. It proceeds from the transverse _Apophyses_ of
the two lower _Vertebra's_ of the Back, and of the upper of the Loins, and
lying on the inner Face of the _Os Ilion_, sticks to the lesser
_Trochanter_ or _Rotator_.

The _Iliacus Internus_ hath its Origine in all the Lips of the inner Cavity
of the _Os Ilion_, and being joyn'd by a _Tendon_ to the _Lumbaris_, is
inserted with it in the lesser _Trochanter_. {49}

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 _Glutæus Major_, _Medius_, and
_Minimus_.

The _Glutæus 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 enters into the Thigh-Bone, four Fingers breadth below the great
_Trochanter_ or _Rotator_, being the thickest of all the Muscles of the
Body.

The _Glutæus Medius_, deducing its Original from the hinder and outward
part of the _Os Ilion_, is inserted three Fingers breadth below the great
_Trochanter_.

The _Glutæus 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_. {50}

The _Pyriformis_ arising from the upper and lateral part of the _Os
Sacrum_, and the the _Os Ilion_ cleaves to the Neck of the great
_Trochanter_.

The _Quadratus_ or square Muscle of the Thigh takes its Origine from the
external Prominence of the _Os Ischion_, and adheres to the outward part of
the great _Trochanter_.

The _Gemelli_ or Twin Muscles arise from two small Knobs in the hinder-part
of the _Ischion_ and insinuate themselves into a small Cavity in the Neck
of the great _Trochanter_.

The Circular Motion of the Thigh is performed by the means of two Muscles,
named the _Obturatores Externi_ and _Interni_.

The _Obturator Internus_ springs from the inner Circumference of the Oval
Hole of the _Ischion_ and its _Tendons_ passing between the two _Gemelli_
are inserted in a small Cavity at the Root of the great _Trochanter_ or
_Rotator_.

The _Obturator Externus_ ariseth from the outward Circumference of the same
Hole of one _Ischion_, and is terminated in the side of the other near the
great _Trochanter_.

_What are the Motions of the Leg, and what are its Muscles?_

The Leg is mov'd four several ways, that is to say, it is bent, extended,
and drawn inward and outward, by the means of eleven Muscles _viz._ three
_Flexors_, four _Extensors_, two _Adductors_ and two _Abductors_.

The three _Flexors_ of the Leg are the _Biceps_, the _Semi-nervosus_, and
the _Semi-membranosus_.

The _Biceps_ hath two Heads, the longer whereof cometh out of the bottom of
the Prominence {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 {52} _Tendon_, which serves likewise
as a Ligament to the Knee.

The two _Adductors_ of the Leg are the _Sartorius_ and the _Gracilis_.

The _Sartorius_ or the _Longissimus_ draws the leg inward, deriving its
Original from the upper _Spine_ of the _Ischion_; from whence it descends
obliquely thro' the inside of the Thigh, and cleaves to the top on the
inside of the _Tibia_.

The _Gracilis_ hath its Origine in the fore-part at the bottom of the _Os
Pubis_, and its Insertion in the top of the _Tibia_ on the inside.

The two _Abductors_ of the Leg are the _Fascia lata_, and the _Poplitæus_.

The _Fascia lata_, or the _Membranosus_, is as it were a kind of large
Band, which covers all the Muscles of the Thigh. It proceeds from the
outward Lip of the _Os Ilion_, is ty'd by a large Membrane to the top of
the _Perone_ or _Fibula_ and sometimes descends to the end of the Foot.

The _Poplitæus_, or _Sub-poplitæus_, arises from the lower and external
_Condylus_ of the Thigh-Bone, passeth obliquely from the outside to the
inside, till it is lost in the upper and inner part of the Leg-Bone under
the Ham.

_What are the Motions of the Foot, and what are its Muscles?_

The Foot performs two Motions by the help of nine Muscles, as being bent by
two, and extended by seven.

The two _Flexors_ are the _Crureus Anticus_, and the _Peronæus Anticus_.

The _Crureus_ or _Tibiæus Anticus_, is plac'd along the _Tibia_, and takes
its rise from its upper and fore-part: Afterward it is bound by two {53}
_Tendons_ to the first _Os Cuneiforme_, or Wedge-like Bone, and to that of
the _Metatarsus_ or Instep, which stayeth the great Toe, after having
pass'd under the annular Ligament.

The _Peronæus 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 _Plantaris_, the _Crureus Posticus_, and the two _Peronæi 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 back-part 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 _Tibiæus 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_. {54}

The _Peronæi_, or _Fibulæi Postici_, are otherwise call'd the _Longus_ and
the _Brevis_, whereof one proceeds from the upper and almost fore-part of
the _Perone_, terminating in the upper-part of the Bone, that supports the
great Toe in the _Metatarsus_, and the other from the lower part of the
_Perone_, adhering in like manner to the Bone with which the little Toe is
sustain'd.

_With what Motions are the Toes endu'd, how many Muscles have they, and
which be they?_

The Toes are bent and extended, as also drawn inward and outward, by the
means of twenty two Muscles, of which sixteen are Common, and six Proper.
The former are two _Flexors_, two _Extensors_, four _Lumbricales_, and
eight _Interossei_. The first _Flexor_ is nam'd _Sublimis_, and the other
_Profundus_.

The _Sublimis_ or _Perforatus_ derives its Original from the lower and
inner-part of the _Talus_ and is fixt in its proper place by four cleft
_Tendons_, which are inserted in the upper-part of the Bones of the first
_Phalanx_ of the four Toes. It is situated under the Sole of the Feet.

The _Profundus_ or _Perforans_ hath its beginning in the top and back-part
of the Leg-Bone and _Perone_, slips under the _Malleolus Internus_ thro'
the _Sinus Calcaris_, and makes four _Tendons_ which pass thro' the
Fissures of the _Tendon_ of the _Sublimis_, and cleaves to the Bones of the
last _Phalanx_ of the Toes, to bow them.

The first _Extensor_ is call'd the _Common_, and the other the _Pediæus._

The _Common Extensor_, or the _Longus_, takes its rise from the top and
fore-part of the _Tibia_ in the place of its joyning with the _Perone_ or
{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 _Pediæus_ 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 fixt 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
_Profundus_, 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, {56}
Extension, 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, arises from the top of the _Perone_
or _Fibula_, on the back 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 springs from the middle of the
fore-part of the _Perone_, passeth over the Foot, and hath its Insertion in
the upper-part of the Bone of the great Toe.

The Proper _Adductor_ of the great Toe, or the _Thenar_, taking its rise
inwardly on the side of the _Talus_, the _Ossa Schaphoidea_ and
_Innominata_, 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 draws inward.

The proper _Abductor_ of the great Toe, or 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. {57}

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 _Uvula_, 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 _Omoplatæ_ 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
  {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' the whole Body?_

It is directly perform'd by Conjugations or Pairs, whereof one goes to the
Right-hand, and the other to the Left: There are nine Pairs of 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 {59} passeth thro' the Hole of the _Dura Mater_,
thro' which the Vertebral Artery enters, to distribute its Branches into
several Parts.

_To what Use 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 Fore-head,
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. {60}

The ninth Pair, after having form'd a Trunk with the eighth, disperseth its
Twigs several ways, whereof one is join'd with the Twig to the tenth, to be
distributed together into the Muscle _Sternohyoideus_, and into the Tongue.

The _Intercostal_ and _Spinal_ are not Pairs of Nerves, but only Branches
or Twigs of other Pairs.

_What is the Distribution and Use of the thirty Pairs of Nerves that
proceed from the Spinal Marrow?_

There are seven that go forth from the several _Vertebra's_ of the Neck,
twelve from those of the Back, five from the Loins, and six from the _Os
Sacrum_, according to the following Progression.

The first of the seven Pairs of Nerves of the Neck proceeds from between
the Occipital Bone and the first _Vertebra_, nam'd _Atlas_, its Fibres
being lost in the Muscles of the hinder-part of the Head and Neck.

The second Pair springs from between the first and second _Vertebra_ of the
Neck; the Fibres whereof are lost in the Muscles of the Head, and in the
Skin of the Face.

The third Pair issueth from between the second and third _Vertebra_ of the
Neck; and its Fibres are lost in the Flexor Muscles and Extensors of the
Neck.

The fourth, fifth, sixth, and seventh Pairs proceed from between the
_Vertebra's_, as before, but their Fibres are lost in the Neck of the
_Omoplata_, in the Arm, and in the _Diaphragme_ or Midriff. Here it ought
to be observ'd by the way that the Arms receive Branches not only from the
{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?_ {62}

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 {63} divers
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 _Upper 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. {64}

_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 Portæ_, and _Vena Cava_;
and the third is twofold, _viz._ the _ascending_ and the _descending_.

The _Vena Portæ_ is distributed to all the Parts contain'd in the lower
Belly, and terminated in the Fundament; where it makes the Internal
Hæmorrhoidal Veins.

The _Vena Cava_ is immediately divided into two thick Branches, one whereof
ariseth upward to the Right Ventricle of the Heart, and forms the
_ascending Vena Cava_; as the other goes downward to the Feet, and
constitutes the _descending_.

_What is the Distribution of the ascending _Vena Cava_?_

It perforates the Diaphragm, goes to the Heart, and ascends from thence to
the Clavicles, {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 _Hæmorrhoidal_ Veins. Afterward the outward
Branch of the _Iliack_ descends in the Thigh, to form the _Crural_, and
others, as far as the _Saphæna_, together with those that are situated at
the end of the Feet.

       *       *       *       *       *


{66}

CHAP XII.

_Of the Anatomy of the _Abdomen_, or lower Belly_.

_What is the clearest Division of the Human Body into various Parts, and
that which is most followed in the Anatomical Schools?_

It is that which constitutes three _Venters_, that is to say, the Upper,
the Middle, and the Lower, which are the Head, the _Thorax_ or Breast and
the _Abdomen_ or lower Belly, together with the Extremities, which are the
Arms and Legs.

_What is the lower Belly?_

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

_What is to be consider'd outwardly in the lower Belly?_

Its different Regions, and the several parts therein contain'd.

_What are these Regions?_

They are the _Epigastrick_, the _Umbilical_, and the _Hypogastrick_.

_What is their Extent?_

It is from the _Xyphoides_ or Sword-like Cartilage to the _Os Pubis_, the
division whereof into three equal Parts, constitutes the three different
Regions; the _Epigastrium_ being the first upward, the _Umbilicus_ the
second, and the _Hypogastrium_ the third. {67}

_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 Umbilical 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,
_Cæcum_ 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?_ {68}

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 Muscles
of the lower Belly. Thus we have taken a View of what Anatomists commonly
term the _five Teguments_, that is to say, the _Epiderma_ or Scarf-Skin,
the _Derma_ or true Skin, the _Panicula Adiposa_, the _Panicula Carnosa_ or
_Membranus 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 _Peritonæum_, 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 _Peritonæum_, 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 {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
_Peritonæum_; 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?_ {70}

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_, where it
produceth a Rupture; it extends it self almost twenty Foot in length.

The first of the thick Guts, known by the 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 of its great Circumvolutions, and
is from eight to nine Foot long. The last is the _Rectum_ or {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, {72} where it assumes the
form of Blood; from whence it passeth to the Lungs thro' the _Pulmonary_
Artery; then it returns to the Heart thro' the _Pulmonary_ Vein, and goes
forth again 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 is the ordinary Passage for the Circulation of the Chyle, and the
Sanguification of the Heart.

_What is the Liver?_

The Liver, being the thickest of all the Bowels, is plac'd in the Right
_Hypochondrium_, at the distance only of a Fingers breadth from the
Diaphragm; its Figure much resembling that of a thick piece of Beef: It is
Convex on the outside, and Concave within; its Substance is soft and
tender, its Colour and Consistence being like coagulated Blood: It is cleft
at bottom, and divided into two Lobes, _viz._ one greater, and the other
less: Its Office is to purifie the Mass of Blood by Filtration; and it is
bound by two strong Ligaments, the first whereof adheres to the Diaphragm,
and the second to the _Xiphoides_ or Sword-like Cartilage. Two great Veins
take their Rise from hence, _viz._ the _Vena Portæ_, and the _Vena Cava_,
which form innumerable Branches, as it were Roots in the Body of the Liver.
The Gall-Bladder is fasten'd to the hollow part thereof, and dischargeth
its Choler into the Gut _Duodenum_, thro' the Vessels that bear the Name of
_Meatus Choledochi_, or _Ductus Biliares._ This Choler is not a meer
Excrement, but on the contrary of singular Use in causing the Fermentation
of the Chyle, and bringing it to perfection. {73}

_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 _Peritonæum_, 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 _Peritonæum_; 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 fasten'd to the Midriff, Loins, and _Aorta_, by the
_Emulgent_ Arteries; as also to the Bladder by the _Ureters_. The Right
Kidney likewise adheres to the Gut _Cæcum_, 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 {74} to
cause it to run thro' the Vessels call'd _Ureters_ into the Bladder.

Immediately above the Reins on each side, is a flat and soft Glandule, of
the thickness of a Nut; they are nam'd _Renal Glandules_, or _Capsulæ
Atribiliariæ_, because they contain a blackish Liquor, which (as they say)
serves as it 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, being plac'd in the middle of the Hypogastrick Region; so that it
is guarded by the _Os Sacrum_ behind, and by the _Os Pubis_ before: Two
Parts are to be distinguish'd therein, _viz_. its Bottom and Top; by its
Membranous Bottom it is join'd to the Navel, and suspended by the means of
the _Urachus_, and the two Umbilical Arteries which degenerate into
Ligaments in adult Persons: As by its fleshy Neck, longer and crooked in
Men, and shorter and streight in Women it cleaves to the _Intestinum
Rectum_ in the former, and to the Neck of the Womb in the latter. Lastly,
its Office is to receive the Urines to keep them, and to discharge them
from time to time.

_What are the Genitals in Men?_

They are the Spermatick Vessels, the Testicles, and the _Penis_. The
Spermatick Vessels are a Vein and an Artery on each side; the former
proceeding from the _Aorta_, or thick Artery of the Heart; and the other
from the Branches of the _Vena Cava_ of the Liver. These Arteries and Veins
are terminated in the Body of the {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 _Præparantia_, and afterwards to cause it to pass thro' others nam'd
_Deferentia_, to the _Vesiculæ Seminales_, from whence it is forc'd into
the _Ureter_, 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 _Ureter_: 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 _Præputium_, 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 _Vesiculæ_, 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 _Uterus_, are
call'd _Deferentia_ or _Ejaculatoria_. {76}

The _Matrix_, _Uterus_ or Womb, is the principal Organ of Generation, and
the place where it is perform'd, resembling the Figure of a Pear 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 _Nymphæ_, 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_.

       *       *       *       *       *


{77}

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?_ {78}

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 all the others; on which account it is call'd _Primus
vivens_, & _ultimum moriens_; that is to say, the first Member that begins
to live, and the last that dies.

_What Parts are to be consider'd in the Heart?_

Its fleshy Substance, with all its Fibres turn'd round like the Skrews of a
Vice; its _Basis_, Point, 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 or small Ears being as it were little Cisterns or Reservers, that
pour the Blood by degrees into the Heart, are situated on each side above
the Ventricles. The Ventricles, which are likewise two in Number, are
certain Cavities in its Right and Left Sides. The large Vessels are the
_Aorta_ or great Artery, and the _Vena Cava_ together with the Pulmonary
Artery and Vein. The _Pericardium_ is a kind of Bag fill'd with Water,
wherein the Heart is kept; which is {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 Sponge, 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 {80} into the Lungs, and the
_Pharynx_ that of the _Oesophagus_ 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 _Crotaphitæ_, or 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?_ {81}

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 of 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 {82} are join'd together by passing one over the
other.

_What is the Use 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 Parietal by a
bastard squamous Suture.

