The Compleat Surgeon Part 23

CHAP VI.

_Of Wounds made by Guns or Fire-Arms._

These Wounds are always bruis'd and torn, with the loss of Substance, and commonly with the splitting and breaking of a Bone: They are red, black, livid, and inflam'd, not being usually accompany'd with an Haemorrhage: They are generally round, and streighter at their Entrance than at their End; at least 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 n.o.ble 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 Pa.s.sage 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 a.s.swag'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 Ca.s.sia, 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 a.s.swage 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 Althaeae_ with a Dram and a half of destill'd Bays; mingle the whole Composition, and apply it: Or else,

Take an Ounce of destill'd Oil of Turpentine, a Dram of Spirit of Wine, and half an Ounce of Camphire; let all be intermixt, and dropt into the Wound: Or else, {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 Mariae_, 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 quant.i.ty 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 quant.i.ty you please of quick Lime well wash'd, and pound it thoroughly in a Leaden-Mortar, with May-b.u.t.ter 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 quant.i.ty; 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 Ma.s.s will be coagulated in form of b.u.t.ter, 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} quant.i.ty 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 quant.i.ty 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-b.u.t.ter without Salt, and let 'em be boil'd up together, and sc.u.mm'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 b.u.t.ter: Otherwise,

Take a handful of fresh Sage-Leaves, two handfuls of Plantane, six Ounces of fresh b.u.t.ter 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 Ma.s.s be mingled to make a Liniment or soft Cataplasm, which may serve to a.s.swage 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 b.u.t.ter, the Oil of White Lillies, and the Yolk of an Egg: Otherwise,

Make a Liniment with fresh b.u.t.ter 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 aegyptiac.u.m_ 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._