The Compleat Surgeon Part 21

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

To form the _Dry St.i.tch_ 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 St.i.tch_, the Operator having drawn together the Lips of the Wound, holds 'em between two Fingers, pa.s.seth 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 b.l.o.o.d.y Rupture or Solution of the Natural Union of the soft Parts, made by a p.r.i.c.king, 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 Circ.u.mstances; but a Complicated Wound, on the contrary, is that which is attended with grievous Symptoms, as Haemorrhages, Fractures of Bones, Dislocation, Lameness, and others of the like Nature. {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 p.r.i.c.k'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 princ.i.p.al 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 a.s.swag'd every thing that might cause an Obstacle.

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

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

{143}

_REMEDIES._

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

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

Take two Ounces of Vinegar, a Dram of _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 _Haemorrhage_, taking Care nevertheless to bind the Part well, otherwise the Astringents do not readily take Effect.

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

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

Take about an equal Quant.i.ty 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 Quant.i.ty of _Pus_ or corrupt Matter, it must be let out. But in case the Inflammation ariseth from extreme Pains, they are to be a.s.swaged 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-Gla.s.ses 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 aegyptiac.u.m_, 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 St.i.tch, 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 Quant.i.ty 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 c.u.mmin 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.