_What is most remarkable in the thickness of the Skull-Bones?_

The _Diploe_, which is nothing else but a _Plexus_ 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 {83} happens 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
Number of Veins, Arteries, Lymphatic 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. {84}

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 divers 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 {85} in the _Os Sphenoides_ on each side, a Hole that
doth not penetrate the _Basis_ of the Skull, but makes a kind of _Ductus_,
about an Hair's breadth long, which is open'd behind the Orbit on the top
of the Space between the _Apophysis Pterygoides_, and the third Bone of the
Jaw; thro' this _Ductus_ runs the lower Branch of the foremost Fibre of the
fifth Pair.

About the length of two Hairs breadth beyond these _Ductus's_, we may also
discover in the _Os Sphenoides_, or Wedge-like Bone, two Holes of an Oblong
and almost Oval Figure, which are plac'd in the hindermost sides of that of
the _Os Sphenoides_, and gives passage to the hindermost Fibre of the fifth
Pair.

The Hole thro' which runs the _Auditory_ Nerve, that makes the seventh
Pair, is in the middle of the hinder-part of the _Os Petrosum_, that looks
toward the _Cerebellum_: This Hole being very large, is the Entrance of a
_Ductus_ that is hollow'd in the _Os Petrosum_, and which sinking obliquely
from the fore-part backward, for the depth of about two Hairs breadth,
forms as it were the bottom of a Sack, the lowermost part whereof is
terminated partly by the _Basis_ of the _Cochlea_, and partly by a Portion
of the Mouth of the _Vestibulum_. At the bottom of this _Ductus_ are many
Holes, but the most considerable is that of the upper-part, thro' which
passeth a Portion of the Auditory Nerve. This is also the Entrance of
another _Ductus_ made in the _Os Petrosum_, which is open'd between the
_Apophysis Mastoides_ and _Styloides_: These other Holes afford a Passage
to the Branches of the soft Portion of the same Auditory Nerve. {86}

Below this _Ductus_ there is a remarkable Hole form'd by the meeting of two
hollow Cuts the larger whereof is in the Occipital Bone and the other in
the lower-part of the _Apophysis Petrosi_: From the middle of the
upper-part of this Hole issueth forth a small Prominence or bony Point,
whereto is join'd an Appendix of the _Dura Mater_, which divides the Hole
into two parts; so that thro' the foremost Orifice passeth the Nerve of the
eighth Pair, and that which is call'd the _Spinal_ Nerve. We shall have
occasion hereafter to shew the Use of the hinder Orifice.

Near the great Hole of the Occipital Bone from whence proceeds the _Medulla
Oblongata_, we may observe a Hole almost round and oblong thro' which
passeth the Nerve of the ninth Pair. This Hole is entirely situated in the
Occipital Bone, and making a little Way in the Bone passeth obliquely from
the back-part forward. In the inside of the Skull this Hole is sometimes
double, but its two Entrances are re-united in the outward-part of the
Skull; and the two Branches that form the Origine of this Nerve and which
pass thro' these two Holes, are likewise re-united at their Departure,
These are the Passages of the nine Pairs of Nerves that proceed from the
_Medulla Oblongata_, and it remains only to show that Paths thro' which the
Intercostal Nerve goes forth, as also that of the tenth Pair. The
Intercostal runs out of the Skull thro' the _Ductus_ that gives Entrance to
the Internal _Carotick_ Artery. As for the tenth Pair, in regard that it
ariseth from the Marrow which is enclos'd between the Occipital {87} Bone
and the first _Vertebra_, it goes forth thro' the Hole of the _Dura Mater_,
where the Vertebral Artery enters.

To know well the Holes thro' which the Vessels that belong to the
inner-part of the Head enter, and issue forth, it is requisite to
distinguish them into those which are distributed to the _Dura Mater_, and
those that are appointed for the Brain. The Vessels of the _Dura Mater_,
are Branches of the _Carotick_ or Vertebral Arteries.

In the _Os Sphenoides_, or Wedge-like Bone, behind the Hole thro' which
passeth the hindermost Fibre of the fifth Pair of Nerves lies another small
Hole, almost round, that gives Entrance to a Branch of the _External
Carotick_ Artery, which in entring, immediately adheres to the _Dura
Mater_, and forms many Ramifications to overspread the whole Portion of
this Membrane, which covers the sides, and the upper-part of the Brain.

At the bottom and top of the lateral outward part of the Orbit of the Eye,
above the acute Angle, for want of the _Os Sphenoides_, there is a Hole
thro' which passeth an Artery, being a Twig of a Branch of the _Internal
Carotick_, which is diffus'd in the Eye, and distributed to almost the
whole Portion of the _Dura Mater_, that covers the fore-part of the Brain.

The Vertebral Artery in entring into the Skull, furnisheth it on each side
with a considerable Branch, which is dispers'd throughout the whole Portion
of the _Dura Mater_ that covers the _Cerebellum_. {88}

As for the Veins that accompany these Arteries, they almost all go out of
the Skull thro' the same Holes where the other enters.

There are four thick Arteries which convey to the Brain the Matter with
which it is nourish'd, and that whereof the Spirits are form'd, _viz._ the
two _Internal Caroticks_, and the two _Vertebrals._

The _Internal Carotick_ Arteries enter into the Skull thro a particular
_Ductus_ made in the Temporal Bone, the Mouth thereof being of an Oval
Figure and situated in the outward part of the _Basis_ of the Skull, before
the Hole of the _Internal Jugular._ This _Ductus_ extends it self obliquely
from the back-side forward, and after having made about three Hairs breadth
in length, is terminated in the hinder-part of the _Os Sphenoides_. The
Artery traverseth the whole winding Compass of this _Ductus_, which
resembles the Figure of the _Roman_ Letter S, and at the Mouth of the same
_Ductus_ runs under the _Dura Mater_ along the sides of the _Os Sphenoides_
to the _Anterior Apophyses Clinoides_, where it riseth up again, to
perforate the _Dura Mater_, and to adhere to the Root of the Brain. These
Vessels, in like manner, after their departure from the Bone of the Temples
to the place where they pierce the _Dura Mater_, make a second Circuit in
form of the _Roman_ Character S. At the place where these _Carotick_
Arteries penetrate the _Dura Mater_, they send forth a thick Branch, which
enters into the Orbit of the Eye, by the lower-part of the Hole, thro'
which the _Optick_ Nerve hath its Passage. {89}

The _Vertebral_ Arteries proceeding from the Holes of the transverse
_Apophyses_ of the first _Vertebra_, turn about in passing under the upper
oblique _Apophyses_ of the seven _Vertebra's_: Afterward they perforate the
_Dura Mater_, and running under the Marrow, enter into the Skull thro' the
Occipital Hole; then inclining one toward another, they are re-united, and
form only one single Trunk.

The Veins that bring back the Blood from the Substance of the Brain, are
emptied into the _Sinus's_ of the _Dura Mater_, which are all discharg'd
into those that are call'd _Lateral_, which last go out of the Skull
immediately under the Nerves of the eighth Pair, thro' the hinder-part of
the Hole made by the meeting of the _Occipital_ Bone, and the _Apophysis
Petrosa_. These Lateral _Sinus's_ fall into the _Internal Jugulars_, which
are receiv'd into a considerable Sinking hollow'd on each side in the
outward, part of the _Basis_ of the Skull, which is nam'd the Pit or Hole
of the _Internal Jugular_.

In the upper and hinder-part of the Hole, from whence the lateral _Sinus's_
issue forth, is to be seen an opening in the Extremity of a _Ductus_, the
Mouth whereof lies behind the _Condyli_, which are on the sides of the
Occipital Trunk: This _Ductus_ is extended about the length of two Hairs
breadth in the Bone, and the Canal enclos'd therein is open'd immediately
into the _Vertebral Sinus_: So that one might affirm it to be as it were
its Original Source. Whence it appears that the Blood contained in the
lateral _Sinus's_ is emptied thro' two places; the greater Portion thereof
descending in the _Jugulars_ {90} from the Neck, and the other in the
_Vertebral Sinus's_: Sometimes those _Ductus's_ are four only on one side,
another while both are stopt up, and the Blood contain'd in the lateral
_Sinus's_ is discharg'd into the _Internal Jugulars_.

Behind the _Apophysis Mastoides_ on each side is a remarkable Hole, thro'
which passeth a thick Vein, which brings back part of the Blood that hath
been distributed to the Teguments and Muscles, which cover part of the
_Occiput_ or hinder-side of the Head: This Vein is open'd into the lateral
_Sinus's_ at the place where they begin to turn about. But in the Heads of
some Persons, this Hole is found only on one side, and even sometimes not
at all, in which case the Blood contain'd in the Vessels falls into the
_External Jugulars_, with which the Branches of this Vein have a
Communication.

In each _Parietal_ Bone on the side of the _Sagittal_ Suture, at a little
distance from the _Lambdoidal_, appears a Hole, thro' which passeth a Vein,
that brings back the Blood of the Teguments of the Head, and dischargeth it
self into the upper _Longitudinal Sinus_. These Holes are sometimes on
both; and then the Blood contain'd in the Branches of this Vein runs into
the _External Jugulars_.

In the middle of the _Sella_ of the _Os Sphenoides_, we may observe one or
two small Holes thro' which (according to the Opinion of some Modern
Anatomists) the _Lympha_ contain'd in the _Glandula Pituitaria_ is thrown
{91} into the _Sinus_ of the edge of the _Os Sphenoides_; nevertheless it
is certain, that these Holes are fill'd only with Sanguinary Vessels, which
carry and bring back the Blood of the Bones and Membranes, whereof those
_Sinus's_ are compos'd; besides that, these Holes are rarely found in adult
Persons.

Between the Spine of the _Coronal_ Suture and the _Crista Galli_, is a Hole
which serves as an Entrance for a _Ductus_, which sinks from the top to the
bottom, the length of about two Hairs breadth in the thickness of the inner
Table of the _Coronal_: The Root of the upper _Longitudinal Sinus_ is
strongly implanted in this Hole, which also affords a Passage to some
Sanguinary Vessels appointed for the Nourishment of this inner Table.

Many other small Holes are found in divers places of the _Basis_ of the
Skull; the chief whereof are those that are observ'd in the _Apophysis
Petrosa_, and give Passage to a great number of Vessels that serve for the
Nutriment of that part of the Temporal Bone which is call'd the _Tympanum_,
or Drum: The other Holes are principally design'd for the Vessels that are
serviceable in the nourishing of divers parts of the _Basis_ of the Skull.

_After what manner is the opening of the Head or Skull perform'd?_

It is done by sawing it asunder round about and above the Ears; then it is
taken off, after having before cut off the Hair, and made a Crucial
Incision in the Skin from the fore-part to the hinder, and from one Ear to
the other; as also after having {92} pull'd off and laid down the four
Corners to the bottom.

_How is the Brain anatomiz'd?_

It is done by cutting it Superficially, and by Leaves, in order to discover
by little and little the Ventricles, Vessels, and Nerves, with their
Original Sources, &c. Or else it is taken entire out of the Skull, (the
Nerves having been before examin'd) and laid down; so that without cutting
any thing, all the parts of the Brain may be set in their proper places, to
find out those that are sought for.

       *       *       *       *       *


{93}

A

TREATISE

OF

_Straps, Swathing-Bands, Bandages, Bolsters, Splints, Tents,
Vesicatories,
Setons, Cauteries, Leeches, Cupping-Glasses, and Phlebotomy._

       *       *       *       *       *


CHAP. XVI.

_Of Straps, Swathing-Bands, Bandages, and Bolsters._

_What is a Strap?_

It is a kind of Band commonly made use of for the Extension of the Members
in the reducing of Fractures and Luxations; or else in binding Patients,
when it is necessary to confine them, for the more secure performing of
some painful Operation: These sorts of Ligatures have different Names, {94}
according to their several Uses, and often bear that of their Inventer.

_What is the Matter whereof these Straps are compos'd?_

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

_What is a Swathing-Band?_

It is a long and broad Band, that serves to wrap up and contain the Parts
with the Surgeons Dressings or Preparatives.

_Of what Matter are these Swathing-Bands made?_

They are made at present of Linnen-Cloth but in the time of _Hippocrates_,
were made of Leather or Woollen-Stuff.

_How many sorts of Swathing-Bands are there in general?_

There are two sorts, _viz._ the Simple and Compound; the former are those
that are smooth, having only two ends; and the other are those which are
trimm'd with Wooll, Cotton, or Felt, or that have many Heads, that is to
say, Ends, fasten'd or cut in divers places according as different
Occasions require.

_What are the Conditions requisite in the Linen-Cloth, whereof the
Swathing-Bands are made?_

It must be clean, and half worn out, not having any manner of Hem or Lift.

_What are the Names of the different Swathing-Bands?_

There are innumerable, but the greater part them take their Denominations
from their Figure or Shape; as the Long, Streight, Triangular, and those
which have many Heads, or are trimm'd. {95}

_What is A Bandage?_

It is the Application of a Swathing-Band to any Part.

_How many sorts of Bandages are there?_

As many as there are different Parts to be bound; some of them being
Simple, and others Compound: The former are those that are made with an
uniform Band; as the Bandage call'd the _Truss_, and divers other sorts:
The Compound are those that consist of many Bands set one upon another, or
sew'd together; or else those that have many Heads. They have also
particular Names taken from the Inventers of them, or from their Effect; as
_Expulsive_ Bandages to drive back, _Attractive_ to draw forward,
_Contentive_ to contain, _Retentive_ to restrain, _Divulsive_ to remove,
_Agglutinative_ to rejoin, &c.

There are others whereto certain peculiar Names are appropriated; as
_Bridles_ for the lower Jaw, _Slings_ for the Chin, the back part of the
Head, Shoulder, and _Perinæum_; _Scapularies_ for the Body, after the
manner of the Scapularies of Monks; _Trusses_ for Ruptures; _Stirrups_ for
the Ankle-Bones of the Feet, in letting Blood, and upon other Occasions.
Lastly, there are an infinite Number of Bandages, the Structure whereof is
learnt by Practice, in observing the Methods of able Surgeons, who invent
them daily, according to their several Manners; and the first _Ideas_ of
these can only be taken in reading Authors that have treated of them.

_What are the general Conditions to be observ'd in the Bandages?_ {96}

There are many, _viz._ 1. Care must be taken that the Bands be roll'd firm,
and that they be not too streight nor too loose. 2. They are to be untied
from time to time in Fractures, they must also be taken away every three or
four Days, to be refitted. 3. They must be neatly and conveniently roll'd,
that the Patient may not be uneasie or disquieted.

_What ought to be observ'd in fitting the Bolsters?_

Care must be taken to make them even, soft, and proportionable to the
bigness of the Part affected; to trimm them most in the uneven places, that
the Bands may be better roll'd over them, and to keep them continually
moisten'd with some Liquor proper for the Disease as well as the Bands.

    _In treating of every Disease in particular, we shall shew the manner
    of making the particular Bandage that is convenient for it._

       *       *       *       *       *


{97}

A

TREATISE

OF

_Chirurgical Diseases_.

       *       *       *       *       *


CHAP. I.

_Of Tumours in general, Abcesses or Impostumes, Breakings out, Pustules,
and Tubercles._

_What is a Tumour?_

A Tumour is a rising or bloated Swelling rais'd in some part of the Body by
a Setling of Humours.

_How is this setling of Humours produc'd?_

Two several ways, _viz._ by _Fluxion_ and _Congestion_.

_What is the Setling by Fluxion?_

It is that which raiseth the Tumour all at once, or in a very little space
of time, by the Fluidity of the Matter. {98}

_What is the Setling by Congestion?_

It is that which produceth the Tumour by little and little, and almost
insensibly, by reason of the slow Progress and thickness of the Matter.

_Which are the most dangerous Tumours, those that arise from Fluxion, or
those that derive their Original from Congestion?_

They that proceed from Congestion, because their thick and gross Matter
always renders 'em obstinate, and difficult to be cur'd.

