The Compleat Surgeon Part 13

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 Ca.n.a.l 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 pa.s.seth 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 pa.s.seth 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 Pa.s.sage 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 Pa.s.sage 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 princ.i.p.ally 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.

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OF

_Straps, Swathing-Bands, Bandages, Bolsters, Splints, Tents, Vesicatories, Setons, Cauteries, Leeches, Cupping-Gla.s.ses, 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 _Perinaeum_; _Scapularies_ for the Body, after the manner of the Scapularies of Monks; _Trusses_ for Ruptures; _Stirrups_ for the Ankle-Bones of the Feet, in letting Blood, and upon other Occasions.

Lastly, there are an infinite Number of Bandages, the Structure whereof is learnt by Practice, in observing the Methods of able Surgeons, who invent them daily, according to their several Manners; and the first _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._

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