The hospital-surgeon: or, a new, gentle, and easie way, to cure speedily all sorts of wounds, and other diseases belonging to surgery. ... In three parts. ... By Mr. Belloste, ...

THE Hospital-Surgeon: OR, A New, Gentle, and Easie Way, to Cure speedily all sorts of WOUNDS.

PART I.

Plainly shewing by Reason and Authority the Ad|vantages of this Way, and Mischiefs of a con|trary Practice: With a Discourse upon Disco|vered Bones; and a Way to Dress, with a new Instrument of the Author's Invention, af|ter the Vse of the Trepan.

CHAP. I. Of the Four Ends proposed in the Using of Tents.

THE Use of Tents in Wounds, be|ing reputed of so long standing in Surgery, and but too much approv'd on, by the Universal Practice, at this Day; it will be necessary for us, before

we deliver our own Method, to give our Thoughts thereon; which also we will con|firm by Reason and Authority.

Fabricius ab Aquapendente in his Eighth Chap|ter Of Wounds, reckons up only three Uses of Tents; but many after him make mention of Four. One is to keep open the Orifice of the Wounds: Another to carry the requir'd Medi|cines to their Bottom: A third to further the coming away of Extraneous Bodies: And a fourth is to drink in as it were, and to contain the Filth and Excrements therein generated.

Our Design is at present to consider, whe|ther these Ends, so far as they are expedient, may not be obtain'd without the Assistance of Tents: For I would not be thought without Reason, to make any Change of the Order re|ceiv'd in managing of Wounds; nor rashly to lay aside any thing that might conduce to the Relief of the Wounded, or facilitate and shor|ten the Cure.

CHAP. II. Of the First End of Tents.

IT is unquestionably certain, that Nature's Endeavours are ever bent towards the sup|plying of what has been taken away by violent means from our Bodies, and uniting the Divisi|ons

made therein: We ought not therefore to keep open the Orifice of a Wound; but if need|ful, it may be widened at the first Dressing; and thereby what is design'd in the first Use, will be sufficiently attain'd. However I don't altogether disapprove of the Use of Dilaters, and sometimes of Tents, when they are required to contain and support Astingents, to stop the Bleeding, or to hinder the Reunion of fresh In|cisions, that sometimes are necessary in the first Dressing of Gunshot Wounds: Especially when there is any Suspition that Extraneous Bodies are lodg'd in the Wound, or some Splinter of a Bone that Nature is not able to reunite. But if once the first two or three Days are over, Tents are not only useless, but extreamly hurt|ful, particularly in Gunshot Wounds, that of themselves are oftentimes sufficiently enlarg'd by the coming away of the bruised Flesh, commonly call'd the Escar, before which we need not fear the closing up of the Wound.

It was seldom ever known that a Wound did fill up, while any forreign Body remain'd within it. Now the Escar is an Extraneous Body in re|gard of those parts to which it immediately ad|heres, and must therefore of necessiy be sepa|rated from them: Moreover Nature can't effect a Reunion of the flesh, till first she have free'd her self of what keeps asunder the Parts to be joyn'd.

Fabricius ab Aquapendente, is of the same O|pinion, Part I. Book 4. Chap. 9. where he says, that Nature never cures a Wound, so long as any thing is in it that offends her.

I do believe there is no Body but will grant that the Separation of the Escar is a Work of Nature, that is most spedily perform'd, where the Natural Heat is most vigorous. Now seeing new Flesh is bred easiliest at the Bottom of the Wound, 'tis there also where it first begins to fill up; and therefore the Orifice is last of all freed from the Escar, and supply'd with new Flesh: for which Cause we have no Reason to fear its too sudden closing; neither does there appear any necessity of using Tents, to avoid that Inconve|niency.

As for Wounds made by sharp Instruments, they have no need of Tents, seeing they don't want to be dilated, but only to be clos'd up: Now what thwarts Nature's Intention not on|ly may, but ought to be laid aside.

Finally, Contused Wounds can't be united, till first what is bruised is remov'd, either by the force of the Natural Heat, or the Application of Dissolving Medicines, or by Suppuration: and consequently it appears that in this Case al|so, as well as the others, Tents may be forborn, and so the first End propos'd in using them is not to be allow'd.

CHAP. III. Of the second End of Tents.

THere will be no need of a great many Rea|sons to demonstrate, that it is an easy mat|ter, to make the Remedies pass to the Bottom of a Wound, without the Assistance of Tents: for to this Purpose nothing more is required, than to give a pretty soft and thin Consistence, to these Oyntments, Balsams, and other such like Remedies, as are commonly us'd in curing of Wounds.

When a simple Division is made in a health|ful and well temper'd Body, Nature stands not in need of any thing else, but the Natural Bal|sam of the Parts, or the Nutricious Juice, in or|der to procure a Reunion, especially if it is in fleshy Parts: in which Case the Tents and Oynt|ments do only irritate the Parts, cause Fluxion of Humours, putrify the Flesh, alter the Nutricious Juice; and so occasion long and very great Sup|purations, which rather hinder than promote the Cure.

CHAP. IV. Of the third End of Tents

THat the Discharge of Extraneous Bodies is at all furthered by Tents, is a thing not to be imagined: Yea on the contrary, we have more Reason to believe that they conduce very much to retain them. For supposing that any thing remains in a Wound, as a Bullet, Pieces of Bone, of Cloaths, or Wad, &c. it is almost impossible ever to draw it forth at the same Place by which it entred, unless it be at the first or second Dressing: And this happens very sel|dom, tho' never without great Pain, and much Time or Trouble.

There is no Probability that a Body so heavy as Lead, can remain for any considerable time in one Place, unless it stick in some Bone or Joynt. The Flesh has not solidity sufficient to detain the Bullet, but gradually yields to its descending Weight: and supposing it did not stir of it self, yet so far wou'd a Tent be from furthering its co|ming out, that it would rather fix it faster, and push it deeper into the Wound: Now the Matter ever follows the Bullet, and makes to it self one or more Cavities; it gathers together, encrea|ses, ferments, and commonly brings on a Fe|ver; the Part is weaken'd, the Body wasted,

and in fine the wounded Person frequently is brought to an untimely End. The like Acci|dents may also be produc'd, by the Splinter of a Bone, or some such other thing, after the same manner. Hence it is, that on the least Suspition, whether from the Complaint of the Wounded, or any other Appearance, of a for|reign Body remaining in the Wound, Search is made thereinto with Instruments, and with the Fingers, but for the most part to no purpose, as I have often seen: And all this to satisfy themselves, and to shew to the By-standers and to the Patient, that no Diligence has been spar'd to further the Cure. This Method is no less hurtful than cruel, and by exasperating the Parts, causes Fluxions, and brings on Putre|faction, yea oftentimes incurable Fistula's. But when all these foresaid Means fall short of Suc|cess, then a lower Part is sought out, therein to make a counter-opening, which sometimes when the Patient is of a strong Constitution, effects the Cure.

Pieces of Garments, of Wad, of Linnen, &c. are often carried by the Bullet into the Wound, and there remain after it is drawn out, being deeper lodg'd: These things are but too capa|ble of occasioning troublesome Accidents; and Tents conduce not a little to keep them there, obstructing the Passage whereby they might be expell'd. It is certain that a Tent always swells in the Wound, and filling up the Orifice, keeps

in the Matter, which not being longer to be contain'd within the narrow Bounds of the Wound, spreads it self into the neighbouring Parts, glides between the Muscles, and carries along with it the Extraneous Bodies, which are there corrupted and putrify'd, and infecting the Wound, occasion Mortifications, or Abscesses very hard to be cur'd.

I say then, to conclude this Chapter, that it is altogether in vain to use Tents with a Design thereby to facilitate the Discharge of Forreign Bodies; and that they rather conduce to keep them in, than assist in furthering their Passage. But if by Chance it should fall out, as sometimes it does, that the Wound close up, when there is some Extraneous Body within; it will occasion an Abscess either under the Ancient Escar, or somewhere else, more convenient for Nature, by the opening of which only whatever is hurtful and improfitable will be discharg'd.

As for leaden Bullets that have not been drawn out at the first Dressing, their remaining in the Parts can do no great hurt, because they are friendly to Nature; and in process of Time, by their own Weight, slip down between the Muscles, and often appear under the Skin, from whence they may be taken out, without either Trouble or Danger. The most Part of Surge|ons are convinc'd of the Truth of what I say: Only this I must acknowledge, that we ought to endeavour to draw forth such Bullets, as are

either lodg'd in a Joynt, or in hazard of falling into some Cavity of the Body; as that of the Scull, of the Thorax, or of the lower Belly, where they might be irrecoverably lost.

CHAP. V. Of the Fourth End of Tents.

AS for the fourth pretended Use of Tents, I grant that they are always soak'd with the Moisture of the Wound; but as they re|tain that Humidity, not suffering it to pass out; so they are thereby swell'd up, and enabled to intercept the Passage of all the other Mat|ter that is generated: Now I would willing|ly hear a Reason for keeping in a Wound Ex|crements, which Nature is so sollicitous to throw out; for being corrupted by their Abode, they alter and destroy the Constitution of the Parts that contain 'em. Seeing then the longer the Matter is detain'd, the more it is deprav'd; I am perswaded 'tis much better to give it a free Passage, not interrupting its Course, than to shut it up with Tents, and force it to take other ways.

Having therefore demonstrated that the Ends that have been designed by the Use of Tents, in so far as they are for the Advantage of the Wounded, may not only be attain'd without 'em, but are really hindred thereby; I will endeavour in the following Chapter to

take the part of Oppressed Nature, and to assert her Liberty by Reasons founded on the Cir|culation of the Blood, and supported by the Authority of many Authors.

CHAP. VI. Consequences deduc'd from the preceding Chapters,

NAture hath been diversly defined by Au|thors who have treated therein. Julius Alexandrinus calls it The Author, the Principle and Efficient Cause of natural Beings. In this Sense it is regarded in Physick as the Cause of Health, and the Physician of Distempers; and is by Van Helmont considered in three different States; to wit, either in its full Strength and Vigour, or as impaired and weakened, or as altogether op|press'd and prostrate.

These things might be apply'd to our present Purpose; however that I may give a more clear and intelligible Idea of Nature, which may bet|ter suit with outward Diseases, I shall look upon her as the Chief Worker of whatsoever concerns our Health: and I am perswaded, seeing she has fram'd every thing according to the Law of its being, she will also maintain them in their ne|cessary Vnion, unite them when divided, and

in a Word, restore them to their first Estate, when any way fallen from it.

This Vnion is so necessary for maintaining Health, and preserving Life, that all, or at least the most part of Diseases, proceed from a De|fect therein: For things of a forreign Quality are one Way or other mixed with the Humours of the Body, which disordering and interrupt|ing the Vnion of their Parts, change and de|prave the good Temperament and Qualities of the natural Balsam, called Radical Moisture; and from hence come Diseases and Death.

In outward Maladies also, and in Divisions of the harder or softer Parts of the Body mani|fest to the external Senses, it is plain that Na|ture suffers, and consequently must strive with all her Might to reunite the divided Parts. The Surgeon as her faithful Minister in curing Wounds, ought to imploy his utmost Care to as|sist her, while she labours to effect that so neces|sary Vnion. To this End he shou'd not only leave her at Liberty, putting no Hindrance in her Way, but also free her from whatever may thwart her Design. Finally, he must assist and imitate her, mind her Inclinations, observe her Proceedings, and follow her as it were step by step, that he may be ever ready to lend her his required Help.

The Art of Physick turns upon this Principle, that Nature has the chief Hand in curing Diseases: 'tis with her the Physician ought to consult, and

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without her Consent as it were he ought never to do or undertake any thing: and in a Word, he only is the ablest Physitian, who has most ear|nestly apply'd himself to the study of Nature.

I acknowledge there are many Cases, where|in Nature alone is not sufficient, and in these she must be helpt out by the Hand of Art: as in the drawing out of Extraneous Bodies from Wounds, cutting off mortify'd Parts, opening Abscesses, restoring broken or disjoynted Bones, and other like Operations belonging to the Pro|vince of Surgery. But let a Surgeon be never so superficially acquainted with Nature, he may easily perceive that by Tents and Dilaters she is oppress'd, depriv'd of Liberty of acting, and directly oppos'd in her Design, which is to reu|nite the divided Parts.

Fabricius ab Aquapendente, whom I mention'd before, asserts, that Nature never cures a Wound, so long as any thing is in it which she can't retain: For in this he is agreed with the most Judici|ous, that 'tis Nature that works the Cure; and at the same time shews, that a Tent is such an Enemy to her, as neither ought nor can be kept within, but to her hurt and destruction. Galen also in his third Book of Method, says, that 'tis not the Remedies, but Nature that closes up Wounds.

Wherefore, Experience having convinc'd me of this Truth, I set my self to consider Na|ture's Designs, her Inclinations, and the Way

she takes to effect the Cure of Wounds; and have observ'd that Tents do ever oppose, and prove a Hindrance to her. 'Tis every Day to be seen that Nature can suffer nothing forreign to abide with her; she endeavours with all her might, to free her self from Tents and Dossels with which Wounds are ordinarily cram'd up: For tho' they did not occasion pain, as we may well assur'd they do, yet being Extraneous Bo|dies, Nature can't endure them without trouble: and let them be never so small or soft, they must necessarily press always upon some Vessels, of which the Body is nothing else but a Contex|ture.

According to their bigness and hardness, Tents do more or less disturb the course and order of the Circulation of the Blood, so far as the Wound reaches: They squeeze out the most subtil part of that, or other Liquors contain'd in the Vessels they press upon, which by the Matter al|ready in the Wound, is converted into its own Nature, and becomes a Ferment, that being re|tain'd, grows hot and corrupt, and so alters the containing and neighbouring Parts, and often|times imparts its vicious qualities to the Mass of Blood, by Vapours sent into the Veins; yea the Matter it self is suck'd up by the Veins, their Orifices being dilated by its Fermentation, Moi|sture, and stay; and this circulating with the Blood, intirely corrupts it, and causes Fevers that end in Death, unless Nature by some critical and

healthful Motion, throw out the Corruption.

Ambrosius Pareus in his ninth Book, treating of Wounds, Chap. 5. forbids the Use of Tents in few words, being therein supported by the Authority of Galen, who in the fourth Chapter of his Method, affirms it to be necessary in all Wounds whither simple or compound, that no|thing be between their Lips that may hinder Reunion. The same Pareus in his ninth Book, Chap. 7. recommends the Use of long and thick Tents in the Beginning, and afterwards advises to make 'em more thin and short; but does not here forbid their Use. In the same Book, Chap. 15. he takes the part of Tents in oppo|sition to a certain Physician, that had written against his Method.

These differing and contradictory Opinions in one and the same Author, must of necessity throw the young Surgeon into perplexing doubts, so that often he can't know, what is best, or what way is most secure. 'Tis certain however, that the mischief of Tents was known to Galen, because he forbids their Use; and also to that Physician who found fault with the Prac|tice of Pareus; his name I know not, but by the acknowledgment of the same Author, he alto|gether lays aside the use of Tents, and orders to dress a Wound but once in four Days. This Method therefore is not so new as at first I thought with my self, for I had form'd my de|sign ere ever I was aware of what I have here

quoted; and it was Experience only that open|ed my Eyes.

Galen Justifies further my Opinion, in his third Book of Method, and ninth Chapter, when he says, that in every Wound there are two sorts of Excrements, a gross and a subtil, which as he affirms, hinder the generation of Flesh. Now if this be so, it is very preposterous to keep them in the Wound with Tents. If it be said, that the Tents may be made so little, as not altoge|ther to fill up the Orifice, nor hinder the passage of the Matter: I answer, that tho' they be made never so small, yet will they fill up the Mouth of the Wound; because they ever swell up to the bigness of the Space they are in: but suppo|sing the most subtil matter to escape, yet the more gross and clammy is by them retain'd, and is enough to occasion grievous Accidents. Now if small Tents prove such a hindrance to the cu|ring of Wounds, what may be expected from these that are long and hard, and pass to the ve|ry Bottom? However these also are used by ma|ny Surgeons, who for want of applying them|selves to the consideration of Nature, and her Intentions in curing of Wounds, continue to follow a Method that is both cruel and destruc|tive.

Tents, Dilaters, and Setons always occasion Dis|orders in the Places where they are apply'd; if they touch the Nerves, they cause extremity of Pain, that is often the Original of many Evils, and

follow'd by many grievous Accidents; such as Convulsions, loss of Sense, &c. If they bear upon a Tendon, its Action is hurt; and motion ceases: if they press the Vessels, as they almost ever do, the Circulation of the Blood is disturb'd.

But suppose a Tent should only press together the * 1.1 fibrous Papil|lae that compose the Skin, which are of a quick sense, being the In|strument of touching; this alone were enough to disturb the Order and Distribution of the Spi|rits; which now moving in a tumultuary way among these fibrous Papillae of the Skin, con|tract them by the Irritation and pricking which they cause. Now the Fibers being shortned, and the Skin contracted, the Vessels must of ne|cessity be doubled or squeez'd together, and con|sequently the Circulation diminish'd, or intirely suppress'd. In these Cases there is not so much Blood carried back by the Veins, as was brought by the Arteries: Now if the Circulation is al|together stopt, a Mortification ensues; if con|siderably diminisht, an Abscess; but if the Hu|mours ouze into the Wound from the Capellary Vessels, large and tedious Suppurations are oc|casion'd.

The Hardness and Swelling are caus'd by the Matter that is stopt, and diffus'd about the Place; and therefore all the Accidents are more or less grievous, and alter according to the force of the Compression, and quantity of

the diffused Matter, the good or bad Disposi|tion of the Blood, of the Humors, or of the Part affected, and the different Degrees of the Natural Heat, which hastens or keeps back the Fermentation and Putrefaction.

From what hath been said it appears, that the Blood and Humours are not carried, or drawn (as some Authors love to speak) to the afflicted Part more abundantly than at other times, altho' the Spirits run thither in much greater Plenty: But as for the Blood, it is evident enough that it circulates less in the wounded, than in the sound Parts, because it moves with greatest Ease in these latter: And it is a Law of Nature, that a Body in motion always moves towards these places where it finds least Opposition.

The truth of this is clearly demonstrated by the Accidents, which some time ago followed on certain Malignant Fevers in places not far distant from hence. They caused an Obstru|ction, and swelling in the lower Belly so con|siderable, that the Circulation was stopt, and a Gangreen ensu'd. But on the contrary, the Blood was violently, and in too great quantity carried upwards; it could not be contain'd within the Vessels, broke thro' all Obstacles, and caus'd sharp Pains, Abscesses, Deliriums, and Death.

I have considered the Accidents that most commonly attend Wounds, and do believe,

that for the most part they proceed from the Disorder of the Circulation of the Blood, oc|casion'd by broken pieces of Bones, Bullets, or some other Foreign thing remaining in the Wound: These things are not of such a Fi|gure as to cause an Irritation, nor can they of themselves produce any putrefaction, and yet they commonly bring on Abscesses. We ought not then to ascribe these Accidents to Pain; for sometimes they come without it; and this often is present where those don't happen. But I am of Opinion, that these extraneous Bodies press the Vessels that are dispers'd through the place where they are, and stop the Blood, which slipping into the Pores and Spaces of the Flesh, by its stay and Fermentation, is there corrupted, and chang'd unto the Matter of an Abscess.

'Tis true, Leaden Bullets, or other things of a like Nature, have been long in the Body, and yet no Abscess hath followed; but this may be attributed to the largeness of the Place wherein they happen'd to be lodg'd so, as not to occasion any Disorder; or because sliding between the Muscles, it did not hinder the Course of the Humours. The other Accidents that ordinarily attend Gun-shot Wounds, are also occasion'd by the Defect of the Circula|tion, as I shall observe in the Sequel of this Discourse; where it shall be made to appear, that Tents and Dilaters us'd in this sort of

Wounds hinder the fall of the Escar, the Dis|solution of what is bruised, and the passing out of whatever ought to be brought away.

This will without difficulty be granted by those, who well understand the Course of the Blood and Humours, and the Union and Order of the Parts that compose the Body. All the Parts are so united one to another, that the least Separation can't be made without Pain, Effusion of some Humour, or some other Dis|order. Experience shews, that 'tis not only the Air that rots the Bones, but also the Nou|rishment of the Nervous Parts when it is al|tered by a malignant Acid; and generally any Matter that has Acidity enough to cause a Fer|mentation and Corruption in the place of its Abode, when kept in by Tents, or other such Obstacle.

Tho' Doleus in his Surgery is not altogether against the using of Tents, yet he shews that we ought to do it with great Caution; from whence it appears he Judg'd them dangerous.

Etmullerus is of the same mind, in his Physical Surgery, where he Joyns such Accidents with the Use of Tents, as ought to fright those who imploy 'em: He advises the using of Pledgets, and quite to lay aside Tents in Wounds of the Nerves and Tendons, and in these of the Joynts. Hence it appears that this Auther was no great Favourer of Tents; for which Reason he orders the Use of the vulnerary Balsam in the cure of

Wounds, which promotes the generation of Flesh, and causes a speedy Union, to both which the Use of Tents is directly contray.

All the famous Physicians, who have treated of Surgery, and the curing of Wounds, are well nigh of the same Opinion. I could reckon up a great number, if I thought that these I have adduc'd were not enough. It appears, as I have said in the Preface, that Septalius and Ma|gatus, both renowned Physicians that practised Surgery in Italy, followed this Method for the space of forty years with very good Success.

M. Caufapé Doctor of Physick, in his Obser|vations on the frequent Use of Bleeding, alto|gether discards the Use of Tents, without any Reserve. He supports his opinion with Reasons, which I had conceived before his Book came to my Hands. But we may be sure that Author did not write on this Subject, before he was ful|ly convinc'd by his own Experience of what he advanc'd. It would be an unpardonable Rash|ness for one to write and maintain that, of which he doubted the Truth, and to establish a Me|thod on false Principles.

I very well know that great Numbers will oppose themselves to what I advance on this Subject, which is the common Fate of all Opi|nions that appear new: but of this Matter Ex|perience only is the most competent Judge; whose Testimony shall be deduc'd at large, and with

all Faithfulness, in the second Part of this Work.

In this first part I make account sufficiently to explain the Reasons that oblig'd me to lay aside the Use of Tents and Dilaters. I can't approve their proceeding, who use them be|cause others have done so, or because the An|cients have ordered it. The Glory or Blame of the Good or Ill Success, say they, accrues not to us; we have Custom and Antiquity for our Warrant. But the Arts and Sciences ought never to be shut up within such narrow and un|equal Bounds. Knowledge, Reason, and Expe|rience would be injur'd to the highest Degree, if we should impose upon them such severe Re|strictions, and take from them that Liberty, which should last equally with the World.

CHAP. VII. Reasons to demonstrate the Mischief of Tents.

MAny of the Ancients, and some of the mo|dern Writers, have spoken of Tents as things indifferent: Such Authors, I mean, as ha|ving written of Surgery and the Cure of Wounds, seem to have brought these things to some Per|fection. They leave it to the Discretion of the

Surgeon either to use them or not, according as they Judg'd convenient. They did not think this matter of such Moment, as to require their Attention. They look'd on these Means with unconcern'd Eyes, referring themselves therein to the Honesty of those, who first wrote of them. 'Tis apparent they had not observ'd, as I have often done, the mischief occasion'd by Tents, the use of which destroys indifferently the Vul|gar with Persons of Merit, whose loss in a State is always to be regretted.

We need not be surprised at what we see hap|pen every day in the Cure of all sorts of Wounds: 'tis not at this time only that one thing has been taken for another. Our Knowledge is not so great as to reach to all necessary Truths; nor do we perfectly understand the Causes of all the Accidents and Disorders that follow upon Wounds. All those who have treated of this Subject have endeavoured to explain them ac|cording to their opinions, as I have done my best to accommodate them to mine. But Occa|sions are now frequent enough, and therefore it will be easie for any one to inform himself of the truth, and to distinguish who are in the Right, and who not.

M. De la Chariere, in his Book of Operations, discoursing of Wounds, advises carefully to wipe away all the matter of a Wound, and to fill up every the very least corner with Dilaters or Dossels, to hinder its staying, lest it should be

suck'd up by the Veins, and carried by the Cir|culation to the Heart. The same Author adds, that the Air is a most powerful Enemy to Wounds: Nevertheless it is impossible to dry up the Matter with all that exactness he re|quires, what diligence soever be us'd, without ta|king up some time; during which the Air will do incomparably more Harm, than the Matter that therein might have remain'd; which often is not endu'd with all these ill Qualities one is apt to imagine, as shall be made to appear in the fourth Chapter of the last Part of this Treatise.

This Author acknowledges that in Contusions, a little extravasated Blood squeezes together the Vessels, interrupts the Course of the Blood and Humours, and causes Fluxions and Inflammati|ons. What then may be expected from a like quantity of Dossels heap'd one upon another? They encrease the Division made in the Body, and oppose the Design that one ought chiefly to have Regard to in curing of Wounds, which is Reunion. To this may be added, that they are more hard, painful, and contrary to Nature, than a little Blood of which he speaks.

As for what is alledg'd by him, that the Matter might otherwise be taken up by the Veins; it is not to be apprehended, unless it were of so great a Quantity as to ferment, or made so long a stay in the Part, as to open and dilate the Orifi|ces of the Vessels. This may indeed fall out in

Wounds of the Breast, as will appear in the se|cond Part of this Book, and in these of the Thorax, where the capacity and heat of the Part, are sufficient to produce that Effect. This al|so may happen in great Abscesses, whereof we will give some Examples at the End of this Work. Finally this may arrive when the Mouth of a Wound is stop'd up with Tents or Dilaters, which too often keep the Matter shut up from one Dressing to another: hence it increases, ferments, and ordinarly acquires a vicious and malignant Quality, which may be communi|cated to the Heart by means of the Circulation of the Blood.

Of all those Mischiefs Tents and Dossels may be accounted the chief Occasion. Now to a|void all these Accidents, and the staying of the Matter in the Wound, we need only leave open the Orifice, and put nothing into the Cavity which may increase the Separation of the Parts; to the end they may come together, when there is nothing to hinder their Reunion, nor any empty Space, where the Matter may make any considerable stay. These I think are good Reasons, and strong enough to overthrow an Opinion, that is contrary to my ten or twelve years Experience.

The same M. De la Charriere, a little further says, that the Orifice of a Wound must be dila|ted when it is so little that it will not suffer Dos|sels to enter, that so it may be fill'd therewith:

and I on the contrary widen it that I may avoid the using of them, for Reasons mention'd before. Moreover it is to be fear'd that a Dilater may be lost, and fixt in a deep Wound. Of this we have had sufficient Proof in the Person of one of our Generals, and many others wounded in the Battel of Marseils.

Wherefore if Tents may be laid aside, as has been done in this Hospital, even in deep Wounds of the most fleshly parts of the Body; much more ought they to be forborn in others.

The same Author before mention'd, rejects the use of Tents, excepting in Wounds of the Breast, and lower Belly that penetrate: Not|withstanding it may be seen in the second Part of this Treatise, where we discourse of Wounds in the Breast, in what manner we have cured many such of different Natures without the As|sistance of Tents.

As for those in the lower Belly, I know it may be said to me, that if I have not us'd Tents to them, it is long of the difficulty of their Ap|plication, and stay in this Part, where, by rea|son of the continual motion, they can't be kept in, unless with a very strait Bandage. But the matter is otherwise; for indeed I see not for what Reason Tents are required to this part a|ny more than to others. Let us suppose now, that the expected Suppuration of the contained Parts that are wounded, is already begun, 'tis impossible the Matter can come away, while the

Orifice is stopt up with a Tent, but it must fall down by its own weight into the lower part of that Cavity: also what Matter or Blood may there be collected, can't be discharg'd by rea|son of the Tent, which is as a Dam to keep it in; especially if we wait till the Suppuration of the Teguments, which is never great, be excited by Irritation or by Tents. Otherwise the Mo|tion in Breathing, and the lifting up of the Pe|ritonaeum in Inspiration, will drive out the Mat|ter as it breeds, if a free passage be allow'd it.

There is one Case wherein Dilaters, and some|times Tents, become in a manner necessary; and that is when a Wound is accompanied with a considerable Bleeding; then they may be us'd to carry Astringents to the opening of the Ves|sels, and to support and keep them on; chiefly in deep Wounds: For if at first we should Joyn the Lips of the Wound, and apply Astringents upon them, the outward Bleeding might be re|prest, before that of the Vessels were restrain'd; and so the Blood running between the Muscles would there be corrupted, and would spoil the Parts wherein it is contain'd, and these that bor|der upon them, and might also occasion Suffo|cation, and a Gangrene. This is what I saw at Turin to befall the Baron de la Serra, a Gen|tleman of Savoy, who being wounded with a Sword near the right Arm-pit, had a branch of the Vena Subclavia opened: he was dress'd by a very expert Surgeon, who, whether by

chance, or otherwise, neglected to apply Astrin|gents to the Opening of the Vessel, tho' the Bleeding was very great: the Wound was joyn|ed, and the Part loaded with Astringents, which were made fast with Compresses and Bandage. In the mean time the Blood continu'd to run from the Vein, and to diffuse it self between the Muscles of the Breast. Two or three Days past before the first Dressings were taken off; and then the Thorax was found to be gangren'd. The wounded Person dy'd in a little time af|ter.

The Cause of this Gangrene can't reasonably be ascrib'd to any thing else but the retaining of the Blood and Matter, which finding no Out|let, press'd together, by reason of their bulk, the Vessels and the Nerves, and hindred the Circu|lation of the Blood, and Course of the Spirits and other Liquors, so that the Blood became quickly corrupted, and caus'd all these Disor|ders. These same Accidents may be occasion'd by Matter, shut up in the Cavity of Wounds by Tents stopping their Orifice; especially if that Matter is considerable for its Quantity, and ve|ry much crowded.

When in my younger Days I frequented Hos|pitals, and practis'd with very able Surgeons, I have seen at time of dressing, the Tents for the most part expell'd from the Wounds, in spite of the Bolsters and Bandage: Nature then clearly signifying her Intention. Nevertheless

they continued still to use them, forcibly thrust|ing them again into the Wounds, tho' not with|out much Pain. What a strange Method is this? How is it possible for a Wound to close up, so long as a forreign Body is entertain'd within it? If a Pea, or a litttle Ball, be kept in an Issue, tho' for ten Years, it will still re|main open: but if you take it out but for one half Day, you shall find it intirely fill'd up.

A Tent does the same to a Wound, that the Ball does to an Issue: and Fistula's that trouble so many People all their Life, are the Effect of Tents that have been inconsideratly us'd, in the Cure of their Wounds. The Humours take their Course through these Places which they find open; this becomes first habitual, and then natural and necessary, and thereby the Flesh is hardened and becomes callous. These Im|purities which Nature sometimes evacuates by ways surprizing to us, being detain'd in one Place, became a Bag of Mattet; and that same Nature, unwilling that any thing superfluous and unprofitable should remain with her, by a peculiar Sagacity, makes a Vertue of Necessi|ty, and uses these Passages she finds open, to free herself from the Excrements and Humours that disturb her; but at the same time a part of the * 1.2 Radical Balsam, which is the Life and support of the Parts, pas|ses out also by the same ways.

I know not to what I can better compare these Openings in the Body, through which Hu|mors take their Course, than to these of Trees, whether made by Nature herself, or the assist|ing hand of Man, by which the Sap that nou|rishes both its Trunk and the other parts passes out. The difference only lies here, that these help to encrease and preserve the Trees, but those to destroy and weaken the Body.

For certain it is that Fistula's considerably impair the Parts, never leave those that have them in an intire State of Health, and shorten their Days, whatever any may alledge to the contrary. But that which surprises me most is to find the afflicted Persons, support the Incon|veniencies they suffer with a kind of Satisfaction, fancying that if in time they should permit their Sores to close up, then Death would un|doubtedly soon after follow.

Wherefore when there is nothing to hinder the filling up of a Wound, Art hath nothing else to do but to observe Nature's Proceedings, which sometimes exceeds in the breeding of Flesh, in soft Parts; and sometimes in generating the Callus in hard Parts: But 'tis observable that in curing Wounds, she proves oftner su|perfluous than deficient. Thus it appears, that Tents ought not to be us'd in Wounds, seeing Nature very frequently throws 'em out; because she can't bear the presence of what is forreign. Don't we see, that so soon as

she is opprest with any thing hurtful, all her Endeavours are us'd to get rid of it? She has a thousand means unknown to us, and often takes such secret and singular ways as are hidden from the most Curious Anatomists. That young Man, under the Care of Fernelius, who had swallowed an Ear of Grass, that came out some time after by a little Abscess between two of his Ribs, is a sufficient Demonstration of this Truth. Ambrosius Pareus also relates that he took from the Groin of a Woman, a Needle that had entered at the Hip of the same side. In fine, the consideration of the surprizing Ways whereby these extraneous things were cast out of the Body, obliges us to conclude, that Na|ture is very wise, and can't endure the least thing that is hurtful or disquieting. A little Dust in the Eye disturbs all her Oeconomy, and no rest is to be expected till it is out. A small Crum of Bread that goes not the right Way, but is by some motion, or the agitation of a little Air thrown into the Wind-pipe, does it not endanger Suffocation? What endeavours are made to cast it out? The Air breaks forth with Violence from the Lungs, the whole Bo|dy is shaken, all its Parts are in motion, the Face is inflam'd, the Eyes run with Tears, Con|vulsions follow, and this admirable Master|piece of Nature, is all in trouble and Disor|der, and all this for a thing in appearance most inconsiderable. A Stone or a little Sand in the

Reins, Ureters, Bladder or Vrethra will scarce permit a moments rest for the violent Pain: And indeed our Life may be called an Image of Death, so long as a Stone is lodg'd in any of these Parts: so true is it that Nature abhors what disturbs her.

Now 'tis to be observ'd, that according to our Method, the Dilaters and Tents with which the Wound was filled hitherto, must be taken out, so soon as the Bleeding is stop'd; and that the surest way is for the Surgeon, altogether hence forth to leave off such dangerous Means: be|cause their use may irritate, and at the same time by touching the Vessels, may open them and renew the Bleeding, which by protracting the Cure, occasions new troubles to the Woun|ded, as I have often seen.

Fabricius ab Aquapendente, Part I. Book 1. Chap. 2. speaking of transverse Wounds of the Forehead, advises to apply long and slender Compresses wet with the White of an Egg, one on each side of the Wound, and to press them together, so that the Lips may touch without stitching, especially if we would avoid the Deformity of a Scar. Now I know no Reason, why the same Method mayn't be put in practice, in Wounds of other Parts of the Body, made by cutting Instruments: Nor do I understand why such should be dilated, seeing they require only Re-union. For my own part, I have practis'd this way in many Places, and

on different parts of the Body with the desired Success.

These who are unprejudicated, or will re|flect but a little on the common Method, will be convinc'd that I don't without Cause reject it. 'Tis easie enough to apprehend the Cause of the perpetual Pains suffered by those miserable Persons, whose Wounds are fill'd with Tents and Dossils: For having thrust in|to the Sore Lint twisted, hard and uneven, and apply'd thereon Plaisters and Bolsters, all is made fast with a Bandage that passes several times about the Part: Now tho' this may seem not to be very strait; yet it is ever tight e|nough, to press upon the Tent, and cause it to touch every where upon lively and sensible Parts. For the inward Parts of our Body are indeed very sensible, and unaccustomed to the Touch of any extraneous thing; so that the Wounded can't move in the least, without great Pain; his wounded Members are utterly disabled, and by a kind of Necessity he is con|fin'd to his Bed as a lame and impotent Para|litick, and always in one Posture, which is no less, if not more pernicious than the Wound it self, especially in Hospitals, where the Beds not being such as are requisite for the Ease and Comfort of the Sick, cause almost univer|sal Excoriations, and oftentimes Mortifications and Gangrenes. This is what I have many times seen; and frequently through the Fault

of those who follow the ordinary Method of Dressing.

Not that other Parts of our Body are disti|tute of Sense, any more than these I just now spoke of; those that are so charitable as to visit Hospitals, will attest this: nothing is there to be heard at the Hours of Dressing, but Cries and Howlings. But we can't enough recom|mend to Surgeons on this Occasion, to use their Patients in the most gentle manner possible: For it must be own'd that there are some a|mong them, that would think they had not ac|quitted themselves as they ought, unless they made those under their hands, to roar out for some considerable Time; which makes many to think that Surgery and Cruelty are unsepara|ble.

CHAP. VIII. The Reasons of the Authors Practice, with the Motives that induc'd him thereto.

FRom what I have already said, I know I shall be accus'd as if I only writ to find fault with the Methods now in use. Neverthe|less I am not affraid to avow, that I am in|spir'd with a much Nobler Design: I take no pleasure to trample upon the Monuments of the

Dead, or to carp at the Living; 'tis Conscience alone that obliges me to maintain what I have advanc'd for the Good of the Publick. But as it will be an hard task to perswade some People of what is contrary to these Maxims they have suck'd in as it were with their Milk, it will be convenient to propose Examples of what ought to be followed, and to point forth what is to be shun'd. For in fine, 'tis here as in Religions, every one thinks his own Method the best.

Among the great number of those, who at this Day practice Surgery, there are very few whose Methods agree. Some, without depart|ing an hair's breadth from the Opinion of the Ancients, blindly follow their Dictates; and it is enough that any thing has been advanc'd by such or such an Author, to make it pass into an unviolable Law. Others more active and Ingenious, not regarding the received Custom, bestow liberal Jeers upon whatever is not the Product of their own Brain, and treading Anti|quity under foot, are every day making new Systems of Surgery. I know not with which party I shall be ranged: But I have done my best to accommodat, what the Ancients have de|livered, to the Opinion of the Moderns, and Circulation of the Blood; imitating in this the Bees that gather from every Flower, what is fit for making Honey: And if Experience may have any Sway, my Practice ought to obtain, as being confir'm'd by it.

These who extol the Cures they have done, have also Reason to support their Practice; which because of the Progress it has made, passes even at this Day for the best, and most secure, in many Places. This Error hath ta|ken so deep Root, and gain'd so many Follow|ers, that notwithstanding all my Experiences, I doubt not but many will stand out against my Method, reject my feeble Reasoning, and treat me as a Violater of Custom and received Max|ims, and a rash and inconsiderate Innovator. For with them it is a general Rule, That a deep Wound ought to be kept long open, in order to a perfect Cure. Yea, the Sick them|selves being prepossess'd in favour of this false Opinion, believe that the Accidents which happen some Months, yea some Years after they have been cur'd, proceed from the too speedy closing up of the Wound, alledging the Wolf was shut up in the Sheepfold. As for my self, I am perswaded, and am able to maintain it, that almost all such Accidents are caus'd by keeping the Wound too long open, whereby the parts being much weakened, are hard to be restored to their first State, so that the lest motion, or Excess, renews the Sore, and brings back the Symptoms.

As for Wounds of the Head, where the Scull is laid bare, Exfoliation infallibly insues, if they are long kept open: If the Cranium is broken, the alteration, and the Accidents, are yet more

considerable, and cause often a Weakness, a depravation of Sense, Giddiness, Head-ach, and other like Distempers, and sometimes a corruption of the Membranes and of the Brain.

It is most certain that a Wound cannot be kept long open, but a great Suppuration shall follow; and then, in spite of all precaution, the Matter that is every where diffus'd, will glide along, and rest upon the Bone; and the most subtle Parts, as Galen says, passing into the Capacity of the Scull by the Fracture, will fall upon the Membranes; from whence it can't be got out, but by the Operation of the Tre|pan; and if neglected, will bring on Mortal Symptoms.

Wounds of the Thorax or Breast may be clos'd up without Danger, as will be more largely made out by Experience, in some Pla|ces of the second Part of this Work. For those which continue to suppurate for a long time, do infallibly bring on the Tissick, Asthma's, the Cough, shortness of Breath, and incurable Fistula's.