_Whence do the differences of Tumours proceed?_

They are taken, _first_, from the Natural Humours, _Simple_, _Mixt_, and
_Alter'd_: _Simple_, as the _Phlegmon_, which is made of Blood, and the
_Erysipelas_ of Choler; _Mixt_, as the _Erysipelas Phlegmon_, which
consists of Blood mingl'd with a Portion of Choler; or the _Phlegmonous
Erysipelas_, which proceeds from Choler intermixt with a Portion of Blood:
_Alter'd_, as the _Melia_ which is compos'd of many Humours, that can not
be any longer distinguish'd by reason of their too great Alteration.
_Secondly_, the difference of Tumours is taken from their likeness to some
other thing, as the Carbuncle and the _Talpa_, the former resembling a
burning Coal, and the other a Mole, according to the Etymology of their
_Latin_ Names. _Thirdly_, From the Parts where they are situated; as the
Ophthalmy in the Eye and the Quinsey in the Throat. _Fourthly_, from
Disease that causeth 'em, as Venereal and Pestilential Buboes. _Fifthly_,
from certain Qualities found in some, and not in others; as the _Encysted_
Tumours, which have their Matter clos'd within their proper _Cystes_ or
Membranes, and so of many others. {99}

_How many kinds of Tumours are there that comprehend at once all the
particular Species?_

They are four in Number, _viz._ the Natural Tumours, the Encysted, the
Critical, and the Malignant.

_What are natural Tumours?_

They are those that are made of the four Humours contain'd in the Mass of
the Blood, or else of many at once intermixt together.

_What are the four Humours contain'd in the Mass of the Blood?_

They are Blood, Choler, Phlegm, and Melancholy, every one whereof produceth
its particular Tumour: Thus the Blood produces the _Phlegmon_, Choler the
_Erysipelas_, Phlegm the _Oedema_, and Melancholy the _Scirrhus._ The
Mixture of these is in like manner the Cause of the _Erysipelatous
Phlegmon_, the _Oedomatous Phlegmon_ or _Phlegmonous Erysipelas_, and the
_Phlegmonous Oedema_, according to the quality of the Humours which are
predominant, from whence the several Tumours take their Names.

_What are the _Encysted_ Tumours?_

They are those the Matter whereof is contain'd in certain _Cystes_, or
Membranous Bags; as the _Meliceris_, and the _Struma_ or Kings-Evil.

_What are Critical Tumours?_

They are those that appear all at once in acute Diseases, and terminate
them with good or bad Success.

_What are Malignant Tumours?_

They are those that are always accompany'd with extraordinary and dreadful
Symptoms, and whose Consequences are also very dangerous; as the Carbuncle
in the Plague. {100}

_What are Impostumes or Abcesses, Breakings out and Pustules?_

Indeed, it may be affirm'd, that all these kinds of Tumours scarce differ
one from another, except in their size or bigness; nevertheless, to speak
properly, by the Names of Impostumes or Abcesses are understood gross
Tumours that are suppurable, or may be dissolv'd, and by those of Breakings
out and Pustules, only simple Pusteal Wheals, or small Tumours, that appear
in great Numbers, and which frequently do not continue to Suppuration; some
of them consisting of very few Humours, and others altogether of dry
Matter.

_What difference is there between a Tumour and an Impostume or Abcess?_

They differ in this particular, that all Tumours are not Impostumes nor
Abcesses; but there is no Impostume nor Abcess that is not a Tumour: As for
Example, Wens and _Ganglions_ are Tumours, yet are not Abcesses nor
Impostumes; whereas these last are always Tumours in regard that they cause
Bunches and Elevations.

       *       *       *       *       *


CHAP. II.

_Of the general Method to be observ'd in the curing of Tumours_.

_What ought a Surgeon chiefly to observe in Tumours, before he undertake
their Cure?_

He ought to know three things, _viz._ 1. The Nature or Quality of the
Tumour. 2. The {101} time of its formation and 3. Its situation: The
Quality of the Tumour is to be known, because the Natural one is otherwise
handl'd than that which is Encysted, Critical or Malignant. As for the time
of its Formation, it is four-fold, _viz._ the Beginning, Increase, State,
and Declination, wherein altogether different Remedies are to be apply'd.
The Situation of the Tumour must be also observ'd, because the dressing and
opening of it ought to be as exact as is possible, to avoid the meeting
with an Artery or neighbouring Tendon.

_How many ways are all the Tumours that are curable, terminated?_

They are terminated after two manners, _viz._ either by dissolving 'em, or
by Suppuration.

_Are not the_ Scirrhus _and the_ Esthiomenus _or Gangrene, two means that
sometimes serve to terminate and cure Impostumes?_

Yes, but it is done imperfectly, in regard that a Tumour or Impostume
cannot be said to be absolutely cur'd, as long as there remains any thing
of the Original Malady, as it happens in the _Scirrhus_, where the Matter
is harden'd by an imperfect dissolving of it, or when the Impostume
degenerates into a greater and more dangerous Distemper, as it appears in
the _Esthiomenus_ or Gangrene that succeeds it.

_Which is the most effectual means of curing Impostumes, that of
dissolving, or that of bringing them to Suppuration?_

That of dissolving 'em is without doubt the most successful, and that which
ought to be us'd as much as is possible; nevertheless some Cases are to be
excepted, wherein the Tumours {102} or Abcesses are Critical and Malignant;
for then the way of Suppuration is not only preferable, but must also be
procur'd by all sorts of means, even by opening; which may be done upon
this occasion, without waiting for their perfect Maturity.

_What are the Precautions whereto a Surgeon ought to have regard before he
undertake the opening of Tumours?_

He must take care to avoid cutting the Fibres of the Muscles, and in great
Abcesses, to cause all the corrupt Matter to be discharg'd at once, to
prevent the Patient's falling into a Swoon.

_Ought the opening of Tumours always to be made longitudinally, and
according to the direct Course of the Fibres?_

No, it is sometimes necessary to open 'em with a Crucial Incision, when
they are large, or when a _Cystis_ or Membranous Vehicle is to be
extirpated.

_How many sorts of Matter are there that issue forth in the Suppuration of
Tumours?_

There are four sorts, _viz._ the _Pus_, _Ichor_, _Sanies_, and _Virus_.

_What is_Pus_?_

It is a thick Matter, and white as Milk.

_What is _Ichor_?_

It is a thick Matter like the _Pus_, but of divers Colours.

_What is _Sanies_?_

It is a watery Matter that riseth up in Ulcers, almost after the same
manner as the Sap in Trees.

_What is _Virus_?_ {103}

It is a kind of watry Matter, being whitish, yellowish, and greenish at the
same time; which issueth out of Ulcers, very much stinking, and is endu'd
with corrosive and malignant Qualities.

_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 occasion 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 Primitive 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 Humours, 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?_ {104}

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
Heart 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 _Aneurisms_ 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. {105}

_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.
{106}

_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 white Bread, till
it comes to a necessary Consistence. Or else take Cow's Dung instead of the
above-mention'd {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 _Unguentum 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 _Unguentum Ægyptiacum_, 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.
{108}

_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_ {109} two Ounces; _Oleum Lumbricorum_ & _Hyperici_, of each
one Ounce; and of the Meal of Wheat 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
_Unguentum Divinum_, a Mixture whereof being made, is to be put between two
Rags, and laid upon the Tumour or Swelling. {110}

If the _Echymosis_ happens in a Nervous Part, Balsam of _Peru_ may be us'd,
or, for want thereof, _Oleum Lumbricorum_ & _Hyperici_, with luke-warm
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 _Paronychia_, 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. {111}

_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 Exuberance, 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 _Necrosis_ and
_Sideratio_. An _Esthiomenus_ is a Disposition to Mortification, discover'd
by the softness of the Part; and a Gangrene is defin'd to be a
Mortification of a Part, occasion'd by the {112} Interception 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 Hæmorrhage; 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 fix'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. {113}

_REMEDIES._

_What are the Remedies proper for a Gangrene?_

They are those that take away the mortify'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 soak'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 _Unguentum
Ægyptiacum_ 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 _Phegedænick_ 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 {114} abstaining from all sorts of Oils and Greases. But
if these Remedies prove unprofitable, 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 felt, as the Air and Cold are more sharp
and Vehement.

_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 _Unguentum
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 of _Panaritium_?_ {115}

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 Millk, 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, _Unguentum 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 {116} each an
equal quantity, adding to every four Ounces twenty Grains of _Saccharum
Saturni_. 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 {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 Ounce 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_, and 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 {118} Gallon 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 partake 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 _Erysipelas_ 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 Saturni_, 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 mingl'd with the above-mention'd Decoctions.

       *       *       *       *       *

{119}

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 Remedies proper for an _Oedema_?_

They are Fomentations, Cataplasms, Liniments, and Plaisters.

The Fomentations 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-iterated; and by this means the Humour is dissolv'd thro'
Transpiration by Sweat.

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 on Ounce of
_Martiatum_, a Pint of Oil of Lillies, half an Ounce of {120} Cummin-Seeds
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. But 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 _Phlyctæna_, 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 _Phlyctæna'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. {121}

_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?_

_Scrophulæ_ or _Strumæ_, 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. {122}

_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 _Hydrocele_ of the _Scrotum_. There is
also a Dropsy of the Breast, and that of the _Matrix_.

{123} _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, {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_, _Sarcoma_, _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 {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 Bistort, 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 necessary to proceed to a Manual Operation, {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, as soon as their Mothers are deliver'd.

_What is a Cancer?_

It is a hard, painful, and ulcerous Tumour, produc'd by an adult 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?_ {127}

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_. {128}

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 _Steatoma_ 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 {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 _Scrophulæ_ 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._

_Want 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 fill'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 _Oleum
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. {130}

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
reiterated 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.

       *       *       *       *       *


{131}

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. {132}

_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 _Anthrax_ 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.

       *       *       *       *       *


{133}

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 {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 Scurvy-grass, 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 {135} _Mercury_
Precipitate, from four to ten Grains; _Mercurial Panacæa_, 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
Marygold.

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 {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. {137}

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.

       *       *       *       *       *


{138}

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 Hæmorrhages, 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, {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 {140} if the Inflammation continue, the Threads are to be cut by
passing a Probe underneath: When the Wound is clos'd, the Threads are cut
in like manner with a Probe; and in drawing 'em out, a Finger must be laid
near the Knot, lest the Wound should open again.

To make the second sort of Stitch for the Hare-Lip, a small streight Needle
is pass'd into the sides of the Wound, and the Thread is twisted round the
Needle, by crossing it above at every Stitch.

To form the _Dry Stitch_ in very superficial Wounds, a piece of new
Linnen-Cloth is to be taken, wherein are made Digitations, or many Corners;
the Selvedge or Hem ought to be on the side of these Corners or
Digitations; and a small Thread-Lace is ty'd to every one of 'em. Afterward
this Cloth is dipt in strong Glue, and apply'd about a Finger's breadth
from the Edges of the Wound; so that a piece thereof being stuck on each
side, the Laces may be ty'd together, to cause the Lips of the Wound to
meet.

To make the _Glover's Stitch_, the Operator having drawn together the Lips
of the Wound, holds 'em between two Fingers, passeth a Needle underneath
'em, and soweth 'em upward all along, after the manner of _Glovers_.

       *       *       *       *       *


{141}

CHAP II.

_Of Wounds in general._

_What is a Wound?_

A Wound is a recent, violent, and bloody Rupture or Solution of the Natural
Union of the soft Parts, made by a pricking, cutting, or bruising
Instrument.

_What ought to be observ'd before all things in the curing of Wounds?_

It is requisite to take notice of their differences, as well as of the
Instruments with which they were made; to the end that Consequences may be
drawn from thence for the Application of proper Remedies.

_From whence arise the differences of Wounds, and which be they?_

They are taken either from their Figure or Situation: With regard to their
Figure, they are call'd Long, Broad or Wide, Triangular Great, Little,
Superficial, or Deep; and with respect to their Situation, they are term'd
Simple, Complicated, Dangerous, or Mortal.

_What is a Simple and a Complicated Wound?_

A Simple Wound is that which only opens the Flesh, and hath no other
concomitant Circumstances; but a Complicated Wound, on the contrary, is
that which is attended with grievous Symptoms, as Hæmorrhages, Fractures of
Bones, Dislocation, Lameness, and others of the like Nature. {142}

_What is a dangerous and mortal Wound?_

A dangerous Wound is that which is complicated the Accidents whereof are
dreadful: As when an Artery is open'd or prick'd, when a Nerve or Tendon is
cut, or when the Wound is near a Joynt and accompanied with a Dislocation
or Fracture. A mortal Wound is that which must be inevitably follow'd by
Death; as is that which is situated deep in a principal Part necessary for
the Preservation of Life.

_What are the Parts wherein Wounds are mortal?_

They are the Brain, the Heart, the Lungs, the _Oesophagus_ or Gullet, the
Diaphragm, the Liver, the Stomach, the Spleen, the small Guts, the Bladder,
the Womb, and generally all the great Vessels.

_Wherein doth the Cure of Wounds consist?_

In helping Nature readily to procure the reuniting of the Parts that have
been divided, after having taken away or asswag'd every thing that might
cause an Obstacle.

_What are the things that hinder the speedy reunion of the Parts?_

They are extraneous Bodies found therein, as Bullets, Flocks, and Pieces of
Wood or Stone, &c. As also sometimes the Accidents which attend 'em; as an
_Hæmorrhage_ or Flux of Blood, Inflammation, _Esthiomenus_ or
Mortification, _Hypersarcosis_, or an Excrescence of Flesh, Dislocation,
the Fracture of a Bone, the Splinter of a Bone, & sometimes a contrary Air.
{143}

_REMEDIES._

_What are the Remedies proper for stopping an _Hæmorrhage_ or Flux of
Blood?_

The common Remedy is a kind of Cataplasm, made up with the Powders of
Aloes, Dragons-Blood, Bole Armenick and Whites of Eggs, which are mix'd
together and laid upon the Wound. But the following is an excellent one.

Take two Ounces of Vinegar, a Dram of _Colcothar_, two Drams of _Crocus
Martis Astringens_; beat the whole together, steeping _Muscus Quercinus_
therein; then throw upon it the Powder of Mushrooms, or of _Crepitus Lupi_:
Apply this Remedy, and you'll soon stop the _Hæmorrhage_, taking Care
nevertheless to bind the Part well, otherwise the Astringents do not
readily take Effect.

To this Purpose you may also make use of Cobwebs, Mill-Dust, and the Powder
of Worm-eaten Oak; or else take Oven-Soot mixt with the Juice of the Dung
of an Ass or Ox, adding only thereto the White of an Egg.

Besides these Remedies there are also actual and potential Cauteries, or
simple Ligatures, which are infallible. Indeed the actual Cautery is not
always sure; because when the Escar made by the Fire, falls off the
Hæmorrhage breaks out again as before: but the potential Cautery is almost
always successful; such as the following.

Take about an equal Quantity of Vitriol and Powder of Mushrooms; apply 'em
upon a little Lint to the Place where the Blood issueth {144} forth, and
you'll see it stop immediately: But Care must be taken to avoid touching a
Nerve or Tendon; by reason that the Vitriol is apt to excite Convulsions.

_How is the Inflammation and Mortification of a Wound Suppress'd?_

If the Inflammation proceeds from the Presence of an Extraneous Body, it
must be taken away as soon as possible with a Pair of Forceps, and if from
the Quantity of _Pus_ or corrupt Matter, it must be let out. But in case
the Inflammation ariseth from extreme Pains, they are to be asswaged with
Cataplasms or Pultises and anodyn Liniments, such as those that have been
already prescribed in the Cure of the _Phlegmon_: or else the Part may be
bath'd with Camphirated Spirit of Wine, mixt with as much Water: _Saccharum
Saturni_ infus'd in Lime-water, performs the same Effect, and the Water of
Crabs alone is admirable in its Operation.

Against the _Esthiomenus_ or Mortification, make use of Wine boil'd with
Wormwood, St. _John_'s Wort, Rosemary and Aloes; or else take the Tincture
of Aloes and Myrrh, or Spirit of Wine alone impregnated with Camphire and
Saffron.

_What is to be done in Case a Convulsion happens by reason of a wounded
Nerve or Tendon?_

If the Convulsion be caus'd by the Presence of an Extraneous Body that
bruiseth the Part it must be taken away; and if from the wounding of a
Nerve, pour into the Wound some Drops of the Oil of Lavender distill'd,
which in that Case is of singular Use; this Oyl may be also taken inwardly
in an appropriated Liquour, such as a {145} Decoction of Wormwood and the
Tops of the lesser Centory. Balsam of _Peru_ us'd in the same Manner, is an
excellent Remedy, and the Oyls of Worms, Snails, St. _John_'s-Wort and
Turpentine are frequently apply'd with good Success.

If the Convulsion proceeds from the Biting of some venomous Creature,
Cupping-Glasses or Leeches are to be immediately applied, putting into the
Wound Treacle with the Spirit of Wine or even Fire it self, and leaving to
the Physician's Care the Prescription of other vulnerary Remedies proper to
be taken inwardly.

_What is to be done to draw the Extraneous Bodies out of a Wound?_

When they cannot be taken away with the Fingers or Forceps, the Patient
must be set in the same Station or Posture wherein he was when he receiv'd
the Wound, in order to get some farther Light to discover 'em; or else such
Plaisters may be us'd as are endu'd with an Attractive Quality:
Particularly this:

Take an Ounce of Treacle, half a Dram of Gum _Ammoniack_, one Dram of
_Bdellium_, and two Drams of Bore's Grease, adding a Quarter of a Pound of
Wax to make 'em up into the Form of a Plaister. It is reported that Hare's
Grease alone hath the same Effect, and that it goes for a Secret among the
Surgeons but you may (if you please) mix it with Ointment of Betony.
However it hath been observed that Leaden Bullets may sometimes remain in a
Man's Body, during his whole Life-time without doing any Harm. {146}

_How are Excrescences to be taken away?_

They may be consum'd with Powder of Allom, _Unguentum Ægyptiacum_, or
_Lapis infernalis_.

_After having remov'd every thing that hinders the reuniting of the Lips of
a Wound, what is to be done to attain thereto?_

The Re-Union in Wounds is properly the Work of Nature; but it may be
promoted by putting into 'em a little Balsam of _Peru_, and drawing
together their Lips with the Fingers. Afterwards the Lips must be kept
closed with a Bandage, a Glutinous Plaister or a dry Stitch, provided the
Wound be only superficial, hindring the Air from penetrating into it. For
Want of Balsam of _Peru_, an excellent one may be made with the Flowers
here specified.

Take the Flowers of Henbane, St. _John's-Wort_, and Comfry and let 'em be
digested in the Sun during the whole Summer-Season in the Oyl of Hemp-seed,
which Oyl, the longer it is kept, proves so much the better, if it be set
forth in the Sun every Summer, the Vessel that contains it being well
stop'd. There is also the Balsam of Balsams, or the Balsam of _Paracelsus_
call'd _Samech_.

To avoid the exposing of Wounds to the Air, it is requisite to cover 'em
over the Dressings with some sort of Plaister, which is usually termed the
Surgeon's Plaister, such is that which is effectual in Dissolving,
corroborating and allaying Pain or Inflammation.

Take the Mucilages of the Roots of great Comfrey and Fenegreek, half a
Pound of Ceruse or white Lead, two Drams of Crude _Opium_, one Dram of
Camphire, as much of Saffron, two Drams of Sandarack, one of the Oyl of
{147} Bays, one half Pound of Rosin, and as much Turpentine and Wax. Boil
all these Ingredients together in a sufficient Quantity of Lin-seed-Oyl,
and make a Plaister according to Art.

In great Wounds it is expedient to lay over the Dressings a Cataplasm or
Pultiss, such as this:

Take the Leaves and Flowers of Camomile, and Melilot, the Tops of Wormwood,
common Mallows and Marsh-Mallows, with the Seeds of Line and Cummin
powder'd: Then boyl the whole Composition in Wine, and add thereto
Barly-Meal, to give it a due Consistence. If there be any Cause to fear a
Gangrene, you may also intermix Saffron, Myrrh and Aloes with Spirit of
Wine.

_Is it necessary to put Tents into all Wounds, and to make use of
Digestives and Suppuratives?_

No: It is sufficient to procure the Re-uniting of the Parts simply by the
Means of Balsam in small Wounds; because they ought not to be brought to
Suppuration: so that Digestives and Suppuratives are only necessary in
great Wounds, and those that are accompanied with Contusion, avoiding the
ill Custom of some Country-Surgeons, that stuff up their Wounds too much
with Tents and Pledgets, whereas they might well be content with simple
Bolsters or Dossels which shou'd be dipt in the ordinary Digestive composed
of Turpentine and the Yolks of Eggs with a little Brandy, or else with the
Tincture of Myrrh and Aloes.

Suppuration may also be promoted by mundifying and quickening the Wound,
especially if the Bolsters be steep'd in the following Composition. {148}

Take half an Ounce of Aloes and Myrrh powder'd, two Drams of _Sal Saturni_,
twenty Grains of _Sal Ammoniack_, the same quantity of beaten Cloves, a
Dram of Queen of _Hungary_ Water and half an Ounce of _Unguentum
Basilicon_, and let the whole Mass be mingled together.

In fine, the whole Mystery consists in well cleansing the Wounds with a
Linnen Cloth, or with the Injections of the Tinctures of Myrrh and Aloes;
or with simple Decoctions of Wormwood, _Scordium_ or Water-Germander,
Bugle, Sanicle and Hore-Hound in White-Wine; as also by prescribing the
Vulnerary Decoctions of Powder of Crab's-Eyes, and _Saccharum Saturni_, to
be taken inwardly, to consume the acid Humours, which are a very great
Obstacle that hinders the speedy cure of Wounds.

_What are the Vulnerary Plants, the Decoctions of which is to be taken
inwardly?_

They are _Alchymilla_ or Lion's-Foot, Ground-Ivy, _Veronica_ or Fluellin,
St. _John_'s-Wort, Wormwood, Centory, Bugle, Sanicle, Chervil, and others.
The Broth of Crabs may also be prescrib'd, which is an excellent Remedy,
and may serve instead of a Vulnerary Potion.

Sometimes Sutures or Stitches contribute very much to the re-uniting of the
Lips of Wounds, when they cannot be join'd by Bandage.

       *       *       *       *       *


{149}

CHAP. III.

_Of particular Wounds of the Head._

_What ought first to be consider'd in a Wound of the Head?_

Two things, that is to say, the Wound it self, and the Instrument with
which it was made; for by the Consideration of the Wound, we may know
whether it be Superficial or Deep; and by that of the Instrument, we are
enabled to make a truer Judgment concerning the Nature of the same Wound.

_What is a Superficial, and what is a Deep Wound in the Head?_

That is call'd a Superficial Wound in the Head, which lies only in the
Skin; and that a Deep one which reacheth to the _Pericranium_, Skull, or
Substance of the Brain.

_What is to be apply'd to a Superficial Wound?_

It is cur'd with a little Queen of _Hungary_ Water; or else with a little
Balsam, laying upon it the Surgeon's Plaister, or that of Betony. But if
the Wound or Rent be somewhat large, it must be clos'd with a Stitch.

_What is to be done to a Deep Wound?_

If it be situated in the _Pericranium_, the Wound must be kept open,
waiting for Suppuration; but if it enter the Skull, an Enquiry is to be
made, whether there be a Simple Contusion, or a Fracture also. In the
Contusion it is necessary to wait for the Suppuration, and the {150} fall
of the Splint, and to keep the Wound open; as in the Fracture, to examine
whether it be in the first Table only, or in both; it is known to be only
in the first, by the Application of an Instrument, and of Ink, as also in
regard that there are no ill Symptoms; but a Fracture in both Tables shews
it self by the Signs; and it may be found out by making a Crucial Incision
in the Flesh, to discover the Fissure.

_What are the Signs of the Fracture of the two Tables of the Skull, and of
the overflowing of the Blood upon the Membranes of the Brain?_

They are the loss of the Understanding at the very Moment of receiving the
Wound; an Hæmorrhage or Flux of Blood thro' the Nose, Mouth, or Ears;
drowsiness and heaviness of the Head, and more especially Vomitting of
Phlegm; from whence may be inferr'd the necessity of making use of the
Trepan.

_What Consequence may be drawn from the Knowledge of the Instrument with
which the Wound was made?_

It is according to the Quality of this Instrument; as it is proper to cut,
prick, or bruise; if it be cutting, the Wound is more Superficial, and not
subject to a great Suppuration: If it be pricking, the Wound is deeper, but
of small Moment: If it be a battering or bruising Instrument, the Wound is
accompany'd with Contusion, producing a great Suppuration, besides the
Concussion and Commotion of the Part, which are inseparable, and often
cause very dangerous Symptoms. {151}

Inferences may be made also from the disposition of the wounded Person; for
a strong robust Man may better bear the Stroke than a weak one; and even
Anger causeth an Augmentation of Vehemency; so that all such Circumstances
are not to be despis'd, in regard that they give occasion to profitable
Conjectures.

_What particular Circumstance is there to be observ'd in undertaking the
Cure of Wounds in the Face?_

It is, that a more nice Circumspection is requir'd here than elsewhere, in
abstaining from Incisions, as well as in making choice of proper Medicines,
which must be free from noisome Smells; and it is in this Part chiefly that
Balsams are to be used, avoiding Suppuration, to prevent Scars and other
Deformities.

       *       *       *       *       *


CHAP. IV.

_Of the particular Wounds of the Breast._

_What is to be observ'd in Wounds of the Breast?_

Two things, _viz._ whether they penetrate into the Cavity of the _Thorax_
or not, which may be discover'd by the Probe, and by a Wax-Candle lighted,
and apply'd to the Entrance of the Wound, obliging the Patient to return to
the same Posture wherein he receiv'd the Hurt, as also to keep his Nose and
Mouth shut: For then the Flame may be perceiv'd to be wavering, the Orifice
of the Opening being full of {152} Bubbles; a Judgment may be also made
from the running out of the Blood.

_What is to be done when it is certainly known that the Wound penetrates
into the Cavity of the Breast?_

It is necessary to examine what Part may be hurt, by considering the
situation of the Wound, and its Symptoms: If the Lungs are pierc'd, a
spitting of froathy Vermilion-colour'd Blood ensues, with difficulty of
Respiration, and a Cough. If any of the great Vessels are open'd, the
wounded Person feels a Weight at the bottom of his Breast, is seiz'd with
cold Sweats, being scarce able to fetch his Breath, and Vomits Blood, some
Portion whereof issueth out of the Wound. If the _Diaphragm_ or Midriff be
cut in its Tendinous Part, he is suddenly hurry'd into Convulsions: And if
the Heart be wounded either in its _Basis_ or Ventricles, he falls into a
Swoon, and dies incontinently.

But if the Probe doth not enter, and none of the above-mentiond Symptoms
appear, it may be taken for granted that the Wound is of no great
Consequence.

_What is to be done when the Wound penetrates into the Chest, yet none of
the Parts are hurt, only there is an Effusion of Blood over the
_Diaphragm_?_

It is necessary to make an _Empyema_, or otherwise the diffus'd Blood in
corrupting, wou'd inevitably cause an Inflammation, Gangrene, and Death it
self.

_What is an _Empyema_?_

It is an Operation whereby any sorts of Matter are discharg'd with which
the Diaphragm is over-spread, by making a Puncture or Opening in the
Breast.

       *       *       *       *       *


{153}

CHAP. V.

_Of the particular Wounds of the lower Belly._

_What is to be done to know the quality of a Wound made in the lower
Belly?_

It is requisite to make use of the Probe, to observe the situation of the
Wound, and to take notice of all the Symptoms: For by the help of the
Probe, one may discover whether it hath penetrated into the Cavity or not,
after having enjoyn'd the Patient to betake himself to the same Posture
wherein he was when he first receiv'd the Wound: By its situation a
Conjecture may be made that such a particular Part may be hurt; and by a
due Examination of the Symptoms, one may attain to an exact Knowledge. As
for Example; It is known that one of the thick Guts is open'd, when the
Hurt is found in the _Hypogastrium_, and the Excrements are voided at the
Wound; as it is certain that one of the thin Guts is pierc'd, when the
Wound appears in the Navel, and the Chyle issueth forth from thence; and so
of the others.

_What Method ought to be observ'd in curing Wounds in the lower Belly?_

It is expedient at first to prevent letting in the Air, and to dilate the
Wound, in order to sow up the perforated Gut, and afterward to {154}
restore it to its place; as also to bind the Caul, which is let out at the
opening, and to cut it off, lest in putrifying it should corrupt the
neighbouring Parts. Then these Parts may be bath'd with Lees of Wine,
wherein have been boil'd the Flowers of Camomile and Roses with Wormwood:
The Powders of Aloes, Myrrh, and Frankincense may be also thrown upon 'em;
and the Wound must be sow'd up again to dress it on the outside, the
Patient in the mean time being restrain'd to a regular Diet. But Clysters
must be forborn on these Occasions, especially when one of the thick Guts
is wounded, making use rather of a Suppository or laxative Diet-Drinks, to
avoid dilation and straining.

       *       *       *       *       *


CHAP VI.

_Of Wounds made by Guns or Fire-Arms._

These Wounds are always bruis'd and torn, with the loss of Substance, and
commonly with the splitting and breaking of a Bone: They are red, black,
livid, and inflam'd, not being usually accompany'd with an Hæmorrhage: They
are generally round, and streighter at their Entrance than at their End; at
least if they were not made with Cross-Bar-Shot, or Quarter-Pieces. {155}

_Of the Prognostick of Wounds by Gun-shot._

When these Wounds penetrate into the Substance of the Brain, or Marrow of
the Back-Bone, or into the Heart, _Pericardium_, great Vessels, and other
noble Parts, Death always inevitably follows, and often happens at the very
Instant. But one may undertake the Cure of those that are superficial, and
which are made in the Neck, Shoulders, Arms, and all other parts of the
Body.

_Of the Cure of Wounds by Gun-shot._

For the better curing of these sorts of Wounds, it is requisite to be
inform'd of the Quality of the Fire-Arms by which the Wounds were made, in
regard that a Musquet is more dangerous than a Pistol, and a Cannon much
more than a Musquet; as also to examine their situation and concomitant
Accidents; for by how much the more complicated they are, so much the
greater is the danger. Then the Patient must be set (as near as can be) in
the very same Situation and Posture wherein he remain'd when the Wound was
receiv'd, in order to discover the direct Passage of the Wound by the help
of the Probe, with which a search is to be made, whether a Bullet, or any
other extraneous Bodies, as Wood, Flocks, Linnen, or Stuff as yet stick in
the Wound; so that Endeavours may be us'd to take 'em out thro' the same
Hole where they enter'd, care being more especially had to avoid making
{156} Dilacerations in drawing 'em out: But if the Operator hath
endeavour'd to no purpose to remove these extraneous Bodies, let him make a
Counter-Opening in the opposite Part, where he shall perceive any hardness,
nevertheless without touching the Vessels; thus the Incision being made, he
may readily draw 'em out with his Fingers, or some other Instrument.

If the Bullet sticks so far in a Bone that it cannot be taken away without
breaking the same Bone, it is more expedient to let it lie therein; but if
the Leg or Arm-Bones are very much split or shattered, then the Amputation
of 'em becomes absolutely necessary. The Pain and Inflammation of the Part
may be asswag'd by letting Blood, topical Anodyns, cooling Clysters and
Purgations; but in case much Blood hath been already lost, Phlebotomy must
be omitted. The Clysters may be made with Decoctions of Mercury, Mallows,
Beets, a Handful of Barley and Honey of Roses.