Tents cannot be kept in Wounds of the lower Belly, because of the perpetual Motion of the Guts; and consequently such are secure from the Pains and Infirmities that follow upon their Use.

Wounds of the Reins, of the Emulgent Veins, and of the Vreters, if not speedily united, leave behind them incurable Fistula's, with a running

of Urine at the Wound. The same falls out in those of the Bladder.

In these of the Joynts, if Tents be us'd, the Cure is very tedious, difficult and dangerous; for commonly there follows upon them an Alte|ration of the Tendons, of the Nerves, and of all the Part; sometimes a shortening or length|ening of the Member, with loss of the nutri|cious Juice, and a Weakness that endures for Life.

Wounds of the Extremities cause an intire dissolution of the Nerves, and often the loss of the Members; those of the Bones, Rottenness: Those of the Flesh moreover, besides a great deal of time spent in vain, occasion much Pain, Vexation, and Charges.

I have seen Wounds of all these sorts; some of them I have had dress'd with Tents, where powerful Digestives were us'd to procure great Suppurations. I have met with others, that were followed by all such Accidents. But this I have ever observ'd, that these which were handled according to my Method, were pre|serv'd from all these troublesome Symptoms.

'Tis known to every one, that in Wounds made by cutting Instruments, Union is imme|diatly to be endeavour'd. In order to this de|sign therefore we ought not to fill such Wounds with Lint, as we have formerly said, seeing this directly thwarts it. It is also very hurtful to

use Digestives, because disordering the Con|texture of its parts, they corrupt the Blood.

The fall of the Escar in Gunshot Wounds cannot be prevented, whatever Diligence be us'd; wherefore Suppuratives are here of no Use, seeing Nature can do that Work without their Assistance, which only weaken and destroy the temperament of the Parts to which they are apply'd. Large Suppurations therefore are not necessary in the curing of Wounds.

For in fine, I can't discover any Reason, why it should be Judg'd requisite that a Wound should suppurat a long time, in order to be brought to a compleat Cure. And surely be|fore we abandon our selves to such a dangerous Practice, it is necessary first to understand what Pus or Matter is, whence it comes, and what is the necessity of it.

We may observe then, that Matter is nothing else but the Blood of ulcerated Parts, discharg'd into the Wound from the Orifices of Arteries that are cut or torn; and this is mix'd with the Nutricious Juice, brought to the Parts for their Sustenance; whereby they are rendred lame as it were and useless. If by the Compression of Tents or Dilaters, the Blood be squeez'd out of the Vessels, it may fill the Capacity of the Wound, whereas otherwise it would have held on its ordinary Course. We are not then to be surpriz'd if the Blood and the Nutricious Juice, are suddenly turn'd into Matter, seeing they

are out of their natural Place. For even as a small Rivulet may make a great Lake, if its Waters are kept in with a Dam: just so the little Pipes that are laid open in a 〈◊〉〈◊〉, tho' but small, in comparison with the 〈◊〉〈◊〉 of its Cavity, being press'd, as has been said, by a Tent, which divides 'em more, and hinders their Reunion, continually pour forth such Li|quors as they contain; and the Tent serving for a Bank, a Lake is form'd in the Cavity of the Wound. We ought not therefore to wonder, if Plentiful Suppurations continue, so long as this Method is followed; and it is an undoubted Error to account such Evacuations profitable. Etmullerus in his Medicinal Surgery is of Opi|nion, that a Wound would close up of it self, if it was not hindered: he says, we ought to en|deavour to prevent the marring, and putrify|ing of the Natural Balsam of the wounded Part, and to use Balsamicks, according to the Princi|ples of Helmont, to hinder it from degenerating into a hurtful Acid, and to preserve it from cor|rupting.

In fine, he finds Fault with the Surgeons for using first Suppuratives, then Digestives, and after Mundificatives, Sarcoticks, and Glutinatives, as they term them: That Way, adds he, is too te|dious, delays the Cure, causes Inflammation of the Part; alters the Nutricious Juice, and often turns the Wound into a sordid Ulcer.

It is apparent by this Authority, that One Re|medy skilfully manag'd, is sufficient to answer all the Intentions proposed in the Cure of Wounds; that great Suppurations are hurtful; and that it is for the great Advantage of the wound|ed, to reject the bulky Rubbish of improfitable Druggs.

As for such Divisions in the Body, where ma|ny small Vessess are quite cut asunder, if the Lips of the Wound are brought together, they will unite of themselves; and this according to the Opinion of many Authors, vouched also by Experience, providing nothing Extraneous go between.

Now touching Gun-shot Wounds, that are so common in the Hospitals of the Army, I am bold to affirm, that my Practice has given me more Insight into their Nature, than all the Authors that ever wrote on the Subject. But not to enter upon a Debate concerning Bullets, it is evident that the Effect they produce in the Body, do something resemble Cauterizing; yet tho' sometimes I use this Word, I can scarcely believe that they really cauterize; but being round, solid, and compact Bodies, they cause Contusion; they tear and bruise whatever is in their Way, and occasion a Heaviness in the wounded Part.

It is certain that the Bullet very often stops the Bleeding of the Wound, whether by the Disorder it causes in the Parts through which it

passes, or by cauterizing with its touch the Ar|teries and Veins: But be it how it will, the Course of the Blood is stopt, and the Passage between the Arteries and Veins is intercepted, so far as the Wound and Contusion reach. The Heart, according to the Law of Circulation, squeezes the Blood it has receiv'd into the Aor|ta, from whence passing into all the other Ar|teries, its Course is stopt at the Wound, where it can't as formerly be receiv'd by the Veins, and finding no free passage, it extends the con|taining Vessels, and forcing its Way, diffuses it self according to its own Quantity, and the Space it finds: Hence proceeds the Hard|ness, Swelling, and Inflammation, so ordinary in Gun-shot Wounds. If the Blood be there cor|rupted, or spoilt by some Malignant Acid, the Symptoms become yet more troublesome and obstinate; and after the Fall of the Escar, Ab|scesses, or large and grievous Suppurations en|sue.

A simple Convulsion only, for like Reasons, is capable 〈◊〉〈◊〉 produce the same Accidents; which being nothing, but a disordering of the Fibers and little Pipes, that changes the Regularity and Situation of the Pores, the Circulation is rendred uneasy, and the Part choak'd up. From hence comes the Dulness, and Absence of the Spirits, which if not speedily recall'd, can't but be attended with grievous Consequen|ces.

I shall speak a word or two of the Cure of a Contusion, in the last Part of this Book: Here I shall only shew, that Tents are very destru|ctive to Gunshot Wounds, in regard they hin|der the Fall of the Escar, and coming away of whatever is bruis'd, which ordinarly is consum'd by Suppuration. A Tent actually hinders the passing out of that Matter, and retains it in the Wound, where it causes all these Mischiefs of which we have spoken. It may also, after the Escar is remov'd, renew the Bleeding; bruising by its rubs, and bringing to Suppuration, the young Flesh, bred upon the Orifices of the wounded Vessels, while the Escar was a sepa|rating.

The multitude of those that are to be seen maimed, and with wooden Legs, and Fistula's, can witness to their Sorrow the Pernicious Ef|fects of Tents: yea how many are there, who by the Loss of their Lives, shew their fatal Con|sequences? Cou'd they have spoken from the Grave, they wou'd have said more than I can on this mournful Subject, and the destructive Custom had soon been supprest. Nevertheless the Pains suffer'd by these unfortunate Persons, their Complaints and Cries, have not yet been able to cause a Method, establish'd and autho|riz'd by Antiquity, to be laid aside: neither has the ill Success of so many Cures in vain attempt|ed, been hitherto capable to undeceive those who have practis'd Surgery.

However, I thought my self oblig'd to com|municate to the Publick, what I knew upon this Subject; that I might, if possible, procure for af|flicted Patients, a Gentle, Speedy, and Easie Me|thod, for the Comfort and Incouragement of such as so generously expose their Life for the Glory of their Prince, and the Good of their Country.

All my Practice is levell'd at these Ends, as may be seen by the Sequel. I abstain from using Tents and Dilaters, as much as I can, and as the Case will bear: I occasion little or no Pain, save at the first Dressing; and then I always widen the Wound, especially if it is a Gun-shot One, and do my best to draw out the Extrane|ous Bodies: Now on this occasion I have three things further to recommend, which are to dress Gently, Speedily, and Seldom.

There is a Way of Dressing Wounds made with Iron Instruments, usual among the Soldi|ers, call'd the Secret Dressing, wherein they care|fully suck the Orifice of the Wound, in order to draw out the Blood therein contain'd; then they take Samaritan Balsam, or Oyle and Wine mix'd without Boiling, and sometimes either of them alone, which they squirt into the Wound from their Mouth, and without any o|their Dressings, cover, and bind it up, mutter|ing some Words between their Teeth, to make the Method appear mysterous, which causes many People to think it magical.

But these Words are ineffectual, and their Vertue imaginary, serving only to palliate and authorize the Ignorance of such People, who know not what they do; and to deceive the Im|agination of the wounded. These Cures tho' accounted miraculous, have nothing in them supernatural, and may be perform'd without in|voking the Assistance of Demons. 'Tis known to every one, that Blood when it is out of the Ves|sels, coagulates, and corrupts in the Wound, if it make any Stay there: and that by Suck|ing out the extravasated Blood, Suppuration is prevented, and also that is remov'd, which might hinder the Reunion.

CHAP. IX. That it is necessary to Dress Wounds Gently.

GEntleness is one of these things, that are in|dispensibly requir'd in curing of Wounds. This Circumstance is so necessary, that without it other things have seldom the desir'd Success; yea so much am I possess'd in Favour of this Opinion, that when I see some that are rigo|rously handled, I often admire how they ever come to be cur'd: and indeed they never are,

without a great many Accidents, that fall out in the Progress of the Cure.

'Tis ordinary for a wounded Person to be seized with a Fever, which being symptomatick, must be a consequence of the Pain. The Inflam|mation that brings along with it such a nume|rous Train of troublesom Accidents, is often occasion'd by an Irritation of the sensible Parts. Want of Sleep▪ proceeds ordinarily from nothing else, but the Pain that is either over all the Body, or in one Part only. Now if by Dressing gently, these three Accidents are avoided, we may quickly hope to see a perfect Cure.

Tents, Dilaters, and Setons, as hath been al|ready sufficiently observ'd, are the principal Cause of the Pain that the poor Wounded en|dure, and the Occasion of so many hurtful Ac|cidents; their remaining in Wounds being in|fallibly attended with most destructive Conse|quences. If then we lay them aside, we may prevent the Pain, and what follows upon it; and so having the Command of whatever may give us trouble in Dressing, we may manage the Cure as we please.

Finally we ought to endeavour with all Care, to remove so soon as possible, what might cause Pain, and by Evacuations and Diversions wisely to withdraw what wou'd foment it: but if it hath already assaulted, we must apply what is most proper to ease, and overcome it: for in

a Word, Pain is a very formidable Enemy in the Progress of any Disease whatever.

CHAP. X. That it is necessary to Dress Wounds spee|dily in order to prevent the Access of the Air.

IN this Chapter I endeavour to shew, that the Dressing of Wounds ought to be per|form'd speedily, because Experience hath taught me, that the Air is a mighty Hindrance of their Cure: And this is one of the chief Reasons that oblig'd me to follow this Method: For tho' some Pain in Dressing is inevitable, yet by this means it lasts for so short a time, that the Wounded scarce perceive it. The Air has not time enough to exert its Influence upon the Flesh destitute of its Coverings; and the nitrous Parts, with which it is thought to a|bound, can't pass to the Bottom of the Wound: for I am of Opinion, it is the nitrous, clammy, and as some think, arsenical Qualities or Par|ticles of the Air, that destroy the due Tempe|rament of the Parts, when depriv'd of their natural Cover, and that consumes, or at least alters the Natural Balsam or Nutricious Juice, which is as the Cement that unites the divided Parts.

All the Ancients and the Moderns also are in this agreed, that the Air is an Enemy to Wounds: And Experience attests, that even the most pure and subtil, is ever attended with a certain sharp and clammy Acidity, that sticks to Iron and Steel and makes them rust.

'Tis the same Air that also occasions so ma|ny Disorders; that alters and corrupts the Bones, hurts the Nerves, and destroys the Ten|dons, corrodes the Flesh, and utterly marrs the Temper of the Parts; wasting the Spirits that preserve the Radical Moisture, which with a lit|tle Help, and often times almost without any, unites broken Bones by a Callus, fills up Wounds with Flesh, cleanses Vlcers, and brings them to a Scar.

Hippocrates, Sect. 5. Aphor. 20. says, that the Cold is offensive to ulcerated Parts; that it hardens the Skin, causes Pain and Hardness, occasions Lividity, Shiverings, Fevers and Con|vulsions.

By the Cold here is to be understood the Air, by means of which Disorders are excited in us; it is corrosive, and therefore exasperates the sensible Parts; it hardens the Skin, thereby hindering the Transpiration of the Vapours, which being retain'd cause Pain, Hardness, and Fluxion, and these produce Shiverings and Fe|vers; and oftentimes are followed by Lividity, Convulsion, and a Gangreen.

The Access of the Cold Air is indeed one of the Causes of the Pain, which is so common in Wounds remaining too long uncovered, because it coagulates the Humours, and causes the Blood in the small Vessels to become more sharp, and so to ferment and corrupt.

A little Experience is sufficient to make one agree to these Reasons: We ought to second the Designs of Nature, that are ever aim'd at the preservation of what is most precious, such as the Spirits: Now we may be assured, that when a Wound is left uncover'd, or often o|pened, there is occasioned a considerable Loss of these same Spirits, whereby the Part is so weakened, that being unable to make the right Use of the Nourishment sent for its Mainte|nance, it is all chang'd unto Matter and Ex|crements.

That Cold is hurtful to Wounds, no Body doubts: All are likewise agreed, that the Air is at all times colder than the inward Parts of our Body. Now if the Touching of the Air only rots the Bones; if it act with such Force and Violence on Bodies so solid as they are; it will undoubtedly be yet more destructive to the Nerves and nervous Parts, that are so ten|der; as also to the Tendons, to the Flesh, and to all Parts in general, to which it has Ac|cess.

The Air moreover produces many other Ac|cidents in Wounds: for as has been said, the

Spirits are dissipated by the long and frequent Attacks of the Air, whereby its acid Parts being at liberty, and not intangled, easily stick to the Flesh, and other uncovered Parts, which they corrode and tear with their Points; hence proceed pricking Pains, whose Cause often ma|ny are at a loss to conjecture.

That same Acidity of the Air, coagulates the Blood in the Mouths of the Arteries, that open unto the Wound; hinders its Course, and makes it to swell up the Vessels, and very often also to discharge it self on the Part: Hence are Tu|mors, Fluxions, Hardness, and if it Ferment, large Abscesses: For Fermentation here is on|ly the changing of Blood unto Matter; now the Blood having neither the same Situation nor Motion as formerly, and its parts being dis|joyn'd, easily corrupts and Ferments in a little time: unless we believe that the Air can't con|geal the Blood in the Vessels, which yet is be|yond Controversie.

That the Air is very piercing, appears from Chilblains, and Kibes in the Heels, where it has the Force to congeal the Blood in the Veins, and capillary Arteries of the Part afflicted. If then it has such Influence on Parts cloathed with the common Teguments; what will it have on such as want 'em? In fine, if it is able to coagulate the Blood in the Vessels where it may freely circulate; much more may be fear'd from its Acidity in Wounds, where the Course

of the Blood being in a manner interrupted, the wounded Part receives but little Aid from the natural Heat, and the Spirits; and the Blood it self, that precious Balsam of Nature, being unmov'd, and not receiving fresh and vi|gorous Supplies from the Heart, is corrupted, as was said formerly, and turn'd unto Mat|ter: and indeed if we press the Places about the Wound, we shall perceive a certain clammy Matter to come out as from so many little pipes, which often also is corrupt and stinking.

Now if Nature, which is every way admirable and always industrious in preserving, don't in such a Case exert her utmost Efficacy, the Part must be mortified, in spight of all the Efforts of the inconsiderat Surgeon: and then if it is a Member that may be cut off, the next thing is to deliberate whether this ought, or may be done without danger. Sometimes 'tis doubted whe|ther the wounded Person can bear up under the Rigour of so painful an Operation, consi|dering his ill Temperament and Disposition of Body, which only are accus'd, as the Cause of all these Accidents; for the Wound of it self was inconsiderable, and might have been soon cur'd, in a Person of a stronger and better Constitution: or otherwise the blame is laid upon some venereal Venom, Vice of the Parent, Disorder, &c. In fine, the Patient and his Temperament, are always found guilty, and fall as Victims to Ignorance.

I have been in many Places my self, where such things have happen'd, and where neither the Persons wounded, nor the Surgeons under|stood the true Cause of the supervening Acci|dents. It is however very requisite in this to employ all our Care; cheifly in Hospitals of the Army, where seldom are to be found, all these Conveniencies that were to be wish'd, for correcting the Cold and the ill Quality of the Air, which frequently is infected, and corrupt|ed. 'Tis in such Places where we ought to hinder it with all our Power to pass unto the inward Parts of our Body, or to get access to those that are destitute of their Coverings, lest at the same time it impart to them its destru|ctive Impressions.

It may possibly be objected to me, that if that acid and nitrous Quality of the Air, can produce such Disorders in Wounds; we ought much more to be incommoded, by the frequent and necessary Use thereof in Respiration. But 'tis answer'd, that the Wind-pipe and Lungs pu|rify the Air, which is in a manner filtrated and prepar'd by them, and so becomes Friendly to Nature, that only uses the purest Parts, dri|ving out by Expiration, together with the hot Vapours or Exhalations of the Breast, that which is useless and hurtful. But it is not so in Wounds, that have no Spring. 'Tis only the Lungs that are fitted, and appointed for receiving the Air; they alone perform the Of|fice

of Bellows to prepare, purify, or to expell it according to the necessity of our Machine.

Besides it may be said, that when the Air en|ters unto places that are covered, and furnish|ed with Membranes, its Acid Parts slide upon them, and take no hold; but if there chance to be Vlcers in the Lungs, the Air will then cause considerable Disorders; and the Cough which afflicts such kind of Patients, proceeds undoubt|edly from nothing else, but the Irritation oc|casion'd by the Air, in parts depriv'd of their Covering.

Moreover it must not be denied, that the Air abounds with very subtil and piercing Parts, because it will pass through the Skarfe-Skin, the Skin, and other Teguments. There are many Examples which shew, that Persons have subsisted by means of the Air passing through the Pores of the Skin, when Respiration was alto|ther Supprest, whether by Suffocation, or o|ther such like Accidents. Some have also been taken down from the Gallows, who were thought to have been a pretty while Dead, and yet with a little help have recovered: whence it is easy to infer, that Nature had found the means, to furnish the Heart and Lungs with a sufficient quantity of Air, to refresh them du|ring that Interval, by the Pores; seeing it could not pass by the way of the Wind-pipe. A like Consequence may be drawn from those that ly in a Lethargy.

We may therefore reasonably infer, that if the Air is so subtil as to pierce, and pass through Membranes so close and compact; it ought much more to penetrate considerably be|yond the Extent and Cavity of a Wound, where there is nothing to purify or subtilise it; as there is, when passing thro' the Pores of the Skin, it supplies the Place of Respira|tion: for since here the Skarf-Skin keeps back the more gross, earthy, and clammy Parts of the Air; we have Reason to think that it ought not to produce any ill Effects, in the Places to which it comes. It were to be wish'd that Wounds were cover'd with something at the times of Dressing, which might perform the Office of the Skarf-Skin, and exclude the Acid and viscous Particles of the Air, together with other noxious Effluvia with which it is fill'd. For if these Exhalations floating in the Air are the Original of so many Diseases, as some mo|dern Philosophers affirm; why mayn't they oc|casion very dangerous Symptoms, when they take hold of, and cleave to live and sensible Parts? Now seeing these Forreign Particles are capable of alterations no less than the Air it self, we may be assured that the ill Qualities which this has contracted in Hospitals by the Breath and Transpiration of the Sick, are also communicated to those; seeing such Atoms have a Substance, and a certain Form.

These Carbuncles that are so frequent in

Hospitals of the Army, are a sufficient Proof of what I say. They are occasion'd, as some think, by the arsenical Particles in the Air, which being taken in by Respiration, are thrown out by the strength of the natural Heat upon some Emunctory. Now seeing this falls out much oftener in Hospitals than elsewhere; we may infer, that the Air also is here much more replenish'd with these subtil and impure Parti|cles; by reason of which the Wounds here treat|ed, without very great Care, become some|times cancerous, always putrid, and often Fistu|lous and incurable.

I have learn'd by my long frequenting of Hospitals, that these Places where the Sick have remain'd for some Time, retain, long af|ter they are gone, the ill Smell communicated by them. This I believe is owing to the im|pure Particles that stick to the Walls: Whence these who design afterward to live in the Place, are oblig'd to Plaister and whiten the Walls, that they may not be hurt by the pernicious Effluvia proceeding from them.

Cloathes, and other Goods, brought from Places where the Plague is, must be cleans'd and purify'd from the Pestilential Particles that cleave to 'em; without which Precaution they might excite a general Pestilence in the Places to which they are brought. 'Tis this which inclines me to think, that the nitrous and vis|cous Quality of the Air, resides in those Par|ticles

or Atomes; which if they are capable to stick to a Body so smooth and polish'd as a Wall, and that for a long time, without losing either their bad Smell, or ill Qualities; much more will they do so to a Wound uncovered, which is always moist, and where they may get easier hold, and act more readily, because of the Ten|derness and weakness of the Parts.

The dead Flesh of any Creature, if it is of|ten handled and exposed to the Air, suddenly putrifies: and a Fatus, a Member, &c. if it be kept in a close Vessel cover'd with Spirit of Wine, may be preserv'd for ever; whereas on the contrary, a little Air will dissolve it, and re|duce it to nothing.

That the Air is a mighty Enemy to Wounds, is a Truth own'd by the modern Practisers of Surgery, no less than by the Ancients: but there are few take sufficient Care, to hinder its Access to the Wounded Parts. Knowledge is in vain when not put in Practise. Neverthe|less this is a thing so absolutely necessary, in the Cure of any Wound whatsoever; that without it, nothing that a Surgeon's Art can perform, is to any purpose, but all is hurtful and destru|ctive.

From what has been said, Consequences may be deduc'd very useful in Practice. All the Regard I have for Antiquity, was not prevalent enough to keep me from the declaiming against an Abuse, tho' establish'd by Custom; seeing

Truth depends on the Things themselves, and not on the Opinion the Ancients had of them. I know many have already express'd themselves on this Subject, much after the same manner as I have done. Celsus, who ought not to be reckon'd among the Moderns, has written some|thing that looks this Way. In his Book Of Wounds of the Skull, Chap. 4. he says, that Flesh breeds easily enough in any part of the Head, except a little above the Space between the Eye-brows, where often there remains an in|curable Ulcer, because in that place there is a Cavity of the Bone full of Air, bordering up|on the Os Cribrosum; which Air hinders the fil|ling up of the Ulcer.

By all this then it evidently appears, that the Air is a powerful Impediment to the Cure of Wounds; and that the speedy Method of Dressing ought to be preferr'd to that which is yet in use in many places. And to conclude, it is certain that the Pain caus'd by the use of a Tent, its remaining in the Wound, the length of the Time taken up in Dressing, and the frequency thereof, of which last I shall speak in the following Chapter, are the genuin Sour|ces of all the Accidents that follow on Wounds. Wherefore we must dress speedily, and accord|ing to our Method, if we would prevent many dangerous Inconveniencies.

CHAP. XI. That Wounds ought to be drest seldom.

GAlen in his Fourth Book Of the Composition of Medicines, Chap. 4. orders to dress Vl|cers but once in three Days. This Method he acknowledges to have come from Asclepia|des; and I can't but wonder that such a Pra|ctice has found so few Followers, being so ne|cessary and advantagious for the Patient.

If Ulcers require not to be dress'd every Day, as this Author thinks, fresh Wounds do yet much less call for it. Nevertheless it is the Custom in almost all Hospitals, to dress regular|ly twice a day; and I believe there is scarce one to be found, that does otherwise, excepting that of Brianson, where they dress the wound|ed, some only once a Day, and others but once in two, three, or four Days. If I had found this Method hurtful, I would not have been so wicked as to continue to use it; much less to desire that others also might do the same.

Pareus, Book 13 Chap. 11. treating of Ulcers, seems to be much inclin'd to the Opinion of Ga|len, when he disapproves often Dressing: and yet in his Eleventh Book, Chap. 5. speaking of Gun-shot Wounds; he orders to dress them twice a Day, and often once in every eight Hours.

It is surprizing, that so famous an Author as Pareus, who believed the Air extreamly preju|dicial to Wounds, adducing also many passages from the Ancients to support that Opinion, should have left behind him Rules altogether re|pugnant to it. But 'tis probable he was so bu|sied in compiling so great a Work, that he had not time enough to make the necessary Reflecti|ons upon this Subject, which requires a very dili|gent Application: and this may be the Reason why in many Places he contradicts himself.

Fabricius ab Aquapendente, Pag. 1. Book 2. Chap. 7. discoursing of the way to preserve the Substance of the Parts in simple Wounds, affirms again and again, that it is enough to take off the Dressings once in three or four Days; which he confirms by the Authority of Galen, where he treats of the Cure of putrid Vlcers.

'Tis certain, that the seldomer a Wound is dress'd, the less it matters; providing it be not stuff'd with Lint or some such thing: the Re|medy also has the more time to communicate its Vertue to the Part, which seems in some sort to be nourished thereby: And the Nutricious Juice, has more liberty and time to restore the lost Substance, and reunite the divided Parts. On the other hand, if it is often drest, the Strength of the Remedy being destroy'd, and its Vertue diminish'd; it becomes so weak, that it has no Effect, and its Moisture running away, like the Sap of a Tree when 'tis pierc'd, is mixed with, and turn'd into Matter.

What Nature does in uniting broken Bones, may instruct us what we ought to do in curing of Wounds: we see that a Callus is bred with|out the Assistance of any thing, by the wise Contrivance of Nature only, if so be that she is not by frequent Dressing, or indiscreet motions of the Part, diverted from her Work.

When the little Fibrous Threads begin to be form'd in a Wound, in order to unite the parts that are divided; and the Nutricious Juice is communicated to the Part, to restore it to its natural State; if then the Part is often disturb'd with frequent dressing, if the Wound is search'd with the Fingers, or with a Probe, or a dry Tent, &c. what Nature has done, will be bruis'd and se|parated; and her Work destroy'd as soon as be|gun: so that if this Method is continu'd, the nutricious Juice becomes thick, and hard, and cleaves to the Sides of the Wound; where it forms a Callosity, and often a Fistula.

Generation then, which is the principal Work of Nature, cannot be accomplish'd with|out Rest; so true it is that Repose is necessary to her in all her Operations. Hence it is that I cannot apprehend by what Reasons they are in|fluenc'd, who by frequent and painful dressing, without any necessity, exasperate the Wounds; and I protest I could never my self indure so cruel a Method. Sometimes they search them with their Fingers, sometimes with an Instru|ment; and not contented with this, if they fan|cy they have found any thing, desire their

Friends present, and their Boys to do the same: and in this miserable Condition is the wretched Patient detain'd sometimes an hour; and that most frequently twice a Day. I dare not ad|venture to name the Places in France, Italy, and Germany, where I have seen the wounded us'd on this fashion; and that by such as held very considerable Posts, where a good Me|thod was extreamly necessary.

Finally, after much time has been spent in taking into the Wound, they think they are bound in Credit, for the satisfaction of the Woun|ded, and the By-standers, to draw out some|thing, and shew it publickly, lest they seem to have labour'd in vain. Now if it should chance that at length any little piece of a corrupted Membrane is found; (which would not be strange in a Wound drest in this manner, where Cor|ruption often causes great Disorder:) it is drawn out with abundance of Ceremony; and the Operater fails not to declare, with great con|fidence, that this is it which occasion'd the Rest|lessness and Pain of the preceding Night. And now, you must think, the wounded Person is half cured.

Heavens! What Abuse? Is it possible that any Man can be so much impos'd upon? I would gladly understand what it is that did se|parate this shred of a Membrane, or these Fi|bers, &c.? It will be answered without doubt that it is Nature; which endeavouring a Reunion, rejects that which opposes it. I demand again

how it was brought to this Place? By the same Nature, will one say. And why then will not she go on to drive that extraneous thing quite out of the Body, seeing she has done so much? She is able to drive out Bullets tho' fastened in a Bone, as I shall shew in the second Part; to expell Splinters; yea, to bring them to the Ori|fice of the Wound; and that a considerable time after it has been clos'd up: why should we then apprehend that she will leave such things with|in, from which she may so easily free her self; either by the Orifice of the Wound, or by some other more convenient way? For it is certain that Nature left to her liberty takes ever the ea|siest way. Besides, all the Parts of the Body have an Elasticity, or Spring, whereby any Forreign Thing is naturally driven from the Center to the Circumference.

Antony Benevent a Physician of Florence relates, that a certain Woman swallowed a very large Needle, which two Years after came away by her Navel: And Tarentus a Physician also, re|ports; that a Maid, who had swallow'd a Needle nigh about four Inches in Length, voided it ten Months after by the Vrinary Passage.

From hence it appears, that the Industry and Sagacity of Nature, surpasses that of all the Esculapian Family: She knows what she does; and wants not to be instructed in the ways she ought to take, in order to drive out of the Bo|dy whatever oppresses, or is forreign and noxi|ous unto her. The Surgeon ought only to em|ploy

his utmost care, to understand and follow her: he must study her Designs, and take all heed not to divert her from her Enterprises; seeing she does nothing in vain.

After what I have said concerning Nature; I would not have any to think, that I am one of those who regard her as a Divinity, and a|scribe unto her a Reason, whereby she diposes all her wonderful Works. Reason I look upon, as a peculiar Priviledge of the Human Soul. Neither am I of the Opinion of Empedocles, that whatever she does is mysterious: 'Tis him that Aristotle, in his third Book of Meta|physicks, ridicules for giving no other Reason for many things that were ask'd him, but this; that it was Nature's Pleasure. All I will say is, that if her Operations are marvellous, they are owing to her powerful Author, who has en|trusted her with whatever we have that is most precious.

But to return to my Subject; it is fit I should advertise my Reader, that I would not have any to follow my Method of seldom dressing, unless first he hath intirely lay'd aside the Use of Tents, and Dilaters; which by retaining the Matter, would cause a Fermentation, whereby these same Tents and Dossels wou'd also be corrupted: This is what fell out not long ago in a Cure to which I was call'd: The Dilaters that had been us'd were carry'd along with the Matter that was discharg'd between the Muscles; and

there putrifying, the Corruption was quickly communicated to the neighbouring Parts: Whence it appears that this Method, hath in it Singularities and insparable Circumstances, that must not be omitted.

M. Verdue in his Pathology, Tom. 1. fol. 439. advises not to do as some Surgeons, who e'ry mi|nite are opening the Wounds of those who are under their Care: For, says he, by too often taking off the Dressings, we hinder their reuni|ting; and give occasion to the Air to insinuate it self into the Wound, and to coagulate the nutricious Juice: this indeed is a most just and reasonable Thought. I remember when I was at Rome in the year 1678, I chanc'd to see a little Book written in Italian by the chief Sur|geon of the Hospital of the H. Ghost, whose name I have forgotten: He therein discours'd of Wounds of the Head only; and prov'd by ve|ry good Reasons, that they ought to be drest only once in three or four Days, and sometimes not so often: Moreover in dressing he did not altogether lay open the Wound, but kept al|ways upon it some thin Cover, as is done at this day in many Places in dressing of Burnings.

In Fine, he took such great care to hinder the Air from passing into, and offending the Wounds which he dress'd; that we may be as|sur'd he Judg'd it a grand Impediment to their Cure: Which was also his Opinion of frequent Dressing. In the same Book he adduc'd many

Examples; among which, were several Accounts of very considerable Cures, accomplish'd by this Method.

It were much to be desir'd that every One, without regarding the publick Censure they might incur, had the same Charity to reveal the Knowledge they have attain'd by their Care and Experience. For it is very probable that by the Vniversality of Mankind, almost an Vniver|sality of Knowledge is possest: One has a Geni|us for one thing; and t'other has a Genius for another, and each their different Endow|ments: and in Civil Life, and particularly in an Art so necessary for the Preservation of Man|kind, every one ought to communicate without Reservation.

After all, there is no Rule without some Ex|ception; and I freely own that their are certain Cases, wherein Tents ought sometimes to be us'd: as in some Wounds of the Breast, and in an Empyema; when we would hinder the total Evacuation of the Blood or Matter, to preserve the Strength of the Patient: and finally, on some other Occasions, where they may be Judg'd absolutely necessary.

There are other Wounds, to which Dilaters are necessarily required; as when the Bones be|ing rotten or alter'd, we wait for their Exfo|liation; or when they must be kept open in or|der to some further Operation to be perform'd upon them.

There are also other Wounds, to which of necessity we must occasion some Pain; whither by drawing forth extraneous Bodies, or by set|ting broken Bones, or by dilating their Ori|fice.

Others there are, that will take up some time in dressing; as in these of the Head, where we often suspect there may be a fracture of the Scull: Also when the Scull is broken; when some Operation is to be perform'd upon the Bones, in complicated Fractures; and when extraneous Bodies are to be drawn out: in such Cases we cannot dress so quickly as were to be wish'd.

To conclude, there are some that must be often look'd to, when notwithstanding our Care, the Suppuration is great: as in Abscesses that are cavernous and deep, in very hot Seasons, and in Patients of an ill Disposition of Bo|dy, who abound in excrementitious Moisture; or when Phlegmons, Erysipela's, Lividity, and Gangrenes, or any other unexpected Accident, follow upon a Wound: For it is the part of a prudent and Skilful Surgeon to accommodate himself to emergent Occasions, and to correct the Symptoms as they fall out.

CHAP. XII. A Discourse upon Discovered Bones; with the way to prevent Exfoliation.

IT is almost an Universal Custom, (at least I have seen it put in practice wherever I have been) so soon as a Bone is uncovered, to widen the Wound by Tents and Dilaters, and wait for its Exfoliation. This is so superstiti|ously observ'd in many of the King's Hospitals, that it would be Judg'd a very hainous Offence, to do otherwise; yea, or to neglect what hath been deliver'd by the Ancients: As if we were eternally oblig'd, blindly to follow their Dic|tates.

Experience has taught me on many Occasions, that nothing more is required, to prevent the Spoiling of a Bone, when only uncover'd, but to defend it from the Access of the Air: For this Intent we ought to endeavour to close up the Wound with all possible speed, by means of pro|per Bandage, and balsamick Remedies; with|out dilating it by Tents and Dossels. Thus the Bone will soon be covered; and the Exfoliation thereof is avoided, which would infallibly fol|low, if time had been given to the Air, to exert its pernicious Efficacy upon it.

Many Authors have injoyn'd Stiching in such a Case. Hippocrates, and several others after him, have approv'd thereof in Wounds of the Head; which notwithstanding may be united without it, unless they are large and tranverse, and of the lower Parts; where stiching often|times becomes necessary, by reason of the figure of the Scull.

If any considerable Portion of the Bone is bared, with loss of the covering Substance, the Wound being large, will take up a long time be|fore it is clos'd up: in this Case all our Care, will not be able to hinder the Alteration, and rotting of the Bone; either by the Air admitted in the numerous Dressings; or by the Matter running along, or staying upon the Bone. To prevent therefore this Inconvenience; we must in the first Dressing pierce the Bone, as nimbly as possible, in many Places, with the Py|ramid or Pike of the Trepan: By this means a way is opened to a Marrowy Juice; which thickning upon it, covers over the Bone in a lit|tle time, without suffering it to lose any of its Substance.

It is well known to Surgeons; that any con|siderable Portion of the Scull, laid bare by a Wound, can never again be covered with Flesh, without the Assistance of Art; because of the Smoothness and Glibness of its Surface: Upon this Consideration it was that many of the Anci|ents thought fit to rasp it, that it might become

rough and unequal; and also to make way for the Orifices of the little Vessels, with which its inward Substance abounds, to supply it with Blood, necessary to breed a new Flesh where|with it may be cover'd.

But the Operation which I have made upon it on many Occasions, and which I here pro|pose; appears to me to be more speedy, safe and profitable, than Rasping; wherein, the In|strument passing to and fro many times, on the whole Surface of the discover'd Bone; heats it, and alters it much more, than the Pin of the Trepan; which only slightly touches it at cer|tain Distancces; and yet pierces so far, as to ap|proach the middle Pith, from which we must fetch the requir'd Assistance. Moreover the Rasp lessens much the thickness of the Bone; whereby those that have undergone that Ope|ration, are subject to Pains in the Head: add to this, that it also leaves after it an unseemly Scar.

This Operation may be us'd, when the first, yea or both Tables of the Scull are broken; providing no inequality be left on the inward Surface thereof; that may occasion Accidents, which will appear in a small time: For if we delay to procure a covering to the Bone, the most subtil Part of the Matter may slide into the Fracture, and there cause some Alteration, or Inflammation, (for according to Galen and Celsus, the Bone is lyable to this Inconveni|ence)

and also yet more troublesome Accidents. Now seeing the first Operation of this Nature which I perform'd, was on the Scull; I shall begin to Justify this Practice, by shewing how it is nourisht.

The Scull, according to the Opinion of ma|ny, has its Nourishment from three different Sources: First, by Vessels proceeding from those of the Dura Mater, and passing into the Cranium, through its internal Surface, or that which is nearest the Brain: Secondly, from the Diploe or middle Pith, a medullary Juice is im|parted to both Tables, whereby they are nou|risht and sustain'd: And thirdly, by its external Part, it receives Nourishment from the Peri|cranium, wherewith it is every where cover'd and defended.

When therefore by some external violence the Bone is depriv'd of that Membrane, and remains uncover'd; 'tis certain that the Air by its Acid and Nitrous Points, takes hold on its outward Surface; and in a little time alters and rots it: and then it must needs exfoliate, be|cause it is bereft both of its Nourishment, and Defence.

It becomes necessary then to make an A|mends, and to draw Nourishment from the neighbouring Parts instead of that which is lost; that at the same time by covering it a|new, may shelter it from external Injuries. Now this we can have from no nearer Place

than the Diploe; but in order to that we must give it an easie Passage, and open to it a Way to fulfil at once the Intention of Nature, and that of the Surgeon. This is accomplish'd by piercing the Bone, as we have said; whereby the Diploe sends forth at these little Holes the most subtil Part of the marrowy Juice; which congealing upon the Bone in three, four or five Days, sometimes sooner, sometimes later, intirely covers it.

Other Bones that have Marrow, are nou|rished from within, by the Vessels of the Mem|brane which cover that Substance; and from without, by the Penostrum, or Membrane where|with they are invested: For this Reason we may perform this Operation, when there is oc|casion, on the Bones of the Shoulder, Thigh, and Leg; and these who doubt of this, may be convinc'd by a Tryal.

That which ought to recommend this Me|thod, and procure it an easie Reception; is that thereby the Cure is accomplish'd in twelve or fifteen Days, or so; whereas otherwise it will take up near sixty; for about forty Days are required to the Exfoliation of the Bone, and twenty more to fill up and cicatrize the Ulcer. Our Way is so exceedingly advantagious to the Wounded, that it ought not to be rejected; nor can it, without offending against that Cha|rity, we owe our afflicted Neighbour, who by the Delay in such Cases, is extremely endan|ger'd,

especially in an Hospital, where the cor|rupt and infected Air ruins in time the strong|est Constitutions. I have often seen, and it is but too ordinary, that the Wounded Persons being cur'd, and just ready to depart from the Hospital, have been suddenly seiz'd by Malig|nant Fevers, Looseness, Bloody Flux, &c. occa|sion'd by their tedious stay in such dismal Pla|ce•• and Death often has been the first thing that deliver'd them from all their Miseries. Therefore we ought to endeavour a speedy Cure, and to spare no Pains to prevent that tedious Exfoliation. But if the Wounded are sent to us with the Bone alter'd, or if we can't avoid this Accident with all our Care, we must endeavour to help on the Separation with all Speed: for as a Gangreen in Fleshy Parts wants the Assistance of Art to put a stop to it; so also does Rottenness, which is a Gangreen of the Bone; wherefore Exfoliation must be hastened by external Remedies, that it may go no further; for sometimes it extends from one End of the Bone to the other.