Some Surgeons are of Opinion that the Patient ought to be purg'd every
other Day, and even on the very same Day that he receiv'd the Wound, if his
Strength will permit; however very gentle Purges are to be us'd upon this
occasion, such as Cassia, Manna, Tamarins, Syrrup of Violets, and that of
White Roses.

In the mean while Anodyns may be compounded to mitigate the Pain; as
Cataplasms or Pultisses made with the Crum of white Bread, Milk, Saffron,
the Yolk of an Egg, and Oil of Roses us'd hot; which last Ingredient is of
it self a very good Anodyn. But to asswage great Inflammations, Oil of
{157} Roses, the White of an Egg and Vinegar beaten all together, may be
laid on the neighbouring Parts.

At first it is necessary to apply spirituous Medicines to the Wound, and
Pledgets steep'd in camphirated Brandy, are admirable for that purpose; but
if there be a Flux of Blood, styptick Waters, or other astringent Remedies
may be us'd, still remembring that all these Medicaments must be apply'd
hot.

To promote the Suppuration of these contused Wounds, a Digestive may be
made of _Oleum Rosatum_, the Yolk of an Egg, and _Venice_ Turpentine.

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 Purtrefaction in those Parts: But a
Cataplasm may be made with Barley-Meal, _Orobus_, Lupins 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 Philosophorum_, Oil of Bays destill'd, Balsam of
St. _John_'s-Wort, Spirit of Wine, and Gum _Elemi_, are excellent
Medicaments for the Nerves: Or else,

Take four Ounces of _Unguentum Althææ_ 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, {158}

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 Ulcers.

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
Mariæ_, till one third part be consumed.

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 {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 superficial, 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 {160} prepar'd 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 thoroughly in a
Leaden-Mortar, with May-Butter without Salt, to make an Ointment, which may
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 {161} quantity of Oil of Roses, to make a very good Ointment: Or
else,

Dissolve _Minium_ or Litharge in Vinegar, 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 {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 {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 _Unguentum Ægyptiacum_ over and above the Ointments and Cataplasms
already describ'd; remembring {164} always, 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 Ulcers in general._

_What is an Ulcer?_

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 an Ulcer?_

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 Ulcers 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 Benign or Malignant, Great, Little, Dangerous, or Mortal; and by
reason of their Accidents, they are term'd Putrid, Corrosive, Cavernous,
Fistulous, Cancerous, _&c._ {165}

_Do Ulcers 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 Ulcers?_

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 are 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 Ulcers?_ {166}

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 Ulcers?_

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 Ulcers?_

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 {167} Success; but then they must must 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 Egg, 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, _Unguentum Ægyptiacum_, 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 Pledgers 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,
{168}

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 _Gonorrhæa_._

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 _Præputium_; 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 Prunella_ 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 {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 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 _Gonorrhæa_ is stopt, to be certain of a perfect Cure, a Dram of the
_Mercurial Panacæa_ 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
_Gonorrhæa_, _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 _Chaude-pisse_ a
running, after it hath been too suddenly stopt. At the same time that the
Astringents are taken with the Mouth, {170} Injections 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 _Præputium_. 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 Panacæa'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 {171} necessary 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
Panacæa's_.

_Of the Pox._

This loathsome Disease begins sometimes with a virulent _Gonorrhæa_, 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 become stinking;
the Almonds of the Ears swell; the _Uvula_ or Palate is down; Ulcers break
out in the Privy-Parts; Bubo's arise in the Groin; as also Warts in the
_Glans_ and _Præputium_; and _Condyloma's_ in the _Anus_.

Indeed the Pox may be easily cur'd in the beginning; but when it hath taken
deep Root {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 _Vuguentum 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, {173}
by a long Continuance, it is not extirpated without 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 Panacæa_ 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, {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
_Panacæa_ alone, without any Frictions: For after the Phlebotomy, {175}
Purgations, and Bathings duly administer'd; the Patient might take ten
Grains of the _Mercurial Panacæa_ 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 _Panacæa_. This Course must be continually
follow'd till the Salivation becomes Laudable, and the Symptoms cease.

_The manner of making the _Mercurial Panacæa_._

To prepare this _Panacæa_, 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 mingled
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 {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 _Panacæa_ 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 dissolved Liquor, which will be as clear as Water, into a Glass Vial,
or into a Stone-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 {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 _Phagedonick-Water_.

The sweet Sublimate, of which the _Panacæa_ 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
{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 Panacæa_._

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 {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
fine 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
Mariæ_, or in a Vaporous Bath, make fit a Recipient to the Mouth of the
Alembick; lute the Joints exactly with a moistened 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 _Panacæa_ will appear at the bottom of the
Cucurbite. If it be not {180} already 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
Venereal Diseases, as also for Obstructions, the Scurvy, _Scrophula_ or
Kings-Evil, Tettar, Scab, Scurf, Worms, _Ascarides,_ inveterate Ulcers,
_&c._ The Dose is from six Grains to two Scruples, in Conserve of Roses.

       *       *       *       *       *


{181}

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 {182} Interdiction 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
abolish'd.

_What are the signs of an imperfect, partial, and incompleat Dislocation?_
{183}

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 found: 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?_ {184}

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 Repercussives and Astringents must be avoided.

_How doth it appear that the Reduction is well perform'd?_ {185}

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 found.

_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 greater 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, {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 {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 fractured?_

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?_ {188}

Divers ways, _viz._ by the ill Disposition of the Part, which becomes
shorter; by its want of Motion; by its flexibility or pliantness elsewhere
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 Fissure, 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
{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 drier; whereas those of Infants are almost
Cartilaginous, and yield or give way to the violence offer'd to 'em; from
whence proceed the sinkings 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 Plaisters, 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 {190} natural 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?_ {191}

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 Myrrh and Aloes; by the application of
_Emplastrum Andreæ 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-Vitæ;_ 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 Extremities 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 {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, Sayine, 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?_ {193}

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 two 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 Fracture?_

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?_
{194}

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
_Univocal_. 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, with 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 {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 {196} _Pericranium_, 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 him 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.

       *       *       *       *       *


{197}

CHAP. IV.

_Of the _Caries_ or Ulcer 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 {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-Vitæ_ 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 {199} _Caries_, proceeding from an internal Cause; nevertheless
they are generally dissolv'd by Frictions with _Unguentum Griseum_, or by
the application of Plaisters of Tobacco, or _Emplastrum de Vigo
quadruplicato Mercurio_; taking also to the same purpose internal
Diaphoretick and Sudorifick Medicines, with convenient Purgatives.

       *       *       *       *       *


CHAP. V.

_Of Cauteries, Vesicatories, Setons, Cupping-Glasses, and Leeches._

_What is a Vesicatory?_

The Name of Vesicatory may be attributed to every thing that is capable of
raising Bladders or 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 {200} Application 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 {201} guided after the same manner. But in Hæmorrhages 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: {202}

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 Seton to 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 {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 Hæmorrhoidal Veins when they are too full; in the
_Varices_ and in several parts of the Face. {204}

_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 Præparata_ in the Forehead; the _Ranulæ_ 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 _Poplitæa_ 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 {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 {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 _Arcæus_'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.

_Under what Vein is the Artery of the Arm?_

It is usually situated under the _Basilica_. {207}

_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. {208}

_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_.

       *       *       *       *       *


{209}

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 {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 Hæmorrhage. {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 with the other very fast in the beginning; 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 {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 Pledgets, a
Plaister, and a Kerchief. {213}

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 out 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 Exfoliation 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 Bandage 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 Chin, the Surgeon takes the
two lower, and draws 'em streight by the sides, so as that side the Napkin,
which is four Fingers broader {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 plac'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
Lancet in form of 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. {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 folded
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 Exfoliation, 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.

       *       *       *       *       *


{216}

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 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 {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 _Uveous_ 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 {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 _Unguis_,
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, and 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.

{219}

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 Hæmorrhage 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.

       *       *       *       *       *


{220}

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 must 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.

{221}

_The Dressing and Bandage._

After the Lips are wash'd with warm Wine, the Points of the Needles must be
cut 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 Holes wou'd scarce be brought to close.

       *       *       *       *       *


{222}

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.

       *       *       *       *       *


{223}

CHAP. VII.

_Of the Operation of the _Uvula_._

When the _Uvula_ 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 {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 Cancer: 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. {225}

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 thro' 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 Brest, and a Scapulary to support
the whole Bandage. {226}

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 Hæmorrhage, 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.

       *       *       *       *       *


{227}

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 {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
{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 kept 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, {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 shou'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 {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 {232} the _Omentum_ or Caul be
mortify'd, the corrupted Part must be cut off; to which purpose it is
requisite to take a Needle with waxed Thread, and to pass it into the sound
Part a-cross the Caul, without pricking the Vessels. Then the Caul being
ty'd on both sides with each of the Threads that have been pass'd double,
may be cut an Inch below the Ligature, and the Threads will go thro' the
Wound, so as to be taken away after the Suppuration. Afterward the
Intestines are to be put up again into the Belly, by thrusting 'em
alternately with the end of the Fingers. But if they cannot be restor'd to
their proper Place without much difficulty, Spirituous Fomentations may be
made with an handful of the Flowers of Camomile and Melilot, an Ounce of
Anise, with as much Fennel and Cummin-Seeds; half an Ounce of Cloves and
Nutmegs: Let the whole Mass be boil'd in Milk, adding an Ounce of
Camphirated Spirit of Wine, and two Drams of _Saccharum Saturni_, with two
Scruples of Oil of Anise, and bathe the Entrails with this Fomentation very
hot. Otherwise,

Apply Animals cut open alive; or else boil Skeins of raw Thread in Milk,
and foment 'em with this Decoction in like manner very hot.

Before the Suture of Stitching of the Intestines is made, it is expedient
to foment 'em with Spirit of Wine, in which a little Camphire hath been
dissolv'd: But if they be mortify'd, they must not be sown up again, but
fomented with Spirituous Liquors. No Clysters are to be given to the
Patient, for fear {233} causing the Intestine to swell; but a Suppository
may be apply'd: Or else he may make use of a Laxative Diet-Drink, if it be
necessary to open his Body: He ought also to be very temperate and
abstemious during the Cure, so as to take no other Sustenance than Broths
and Gellies.

If the Intestines cannot be put up again, the Wound is to be dilated,
avoiding the White-Line, and that too at the bottom rather than at the Top,
if it be above. To this purpose the Intestines are to be rank'd along the
side of the Wound, and a Bolster is to be laid upon 'em dipt in warm Wine,
which may be held by some Assistant. Then the Surgeon introduceth a
channel'd Probe into the Belly, and takes a great deal of care to fix the
Intestine between the Probe and the _Peritonæum_, 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
_Peritonæum_, Muscles, and Skin on the side of the Wound, passeth the
Needle with his other Hand into the Belly, the Point of which is guided
with the Fore-Finger, and penetrates very far: Then he likewise passeth the
other {234} Needle thro' the other Lip of the Wound into the Belly,
observing the same thing as in the former, and without taking his Fingers
off from the Belly. If there are many Points or Stitches to be made, they
may be done after the same manner, without removing the Fingers from the
Part, whilst a Servant draws together the Lips of the Wound, and ties the
Knots. Afterward the Wound may be dress'd, and the Preparatives or
Dressings kept close to the Part with the Napkin and Scapulary. But the
Patient must be oblig'd to lie on his Belly for some Days successively, to
cicatrize the Wound thereof, or that of the Entrails.

If the Intestine were entirely cut, it wou'd be requisite to sow it up
round about the Wound, after such a manner that some part of it may always
remain open; for if the Patient shou'd recover, his Excrements might be
voided thro' the Wound; of which Accident we have an Example in a Soldier
belonging to the Hospital _Des Invalides_ at _Paris_, who liv'd a long time
in this Condition.

       *       *       *       *       *


CHAP. XII.

_Of the Operation of the _Exomphalus_._

This Operation is necessary when the Intestines or Entrails have made a
kind of Rupture in the Navel, and may be perform'd thus: When the Patient
is laid upon his Back, an Incision is to be made on the Tumour to {235} the
Fat, by griping the Skin, if it be possible, or else it may be done without
taking it up. Then the Membranes are to be divided with a Fleam to lay open
the _Peritonæum_, for fear of cutting the Intestine; and as soon as the
_Peritonæum_ 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
_Peritonæum_, this Fleshy Mass must be entirely loosen'd, and then a
Ligature may be made to take it away, with some part of the Caul, as we
have already shewn in the _Gastroraphy_. Afterward the Stitch is to be
made, as in that Operation, and the Wound must be dress'd, observing the
same Precautions. The Dressing is to be supported in like manner with the
Napkin and Scapulary.

       *       *       *       *       *


{236}

CHAP. XIII.

_Of the Operation of the_ Bubonocele, _and of the compleat Rupture._

When the Intestinal Parts are fall'n into the Groin or the _Scrotum_, the
Operation of the _Bubonocele_ may be conveniently perform'd; to which
purpose the Patient is to be laid upon his Back, with his Buttocks somewhat
high; then the Skin being grip'd a-cross the Tumour, the Surgeon holds it
on one side, and the Assistant on the other, till he makes an Incision,
following the Folds or Wrinkles of the Groin; when the Fat appears, it is
requisite to tear off either with a Fleam or even with the Nails, every
thing that lies in the way, till the Intestine be laid open, which must be
drawn out a little, to see if it do not cleave to the Rings of the Muscles.
The Intestine must be gently handl'd, to dissolve the Excrements; and those
Parts must be afterward put up again into the Belly (if it be possible)
with the two Fore-Fingers, thrusting 'em alternatively; but if they cannot
be reduc'd, the Wound is to be dilated upward, by introducing a channell'd
Probe into the Belly, to let the Sizzers into its Channelling. If the Probe
cannot enter, the Intestine must be taken out a little, laying a Finger
upon it near the Ring, and making a small Scarification in the Ring, with a
streight Incision-Knife guided with the {237} Finger, to let in the Probe,
into which may be put a crooked Knife, to cut the Ring; that is to say, to
dilate the Wound on the inside; but care must be had to avoid penetrating
too far, for fear of dividing a Branch of Arteries; and then the Parts may
be put up into the Belly. If the Caul had caus'd the Rupture, it wou'd be
requisite to bind it, and to cut off whatsoever is corrupted, scarifying
the Ring on the inside, to make a good Cicatrice or Scar.

_The Dressing and Bandage._

The Dressing may be prepar'd with a Linnen-Tent, soft and blunt, of a
sufficient thickness and length, to hinder the Intestines from re-entring
into the Rings by their Impulsion, a Thread being ty'd thereto, to draw it
out as occasion serves. Then Pledgets are to be put into the Wound, after
they have been dipt in a good Digestive, such as Turpentine with the Yolk
of an Egg, applying at the same time a Plaister, a Bolster of a Triangular
Figure, and the Bandage call'd _Spica_, which is made much after the same
manner as that which is us'd in the Fracture of the Clavicle.

_Of the compleat _Hernia_ or Rupture._

It happens when the Intestinal Parts fall into the _Scrotum_ in Men, or
into the bottom of the Lips of the _Matrix_ in Women. To perform this
Operation, the Patient must be laid upon his Back, as in the _Bubonocele_,
and the Incision carry'd on after the same manner; which is to {238} be
made in the _Scrotum_, tearing off the Membranes to the Intestine. Then a
Search will be requisite, to observe whether any parts stick to the
Testicle; if the Caul doth so, it must be taken off, leaving a little Piece
on the Testicle; but if it be the Intestine, so that those Parts cannot be
separated without hurting one of 'em, it is more expedient to impair the
Testicle than the Intestine. If the Caul be corrupted, it must be cut to
the sound Part, and the Wound is to be dress'd with Pledgets, Bolsters, and
the Bandage _Spica_; as in the _Bubonocele_.