It is the Surgeon's Province, to pick out such Remedies as are proper for this Intenti|on. The Ancients and Moderns have left us good store of this kind; but above all, we must avoid the use of Acid Spirits, which in|crease the Rottenness, and have the same Ef|frct on a Bone, as Aqua fortis on Iron. The actual Cautery is a great Help on these Occa|sions;

as also Euphorbium infus'd in Spirit of Wine.

The Rules I have proposed to prevent Ex|foliation, are inconsistent with the Opinion of many Italian Surgeons, who maintain, that the Bone, so far as hath been touch'd by the Air, will infallibly exfoliate. I have heretofore had great Debates on this Subject with some Peo|ple, who through a Stiffness of Opinion, with|out any Ground, would neither yield to Rea|son, nor Experience; not being able to bear what was contrary to their own Principles and Pra|ctice.

CHAP. XIII. How to Dress with a New Instrument, after Trepanning, or Accidents of that Nature.

WOunds of the Head accompany'd with a Fracture of the Skull, are such as require an expert Surgeon: I am convinc'd, and I suppose none will deny it, that the Air is hurtful to them: in this both Ancients and Moderns are agreed.

'Tis certain notwithstanding that a great Part of the Accidents that follow upon them, proceeds only from the little Care that is ta|ken,

to hinder the Access of the Air into the Wounds, whether the Scull be only bared, or broken, or also trepanned. I have discours'd of discovered Bones in the foregoing Chapter; I have only two or three Words more to speak, of such Wounds, where the Scull has lost some of its Substance.

When the Dura Mater is uncovered, I pre|pare a Plate of Lead very thin, and very smooth, pierc'd with Holes in several Places, without any Inequality, cut and fitted to the Bigness of the Opening; and to make it more exact, I sketch it out with the Crown of the Trepan, that I have us'd, or am to use in this Operation: or its Measure may be taken from the Piece of the Scull cut out by the Trepan. On each side of this Plate is left a little Ear, somewhat longer than the thickness of the Scull; these little Ears I bend both one way, so as they may be perpendicular to the Plate; and so much of them as exceeds the thickness of the Scull, I bend outwards again, that thereby they may rest upon the Scull, and by which, as by two little Handles, I may lift them up with Pincers, if need be, at each Dressing; these two little Handles may be cut something broader, than the two pieces that joyn them to the Plate, which must be of an equal Breadth. When I use it, I dip it in some pro|per Medicine pretty Warm, and apply upon it a very soft Pledget of fine Lint.

I have found very much Good by this Me|thod, and have observ'd a five-fold Advantage in the Use of this Plate. First, the Matter or Blood contain'd within the Scull, passes out at the Holes of the Plate, and is imbib'd by the soft Lint that I put over it: and if it has acquir'd any mischievous Quality by staying there, which often falls out, the Lint by which it is soak'd up, detains it from touching the Dura Mater, and imparting the Contagion thereto; and consequently, there is less Hazard of its Alteration.

In the Second Place, this Plate, by lightly pressing upon the Dura Mater, facilitates the coming out of the Matter or Blood extravasa|ted under the Scull.

Thirdly, It hinders the breeding of a Fun|gus, and the bunching out of the Dura Mater beyond the Scull, which otherwise often comes to pass; obliging us either to cut off, or to consume with Cathecreticks that which so stands out; whereupon very grievous Acci|dents sometimes ensue.

A Fourth Advantage is, that it hinders by its slight Pressure, the Dura Mater, in its con|tinual Motion, to strike against the Inequali|ties and pointed Parts of the Scull; that re|main after a Piece has been rais'd by the O|peration of the Trepan, or intirely separa|ted by some external Violence.

And Finally, it protects the Brain and its

Membranes from the Assaults of the Air, per|forming in some sort the Part of that Piece of the Scull that was taken away.

When we are assur'd that there is, or are in Doubt that there may be some coagulated Blood under the Scull, we may for some time omit the Use of the Plate, that we may leave it a free Passage; and afterward we may use it, until the danger of the Accidents is over; and then we must use it no longer: otherwise it may prove an Hinderance to the Reunion, and the Generation of the Callus.

When the Operation of the Trepan is per|form'd on the Basis of the Scull, as is usual now to be done without Scruple, the bunching out of the Dura Mater is more to be fear'd; and of consequence this Plate is absolutely necessa|ry to support it, and keep it in: but for the O|peration on this Place, as well as for that on o|thers, we must endeavour, as far as the Case will bear, to choose the highest Part; that the Plate may have the less weight to sustain. We may safely use it for fourteen or fifteen Days, if we Judge it needful; and it may be made of Gold, Silver, &c. according to the Desire and Ability of the Patient: but for my self I always use a leaden one; for every Bo|dy knows that this Metal is freindly to Nature, and is vulnerary and drying.

Tho' there were no other Advantage to be reap'd from the Use of this Plate, but only

that it defends the Brain, and its Membranes, from the Insults of the Air, this were enough to recommend it to our Esteem. It is certain that the Air acts not with that Force, when its Acid Parts find a hindrance in their way, or when they must pass through such little holes as these of this Instrument: and some|times I don't lift it up but in two or three Days, when it Matters freely, and the Acci|dents abate.

M. Verdue affirms, that the Fungus that breeds on the Dura Mater, is caus'd by the Attacks of the Air: in a word, all the Ancients and Moderns are of one Mind in this, that the Air is exceeding destructive to the Membranes, and to the Brain.

It is not then without Cause that Nature as a good and provident Mother, hath taken Care to encompass the Brain with two Mem|branes, the Scull, the Pericranium, the Tegu|ments and the Hairs, on every Side, to cover it from the Impresions of the Air, which of all the Elements is most hurtful to it: and the most part of those that have been trepaned, or by a Fracture of the Scull have lost some part of its Substance, without having the Brain or its Membranes hurt, are subject to a number of very troublesom Acccidents.

The Reason of this may be easily conceiv'd: for the Air, at certain Seasons, and in certain constitutions thereof, being indow'd with more

piercing and subtil Parts, or the Skin being more relax'd; finds nothing sufficient to stop its Course, and passes, notwithstanding the Callus, which is never so solid as a Bone, to the Membranes, which are extreamly sensible of Cold, and there occasions these Pains that such kind of People are subject to.

That the Discription of the Plate, may be the Better understood, we have here subjoyn|ed its Figure.

[figure]

The Figure of a Plate with Nine Holes, to be used when the Crown of the Trepan is large.

[figure]

A little Plate with Five Holes.

[figure]

The Figure of a Plate ready for Vse, with the little Ears bent.

THE Hospital-Surgeon: OR, A New, Gentle, and Easie Way, to Cure speedily all sorts of WOUNDS.

PART II.

Further evincing the Excellency of this Way, by a faithful and particular Account of Wounds of all Kinds, and in all Parts of the Body, thereby brought to a quick and happy Cure; together with Vseful and Practical Re|flexions.

CHAP. I. The Reasons of Writing this Second Part; with a general Proposal of what it contains.

THO' Sound Reason, supported by Authority, may appear to be a Proof of the Goodness of any Thing, convincing enough, and ca|pable to sustain the Weight of what Conse|quences

might thence be deduc'd; yet does there oftentimes still remain an Uneasiness and Hesitation in the Mind, no otherwise to be remov'd, but by Ocular Demonstration, as it were, and Experience: for nothing so infal|libly shews the Possibility of Things, as their having already come to pass; nor can any Thing so well assure us, what will follow upon them, as a multitude of Tryals. 'Tis this Consideration that induc'd me in this second Part, to give a History of some Wounds hand|led according to my Method, that Justify my manner of Practice.

Had I thought it requisite, I cou'd have fill'd a great Volume with Cures that I have done these ten or twelve years, which were all brought to a happy Conclusion, and com|pleated in a very small time. But to avoid tediousness, I resolv'd to set down as few as possible. Yet in spite of my Design to relate only one of each sort, and each Part, I found my self necessitated to exhibit many; of which tho' some at first may appear altogether alike, yet if they be more narrowly scann'd, they will be found to differ in some very material Cir|cumstances.

As for the Order observ'd in these Relati|ons, I have followed that of the Dignity of the Parts, beginning at the Head, and ending with the Extremities; not minding the Series of time wherein they happened. I have de|scrib'd

all things Just as they were, without either adding or diminishing; having no other Design, but to make the Easyness and Expe|dition of this Method appear, by the Exam|ples I here relate.

CHAP. II. Of the Head.

OBSERVATION I.

AFter the War broke out in Savoy, there was brought to the King's Hospital at Luserne, where I was then Surgeon Major, in July 1690, a Soldier call'd La Grandeur of the Regiment of Poudenx, which is now that of Ga|tinois. He had received a Wound on the right Side of his Head with a pretty large Bullet; which grazing upon the most convex part of the Bone of the Sinciput; had only carried a|way the common Teguments, not hurting the Scull; but the Membrane that immediatly in|vests it was so bruis'd, that it appear'd livid. I know, if time had been given, it would have come to Suppuration; whereupon the Alteration and Exfoliation of the Bone must needs have ensu'd: to prevent which, I tear'd off with my Nails the Pericranium so far as it was bruis'd, being something more than the

bigness of a Silver Shilling; and forthwith I struck the uncovered Bone, in several Places, as nimbly as I could with the Pyramid of the Trepan; and then cover'd it with some Lint wet with Spirit of Wine: the rest of the Dres|sing was charg'd with a simple Digestive, upon which I put Emplastrum de Botemea, and above all the Cap.

After two Days I took off the Dressings, and found the Bone covered with a lively Red, from whence I conjectur'd that it would soon be cloath'd with Flesh: two Days after this it was drest in like manner as before, and then the Bone was half cover'd over; for which Cause I let it alone for three Days more; so that in seven Days time the Bone was altoge|ther hid with new Flesh, which was instead of a Membrane to it; and now nothing more was requir'd, but by dressing it every other Day to attend the Fall of the Escar. Finally, in the Space of eighteen Days, the Wound was fill'd up and compleatly cur'd.

REFLECTION.

If this Wound had been manag'd after the ordinary Method, I leave it to consideration, whither the Cure would have been so speedily accomplish'd. From that time forward, I e|ver kept to this Method, which I have us'd in many Occasions, and never found that the

Wounds opened again, yea, or that Exfoliati|on, or any other evil Accident ensu'd.

This and the following Example I Judg'd sufficient to establish our Way of Dressing: And indeed seeing it has been attended with Success in such Cases, we ought to remain as|sur'd, that it will prove no less effectual in in|cised Wounds, and others also where the Bone is laid bare, whither by that which inflicts them, or by the Suppuration of the Pericrani|um. But we must observe, if the Pericranium is bruis'd or discolour'd, as in the preceeding Case, and Suppuration appear unavoidable; that the securest way is to tear it off, and speedily to uncover the Bone, that the foresaid Operation may take Place; whereby the Cor|ruption of the Bone will be prevented, which might be occasion'd by the lodging of the cor|rupt Matter thereupon; and then the Opera|tion would be too late.

CHAP. III. Of the Head.

OBSERVATION II.

A Certain Soldier nam'd Chasteau-montague, of Aligny's Company in Villars his Regi|ment, together with a Companion of his in

the same Company, was, during the Cam|paign in the Year 1694. brought to the Ho|spital establish'd for the King's Army at Brian|son.

The first had receiv'd a Cut on the middle of the Os Sincipitis of the left Side, whereby the Bone was uncovered, to the bigness of a Silver Crown Piece. At the second Dressing I made eight or ten little Holes with the Pier|cer upon the discovered Bone, not reaching so deep as the middle Pith or Diploe, that I might make Trial, if I cou'd accomplish my Design, without piercing through the first Table. I apply'd upon the Bone so far as it was laid bare, Lint dipt in Spirit of Wine, dressing the rest of the Wourd, with the sim|ple Digestive, Emplastrum de Betonica, and the Kerchief.

I waited two Days before I dress'd it again, and then found that my Operation had not been without Effect. The Bone was become reddish, and the Holes made by the Piercer, to which this Effect was owing, began as it were to sprout forth; which made me con|clude, that Nature would accomplish the Work she had already begun. For the first eight Days he was dress'd but four times, af|ter which the Bone was wholly covered: and in eight or ten Days more, wherein he was dress'd but every third Day, the Wound was fill'd up, and a good and firm Cicatrix for|med.

He came into the Hospital on the 25th of May, and upon the 11th of June he went out perfectly cur'd; all that were therein be|ing Witnesses of the Operation, and the Spee|diness of the Cure.

His Companion had several Cuts over all his Head, which he had received in the same Occasion, but especially a deep one upon the upper and middle part of the Forehead-Bone. Finding that in none of them the Scull was fractur'd, I judg'd it sufficient to joyn to|gether their Lips; only in the last, during the first Days, I left two small Threads of Lint dipt in Spirit of Wine, with the Ends hang|ing a little out of the Wound. Four Days after, I caus'd to be remov'd whatever might hinder the reuniting thereof, dressing only once in three Days, because no Accident ap|pear'd.

The Suppuration in this last Wound was but very inconsiderable; and no Bones came a|way, neither was there any Exfoliation: So this Man also was cur'd, and return'd unto the Regiment with his Companion.

REFLECTION.

Had I only recounted one Cure of this Na|ture, done in a place at a great Distance from Paris, the Truth thereof might readily enough have been call'd in Question: But

these, with many others of the like kind, ha|ving been publickly perform'd in an Hospital, to which every one had free Aceess, and as it were in view of the World, ought not only to remove all Scruple as to the Truth of the Matter of Fact, but also to establish the Re|putation of a Method, attended with Expedi|tion and Security. The Excellency and Use|fulness of the little Operation perform'd up|on the uncovered Scull off the first Man, may be easily made apparent to every one; be|ing founded on Reason and Experience. M. Jou|ve, a very expert Physician belonging to this Hospital, was an Eye-witness of the happy Success of these last Cures; he having been present from the Beginning to the End.

I should but weary my Reader, and my self also, if I should go about to reckon up the number of those, who in three Years time, with a surprizing Quicknss, have in this Hos|pital been cur'd of Wounds of the Head; as well such wherein the Scull was cut more or less, as those wherein it had lost of its Sub|stance.

I am not the only Person, who hath con|quer'd Scruples commonly enough entertain'd about Wounds of the Head. Ambrosius Pa|raeus reports, that he cur'd in a small time a certain Person, that with an edg'd Instru|ment, had a large piece of the Forehead-bone intirely separated, and hanging over upon the

Face by the Skin only; which yet was easily enough reunited.

In the Scull, as in other Bones of the Body, when a Piece is separated, whether by a Cut, or Fracture, so as yet to adhere to the encom|passing Membrane; it is sufficient artfully to restore it to its natural Place, in such a man|ner, that it may have the same Situation and Disposition as formerly; that so the Pores may answer, and the Nutricious Juice necessary to form the reuniting Callus, may be freely ad|mitted; which could not be done without ex|treme Difficulty, if it were placed either to high, too low, or aside; in which Cases, the natural Order and Situation of the Part be|ing alter'd; it is impossible it can sit so close to the Bone from whence it was divided, but that many little Distances must interveen, that are liable to be fill'd with Lympha, Blood, or Matter, or all three together; which alter the wounded Part, corrupt its Aliment, and bring that Membrane to Suppuration, by which on|ly the divided Part was tyed: So that Na|ture must now of Necessity throw it off, as an Extraneous Body.

From hence we may readily conclude, that it is not at all necessary, to permit Wounds of this kind to come to Suppuration, or to keep them open in Expectation of the coming a|way of Bones, which, without Danger, may be avoided.

This our Method is also confirm'd, by the Authority of Rhasis, and Serapion, Authors celebrated by Antiquity; who treating of Wounds of the Head accompany'd with a Fra|cture of the Scull, tell us that it was their Cu|stom to stitch them, even when the Fracture pass'd through both Tables. M. Verdue also in his first Volume, Chap. 18. Of Wounds in the Head, makes mention of a Fracture of one of the Ossa Sincipitis, that reach'd from the Sagittal to the Lambdoidal Suture, which was cur'd without the Assistance of Operation.

The Diploe or middle Pith, plentifully sup|plies the Scull with Nutricious Juice; from whence it is, that when broken it is more ea|sily united, than any of the other Bones, tho' yet its Callus is less firm: And providing the Brain with its Membranes are safe, we need not fear any Danger from the Fractures of the surrounding Bone: But tho' this may some|times fall out; yet is it scarce to be expect|ed, but that the violence that occasions a Fracture in the Scull, should by the sudden Jolt or Concussion, produce some Disorder in such a soft glandulous Body as is the Brain. Great Carefulness therefore and Attention is here requir'd: for a Rupture of the Vessels, or a Dilatation of their Mouths, that are frequent enough in such Cases, and cause Effusion of Blood, don't appear at first; as I have often|times observ'd: but so soon as the Accidents

begin to shew themselves, Operation must not be neglected.

It will possibly be objected, to what I have said, concerning carefully placing the broken piece of Bone, in the same Situation it had for|merly; that the Bones of other Parts of the Body may be reunited by Means of a Callus, even when so ill plac'd, that there is a neces|sity of breaking them anew, in order to re|store them to their natural Figure. But the Answer is easy; for there is a Difference be|tween the former Case, wherein a Piece or Splinter of Bone is seperated from the whole; and this, where the Nutricious Juice, that comes from the One as well as the other Part, meets, diffuses it self, and coagulates about the Fracture, and so forms that which we term a Callus: but in the other Case, the Alimen|tary Liquor proceeds, and is communicated from one of the Parts only; and if it find no Pores rightly dispos'd to receive it, there be|ing nothing to which it can Joyn it self, it is alter'd and corrupted; and the loosened Piece shares with it in the same Fate.

As for the Operation of Trepanning▪ which I have often perform'd, seeing nothing extra|ordinary hath therein occur'd, I will pass it o|ver in Silence.

CHAP. IV. Of the Head.

OBSERVATION III.

ABout the Conclusion of the Year 1689, a little time before the War of Savoy, the Vaudois cut off almost all the Inhabitants of Pramol, which depends on the Valley of St. Martin. I was at that time Surgeon Major to the Hospital of the Army of his Royal High|ness the Duke of Savoy: Thither were brought a great number of Men, Women, Maids and Children in a most deplorable Condition; and among others a young Girl about nine or ten years of Age, who besides others in the Body and Arms, had received eighteen or nineteen blows on the Head with a Cutlass, each where|of had pierc'd the Scull, some even to the Du|ra Mater; some Pieces of the first Table were carried away, and some of both Tables intirely seperated.

I caus'd in the first place, such Parts to be shav'd as wou'd bear it; and afterwards I gent|ly rub'd the whole Head, with a Liniment made of Vnguentum de Betonica, the Yelk of an Egg, and Spirit of Wine, mix'd together: in this mixture also I dipt large Pledgets, with

which I cover'd all the Head, without either Tents or Dilaters; above these I put Empla|strum de Betonica, and over all the ordinary Cap.

What her Age and Strength would allow, was done for diverting the Humors; and the first Dressings were left untouch'd for two Days; which Method was continu'd for fifteen Days: when we took off the Plaister, almost at every Dressing we found Pieces of Bone sticking to the Pledgets: What was altoge|ther separated, came away with Eease: And in fine, such Bones as yet adher'd to the Peri|cranium were reunited, and what was wanting in the Cranium was speedily supply'd. When I perceiv'd the Suppuration to diminish, I dress'd but once in three days. This Course I found so successful, that in the space of a|bout five weeks the Cure was perfectly accom|plisht. This poor wounded Girl, was known to almost all Pignerol; being very remarkable by the loss of one of her Ears, which she had sustain'd in this afflicting Occasion.

REFLECTION.

This Cure is altogether to be ascrib'd to Nature, as being intirely her Work: and had not great Circumspection been used, in pro|hibiting the access of the Air, in this Case, where the very Membranes of the Brain in

several Places were discover'd, it could not have had so speedy, easy, and successful an Upshot; especially had it been manag'd in the ordinary Way: For besides that the Cure would have been unsufferably tedious; a thousand dangerous Accidents might have arriv'd chief|ly in an Hospital, where long-winded Cures are seldom attended with success. In fine, notwithstanding the Novelty that may be charg'd upon this Method, it is supported by the Authority of Hippocrates; who, B. 5. Aph. 17. affirms that the Air is an Enemy to the Brain, the Bones, the Nerves, and to our Nature in General. Galen in his Book De usu Partium, ch. 1. says, that the Air is prejudicial to Vlcers, by which word he understands all Sores; and adds, that in trepanning we ought to take special care not to cool the Brain as well during the Operation, as when it is over.

The Access of the Air, is not only hurtful to the Wounds of the Scull and Brain; but al|so to those of the other parts of the Body; in which the Accidents are neither so sudden, nor so violent; yet ought they to be regard|ed with all necessary Care: for if you ever so little neglect the Conservation of the Natural Heat and Spirits, the wounded Member must needs fail, and frequently the Owner also shares in the same Destiny.

CHAP. V. Of the Face.

OBSERVATION IV.

IN the year 1689. I being in the same Post, and at the Place before mention'd, when the Vaudois were driven from the Valleys of Lu|serne: A certain Officer, whose name civility ob|liges me to conceal, was wounded with a bro|ken Sword in the left Cheek, towards the cor|ner of the nether Jaw, about an Inch below the Ear; and the Ductus Salivales were torn.

He was at first dress'd by a Surgeon, who according to his usual manner, dilated the Wound, by thrusting into it as much lint as it could contain. A considerable time pass'd, without any appearance of a Cure, and by little and little it became fistulous. I was call'd by the wounded Person to give him my Advice and Assistance: and forthwith I con|sum'd the Callosity, by touching it nimbly with Tents dipt in dissolv'd Causticks: I caus'd him to be fed with Jelly-broth to be taken with a Quill, that there might be no occasion to move the lower Jaw; ordering him also to keep himself very quiet, without either speaking or moving: and when all the Callo|sity

was taken off, I apply'd to the Wound the Balsam of Peru, and pressing together the Lips with long slender Boisters, I covered it with the Styptick Plaister of Crollius. Thus he was cur'd, not without difficulty; tho' at first it might have been done with great Ease.

CHAP. VI. Of the Face.

OBSERVATION V.

BEing in Pignerol in the year 1691, the Chevalier Vauban, a Captain in the Regi|ment of Beaujolois, sent for me to see his Bro|ther; who was run with a Sword into the Cheek: The Wound had been dress'd by a Surgeon, who at first thrust into it a Tent both thick and long, which pass'd into his Mouth; and continuing the same Method for six or se|ven Days, the Patient was thereby thrown into a violent Fever; and his Head and Face were exceedingly swell'd, by reason of the great Flux of Humors.

After we had laid aside the Tent, we found it necessary to have recourse to such Means as might divert the Humors; but the Accidents, which so great an Irritation of the Parts had occasion'd, could not be easily remov'd; ne|vertheless

they were at length conquer'd, tho' not without difficulty; and by means of Sar|coticks we compleated the Cure: but an ugly Scar remain'd behind, occasion'd by the incon|siderate use of the Tent.

REFLECTION.

The Face being the Image of God, and as it were an Abridgment of all the Beauties of Nature; which as a little World representing in Miniature, what is more voluminously dis|play'd in the great bulk of the vastly-extended Universe; ought doubtless to enjoy some pri|vilege over the other parts of the Body: Hence it is that all the Authors both Ancient and Modern, tho' for the most part they have allowed the use of Tents in all other Wounds, yet have they unanimously condemn'd it in those of this Part; which nevertheless have been cur'd with wonderful Facility, and by the use of the very weakest of Sarcoticks.

Fabritius ab Aquapendente, in Wounds of the Face recommends the use of the dry Stitch, to avoid the deformity of a Scar: and indeed, seeing we are to preserve the Beauty of the Countenance as much as possible, they are to be accounted very unskilful Surgeons, and but ill instructed in what belongs to their Busi|ness, who employ Tents in such occasions: The Saliva seems to be that Balsam which is

peculiar to the Face, assigned thereto by Na|ture, that has also granted to all the other Parts one proper to them.

CHAP. VII. Of the Tongue.

OBSERVATION VI.

IN the Year 1689. A Lieutenant of the Militia of Mondevis, having his Mouth o|pen, as he gave orders to his Soldiers, in an In|counter, receiv'd a Bullet that broke and tore all his Tongue into five or six pieces, which were not altogether seperated, but stuck toge|ther on the upper part. He was carried to the Hospital of Luserne, and forthwith there dress'd by M. de la Ramee, Master Surgeon at Turin, and skill'd in his Employ: But finding that with all his Care, he was not able to stop the Flux of Blood, which was considera|ble, he desir'd my Advice in this affair.

Having search'd his Mouth, in order to dis|cover from whence the Blood came, I found the Bullet lodg'd under one of the corners of the lower Jaw-bone, having only fretted the Skin of that part; and finding no other Place from whence the Blood could come, but these Veins under the Tongue, call'd Ranulares, I pro|posed

to heat red hot three of these small caute|rising Irons, which are us'd for the Teeth, and to apply them to the Ranulares; which being accordingly done, the Bleeding was stopt, and the wounded Person speedily cur'd.

REFLECTION.

The Ancients have ordered to stitch the Wounds of the Tongue, unless the pieces be altogether separated, in which Case the Ope|ration is to no purpose, and the Reunion im|possible: Fabricius ab Aquapendente is of the same Opinion: but as for my self, I can see no manner of necessity for such Stitching; seeing Nature alone, when left in Repose to her self, does excellently accomplish the Uni|ting of the divided Parts without it. Every body knows, that the Tongue is situated in the Mouth under the arched Palate, and made up of innumerable little nipple-like Bodies, en|compass'd on all sides by the Teeth, and sup|ported in such a manner that its parts are kept together, and cannot fall asunder. The Spittle is its Balsam, and oftentimes the only Remedy necessary to cure its Wounds. This is what I have observ'd in the preceeding Cure; for this Gentleman's Tongue was, af|ter some small time, altogether so well, that scarce any Signs of the Division of its Sub|stance could be discern'd: but whereas it had

been torn by the Bullet, and scorcht with the Cautery, it must of necessity have lost of its Substance; nevertheless Nature found the way to make up what was wanting, and to effect a compleat Union of the divided Parts: from whence I have Reason to conclude, that what the Ancients have left us in Writing is not al|ways true.

I have dress'd a great many with Fractures of the lower Jaw-bone, but chiefly two Soldi|ers who were wounded in that part at the Battle of Marseils, One of whom had more than half of the Bone broken to pieces; who nevertheless were perfectly cur'd, as others had been: they are at this time amongst the Invalids, being disabled, and much deform'd. Of these I will not speak more particularly, having observ'd nothing Extraordinary in their Case.

CHAP. VIII. Of the Neck.

OBSERVATION VII.

IT would be both tedious, and unprofitable, here to relate Examples of Wounds in the Neck, of which I have cur'd a great number, in very little time, and with Simple Remedies

only. I have also several times taken out Bullets, which have been lodg'd there for some time, yea many Years. I shall content my self therefore to give my Thoughts of what I judge necessary to the speedy Cure of Wounds of this part, in the following Chap|ter.

REFLECTION.

All the Ancients agree in this, that Wounds of the Neck, tho' passing quite thorow, are ea|sily enough cured, provided the great Ves|sels, and Spinal Marrow be not hurt: But they give no sufficient Reason for their Opini|on. I know not if I have hit the Matter a|right; but in my Opinion it proceeds from this, that the use of Tents has been laid aside, which in the Wounds of this Part cannot be employ'd, because of the necessary Uses of the Wind-pipe and Gullet, that would be hin|dred by so hard a Bandage as is requir'd to keep in a Tent.

It is therefore, according to my Opinion, Nature her self, who being freed from Impe|diments, speedily heals up the Wounds of the Neck: and this greatly confirms the Reason|ableness of my Method; for those who fear, lest the Omission of Tents, should bring on Ab|scesses, Bags, and Sinuses; have more Rea|son

to apprehend such Accidents in the Wounds of this, than in these of any other part.

'Tis well known that this part is obnoxi|ous not only to the Bronchocele, Afflux of cold Humors, and Quinsie; but also to Phlegmons, St. Anthonies Fire, and all other Indispositions in general that afflict the whole Body: for this Part, by reason of the Glands, that here are very numerous, is always charg'd with abundance of Humors, which render it sub|ject to all such Disorders as proceed from these thrown out upon the parts.

It must also be own'd, that there is not a|ny Part in all the Body, which in proportion to its bigness, contains any thing nigh so great a Number of Blood-Vessels as are here to be found.

And in fine, if it were true that the use of Tents would prevent Fluxions, Collections of Matter, Bags, and Sinuses; I know no o|ther place of the Body, that when wounded, would be in more need of them, than the Neck; which is extreamly subject to such Accidents.

Wherefore, since Wounds of the Neck, that of all the Parts is most liable to dangerous Symptoms, may not only without Tents be cur'd, but even much more safely and speedi|ly than with 'em; we may conclude that these of other Parts, ought to be treated also with the same Gentleness, and set at Liberty from the Tyranny of Tents.

CHAP. IX. Of the Breast.

OBSERVATION VIII.

BEing at Pignerol in the Month of April, 1692. M. de Fontaniere, Commander of the King's Battalion, received a Thrust with a Sword, about two Inches above the right Nipple, and in the Side thereof towards the Arm-pit, which enter'd the Body between the third and fourth Rib.

He was dress'd by one of the Surgeons in Pignerol; before which he had lost, according to conjecture, about between seven and eight Pounds of Blood; and notwithstanding of the Dressings, the Flux of Blood did still conti|nue; for which Reason I was sent for by the Wounded Person and his Friends. I search'd the Wound in presence of him that had for|merly dress'd it, and drew from it between eight and nine Ounces of Blood: And lest at first I should appear ridiculous, I permitted it to be dress'd with a Tent, and immediately af|ter caus'd him to be let Blood; and advised his Friends to dispose him, to set his Affairs in Order. All the signs were dangerous; his Pulse was weak and convulsive, he had frequent Swoonings, and Pains over all his Body. A Clyster was given him, and some weak Cordi|als

in good Broth. A little after the Bleeding, he was seiz'd with a Fever: and all these Acci|dents concurring, made us question whether he could outlive that night; which yet he did in great pains over all the Breast, and perpe|tual restlesness.

In the morning, which was the end of the first Day of his Wound, we took off the Dres|sings; and found that it had bled all night; between six and seven Ounces of Blood half corrupted issuing from the Wound, which was drest as the Day before. The Clyster was re|peated: we gave him Aperitives and Vulneraries in Syrup of Violets: And in his Broths a Dia|phoretick made up of some grains of Vitriol calcin'd, and the powder of a Human Scull, which gave no small Relief, being a Specifick in such sort of Wounds.

After the Dressing, the Blood yet run from the Wound into the Bed; and as we were preparing to Bleed him again, news were brought him, that he behov'd to change his Lodgings; and for his greater security, to some Place at a considerable distance from that where he was. In this occasion, his Removal threatned no less than Death; for this was but the beginning of the second Day of the Wound. I was willing to see it before his Departure, tho' it had been dress'd but a little time before: but having perceiv'd, at the last Dressing, that some Blood run from one of these Arteries that

pass along the lower part of each Rib; and ha|ving only out of complaisance continued the Tent, I design'd to use one of another sort than had been yet done, seeing there was now no time to loose.

I prepar'd therefore a soft Tent, indifferent|ly thick, and blunt at the end, that it might rest upon the Rib, without touching the Pleu|ra, or passing into the Cavity of the Breast: This being dipt in a simple Digestive, and roul'd in Vitriol finely pulveriz'd, I apply'd with a broad head as is usual, together with the rest of the Dressings, and the Plaister of Andreas a Cruce. After having taken some Broth, he was put into a Chair and carried to his new Lodgings, where he might remain more conveniently: By the way he only lost a little Blood, tho' many had been of Opini|on, he could never come alive to the end thereof.

He rested a little that night; and in the Morning, which was the end of the second Day, the Fever was still pretty violent; the Wound was without Moisture or Blood; the Pleura was reunited: he felt a Heaviness, and breath'd with some difficulty. The Wound we drest now with a small Dilater only, to which for more security a long thread was ty'd, applying the other things as before. I bled him in the Arm; and encreasing the Dose of the Diureticks with the Syrup of Maiden-hair,

order'd an Emulsion to be taken at night with two Grains of Laudanum.

All these things succeeded so well, that the next Day, which was the end of the third since he was wounded, I found the Fever dimi|nished: He breath'd more freely; felt little or no heaviness; and in the Night time had voided such abundance of Vrine, that we may reasonably enough suppose this to have been a critical Evacuation; he had also spit store of bloody Matter. The Wound being now in a very good condition, from this time forward I dress'd it with a Plaister only.

At night I observ'd a Moisture upon him; which made me believe, that Nature might ac|complish the rest of her work by Sweat. Wherefore, that I might not let slip so favora|ble an Occasion, and to assist Nature, I caus'd prepare for him a Potion with the distill'd Waters of Carduus benedictus and of Scabious, four Grains of Diaphoretick Antimony, half a Dram of the Confection of Hyacinth and of Al|kermes, a little of the Powder of Vipers, and two or three drops of the Spirit of Sal-armo|niac. This Remedy being given so seasonably procur'd a thorough Sweat; and in the Morn|ing, which was the end of the fourth Day of the Wound, the Fever was gone; the weight upon the Diaphragm remov'd; and he breath'd without difficulty: and finally, all these Symp|toms being evanish'd, the Wound was only

drest with a Sarcotick Plaister, as if it had been a simple Excoriation.

The Day after, which was the fifth of his Wound, he mounted his Horse without help, and went to Diblon for a more pure and tem|perate Air, where he no longer kept his Bed, tho' he found not thereby the least Inconveni|ency. There I purg'd him twice, which was done not out of any absolute necessity thereof, but as an expedient precaution: I advis'd him also for a time to live somewhat moderat|ly. Thus that Wound which appear'd to us at first Mortal, and was attended with a nu|merous train of dangerous Symptoms, was in five Days time compleatly cured, to the A|mazement of all Pignerol.

REFLECTION.

This Method of Practice, will appear at first to be ridiculous, and rash, to those who have not considered so much as I have done, the surprising Works of Nature; nor these secret Passages she finds out, to discharge her self of what is troublesome to her in like Cases; nor how in particular she oftentimes effects a Crisis by the way of Vrine.

But seeing experience has frequently taught us, that an Empyema in the Breast, has been carried off by means of Diureticks, the Matter, as the Ancients thought passing to the Urina|ry

Vessels through the Vena azygos, but much more probably through Ways to us yet un|known; why may not a little extravasated Blood contain'd in the cavity of the Breast, or lying upon the Diaphragm, be discharg'd by the same Ways, or by those of Sweat, especi|ally if Nature be therein assisted by the use of Diaphoreticks?

By these Ways then, now mention'd, the Breast may be sufficiently freed from Humors that Oppress it; chiefly in a young and vigo|rous Body: neither is there now Place for a|ny to doubt of this, of which so many People in our Days have been Eye-witnesses, who can yet testifie the same.

Wherefore, there is no Reason to be so obsti|nately bent, for using Tents in Wounds of the Breast; unless it be to carry Astringents to some place, whether otherwise they could not reach; or to support and keep them on: But in all o|ther Cases they ought intirely to be laid aside: For by exasperating such parts as they touch, they are apt to renew the Flux of Blood; they hinder the closing up of the Wound; and by wi|dening the Division of the Pleura, occasion an Inflammation thereof.

It also frequently falls out, when a Tent is something long, that it touches the Lungs, and bruises 'em by reason of their continutl Moti+on, and beating against its Point; yea often|times it enters into, and divides their Substance

making its way through the investing Mem|brane, now brought to Suppuration. In Wounds also where the Lungs are not spoil'd, there being only a simple Division of their Substance with a sharp Instrument, a Tent may increase the Separation, and by iritating the Parts, cause a discharge of Humors there|upon, and great Suppurations, which end or|dinarly in incurable Fistula's.

Moreover a Tent presses upon the Muscules of Respiration, and permits not the Patient either to cough, spit, or breath freely: It hinders the Circulation of the Blood, by bear|ing on the Vessels; so that the wounded is in danger of Suffocation, by the collection of Blood, Matter, or Phlegm, and oftentimes of all three together; unless they are by some Means discharged: But if there is not a suffi|cient quantity of one or all of these, to produce such an Effect; and if the Lungs are yet at liber|ty to perform their wonted motions, yet these Humors will there ferment, and corrupt; and occasion putrifaction in the parts that contain 'em.

But after all, this Accident may sometimes have an happy Event; and a bad Cause may by chance produce a good Effect. For our Body, as we are inform'd by Anatomy, being nothing else but a Contexture of Vessels; it may happen in Wounds of the Breast, that the Blood or Matter collected in the Substance of

the Lungs, or upon the Midriff, may there un|dergo a Fermentation, and thereby, together with the Heat and Moisture of the part, open and dilate the Pores of the Veins; whereby these Humors being taken into and mixed with the Blood, rarify, subtilise, and dispose it to throw off the Offending Matter, either by Sweat, Urine, or other Crises of alike Nature, according to the Disposition of the Body.

And surely we need make no great difficul|ty, to believe that such a thing might happen in a Wound of the Breast, if we will consider what befell M. de la Place, a Captain in the Regiment of Barrois, who voided by Stool the Matter of a great Abscess in his Arm, oc|casion'd by a Wound he had received in that Part; of which we will give you a particular account in the last Chapter of this Book; as also of another wounded in the last Campaign, from whom the Matter, that was contain'd within the Breast, was drawn away by open|ing the Vena Mediana, with a design only to let Blood.

In fine we may say; tho' the ways by which these Crises were effected are not altogether known to us; yet it is very certain that there are such: and seeing Nature is not ignorant of them; we ought to leave to her conduct, the Success of a Work, whereof she ought to have all the Honour, and which she alone brings

to pass; our part being only to wait upon her, and assist her in her Design.

Galen in his 5 Book de locis, hath observ'd that Matter contain'd in the Breast, is often|times carried off by Vrine, the same thing also he affirms in his 6th Book de partium Morbis.

Andreas a Cruce, a famous Physician of Ve|nice, in the first Section of his fourth Book of Surgery, in express terms forbids the use of Tents and Pipes in the Wounds of the Breast; he advises only to use a Plaister, the Advantage of which I have thorowly experienced.

Fabricius ab Aquapendente, Part I. Book 2. Chap. 42. says, that he has often seen the Matter contain'd in the Breast in a Pleurisie, or Peripneumonia, discharg'd by Vrine. He relates an Authentick History of a Wound piercing into the Cavity of the Breast, which having been dress'd as a simple One of the common Teguments, the Patient was on a sudden surpriz'd with such Symptoms, as plainly discovered the Nature of the Wound. That he might be relieved with as much ease as possible, and not put to the torment of a Counter-opening, it was thought expedient to dilate the Wound; but it was so well clos'd up, that the Operation of the Empyema was re|solv'd on next Day. But during the Night sage Nature had accomplish'd the Work; a Glass full of Blood being voided by the Urina|ry Passages, whereby the Spitting of Blood,

difficulty of Breathing, and all the other Ac|cidents were compleatly remov'd.

The same Author, recommends on such Oc|casions, the use of strong Diureticks, unless a Fever hinder: and in the above-cited Chap|ter, he says, that there are some, who will not allow Wounds of the Breast to be kept open, but suffer them to close; lest other|wise the Natural Heat might be dispers'd, and the cold Air should enter in, and spoil the neighbouring Parts: He adds, that the Use of Tents occasions Fistula's.