       *       *       *       *       *


CHAP. XIV.

_Of the Operation of _Castration_._

The Mortification or the _Sarcocele_ of the Testicles, gives occasion to
this Operation; to perform which, the Patient must be laid upon his Back,
with his Buttocks higher than his Head, his Legs being kept open, and the
Skin of the _Scrotum_ taken up, one end of which is to be held by a
Servant, and the other by the Surgeon, who having made a longitudinal
Incision therein, or from the top to the bottom, slips off the Flesh of the
_Dartos_ which covers the Testicle, binds up the Vessels that lie between
the Rings and the Tumour, and cuts 'em off a Fingers breadth beneath the
Ligature: But care must be taken to avoid tying the Spermatick Vessels too
hard, for fear of a Convulsion, and {239} to let one end of the Thread pass
without the Wound. If an Excrescence of Flesh stick to the Testicle, and it
be moveable or loose, it is requisite to take it off neatly, leaving a
small Piece of it on the Testicle; and if any considerable Vessels appear
in the Tumour, they must be bound before they are cut.

_The Dressing and Bandage._

The Dressing is made with Pledgets and Bolsters laid upon the _Scrotum_;
and the proper Bandage is the _Suspensor_ of the _Scrotum_, which hath four
Heads or Ends, of which the upper serve as a Cincture or Girdle; and the
lower passing between the Thighs, and fasten'd behind to the Cincture.

There is also another Bandage of the _Scrotum_, having in like manner four
Heads, of which the upper constitute the Cincture; but it is slit at the
bottom, and hath no Seams; the lower Heads crossing one another, to pass
between the Thighs, and to be join'd to the Cincture. Both these sorts of
Bandages have a Hole to give Passage to the Yard.

       *       *       *       *       *


{240}

CHAP. XV.

_Of the Operation of the Stone in the_ Ureter.

If the Stone be stopt at the _Sphincter_ of the Bladder, it ought to be
thrust back with a Probe: If it stick at the end of the _Glans_, it may be
press'd to let it out; and if it cannot come forth, a small Incision may be
made in the opening of the _Glans_ on its side.

But if the Stone be remote from the _Glans_, it is requisite to make an
Incision into the _Ureter_; to which purpose, the Surgeon having caus'd the
Skin to be drawn upward, holds the Yard between two Fingers, making a
Longitudinal Incision on its side upon the Stone, which must be prest
between the Fingers to cause it to fly out; or else it may be taken out
with an _Extractor_. Then if the Incision were very small, the Skin needs
only to be let go, and it will heal of it self; but if it were large, a
small Leaden Pipe is to be put into the _Ureter_, lest it shou'd be
altogether clos'd up by the Scar: It is also expedient to anoint the Pipe
with some Desiccative Medicine, and to dress the Wound with Balsam.
Afterward a little Linnen-Bag or Case is to be made, in which the Yard is
to be put, to keep on the Dressing; but it must be pierc'd at the end, for
the convenience of making Water, having two Bands at the other end, which
are ty'd round about the Waste.

       *       *       *       *       *


{241}

CHAP. XVI.

_Of the Operation of _Lithotomy_._

This Operation is undertaken when it is certainly known that there is a
Stone in the Bladder; to be assur'd of which, it may not be improper to
introduce a Finger into the _Anus_ near the _Os Pubis_, by which means the
Stone is sometimes felt, if there be any: The Finger is likewise usually
put into the _Anus_ of young Virgins, and into the _Vagina Uteri_ of Women,
for the same purpose. But it is more expedient to make use of the Probe,
anointed with Grease, after this manner: The Patient being laid on his
Back, the Operator holds the Yard streight upward, the _Glans_ lying open
between his Thumb and Fore-finger; then holding the Probe with his
Right-hand on the side of the Rings, he guides it into the Yard, and when
it is enter'd, turns the Handle toward the _Pubes_, drawing out the Yard a
little, to the end that the Canal of the _Ureter_ may lie streight. If it
be perceiv'd that the Probe hath not as yet pass'd into the Bladder, a
Finger is to be put into the _Anus_, to conduct it thither. Afterward in
order to know whether a Stone be lodg'd in the Bladder, the Probe ought to
be shaken a little therein, first on the Right-side, and then on the Left;
and if a small Noise be heard, it may be concluded for certain that there
is a Stone: But if it be judg'd that the {242} Stone swims in the Bladder,
so that it cannot be felt, the Patient must be oblig'd to make Water with a
hollow Probe.

Another manner of searching may be practis'd thus: Let the Yard be rais'd
upward, inclining a little to the side of the Belly; let the Rings of the
Probe be turn'd upon the Belly, and the end on the side of the _Anus_; and
then let this Instrument be introduc'd, shaking it a little on both sides,
to discover the Stone.

In order to perform the Operation of Lithotomy, the Patient must be laid
along upon a Table of a convenient height, so as that the Surgeon may go
about his Work standing; the Patient's Back must also lean upon the Back of
a Chair laid down, and trimm'd with Linnen-Cloth, lest it shou'd hurt his
Body; his Legs must be kept asunder, and the Soles of his Feet on the sides
of the Table, whilst a Man gets up behind him to hold his Shoulders: His
Arms and Legs must be also bound with Straps or Bands. Then a channell'd
Probe being put up into the Bladder, a Servant standing upon the Table on
the side of the Chair, holds the Back of the Instrument between his two
Fore-fingers on that Part of the _Perinæum_ where the Incision ought to be
begun, which is to be made between his Fingers with a sharp Knife that cuts
on both sides: The Incision may be three or four Fingers breadth on the
left side of the _Raphe_ or Suture: But in Children its length must not
exceed two Fingers breadth. If the Incision were too little to give Passage
to the Stone, it wou'd be more expedient to enlarge it than to stretch the
Wound {243} with the Dilatators. When the Convex Part where the channelling
of the Probe lies, shall be well laid open, the Conductors may be slipt
into the same Channelling, between which the _Forceps_ is to be put, having
before taken away the Probe. Some Operators make use of a _Gorgeret_ or
Introductor to that purpose, conveying the end of it into the Chanelling of
the Probe; which is remov'd to introduce the _Forceps_ into the Bladder:
And as soon as they are fixt therein, the Conductors or _Gorgeret_ must be
likewise taken out. Afterward search being made for the Stone, it must be
held fast, and drawn out of the Bladder: But if the Stone be long, and the
Operator hath got hold thereof by the two Ends, he must endeavour to lay
hold on it again by the Middle, to avoid the great scattering which wou'd
happen in the Passage. The Stones are also sometimes so large, that there
is an absolute necessity of leaving 'em in the Bladder. Again, if the Stone
sticks very close to the Bladder, the Extraction ought to be deferr'd for
some time; and perhaps it may be loosen'd in the Suppuration. Lastly, when
the Stone hath been taken out, an Extractor is usually introduc'd into the
Bladder, to remove the Gravel, Fragments, and Clots of Blood.

After the Operation, the Patient is carry'd to his Bed, having before
cover'd the Wound with a good Bolster; and if an Hæmorrhage happens, it is
to be stopt with Astringents. A Tent must also be put into the Wound, when
it is suspected that some Stone or Gravel may as yet remain therein: But if
it evidently appears that {244} there is none, the Wound may be dress'd
with Pledgets, a Plaister, and a Bolster, of a Figure convenient for the
Part. The Dressing may be staid with a Sling supported by a Scapulary; or
else the Bandage of the double T. may be us'd, the manner of the
Application of which we have shewn elsewhere. The Patient's Thighs must be
drawn close to one another, and ty'd with a small Band, lest they shou'd be
set asunder again.

The Operation of Lithotomy in Women is usually perform'd by the lesser
Preparative, which is done by putting the Fore-finger and Middle-finger
into the _Vagina Uteri_, or into the _Rectum_ in young Virgins, to draw the
Stone to the Neck of the Bladder, and keep it steady, so that it may be
taken out with a Hook, or other Instrument.

This Operation may also be effected in Women, almost in the same manner as
in Men; for after having caus'd the Female Patient to be set in the same
Posture or Situation as the Men are usually plac'd, according to the
preceeding Description, the Conductors may be convey'd into the _Ureter_,
to let in the _Forceps_ between 'em, with which the Stone may be drawn out:
But if it be too thick, a small Incision is to be made in the Right and
Left side of the _Ureter_.

The lesser Preparative was formerly us'd in the Lithotomy of Men, after
this manner: The Finger was put into the _Anus_, to draw the Stone toward
the _Perinæum_; then an Incision was made upon the Stone on the side of the
Suture, and it was taken out with an Instrument.

       *       *       *       *       *


{245}

CHAP. XVII.

_Of the Operation of the Puncture of the _Perinæum_._

This Operation is necessary in a Suppression of Urine, where the
Inflammation is so great, that the Probe cannot be introduc'd. Then an
Incision is to be made with the Knife or Lancet, in the same Place where it
is done in Lithotomy; and a small Tube or Pipe is to be put in the Bladder,
till the Inflammation be remov'd.

       *       *       *       *       *


CHAP. XVIII.

_Of the Operation of the _Fistula in Ano_._

Fistula's are callous Ulcers: If one of these happen in the Fundament, and
is open on the outside, it may be cur'd thus: After the Patient hath been
laid upon his Belly on the side of a Bed, with his Legs asunder, the
Surgeon makes a small Incision with his Knife in the Orifice of the
_Fistula_, in order to pass therein another small crooked Incision-Knife,
at the end of which is a Pointed Stilet with a little Silver Head which
covers it, to the end that it may enter without causing Pain. When the
Surgeon hath convey'd his Knife into the {246} _Fistula_, having the
Fore-finger of his Left-hand in the _Anus_ or Fundament, he pulls off its
Head, holding the Handle with one Hand, and the Stilet that pierceth the
_Anus_ with the other; and at last draws out the Instrument to cut the
_Fistula_ entirely at one Stroke.

If the _Fistula_ hath an Opening into the Intestine, an Incision is to be
made on the outside at the Bottom thereof, to open it in the Place where a
small Tumour or Inflammation usually appears, or else in the Place where
the Patient feels a Pain when it is touch'd. If the Tumour be remote from
the _Anus_, it may be open'd with the Potential Cautery, to avoid a greater
Inconvenience. After having thus laid open the very bottom, the little
Incision-Knife and Stilet, with its Head, is to be pass'd therein, the end
of the Stilet is to be drawn thro' the _Anus_, and the Flesh is to be cut
all at once. But if the _Fistula_ be situated too far forward in the
Fundament, the _Sphincter_ of the _Anus_ must not be entirely cut,
otherwise the Excrements cannot be any longer retain'd. Lastly, when the
_Fistula_ hath been treated after this manner, all its Sinuosities or
Winding-Passages ought likewise to be open'd, and the Wound being fill'd
with thick Pledgets steept in some Anodyn, is to be cover'd with a Plaister
and a Triangular Bolster; as also with the Bandage call'd the T.

       *       *       *       *       *


{247}

CHAP. XIX.

_Of the Suture or Stitching of a _Tendon_._

It is requisite to undertake this Operation when the Tendons are cut, and
when they become very thick. If the Wound be heal'd, it must be open'd
again to discover the Tendon, and the Part must be bended, to draw together
again the ends of the Tendons. Then the Surgeon taking a flat, streight,
and fine Needle, with a double waxed Thread, passeth it into a small
Bolster, and makes a Knot at the end of the Thread, to be stopt upon the
Bolster. Afterward he pierceth the Tendon from the outside to the inside,
at a good distance, lest the Thread shou'd tear it, and proceeds to pass
the Needle in like manner under the other end of the Tendon, upon which is
laid a small Bolster, for the Thread to be ty'd in a Knot over it. Then he
causeth the Extremities of the Tendons to lie a little one upon another, by
bending the Part, and dresseth the Wound with some Balsam. It may not be
improper here to observe, that Ointments are never to be apply'd to the
Tendons, which wou'd cause 'em to putrifie, but altogether Spirituous
Medicaments; and that the Part must be bound up, lest the Extension of it
shou'd separate the Tendons.

       *       *       *       *       *


{248}

CHAP. XX.

_Of the _Cæsarian_ Operation._

When a Woman cannot be deliver'd by the ordinary means, this bold and
dangerous Operation hath been sometimes perform'd with good Success. The
Woman being laid upon her Back, the Surgeon makes a Longitudinal Incision
beneath the Navel, on the side of the White-Line, till the _Matrix_
appears, which he openeth, taking great care to avoid wounding the Child:
Then he divides the Membranes with which it is wrapt up, separates the
After-Burden from the _Matrix_, and takes out the Child. Lastly he washeth
the Wound with warm Wine, and dispatcheth the _Gastroraphy_ or Stitching up
of the Belly, without sowing the _Matrix_. After the Operation, Injections
are to be made into the _Matrix_, to cause a Flux of Blood; and a pierc'd
Pessary must be introduc'd into its Neck.

       *       *       *       *       *


{249}

CHAP. XXI.

_Of the Operation of _Amputation_, with its proper Dressings and Bandages._

The Leg is usually cut off at the Ham; the Thigh as near as can be to the
Knee; and the Arm as near as is possible to the Wrist: But an Amputation is
never made in a Joynt, except in the Fingers and Toes.

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 Leg 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, to 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 be {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 Pincers that are clos'd with a small {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 _Malta_ 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, {252}

_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 covered, 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 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.

       *       *       *       *       *


{253}

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
{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: Then 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. {255}

_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
{256} forward in the Vein, and drawn back again streight, without turning
it up, otherwise the Artery or 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
{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 {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.

       *       *       *       *       *


{259}

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 Hæmorrhage 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.

       *       *       *       *       *


{260}

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 {261} a small Leaden Pipe is to be put into the
Opening.

If there be a carnous Excrescence 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 _Præputium_ is so streight that the _Glans_ can be no longer
uncover'd, this Indisposition is call'd _Phimosis_; but if the _Præputium_
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
_Præputium_ 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 {262} made directly at the
bottom of the _Glans_: Then the Surgeon having drawn out the bottom of the
_Præputium_, introduceth a small Instrument with a very sharp Point on its
flat side, at the end of which is fixt a Button of Wax, pierceth the
_Præputium_ 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 _Præputium_; and afterward convenient
Remedies may be apply'd to remove the Inflammation, and prevent the
Mortification of the Part; so that at length the _Præputium_ 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 Needle with a double wax'd Thread; then he makes a
Ligature both above and below the dilatation of the Vein, opens the dilated
Part with a Lancet, to let out the Blood, and applies a convenient Bandage:
But without performing this {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 a 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_; nevertheless 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 hurt. 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 putrifie, 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 {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.

       *       *       *       *       *


{265}

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, Fomentations are to be apply'd to the Part; a Linnen Cloth is to
be laid upon the Neck of the fallen _Matrix_; and it is to be thrust very
gently with the Fingers, without using much force. If the _Matrix_ shou'd
fall out again, it wou'd be requisite to convey a Pessary into it, after it
hath been reduc'd; and to enjoyn 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, after this manner:

The Surgeon having moisten'd the Skin for a while with Spittle, or else
having caus'd a light Friction to be made with a warm Cloth, applies a
perforated Plaister to the Part, and breaks the Cautery-Stone, to be laid
in {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.

       *       *       *       *       *


{267}

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, or the Blood of some Fowl, the Opening of the Box is to
be set to the Part, or the Leeches 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 a 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 Sting 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. {268}

_The Dressing_

Is made with a Bolster soakt in some Styptick Water, if the Blood will not
otherwise stop; or in Brandy or _Aqua-Vitæ_ 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.

       *       *       *       *       *


{269}

CHAP. XXXVI.