Ambrosius Pareus, Book 10. Chap. 32. ap|proves the Practice of those, who make use of Tents in Wounds of the Breast; and else|where commends such as employ them not: so that as to this Point he seems to have been undetermin'd, and inconsistent with himself.

In the same Chapter also, he speaks of a Cure done by himself without Tents; and af|terwards he affirms, that Fistula's, which fol|low upon Wounds of the Breast, are oftentimes occasion'd only by the Use of them. The same Author, in the 51th Chapter of the 17th Book of his Treatise of Matter and Blood that may be carried off by the Veins, demonstrates by many Reasons that such an Evacuation may be; and shews that Galen was of the same Mind.

Hollerius in his Commentaries, is of the same Opinion; and M. Verdue, Tom. 2. chap. 28.

affirms that Wounds of the Breast, the more they are exposed to the Air, are so much the more dangerous.

It would be a very tedious task to recount all the Authors, that have approved of this Method, altho' it is but little put in Practice: And it would be a very easie Matter to bring many Examples, of Cures wrought by Nature through secret and occult passages conveying Humors and Matter, into other Parts than what were first affected.

CHAP. X. Of the Breast.

OBSERVATION. IX.

ABout the end of the Year 1693, there was brought to the Hospital of the King at Brainson, a Granadeer of the Regiment of Touraine; together with a Servant of M. De Lesseraine formerly Commissary at Pignerol.

The first, was run into the side-part of the Breast, between the third and fourth Ribs, with a Sword, which past into the capacity of the Thorax, and pierced the Lungs. The usual Symptoms appear'd at first; and Diversions were made. The first and second Day, some Blood came from the Wound; which was only

drest with the Plaister of Andreas a Cruce, without either Tent or Dilater. Diureticks also and Diaphoreticks were us'd; and upon the fourth Day he voided great abundance of Vrine: by which critical Evacuation, he was freed from the Fever, Difficulty of Breathing, weight upon the Midriff, and spitting of Blood: and on the fourteenth Day he was compleatly cur'd.

The Other had received just such another Wound, piercing in like manner; only higher by one Rib: The Symptoms, were so violent, that tho' it was immediately dress'd, yet was there no hope of Cure. He was treated after the same manner as the former: But he was much more speedily cur'd, by means of an universal Sweat; whereby that very Day all the Acci|dents were remov'd. In eight Days time, he went out from the Hospital intirely cur'd.

Were I to give a particular account of the numerous Cures of alike nature, that have been done according to this Method, there would be enough to fill a great Volume; all which were neither attended with any evil Accidents during the time of the Cure, nor followed by any after it; nor did they ever leave Fistula's behind 'em. I shall speak of Gunshot-Wounds, in the follow|ing Chapter.

CHAP. XI. Of the Breast.

OBSERVATION X.

IN the Year 1692. there was brought to the foresaid Hospital of Brianson, a Priso|ner of the Army of Savoy; who was wounded with a Bullet, that entred near the right Pap towards the Arm-pit; and pass'd out of the Body four Finger's breadth from the sixth Ver|tebre of the Back; having in its way broken asunder the fourth Rib.

I enlarg'd both the Orifices, but a little more that of the Back, which was somewhat lower than the other. We dress'd him only once a Day at first, without either Tents or Dilaters; and from the hinder Orifice came forth a certain thin watery Humor; which E|vacuation continued till the falling of the E|scar; after which time he was dress'd only once in two Days. I kept the last mention'd Ori|fice open from time to time by means of a piece of prepared Spunge; conjecturing, that there were some Splinters of Bone to be dis|charg'd; which accordingly came to pass without any pain, about the eighteenth Day of the Wound: from that time forth I endea|vour'd

to heal it up, applying between the Ori|fices Compresses, dipt in warm Wine. Du|ring this Cure, I could observe no sensible Crises; nor did any Accident happen: It was finished in thirty Days.

REFLECTION.

In this Wound the Lungs were untouch'd, for any thing that appear'd; a Rib only being bro|ken, and the Pleura hurt: which indeed had been sufficient to produce fatal Accidents; had any other Method been followed: for if in this Case, Tents had been used; or had the Wound been cram'd full of Dossils, as has been often done on such occasions; the Matter proceed|ing from the Dissolution of the Escar and the Contusion, being pent up betwen the two Orifices, and still encreasing, and finding no Vent; would infallibly have broken into the Cavity of the Breast; from whence it could not have been drawn forth, but by the Opera|tion of the Empyema.

An Ancident like unto this, happened this Year to a famous Officer of our Army in Savoy; who having receiv'd a Wound which was thought to peneteate, and really did so, was dress'd with Tents; but the Matter finding the Way, by which it should have been discharg'd from the Body, altogether intercepted; and passing among the broken pieces of a fractur'd Rib, diffus'd it self into the Capacity of the

Thorax: And in this Condition he dyed, hav|ing his Breast full of Matter.

CHAP. XII. Of the Breast.

OBSERVATION XI.

UPon the twelfth Day of June, 1693. The Marquess De Larray, Lieutenant Gene|ral, took by Storm a Post in the Valley of Barcelonetta; and in this Occasion, had five and twenty, or thirty Men wounded; who were brought to our Hospital of Brianson: and among others there was one call'd Simon Contaut, of the Regiment of Vendosme, and Company of Berole. This Man had receiv'd a Bullet, which went in hard by the sixth Ver|tebra of the Back; breaking in its Passage the transverse Process on the right side; and came out on the fore part of the Thorax, be|tween the second and third Rib towards the left side.

This Wound was attended, with all the most dangerous Symptoms, that use to appear when the Lungs are wounded; being one of the most considerable that had been under Cure in this Hospital.

There was not here any need of dilating the Orifices; the largeness of the size of the Bul|let, having done it to some purpose: The Wounds were drest without any Tent, but only with large Pledgets, and a good agglutinative Plaister; the Compresses and Bandage being such as is usual. Diversions were made with|out delay; and a course of Diet appointed: He was dress'd but once a Day, and that with all possible Speed.

The hinder Orifice of the Wound did blow with such force, that all the By-standers were surpriz'd thereat; and such a prodigious quan|tity of Water did issue from it, that oftentimes it was necessary to change the Linnens twice a Day. Diuretick and vulnerary Potions were given.

This large Evacuation, continued for a|bout twelve or fourteen Days; after which the wounded Person was dress'd but once in two Days. The twentieth and first or twen|tieth and second Day, the Opening of the Pleura on the Back was perfectly clos'd up; that before having preceeded it some Days. There was nothing came away that we could observe, either from the broken Process, or the Ribs that had been touch'd in the passage of the Bullet: and in thirty five Days, or thereabout, the Orifices were both intirely fill'd up.

REFLECTION.

This wounded Man was sent to the Hospi|tal, as one of whom all hopes had been laid aside: for the Surgeon Major of the Regiment, who at first drest him with great Care, told his Captain that his Death was inevitable.

This same Captain, about a Month after coming to Brianzon, with the Lieutenant Col|lonel of his Regiment, who had been wounded with a Sword; was much surpriz'd when he was visited at his Lodgings by this Soldier, who was at that time as vigorous, as before he had receiv'd his Wounds; at which he now had only a Plaister. The Surgeon also testi|fied to me his Amazement; and enquired, af|ter what manner I had proceeded, to accom|plish that Cure in so small a time.

This Cure is of it self sufficent to evince, that in Wounds of the Breast, there is no need of Tents; and moreover does demon|strate; that the Operation of the Empyema, is attended with much better Success, when per|formed on the hinder, than on the lateral Parts of the Thorax: For this Operation is done, with design to give a Passage, to the extravasated Blood; and to evacuat the Mat|ter contain'd in the Cavity of the Breast; for which purposes this Place, is much more conve|nient than the others; the Humors being there|by

by discharg'd so soon as bred, unless they be retain'd by Tents: The wounded are not trou|bled with violent Agitations; but enjoy a pro|found Quiet: The Parts have liberty to per|form the necessary Motions; and Nature acts without constraint; finding always the ways open, by which she may deliver her self from what is contrary, and hurtful unto her; so that nothing is now to hinder her from clo|sing up the Wound, when ever she shall find her self disposed so to do.

If then Gunshot-Wounds of this Nature, not|withstanding the Havock that the Bullet makes in the Places through which it passes, are so easily and speedily cured, by this Me|thod; we have all the Reason in the World to believe, that the Wounds, made by sharp In|struments, where there is ordinarly only a sim|ple Solution of Continuity, may be cured with much greater facility.

But we must observe, that in this Way of Dressing, great Care is to be had, of covering such Wounds with good substantial Pledgets of such bigness, that there may be no danger of their being push'd into the cavity of the Breast, by the weight of the incumbent Air▪ And upon the Pledgets we must apply a strong and agglutinative Plaister; such as that of An|dreas a Cruce; which also must be sustain'd with a Compress of four doubles, and all kept on with the Napkin and Scapulary; all which

Precaution is necessary to withstand the en|try of the Air, which otherwise, the use of Tents being laid aside, might pass into the Thorax, and there produce fatal Accidents.

M. Verdue, Tom. 1. Chap. 14. advises not to use Tents in Wounds of the Breast, for too long a time; lest thereby incurable Fistula's be occasion'd.

CHAP. XIII. Of the Breast.

OBSERVATION XII.

WHen I was at Liserne, there was brought to the Hospital, in the Year 1688. a Soldier of the Regiment of Saluce, who was wounded with a 〈◊〉〈◊〉, (which is a Weapon made in form of a Poniard) on the side of the Cartilago ensiformis; the Wound, as was evi|dently to be seen, when it was dilated, passing upwards by the short Ribs, and piercing the Midriff in its fleshly part.

He was dress'd with a Pledget only, cove|red with an Incarnative that was pretty liquid. The necessary Diversions were perform'd, and such a Diet was ordered, as suited best with the greatness of the Wound, and the Strength

and Constitution of the Patient. He was dress'd only once in two Days. The Suppura|tion was but very small; and in the space of eight or nine Days, he was compleatly cu|red.

REFLECTION.

If this Wound had been dress'd with Tents, after the ordinary Manner; I leave it to be Judg'd by every one, if such a desirable Suc|cess could have been expected; seeing the Tent would unquestionably have caus'd fear|ful Irritations of the Diaphragma, which with|out it is with great difficulty brought to re|unite, because of its perpetual and necessa|ry Motion. In fine, this Wound, how incon|siderable soever it might appear, had certain|ly prov'd Mortal, if it had been stuff'd with an Extraneous Body; which by encreasing the division of the Midriff, would have prov'd an Impediment to its Action: For every Bo|dy knows, that Wounds in its nervous Part are deadly; and that these in the fleshly Part, may become so, when exasperated by ill Treat|ment, or neglected.

CHAP. XIV. A Remark on One that was wounded in the Breast.

OBSERRVATION XIII.

IN the last mention'd Year, and in the same Hospital; one of the wounded died on the fifth or sixth Day of his Wound: And because it had not at all appear'd to be mortal, the Bullet having but glanc'd upon him, whereby the fifth Rib, was only broken, and the Pleura slightly hurt, I opened him, that I might discover the Cause of his Death. At first I was of Opinion, that an Asthma, with which he was afflicted when alive; and which had almost quite disabled him for Service; had conduced much to the shortning of his Days: But I was convinc'd of my mistake, when I perceiv'd all the Parts in the Breast in a very good Condition; only the Heart had its Ventricles fill'd with Polypuses of the thick|ness of a large writing Quill, and about the length of the little Finger; there being four in the right, and two in the left Ventricle.

If we may give credit to Dr. Lower of Oxford, in his Treatise on the Motion of the Heart; we may easily enough account for the Death

of this Man. He says, that in order to con|tinue the Circulation of the Blood, and to send a convenient quantity thereof through the Ves|sels; the two Ventricles of the Heart must be of an equal Capacity, and moreover that they must have alike Strength, to undergo this La|bour. Now this Equality not being to be found, in the Heart of him of whom we speak; its motion must needs have been deprav'd by the Disproportion of the weight of the Polypu|ses; and by the Inequality of the capacity of the Ventricles: or because the Heart being o|vercharg'd, could not contract it self without much difficulty; so that remittting much of its Motion, it became weak and languishing▪ and the Midriff also, to which it is always ty'd, did loose its necessary vigour; especially after his receiving the Wound; by Reason of which, the Breast could not be dilated, without trou|ble and Pain, because of the broken Rib, and of the Solution of continuity of the Pleura, In|tercostal Muscles, and Muscles of Respira|tion: Wherefore the Heart and Lungs being depriv'd of their necessary Relief; Suffocati|on and Death were unavoidable.

Tho' this is a Subject forreign to our pre|sent Design; yet we Judg'd it would not be a|miss, here to take notice of it, for Caution, and Advice to others in a like Occasion.

CHAP. XV. Of the lower Belly and Loins.

OBSERVATION XIV.

IN the same Year 1688. a Soldier of the Re|giment of Montferrat, called Sans Soucy, was wounded by a Bullet; which entring be|fore at the Region of the Navel, came out be|hind at that of the Reins, piercing the right Vreter, as it pass'd along. He was at first dress'd by one of the Master-Surgeons of Tu|rin, who us'd to assist us; which he perform'd after his own Way.

The Orifice which was in the Belly, not|withstanding the Tents which he us'd, was clos'd up, after the falling off of the Escar of the Teguments; but it fared otherwise with that in the Back; for that Surgeon being care|ful to keep it open with a thick and long Tent, hinder'd also the Re-uniting of the Vreter, which occasion'd the Vrine to come forth at the Wound. I having seen him one Day, ad|vis'd the Surgeon speedily to take away the Tent, if he would avoid an incurable Fistula: but my Words were to no purpose; for had he comply'd with 'em, he would have thought he had offended against the Rules of Art, and

ancient received Maxims; with which my Ad|vice was inconsistent.

Some Days after, seeing this Wound in a very bad Condition; being covered with a whitish Flesh almost without Sense, and ready to become a Callus; I was willing to prevent the fatal Consequences of that indiscreet Dres|sing: wherefore, with a dissolv'd Caustick, I consum'd all that appear'd callous about the lips of the Wound; causing also some of it to pass into the Cavity thereof: and leaving out the Tent, I expected the Discharge, of what the Caustick had mortify'd: When the Flesh had regain'd its usual Colour, without loss of time, I syring'd into the Wound some Balsa|mick Water. I also us'd the Balsam of Peru, alone for some Days; and after that, the Styp|tick Plaister of Crollius, with little longish Compresses that were plac'd on the two Sides of the Wound, to press together the Brims. Thus the Wound begun to be fill'd up; and the Urine did by little and little re|sume it's former Course; and in about 18 or 20 Days, the Wounded Person was perfectly cur'd.

REFLECTION.

In the Progress of this Cure, may evident|ly be perceived the difference, between the Method us'd by many Surgeons, fondly con|ceited

of their own Opinions; and that which I practise: for if in this Case, the first had been continued but for eight Days time, the Wound had become either extreamly difficult, or impossible to be cur'd. This is confirm'd by the Wound in the Belly; the speedy Cure whereof, is to be attributed to the Motion of the Intestines; which, contrary to the Design and Desire of the Surgeon, expell'd the Tent so soon as apply'd, in such sort that it was compleatly cur'd, a little after the falling of the Escar.

Wherefore we can never too much blame those, who are so obstinately wedded to the Use of Tents, in Wounds of the lower Belly: they ought altogether to be laid aside, in spite of all the Objections that may be made on their behalf, for which undoubtedly there is no Real Ground. Experience gain'd by Pra|ctice, has so undeceiv'd me touching the Use of Tents, that I have left off the Use of them, not only in the lower Belly, but even in all o|ther places of the Body, unless upon a very pressing Necessity: But in Wounds of the E|mulgent Vessels of the Reins, of the Vreters, and of the Bladder; as also in those of the Joynts, they occasion Accidents which often|times prove mortal: or otherwise leave be|hind them Infirmities, that ever after render Life miserable.

CHAP. XVI. Of the Ventricle.

OBSERVATION XV.

ONe of the principal Deputies of the Ho|spital of Brianzon, in the Spring of the Year 1695. receiv'd a Wound in the upper and middle part of the right Hypochondrium; piercing in appearance to the Ventricle, or to the Pylorus. I could not find out the depth of the Wound with the Probe; notwithstand|ing of all the Postures I could put the Pati|ent in. But an Accident that immediately fell out discovered the truth of the matter: for tho' he had supp'd very slightly, he vomi|ted up again all he had taken, mix'd with pure Blood. I immediately dilated mode|rately the Wound; that a free Passage might be left to the Blood, that, possibly, was extravasated in the lower Belly, or to the Matter, that might afterwards breed there. I dress'd him with a Pledget only, upon which I apply'd a suitable Plaister and Bandage. I bled him a little after, and or|dered a very exact Course of Diet: the Blood was thin, muddy, and corrupted; whereby I perceiv'd the ill Habit and sickly Disposition of

his Body. He spent the Night in Restlesness, because of Pains over all the lower Belly, and a violent Fever, which kept him from Sleep. In the Morning I repeated the bleeding: He had several Motions to vomit, but could not; and nothing at all came from the Wound, which was dress'd as before.

There being two Enemies to be grappled with, I propos'd to continue the Diversions without Interruption; which was also approved of by our Physicians. We used Potions, Ju|leps and Ptisanes, such as were most proper for purifying the Mass of Blood, and blunting the Points of the Acids; to which I added some Vulneraries: Suppositories were us'd, to pro|cure Stools, but to no purpose; which oblig'd us to give him from time to time half a pound of Decoction in a Clyster, but with small suc|cess. This Method we continu'd for seven Days, without being able to observe any con|siderable change, either as to the Fever, or the Pain; in which time he was let Blood six or seven times. In fine towards the seventh or eighth Day of the Wound, his Bellly was opened, and at first he had a kind of a bloody Flix, but afterward, he voided pure Blood, tho' in no great quantity. I caus'd boil some vulnerary Plants with his Broth; and made him take for some Days fasting, a little spoon|ful of our Samaritan Balsam, call'd that of the Scripture. The Fever and Pains abated a

little, which gave me some hopes of recovery. The voiding of Blood by Stool continu'd till the fourteenth Day; and then all the dange|rous Symptoms disappear'd, and the Wound was compleatly cur'd, without having afford|ed any considerable store of Matter.

REFLECTION.

It was only the Situation of the Wound, together with the Accidents which followed, that made me conclude, that either the Ventri|cle or the Pylorus was wounded. Having there|fore no certain sign, to direct my Judgment in this Affair; I try'd if the Sword that had giv|en the Wound, could make any discovery; and found it was mark'd with Blood, the length of ten inches or thereabouts: There needed no more to assure me of the Nature of the Wound: But that which altogether con|vinc'd me, was the Blood voided by Stool, the seventh Day of the Wound: This having been collected in such a quantity, as was suf|ficient to press and push forward the Excre|ments contain'd in the Guts; at length made way for it self: And if we had delay'd to bleed him, or done it more seldom, he would cer|tainly have had a great and very dangerous Flux of Blood, besides a number of other Ac|cidents that infalliby had followed.

It appears then, that the true Knowledge

of Wounds, which pierce into any Cavity o•• the Body, and hurt the inward Parts, de|pends upon the Accidents: and it is of high concern to a young Surgeon, not to confide too much in his Probe, or thereby to give his Opinion: he ought also to make all requisite Diversions; and to endeavour with all neces|sary Care, to avoid and prevent Accidents; which too often, when arriv'd to a certain height, become Proof against all our Indea|vours.

A great many wounded Persons, have been sent to me, dress'd at first as if their Wounds had been but slight; which nevertheless I have found to be deep, and very considerable. It is sometimes not possible, to put the Pati|••nt in the same Posture he was in, when he received the Wound: So that it is an easie matter to be deceiv'd, if we trust to such uncertain Tryals, as those made with the Probe: The Parts may have chang'd their Si|tuation, or they may be swell'd; or clotted Blood gathered together in the Wound, may oppose the Probe's Passage; or, when it can't trace the Way of the Instrument that made the Wound, it may slide along, between the Interstices of the Muscles. Oftentimes the Wounded either know not in what Posture they were, or are mistaken therein; or they are not in a Condition to give an Account. Finally, it is much better to exceed in Exact|ness,

which can't prejudice the Patient; than to take up with an Vncertainty, which may cost the wounded his Life, and the Surgeon his Reputation.

Moreover, it appears by the Success of this Cure, that the Orifices of penetrating Wounds, afford but very small Assistance, to the Cure of the inward wounded Parts: For it is next to impossible, to convey, through them, Remedies to those Parts, that want 'em, and for which they are design'd: This I am bold to affirm, contrary to the sentiments of the Ancients, and of Fabricius ab Aquapenden|te, and some Moderns. It is also scarcely to be expected, that the Blood which flows from these Parts, should come forth by the external Orifice; as we have observ'd: Unless the low|er Belly be quite fill'd up with Blood. And in fine, the keeping open of the Wounds, is more pernicious than profitable; serving only to in|introduce the Air into Places, where it almost never fails to occasion Irritations, disquieting Pains, Coagulations, Obstructions or Cor|ruptions, and oftentimes all these Evils toge|ther.

Galen affirms, that Wounds in the Bottom of the Ventricle, if not great, are curable: But Celsus is of Opinion that they are mortal: Now, how to reconcile such opposite Senti|ments, I know not. However that they are not absolutely Mortal, this Cure is a suffici|ent

Proof: But it is nevertheless true, that they are very dangerous, and their Cure un|certain; being atttended with many Acci|dents, the least of which may prove fatal: Such as Vomiting, a Disorder peculiar to this Part; or a Flux of Blood from the branches of the Arteria caeliaca, the Vena Gastrica and Gaf|frepiploica; whether scarce any Astringents can reach, and where they can't be kept on: also Convulsions may be occasion'd by the wounding of the Nerves that proceed from the Recurrents: Add to these, that by Wounds of this part, the Chyle may be evacuated, so soon as made.

CAAP. XVII. Of the Perinaeum.

OBSERVATION XVI.

DUring the Campagne of the foremention'd Year 1688, a Soldier in the Regiment of the Duke of Savoy, and Company of St. George call'd La Couleur, was sent to me, ha|ving an Abscess which cover'd all the Perinaeum and part of the Scrotum.

After I had opened it on the left side, at that Place where ordinarly the Operation for extracting the Stone is perform'd; there came

forth a great deal of corrupt Matter, with much Vrine, whereby I understood that by the long stay of the Matter, the Membranes of the Bladder were vitiated and corroded.

I used neither Tent nor Dilater to the Sore, but judg'd it sufficient, to drop into it a Medi|cine for cleansing the Ulcer. The Suppuration lasted for the space of fifteen Days; which yet hindred me not, from the very first to use lit|tle long and slender Bolsters, for bringing to|gether the divided Parts, which I kept fast with a strong Bandage, fitted to the Figure of the Part.

After this, perceiving the Matter came away in a moderate quantity, and of a laudable consistence, tho' mix'd with some Urine; I used more powerful Incarnatives, Balsamick Water, and the Balsam of Peru, and upon these Crollius's Plaister: I straitned the Ban|dage, obliging the Patient to keep his Thighs close together: Thus by degrees the Urine resum'd its former Course, and in five or six Weeks time the Cure was finish'd.

REFLECTION.

This Cure is inconsistent with the Opinion of Galen, who Aphor. 18. says, that divisions of the Blader, cannot be united, because it is a Part without Blood.

I have had many under my Hands, that were wounded in the Bladder, which were all happily cur'd by the same Method: And in|deed if loss of Substance occasion'd by the cor|rupting Matter of an Abscess, has been readily enough made up; it is easie to believe, that simple Divisions thereof by external Causes, may with much more Ease and Expedition be united. This is sufficiently demonstrated, by the great number of those which have recove|red after Cutting for the Stone: And if some|times Fistula's were left after this Operation; they have been occasion'd, by keeping Tents in the Wound without any necessity: I know M. Verdue imputes this to the sharpness of the Urine; but that I can't be perswaded of; ha|ving observ'd in many Places of my Travels, that the country People have us'd nothing else, but their Vrine, to cure their Wounds.

But if we reflect a little on the Effects produc'd by Tents, which many People use in the Divisions of this Part; we may soon be convinc'd, that they are the Cause of this Ac|cident, by keeping open a way for the pas|sage of the Vrine: which tho' it cannot run in a full Stream, so long as it is hindred by the Tent; yet this being penetrated by the Vrine, dulls the Sense of the place, and turns the Flesh Callous.

When a Wound abounds in Moisture, be the Humor what it will, it is of difficult Cure:

this is sufficiently confirm'd by the Fistula's which happen in the Breast or Joynts, tho the Urine have no hand in the Matter. Moreo|ver, to convince us that the Humours, where|with Wounds and Ulcers are watered, are an hindrance to their Joining and filling up; we need only to consider, these Openings in the Thighs and Legs of Hydropick Persons, that are made by Nature, or that we are necessita|ted to make by Art. Every body knows that the Cure of these, is extreamly difficult to be effected, because of the Humidity wherewith they are continually soaked; which is suffici|ent to support what we have advanc'd on this Subject; and to perswade such as are of a contrary Opinion.

Moreover, the Breaking, or Fretting of the Lymphatick Vessels, which occasions the perpe|tual running of watery Humours in Sores, hin|ders their Reunion; in regard that this Sero|sity dilutes and carries away the Nutricious Juice, and brings them to a Fistula. Great Suppurations also have the same mischievous Effects; but these being not so obstinate, are more easily conquer'd, than a Running of the Lympha.

Finally, if we would effect a speedy Cure in Wounds of the Bladder, we must carefully shun whatsoever may widen them, or hinder their Re-union; we must apply some power|ful Incarnative, such as the Balsam of Peru; a

substantial Agglutinative Plaister, as that of Crollius, with small longish Compresses, and a sufficient Bandage, as hath been said: but a|bove all, we must take Care that the Patient be altogether at Rest, without any Distur|bance. These are the Means, which I have found most effectual, and most successful, in bringing such kind of Vlcers to a perfect Cure.

CHAP. XVIII. Of the Fundament.

OBSERVATION XVII.

MOnsiue de Monrodon, Captain of a Batta|lion of the King's Regement, command|ed by M. Desbordes, having been four Years ago cured of an Abscess in the Anus, there re|mained still some Fistulous Sinuses, from which there was always discharg'd a great deal of Matter: This Inconvenience oblig'd him, in the Year 1695, to demand my Advice. Ha|ving observ'd several Callosities about the A|nus with deep and winding Cavities, I pro|pos'd to him, to lay open the Fistula, in or|der to consume these Hardnesses, and cleanse the Bottom thereof, without which there was no Hope of a perfect Cure. But he calling to

Mind the Torments, he had endur'd in the first Cure, put it off for some time; till fal|ling into an Indispotion occasion'd by his ill habit of Body, the Fistula open'd of it self, a|bout a Month after I had seen him, with an extraordinary Running, and great abundance of Matter, accompanied with a quick and in|supportable Pain.

I was at that time, in a Place at some di|stance from our Hospital; wherefore he caus'd himself to be dress'd by a Mate of the Regi|ment, who having nothing but the common Re|medies, and understanding only the ordinary Method, fill'd up that large Cavity with a great quantity of Lint, arm'd with suppurative and putrifying Medicines, which made a terrible Corruption, and great Havock in the Part; en|creasing the Suppuration, and the Pain. He then sent me an Account, of the deplorable Condition to which he was reduc'd; praying me to come and see him. When I came I ad|vis'd him to cause himself to be remov'd unto a Place, where I might take care of him my self; which also was done that same Day. The Matter that was retain'd, and the conti|nual Exasperation of the Parts, had made a Hole, big enough to admit ones Fist, which pass'd with a winding course even to the Os sacrum; there was also another Sinus that reach'd to the neck of the Bladder: so that the sick Per|son could no ways go to Stool, or enjoy one Minute of Repose.

Having taken him under my Care, I dress'd him only with the Red Balsam melted with an equal quantity of the Samaritan Balsam; which I pour'd warm, into the Sinuses; and after having fill'd them therewith, I cover'd the O|rifice with a large Pledget dipt in the same, over which I put a Plaister, and upon this a Compress; making all fast with a convenient Bandage. I caus'd him use some absorbing Medicines to dull the Points of the Acids, and Ptisanes to putrify the Blood, and also some gentle Purgatives. This Method succeeded so well, that the Matter which was thin, putrid, and corrosive, became laudable; the Flesh which was loose and wasted, by degrees reco|ver'd its firmness; the Patient went to Stool every Day without any Pain; at Night also he enjoy'd the Repose which was so necessary for him: and finally, in one Month's time he was compleatly cur'd; the Sores being brought to a firm and laudable Scar, to the amazement not only of the Patient himself, but of all those also who knew, to what a deplorable Conditi|on he was formerly reduc'd; being without all Hope of being cur'd.

REFLECTION.

These kinds of Distempers, are extreamly ••roublesome, that affect parts, on which, by Rea|son of their necessary Vse, it is very difficult

to keep the Dressings: such a Part is the Anus, that is often afflicted with great Suppurations, and dismal Putrefactions, which delay and pro|tract a Cure to a formidable length. The Person we have been just now speaking of, is a clear demonstration of this. In the first Cure, six Months time were spent; he endur'd much Pain and Trouble, and after all it was not brought to Perfection: From whence I infer, that it is evident, that the Gentleness and Easi|ness of our Method, was the genuine Cause, of the perfect and speedy Cure that ensued: For that Organ which serves for the Common-shore of the Body, being left at Liberty, and not straitned by an Extraneous Body; the Ex|crements were neither press'd nor retain'd, but were discharg'd with Ease, and without Pain: whereas on the contrary, when Wounds in this Part, are cram'd up with Lint, it is impossible that Evacuations can be made by the Anus, but the Excrements must press and squeeze the crouded Lint against the Sides of the Sore; which must needs occasion insuffera|ble Pains, and oftentimes also a Flux of Blood: And indeed Monsieur de Monrodon affirm'd to me, that he never went to Stool all the time of his first Cure; but he was still troubled with these two Symptoms.

Finally we may see, that when Putrifying and Suppurating Medicines are laid aside; the Parts are by the means of unctuous Balsamicks,

gradually restor'd to their former Tempera|ture; and that when the Points of the Acids are broken, and the Mass of Blood purifyed by proper Remedies, the natural Balsam of the Parts, doth cleanse, fill up with Flesh, and cicatrize, when ever the Occasion requires.

CHAP. XIX. Of the upper Part of the Shoulder.

OBSERVATION XVIII.

IN the Year 1678. as I travelled from Turin towards Rome and Venice, there was brought to me, the Son of an Inhabitant of a certain place called La Rose, having an Abscess that covered all the Acromion, and the upper part of the Shoulder-bone of the right Side, with a great Defluxion of Humour upon the Joynt. I shewd his Father the urgent necessity there was of opening it, and the Accidents that otherwise might ensue: but the fond Love he had for his Son, made him withstand the Pro|posal. Some time after this it opened of its self; and the thinnest part of the Matter, made its way through several Holes, into which so many Tents were put by a Surgeon of the Place, who dress'd him, at his Father's Desire. This Method was followed for two

or three Months without any Prospect of a Cure.

At my Return, he was committed to my Care, in a very bad Condition: he was alto|gether depriv'd of the Motion of his Arm; several Cavities were form'd about the Joynt; there was a perpetual Flux of Matter; and the Ligament were relax'd; which made me fear the falling out of the Head of the Hu|merus. I was perswaded that the Distemper was past Cure; considering the Weakness of the Patient, and of the part affected, and the ill Disposition of his Body; which yet was but a Symptom of the Disease, occasioned by the great Irritations, and continual Discharge of Humours, as I knew by the Sequel. I made however a pretty large Opening in that which I judg'd the most depending part, and straight|way took away the Tents, tho' at that time I was not altogether convinc'd of their perni|cious Effects.

From that time forth the Flux of Matter begun to diminish, which made me endea|vour, with all possible speed, thorowly to cleanse the bottom of the Ulcer, and the Si|nuses, with a Lotion of Birthwort, Myrrh, Su|gar-candy, and Vitriol, in White-wine; which had very good Success: I did my best, also, to strengthen the Joynt. Finally the Cavi|ties were fill'd up by degrees; the higher O|rifices were first clos'd up, and the others af|terwards.

He was cur'd in two Months time; but his Arm was something more than other two, before it recover'd its Strength.

REFLECTION.

This sudden good Success, falling out so un|expectedly, and at a time when I had casually, tho' very seasonably, laid aside the use of Tents, began to open my Eyes and to make me enter|tain an ill Opinion of them: For I could blame nothing on this occasion, save the Tents, which had been so long kept in the Sore, for having caus'd all these Accidents, by the Irri|tation and compression of the Parts: And moreover by hindring the Discharge of the Matter, from one dressing to another; where|by it had time to gather, and to ferment, to encrease the Cavities, and Waste of the Sub|stance, to moisten the Tendons, slacken the Ligaments, and to weaken and intirely ruin the Part. Finally, the most part of the Sym|ptoms, ceasing with the leaving out of the Tents; does sufficiently evince, that they pro|ceeded from them: and had the first Method been continu'd in for a Month or two, a com|pleat dislocation of the Head of the Shoulder-bone, the corruption of the Ligaments, and in|curable Fistula's, had certainly ensu'd; and the Patient would have thereby been made lame during his Life.

CHAP. XX. Of the Shoulder.

OBSERVATION XIX.

IN the Year 1692. a Soldier of the Regiment of Sourche, whose name I have forgotten, was brought to the Hospital at Brianzon. He was wounded with a Bullet, which entered at the foremost and middle part of the Acro|mion, and came out on the upper part of the Shoulder-blade; breaking the Acromion, with a part of the Scapula, as it went along.

The Orifices were straitway dilated, and drest only with Pledgets and the Digestive: Diversions were speedily made, and his Diet or|dered. In the first Dressings, several pieces of Bone, that cou'd not be reunited, having been almost wholly separated, came away; seve|ral others that were yet ty'd by a small piece of the Periosteum, tho' in appearance shaking and ready to fall off, were yet joyned again.

Finally, all the adhering Splinters being a|gain united, the Wound began to fill up; and in two Months time, or thereabout, was brought to a firm and laudable Cicatrix; to the great Surprise of all who had been present

at the Dressings: no Accident having happen|ed all the time of the Cure.

REFLECTION.

It will certainly be thought strange, that I permitted the Orifices to be clos'd up, with|out expecting the Discharge of the Bones: And it will possibly be said that I dress'd not according to Art.

But to me it appears much more reasonable and advantageous, to have preserv'd them, than occasion'd their Loss; seeing a Callus has never the becoming Convenience of a Natural Part: And the Excellency of Art consists, in curing speedily, if possible, and without Pain; and in preserving the Figure, Substance and Disposition of the wounded Parts. 'Tis certain, that Health being the End of the Surgeon's Art, the principal De|sign is attain'd, when the Cure is perform'd.

If that Intention which ought to be the Scope of the Artist, can, by this Method, be Gently, Easily and Speedily accomplish'd; there is no Controversie but that it ought to be preferr'd to all others that are contrary to it.

CHAP. XXI. Of the Arm.

OBSERVATION XX.

THE following Year, a Granadeer of the Regiment of Navarre, call'd Belle Hu|meur, was brought to the same Hospital, wound|ed with a Shot on the upper Part of the left Shoulder-bone, about an Inch, or two Fingers breadth below the Joynt: The Bullet entred on the fore Part, and went out behind, making a terrible havock. Three or four Days pass'd, wherein he was not dress'd, but only slightly at first, and without making any Diversion. The whole Arm was distended like a Foot-ball, the Orifices were choak'd up, inflam'd, and dispos'd to Gangrene.

I made Incisions in the Orifices, to give breath unto the Wound, and Scarifications o|ver all the Arm; and having dress'd with a Digestive only, without Tents or Dilaters, I let a good quantity of Blood run from the Part, by the Incisions, to empty it somewhat; and afterward fomented it with Spirit of Wine and a little Sal-armoniack: I apply'd over all the Arm Diapalma dissolv'd in Oyl of Roses and

Vinegar, which in a little time abated the In|flammation of the Part, and lessened the Swelling.

Diversions were not omitted; but in spite of all could be done, three Abscesses were form'd; one at the bending of the Elbow in|wardly, another on the outward and middle part of the Arm, and the third on the hinder and almost lowest part of the Humerus: They were all three opened, and by their plentiful Suppuration, the whole afflicted Member was eased. After three or four Splinters of the Bone, that stuck by their upper part only to the Periostium, were again Joyn'd, I bent all my Endeavours to bring together, and unite the Lips of the Wound: And when the Escar was intirely fallen, and the Symptoms vanish'd, I us'd only a simple Incarnative, dressing but once in two Days: The Suppuration was but small, and the Orifices begun apparently to fill up, and in thirty Days were quite skin'd o|ver: So that from thenceforth I us'd the rol|ling Bandage and Plaisters, in order to fortify the Callus; And now his Diet is increas'd, and he is able to rise from his Bed. Finally he de|parted to return to his Regiment, forty four Days after he had receiv'd the Wound.

REFLECTION.

The delaying of the Diversions, as evident|ly appears, was one of the chief Causes of the Accidents that followed upon this Wound; and 'tis plain that if Tents, Dilaters, or other ex|asperating things had been us'd in dressing, they had infallibly prov'd an Impediment to the Discharging of the Part, and ripening of the Abscesses, for Reasons adduc'd in the first Part, when we discours'd of their fatal Ef|fects.

Nature is, in such Cases, sufficiently per|plex'd, without the additional Oppression of the most grievous of all her Enemies: She is, as it were, fetter'd, and can't act: And when by a healthful and critical Motion, she endeavours to deliver her self, as in the Abscesses of the former Cure; she is unable to produce any desirable Effect, so long as the Wound is cram'd full of Lint: and the most frequent Conse|quence of this, is a Stifling of the Natural Heat, after which follows a Gangrene.

There have but few Accidents followed up|on Wounds, treated after our Method; and I am bold to affirm, that scarce any have mis|carried under our Care, tho' more dangerous|ly wounded than this Soldier of whom we have been speaking; all which is owing to the Gen|tleness of this Way, and the Use of Diversions.

CHAP. XXII. Of another Wound in the Arm.

OBSERVATION XXI.

IN the Year 1690. a little time after the War was declar'd in Savoy; a Soldier of the Regiment of Pondenx, nam'd La Montague, was sent to the Hospital at Brianson, who had got a violent Blow with the Handle of an Hal|berd, on the middle and outward Part of the left Humerus, whereby the Bone was broken to pieces, with a Wound, and gteat Contusion.

Several portions of the Bone stuck out at the Wound, which did still adhere to the Peri|osteum. I plac'd them one by another, as gently and nimbly as possibly I could; endea|vouring to give them their natural Position. I rub'd the Part with a powerfully dissolving Balsam very warm, which I had caus'd to be prepar'd for Contusions. I joyn'd the Lips of the Wound, and apply'd an Incarnative. I gently roll'd the part with a Band about three Fingers breadth above the Wound, and with another as much below it; applying a Plaister made of Diapalma dissolv'd in Oyl of Roses, and Vinegar, between the Bands, the middle part whereof being opposite to the Wound,

the Ends met upon it, and covered it: Upon this I put a Compress, of the same figure and bigness, folded into three or four doubles, and dipt in warm Wine: And then a piece of Past-board, which resting with its ends upon the two Roulers, and embracing and keeping fast all the Wound-apparel; came together, and was tied on the hinder part of the Arm.

In this Past-board there was a Hole cut out, where it covered the Wound, to which a piece of the same was fitted, to be taken off at each dressing, and afterward put on: This was made fast with a little Band, which I roll'd about all the Past-board after I had apply'd my Dressings, in such fashion, that without disturb|ing either the Arm, or the Past-board, I had nothing to do, but when there was Occasion, to unty the Band, take off the piece, and lift up the two ends of the Compress and of the Plaister; and so to embrocate the Wound, and then to dress it with a Pledget only, and do it up again.

In this manner, it was dress'd once a Day, for five or six Days: after which I gently took off all the Dressings, save the Rollers; and changing the Plaister and Compress, I drest but once in two Days. No Accident happen'd; for the Contusion was quickly dissolv'd, no Bones were discharg'd, and the Suppuration was but little; Diversions having been made from the very first. The Wound was fill'd up,

and compleatly skin'd, about the twenty se|cond Day of the Wound: wherefore I thence|forth dress'd it only with Rollers, the Plai|ster pro Fracturis, and the necessary Splents. Since that time I have not seen him, because then we parted from Luserne; but 'tis certain he was past all Danger.

REFLECTION.

If this Way of Dressing, be compar'd with that of many Surgeons, who not only fill up the Sores with Lint, but also at each Dressing move to and fro the broken Pieces of Bone, in order to promote their Separation, it may be seen how different the Success will prove. Had I treated this Wound in a rigorous man|ner, such Accidents had undoubtedly happen'd as would have baffled my Care. The Sup|puration would have been great; and thus the Pieces of the Bone, thereby quite separated, and carried into some Cavity, had caus'd many Abscesses and Sinuses: which Disorders, oftentimes cause a necessity of Amputation; and when the Strength is decay'd, they bring on Death. After this I made use of a Piece of white Iron, form'd in the same Fashion as the Past-board, with a Window opening upon the Wound, which being lift up, I dress'd it with|out moving the Body of the Machine. But seeing in those Places where Hospitals are,

we have not every thing requisite at hand, the Surgeon must supply that Defect by his own Ingenuity.

CHAP. XXIII. Of the Fore-Arm, or Cubit.

OBSERVATION XXII.

IN the same place, a Soldier in the foresaid Regiment, receiv'd a Shot in the Fore-Arm, on the middle and hinder part; which broke the Radius, and carried away a Part of the Cubitus.

He was dress'd after our Method; but the Cavity of the Wound was filled with a Pledget of very fine Lint, dipt in a Mixture of our Balsam, and a little Linimentum Arcaei, which easeth Pain, promotes the fall of the Escar, and resists Fluxion of Humours. Diversions were made, and his Diet ordered.

We dress'd him after two Days, and found two or three pices of Bone sticking to the Lint. In the second Dressing, I set the Ra|dius, keeping it firm with little Compresses stiffned with Past-board: One of these I put on the fore-part of the Arm upon the broken Bone, another on the inward, and a third on the outward part; making them all fast, with two Rollers, one above, and the other below

the Fracture: this Apparatus kept the Arm streight, and serv'd instead of a Defensive. Over all we apply'd the Past-board, and sup|ported the Arm with a Sling. The Suppura|tion was very moderate, and another piece of Bone came afterwards away: We dress'd but once in two Days; and on the twelfth or fif|teenth of the Wound, the Flesh begun to co|ver the Bone; for which Cause, we dress'd him only once in three Days, and that very gently and speedily. Towards the twentieth Day, the Wound began to be fill'd up. The defect of the Cubitus was made up with a Callus, and the Radius recover'd without Exfoliation; and all in four Weeks time: after which I only us'd a Roller on the fractur'd place. About this time we parted from Luserne, and I have not seen him since.

REFLECTION.

The good Success, the Expedition, and the Gentleness of these Cures, ought, in my O|pinion, to give some Reputation to this way of Dressing. I have not seen, since first I entred upon Practice, any Method followed that has been either so short, so easie for the Patient, or so certain in the Consequence. Hereby these Pains are prevented, which or|dinarily bring Fevers, that are attended with many other Accidents: Abscesses, Fluxions,

and Inflammations are avoided: the Matter is but little, and that laudable: the Wounded can take solid Nourishment, and necessary Rest; whereby all the Faculties become more vigo|rous, and Nature more active, Flesh is more easily generated, and a Callus more speedily formed: and in fine, every thing with more facility re-establish'd, and reduc'd to its for|mer State.

CHAP. XXIV. Of another Wound in the Fore-Arm.

OBSERVATION XXIII.

ABout the End of the Year 1695. I being in the same Post in the Hospital of the Abby of Oulx, wherein I was in that of Bri|••••••on, there was brought to us one call'd Beau|••••••••, belonging to the King's Battalion com|manded by M. Des-bordes, and of the Compa|ny of M. du Mont. He was run with a Sword into the middle and inward Part of the left Arm, whereby the Artery between the Radius and Cubitus was opened.

He had remain'd eight or nine Days in his Quarters, being dress'd by one of the Mates; who, without making any Diversion, only shut up the Wound with a strong Stopple, which

restrain'd the great Flux of Blood between Dressings: But at the time of Dressing he bled excessively. The Blood which was ex|travasated in the Member, did there corrupt, and caus'd Abscesses in several Places. But at last, his Surgeon, seeing that his Strength was daily diminished, and fearing some fatal Acci|dent, caus'd him to be sent to Oulx.

His Weakness was advantageous to him: for whereas Amputation was chiefly indicated, his loss of Strength was a contrary Indication that prevail'd over the former. I dilated the Wound that I might discover the Artery, and empty the Part, of that Matter and clotted Blood, wherewith it was fill'd. But being then unfurnish'd with such things as were ne|cessary for my Design, I apply'd a Button of Vitriol to the Opening of the Artery; and having fill'd the Wound with Lint, and apply'd the other Dressings necessary on such Occasi|ons, I let him Blood twice, but in small quan|tities; and gave him certain Emulsions, where|in were mix'd some Anodyne Medicines, to re|tard the Motion of the Blood. I let two Days pass without Dressing; but on the third, I found all I had done, was to no purpose. At the Place where the Artery was opened, there was a considerable and painful Swelling; the Lint that fill'd the Wound, was heav'd up with the Pulsation, and a Bloody Water came out, which presag'd the sudden return of the

Bleeding. I caus'd prepare my Troches of Rose-water, Gum-Dragant and Vitriol, with some good Styptick Water, and two Days after I took out all that which fill'd the Wound: I also took away the Escar made by the Vitriol, and the Fungus that was grown in the Wound; which I further dilated to give vent to the Blood, that had diffus'd it self through the Flesh, beyond the extent of the Wound. All this time I repress'd the Bleeding by the Turnkey, which I caus'd to be slackned, to discover again the Opening of the Artery, to which I apply'd two little Troches, supported by a small Compress, dipt in the Styptick Wa|ter: I fill'd the Cavity of the Wound with Dossels pretty hard; and moisten'd in the same Liquor; then I took a large Compress of three Fingers breadth; thick, and a Foot in length, cover'd only with Bole dissolv'd in Vinegar; this I apply'd along the Artery, even to the Arm-pit; and lastly an astringent Plaister, which I made fast with Compresses, and strong Bandage. I caus'd the Arm to be laid on a Pillow, with the Hand higher than the Elbow. Two Days after, I unty'd the Rollers, and took off the Compresses and the Plaister; and seeing things in a good Condition, I apply'd new Astringents, without touching the Wound. This Method I continu'd two or three Days: afterward I begun to remove the Dossels that were outmost, sustaining always the others

with new ones, hindering also those which were next to the Artery to fall off untill the Suppuration were begun, that time might be given to the Flesh, to cover the Artery; the Bleeding being very well stop'd. In effect a|bout ten or eleven Days after the Application of these Dressings, all came off of its own Ac|cord, not one drop of Blood following; for the Artery was pretty well cover'd. All this was done in presence of M. Davejan, one of the Physitians of the Hospital, a Man of Integri|ty, Merit, and great Skill. Finally the Wound was in a little time compleatly cured.

REFLECTION.

These kinds of Wounds, where Arteries are opened, are of all others the most ticklish; they give a great deal of Trouble; and but lit|tle Reputation is gain'd by their Cure. Every one knows, that there was no place for the O|peration of the Aneurisma, where this Artery was opened; and that it was necessary either to cut off the Member, or to let the wounded Person perish, or to stop the Bleeding by such means as I us'd. By this we may see, that it is not good to be too hasty in cutting off a Member, where Arteries are opened that admit not the Aneurisma; that we ought not to dispond, tho' our first Attempts to stop the Flux of Blood, prove unsuccessful; and that

the Troches which I use, are upon many ac|counts better than Vitriol. This is not the on|ly time, that I have experienc'd the Success of this Method, in a like Occasion: I made some Tryals of the same at Luserne in the Year 1686. and in particular, upon a certain Soldi|er, who had the Artery that is between the Tibia and Fibula opened: After much trouble, before I would condescend to the cutting off of the Member, I was willing to try this Method, which had also a very happy Success. That we may preserve a Member, we are to leave nothing undone; neither ought we to consent to its Amputation, untill first all other Means have been in vain assay'd.

CHAP. XXV. Of the Hands.

OBSERVATION XXIV.

SInce the beginning of the War, I have had under Cure very many, whose Hands were pierc'd, torn, or half carried away by such Fire-Arms as burst asunder, which is a thing very ordinary in Armies. Many others also have I dress'd, that had their Hands shot through with Bullets, and cut with sharp Instruments, of which I shall not speak in particular.

But I may say, that all those I have dress'd, in these latter times, tho' by the Wounds, the part has been very much shatter'd and torn, have been always cur'd, without losing what remain'd of the Member, and with little or no discharge of Splinters of the Bones, or loss of Fingers, or their Joynts.

In this kind of Wounds, as well as in others, I have avoided frequent Dressing, and the Use of putrefying Medicines: and I own that I have ever found the Spirit of Wine, a very suc|cessful Remedy in Wounds of the Extremities, and in those of Nervous Parts. I have us'd 〈◊〉〈◊〉 it chiefly in Hospitals, where it brought al|ways a speedy Relief.

Many of the Ancients, have ordered to keep open for some considerable time, the Wounds of the Nerves and Tendons; to give vent to such Matter, as by its Stay, might corrupt the Substance of the Parts.

But Experience has taught me, that 'tis much more benificial to the wounded in such Cases, to hinder, than to promote the Suppu|ration; by doing betimes what is necessary to prevent Fluxions upon the Part: some|times applying good Defensives to the superi|or Parts, to repress the activity of the Blood; and some times using resolving Anodines to the Place afflicted, if there is need, to prevent or take off the Pain, from which most comon|ly the Accidents proceed that attend such

Wounds; and to stave off at the same time the Attempts of the Air, which is the greatest E|nemy of the nervous Parts.

I can aver, that by using this Method, I have cur'd such Wounds much more suddenly, than I could any other Way. I believe also, seeing all are agreed that the Air is pernicious to Wounds in general, that none will question but these of the Nerves, receive thereby a more notable prejudice, than those of any o|ther Parts of the Body; considering their Tenderness, the Nature of their Substance, and their Temperament. I leave it then to Conside|ration, whether Wounds of this kind, could be defended from the Injuries of the Air, if they were kept open, according to the Opini|on of the Ancients.

But it will be said, that 'tis extremely diffi|cult, after all possible Precaution, to avoid the use of putrifying and irritating Medicines, and of Dilaters, in Cures that are tedious: For if such things as breed Flesh, and are bal|samick be us'd, when the Wound at the same time must be keept open, there will be a ne|cessity of consuming incessantly the Flesh with Cathereticks; which are very apt by the Pain they cause, to produce Accidents, especially in parts so sensible as these.

Now to this I say, that if Suppurating and Putrifying Medicines are us'd, there almost e|ver infallibly follows a great Suppuration; and

sometimes a total Dissolution of the nervous and tendinous Parts: Especially if Tents or Dilaters be also imploy'd; which, if but for a small time they touch such Parts, do often|times draw on Incurable, and sometimes Mor|tal Symptoms.

Wherefore, I have ever judg'd it best, to close up the Wound so soon as possible, on such Occasions; chiefly when there is no ex|traneous Body, which of necessity must be drawn forth; or if all requisite Diligence, has been already at first Dressing us'd to that in|tent. In fine, tho' I have ever, not only a|voided with all possible Care, the using of pu|trifying Things; but also have indeavoured to dress as Seldom as might be; I dare affirm, that in this way of practice, there never hap|pened even the least Accident, to all that great number of wounded Persons, drest according to it, in our Hospital at Brianson.

Pareus, Book 10. Ch. 9. shews, that by this Method he successfully cur'd the Pricking of a Tendon, which King Charles the ninth, had received in Blood-letting: Tho' in another Place, he exceedingly finds fault with those, who use the Stitch to wounded Tendons: He would undoubtedly have been of another Mind, had he liv'd, and seen, as I and many others have done, how often the deceas'd M. Bien-aise, an expert Surgeon, has perform'd the same with Success in his House at Paris. But after

all, we may maintain, that he is not the first, who has practis'd the Stitching of a Tendon: For in former times it was ordinary, and many of the Ancients have done it.

CHAP. XXVI. Of the Thigh.

OBSERVATION XXV.

IN the Year 1686. when the Vaudois were driven from the Vallies of Luserne; one Le Grand, a French-man by Birth, Sergeant in the Regiment of Guards, and at present an Officer in a Regiment of Fusileers belong|ing to His Royal Highness, being wounded by a Bullet in the upper and outward part of the right Thigh, and the Ball not to be found, was brought to the Hospital at Luserne.

He had lain a Day and a Night helpless up|on the Ground; which occasion'd a conside|rable Fluxion, and an Inflammation of the Part. I made large Incisions, and spar'd no Pains to find the Bullet, but all in vain.

He was forthwith let Blood, and had a Clyster given him; an exact Course of Diet being ordered. The Bleedings were repeat|ed, with the other Remedies for withdrawing the Humors from the Part. The Swelling

and Inflammation were lessened; and I began to think, that things were in a pretty good Condition: I kept in the Wound only a little Tent, about the length of two Fingers Breadth, very soft, and of pretty fine Lint.

Thus the first Accidents were vanquish'd; but, others more troublesome and more ob|stinate yet remain'd▪ for the Suppuration and Flux of Humours was so prodigiously great, that I verily believ'd, his whole Body would thereby have been dissolv'd. At every time we opened the Wound to dress it, which was twice a Day, more than a Pint of Matter came away, besides what was discharg'd be|tween Dressings, which might be judg'd as much: In the mean time the Strength of the Wounded Person was more and more impair|ed, and his Body insensibly wasted away.

I could ascribe all these Accidents, to no|thing else but the Bullet, which remain'd in the Member: and this I the rather inclin'd to think, in regard that almost all the Bullets, that were drawn from Wounds during this Campagne, were full of Sublimat, or Glass; and many others of other Metals, and Tin.

I advised with M. Conte, then at Luserne, Surgeon in Ordinary to his Royal Highness; who being acquainted with the Order of Cure, and the Symptoms, was of Opinion, that by Purging the Moisture might be dry'd up; this was accordingly put in practice.

I was so eagerly desirous to effect this Cure, as if all my Reputation had depended upon the Success: and indeed it appear'd, as if Pro|vidence had thereby design'd to open my Eyes, and to make use of me for the Relief of ma|ny others being qualified for that end, by the Experience I therein attain'd.

The Wounded Part was greatly disordered by the Purging, yea in such sort that I fear'd a Gangreen: the Fever was encreas'd, and the Patient had quitted all his Hopes, notwith|standing the Assurance he had conceived, of being cur'd under my Hands.

As for my self, I began to despair; although it is my Humour never to give over my Wounded Patient, so long as Life continues: For his Thigh was all over livid, and the spa|ces between the Muscles, yea all the Member, was fill'd and soak'd with Matter, which eve|ry Day increas'd, the Wound being as it were an inexhaustible Fountain. I considered with my self a thousand times, if there was any thing more I could do, or any thing further to be us'd. I had perform'd all that Art pre|scribes, to dry up that Matter wherewith the Part was ever fill'd; having us'd not only hard Bandge with expulsive Compresses, to hinder its gathering together and abode in the part; but also sudorifick Decoctions, tho' all in vain. I was also thinking, to make a Counter-Open|ing under the Thigh, to give a more free

course to the Matter, and to hinder its Stay; but on second thoughts, I believ'd it would be to no purpose.

M. Conte, and generally all who saw the Man, despair'd of his being cured; and told me, that I vex'd my self in vain, as if all my Reputation had depended upon the Cure.

Although I had hitherto assay'd all sorts of Means in Vain, yet I was obstinatly bent to find out some other Way, by my own Conside|ration; seeing the wounded Person himself was also desperate.

As I have formerly said, I had hitherto kept in the Wound a little Tent, about two Finger's breadth long, and very soft: This I resolv'd altogether to lay aside, and to dress the Wound with a Pledget and Plaister only, and such a Bandage, as might be sufficient to keep 'em on.

This affrighted the poor dying Man; and it was with great difficulty that now I could ob|tain his Consent, to have that power over him which of right belong'd to me, and what formerly he had so freely granted.

In the Evening to my great Surprise, I found him in a much better Condition: The Matter came not away in so great a quantity: That night he slept much better than ever yet he had done, since he receiv'd his Wound; and in the Morning I found him yet better: This Evening the Matter began to be of a

good Consistence, and to be discharg'd in mo|derate quantity. Henceforth I dress'd but once a Day.

His Fever, which had continu'd from the beginning, left him altogether, the second Day after the leaving out of the Tent; and from the fourth, he was drest only once every other Day; he also began to eat, and to reco|cover his Strength: from the eighth Day no|thing further came from the Wound, and on the twelfth after the disuse of the Tent, he was intirely cur'd; to the Truth of which I call God to witness.

REFLECTION.

This is the Cure, as I sincerely protest, to which I have been most oblig'd. It was this which made me embrace that Method, which now I expose to publick View; and which from this time forth succeeded so happily with me: and it is certain, that I had infallibly cur'd my Patient at once of all his distempers, if I had continued but only for seven or eight Days, to use a Tent, tho' never so small and soft.

From this time forward, I resolved to a|bandon the use of Tents, and to give my Ad|vice in this Affair to the Publick, when once an opportinuty should present it self. I com|municated my Design to M. Thouvenot, Physician

in ordinary, and Chief Surgeon to their Royal Highnesses, a Man of great Learning and Expe|rience, to be esteem'd, as well for his profound Knowledge, as his eminent Vertue: And ha|ving related to him a discription of the Cure, he confirm'd me in my Opinion.

It was here therefore, in the King's Hospi|tal settled at Brianson, that I drew out seve|ral Observations which I had made, and some Accounts I had kept of many Cures, done in different Times and Places; in order to make up a Collection of them, together with some others done in this Hospital.

But to return to the preceding Cure; it is convenient to observe, that tho' the Bullet was lodg'd in the Member, yet no Disadvan|tage did thereupon ensue to the Patient: which made me think for a time, that the Bullet, hitting upon the Belly of some large Muscle, might have rebounded the same way by which it enter'd. But I found my self out in my Calculation: for being at Turin about a Year and half after this Cure; I was sent for, from the Cittadel where I stay'd; and when I came, I found this same Person whom I had cur'd of his Wound, who shew'd me a a little Abscess that was form'd upon the old Scar. I opened it without Difficulty, and perceiving something white and hard, with my Instrument I drew out the Bullet, which was flat, with a piece of the Thigh-bone stick|ing

to it: The Ulcer was quickly cur'd with|out any Inconvenience, and never more re|turn'd.

Had I at first Dressing found out the Bul|let, to the Misfortune of the Wounded Per|son, I should have been oblig'd by Custom, and the Rules of our Art, to draw it forth; tho' it had been, as indeed it was, sticking in such a part of the Bone, as was encompass'd with greatest Depth of Flesh. But for cer|tain, it could not have been got out with such Ease; or without Pain, and griveous Irritati|ons: Besides I question if the Patient, who was of a bilious Constitution, could have born up, under so tedious, and painful an Operation; seeing an infinite number of Accidents had been occasion'd, only by the touches of a little and very soft Tent. Wherefore I am perswaded, and am bold to affirm, that it is not always necessary, to draw forth the Bullet, when it is lodg'd in a Bone, that lyes deep under the Flesh: Nature, that is much wiser than we, has more gentle and easy ways; and best knows the time to free her self of what is hurt|ful to her.

Hippocrates in the fifth of his Epidemicks re|lates, that he drew forth the Head of an Arrow; from the Groin of a Man, after it remain'd six Years in his Body, without any Accident hap|pening during all that Time.

Alexander Benedictus reports, that a certain Man was wounded in the Back with an Arrow, the Head whereof could not be got out, being bearded, and two Finger's breadth in length: which yet two Months after the Wound was cured, the Patient voided by Stool.

Hildanus in his 6th Observation tells us, that he took out the point of a Knife, which had re|main'd two years, among the acute Processes of the Verterbrae of the Loins, without producing any Accident there.

Let us now therefore acknowledge that Na|ture is wonderful in her Operations! These Examples, together with my own Experience, and Reason, have made me very cautious in drawing forth of Bullets, when they are not lodg'd in Places where they may marr, or quite destroy the Action of any Part; nor in danger of falling into some Cavity.

This Cure, is of it self enough to convince any one of the Advantage, and to establish the Credit of my Practice; it having been pub|lickly perform'd, yea authoriz'd and approv'd by many learn'd Physicians, and skillful Sur|geons of the Court of Savoy.

Since that time, I have in several Places, and in diverse Hospitals, cured many, who have had their Thighs pierced quite through, without either Tents or Dilaters; save only in the first Dressing, for supporting and contain|ing the Astringents necessary to stop the Bleed|ing.

This is contrary to Pareus his Method, who in the thirty seventh Chapter of his tenth Book of Wounds affirms, that Wounds of the Thighs and Legs ought to be kept long open, that the corrupted Membranes may have time to suppurate and come away: as if, indeed, Na|ture that has brought solid Bodies, such as Iron, Bullets, Bones, &c. to the Orifice of Wounds, even after they have been a considerable time cicatriz'd, as hath been formerly observ'd, were not of sufficient Power and Sagacity, to expell some Shreds of corrupted Membranes.

But to avoid corrupting of the Part, the Wounds must be speedily clos'd up; Tents and Dilaters laid aside; the Air must be carefully excluded from the wounded Parts, great Sup|puratives must be cashier'd; and we must dress as quickly, and as seldom as possible.

CHAP. XXVII. Of the Knees.

OBSERVATION XXVI.

IN the Year 1691. when I was at Pignerol, a Captain of a Battalion of the King's Re|giment, commanded by M. de Launay, was wounded in the right Knee with a Bullet,

which went in at the outward and middle, and came out at the inward and upper part thereof. He was drest for four whole Months by a Surgeon of the Army, very well skill'd in his Imployment, but who followed the com|mon Method: He had also advis'd with the Surgeon Major of Pignerol, who had given o|ver hopes of the Cure. The Surgeon that had him under Cure, not thinking to make any long stay in this City, propos'd to me, after so long a time, to undertake the Care of dres|sing him; which I also did.

I found five or six Holes in his Knee, all of them fill'd with Tents that were hard, and long enough to reach to the Bottom. His Leg and Foot were swell'd, his Body very thin, and he had a slight Fever, which had ne|ver left him from the first time he receiv'd his Wound, with perpetual Watchings, and a Loathing of all kind of Food.

I began to leave out all the Tents, and with a small Incision at the lowest Part ••hereof, I dilated the Wound: I laid aside the Aromatick Wine, that had been so long us'd ••o no purpose; and left off the use of a certain ••njection, which being apply'd twice a Day, ••y the Intolerable Pains it occasion'd, had ••angled all the Joynt, and caus'd a communi|••ation amongst all the Holes, which were ex|••ctly stopt with the Fingers, every time that

Medicine was employ'd, that it might make some Stay in the Part.

I dress'd him indeed with the Remedies, that had been formerly us'd; but I took Care to apply them more conveniently, and to accom|modate 'em better to the Nature of the Part, and of the Wound.

When I came to see him the Day following, so soon as he saw me he embrac'd me, and swore in the presence of many Officers, that he was inexpressibly oblig'd to me: And, which was no less surprising than true, he told me, that he had slept all Night, tho' he had not done so, since the first Day of his Wound: that he felt no more Pain in his Knee, and be|lieved his Fever was gone.

He was so encourag'd with this good Suc|cess, that from that time forth he thought him|self cured. For five or six Days, he was dress'd after the same manner once a Day; and after that once every other Day; nei|ther did I change the Oyntments and Plai|sters, which had been so long us'd before with|out any Advantage. The Cure was compleat|ed in less than a Month: After which I ad|vis'd him to go into his own Country, there to use the Waters, in order to strengthen the Part that was weakened by the frequent Dres|sing, and if possible to enable him freely to ex|tend it.

REFLECTION.

It appears by this Cure, that a good Method is the most effectual Remedy, and the princi|pal Instrument in healing Wounds. If any Man will but be at the Pains, to ponder this Case, I doubt not but he will be convinc'd, that the Tents, the Injection, and the other humid things wherewith the Part was perpe|tually moistened, were the Cause of the de|plorable Condition of the Wound. Now if such a thing, as it often falls out, had hap|pen'd to a common Soldier, under necessity of being sent to an Hospital, and treated in the common Way; he must have endur'd twenty Deaths by the tedious and painful Dressings: yea, it is certain, that he could never have held up under them; being at the same time depriv'd of all necessary Conveniences, brea|thing in an unhealthful and corrupted Air, and having Food, neither so nourishing, nor given him at such seasonable times, as a Cap|tain might, who was willing to spare nothing, that might conduce to the Preservation of his Life.

The Account I have given of this Cure, has nothing in it which is not exactly conformable to the Truth. The Gentleman who was wounded himself made the same Relation to M. Goiffons, a very learn'd and experienc'd Physician of

Lyon, and Chief Physician of the King's Ar|mies in Italy.

'Tis true, the Wounds of the Joynts require very great Care, there being few that are ob|noxious to more troublesom Accidents: and when the Part is much shatter'd, they are judg'd mortal. However I am very certain that great Abuse is committed, in the man|ner of Dressing them; and this I judg'd my self oblig'd not to conceal.

The Joynts moreover, are nervous or ten|dinous Parts, and are known to be of a cold and moist Temperament: wherefore they must be guarded from the Attacks of the Air; they must not be exasperated by the Touches of Tents and Dilaters; putrifying Medicines must be suppress'd, because they weaken the Parts to which they are apply'd, and ruin these that are nervous and tendinous.

All these liquid things which are common|ly us'd, are also hurtful to the Joynts; such as Aromatick Wine, Fomentations, and Inje|ctions, &c. Such things as are heating and drying are profitable: We must endeavour to hinder the Waste of the Spirits, and season|ably to perform the necessary Diversions; ob|serving a drying and slender Diet, and using to the Wound Sarcotick Medicines, such as Balsams, or Spirit off Wine; avoiding also long and frequent Dressings. If this Method is followed, all these Accidents, which ordina|rily

accompany Wounds of this Nature, will be prevented.

Fabricius ab Aquapend••nte, in his first Part, Book I. Chap. 49. treating of Wounds in the Joynts, says, That they are not only ex|treamly hard to be cur'd, but also dangerous and mortal; and he adds, that the Cure is dangerous and difficult, both in regard of their own Essence, and also of that of the Joynts: for Nature being the Cause that produces Flesh, and fills up Wounds, is less vigorous in the Joynts, which are cold in Temper, and de|stitute of Blood and Flesh, than elsewhere; especially when weakened yet further by a Wound.

Afterwards in the same Chapter, being sup|ported by the Authority of Galen, in his third Book Of Fractures, he affirms, That whatever lies under the Skin, is advantag'd by being cover'd therewith: and considering that the Joynts are cold, without Blood, and without Flesh, he says that their natural Heat is soon extinguished, especially when expos'd to the Cold of the Air. These were the Thoughts of this Author, who was accustomed to use the Stitch on such Occasions, to protect this kind of Wounds, from the Injuries of the Air.

He further adds in the same Chapter, that Wounds in the Joynts ought not to be left open, or expos'd to the cold Air, because thereby we run the hazard of quenching the Natural

Heat, and of a Gangrene; or if this should not fall out, yet is there seldom seen any Di|gestion in the Wound, when so treated.

These Parts then, as hath been said, are naturally very weak, destitute of Heat, and plentifully watered with Moisture; which by reason of the abounding Salts, is apt to con|tract an Acrimony and Malignity; especially when it is retain'd in the Part with Tents: Now this same Moisture, insinuating it self into the Pores of the nervous Fibers, fails not to harden them, and render them callous; from whence it comes, that these Wounds of|ten end in Fistula's. 'Tis observable also, that if there happen any Change or Disorder in the Blood, this Humour becomes so corro|sive, that it rots the Bones, and destroys the Parts where it comes. Long and frequent Dressing moreover, occasion the like Acci|dents, because of the Admission of the Air, that increases the force of the Acids, and ea|sily destroys that small Portion of Spirits and Heat, with which these Parts are furnish'd.

All these things are of the greatest Impor|tance, and well deserve our serious Conside|ration: and if Reason in any thing ought to prevail over Custom, 'tis chiefly here, where the Life of Mankind is concern'd, which is a thing so precious, that it very well Merits our most particular Care.

After all, I am of the Mind, that the Autho|rity of so famous a Person as Fabricius ab Aqua|pendente, ought to give some Reputation to my Opinion. But before I conclude this Chapter I will moreover affirm, that if Wounds in the Joynts are hard to be cur'd, and often degene|rate into Fistula's; this is not so much owing to the weakness of these Parts, as to to the Man|ner, us'd by most part of Surgeons, in dressing them.

CHAP. XXVIII. Of the Leg.

OBSERVATION XXVII.

ONe La Grandeur, who was of the Guards of the Marshall de Catinat; General of the King's Forces in Italy, being at the Siege of Luxemburg in the Year 1684. had received a Wound, with the Shiver of a Granade, in the left Leg, which left behind it an Ulcer near the inward Ankle, that had baffled the Care of the Surgeons.

This Man being at Pignerol, about the be|ginning of the Year 1692. took a Resolution to have his Ulcer cur'd, tho' it had been of a pretty long standing, and was to him instead of an Issue. Here he finds a Surgeon pliant

enough; who, without foreseeing what Acci|dents might follow, or considering the Evil Disposition of Body, and the bad Constitution of the Patient, takes bim in Hand, dresses him, and heals up this Ulcer.

But in a little time after, he had ample Oc|casion to repent the rashness of his underta|king: For the impure Humors of that un|wholsom Body, which had taken their Course that Way, not finding any Outgate, were by degrees gathered together in the Member, and by their Stay, arriv'd at a pitch of Malig|nity sufficient to cause a Gangrene.

On the middle and inward Part of the Leg there arose a Tumor, or swelling, which was forthwith taken by his Surgeon, who had very little understanding in such Cases, for a Phleg|mon; whereupon without further Deliberation, he begins with Bleeding, which he repeated five or six Times.

The Humour retain'd in the Part, not being able to come to a perfect Concoction, because of the defect of Heat and Spirits, made its malignity appear, and corrupted a great Part of the Leg. The Gangrene appeared: And the Surgeon made an opening in the highest part of the Tumor, from whence came forth a little foetial Lympha. But the Disease increa|sing every Moment, both the Patient and the Surgeon were allarm'd, and sought out for

some Body to advise with, about cutting off the Member.

I was order'd by the Marquess of Chamlay, who was then at Pignerol, to go see him, and to employ my utmost Care to retrieve him if possible, from that miserable Condition. I made incisions in his Leg, from the Knee to the Ancle on the inside, and touch'd it with a very piercing Spirit so far as the Gangrene reach'd: I ordered for the Patient the strong|est Cordials, not forgetting Oriental Bezoar, and generous Wine, which I caus'd to be given him from time to time.

Three Days pass'd over, in spite of all I could do, before a Stop was put to the pro|gress of the Gangrene: The unseasonable Bleedings, his Diet, his Fever, and the other Evils with which he was opprest, had so im|pair'd his Strength, that nothing could be hop'd therefrom. Nevertheless, I judg'd no Way wou'd be more compendious and effectu|al, than that of Sweat, to withstand the Evil ••n its Principle, and to ease Nature overwhel|med with a World of Impurities: Wherefore 〈◊〉〈◊〉 did my Endeavour to procure it; and for ••hat Purpose made him take one Evening a ••entle Sudorifick.

This Remedy had all the success I could ex|••ect; the Patient sweated a little that Night, ••hich forthwith put a stop to the Course of 〈◊〉〈◊〉 Gangrene. The Escar came away but very

slowly, because of the weakness of the Patient. But when this was intirely separated, another Accident superven'd, which threw us into a new perplexity: For a large Tendon that had been altered by the Gangrene, and was wasted by the Suppuration, being joyn'd to its Origi|nal by a small Portion only, drew after it the Matter; and notwithstanding all our Care, form'd a very considerable Abscess under the Joynt of the Knee, which by encreasing by little and little overspread all the hinder Part of the Thigh.

I dilated the Wound, making a fresh Incision, wherein I put a very small Dilater, to hinder its closing up: I us'd the Dilater for seven or eight Days, in which time the Matter increas'd, the Sinus was enlarg'd, and the Thigh swell'd and became painful.

I resolv'd then, to find the most depending Part, that I might there make a Counter-O|pening, whereby to give a passage to the Hu|mors, and to hinder their Abode in the Part: so I made a mark without, upon the Place I destin'd for that Operation.

Nevertheless, I was willing first, to try all other means I could think on: I begun to leave out the Dilater, which I had only kept between the Lips of the Wound, not suffering it to pass into the Cavity of the Ulcer: so I drest the Wound only with a Pledget, and a Plaister, and such a Bandage as might keep them on.

The next Day, very little Matter came a|way; and the Day after that, yet less: The swelling, and Pain of the Thigh were dimi|nisht; the large and deep Sinus was fill'd up in four or five Days; thus the Operation I de|sign'd was prevented, and the Patient cur'd in ten or twelve Days after.

REFLECTION.

'Tis no wonder, that very many able Sur|geons, have been deceiv'd, without perceiv|ing it, in the too frequent use of Tents, and Dilaters, these fatal Instruments; seeing I, who had bid them open difiance▪ could not keep my self from a Surprise: And indeed he must be a capital Enemy to 'em, and have ex|perienc'd their pernicious consequences, who can imagine that a thing so small, as this Tent was, could occasion such considerable Acci|dents.

I was much amaz'd at this Event, and con|firmed thereby in my Aversion for Tents and Dilaters; resolving now to use more Caution than ever, if I shou'd at any Time be necessi|tated to use them.

I willingly own, that the Collection of Mat|ter under the Thigh was not occasion'd by Tents: They are not always the Cause of Impostumations, nor of the Accidents that follow. Notwithstanding their Use contributes

much to delay the Cure, and to render the Symptoms were obstinate, as may be seen by the preceeding Cure: For after the widening of the Sore, a free passage being given, the Matter would have been discharg'd insensibly, and without Intermission, if it had not been hindered by the Dilater; which, how little so|ever, was yet sufficient to obstruct its passage.

I hope then, I shall not be thought with|out good Reason, to have done my endeavour to put down the use of Tents, seeing it is attend|ed with such pernicious Consequences. 'Tis easy to judge, that if a little Dilater, about the bigness of a middle-siz'd Bean, was able to occasion such troublesome Symptoms; a long and thick one, must have caus'd much more Ir|ritation and Disorder. If I had continued to use that Extraneous Body yet eight Days longer, it would have brought on a new Mortifica|tion, which at that Time, might have laid the Patient in his Grave, considering the deplora|ble Estate he was reduc'd to by his former Di|stempers.

CHAP. XXIX. Of another Hurt in the Leg.

OBSERVATION XXVIII.

IN that same Year, when I was in the Hos|pital of Brianson, there was brought thither a Soldier of the Colonel's Company in Ca|tinat's Regiment of Foot, who had both the Bones of his left Leg broken together with a Wound, two Fingers breadth below the Gar|ter: This Accident befell him upon the Works of the foresaid City.

The lower part of the Tibia, came out at the Wound, and pass'd over its upper Part two Fingers breadth; wherefore we were ne|cessitated to make a vigorous Extension, be|fore we could put all things in their right Place: We joyned the Lips of the Wound, and dress'd with Pledgets only; having made an Embrocation, to dissolve a very considera|ble Bruise, to which we apply'd our Diapalma dissolv'd: Two or three Fingers breadth a|bove the Fracture, we encompass'd the Mem|ber with a little Roller, using another in like manner below it; the space between we fill'd up with double Compresses, dipt in Wine or Brandy: under the Leg we us'd a Past-board,

to hinder its bending at the Fracture, and o|ver this the Bandage with eighteen tails; Fi|nally, having made all fast with the Juncks, and their furniture; Diversions were made in due time, and a Course of Diet ordered.

By reason of the Contusion, we were forc'd to dress once a Day; which we did without undoing the Rollers, or giving any trouble to the Member; and when I saw the Bruise, be|gin to be dissipated, from which I had fear'd some Accidents, he was dress'd but once in two Days: On the twelfth Day, we took off the Rollers, that we might straiten them a little; which we did in such a manner, that the Bones remain'd streight and unmov'd; the Wound then had begun to fill up; and there was not the least Exfoliation, nor Separation of any Bone.

The Wound was compleatly cur'd in nine|teen or twenty Days; after which we us'd the Rollers, with Splents and the Juncks upon the Place of the Fracture.

This Patient was pretty fortunate in this, that during the Cure he had not felt the least Disturbance, or Inconvenience; notwithstand|ing of the Unwholsomness of the Beds in the Hospitals of the Army: After fourty Days the Juncks were laid aside, and he began to walk with Crutches; and in a Month after he return'd to the Regiment.

REFLECTION.

By this Cure, which was publickly per|form'd, it appears; that it is not absolutely necessary, to widen the Wound in complica|ted Fractures, as some are of Opinion; for so soon as it is dilated, the Cavity is fill'd with Matter, that slides in between the broken Bones; and being once there, it is impossible to bring it away, or hinder its Stay; and thus it alters and rots the Bone which it touches; it dilutes and depraves the nutricious Juice thereof, mixing with it, and rendring it un|fit for breeding a Callus: Finally, it causes Exfoliations and Separations of Bones from the Extremities of the Fracture; and oftentimes sliding along the Bone upon the Periosteum, produces Abscesses, and Sinusses very hard to be cur'd.

The Patient all this time, is in very great danger; chiefly in an Hospital, where he is every day tormented once, and often twice, with long and painful Dressing. The Part is weakened, and the whole Body wasted away. Besides 'tis observable that but few Fractures that are accompany'd with a Wound, are ever cur'd in Hospitals, especially when dress'd ac|cording to the ordinary Method; and above all, these of the Thighs and Legs, where the Wounded is confin'd to his Bed, are most sel|dom cur'd.

Among all the Ancients that I have read, I find none that more favours my Method of treating complicated Fractures, than Fabricius ab Aquapendente; for in his first Part, Book 4. Chap. 9. and in many other Places of his Works, he is not for dilating such kind of Wounds; but leaves the Separation of Bones to Nature's conduct: And tho' he expect, that some Splinters of Bones are to come away, yet he fails not to stitch up the Wound: For, says he, Nature will never cure a Wound, in that Place where a Bone is to be excluded; wherefore we ought to endeavour, to heal up such Wounds; which we shall not be able to effect, unless Nature Judge it convenient, and find that their remaining open would be unprofitable.

CHAP. XXX. Of a third Wound in the Leg.

OBSERVATION XXIX.

ON the fifteenth of June, 1698. a Mason call'd La pierre, was sent from Mont Dau|phin, to the Hospital at Brainson, who laboring on the Fortifications of that Place, had the inner Bone of his right Leg broken about the

middle, with a Wound six Fingers breadth long, and two in width. This was one of the most considerable Fractures that had come un|der our Care in this Hospital, and yet one of these that were soonest cur'd.

After we had reduc'd the Fracture, we joyned the Wound, and drest it with a good in|carnative; we fomented where it was necessary, and put on the Dressings in the manner above describ'd, we perform'd the usual Diversions, and left all untouch'd for three Days. We drest it a second time after the same manner, letting it alone again other three Days: In fine, at the fourth dressing, that is upon the twelfth Day from the first dressing, the Wound was quite fill'd up, and more than half skin'd over; wherefore straightway, as gently as was possible, we took off the Bandage with eighteeen tails, using instead thereof Rollers, with light and easy Splents upon the Fracture: no Accident happen'd during all the time. In fourty Days space he was able to walk with Sticks, which also he laid aside soon after.