_Of _Scarifications_._

Scarifications are to be made more or less deep, accordingly as necessity
requires, beginning at the bottom, and carrying them on upward, to avoid
being hinder'd by the Hæmorrhage. They must also be let one into another,
that Strings may not be left in the Skin.

       *       *       *       *       *


CHAP. XXXVII.

_Of the Application of _Vesicatories_._

Vesicatories are compounded with the Powder of Cantharides or Spanish
flies, mixt with very sower Leaven, or else with Turpentine. Before they
are apply'd, a light friction is to be made on the Part with a warm cloth,
and a greater or lesser quantity is to be laid on, accordingly as the Skin
is more or less fine, leaving 'em on the Part about seven or eight Hours;
then they are to be taken away, and the Blisters are to be open'd, applying
thereto some sort of Spirituous Liquor.

       *       *       *       *       *


{270}

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 usual 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 required to take away any Blood. Lastly, the
Incisions are to be wash'd with some Spirituous Liquor; and a Bandage is to
be made convenient for the Part.

       *       *       *       *       *


{271}

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 Heel, it may be par'd with a Razor; and
if the Matter be lodg'd under the Nails, it wou'd be required to scrape 'em
with Glass before they are pierc'd.

       *       *       *       *       *


{272}

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 {273}

_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 sides 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_.

       *       *       *       *       *


{274}

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 sound 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, {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.

       *       *       *       *       *


{276}

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 _Capeline_ or Head-Bandage, provided the Fracture be in
the middle of the Clavicle. A Band {277} being taken about six Ells long,
and four fingers thick, roll'd with two Balls; it is apply'd in 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-hole and above the Breast, to be carry'd over the 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 Arm-pit, and upon
the Band that made the Roller, which is elevated by making a third Roller
upon the Clavicle: These Circumvolutions around about the Body are
continu'd, as also these Rollers upon the Clavicle, till it be entirely
cover'd. Some Circumvolutions are also made upon the upper part of the Arm,
near its Head: The Space that lies between the Rollers and the
Circumvolutions of the Arm, and which bears the Name of _Geranium_ or
Stork's-Bill, is likewise cover'd with some Circumvolutions, and the Band
is stay'd by making Circumvolutions quite round about the Body.

If the Fracture were near the Head of the _Humerus_ or Arm-Bone, a sort of
Bandage might be prepar'd, which is call'd _Spica_, with a Band roll'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 one behind the Back:
The other end is convey'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
other Shoulder behind; it is brought back again before, to form a second KY
upon the {278} Fracture; 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 {279} Shoulder, and afterward above it, to
make a KY in the middle of the Back; then passing under the other Arm-hole,
it is brought up to the Shoulder, to be let down, and to form a second KY
upon the middle of the Back: These Turns are continu'd in making Rollers,
till the _Omoplatæ_ are all cover'd: Circumvolutions are also made round
the upper part of the _Humerus_, as in the _Spica_; and the Bandage is
finish'd by Circumvolutions round about the 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 advanc'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 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.

{280}

_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.

{281}

_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, once before, and the other behind; it is pass'd under the other
Arm-hole; the Heads are cross'd upon the Shoulder, and it is brought down
backward and forward, forming a KY before and behind. Afterward the Bank 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 a Cirumvolution
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; {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 Spinosæ_ 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_.

       *       *       *       *       *


{283}

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 H 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 the 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 {284} Fracture, 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 {285}

_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 cover.
Afterward our Longitudinal Bolsters must be laid upon the Fracture round
about the Arm, which are to be kept close with a third 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 may be stay'd round the Body, or else beneath
the 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 the Arm; but they
must not cross one another. These Paste-boards are to be fasten'd with
three Ribbands, and the Arm is to be put into a Scarf made with a large
Napkin, which is to be first apply'd in the middle under the Arm-pit, the
Arm resting upon it, so that {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.

       *       *       *       *       *


{287}

CHAP. XII.

_Of the Fracture of the _Carpus_ or Wrist-Bone._

If the Bones of the _Carpus_, or those of the _Metacarpium_ be fractur'd, a
Servant must hold the Arm above the Wrist, and another the Fingers; whilst
the Operator sets the Bones in their place, so as no unevenness may appear
in the Part.

_The Dressing and Bandage._

Of the Fracture of the Wrist are to be prepar'd with a Band roll'd with one
Head, being six Ells Long, and two Fingers broad; so that three
Circumvolutions are to be made upon the Wrist; the Band is to be pass'd
over the Hand, between the Thumb and the Fore-finger, making the Figure of
KY upon the Thumb. Then after having made divers Rollers upon the _Carpus_,
a Bolster is to be apply'd, with a little Piece of Paste-board of the same
Shape with the Wrist; several Rollers are to be form'd on the top of the
Elbow, to stay the Band above it; and the Arm is to be put into a Scarf.

       *       *       *       *       *


{288}

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 Shape 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.

       *       *       *       *       *


{289}

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 stay'd with a Band, and the Arm to be put into 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 Bone pass one over another, it may be soon
known, because the hurt leg 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 lay his Thumbs upon the fractur'd Bone, to thrust it
back into its place, and afterward to apply {290}

_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 {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 on 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, no 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 {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, or else they pass
one upon another; and in this 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 an Extension is not requisite as
when they are both shatter'd, and it is to be drawn only on one side;
whereas the drawing ought to be equal on both sides when both Bones are
concern'd. {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 Ells long, the
second three, and the third three and a half. Three very streight
Circumvolutions are to be made upon the Fracture; the Band is also to be
carry'd up with Rollers, and stay'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, {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 fixt 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 below 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 {295} be taken
of the length of the Part, and broad enough 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
are form'd, every one of which will be four fingers broad, the upper Heads
being a little shorter than the lower. This Band of eighteen Heads is to be
laid upon the Scarves, and a Bolster is to be apply'd to it four Fingers
broad, as long as the Scarves. The Leg is laid upon this Bolster, and it
hinders the corrupt Matter from falling on the Bandage.

When the Wound hath been dress'd, the fracture is to be incontinently
surrounded with one of the Heads, which ought to cross one another: Then
after the Leg hath been bound with the first Heads, two Longitudinal
Bolsters 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. {296}

_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_.

       *       *       *       *       *


{297}

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
lays his Thumb upon the Root of the Nose, and then he introduceth a little
Stick trimm'd with Cotton, into the Nostrils, and by the means thereof
thrusts back the Bones into their place. {298}

_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. {299}

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
remains 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 {300} Surgeon 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 {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 fear 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 {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 to 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.

       *       *       *       *       *


{303}

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.

       *       *       *       *       *


{304}

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 Part 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 {305} Patient 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: {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 {307} the Hand
toward the Shoulder; or else a Tennis-Ball may be laid in the Fold of the
Elbow, and the Arm drawn toward the Shoulder.

For the External Luxation, the Extension is to be made, whilst the Surgeon
thrusts back the Elbow into its place: Or else a round Stick may be taken,
and trimm'd with Linnen-Cloth, with which the Bone is to be push'd back
into its place during the Extension. This Stick may be also us'd in the
reducing of the Internal Luxation.

For the Lateral Luxations, the Extension may be made in like manner; the
Surgeon at the same 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 Rollers 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.

       *       *       *       *       *


{308}

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 _Carpus_ 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. {309}

_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 {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.

{311}

If the Luxation be Posterior, a Tumour is felt 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 lifted off from the Ground, and the hurt
Person is apt to fall backward.

To reduce the Internal Luxation, the Patient is 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, to 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 down-ward, 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. {312}

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. {313}

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 is
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
{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.

       *       *       *       *       *


{315}

A

TREATISE

OF

_Medicinal Compositions_

Necessary for a

SURGEON.

       *       *       *       *       *


CHAP. I.

_Of Balsams._

       *       *       *       *       *


_The Balsam of _Arcæus_._

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 small Pieces, hath been melted over a very
gentle Fire, add to it the Turpentine, Goats-Suet, and {316} Swines-Grease;
and when all these Ingredients are well 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
Mariæ_, till the Wine be consum'd and let it be strain'd and squeez'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
Aguapendente_, a 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 space of twenty four Hours. But the Wound must be
at first wash'd with good White-Wine cold, and afterward anointed {317}
with this Balsam well heated. If the Wound be deep, it may be syringed with
the same Balsam very hot, and the sides of it anointed when drawn together.
Then a Bolster steep'd in the Balsam is to be apply'd to the Part, and upon
that another Bolster soakt in the Lees of Wine; as also over this last
another drie Bolster.

_The Green Balsam._

Take Linseed-Oil and that of Olives, of each one Pint; one Ounce of Oil of
Bays; two Ounces of _Venice_ Turpentine, half an Ounce of the destill'd Oil
of Juniper-Berries, three Drams of Verdegrease, two Drams of Sucotrin
Aloes, two Drams and a half of White Vitriol, and one of the Oil of Cloves.

Having made choice of the best Olive and Linseed-Oil well purify'd and
mingl'd together in a Skillet or Pan over a very gentle Fire, let the
Turpentine and Oil of Bays be incorporated in it; then having taken off the
Pan from the Fire, and left the Liquor to be well cool'd, let it be
intermixt by little and little with the Verdegrease, the White Vitriol, and
the Sucotrin Aloes beaten to fine Powder: Afterward the destill'd Oils of
Cloves and Juniper-Berries being added, and the whole Composition well
mingl'd together, the Balsam will be entirely compounded according to Art.

This is the Balsam that hath been so much talkt of at _Paris_, and which
many Quack-Salvers, pretending to the Art of Physick and Surgery, keep as a
great Secret. Indeed it is very good for all sorts of Wounds, whether they
{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.

       *       *       *       *       *


{319}

CHAP. II.

_Of Ointments._

       *       *       *       *       *


__Unguentum Althææ_._

Take of the Roots of _Althæa_ 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 _Hederæ_ 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 {320} consum'd: 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
_Hederæ_ 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. {321}

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 an Ointment. {322}

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
six 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 _Fæces_ or Dregs, it may be kept for use.
{323}

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 Hæmorrhoids 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 a 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 {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 taken 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 Chafings and Redness that happen in the Bodies of
Infants; It is of great efficacy in the healing of Contusions, and it
serves to consolidate and cool light Wounds.

__Unguentum Ægyptiacum_._

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 {325} Skillet 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. {326}

_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 Mariæ_, 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 Hæmorrhoids 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 _Unguentum de Cerussa_. {327}

_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 {328}
pounded 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 muddy 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 be 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 {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 Cauteries.
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 _Unguentum Althææ_,
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 {330} Charcoal Fire is 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.

{331}

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 _Opopanax_ 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 aquir'd the Consistence of
a somewhat solid {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_.

{333}

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, {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 Mariæ_; 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
{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 Mariæ_ 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 Shells, 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 {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 Retention 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 squeeze '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,
{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 is opening and discussive: It
is very good against the Palsie, and the Shiverings or cold Fits of a
feaver 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 harden'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 at 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 pour'd very hot into a little Linnen-Bag, which is to
be ty'd, and set in a Press between two heated Platines; so that the Oil
may be squeez'd out as readily as is possible.

This Oil mitigates the Pains of the Ears and Hæmorrhoids, 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._

       *       *       *       *       *


{338}

CHAP. VI.

_Of _Collyrium_'s._

_Collyrium'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 {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 infus'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, {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. {341}

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 Hæmorrhoidal 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

  _Of _Synthesis_, _Diæresis_, _Exæresis_, and _Prosthesis__             2

  _What ought to be observ'd before the undertaking of an Operation_     3

  CHAP. II.

  _Of Chirurgical Instruments, portable and not portable_                5

  CHAP. III.

  _Of Anatomy in general, and in particular of all the Parts of which
   the Human Body is  compos'd_                                          7

  CHAP. IV.

  _Of the general Division of a Human Body_                             10

  CHAP. V.

  _Of the Skeleton_                                                     12
    _Of the different kinds of Articulations,_                          14
    _Of the Number of the Bones of the Human  Skeleton_                 16

  CHAP. VI.

  _Of Myology, or the Description and Anatomy of the Muscles
   of the Human Body_                                                   19

  CHAP. VII.

  _Of the Myology or Anatomy of the Muscles of the Head_                21

  CHAP. VIII.

  _Of the Myology or Anatomy of the Muscles of the Chest, or of
   the Breast, Belly, and Back_                                         31

  CHAP. IX.

  _Of the Myology or Anatomy of the Muscles of the lower Belly_         34
    _Of the Muscles of the Parts that serve for Generation
     in both Sexes_                                                     36

  CHAP. X.

  _Of the Muscles of the Shoulder-Blades, Arms and Hands._              37

  CHAP. XI.

  _Of the Muscles of the Thighs, Legs, and Feet,_                       48
    _A List of all the Muscles of the Humane Body,_                     57

  CHAP. XII.

  _Of the Anatomy of the Nerves, Arteries, and Veins in general_        58
    _Of the Structure of the four Tunicks of the Arteries_              61
    _Of the Structure of the four Tunicks of the Veins_                 63
    _Of the Beginning and Origine of all the Veins_                     64
    _Of the Distribution of the ascending _Vena Cava__               Ibid.

  CHAP. XIII.

  _Of the Anatomy of the _Abdomen_ or lower Belly,_                     66
    _Of the Opening of a dead Body at a publick Dissection_             67
    _Of the _Peristaltick_ Motion of the Guts_                          71
    _Of the Parts appointed for Generation in Men_                      74
    _Of the Parts appropriated to Generation in Women_                  75

  CHAP. XIV.

  _Of the Anatomy of the Breast, or middle _Venter_,_                   77
    _The manner of opening the Breast in order to dissect it_        Ibid.

  CHAP. XV.

  _Of the Anatomy of the Head or upper _Venter_,_                       80
    _An exact Historical Account of the Holes of the Skull, and
     the Vessels that pass thro' 'em_                                   83
    _The manner of opening the Head, and Anatomizing the Brain_         91

  CHAP. XVI.

  _Of Straps, Swathing-Bands, Bandages, Bolsters, and Tents_            93

A Treatise of Chirurgical Diseases.

  CHAP. I.

  _Of Tumours in general, Impostumes or Abcesses, Breakings out,
   Pustules, and Tubercles_                                             97

  CHAP. II.

  _Of the general Method to be observ'd in the curing of Tumours_      100
    _How many several ways may all curable Tumours be terminated_      101
    _What are the best means of curing Impostumes, whether to
     dissolve, or to bring 'em to Suppuration_                       Ibid.
    _Of the Circumstances, to be observ'd by a Surgeon in the
     opening of Tumours_                                               102
    _Of the general Causes of Tumours_                                 103

  CHAP. III.

  _Of Natural Tumours, and first of the _Phlegmon_, and
   its Dependances_                                                    104
    _Of Remedies proper for the _Phlegmon__                            105
    _Remedies for the curing of _Aneurisms_ and _Varices__             108
    _Remedies for _Echymoses_, Contusions, or Bruises_                 109
    _Of Tumours, and their Remedies_                                   110
    _Of a Gangrene_                                                    111
    _Remedies for a Gangrene_                                          113
    _Of Kibes and Chilblains, and their Remedies_                      114
    _Of the _Panaritium_ and its Remedies_                           Ibid.
    _Of a Burn and its Remedies_                                       115
    _Of the _Erysipelas_ and its Dependences_                          116
    _Remedies for the _Erysipelas__                                  Ibid.
    _Of _Erysipelatous_ Tumours or Impostumes, and their Remedies_     118
    _Of the _Oedema_, and its proper Remedies,_                        119
    _Of _Oedomatous_ Tumours and Impostumes_                           120
    _Of a _Scirrhus_ and its Remedies_                                 123
    _Of _Scirrhous_ Tumours_                                           124
    _Remedies for the _Polypus__                                       125
    _Of Cancers_                                                       126
    _Remedies for Cancers_                                 Ibid. _and_ 127

  CHAP. IV.

  _Of Bastard or _Encysted_ Tumours_                                   128
    _Of the Remedies for _Encysted_ Tumours_                           129

  CHAP. V.