REFLECTION.

This wounded Man was shewed as a Prodi|gy, to all who came to the Hospital. Tho' this Cure had been the only one, I had ever perform'd this way; yet the Success I had therein, had been sufficient to convince me of

the Excellency of this Method; and to en|gage me to follow it during my Life. But seeing it is moreover supported and approv'd by Authors, and confirmed by many other Cures of a like Nature; all the pretended Rea|sons that may be brought against it, will prove too weak to overthrow it, and will be slighted by all Men of good Sense, and Lovers of the Truth: And whatsoever may be said in order to censure it, will be so far from lessening its Merit, that it will rather heighten the E|steem taereof.

In the last Part of this Work, where I treat of Fractures that are attended with a Wound, I give some Reasons, further to justify this way of Practice.

CHAP. XXXI. Another Case, whereby this Way of Dres|sing complicated Fractures of the Legs; is confirm'd.

OBSERVATION XXX.

A Soldier call'd La Violette, of the Regiment of Nivernois, and Company of Bonal, was brought to the Kings Hospital, settled at the Abby of Oulx, on the first of May 1696. He

had two Wounds upon the Os sincipitis of the ••ight side with the Bone uncover'd; all his Face was bruis'd; three of the true Ribs on the same Side, were forc'd inwards; he had many Bruises on his Body; his right Arm was out of Joynt; and the Hand all torn; both his Legs were broken and shatter'd, the Right one without a Wound, and the Left with one: All which Havock was caus'd by a Fall from a very high Rock, near the Barrier of the Fort d' Exille.

All his Wounds were dress'd, but these of his Head, which were not observ'd till the next Day. His Arm was reduced; his right Leg, which was broken about three Fingers breadth above the Ancle, was drest with the circular Bandage; the left with that of eigh|teen tails; the Tibia was broken to pieces in the middle; many of the Splinters were out of their Places, being unloos'd from the Bone at one End; and so could not he brought toge|ther, and altogether set right in the first Dressings; the Orifice of the Wound was not large, and we did not dilate it: It bled indif|ferent much for the three or four first Days. I let the bleeding stay of it self, without u|sing Astringents. I let him Blood many Times, both in regard of the Contusions and Fractures, and also because of the forcing in of the Ribs, which occasion'd a great difficulty of breathing. I caus'd a hole to be made in the Straw-Bed

and Cloathes, which was sowed round, to af|ford him the conveniency of going to Stool, without being removed; it being impossible to touch him, without putting him to grievous Torments. The Wounds in the Head were soon fill'd up, without any apparent Exfoliati|on; the Bruises in his Face were remov'd; his Ribs were restor'd by means of sticking Plaisters; and the difficulty of breathing, con|tinu'd but for six or seven Days: The Dislo|cation of his Arm, and the Wounds of his Hand gave us no trouble: The simple Frac|ture, tho' the Bone was shatter'd, was not fol|low'd with any Accident: the Wound of the compound one, was compleatly heal'd in eight or nine Days; after which, we put little Bol|sters upon the protuberant pieces of the shat|tered Bone, tying them on with Rollers; which had so good success, that at the next Dressing, no inequality was to be seen. A|bout the fortieth Day after the receiving his Fall he was able to stand up with Crutches; and his left Leg that had the complicated Fracture, was stronger and more clever, than the Right, that had the simple one only; which was much admir'd by many.

REFLECTION.

This Cure may be of excellent Use, to esta|blish the Credit of the others, if there is any

need thereof. That which makes it remarka|ble, is, the two Fractures of a different Kind, in the same Person, one of them being compli|cated, which yet was soonest cur'd; and the Patient was able to use the Leg wherein it was, before the other. M. Davejan, and M. Mi|chellet, the King's Physicians in this Hospital, knowing Men, and beyond all Exception, were Witnesses of what I have here related; and know that I have added nothing to the Truth: 'tis thought also, that this is the first time, that a complicated Fracture was drest after this manner in this Hospital, tho' it be of a pretty long standing. These same Gentle|men have oftentimes seen, Wounds no less con|siderable then these, brought by the same Me|thod to a speedy and happy Cure.

I believe indeed, that the strong Constitu|tion of the Patient, conduced much to the good Success of the Cure; but it is no less true, that the requisite Diversions were not delayed, whereby whatever might have occasion'd trou|blesome Accidents, was remov'd: moreover▪ he was gently treated in dressing, and the Sores were not exasperated, so that in the first Days he felt but a very slight Pain: He rested well, and was able to take with much ease, such Food as was proper for him.

You will very seldom see, a wounded Per|son in so deplorable a Condition, as this Man was: All the Parts of his Body, were either

wounded, or bruis'd: Had but any Accident followed, Death had been unavoidable, and our Care in vain: and if the Dissolvents and Diaphoreticks, had not unloaded the Parts, promoting the Circulation of the Blood, and Course of the Humors by a gentle and insensi|ble Transpiration, I doubt the Event had neither been so sudden, nor so desirable.

'Tis well known, that in Practice, there is a great difference made between Fractures not accompanied with a Wound, and those that are: in many Places, the latter are accounted very hard to be cur'd, and often are Judg'd in|curable; especially those of the lower Extre|mities, that indispensibly oblige the Patient to keep his Bed.

I don't question but very many, especially the Admirers of Antiquity, will find fault with this Method, and reject my Rules; but let them, with all my Heart, charitably oblige the Pub|lick, with more easy and more sure Ways, and confirm them with unquestionable Experi|ence, and I promise them, to be among the first that shall embrace their Party.

CHAP. XXXII. Of the Feet.

OBSERVATION XXXI.

UPON the 25th of June of the same Year 1696, an Irish Gentleman, call'd John Donoughal, Nephew to Lieutenant-Colo|nel Athlone, was brought to the Hospital of Brianson, having been wounded at an Action in the Valley of Barcelonetta. He was shot into the right Foot: and the Bullet entring on the upper and foremost part of the Metatarsus towards the Side, was lodg'd between two Bones of the same Part.

A Surgeon, upon the Spot, did whatever he could, to draw out the Bullet, by the same way it entred; but his Endeavours prov'd fruitless.

The first Day that I drest it, after I had consider'd the Wound, and observ'd the Way of the Bullet, I found it could not be got out, unless a Counter-Opening were made; which accordingly was done, at the middle and hin|der Part of the Metatarsus, and the Bullet was drawn out with very little Pain.

The Wounds were drest according to our Method, with Embrocations over all the Part; Diversions were not omitted, and he was dress'd but once a Day with our simple Remedies, and the Plaister of dissolv'd Diapalma.

The Escar being separated, no great Suppu|ration ensu'd; no Bones came away, at least that we could observe: henceforth he was drest but every other Day, and was cur'd in thirty Days, or thereabouts; after which time he re|turn'd on Foot to his Regiment.

REFLECTION.

'Tis almost universally known, that Wounds of the Extremities, accompany'd with a Frac|ture, are tedious and troublesom to be cur'd: the Tendons and Nerves that here abound, make these Parts of a quick Sense, and render the Wounds therein, obnoxius to grievous Ac|cidents: therefore it is that they require to be dress'd with much Gentleness, and Remedies particularly suited to 'em. I have elsewhere remark'd, that Tents, and putrifying Medicines, are extreamly hurtful to Nervous and Tendi|nous Parts, wherefore I shall speak no more of them. I shall only here take notice, that some prepossest Persons have had the confi|dence to say, that this Way of Dressing, so gentle and so easy, has something of Rashness in it; that it is very dangerous to omit the

Circumstances observ'd by the Ancients; that their Rules, were not laid down without good Reason; and that their Method, in Fine, ought to be put in Practice among the Soldi|ers. Tho' Reason and Experience are both on my Side; yet I am ready further to maintain, that this Method has nothing of Temerity in it, seeing it follows the Footsteps of Nature, which ought ever to be our Guide in the Cu|ring of Wounds. We can never go astray, if we follow her Conduct; and if we swerve from her Paths, we can't but fall headlong into Dangers.

Mereover, it is no less necessary, to be an able Surgeon, and expert in Practice, in order to manage a Cure according to this Method, that appears so easie; than according to the common way of Practice, which is full of so many Circumstances that are ever unprofita|ble, and oftentimes pernicious. And we may reasonably presume, if our Method has been so successful, when practis'd on Soldiers dieted and dress'd in an Hospital, where the Air is often|times infected; that it will yet be much more so when used towards Patients, who have all the Conveniences of Life, and who breath in a pure Air.

CAAP. XXXIII. Of the Feet.

OBSERVATION XXXII.

WHen I was at Luserne, in the Year 1688. a Soldier of the Trained-Bands, was brought to the Hospital there; who had re|ceiv'd a shot in his right Foot, that was pretty remarkable for the way of the Bullet; which was of a very small Size. It enter'd at the inward and middle part of the great Toe, and came out at the end of the little one; no Ex|coriation appearing either above or below.

The first and second Bones of the great Toe were broken: the second of the three next, were intirely crush'd to pieces; and the last of the little Toe in like manner.

When we parted the Toes one from ano|ther, a great many little pieces of Bones were to be seen, which seem'd only to hang by a Thread. I first set to rights every Bone by it self; and afterward set them in order one with another: between every Toe and its fel|low, I gently slipt in a little piece of Linnen, dipt in Spirit of Wine; and I made small Compresses pretty hard and longish, which I put

above, and under the Toes, in form of Splents, being wet also with Spirit of Wine: I wrapt all up in Linnen, without Oyntments or Plai|sters; and supported the Foot with a Sole, sustaining all with an easie Bandage.

I took off the Dressings after two Days, and without removing the little pieces of Linnen between the Toes, I fomented all the Part with Spirit of Wine, and dress'd it as before: the Suppuration was but very small; and in|deed it was with Design to prevent it that I us'd nothing but the Spirit of Wine; which was the only Remedy I employ'd to compleat the Cure: this was effected in about three Weeks time, without the coming away of the least bit of the Bones, tho' they had been intirely shatter'd to Pieces.

REFLECTION.

All Experience assures us, that 'tis Nature and a good Method that effect the Cure, and not at all either the great Labour, or vast Charges bestowed upon it. If I had used in this Case the ordinary Oyntments and putre|fying Medicines, they would have occasion'd a plentiful Suppuration, whereby the Splinters of the Bones had been loosen'd, and brought away, the Cure had been delayed, and possi|bly the Toes lost; which had been enough to render the Patient lame for all his Life.

Tho' this Cure is not of great Consequence, yet the Conduct therein us'd, may suffice to shew, that the Bones do easily enough reunite, when they enjoy the necessary Repose; when the Air has no time to alter them, or to exert its Efficacy in the Wound; and when the use of Suppurative Remedies is laid aside, which are ever hurtful, as has been above observ'd: and I will here add, as to the last mention'd Medicines, I know no kind of Wound, in what part of the Body soever, that does ab|solutely stand in need of them.

But lest I should weary my Reader, with unprofitable Repetitions, I shall content my self, with having describ'd the two preceding Cures of Wounds in the Feet: tho' in this Hos|pital, we have had a great number of this Nature through our Hands, that have had a most Happy and comfortable Event.

CHAP. XXXIV. The Conclusion of the Second Part.

IF my weak Reasonings, and the Authorities I have adduc'd, together with the Expe|riences, which I have faithfully related, shall not prove sufficient, to convince some Persons of the Excellency of my Method; I have only one Request to make, to such as shall with-hold

their Approbation, which is, that they wou'd make a Trial thereof themselves.

I could have recited, a very great number of Cures, like unto these contain'd in this se|cond Part: I could have describ'd the Cures I have performed on wounded Persons in my Travels; or in the Army, where Occasions of this Nature daily present themselves, because of the Actions that ordinarly fall out: such are those of the Valley of Barcelonetta, and the Battel of Marseills, fought Oct. 4. 1693. But this would have been, for the most part, to say the same things over and over again; all these Cures being manag'd well nigh after the same Way.

I suppose, it will be easily enough believ'd, that I could have enlarged the bulk of this Volume, with many other Observations; see|ing it is a Truth, that in four Years time, wherein I have been in this Place, more than three Thousand Persons have gone from it com|pleatly cur'd.

Some there are, who, not being able to dis|cover the genuin Cause, of the desirable Suc|cess, that has attended the Cures, done in this Hospital; and willing to blast the Repu|tation of a Method, to which only they were owing; have attributed all to Chance, and have given out that we have been accompani|ed with an Extraordinary Good Fortune: as if forsooth, the Curing of Wounds were like a

Game at Cards, or throwing of Dice; or as if blind Chance had any thing to do, where Experience and good Conduct are so indispen|sibly necessary.

I have hitherto only treated of such Wounds, as were very considerable, and were almost all somewhat complicated: from whence I hope it will be believ'd, that simple Wounds, where|with I was unwilling to fill up this Part, were cur'd, after this Method, with much more Speed and Ease, than those here related.

It may possible be thought strange, that in certain Cures of single Centinels, describ'd in this second Part, I have declared that I us'd, on different Occasions, the Balsam of Peru; which is scarcely probable, considering the Place, and the Condition of the Persons. This I own; and do nevertheless aver, that I have said nothing but the Truth: But when it is considered, that his Royal Highness the Duke of Savoy, sent his Apothecary to Luserne, with Orders to supply himself from thence, with whatever was most precious; and to fur|nish a most compleat Shop of Medicines, for the Hospital of that Place, what I have said will easily be believ'd; seeing not only that Remedy, but also Pearls, Bezoar, and the most costly Cordials, were bought up, and us'd freely, and without Distinction.

THE Hospital-Surgeon: OR, A New, Gentle, and Easie Way, to Cure speedily all sorts of WOUNDS.

PART III.

Exhibiting a General View of the Author's new Way of Practice, not only with respect to Wounds, but in other Cases belonging to Sur|gery; and a Description of the simple Re|medies he uses: With some Observations.

CHAP. I. The Design of this Part: And what it contains.

ALtho' in the preceeding Parts of this Book, where I declare the Ad|vantages, and Excellency of this Way, confirming the same by Reason, Au|thority, and manifold Experiences, I have suffi|ciently made known my Practice, with Relati|on

to Wounds; yet, because it is there deli|vered without any Method, and with frequent Interruptions, being interwoven with my Rea|sonings and Observations, I shall for the Ease, and Advantage of my Reader, but especially of the young Surgeon, in this third Part give a ge|neral Prospect, as it were at once, of all the Parts of my Practice; and that not only in what con|cerns Wounds, to which I principally confin'd my self in the two former Parts, but also in o|ther Cases, that fall under the Surgeon's Care.

I will likewise here, ingenuously and with|out Reserve, give a Description of the simple and easy Remedies which I have us'd as well in the Cure of Wounds, as in that of other Distem|pers that come within the Jurisdiction of Surge|ry; the happy and comfortable Effects that I have so frequently seen produc'd by them, is e|nough in my Opinion, to recommend them to the Esteem and Use of the Wise and unpreju|dicated Artist, and who candidly designs the Good of such of his fellow Creatures, as fly to him for a Refuge in their Distress.

Finally, I will as I go along, deliver some Observations very instructive, and useful to il|lustrat and confirm the Subjects, for the sake of which they are adduc'd: to which, when necessary, Reflections shall be subjoyn'd. I shall begin with Tumors and Abscesses.

CHAP. II. Of Tumors and Abscesses,

MOnsieur Bertrand, a Physician of Marseils, in his New Reflections upon Acid and Al|kali; gives, in few Words, a very clear, and exact Notion of the Nature of Tumors. But seeing I am confined, by my proposed De|sign, only to declare my Practice with respect to them; those who desire to search into their Causes, and examine their Differences, must consult such Authors as have written upon them.

The Moderns, are not well agreed with the Ancients, in this Matter; for since the Circula|tion of the Blood has been found out, the true Causes of many Accidents, that fall out in the Cure of Tumors, have been discover'd, which the Ancients explain'd, in a manner altogether different.

Wherefore, seeing a Disease, after its Nature is understood, is easy to be cur'd, if one brings but a little Application of Mind; the young Surgeon, will do well to search into the Cau|ses of Tumors, in the Works of the Moderns, where also he will find suitable Remedies. Et|mullerus in his Medicinal Surgery, describes a

great number of very proper Medicines; as also M. Verdue in his Book call'd Pathalogie de Chirurgie.

This only I will say by the by; that the Tumors that are accompanied with Inflamma|tion, such as a Phlegmon, and an Erysipelas, have more need of Dissolving than Repercussive Medi|cines: I was confirm'd by Experience in his O|pinion, and the Truth thereof at this Day is not doubted; tho' yet it is contrary to the Rules of the Ancients: For a Phlegmon pro|ceeding from an internal Cause, according to the Moderns, is nothing else but an Obstructi|on of the Vessels; and that from an external Cause may be accounted of the same Nature. This Accident does very commonly happen in Gunshot-Wounds: Under which Head, we will speak a Word or two thereof.

According to these Principles, Resolvents are absolutely necessary in order to fulfil the first Intention, which is to dissolve or to cause transpire the accumulated Humor.

An Erysipelas, according to these same Mo|derns, is caus'd by a subtil and Volatil Acid, diffus'd over the Skin, or the Muscles: Dissolving Medicines are also proper in this Disease: Spirit of Wine prepar'd with Camphire, the Su|gar of Lead, or Elder-Vinegar may be us'd.

The Accidents that follow upon a great E|rysipelas, are frightful and violent. I remem|ber, that when I was at Luserne, a certain

Person who had a Fever, was seiz'd with a like Distemper; it reach'd from the middle of the Thigh to the Heel: He was not so wise, as to give us notice of it in time, but kept the whole Part out of the Bed for a whole Night, in a pretty cold Season; which caus'd such a Re|percussion, that on the Morrow all the Part was gangren'd, and all our Care and Diligence could not prevent its intire Mortification; for in a very little time the Gangrene turn'd to a Sphacelus. Before he dy'd the one half of his Body was intirely corrupted and putrify'd: I never saw so dreadful a Sight, or smelt so in|tollerable a Smell: For not only the Hospital, but even the whole City was in danger of be|ing infected thereby, when he was yet alive.

When an Erysipelas, will not yield to dissol|ving Remedies, we ought without delay to have recourse to Scarification of the whole Part, to give a passage to the Blood; and moreover we shou'd foment the whole Part with Spirit of Wine prepar'd with Camphire, or some other Spirituous and piercing Liquor: Vi|negar, wherein Sal armoniac is dissolv'd, or com|mon Salt when that is wanting, may also be us'd. Notwithstanding it is not to be thought that Repelling Medicines, are altogether to be laid aside; only 'tis fit we know how to use them in suitable Occasions.

In the Year 1693. M. Dechamp, then Com|mander of the third Battallion of Sault, but

now Lieutenant Colonel of the same Regiment, having an Erysipelas in his Leg, had been treat|ted, with the Dissolving Remedies prescrib'd by the Moderns, for three Weeks time, with|out perceiving any advantage thereby: where|upon he caus'd himself to be brought to this Town, that he might be under my Care; and being inform'd by him of what Remedies had been us'd, I thought fit to apply Repercus|sives; and in eight Days after he departed, be|ing intirely cur'd. In order to a prudent Use of Remedies, the Age, and the Constitution of the Patient, the Season of the Year, and the Nature of the Part affected are duly to be con|sidered. But I shall not further insist upon a Subject, from which I hasten.

Now as for Abscesses of all sorts, which have come under our Hands in this Hospital, and have been cur'd with an Expedition that may appear incredible, I will only say this; that judging it sufficient, to make a large opening in them, I left the rest to the sage conduct of Nature; not forgetting however general Remedies, and the ordering of Diet. But as for the dressing of the Vlcer, I only us'd a simple Pledget, cover'd with the most common Medicines; and sometimes in case of a Cavity small Compresses for expelling the Humor; also a Plaister, with a Bandage sufficient to keep it on.

The great number of those, who have been treated, in this Hospital, according to this Method, and cured in a very small time, is al|most wholly beyond Belief.

When the Orifice is not stopt up with an Ex|traneous Body, 'tis evident that the Matter can make no Stay in the Parts, but will come away without Intermission; and the Parts, that were thereby kept at some distance from one ano|ther, come together, and at the same time, do al|together expel what may there be contain'd; and leave no empty Space, for the Collection or Abode of what is useless and inconvenient: Hence the Parts are united, Nature acts at her Freedom, whose Balsam generates Flesh better than all the Remedies in Pharmacy.

I hope I may presume, that none will think, I would have continued in the Use of this Me|thod, for so long time, had I not experienc'd its desirable Effects, in a thousand Occasions: and I could safely take my Oath, that never any the least Accident, happened to any of those, who were dress'd after this manner: Every one may believe as he thinks good of what I say; but I dare aver, that I am much more careful that what I say should be True, than that it should be Perswasive.

As for Scrophulous Tumors, or a Bronchocele, I have not found any Remedy so successful as Mercury; and I believe, in the Opinion I have of it, I am not singular: the many Experi|ences

I have had thereof, make me much to va|lue it. He that well understands the Cause and Nature of these Evils, and withall the Vertues and Vses of the Remedy whereof I speak, will agree with me, that this only can effect a Compleat Cure. But all consists in the discreet Using thereof: the best of Remedies and the most exquisite Instruments, are ever dange|rous, when manag'd by Surgeons that are void of Knowledge and Experience. I may possi|bly, one Day make known to the Publick, the Way which I have successfully us'd, to bring to a perfect Cure, a great number of such Maladies as I now speak of, and these the most obstinate and inveterate of their Kind.

CHAP. III. Of a Gangrene.

A Gangrene is an Accident, that occasions very much Trouble in the Hospitals of the Army. I shall say nothing of its Causes. M. Thevenin has fully treated of this Matter; and M. Causape, in his Book Of Fevers, has given a brief Discourse thereon upon diffe|rent Principles. Young Surgeons may betake themselves to the reading of them, for their Instruction herein.

Wherefore omitting this, I say, that here we have no time to lose, but must immediate|ly apply our selves to stop its Progress, and to avoid the fatal Consequences. When the great Vessels are thereby intirely intercepted, in a Member that may be cut off; the best Way is to come speedily to Operation, without at|tending a Sphacelus; for the Gangrene goes on so swiftly in a small time, that the sound Parts care assaulted, before ever we can well know what we are a doing.

A Gangrene often happens in Gunshot Wounds, if it is not prevented; as also in Bruises; in Wounds made by cutting, or bruising Instru|ments; and also after a great Phlegmon, or an Erysipelas; and sometimes by an Extremity of Cold: This last kind is very frequent about the End of Campains: The Remedy we us'd was Spirit of Niter, or Aqua fortis, wherein Crude Mercury to half the quantity is dissolv'd: with this we have easily enough stopt Mortifi|cations in the Feet or Hands, applying over all the Extent of the Gaegrene a little piece of Linnen wet in this Liquor: and when this can't be had, other Spirits may be us'd that are near of the same Quality.

This Remedy I have found to be so gentle, and so quick in its Operation, that I never use any other, in any sort of Gangrene. It ad|mirably well separates what is dead from what is alive, without scarifying or cutting; unless

when the Mischief lies very deep, where these violent Remedies are absolutely necessary.

Cordials and Wine, ought never to be omit|mitted in such Cases, to fortify and defend the natural Heat, from an Enemy, that often|times assaults it in its very Principle. When the Body is plethorick, Bleeding and Clysters are no small Help. In the beginning of a Gan|grene, to Topical Remedies, Diversions may be added, without forgetting to order the course of Diet, which also demands our particular Care. So soon as I have discover'd a Disposi|tion to Mortification, I have sometimes us'd Cataplasms, and Emplasticks when the Inflam|mation would allow, to recall the Spirits, and to give Nature time and Strength, to resist and to overcome, by the force of the Heat con|centrated, the Matter already endow'd with a malignant Quality, or just ready to become such; and I have often seen such kind of Ma|ladies, to end happily in an Abscess, with a laudable Concoction▪

When a Phlegmon that follows on a Wound, is violent and Obstinate, and will not yield to Diversions, and dissolving Medicines, we must without delay scarifie the Part, so far as the Tumor reaches, to give an Out-let to the Blood that is extravasated, and often also corrupt|ed; and to discharge, and relieve the Part, that otherwise might be suffocated by the Ful|ness and Obstruction, bathing is afterward

with Spirit of Wine and Sal armoniac: for if we be remiss in our Care, the Enemy that is conceal'd within, is privately at Work; and when the outward Signs of the Gangrene ap|pear, all that is under the Teguments, is often found already corrupted, and in irremedible disorder.

An Erysipelas is yet more formidable; for it is more sudden, and more nimble in its Opera|tion: It is the part of a prudent Surgeon, to take heed to it in time. A Fomentation with Spirit of Wine, Vnguentum Egyptiacum and Sal armoniac, may be us'd.

Many Authors, have describ'd a great num|ber of Remedies, very proper in the Cure of Gangrenes: But in the Hospitals of the Army, there is not always the conveniency of making a Choice; wherefore it is good to know how to use such as are simple, and easie to be found: 'tis not always the most pompous Com|positions, that are of greatest Efficacy.

In this sort of Distempers, it is very necessary to make use of Inward Remedies, as well as Topical ones; such as strong Cordials, Venice Treacle, Confection of Hyacinth and Alkermes, and Alexpharmicks, to which a little Camphire may be added. Wine ought to be numbered amongst the Cordials; it is one of these, which I very frequently use in Hospitals. Ger|mander taken inwardly, and apply'd outward|ly upon the Grangrene, is a Remedy not to be dispis'd.

A great many Remedies, very proper for a Grangrene, may be seen in Etmullerus: He has also given an account of the way us'd by the Germans, to separate the mortify'd from the sound Parts, which is done with the Butter of Antimony: This is the Remedy they use in the Amputation of Members, to avoid the use of the dismembring Knife, and of Astringents that burn and cauterize.

This Remedy might be us'd, with the same Success as the Spirit of Nitre, which I have spoken of before; there is no Difference, provi|ding we have regard to their Nature, in using 'em: But whither the one or 'tother be us'd, to stop a Gangrene, a simple Digestive will af|terward be sufficient to hasten the falling of the Escar, and finish the Cure.

CHAP. IV. Of Ruptures.

RVptures are very frequent amongst the Sol|diers. The Toil they undergo, and their Manner of Life, do alike conduce to bring them to that miserable Condition; by reason of which there is often a necessity, to send them to Hospitals.

My Design in this Place, is only to give an account of the way I use to help this sort of Distemper: For I am convinc'd, and no Body doubts of it, that a Truss is the most sure and most infallible Remedy, to hinder the Falling down of the Guts: But, as there is no Con|venience for making of them in Hospitals, so Accidents must be quickly provided for that come oftentimes all of a sudden; such as the Descent of the Intestins into the Scrotum; for the Pains are then extreamly violent, and so grievous that they resemble those of the Passio Iliaca.

Wherefore, in such an Occasion, I apply a Cataplasm of OxDung; or else when I may have it so, I use it fry'd in Oyl of Hemp-seed, or in that of Violets. This Remedy eases the Pain, by dispelling the Wind, and so gives Liberty to restore the Gut unto its Place, providing the Intestine is without Excrementitious Mat|ter in it. Astringents of the first Rank may also be us'd as Common Bole, &c. mix'd with the Glair of an Egg or Vinegar. Some use Emolli|ents, but their Operation is to slow, in a case requiring such hast.

I have often found much advantage from a Fomentation made up of Pomgranate Flowers, Nut-Galls, Cypress Nuts, Pomegranate-Rind, Al|lom, Camomil and Melilot Flowers, with com|mon Salt, all bruised and beaten, and boil'd in Forge-water, or in rough Wine; I use it very

warm all together, without straining the Liquor: with this Remedy, I have restored Prtients, who seem'd to be upon the very Blink of Death. Moreover the Emplastrum pro Hernia ought to be apply'd, upon the Dilatation of the Peritonae|um; which without a Truss, the best of all Re|medies, will do no great Feats.

CHAP. V. Of Wounds.

I Have sufficiently explained my Method, as to what concerns Wounds, in the Account of Cures contain'd in my second Part. My Design is here, (for Reasons mention'd at the beginning of this Part) to entertain my Rea|der with a General and comprehensive Idea of my Way of Practice, that may quadrat to all the different sorts of Wounds that occur.

Perhaps this Method may seem to swerve a little from that of the Ancients, or may not a|gree so much with that in use amongst the most Part of the Moderns, as some could desire: But I would entreat those who shall read this Treatise, not to condemn it, before they have thorowly examin'd the Truth of the Matters of Fact, and the Reasonableness of the Rules there|in laid down; for our usual Rashness in judging

of what we don't altogether understand, is of|ten the Cause of our Error: However I am in good Hopes, that e're it be long this Way shall be acknowledged to be the Product of Expe|rience; and its Evidence to be an infallible Mark of its Truth.

Moreover; I dare confidently affirm, that this Method, howsoever new it may appear to many, ought not to be number'd among these things that are more curious than profitable. Rea|son speaks for it: Nature vouches it: Experi|ence confirms it; putting it beyond all doubt; and about three thousand Wounded Persons hap|pily cur'd by it, may warrant any one in the Use thereof. In the first and second Part of this Work, I explain at length the Reasons that Justify my Practice, and support them with se|veral Authorities both of the Ancients and Mo|derns.

If I condemn Tents as Instruments unprofi|table and destructive, 'twas Experience that convinc'd me of their Mischeif: and I hope, henceforward very many Surgeons shall range themselves on my Side.

If I recommend in a special Manner, a Gen|tle and Speedy Way of Dressing; I must herein be justify'd, by all Men of a sound Understand|ing: And indeed I don't question, but every reasonable Person, after he has been rightly inform'd, will sufficiently approve what I have advanc'd in this Matter.

Finally, in asserting that the Air is hurtful to Wounds, I have said nothing but what Hip|pocrates, Galen, and many others were suffici|ently convinc'd of. 'Tis known to all that the cold piercing Air, is very pernicious to our Na|ture: On this I have enlarg'd a little, in the seventh Chapter of the first Part, suitable to that little Measure of Vnderstanding, where|with I am endow'd.

I suppress frequent Dressing, that Nature may be allowed Time to act, and to restore the wounded Parts, unto their first Condition; which she can't do, when she is so often inter|rupted in her Work.

I have ever observ'd this as a general Rule; to dilate by making Incisions Gun-shot Wounds at the first Dressing; as also all other penetrating Wounds, and such as have a narrow Orifice: This is the true Way to keep off, and to avoid the most part of Accidents that hap|pen in Practice; and to prevent being re|proach'd, when any troublesome Symptom falls out: I sometimes use Dilaters, in the first Dressing, to hinder the Union of new Incisi|ons; to keep their Brims asunder, and to leave an open Passage for Matter, or any thing else to come away, when Nature shall be dispos'd to expell 'em; otherwise I use them not, lest I should hinder the closing up of the Wound.

When the Bleeding is Obstinate, I use cal|cin'd Vitriol, astringent Pouders, Pouder of the

Vine, Styptick Waters, &c. 'Tis only in de|sperate Cases that I have recourse to Roman Vitriol, Aqua fortis, and the Actual Cautery.

I have ever in the first Dressings, found much Advantage from Defensives, which I ap|ply'd above, and sometimes below the Wound, to allay the Heat of the Blood, to moderate its Activity, and resist Fluxions; observing always to make them somewhat Emplastick.

I am always careful, to empty the lower Belly by Clysters; having found that the Re|taining of the Excrements, is ever a mighty Hindrance to the Good Disposition of the Bo|dy.

When the Bleeding has been great, I don't take off the first Dressings, till the second or third Day after they are apply'd; that the Wounded Vessels may have time to unite: and, providing the Season, and the Pain, or o|ther Accidents don't hinder, I every Day take off the Roulers during that time; and lea|ving only that which supports and keeps on the Astringents, I make Embrocations when needful, and renew the Defensives: by this means, I often avoid the Suffocation that may happen, if the Astringent and Emplastick Medi|cines are too long kept on the Parts; which by stopping up the Pores of the Skin, and re|taining the Vapors that ought perpetually to pass out thereby, are the Occasion of many very grievous Accidents that happen to

Wounds. Too great a quantity of Bands and Compresses, has often the same Effect.

I use only Pledgets after the first, and some|times after the second Dressing; and conti|nue the Embrocations, till the Contusion is dis|solv'd; which may be in five or six Days more or less, according to the Bigness and Condition thereof, or to the Nature of the affected Part.

When a Phlegmon, or an Erysipelas, &c. hap|pens to a Wound, I avoid the Use of Vnctuous Things, which are hurtful here; employing only such Cataplasms as are proper for easing Pain, and sometimes also dissolving Medicines, which together with Diversions, and a proper Course of Diet, resist, and overcome these Ac|cidents.

I find it very profitable, when I dress the Wound, to cover it with a Linnen Cloth wet with warm Wine or Brandy, immediately after I have taken off the Dressings: this defends, strengthens, quickens and unites the Spirits; and hinders the Particles of the Air, and the Effluvia therein, to stick to the Wounds, or pass to their Bottom.

After the first Dressing is over, I never search the Wound either with my Finger or Probe, unless there is an absolute Necessity thereof. I also disallow the use of dry Tents, so commonly employ'd for drying up the Mat|ter from the very Bottom of Wounds; and

and generally every Thing that may irritate, or occasion Pain, or may oppose the Design of Nature, which is the Healing up of the Wound.

I don't, as some do, take up a deal of Time, in striving exactly to empty the Wound, of all the Matter that is in it; but as quickly as can be, I apply the Dressings, to hinder, as hath been said, the Action of the Acid Parts of the Air, and the Dissipation of the Spirits; that the Strength of the afflicted Parts may be preserv'd as much as possible; which is very requisite, in order to enable them to bear up against them any Evils, where|with they are assaulted on all Hands.

When, I say, in the fifth Chapter of the first Part, that the Matter ought not to be retain'd in Wounds; and that Nature would not be at such Pains to drive it out, if she could have any Advantage by its Stay; this is to be understood of such Matter, as is kept in by Means of Tents, which becomes hot, and ferments, and by its Abode acquires an evil Quality, and might be suck'd up by the Veins: for that which is Laudable, is hurt|ful only by Accident; being of its own Na|ture Balsamick, because it is ever mixed with good store of the Natural Balsam, or Nutri••ious Juice, which without Intermission flows into the Wounded Parts. What I say, is confirm'd by that which is done, in some Places of Hol|land;

where of the Laudable Matter that runs from Wounds, they make a Balsam that is of great Use in their Cure.

It is not at all improbable, that the Sound Matter that comes from Wounds may promote their Cure, when by the Hand and Diligence of a skilful Artist it is purify'd, and separated from its Excrementitions Parts; for what remains, is only the Balsam of the Blood. This will be more easily conceiv'd by those that consider, that there are some learned and Ingenious Ita|lians, who cure the Bludy-Flux, with a Salt drawn from the Excrements of the Patient; and also such as have a Dropsy, with the Salt of the Waters, that are drawn from their Bel|ly. Etmullerus also, very much commends the Excrement of the Ears, for curing Wounds.

All these things, contain less balsamick Juice, than the Matter that runs from Wounds, when it is not altered by the Heat of an essen|tial or Symptomatick Fever, when it has not remain'd long in the Wound, being detain'd there by Tents, &c. or in fine, when it is not deprav'd, by the use of putrifying Medicines, or others of a like sort, that destroy its natural Temperament.

M. Verdue, Tom. 1. Pag. 440. speaks very patly to this Purpose, when he says, that Mat|ter is the Chilous Part of the Blood: Where|fore it is against all manner of Reason, that some Moderns require, that the Wound be ac|curatly

wip'd dry; seeing thereby it is de|priv'd of that, which only can effect the Cure.

When I know, or am in doubt that there is some Extraneous Body in a Wound, which Nature would exclude by the Orifice, or that any Splinter is separated from a Bone; with|out having to do with Tents, I sufficiently di|late the Wound with Prepared Spunge, or the Pith of Elder, or Gentian Root fitted for that purpose, that a free Passage may be given to any thing that must come away: This way is understood by every Surgeon; and there is no Difficulty therein, providing one be care|ful to use it Seasonably.

I can't restrain my self from highly blaming those, who very patiently marshal up in Or|der, a great number of Dossels or Dilaters, of which they make three or four Lays in Wounds that are any thing large, observing a certain Symmetry and Proportion, which ex|poses to the View of Assistants a Method, no less pernicious, than contrary to Common Sense and Reason. As for the Decency and Seemli|ness, which adorn and set off that Way, it will be no less conspicuous, in making large Pledg|ets of long and pretty fine Lint, that may at once reach over all the Extent of the Wound.

I my self have experienc'd, what a fond O|pinion is commonly entertain'd of that Cruel Method: for the greatest part of Wounded

Persons, believe themselves neglected, if an Hour is not spent in searching their Wounds, and as much in Applying the Dressings: but Charity obliges us to free them from their Er|ror.

When a Wound is deep with much Loss of Substance, I fill it only with Pledgets of fine Lint; left leaving an empty Space, it should be fill'd up with Air: I apply them very slightly cover'd, or moistned with some Medi|cine, agreeable to the Nature, and Quality of the Wound: these are not so hard as Dossels, and consequently occasion less Pain; and don't so much hinder the closing up of the Wound, being not so compact as to hinder the breeding of Flesh; neither are they so apt as Tents to be lost in the Wound, or fix'd in some Corner of its Cavity.

I am no less careful, to suppress Injections than Tents; having observ'd their Effects to be no less pernicious: for they liquefy and dis|solve the Blood, enlarge the Wound, cause Pain, and make proud Flesh to grow.

I disallow the Use of Aromatick Wines in dressing, as also of Fomentations, that are fre|quently us'd by some, which conduce very much to the protracting of the Cure.

'Tis very sure that these Parts drink up the Moisture, which softens, relaxes and puffs up the Skin; and passing through it, fills them like Spunges: the Natural Heat of the afflicted Parts,

is thereby suffocated and extinguisht, no perfect Concoction can be perform'd; but all is turn'd to Matter and Corruption: and if this Method is long continu'd, as it too often falls out, the Ligaments are relax'd, and the Patient is in Danger of being lame for all the rest of his Life.

This way of Practice, is in a particular manner pernicious in Hospitals of the Army, where that which is necessary, to give Reme|dies all the required Qualities, is not always to be had: For Instance, how can they be kept warm, without a sufficient number of Cloathes to preserve the Patient from the Cold? Hence it is that in a Moment after Application, all the Dressings become cold and frozen, which occasions Oedema's very hard to be cur'd; and oftentimes also Symptoms that are yet more troublesom.

A right Course of Diet, is so neeessary in curing of Wounds, that without it, an infinite number of Accidents, cannot be prevented: But it is necessary to have respect to the Age and Constitution of the Patient, to his Habit of Body, to the Season of the Year, and the Nature of the Wound.

'Tis to be observ'd, that a very exact Diet is a mighty hindrance to the Cure of Wounds in Soldiers, who ordinarily feel more the Inconveniences of a too scanty, than those of a too plentiful Table. Wherefore I don't

altogether deprive 'em of the use of substantial Food, unless when Necessity requires otherwise; and this keeps up their Strength: For Broths tho' good, are not so nourishing in Hospitals, as to be sufficient of themselves for Food: and yet this is no prejudice to the necessary Diver|sions. Wine also ought not to be kept from them, being allay'd a little, unless in some ve|ry important Cases: It resists the ill Quality and Malignity of the Air, which is always im|pure in Hospitals; and in a Word Wine is their Cordial and Counter-poison.

It is very necessary also, especially in Hos|pitals of the Army, to have Regard to the Si|tuation of the wounded Part, which ought to be such, as to give liberty to the Circulation of the Blood, and a Descent to the Matter, and Ease to the Patient; I have known the neglect of this Point, occasion very troublesom Symp|toms.

If a Surgeon is not so charitable, as to give Instructions, to those that attend the wounded, how to make their Beds suitable to the Quali|ty and Nature of their Wounds; the miserable Patients, are ever in Pain by the Inconveni|ent Position; which is enough of it self to deprive them of the Rest, that is so necessary for 'em, and to render their Sufferings and our Cares to no purpose.

The Head ought to be plac'd indifferently high, and laid upon something that's soft, with|out

Feathers, if it may be had, with a Descent to promote the Discharge of the Matter: When the Neck is wounded, it must be in a man|ner slightly supported by the Pillow: or, by Linnen folded into several Doubles, we must fill up the empty Space between the Head and Shoulders.

Wounds of the Breast require an easie and un|strain'd Posture, rather high than low. But in this we must have most Regard, to the Con|veniency of the wounded Person.

These of the lower Belly and Loins, demand almost the same Situation: To these of the Bladder and Genital Parts, an undisturb'd Re|pose, a convenient Bandage, which is a Suspen|sory, and a Position somewhat raised, are very needful.

Every Body knows that the Arm, when wounded, must be supported by a Sling that passes over the Neck; and that in Wounds and Fractures of the Shoulder-Bone, a Pillow is necessary to keep it almost as high as the Breast, in which posture it is most at ease: In Wounds or Fractures of the Wrist, Metacarpus and Fingers, we must keep the Hand extended with a piece of Board.

Wounds of the Thighs, require that the Member be plac'd streight, neither too high nor too low. These of the Legs and Feet, do necessarily demand that the Part be something high, that so the courser Blood may freely cir|culate;

for otherwise, the Blood, by its Weight, might be stopt in the Veins, and corrupted there; and thus the Circulation being sup|press'd, many grievous Accidents would ensue. This hanging or low Position of the Legs, not being minded by many Surgeons, exceedingly conduces to render Wounds of these and the Feet very uneasie to be cur'd, and makes 'em degenerate into Vlcers.

It is also very necessary to stretch out the Legs, and keep them straight during the Cure; otherwise it will be difficult, to restore them to their natural Figure, after it is over, chief|ly if it has been of some Continuance; as, sup|posing the Leg had been kept bent, when un|der Cure of a complicated or simple Fracture. This is what I have often observ'd, and to which young Surgeons would do well to take heed. Fractures of the Tibia and Fibula, and simple Wounds in the Legs, if any thing con|siderable, stand in need of a Sole to sustain the Foot, as well as these of the Tarsus, Metatar|sus, and Toes.

Too strait Bandage, especially in Gunshot-wounds, occasions troublesom Accidents; it hinders the Circulation, and causes frequently Mortifications: Wherefore I use only such as may keep on the Dressings, chiefly in the first Days: Many have been brought wounded to this Hospital, with the Parts half Gangren'd, by too tight Tying; for in Gun-shot Wounds

the wounded Members, ever swell some more some less, whereby the Bandage, tho' but mo|deratly strait, becomes intollerable before the next Dressing. Rest also is of no less Consequence to the Patient. Now where all these things meet together, and are rightly or|der'd, they are commonly of very great Advan|to the wounded.

I use Purgatives with great Caution, and af|ter the time of the most dangerous Symptoms is over, beginning ever with the slightest, that only loosen, such as Cassia and Manna, &c. du|ring which time Clysters, together with the use of Prunes, give no small Relief; Oats and cleansed Barly being easily digested, and yeild|ing a moderate Nourishment, qualify the pre|ternatural Heat of the Blood, and keep open the Belly.

As for the Topical Remedies, which I com|monly employ in Dressing of Wounds, they have nothing singular in them, which is not pretty well known to the most part of Surge|ons.

I avoid as much as possible the use of Putri|fying Medicines, and of Powerful Suppuratives; because they destroy the Temperament of the Parts, disunite the Particles of the Blood, cor|rupt and deprave the Nutricious Juice, which ought carefully to be preserv'd in a good Con|dition. 'Tis this which mov'd the Ancients so

often to recommend to us, to maintain the wounded Parts in their Natural Temper.

Hippocrates affirms, that all Contused Wounds ought to be brought to Suppuration, in order to a speedy Cure, whereby he seems to patro|nize and allow the use of Putrifying Medicines, which commonly are employ'd to bring a Wound to Suppuration. But me thinks, this ought not to take place in the Hospitals of the Army, where the Air is ordinarily infected by the Breath, and abode of the Sick; and which are almost ever encompassed with the Graves of the Dead, whose number is but too great.

'Tis very certain, that this nearness of the Place of Burying, chiefly in hot Seasons, im|parts to the Air, by the Steams that rise from thence, a Complication of Corruption and ill Qualities, that occasions Rottenness in Wounds, Alteration and great Suppuration; and often causes great Mortality, in the Hos|pitals, and Places adjacent. Now according to this Maxim of that Author, Gunshot Wounds must be drest with these same Medicines, see|ing they are of the number of contused ones.

I don't absolutely deny, but there may be some Occasions, wherein such may be us'd: However I may be allowed to say, with all the Respect I owe so celebrated an Author, that in Hospitals, we ought to shun as much as possible, Putrefying and Suppurative Remedies, and others of a like Nature; even where the

Escar may require a considerable time before its Falling: For by the seasonable ordering of Diversions, and the Course of Diet, all these Accidents are often prevented, which the de|lay of the Suppuration might cause: and one may without scruple use, as I have done, such Remedies as have a Vertue to resist Corrupti|on; as the Spirit of Wine, which Etmullerus prescribes even in Gunshot Wounds, and which I us'd at the first Dressing, on the Day of the Battle of Marseils, without having observ'd a|ny evil consequence of my so doing: for besides a Good Method, which may be call'd the Strength and chief Instrument of a Workman, it is of high concern to understand, and to know how to choose Remedies, that agree with the Temper of the Parts to which they are apply'd, and to maintain them in that State wherein God has created them: But it proves often a very difficulty Task, to satisfy this In|tention.

As there is an admirable variety of Constitu|tions, so it would seem, that it were necessary to use different Remedies to Wounds of the same Nature, and of the same Parts, in diffe|rent Subjects: The Sex, Age, and Season must also be considered: I have likewise observ'd in my Travels, by People of different Nations that have been under my Hands, that diverse Climates require particular Applications, in cer|tain Circumstances, necessary to the Cure of

Wounds: For the Constitutions of Men, de|pend chiefly on the Countries they inhabit; on their Situation, high or low, dry or moist, the Winds that rule, the Food and Water that they take: So that they differ among them|selves, according as the Heavens look upon them with different Aspects.

But not to search any further into these things, which can't be contain'd within the Limits, prescrib'd to this little Work, and don't properly belong to my Subject; I will on|ly say, that it is easy enough to distinguish a proper Remedy, from one that is not so: That which corrupts and depraves the Natural Balsam, is known by looking into the Wound; from which, if there proceeds a strong and Stinking Vapor; 'tis a sign that the Matter is not concocted, seeing it is thin, blackish, too plentiful, watery, and of an offensive Smell.

The Flesh likewise has its peculiar Signs; it is dull of feeling, and sometimes is cover'd with another proud Flesh: Oftentimes there is to be seen over all the Wound, a certain black or white Filth, which some, as I have often known, scrape or cut off at every Dressing; whereby the Wound is enlarg'd, and the Cure delay'd: Others imputing it to the vicious Temperament, and ill Disposition of the Pa|tients Body, have recourse to Purgatives, which occasion still more new Accidents, such as Fevers, &c.

But be this as it will, 'tis certain that we ought not always to delay till the last, before we change the Remedy; our Smell and our Sight only are sufficient to direct us in this Oc|casion: Hippocrates orders a Medicine to be chang'd, when it does not what it ought, or was design'd for.

But we must not on the other Hand, fall in|to the contrary Extremity, of changing the Oyntments sometimes once, and often twice e|very Day; not giving time to a Remedy to act, and exert its Vertue, on the Part to which 'tis apply'd: 'Tis necessary, that the wounded Part draw as it were Nourishment from the Medecine, and therefore it must have a requisite Time, allowed it for that Pur|pose: it must, if I may be allowed so to speak, amalgamate with the Nutricious Juice of the Part; or at least, if it don't increase its Quan|tity, it ought to preserve it in the natural State, and when fallen therefrom, restore it again. To be capable of these Effects, it must be endow'd with a Volatil and Oyly Spirit, vis|cous also and temperate, as Balsams and Vul|neraries are, which I have us'd with very good Success.

I have often experienc'd on many Occasions, in several Hospitals, and chiefly in this, and in very considerable Cases, that after I had in vain us'd many Remedies authoriz'd by Custom, the Balsam describ'd in the Sacred Writings, has

had surprizing Effects; and that Members at the Point of being cut off, have been thereby cur'd with much Ease. This Hospital of Bri|anson, might afford many Instances of the Truth hereof; but I shall content my self with the two following.

CHAP. VI. An Observation of a very considerable Case.

A Surgeon of this Hospital, being one of those who was most employ'd in dressing the wounded, by Accident had a Thorn run into the middle Finger of his right Hand, which pierc'd the Tendon of the Muscle that bends it: his whole Hand and Arm were attack'd with very troublesome Symptoms, accompany'd with a continual Fever extreamly violent, and an unsufferable Pain.

Five or six Days past over, before I had notice of this Accident; and all the Symptoms were at the very worst: I found all things in a deplorable Condition, the Arm swell'd as big as the Leg, the Hand of a Monstrous Size, and the Finger as great as ones Arm; many Cavi|ties were in the inward Part thereof, and some in the outward, from which issued a serous Matter; there was another large Sinus under

the Musculas palmaris, with an Orifice near the Roots of the Fingers.

I straitway laid open the Finger, on the in|ward Part, from one End to the other, and found the Tendon swell'd and corrupted; I did not enlarge the Orifices on the outward Part, nor that of the Palm, hoping that all these would he well, if I could but overcome the Ac|cidents.

He was Let Blood, and had a Clyster given him, tho' somewhat too late; he observ'd an exact Course of Diet, and was drest with the Balsam of Arcaeus. On the Morrow when I took off the Dressings, I was surpriz'd, as I had been the Day preceeding, with a Vapor of an intollerable Smell; the Lips of the Wound were turned outward, which made me despair of a Cure, and judge it would be ne|cessary to cut off the Hand: The Matter re|main'd undigested, the Fever, the Pain, and the Swelling continu'd as before: he was drest in the same manner as the Day before, with addition only of a little Spirit of Wine. The Bleeding was repeated, and also the Clyster.

The Day following, the Wound was in the same Condition, save that the Corruption appear'd to encrease: We were of Opinion, that nothing but Amputation could save his Life. But for as much as Art and Reason di|ctate, that the preservation of the Members ought to be endeavour'd so much as possible;

and as we are oblig'd in Conscience to try all Remedies before we come to that Extremity: I resolved, forthwith, to change the Medi|cines; judging rightly that what had been us'd, might have occasion'd, this depravation of the Salts; whence it was to be fear'd, a total Corruption of the Nutricious Juice might fol|low.

Wherefore now I us'd the Balsam of the Scriptures, mixt with a third Part of that of Arcaeus, in this I wetted the Pledgets, which I apply'd very warm over all the Wound, and upon the Sinusses: I pour'd some of it also into the Sinus of the Musculus palmaris, and upon it I put a Plaister of Dipalma dissolv'd in Oyl of Roses and good Vinegar.

On the next Day after this, we found all things much chang'd to the better: The Fe|ver and Pain were lessen'd, and there was no|thing so ill a Smell as before.

I question not, but the Fever is a Symptom troublesom enough, and able to cause all these Effects; and that by the Motion it excites in the Blood, it seperates saline and sulphureous Juices, that by irritating the Fibers may occa|sion that turning out of the Lips of the Wound, their Swelling, and that insupportable Smell: But it can't, on the other side, be deny'd, that outward Remedies conduce much, to pro|cure that Fermentation and Corruption in the wounded Part, when they are such as putrify;

because they dissolve the Blood and other Li|quors, causing Irritations, Corruptions, and great Suppurations; and destroy the Tempera|ment of the Parts, to which they are apply'd. Whereas when Balsamick, and Spirituous Medi|cines are us'd, they produce quite contrary Ef|fects: For by allaying the Sharpness of the Humors, and making the Blood fluid, they resist Corruption, dry up the Moisture, and in the Place where they are apply'd, abate the Commotion of the Humors, caus'd by the Fever.

In fine, whither it was by this, or any other Way, 'tis certain that the Change of the Me|dicine here, produc'd a notable Alteration on our Patient: for tho' the Fever appear'd but very little abated, by all that I had formerly done; the very next Day after this the Lips begun to come nearer together, the Pain and Defluxion ceas'd; and which is most of all, the ill Smell was quite evanisht; so that in five or six Days he was past all Danger, and the Cure was compleated in a little time af|ter.

M. Le Clerk, Physician to the King, in his Compleat Surgery, commends much the Sama|ritan Balsam, to which we have given the Title of The Balsam of the Holy Scriptures: and the Approbation of such a Man is sufficient to justifie its Use. I thought it not unfit like|wise here to subjoyn the Discription of another

compound Samaritan Balsam of an admirable Vertue. It is made up of equal Parts of Spa|nish Wine and Oyl of Roses, to each Pound of which Mixture two Ounces of Sugar-candy, and as much Honey of Violets must be added, and all boil'd on a gentle Fire, and skim'd till the Wine is consum'd. This may be call'd the Balsam of Balsams, or the Compound Sama|ritan Balsam.

CHAP. VII. An Observation of another Case.

M. Vert the Younger, an Ensign of the Company of M. de Beauvet, Lieute|nant of the King at Brianson, and Commander of the Second Battalion of Sault, had no less Reason to applaud my Method, and the good Effects of my Remedy, than him we discours'd of in the preceding Chapter.

He was wounded with a Sword, at Pragelas, in the outward Part of the left Arm, near the bending of the Elbow. The Wound was at first neglected, being not well dress'd: for without dilating it in any Manner, a Tent was thrust into it as long as it could possibly re|ceive; which occasion'd such frightful Acci|dents, that the Patient thought of nothing

but losing both his Arm and his Life. In the inward part of the Arm, opposite to the Wound, Matter was collected, and Abscesses form'd; which oblig'd him to consult the principal Sur|geons of the Regiments, who thought it con|venient, to make an Opening in that Part, which accordingly was done. By the large and deep Incisions that were made, the Artery was opened; so that they were oblig'd to use the Actual Cautery to stop the Bleeding: By this means the Wound was enlarg'd, and the Pain and the Accidents increas'd.

The first Wound, was still drest, as before, with Tents: but the Wounded Person having kept his Bed for fifty Days, and his Wounds being still in a very wretched Condition, he was ad|vis'd by the abovemention'd Gentleman M. de Beauvet, to cause himself be transported to Bri|anson, to try if there he might find any Help. He was committed to my Care, and I found the inward or lower Wound, the length of a large Span, and four or five Fingers breadth wide: The Artery and Tendons were uncover'd, the ancient or outward Wound, whose Ori|fice was very strait, had in it a pretty long Tent, which shut up the passage of three or four Sinusses, that took up all the Joynt.

The Arm and Hand were Oedematous, be|ing much swell'd, and painful; I began by making an Incision in the Wound on the out|ward Part, whereby I discovered the Orifices

of the Sinusses, into which I dropt a little of our Balsam, mixt as I formerly said, with some of that of Arcaeus.

The large and lower Wound was drest with the same Remedy: We us'd expulsive Cmpres|ses, to press together the Sides of the Cavities, which we kept on with a proper Bandage: Moreover we laid aside the Aromatick Wines that had been before us'd upon all the Part, to its great Detriment.

Three Days after it had been drest in this Fashion, the most Part of the Accidents disap|pear'd: he begun to rise up from his Bed, to take his Victuals, and to gather Strength; all the deep Cavities were fill'd up; the Artery, the Nerve, and the Tendons were cover'd over; the Pain, the Fluxion and the Oedemaetous Swel|ling were 'quite gone; and by this powerful Incarnative the Cure was compleated in a Fortnight, with the assistance of a little Vn|guentum Apostolorum, wherewith we sometimes use to consume the Flesh: After this he mounted his Horse, and went for the Air into his own Country.

This I may confidently affirm, as a certain Truth, that when the Balsam we speak of is genuin and unsophisticated, it may serve at the same time both for Food and Medicine, be|ing made up only of sweet Oyl and Wine: And that it may be us'd not only for curing Wounds of the Mouth, of the Tongue, of the Gul|let

and Wind-pipe, and generally of all the Breast; but likewise in obstinate Dysenteries, in Relax|ations of the Fibers of the Ventricle, in Vlcers thereof, and in these of the Guts, and of all the lower Belly. For if we consider its Na|ture, we shall find it of a friendly Quality, and extreamly agreeable to our Constitution; being compounded of such things as serve us dayly for Food. Sweet Oyl softens, loosens, sweetens and penetrates; and when it is boil'd with Wine, which it devours as it were and consumes, retaining with its self all the Ver|tue thereof, it is enabled to perform all these Operations with much more Ease: It cuts, dissolves, strengthens, restores the Spirits, breeds Flesh, and is Astringent; all which our Balsam performs, being indow'd with the most useful Vertues of these Remedies, and contain|ing a Volatil, Oyly, and Temperate Salt, that is Astringent and Sarcotick: And if a lit|tle Sugar is boil'd with it, it becomes yet more excellent, is more Vulnerary and Balsamick, has no Acrimony, and is without either Smell or Tast.

Had this Remedy, how simple soever it may appear, produc'd such Effects, in the Hands of any other but my self; they wou'd without question have made a great Secret of its Com|position: and tho' this had been known to many, yet they wou'd never have publish'd its Vertues.

It were greatly to be wish'd, that there were only one Remedy, which might be able to answer all Intentions; so we shou'd not be always oblig'd to have in the Patients Cham|ber, a whole Apothecary's Shop; which is often no less prjudicial to the Purse, than offensive to the Smell.

Being about six Years ago at Turin, I cur'd a Gentleman of an inveterate Ulcer, that encompass'd all the Bottom of the Vvula: Many Surgeons had to no purpose us'd a great many Remedies: And I in like manner after the use of some more with no better Success, bethought my self at length of my Anodin Bal|sam: In this I dipt a Linnen Rag ty'd to the end of a Probe, and therewith touch'd the Ul|cer twice a Day: By this Means, as I solemn|ly protest, in twelve or fifteen Days, the Vl|cer was compleatly cur'd.

This Remedy, how ancient soever it is, will appear new to many. However 'tis cer|tain that Hippocrates in complicated Fractures, us'd little Linnen Rags dipt in Oyl and Wine mixt together, to allay the Pain, and prevent Convulsions, which is a Precedent sufficient to invite our Imitation.

It hath been the Policy of almost all who ever wrote of Medicine, still to reserve some|thing undiscover'd to themselves. I could name a great number of Authors, who have published the Vertues of certain Remedies,

whereof they have never given the Composition; or if they have, it has been in such Ambiguous and Aenigmatical Terms, that it is hard to un|derstand any thing of it. And indeed I must acknowledge that a Remedy, when it becomes common, how good soever it may be, loses much of its Esteem.

I have formerly said, that the Variety of Constitutions, and Diversity of wounded Parts, require sometimes a Difference of Remedies; to this we must have all due Regard: For it often falls out, that even the most excellent Medicines, are not capable to answer all our Expectations; especially when the Patient is of an ill Constitution, and the Distemper obsti|nate, and troublesome.

However it is not good, to put too much Confidence in this single Composition, as if it were an Universal Remedy, if at any Time the Success prove not answerable to our De|sires: I own that I have been oblig'd my self in such Cases, to boil in our Balsam, the Grea|ter Consound, Bugle, Sanicle, some Lavender, Clary, St. John's Wort, and the Lesser Moon-Wort, which is a powerful Vulnerary, and ve|ry common in these Parts; and afterwards to give it some Consistence, with about a third Part of the Balsam of Arcaeus: This Com|position, has done surprising things; it hath consumed and remov'd Fungusses, from Feet that had been intirely Frozen, and also from

Amputations, which had withstood all other Remedies: It procures a good and moderate Suppuration, eases the Pain of Wounds in the Nerves, allays and resolves powerfully, fills up with Flesh in a small time, in fine, an Em|brocation therewith, cures speedily Bruises of all sorts.

Altho' I have these Remedies in great E|steem, and am confirm'd in my Opinion of their Excellency by a multitude of Experiences that I have had; Yet I don't pretend to lay aside the Oyntments, Cerats, and Plaisters of Pharmacy; which may be of very great use, and are every Day employ'd with Success, by very skillful Persons in curing Wounds.

This only I will affirm, by the way; that the most Part of Oyntments have a strong smell, that is not only disagreeable to the Wounded; but is also no less hurtful to the Wounds, than offensive to the Smell; and ve|ry much conduces to render them putrid, sa|nious and Virulent.

There are also several Places, where they very unadvisedly use Corrosive Sublimat, Arse|nick, and other things of a like Nature, in the Cure of Wounds, not foreseeing their fatal Ef|fects. Nevertheless we can't here be too cau|tious: All the Parts of our Body, are made up of Veins, Arteries, Nerves, Lymphatick Ves|sels and Glands, that are easily affected by whatever touches them, and that by means of

the Circulation convey to the large Vessels, and the Original of the Nerves, the good or ill Qua|lities that have been imparted to 'em. The Contagion, that is communicated to the Sheets of a Bed, wherein one that has the Pox or itch has lain for a Night only, will imprint its Characters on a sound Person, that after lyes in 'em; tho' the impure Matter touch only the Scarf-skin, and is to Appearance much less active than Arsenic or Sublimat.

The unfaithfulness us'd, in making up cer|tain Compositions, which I have experienc'd on some Occasions, hath oblig'd me, to resolve to make up my self, some that are more simple, and much more Effectual.

Etmullerus in his Medicinal Surgery, and many others before him, have complain'd of the prodigious number of Medicines used in Practice; and of the great many Plaisters, Oyntments, Cerats, and a thousand other useless things, good for nothing, but to perplex the Mind of young Surgeons. That great Maga|zine of Pharmacy, might be reduc'd to much narrower Bounds. Experience has convinc'd me of the truth of this; and there are at this time many Persons, very expert in Chirurgical Practice, that are herein of my Opinion; some of whom think, that one Remedy only may answer all: It were well if such a Method might be establisht, for the good of the Wounded, and the Conveniency of Surgery.

But I am enclin'd to think, that no Man has yet gain'd that Point; which is extream|ly hard to be attain'd, because of the Diver|sity of the Parts of which we are compos'd, and the Variety of Constitutions in different Persons. 'Tis this Considetation, that hinders me to give Credit, to that universal Remedy which a certain Modern, otherwise a very able Surgeon, and at some distance from these Parts, hath endeavour'd to establish. But if I am not al|together of this last Opinion, I am yet much further from that of the Ancients, who have left us such a Numerous List of Remedies, as can't be either committed to the Memory, or retain'd therein. A great deal of Study, and diligent Application is necessarily requir'd, in order to know their Vertues and Properties: For to make the right use of a Medicine, we must know its Nature and Effects, not abandon|ing the Success to uncertain Chance, and the Fidelity of another, as is often done.

Moreover, it is very hard to believe, that all these mighty Compositions, are answerable in their Effects, to the Expectations had of 'em: the numerous and differing Ingredients do oppose, alter, and destroy one another. The most Simple Things are most agreeable, and sympathize most with our Nature.

I could never yet learn, that Solomon, who had an Vniversal Knowledge of all things, left behind him for the Cure of Wounds, Composi|tions

so perplexing, and stuff'd with such a number of Ingredients, as these, which some use at this Day: In his time, two or three Simples, suffic'd to make a Balsam, which was nothing inferiour to many others, that are now cry'd up as Infallible Remedies.

Balsams are recommended, in the curing of Wounds, by the most Part of the Ancients, and almost all the Moderns, contrary to the Opi|nion of some that Practise Surgery, Enemies to Antiquity; who therein act, as the Quacks do, contrary to all manner of Reason: But an undis|creet Passion, ought never to prevail over that, which is justifyed and supported by Experi|ence.

Tho' I don't approve of Medicines, made up of numerous Ingredients, yet I have often us'd the Styptick Plaister of Crollius; which, tho' it may be accounted of this number, ought not at all to be laid aside: For when it is faithfully made up, it hath Vertues too effectual to be neglected, and not sought after. When I have a Mind to give it a softer Consistence, and reduce it to the form of an Oyntment, that I may make use of it in dressing of Wounds, I melt it with the Balsam which I have de|scrib'd; and sometimes with the Oyl of St. John's Wort, prepar'd with Gum-Elemy.

It will answer all the Expectations, may be had of it, in curing Wounds and Ulcers: It allays Pain, cleanses, and breeds Flesh: those

who will give themselves the trouble to exa|amine its Composition, and Ingredients, will a|gree with me, that 'tis not impossible, but it may have all these Vertues.

I have sometimes us'd, and also in this Hos|pital, a Red Balsam made with an Ounce of Red Saunders, and White Wax; two Ounces of Venice Turpentine, Oyl of Roses, and Rose-water, and a Dram of Sal armoniac; all mixt toge|ther, and hastily boil'd, and kept for use: It resists Putrefaction, and lessens Suppuration.

The Simple digestive, is a Remedy that I commonly use, to bring away the Escar in Gun-shot Wounds; mixing always therewith a little of the Yolk of an Egg, and some Spirit of Wine: I renew it every Day, because it soon corrupts, by Reason of the Yolk of the Egg.

Turpentine is a simple Balsam, which is ex|cellent for curing of Wounds: The Country People about Brianson, who gather a great quantity thereof from the Wood of the Larch-Tree, use nothing else, but this Single Remedy, without any mixture, for the Cure of their Wounds: Certain it is, that they who are accustom'd to mix with it, a great number of Ingredients, and Catagmatick Powders, spoil its Vertue, and can expect nothing from it, but bad Succes.

Arceus his Balsam us'd in so many Places, is not to be despis'd when rightly compos'd: But 'tis convenient to remark, that it agrees

not to all Distempers, nor all Parts of the Body, as was observ'd in the first Remark of this third Part: Which I have also experienc'd since, in many other Occasions.

Basilicon, is one of the most common Oynt|ments, and most us'd: I sometimes imploy it to receive the Pouders, that I think necessary, ei|ther to Irritate, or procure Suppuration when I judge it convenient: Otherwise I don't much deal with it.

It sometimes falls out, by the use of Sarco|tick Balsams, that the Flesh grows so fast, as to oblige us to consume it; and also the Orifices of the Lymphatick Vessels, oftentimes raise up certain Protuberances, that together with the superfluous Flesh, forms as it were a resem|blance of Mushrooms, which some endeavour to remove with Cathereticks, but to no purpose.

I have observ'd, that to touch the Excres|cence all over, with a Dissolution of the Caustick Stone, is much better, than any other means, that can be us'd, for this Intention; providing the Application be renewed, so oft as is needful. I have in eight or ten Days, consumed Mush|rooms as big as my Fist; which the ordinary Powders cou'd not have done in two Months. It may be seen, in several Places of the se|cond Part of this Book, that I have us'd it, with a quick and happy Success, when there was Occasion to take off the Callosity, happen|ing to Wounds, in order to procure a Reuni|on:

and when these kind of Protuberances, have but a dull Sense, I don't scruple to sprinkle upon them, the foresaid Caustick pul|veriz'd, or to apply Pledgets dipt in a Dissolu|tion thereof, till I have procur'd such Smooth|ness, as is requisite in order to a laudable Cica|trix, and have restored the Feeling of the Part.

When I only intended to bring to an Equa|lity, the luxuriant Flesh; and procure a firm and handsom Scar, I have us'd with good Success Vnguentum Apostolorum, mix'd with a little Vn|guentum Egyptiacum: This destroys proud Flesh, and is an excellent Medicine for Vlcers, to be apply'd before the use of powerful Sarcoticks: For it quickens the Flesh, consumes superfluous Moisture, and resists Putrefaction.

I have always mightily approv'd, the use of the Spirit of Wine, and have often caus'd dress Wounds of the Extremities, with this Re|medy only: 'Tis true it delays Suppuration, and protracts, the coming away of the Slough in Gunshot Wounds; but it powerfully resists Pu|trefaction, corroborates and quickens, hinders Excessive Suppuration, and the Dissolution of the Nerves, to which putrifying Medicines are very hurtful.

The Emplastrum Tripharmacum Juberti, made of Litharge, Oyl, and Vinegar, to which I add a little scrap'd Lint, is admirably good to digest a Wound, and bring it to Suppuration, with|out occasioning great Putrefaction: It mightily

dissolves Contusions, and its use is of great be|nefit.

It is certainly very convenient, that a Sur|geon have some peculiar Remedy, the Vertues whereof he is well acquainted with, to which he may have recourse in obstinate and trouble|som Accidents, that sometimes follow upon Wounds, and will not yield to the Common Re|medies. It is often also expedient to change the Medicines, as I have formerly said, and not always to be confin'd to one thing: For the Fondness one may have for a Balsam, or an Oyntment, that, possibly, may have done very good Service on many Occasions, ought not to prevail so, as to make us employ it in all Times and Places: The best and most Ap|prov'd Remedies, have not always the same Ef|fects, or the same Success: For certain it is that not meeting with the same Constitution in all Persons, 'tis impossible they can have the same Operations.

REFLECTION.

I have often observ'd, and it daily falls out▪ that Quacks, who have neither Skill nor Expe|rience, have succeeded in the Curing several Distempers, after they were given over by Pro|fess'd Surgeons, who had bestow'd much time, and us'd many Romedies to no purpose: But I don't at all think it strange; for Those, leave Nature to her Self, in such Occasions; and 'tis she only that works these Miracles, that are

unjustly attributed to them, and give such Re|pute to their Remedies.

Not, but that acting without any Rule, they commit very gross Blunders; being una|ble, with all their Balsams, to correct, over|come, yea or foresee the Accidents, that of|ten follow upon Wounds: For all their Skill, extends no further, than to the making up of their Remedies; and that which can't be cur'd by these, passes with them for incurable. It is not so with regular Surgeons; they know the Causes of Accidents, and apply thereto the ne|cessary Remedies, without abandoning the wretched Patient to his ill Fate.

It is indeed a notable Shame, that a wound|ed Person should go from under their Hands, to be cur'd by a Quack, a Clown, or a simple Woman. I have known, in several Places such, who by the Sale of their Remedies, have acquir'd great Reputation; whether by the Confidence, that wounded People had, of the Vertue of their Balsams; or for a Reason that appear'd very convincing; to wit, that tho' they neither us'd Tents nor Dilaters, yea in very express terms discharg'd them, yet they often succeeded in their Cures, to the Disgrace of Surgery. However, it must needs be, that the Inventers of these Balsams, did discover some Inconveniences in the use of Tents, see|ing they have altogether forbidden to employ 'em: Now, I suppose it will easily be believ'd,

that these Men or Women, who are employ|ed in selling them, are not the first Authors; and that these who first us'd 'em, were not al|together destitute of Knowledge.

Diapalma, is one of the Plaisters, most com|monly us'd in Hospitals of the Army: When it is rightly made up, and dissolved, as was said before, it is not to be despis'd: And I add to it, when the Case requires, a little of Empla|strum de Betonica.

Emplastrum divinum, Manus Dei, Gratia Dei, &c. are Plaisters of a singular Vertue; but very seldom to be found made up, with all the requsiite Fidelity.

I have nothing in particular to say, concern|ing Cataplasms, according to the ordinary Method: It belongs to the prudent Surgeon, to give them what Form and Qualities, he thinks fittest for the present Occasion.

I have often faund much more Advantage, from the Use of Emplastrum Tripharmacum spo|ken of before, and Diapalma dissolv'd, which don't so much clog the Parts, to which they are appply'd, nor at all hinder Transpiration. Anodine Cataplasms, such as that of the Crum of Bread, and others of that Nature, are very useful in great Inflammations of Wounds, after the necessary Diversions have been perform'd; they allay the Heat of the Blood, extinguish the Acrimony of Salts, and relax the Skin. Vnguentum Santalinum may also be us'd to good

Purpose: And when the Pain is partly re|mov'd, I use Dissolving Medicines, which at first would have encreas'd the Inflammation and Fermentation.

Before I put an end to this Discourse, I will remark, that it is very requisite for a Surgeon of a Field-Hospital, or of an Army, who may sometimes be shut up in a besieged Place, ill furnish'd with Medicines for the use of the Wounded, to understand, how to make up simple, and easy Remedies, with few Things, such as those before mention'd for Wounds, and these of which I shall afterwards speak for Vlcers; which in time of need may serve for all: Brandy, which is the ordinary Refuge, in want of other Remedies, may also be lack|ing. It is the part of a prudent Surgeon wisely to provide for this necessity, and to ac|commodate himself to the time, by dressing the wounded Seldom, and according to our Method: Thus fewer Medicines shall be us'd, a little shall go a great Way, and every one shall have Reason to be satisfy'd.

A great number of Abscesses, Wounds, Vl|cers and Fractures of all sorts, that have been under our Hands, in this Hospital, have been cured according to this Method; wherein there is nothing but what is Gentle and Easy. All the Amputations that we have perform'd, were drest only once in two or three Days, du|ring the whole time of the Cure, with our sim|ple

Remedies; and that with very good Suc|cess. Those who have been so happy, as to avoid the malignant Influence, of the Conta|gious Steams, that have so long prevail'd in the Air, have experienc'd the Comfortableness of this Method, by the suddenness of their Cure, compleated without any Exfoliation of the Extremities of the Bones: Which infalli|bly had followed on Frequent Dressings.

I commonly use a Button of Vitriol, to caute|rize the Vessels, and stop the Bleeding, which I ever found successful; neither did the Flux of Blood ever return. The two Stitches with a Needle, made cross-wise upon the Vein or Artery, are very sure; this is a common Way, which I have sometimes, and yet do follow: But the Falling of that Suture, is sometimes so tedious, that it exhausts the Patience, both of the wounded Person, and the Surgeon; not|withstanding its use is very safe: For the Bleeding is less to be fear'd this Way, which is quick and gentle, than any other. The actual Cautery is now out of use, unless it be in Amputa|tions perform'd on the Dead.

Tho' in the Cures of the Penetrating Wounds of the Thorax, spoken of in my second Part, I was not oblig'd to perform the Operation of the Empyema; yet I have had Occasion to use it, on many other wounded Persons, since I embrac'd this Method: For take what Way, or what Care you will, it is oftentimes absolutely

necessary. When the Cavity of the Breast is full of Blood, and the Orifice of the Wound high, it is not then safe, to attempt to empty it, by the way of Vrine, which might be too slow, and is too uncertain; but we must with|out delay fall about the Operation.

I will not here, describe the Manner of performing this, or other Operations. M. Verduc, and M. Chariere, have lately afforded suffici|ent Means of Instruction in this Affair. This I will only say on the Subject in hand, that this Operation, ought always to be perform'd on that Side, where the Effusion of the Blood is; and if it is found to have been on both Sides, and one Opening does not give the Ease that is expected, tho' the extravasated Blood is discharg'd; we must make an Opening also on the other Side, after the first is carefully clos'd up, and the Patient has had some time allow'd, to recover his Strength. Sometimes I am oblig'd to use Tents for the first Day, left the Division of the Pleura, that was but newly made, should unite again; and so there would be a necessity of a new Operation the next Day, to let out that Blood, which being coagulated, could not at first be brought a|way, and can hardly be evacuated by any o|ther Means. As for these Openings made in the Body by Bullets, in Gunshot Wounds, there is no need of Tents to keep them open, for they cannot be clos'd up, till the Escar is se|parated.

I have already said, that in Openings which I make to evacuate the Collections of Matter, or Abscesses in the Thorax, ocasion'd by a Pleu|resy or Peripneumonia, I use Tents without a Point in the first Days, to keep the Matter from coming out all at once: Otherwise the Place that was possest by the Matter, wou'd soon be fill'd with Air; which, being ever colder than the inward Parts of the Body, might occasion Coagulations, Suffocations, and Swoonings. Moreover, when a great deal of Blood is extravasated, it must also be let out by Degrees. Now in such Occasions Tents are necessary: But these being once over, I lay them aside for good and all; that a free Passage may be given to the Matter, that the Genera|tion of a Callosity, about the Sides of the Open|ing, may be prevented, and that nothing may be left to hinder the Reunion.

By this Method, the wretched Patient is deli|vered from a great deal of Trouble, Pain and Vexation; being enabled thereby to enjoy a Repose, which otherwise he could never have expected: And by seeing him thus from Pain, what inumerable Accidents are avoid|ed?

Had not Charity and Patience prevail'd in this Place, and restrain'd us from cutting off, without further delay, Members, that were only gangren'd by an Extremity of Cold, as other Surgeons of Hospitals have done; this of

Brianson, wou'd have been full of Invalids. For about the End of the Campain, in the Years 1692, and 1693. a great number of sick Persons were brought thither from Pigne|rol and O••lx, who in passing the Mountain Genévre, were in such manner seiz'd and pe|netrated with the Cold, in the Extremities of the Body, that a total Loss of Sense, and al|so a Gangrene did ensue; the most part of whom, notwithstanding, were cur'd without Amputation; those only excepted, that had been before, worn out with long Sickness.

CHAP. VIII. Of Gunshot Wounds.

SEing Wounds are the Principal Subject of this little Treatise, it was not fitting that those inflicted by Fire-Arms should here be for|gotten. Wherefore, I shall say something of them in this Chapter.

Gun-shot Wounds are acknowledged by all to be very troublesome, because of the Tearing and of the Disordering the Flesh, occasion'd by the Bullet, the Stop put to the Circulation so far as they reach, the Havock that attends them, and the Obstructions they occasion; all which are but too too able to produce very grievous Acci|dents.

Fluxions, Mortifications, and Gangrenes are here very much to be feared; to prevent which, I at first give Breathing to the Wound with pretty large and deep Incisions, accord|ing as the Nature of the Part, and bigness of the Wound do require. I do my utmost to draw out the Extraneous Bodies, if there are any, putting the Wounded Person in the same Posture wherein he received the Wound: Afterwards I dress it according to my Me|thod, and seasonably perform the requisite Di|versions. A Flux of Blood, is almost never to be fear'd till the Escar be fallen, unless some great Vessel be wounded.

Nevertheless, I can truly affirm, that there never happened any Flux of Blood in Gunshot Wounds, since I laid aside the use of Tents: for according as the Escar is dissolv'd and comes away, a new Flesh is bred without any hin|drance, and covers the Wounded Ves••els, which can't be when it is prest by Tents. This is a Truth so evident, that I hope no Man will call it in Question.

Diet ought always to be rightly order'd: and if notwithstanding all our Care and Pre|caution, dangerous Symptoms do follow, we must endeavour to ease and relieve the Part, by making many Scarifications thereon, in or|der to give a Vent to the extravasated Blood, and to hinder its Stay and Fermentation. But seeing the most part of the Accidents that

happen, are more or less troublesom, accor|ding to the different Bigness of the Contusion; I do what I can to dissolve it, as soon as possi|ble, and to restore the Humours to their usual Motion: For according to the Definition we have laid down in our first Part, A Contusion is a Disorder of the Fibers and little Vessels, that changes the Regularity and Situation of the Pores: but this is often accompany'd with an Effusion, or Extravasating of Blood, which pressing upon the Vessels, hinders the Course and Motion of the Humors and Spirits. The Accidents that follow, in this last Case, are much more troublesom; wherefore, without expecting the Effects of dissolving Medicines, I forthwith have recourse to Scarification; for Mortifications often times surprize of a sudden: however, seeing things come not always to this Pass, I sometimes use Dissolving Medi|cines.

We have known, a very warm Embrocation with Oyl of Roses, to which was added a little of that of Turpentine and some Spirit of Wine, pro|duce exceeding good Effects: it begins the Disso|lution, relaxes the Skin, and disposes the Part, to receive afterwards the Impression of the Plaisters; such as the Tripharmacum Juberti, Diapalma dissolv'd as we have ordered, fresh Cow-dung fry'd, with Volatil Salts, as also that of other Animals: the Roots of Briony infus'd in Spirit of Wine are in this Case very proper.