  _Of Critical, Malignant, Pestilential, and Venereal Tumours
   and Impostumes_                                                     131

  CHAP. VI.

  _Of the Scurvy,_                                                     133

A Treatise of Wounds, Ulcers, and Sutures,

  CHAP. I.

  _Of Sutures or Stitches,_                                            138

  CHAP. II.

  _Of Wounds in general_                                               141
    _Of Remedies proper to stop the Hæmorrhage of a Wound_             143
    _What is to be done when a Convulsion happens in a Wound, by
     reason of a Wounded Nerve or Tendon_                              144
    _What Course is to be taken to draw extraneous Bodies out of
     a Wound_                                                          145
    _Of Vulnerary Decoctions to be taken inwardly_                     148

  CHAP. III.

  _Of the particular Wounds of the Head_                               149

  CHAP. IV.

  _Of the particular Wounds of the Breast_                             151

  CHAP. V.

  _Of the particular Wounds of the lower Belly_                        153

  CHAP. VI.

  _Of Wounds made by Guns or Fire-Arms_                                154
    _Of the Prognostick of Wounds by Gun-shot_                         155
    _Of the cure of Wounds by Gun-shot_                              Ibid.
    _Of a Burn made by Gun-powder_                                     159

  CHAP. VII.

  _Of Ulcers in general_                                               164

  CHAP. VIII.

  _Of Venereal Diseases_                                               168
    _Of the _Chaude-Pisse_ or _Gonorrhæa__                           Ibid.
    _Of Shankers_                                                      170
    _Of Bubo's_                                                      Ibid.
    _Of the Pox_                                                       171
    _The manner of making the _Mercurial Panacæa__                175, &c.

A Treatise of the Diseases of the Bones.

  CHAP. I.

  _Of the Dislocation of Bones_                                        181

  CHAP. II.

  _Of the Fractures of Bones_                                          187

  CHAP. III.

  _Of the particular Fractures of the Skull_                           192

  CHAP. IV.

  _Of the _Caries_, _Exostoses_, and _Nodus_ of the Bones_             197

  CHAP. V.

  _Of Cauteries, Vesicatories, Setons, Cupping-Glasses, and Leeches_   199
    _Of the compounding of Potential Cauteries_                        201

  CHAP. VI.

  _Of Phlebotomy_                                                      204

A Treatise of Chirurgical Operations.

  CHAP. I.

  _Of the Operation of the _Trepan__                                   209
    _Of the Bandage of the _Trepan__                                   213

  CHAP. II.

  _Of the Operation of the _Fistula Lachrymalis__                      214
    _The Dressing and Bandage of the _Fistula Lachrymalis__            215

  CHAP. III.

  _Of the Operation of the Cataract_                                   216
    _The Dressing and Bandage of the Operation of the Cataract_        217
    _Of purulent Matter gather'd under the Corneous Tunicle
     of the Eye_                                                       218
    _Of a Tumour that ariseth in the Eye,_                           Ibid.
    _Of the Eye-Lids glu'd together_                                 Ibid.
    _Of the Hairs of the Eye-Brows that offend the Eye_                219
    _Of the 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_                                   220
    _The Dressing and Bandage for the Hare-Lip_                        221

  CHAP. VI.

  _Of the Operation of _Bronchotomy__                                  222

  CHAP. VII.

  _Of the Operation of the _Uvula__                                    223

  CHAP. VIII.

  _Of the Operation of a Cancer in the Breast_                       Ibid.
    _The Dressing and Bandage of the Breast_                           225

  CHAP. IX.

  _The Operation of the _Empyema__                                     227
    _The Dressing and Bandage for the Operation of the _Empyema__      228

  CHAP. X.

  _Of the Operation of the _Paracentesis_ of the lower Belly_          229
    _The Dressing and Bandage for that _Paracentesis__                 230
    _The Operation of the _Parcentesis_ of the _Scrotum__            Ibid.

  CHAP. XI.

  _Of the Operation of _Gastroraphy__                                  231

  CHAP. XII.

  _Of the Operation of _Exomphalus__                                   234

  CHAP. XIII.

  _Of the Operation of the _Bubonocele_, and of the compleat Rupture_  236
    _The Dressing and Bandage_                                         237
    _Of the compleat Rupture_                                        Ibid.

  CHAP. XIV.

  _Of the Operation of _Castration__                                   238
    _Of the Dressing and Bandage for the _Castration__                 239

  CHAP. XV.

  _Of the Operation of the Stone in the _Ureter__                      240

  CHAP. XVI.

  _Of the Operation of _Lithotomy__                                    241
    _The Dressing and Bandage for the Operation of _Lithotomy__        243
    _Of the Operation of _Lithotomy_ in Women by the lesser
     Preparative_                                                      244

  CHAP. XVII.

  _Of the Operation of the Puncture of the _Perinæum__                 245

  CHAP. XVIII.

  _Of the Operation of the _Fistula in Ano__                         Ibid.

  CHAP. XIX.

  _Of the Suture of Stitching of a Tendon_                             247

  CHAP. XX.

  _Of the _Cæsarian_ Operation_                                        248

  CHAP. XXI.

  _Of the Operation of _Amputation_; with its proper Dressings
   and Bandages_                                               249 and 251

  CHAP. XXII.

  _Of the Operation of the _Aneurism__                                 253
    _The Bandage for the _Aneurism__                                   255

  CHAP. XXIII.

  _Of the Operation of _Phlebotomy__                                 Ibid.
    _The Bandage in _Phlebotomy__                                      256

  CHAP. XXIV.

  _Of the Operation of _Encysted_ Tumours_                             257
    _Of _Ganglions__                                                   258

  CHAP. XXV.

  _Of the Operation of _Hydrocephalus__                              Ibid.

  CHAP. XXVI.

  _Of the Operation of cutting the Tongue-String_                      259

  CHAP. XXVII.

  _Of the Operation of opening stopt _Ductus_'s_                       260
    _Of an Incision made to open the _Vagina Uteri__                 Ibid.
    _The manner of separating the Lips of the _Pudendum_ when
     conglutinated_                                                  Ibid.
    _The manner of opening the _Vagina_ when stopt with a Fleshy
     Substance_                                                      Ibid.
    _The Method of opening the Urinary _Ductus_ as well in Boys as
     in young Virgins_                                               Ibid.
    _The Method of opening the _Ductus_ of the Ear, when stopt with
     a Membrane or a Carnous Substance_                                261

  CHAP. XXVIII.

  _Of the Operation of the _Phimosis_ and _Paraphimosis__            Ibid.

  CHAP. XXIX.

  _Of the Operation of the _Varix__                                    262

  CHAP. XXX.

  _Of the Operation of the _Panaritium__                               263
    _The Dressing and Bandage for this Operation_                    Ibid.

  CHAP. XXXI.

  _Of the Reduction of the falling of the _Anus__                      264

  CHAP. XXXII.

  _Of the reducing of the falling of the _Matrix__                     265

  CHAP. XXXIII.

  _Of the application of the Cautery and its Bandage_                Ibid.

  CHAP. XXXIV.

  _Of the Application of Leeches, and the Dressing_                    267

  CHAP. XXXV.

  _Of the application of the _Seton__                                  268

  CHAP. XXXVI.

  _Of Scarifications_                                                  269

  CHAP. XXXVII.

  _Of the Application of _Vesicatories__                             Ibid.

  CHAP. XXXVIII.

  _Of the application of Cupping-Glasses_                              270

  CHAP. XXXIX.

  _Of the opening of Abscesses or Impostumes_                          271

A Treatise of the Operations of Fractures.

  CHAP. I.

  _Of the Fracture of the Nose_                                        272
    _The Dressing and Bandage for the Fracture of the Nose_            273

  CHAP. II.

  _Of the Fracture of the lower Jaw_                                   274
    _The Dressing and Bandage_                                       Ibid.

  CHAP. III.

  _Of the Fracture of the _Clavicle__                                  276
    _The Dressing and Bandage_                                       Ibid.

  CHAP. IV.

  _Of the Fracture of the _Omoplata_ or Shoulder-Blade_                278
    _The Dressing_                                                   Ibid.

  CHAP. V.

  _Of the Fracture of the Ribs_                                        279
    _The Dressing and Bandage_                                         280

  CHAP. VI.

  _Of the Fracture of the _Sternum_ or Breast-Bone_                  Ibid.
    _The Dressing and Bandage_                                         281

  CHAP. VII.

  _Of the Fracture of the _Vertebra's__                              Ibid.

  CHAP. VIII.

  _Of the Fracture of the _Os Sacrum__                                 283

  CHAP. IX.

  _Of the Fracture of the _Coccyx_ or Rump-Bone_                     Ibid.
    _The Dressing and Bandage for that Fracture_                       284

  CHAP. X.

  _Of the Fracture of the _Humerus_ or Arm-Bone_                     Ibid.
    _Its proper Dressing and Bandage_                                  285

  CHAP. XI.

  _Of the Fracture of the Bone of the Elbow_                           286
    _The Dressing and Bandage_                                       Ibid.

  CHAP. XII.

  _Of the Fracture of the _Carpus_ or Wrist-Bone_                      287
    _The Dressing and Bandage_                                       Ibid.

  CHAP. XIII.

  _Of the Fracture of the Bone of the _Metacarpium_ or Back of
   the Hand_                                                           288
    _The Dressing and Bandage_                                       Ibid.

  CHAP. XIV.

  _Of the Fracture of the Bones of the Fingers_                        289

  CHAP. XV.

  _Of the Fracture of the Thigh-Bone_                                Ibid.
    _The Dressing and Bandage_                                         290

  CHAP. XVI.

  _Of the Fracture of the _Patella_ or Knee-Pan_                       291
    _The Dressing and Bandage_                                       Ibid.

  CHAP. XVII.

  _Of the Fracture of the Leg-Bone_                                    292
    _Its proper Dressing and Bandage_                                  293
    _The Dressing for complicated Fractures_                           294

  CHAP. XVIII.

  _Of the Fracture of the Bones of the Foot_                           295
    _The Dressing and Bandage_                                         296

A Treatise of the Operations which are perform'd in Luxations.

  CHAP. I.

  _Of the Luxation of the Bone of the Nose_                            297
    _The Dressing and Bandage proper for such a Luxation_              298

  CHAP. II.

  _Of the Luxation of the lower Jaw-Bone_                            Ibid.
    _The Dressing and Bandage_                                         299

  CHAP. III.

  _Of the Luxation of the _Clavicle__                                Ibid.

  CHAP. IV.

  _Of the Luxation of the _Vertebra_'s_                                300
    _The Dressing and Bandage_                                         301

  CHAP. V.

  _Of the Luxation of the _Coccyx_ or Rump-Bone_                       302

  CHAP. VI.

  _Of the Bunch_                                                     Ibid.

  CHAP. VII.

  _Of the Luxation of the Ribs_                                        303
    _The Dressing and Bandage_                                       Ibid.

  CHAP. VIII.

  _Of the sinking of the _Xiphoides_ or Sword-like Cartilage_          304

  CHAP. IX.

  _Of the Luxation of the _Humerus_ or Arm-Bone,_                    Ibid.
    _The Dressing and Bandage_                                         306

  CHAP. X.

  _Of the Luxation of the Bone of the Elbow_                         Ibid.
    _The Bandage for the same Luxation_                                307

  CHAP. XI.

  _Of the Luxation of the _Carpus_ or Wrist-Bone_                      308
    _The Bandage_                                                      309

  CHAP. XII.

  _Of the Luxation of the Bones of the Fingers_                      Ibid.
    _The Bandage for that Luxation_                                  Ibid.

  CHAP. XIII.

  _Of the Luxation of the Thigh_                                       310
    _Its proper Dressing and Bandage_                                  312

  CHAP. XIV.

  _Of the Luxation of the Knee_                                      Ibid.
    _The Bandage_                                                      313

  CHAP. XV.

  _Of the Luxation of the _Patella_, Knee-Pan, or Whirl-Bone
   of the Knee_                                                      Ibid.
    _Of the Separation of the _Perone_ from the_ Tibia               Ibid.
    _Of the Luxation of the _Astragalus__                              314
    _Of the Separation of the _Calcaneum_ from the _Astragalus__     Ibid.

A Treatise of Medicinal Compositions necessary for a Surgeon.

  CHAP. I.

  _Of Balsams_                                                         315
    _The Balsam of _Arcæus__                                         Ibid.
    _The Balsam of _Spain__                                            316
    _The Green Balsam_                                                 317
    _The _Samaritan_ Balsam_                                           318

  CHAP. II.

  _Of Ointments_                                                       319
    __Unguentum Althææ__                                             Ibid.
    _The mundificative Ointment of Smallage_                           320
    _The black or suppurative Ointment_                                321
    __Unguentum Rosatum__                                              322
    __Unguentum Album, aut de Cerussa__                                323
    __Unguentum Ægyptiacum__                                           324
    __Unguentum Basilicon_, or the Royal Ointment_                     325
    _A cooling Cerate_                                                 326
    _An Ointment for Burns_                                            327

  CHAP. III.

  _Of Plaisters_                                                       328
    _Of Plaister of _Diapalma__                                      Ibid.
    _The Plaister of simple _Diachylum__                               329
    _The Plaister of _Andreas Crucius__                                330
    __Emplastrum Divinum__                                             331

  CHAP. IV.

  _Of the Cataplasms or Pultisses_                                     332

  CHAP. V.

  _Of Oils_                                                            334
    _Simple Oil of Roses made by infusion_                           Ibid.
    _Compound Oil of Roses made by infusion_                         Ibid.
    _Oil of sweet Almonds made by expression_                          335
    _Oil of Bayes_                                                     336
    _Oil of Eggs made by expression_                                   337

  CHAP. VI.

  _Of _Collyriums__                                                    338
    _A dry _Collyrium__                                              Ibid.
    _A blue _Collyrium__                                               339

  CHAP. VII.

  _Of Powders_                                                       Ibid.
    _A Powder against Madness or Frenzy_                             Ibid.

  CHAP. VIII.

  _A Styptick Water_                                                   340

The END of the TABLE.




       *       *       *       *       *




Transcriber's note:

Changes made to the printed copy.

Page 20. "causeth the Antagonist to swell": 'Anatgonist' in original.

Page 29. "which arising from the fore-part on the inside": 'ari-rising' on
line break in original.

Page 30. "The Scalenus or Triangularis": 'Scalenu' in original.

Page 36. "round ligament of the Matrix": 'liga-' appears only as the
catch-word in original.

Page 113. "the mortify'd and corrupt Parts": 'morrify'd' in original.

Page 117. "and often renew'd": 'ond often renew'd' in original.

Page 118. "Tumours or Impostumes that partake": 'parrake' in original.

Page 130. "reiterated Purgations": 'reirerated' in original.

Page 146. "Oyl of Hemp-seed": 'Hmp-seed' in original.

Page 160. "which may be laid altogether": 'be be' in original.

Page 180. "all sorts of Venereal Diseases": 'Venenereal' in original.

Page 202. "In what Parts is the Seton to be apply'd?": 'to Seton be' in
original.

Page 216. "taking a Steel-Needle": 'a a' on line break in original.

Page 229. "This Dressing is to be kept close": 'kepc' in original.

Page 237. "to make a good Cicatrice or Scar.": 'to to' on line break in
original.

Page 249-50. "the Periosteum is to be scrap'd": 'be' catch-word only, not
in text in original.

Page 252. "round about the Stump": 'the about the' in original.

Page 269. "with a warm cloth": 'wram' in original.

Page 288. "the Shape of the Part": 'Skape' in original.

Page 299. "but remains somewhat open": 're-remains' on line break in
original.

Page 302. "requisite to keep Emollients": 'lo keep' in original.

TOC. "Of the Muscles of the Parts that serve for Generation": 'Geration' in
original.



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