Dissolving▪ Cataplasms are sometimes very seasonable, providing they be not too empla|stick: and if in spite of all our Care a Gan|grene should follow, we must use these Reme|dies which were describ'd under that Head. But this Accident never yet fell out in any of these Wounds, whereof we had the first Dres|sing; and I can aver, that tho' simple Gun-shot Wounds, are drest in this Hospital as Excoria|tions only, yet are they always cur'd with a surprizing Quickness: Nevertheless we per|form all the necessary Diversions. The Re|medies we us'd may be seen in the Relation of the Cures.

CHAP. IX. Of Burns.

THE Accidents occasion'd by Gun-powder, might afford us Subject of much Dis|course upon Burn; But I design only to speak a Word or two thereof, that I may thence have Occasion, to point forth the Re|medies I use in their Cure.

The Tallow of which they make Candles, melted with the Oyl of Walnuts to the Consi|stence of an Oyntment; will answer to all the Intentions propos'd in this Matter. I have not found any thing either so effectual, or so

easie: it will terminate the Empyeme, and cures generally all sorts of Burns whatever, in very short time: In fine, this is the Remedy which we ordinarily use. Benjamin, Vnguentum Popule|um, and the Yolks of Eggs, may be us'd when this can't be had. There are but very few Surgeons, who have not always some particu|lar Remedy for Burnings, some more some less effectual. Etmullerus, and other Authors, have given a great number of very good ones: and M. Verduc in his Pathology, explains their Na|ture and their Differences, in a very clear and unintelligible way.

A little time after the Declaration of War, an Accident happen'd in the Valleys of Lu|serne, which afforded us many frightful Spe|ctacles. The Guard-house of the Fort of Tour, call'd St. Maries, fell down upon about thirty Soldiers, as they were warming themselves a|bout a great Fire; of whom twenty, or there|abouts, were buried with the Ruines, in the Chimney by the Fire. A good deal of Time was spent before they could clear away the Stones and the Rubbish, and get out these poor wretched Creatures. Some were found dead, and roasted; others were brought into the Hospital of Luserne. A Plaister as big as a Bed-sheet, was scarcely sufficient to dress them. Two or three dy'd; and five or six were cur'd by the assistance of Cordials, Diaphoreticks, and absor|bing

Medicines, taken inwardly to facilitate the opening of Obstructions; while outwardly, the most proper Oyntments, were us'd to allay the Pain, and dissipate the corrupt Matter, to which I caus'd add a little Camphire and some Yolks of Eggs mixt together: To conclude, after very frightful Suppurations, the Cure was compleated; but they were for the most part, like so many Serpents, all oblig'd to change their Skin.

CHAP. X. Of Ulcers.

ETmullerus is of Opinion, that the Cause of Vlcers, proceeds from an Acid, whereby the immediate Nourishment, distributed to the Part, is corrupted, and losing its Oyly and Balsamick Nature, becomes sour, and altoge|ther unfriendly to the Part, that it ought to nourish, and so considerably encreases the acid Ferment, and augments its Activity.

According to this Definition, a Topical Re|medy well accommodated to the Kind of the Disease, and that destroys Acids, and repairs the Balsamick Nature of the Nutricious Juice, if sufficient to bring this sort of Distemper to a perfect Cure. I have often in this manner

cured, many poor afflicted Creatures, without the use of General Remedies. But not to make any change in the manner of Dressing, I say in the first Place, that Vlcers are but too com|mon in the Hospitals of the Army: Tbe ill Dyet of the Soldiers, their Irregularities, their Fatigues, and their unavoidable Nastiness, are more than enough to occasion such as are very obstinate, and difficult to be cur'd. Second|ly, we have in this Hospital followed a Method, whereby in a little time, a great number of Vlcers were cur'd: For after General Remedies, and some slight Diversions, I us'd a Decoction of Walnut Leaves with a little Sugar; in this I dipt Pledgets, which I apply'd moderately hot, letting often three Days pass over with|out taking off that Dressing.

Many Persons in France, I know, have kept this Composition as a great Secret; but I thought it wou'd have been inconsistent with Charity, not to publish its Vertues, and the manner of making it.

I have experienc'd on a thousand Occasions, that it mightily cleanses, and breeds Flesh; mor|tifies and devours it Acidities, resists Putrefa|ction; removes plentiful Suppurations, and con|sumes the Moisture that hinders Reunion: In fine, it hath Vertues that surpass Belief, and its Effect is more quick than that of all the Oynt|ments, and Cerats with which Apothecaries Shops are stor'd, and which are commonly us'd

in curing of Vlcers, but often to no purpose. In the mean time I dare affirm, and that truely, that in the Places where I have us'd it, all these Vlcers, that were formerly thought Incurable, were thereby ended in a very short time.

Tho' I do but very seldom make any use of Injections, nevertheless, I have been some|times oblig'd, to have recourse to this Remedy, from which I have reap'd more advantage, then from all those us'd in Practice; and espe|cially in hollow and deep Vlcers: As also in large Abscesses of fleshy Parts, where there is great Putrefaction, and sometimes a considera|ble Cavity.

The Scriptural Balsam, spoken of before, which is only an equal Quantity of Oyl and Wine, boil'd to the consumption of the latter, is also an excellent Medicine for Vlcers: With this Remedy only, I have cur'd great num|bers.

Many Authors there are, who have left us an Account of a vast number of Remedies, which are us'd in Hospitals; for which Reason, I will say nothing of them here, where my De|sign is only to make known those I use in my own Practice.

By what I have said of the seldom dressing of Wounds, it may be easily guess'd, that I am not for frequent Dressing of Vlcers: For if they proceed from an Acid, as Etmullerus thinks

we ought to endeavour not to promote the Coagulation, by admitting the Acid of the Air, which by insinuating its pointed Articles into Vlcers, corroborates the Cause, renders them putrid, sanious, and sometimes incurable.

'Tis not without ground, that Galen, as hath been declar'd already in the first Part, in his Fourth Book, of the Composition of Medicines, Chap. 4. hath ordered, to dress Vlcers, but once in three Days: And I believe that it wou'd yet be better, to do it more seldom; un|less some urgent Cause require it; such as the Season of the Year, the badness of the Hu|mors, or some other evil Disposition of Bo|dy.

We may observe, that Suppurative Medi|cines, us'd in dressing Vlcers, are extremely pernicious: For the Matter is but too plenti|ful, and requires to be lessened, and dry'd up, if we desire a perfect Cure. The Application of Topical Remedies, when well chosen, often|times performs in this Case, what neither Di|versions, nor Internal Medicines cou'd do; and of such there are good store: But it depends only on the Prudence, and Skill of him that pre|scribes 'em, to use them seasonably; for we can expect no desireable Effects, either from one kind or another, but according as they are properly apply'd.

Vnguentum Apostolorum, mix'd with Vnguen|tum Egyptiacum, is not to be despis'd: It con|sumes

all the corrupted, and the Superfluous Flesh. I have often apply'd this, before I made use of our Lotion.

The Aqua Phagaedenica, or Lime-water mixt with Salt of Lead, or Sal Armoniac and Aqua Coelestis, have also serv'd us on such Occasi|ons; for if one Remedy fails, as often falls out, we must have Recourse to another.

CHAP. XI. Of Simple Fractures.

IN the Cure of Simple Fractures, commonly four things are propos'd to be done. First, to set the Bone, or bring it to its natural Fi|gure. Secondly, to keep it so, with fit Dres|sings. Thirdly, to take care of the neighbour|ing Parts. And fourthly, to give the afflicted Member a convenient Posture.

First then, Extension is almost ever necessary, to reduce the Bone to its natural State, which is to be more or less vigorous, according to the Quality of the Fracture, the Nature of the Broken Part, or the Age and Sex of the Pa|tient: but we must observe not to make Ex|tension, when Inflammation, or other Accidents appear, till they are either remov'd, or con|siderably abated.

As to the second thing, which is the neces|sary Dressings, I have always observ'd the Di|rection of Hippocrates, in using three Bands as he did, in simple Fractures: Celsus employed six, but these, in my Opinion, were too ma|ny for the Part: wherefore, I chus'd rather to follow the Practice of Hippocrates, approv'd of by Galen, in the Fifth Chapter of his Book of Method.

The most Part of those who practise Surgery, differ in the Use of Topical Remedies. Some apply all Dry: As for my self, who am not confin'd, to the Way of the Ancients, in this Matter, I have found that the Glair and Yolk of an Egg, beat up together with a little Oyl of Roses, will answer all Expectations: It is A|stringent, Anodine, and Dissolving: The rest of the Dressings, I use dry, unless an Inflammation, or some such thing, oblige me to the contrary: For as it is my Way to dress my Patient as sel|dom as possible, I apply the Bandage dry, that it may be the faster, and less apt to slac|ken.

Plaisters, and Emplastick Medicines employ'd in Fractures, stop up the Pores of the Skin, keep in the Vapours, that occasion Itching, and so oblige to take off the Dressings, oftner than is expedient; wherefore I endeavour, to avoid whatever may cause that Accident.

Hippocrates, used to take off the Dressings, three Days after Application. Many stay till

the seventh; and for my self I delay it as long as ever I can. Experience has taught me, that it is most advantageous for the Patient not to be dress'd, till the Callus is intirely form'd; unless the Bands are loosen'd, or some unexpected Accident hath fallen out, such as Itching, and Disordering of the reduced Bones. I could recount a great number of Soldiers, that have departed from this Hospital, cur'd of Simple Fractures of all sorts, according to my Method; but I shall content my self with the Relation of the following Cure.

A Soldier call'd La Tulippe, of the Regiment of Conde, was brought to this Place, having his right Thigh-bone broken about the mid|dle, and shattered: This unlucky Accident befell him, as he was sleeping upon Mount Ge|névre, under a Tree, which at the same time was cut down, and fell upon his Thigh. So soon as he was committed to my Care, I re|duc'd the Bone by a vigerous Extension, and apply'd a linnen Cloth, dipt in an entire Egg, beat up with a little Oyl of Roses, and a small quantity of good Vinegar, upon which I put some Compresses, then three or four pretty long Rollers, with some Splents of Past-board, en|compassing all with a Piece of the same; and last of all the Juncks, with what belongs to 'em. Diversions were perform'd, and a moderat Diet ordered. I let the Dressings stay on for twen|ty

Days; at the end of which time, I found the Part in its right and natural Disposition: At this Dressing, I us'd Emplastrum pro fracturis, and apply'd the Bandage as before, with Splints of Wood, and the other things necessary. In twenty Days after, I took off the Dressings a second time, and found all things to my Satis|faction: and Twenty Days more pass'd before I look'd to it again; so that in sixty Days, I drest him only three times, not reckoning the first: He began now to rise and to walk on Crutches; and we continu'd still the Dressings upon his Thigh, omitting the Junks. In fine, after he had remain'd sometime in the Hospital, to recover his Strength, he return'd to his Regiment.

'Tis convenient to observe, that in Simple Fractures of the Thigh, we ought always to use on the hinder part, a Splent of the breadth of two or three Fingers, to sustain the Bone, which without this Precaution would be in Danger to bend, in Hospitals of the Army, where the loose Straw on which the Soldiers lie, is apt to slip from under them, and so to make Holes or Furrows, capable to disorder the joyning of the broken Parts, unless they be supported by some thing, that is sufficient|ly stiff.

I have no Credit to give, to the inward Remedies, which some use for breeding a

Callus▪ such as the Juice of Cowslip, of Agri|mony, or its Root, taken in Drink; and many others to be seen in ancient Authors. Nature is the Architect, and principal Framer of the Callus, when she is allow'd that Repose, which is necessary to her Acting: however I don't disapprove, the use of incrassating Nourish|ment, on such Occasions.

In the third Place, as to the Care of the neghbouring Parts, when the Fracture is much shatter'd and very painful, it is exceeding ad|vantagious to apply Defensives to the Superior Parts, and the Emunctories: the Liniment made of an Egg beat up with Oyl of Roses, and some|times with a little of that of Turpentine, and some Vinegar; when the Contusion is great, answers also to this Intention; together with Embrocations with dissolving Oyls. Above all, Diversions are of great Efficacy, to pre|vent and remove Accidents.

As for the fourth Thing; it is of great Im|portance to the fractur'd Member, to be plac'd in a convenient Situation, upon which very often depends the good or ill Success of the Cure. In Hospitals of the Army, all the necessary Conveniences are not to be found; but the Ingenuity of the Surgeon, ought to make up that Defect. The greatest Part of the Wounded, are only laid upon Straw, which has not Stability enough, to keep a Member

long in the same Situation: 'tis this Conside|ration that obliges me, after applying the three Bands, spoken of above, to use Splents in the first Dressing, unless the Pain engage me to defer 'em; and afterward, I make all sure with a fourth Band: I add also the Juncks; and the Sole with what belongs to 'em; if the Fracture is in the Thighs or Legs, if in the Arm, I use the Sling; as also, if in the Fore-Arm, the Case of Past-board: all being well ty'd on, secures the Part in such sort, that there is no hazard of its being disorder'd. This is the Method I use in Simple Fractures.

CHAP. XII. Of Compound Fractures.

COmplicated Fractures are very hard to be cur'd. In the second Part of this Trea|tise may be seen, the manner how a good num|ber of such, were brought to a perfect Cure: But we must not always flatter our selves, with Expectations of the like good Success; chiefly when part of the Substance of the Bone is lost. The Youth, and good Constitution of the Pati|ent, are great Helps in such Occasions. The Method of Dressing Gently, Speedily and Seldom, saves a great deal of Time, and prevents very many Accidents. Nature, when at Liberty, and acting without Restraint, does things very surprising, and such as we wou'd have judg'd to be impossible.

The Generation of a Callus in a Simple Fra|cture, is undoubtedly more speedy, than in a complicated one: In the first the Heat is kept in, and united, and acts with more Strength and Quickness. The Bone being covered by the Teguments, is shelter'd from the injuries of the Air: For according to Fabricius ab Aqua|pendente, Part. 1. Bo. 4. Chap. 9. the exter|nal Air alters the Bones, and destroys their

Natural Temperament: More over Nature is not diverted, nor disturb'd in her Action by Dissi|pations or Suppurations. All consists in the Re|ducing of the Fracture, or rightly Setting the Bone; as we have taught in the former Chap|ter.

From these Reasons a Consequence may be drawn, to justify my Method in respect of Com|plicated Fractures: For by Suppressing frequent Dressing, and giving all Diligence, to hinder the Access of the Air to such Wounds, I pre|vent all the Accidents it might occasion; as great Suppurations, Alterations, Rottenness, Flux|ions, Pains, and generally whatever prolongs the Cure, and often makes the Wounds incu|rable.

In Complicated Fractures, when there is great Suppuration, the Matter must undoubtedly be mixt, with the Nutricious Juice of the Bones, which from the first Moment of the Fracture begins to cover the Ends of the Bone, and form a Callus. Tents and Dilaters, with which com|monly these sorts of Wounds are fill'd, by their Touch, hinder this Work, which ought not to by interrupted. Long and frequent Dressings, give time for the Air to penetrate into the Wounds, whereby the Nourishment of the Bone, loses what was spirituous in it, coagulates, breeds obstructions, or is turn'd into Matter. More|over this Method, not only occasions always

Irritations and Pains, but also deprives the Sick of that Rest, which is absolutely necessary to 'em.

Fabricius ab Aquapendente, in the eighth Chap|ter of the same Book, treating of Complicated Fractures, where the Bone is not uncovered, Or|ders the Lips of the Wound to be joyn'd toge|ther, and that it be drest but once in three Days. And in the tenth Chapter of the same Book, speaking of Complicated Fractures where the Bone is laid bare, directs to Joyn the Lips of the Wound by Stitching or otherwise; and af|terwards to go on with the Cure, as in a Sim|ple Wound.

I am not therefore the only Person, that has drest complicated Fractures after this Man|ner. It may be observ'd also, that Rhasis, and Serapion us'd this Method, in the Cure of Wounds of the Head with a Fracture of the Scull; for they say, that Wounds of the Head must be stitch'd up, even where the Scull is broken quite thorow.

If this may be done on such Occasions, much more in complicated Fractures of other parts of the Body: now the Stitching us'd by these Authors in Fractures of the Scull, was for no other End, but to exclude the Air, which might have prov'd hurtful to the Brain, the Membranes, and the Scull.

Galen, and Avicen advise Stitching in such a Case; but Hippocrates forbids it, in his Book

of Wounds of the Head. For my self I very rarely use it, in any part of the Body, tho' I don't disapprove it: But in Gunshot Wounds, it can't be practis'd, for many Reasons known to every Body.

Fractures with a Wound, are in general very troublesom: But these caus'd by Fire-Arms more than others; and they are also more or less hard to cure, according to the Part where|in they are: For the Complicated Fractures of the Thigh, which we have had under our Care in this Hospital, were not so soon cur'd as those of the Leg; nor these, as the Fractures of the Arm, and so of others; tho' in all, the same Method was always follow'd.

As to the difficulty of curing those of the Thighs, it is often occasion'd, by the Inconve|niences to be met with, in the Hospitals of the Army: For there is difficulty in giving Clysters there, where we cannot afford the Ac|commodations necessary for voiding the Ex|crements: because wanting, ordinarly, Servants, handy and charitable enough to assist the Pa|tients in such Occasions, they ly in their Na|stiness, and are indiscreetly and violently mov'd; by which means the Cures become te|dious and difficult. For we may be sure, that Nature acts with no less Diligence and Wisdom upon these, than upon other Parts.

I make no question, but many Persons will condemn this Way of dressing complicated

Fractures, which possibly will appear to be ve|ry new; For I own I never hitherto saw it us'd by any. But we ought not to be too for|ward to affirm, that what we have not seen, is not. There are, without doubt, many Secrets, both in Nature and in Arts, which wou'd be of notable advantage, were they known to us.

Those, who will give themselves the Trouble, exactly to follow this Method, may extricate themselves from the Errors, with which their Minds were prepossess'd against it.

CHAP. XIII. Of Dislocations.

'TIS in the Cure of Dislocations, that Art has the Advantage over Nature; be|cause that alone accomplishes the Cure, with|out the Assistance of this: the Operation of the Hand, Machines and Bands, are the Means, that Surgery imploys to reduce them.

Tho' this Subject, would afford an ample Field to Theory; yet I shall remit the young Surgeons to such Authors, as have designedly treated thereon. I will only say, that it is ne|cessary to be throughly instructed, in the Knowledge of the Bones, and Bandages; and that, if possible, we must not lose one Minute of time, to restore the Parts that are disloca|ted, before the Accidents supervene, that of|tentimes hinders the Operation. For the Head of the Bone, that is out of its Place, commonly presses on nervous and sensible Parts, and sometimes squeeses together the Vessels, that carry the Blood for the Nourishment of the Parts, which occasions a kind of Palsy and Atrophy, and sometimes a Fluxion: Moreover the Cavity of the receiving Bone, may be fill'd

with the Synovia, or Humor that moistens the Joynts; which, if it be coagulated there by some Acid, will hinder the Head of the Bone to go into that Place, from whence it came out; in which case we may reckon the Resto|ring of the Bone to be impossible. Where|fore, we ought at first to employ all our Care, to procure its Reduction.

The Instruments necessary to reduce Old Luxations, or such new ones as require great Force, are not all to be found always in Hos|pitals of the Army; but the Hand of Servants, and the Ingenuity of the Operator, ought to make up that want as much as possible.

Guy de Chauli••e, Fabricius ab Aquapendente, Pareus, and many others, have sufficiently explained the manner of Reducing Dislocations. A young Surgeon ought to omit nothing, that may conduce to his Accomplishment herein: For it is by these simple Operations, that the Vulgar knows to discern the Skilful from the Ignorant; because these sorts of Performan|ces are altogether Chirurgical, and require only the Dexterity of the Artist to accomplish 'em.

I have found by Experience, that an Egg, beaten up with Oyl of Turpentine and a little Vi|negar, is very profitable to the luxated Parts, to which it is apply'd; yea that it is a Reme|dy sufficient to answer all Intentions: Aroma|tick

Wine may be us'd, when this can't be had. If your design is only to strengthen, the Plai|ster Pro Fracturis will do the Business.

Bleeding, Clysters, and a convenient Course of Diet, ought not to be neglected, in great Luxations attended with Contusion: These sorts of Remedies oftentimes prevent being surpriz'd with Accidents, and remove them when present.

CHAP. XIV. Of the Relaxation of the Joynts.

SOldiers, who commonly ly on the Ground during the Campain, in very severe Sea|sons, are lyable to have their Bodies stuff'd with superfluous Humors, wherewith all the Parts in general are soak'd: but in a special man|ner they very often fall upon the Joynts, where softning, and relaxing the Ligaments that kept them fast, they do thereby occasion Luxations of the Parts.

This kind of Distemper, is very hard to be cur'd, and will scarcely yield to Remedies: we have had of them under our Hands in this Hospital, which have occasion'd us a great deal of Trouble, and but little Credit. Hippo|crates in such Cases advises the use of the actual

Cautery, and Galen after him is also for the same Operation, in order to drain and consume the slimy and watery Humours, to strengthen the Skin, and to fasten and fortifie the Joint.

Hippocrates, for this purpose uses a Rope of raw Flax, which being set on fire, yields a Coal, like that of the Match us'd in Armies; and Aetius, according to Archigens, did it with the Root of Fullers-Weed and of Birth|wort, probably to render the Operation more gentle: it is perform'd upon the Place, where the Head of the Bone bunches out.

This Remedy is rude; and we have never us'd it in this Hospital, because it frightens the Patient. Nevertheless these Distempers, are somtimes so painful, and withal so obsti|nate, that those who are under 'em, willingly submit to the most cruel Operations, that they may be released therefrom.

Fabricius ab Aquapendente relates, that after he had in such a Case, to no purpose, us'd very many things; the Patient was cur'd with a Plaister of a certain Herb, which he believ'd was Hearts-Ease, that was apply'd to him by a Quack.

As for my self, tho' I don't disapprove the Way us'd by the Ancients in this Case, yet I am of Opinion that it ought not to take Place, till more gentle Methods are first try'd: And this is the course we use to take, at first trying

whatevet may heat, cut, dry, and strengthen: The Oyl of Lavender, the Fat of the Mountain-Rat, and Spirit of Wine, or the Queen of Hun|garies Water, made up in form of a Liniment, and apply'd very warm, give great Assistance in such Cases; to which may be added a little of the Oyl of Turpentine, which cuts, and opens the Passages, so making way for Dissolving and Drying Medicines.

But when I find these Remedies ineffectual; I use such things as irritate, Vesicatories, and caustick Herbs, such as Spurge, Celandine, and the like; which by the exasperation of the Pain, may cause a Fluxion upon the Part af|fected, that so the matter being after digested and ripened by a Fermentation; all may be happily ended by an Abscess, as sometimes fails out.

When we have brought things to this Pass, we must not fail, without delay to restore the Bones into their Cavity, and to fortify the Joynt, with good Aromatick Wines quickened with Spi|rit of Wine; or else with Man's Grease, and a little of the Queen of Hungaries Water, mixt and apply'd hot: and generally we may for this purpose use any thing, that may strenghthen the Member, and wast the Moisture. In the mean time, the Part must always be supported with a good Bandage, and surrounded with Compres|ses and Bolsters, to command the Bone, and

keep it fast in its Place: moreover the Patient must be very careful to keep himself quiet, and must observe a Drying and Attenuating Course of Diet.

CHAP. XV. The Conclusion of the Third Part; with some very useful Remarks.

MY principal Design in this little Trea|tise, being to introduce for the Relief of Wounded Persons, a Gentle, Speedy, and Ea|sie Way of curing their Distempers; I have en|deavoured to confirm the same, as much as lay in my Power, by Reasons and Experienees. I am not ignorant, that this Part of Surgery which concerns Wounds, does not exhaust its Bounds; and that I have only slightly touch'd on other Things, that are of no less Impor|tance.

My Intention, was not to transcribe from other Authors; and therefore I thought it e|nough, superficially only to declare my Thoughts, of the other Parts of Surgery; wherein also I have confin'd my self, to that which is most common, and most necessary, and was withall most particulurly known to me;

not being willing to speak of many Things, a|bout which I had nothing new to advance. I think I have done what I design'd, and am ambitious of nothing else, but that my Inten|tion, which I have sincerely declar'd, may have all the Success I cou'd wish it.

The Course I take to prevent the Scaling of Bones, explained in the first Part of this Book, I learnt from Experience; I hope also it will be found very useful and necessary, in dressing Wounds where the Bone is uncovered.

I drew also from the same Fountain, the manner of Dressing after the Operation of the Trepan; and yet I doubt not, but it will have the Fate to be condemn'd as new: However, I will not spend Time in anticipating the Ob|jections of others, by answering them before hand: For whatever might be said in com|mendation of the Plate, which was never us'd by any before me, wou'd only prove an In|ducement to excite the Criticks to decry it.

Experience, and Reading have inform'd me, that the Air is a mighty Hinderance to the Cure of Wounds: and I have endeavoured to find out an easy Way to hinder its Access, especial|ly in Wounds where the Scull is cut: For 'tis evident, that the most part of the Accidents that attend such Wounds, are occasion'd only, through the little Care taken, to keep off the Assaults of the Air, which are promoted by

the Custom of long and frequent Dressings.

I have seen Surgeons spend whole Hours, in dressing Wounds of the Head, accompany'd with a Fracture of the Scull, to loosen, break, or cut off the Splinters, or some Piece of the Bone; which ought never to be done, unless we are very well assur'd, that they prick the Dura Mater.

There are many, who think they have spect well, if at each Dressing, they can but extract some little Bit of broken Bone, which they carefully preserve, to shew to all that come, thinking thereby to gain Credit; and to raise their Reputaeiou, by that which ought to be condemn'd, and often costs the Wounded Per|son his Life.

A very famous Officer, not long ago expe|rienc'd, the fatal Effects of this cruel Method: for having had his Scull broken by a Bullet, whereby he was in a manner trepann'd, with|out hurting the Brain, or its Membraues; or occasioning any dangerous Symptom: some Time was unadvisedly spent twice a Day, in loosening, and pulling away forcibly little Por|tions of the Bone, which Nature wou'd easily have separated, supposing that afterwards, which yet was impossible, they might chance to prick the Dura Mater: by this Method the Dura Mater, and the Brain were altered, and visibly mortify'd; so that he dy'd on the Ele|venth

Day of his Wound. I was indeed call'd to give my Advice, after his Condition was desperate; but all I could do in this Case, was to give him notice of his approaching Death.

Many Surgeons, in a vain Ostentation, spend all their Life, and exhaust their Diligence, in unravelling all the Secrets of the new Disco|veries in Physick, and in qualifying themselves to discourse accurately thereon; contemning all the Opinions of the Ancients: while in the mean time, they remain in an intire Igno|rance of the Practice, notwithstanding all their Science. If these Men were as desirous to be knowing, as ambitious to appear so, they would take another Course: And not confining themselves only to Reasonning, and to shew their Wit in Consultations, neglect to improve a good Method.

It is not enough to understand the Nature, and Difference of Wounds, and to know the cause of Accidents that besall them, nor yet quaintly to explain 'em, by Reasons purely Speculative and Chymerical: We must joyn to the Theory, that is indeed very useful and necessary, a Method of Curing and Rooting out Distempers, which is to be look'd on as the most necessary Part of Surgery: But it is rare for those, who addict themselves wholly to Reasonning, to have such regard for Practice, as to acquire it to Perfection, and to abandon

their own Maxims, to follow others that are contrary to 'em. Wherefore, I have address'd this little Discourse to young Surgeons, who may possible reap some Advantage from it, not being uncapable of the good Impressions, one desires to make upon 'em.

I am not desirous, that the Newness of this Method, should either engage them to follow it, or oblige 'em to reject it; but only wish that they may put it to a Tryal, in order to make a true Judgement: For every reasona|ble Man, ought wisely to inform himself of the Truth of Things, and to examine their Con|sequences, before he positively give his Judg|ment. Nothing is more Easy for one, than to Pass a Verdict; and nothing more Difficult, than to Judge aright.

I am convinc'd by Experience, that it is dangerous to credit the Testimony of others. The wrong Judgment made on a Wound, that one of our most famous Generals receiv'd, Octo|ber 4. 1693. being the Day of the Fight of Marseils, and my Easiness to rely on the Fi|delity of another, and on the Report made to me, the Day after the first Dressing thereof, had almost cost him his Life. The Wound was deep, and made by a large Bullet, and was drest at first, as if it had been only a simple one, with a great quantity of Lint, where|of a Part was lost and fix'd in the Depth of the

Wound: However it happen'd very fortunate|ly, that it was driven out by the Matter; but it left behind it, in the Place where it was hid, a considerable Mortification, which gave occa|sion to make great and deep Incisions, where|by a Fracture was discovered. Prudence hin|ders me to declare at more length, the Cir|cumstances that accompany'd this Cure, to which M. Dalibour, Master-Surgeon sworn at Paris, and Surgeon Major of the Horse of the Houshold, an able and experienc'd Man, was called to give his Advice. In a Word, after many Accidents, all was brought to a happy Conclusion.

It is therefore absolutely necessary, for a Surgeon, who is careful of his Reputation, to search the Wounds himself, which were not drest by him at first, in order to discover their Nature, and know their Extent. This was not the only Person, who in the Day of that Fight, experienc'd the Inconveniency of be|ing dress'd at first in a Hurry. I have for good Reasons, not mention'd several other Cases not much differing from the former, that occur'd in the same Occasion, wherein there were many dress'd in that Quarter, that was assign'd to the Body of Reserve, be|longing to our Army.

In this Book, and particularly in the se|cond Part thereof, may be seen, after what

manner, I have brought to a perfect Cure, a great number of Wounds, of all Kinds and Quali|ties, with much Ease, small Charge, and with simple Remedies, which are no less useful to the Rich, than convenient for the Poor.

The great Charges ordinarly laid out upon the Cure of Wounds, sometimes involve the Pa|tient, after that cure is perfected, in Evils no less troublesom than the former: The Wounds are fill'd, and clos'd up, but the Pockets are opened, and drain'd. That Person, of whom I spoke in the twenty fifth Chapter of the Se|cond Part, before he came under my Care, had a Bill of Three hundred and seventy six Li|vers, brought him by the Apothecary, for Medicines furnish'd by him; when yet after all that Expence, there was no Appearance of a Cure.

The Credit of a Surgeon, does not consist in emptying the Shops, to cure his Patients: On the contrary, we ought rather Christian like to be saving of the Money of those, who put their very Person and Life in our Hands: And if they chance to prove so ungrateful, as to deny us what we have deserv'd; after such a good Deed, we may expect our Reward from Heaven. We ought not to be brib'd, by the consideration of a Mean Interest, to a|bandon the Fidelity, wherewith we ought to endeavour the Speedy Cure of our Patients.

If a Patient is destroy'd by unexpected Acci|dents, when the Cure is delay'd on a mercena|ry Account; the Surgeon, under whose Care he was, becomes guilty of his Death.

I have seen many Persons of Note, whom I won't name, who passing through Brianson, eight or nine Months after the Battel of Mar|seils, wherein they had been wounded, were either fistulous, or very far from being com|pleatly cur'd.

Nevertheless, that I may not rashly blame those, who had these Persons under their Care, I am willing to believe, that the Ten|derness of their Constitution, their ill Tempera|ment, or the unwholsom Air, which very much conduces to continue the Wounds, oc|casion'd that Tediousness of these Cures; which in other Persons and Circumstances, had been perfectly finish'd in two or three Months at most: but I can't restrain my self from saying, that the Tents, as well as the fre|quent, and painful Way of Dressing so much in Use, are sufficient to cause all these Acci|dents, and to hinder the Cure of Wounds: and this is what makes Surgeons hated, and Surgery chargeable.

In this little Work, I have done what I cou'd to shew, not so much by Reasoning, as Examples and Authority, that Nature has the greatest Hand in curing Wounds; or to speak

more truly, that she is the principal Worker therein: But I leave it to the performance of more delicate Pens, to celebrate her Praises, and publish her Excellencies; contenting my self to admire her Wonders, which are no less unaccountable than they are surprizing.

The Year 1686. afforded me an Occasion, wherein it appear'd, that Nature ever acts for the Preservation, of the most noble and the most perfect of her Works. A Soldier of the Fort of Mirabout, which parts the Valleys of Luserne from Queras, having rob'd his Cap|tain, was pursu'd; and finding no other Way to escape, he threw himself down from the top of the Walls upon the Rocks, where falling on his Feet, they were not only put out of Joynt, but each of them were fractur'd with a Wound: He was taken, and brought to the Fort, where there was no Surgeon, by reason of the Small|ness of the Garrison.

He lay four Months on Straw, without any Relief but Bread and Water; during which time his Feet were gangren'd, and soon after|ward intirely mortified.

But, which is extremely surprizing, around the lower part of both the Legs, a little above the Ancle, Nature her self form'd a certain Wreath or Roll, which stopt the Progress of the Mortification, so that what was beyond this, was abandon'd to the Fury of the Sphacelus,

while whatever was above these Rolls, was free from Blemish.

He cut off the Right Foot himself by the Joynt, with a little Pocket-knife, without ei|ther Pain or Bleeding; and because the Putre|faction, occasion'd an Intollerable Smell over all the Fort, by Reason of the excessive Heat, he was sent to our Hospital at Luserne.

By the Way he lost a good part of the Other Foot, which came away of its own accord; and notwithstanding the contagious Smell, which as a Carrion, he dispers'd in all the Places where he pass'd, and also the extreame Heat of the Season, the Mortification did not pass over the Bounds that Nature had given it; only these Wreaths that we mention'd above, were considerably increas'd in Bulk by the Way.

After he had recovered his Strength, by the Assistance of good Cordials, some Wine, and Victuals, I cut off all that appear'd to be intirely mortify'd, not sparing the highest Pla|ces of the Rolls, which cast an insupportable Smell: I let him rest till to morrow, and then cut off one Leg, and the other the Day after: For the Ends of the Tibia and Fibula were al|together rotten and uncover'd. Finally, no o|ther Accident hppen'd during the rest of the Cure, which was compleated not long after.

This wonderful Example, is sufficient to e|vince, that the want of Art, is oftentimes sup|ply'd

by Nature. This may further appear al|so by what follows, being a very strange thing that happen'd at Pignerol. M. De la Place, Captain in the Regiment of Barrois, was wounded with a Bullet at the Battel of Marseils, that entred at the middle and hinder Part of the Fore-arm, and came out at the lower and fore-part of the same, breaking the Cubitus in its passage. He was drest by M. Malinas, a Surgeon-Major belonging to the Army in Italy, and Master Surgeon of Lyon, very skilful in his Imployment.

This Wound was attended with some trou|blesom Accidents: For together with a Conti|nual Fever, an Abscess was form'd by a Colle|ction of Matter, which was extended over all the Arm and Fore-Arm: But as they were pre|paring to make an Opening, the wounded Per|son was seiz'd with a great Loosness, which all of a sudden put an End to that Tumor, and re|stor'd the Arm and Fore-Arm to their natural State. This unexpected Accident, being fol|lowed by so surprizing an Effect, oblig'd his Surgeon to cause take a view of that, which the Patient had voided, and it was found to be the very Matter of the Abscess, without any thing else, save some little Excrement, which remain'd altogethr unmix'd therewith: More|over, according as new Matter was gathered in the same Places, it was still voided again by

Stool, in a little time after. In fine, the Wounds being compleatly cur'd, the Loosness ceas'd, because that was remov'd which occasion'd it.

Perhaps the Matter was taken up by the Veins, and by means of the Circulation carried to the Mesaraicks, and thence emptied into the Guts: but this I only propose as an uncertain Conjecture, all other Ways being to me un|known: I willingly leave it to the Learn'd, to be explain'd according to their different Apprehensions. But that which inclines me to think, that this Way has some Appearance of Truth, is, that this same Surgeon solemnly pro|tested to me, that at the beginning of the same Campain, he had under his Care a Captain, who had a Wound in the Thorax, that pierc'd into the Substance of the Lungs, and was ac|company'd with all the Accidents, common to such kind of Wounds; all which, nevertheless, were remov'd by Opening a Vein in the Arm, which was done with an Intention to let Blood, instead of which nothing came out by the Orifice made in the Vein, but real Matter, that had been sent thither from the Breast. Ma|ny Persons worthy of Credit, who were Eye-Witnesses, assur'd me of the Truth of this Prodigy.

Fabricius Hildanus, Chapt. 3. Observ. 39. re|lates, that an Inveterate Vlcer in the Leg with a Fistula, having been rashly and unseasonably

cur'd, was followed by a Pleuresie, in which the Patient voided at the Mouth a Matter, like to that which us'd to come from the Vlcer of the Leg.

It were an easie Matter, to adduce an infi|nite number of Examples almost alike, where|in Nature appears to have surpass'd even her self; either in Preserving Parts afflicted, or in easing such as are Overcharg'd with Humours, or finally, in Uniting such as are Divided.

In the Year 1686. one Lansaveche, Quar|ter-Master of the Dragoons of Verue, in the War against the Vaudois, was wounded by a large Bullet, in the upper and side-part of the Hypogastrium, and by all the Accidents it ap|pear'd, that the Colon was opened and torn by the Bullet: there came out at the Wound, for more than the space of two Months, an excrementitious Matter, during which time he suffer'd grievous Pains: At length Nature, without any Assistance, clos'd up the Wound of the Gut, tho' the Bullet was lost; and he left Luserne at the Breaking up of the Hospi|tal, which was three Months after his Recei|ving the Wound.

Hildanus, has a like Observation, of a cer|tain Man, who had one of the great Guts o|pened, in the Operation of the Bubonocele, which clos'd up of its own Accord. In fine, as we are oftentimes surprized by things, that

could not be hop'd, but from either the Boun|ty, or even the Caprice of Nature; so also ve|ry extraordinary things fall out in Wounds, by an Effect of Chance, as well by reason of the Posture Men are in when they receive their Wounds, as because of the Figure of these things with which they are wounded.

In the same Year 1686. One wounded with a Shot, was brought to the Hospital at Luserne: the Bullet entered, on the lower and middle part of the Os Occipitis, and grazing upon the Temple-Bone, came out under the Right Ear, carrying away a Part therof. Tho' it plain|ly enough appear'd, that the Bullet had touch'd the Scull, yet the Wound was dress'd as a sim|ple one, because no Accident appear'd; and it was left to the Care of the Servants: thus three Days past; during which the Patient was troubled with a Restlesness, complaining only that he could nor put himself in an easie Posture, which was not much minded: Ne|vertheless, he dy'd on the fourth Day of his Wound, with all the Symptoms that usually attend sleepy Distempers.

The unexpected Death of this Man, oblig'd me to open his Scull: I found he had been wounded with a little Wedge of Lead, which hitting against the middle Ridge, on the low|er Part of the Os Occipitis, when at the same time his Head was bow'd down, was cut in

two by the sharp Edge of the Bone, and one part thereof had slipt upon the Temple-Bone, as was said, and the other had enter'd the Cavity of the Scull of that same Side, and remain'd fix'd between it and the Membranes, which were cut and press'd thereby. His Fellow-Sol|dier in the same Day and Action, had two Wounds by one Shot; the first a little below the Yoke-Bone of the left Side, and the other in the middle part of the Right Hypochondre: Yet he was compleatly cur'd in twelve Days, with a Moderate Suppuration, and no Accidents.

I have seen many Wounds, that were no less strange than these: But in order to make a right Judgment in such like Cases, the Nature and Figure of the wounded Part, the Posture of the Person when he received the Wound, together with the Figure of that which made it, must all be very carefully examin'd before|hand. Now the ready apprehending of all these Circumstances, with many others also, very ne|cessary to be known, in order to successful Pra|ctice, can't be attain'd by Surgeons, without great Study, continual Exercise, and unwearied Diligence.

The Ascent, whereby we mount unto the Temple of Esculapius, is no less difficult and steep, than that by which we rise unto Mount Pernas|sus: 'Tis almost impossible to get up, without making some false Steps. However 'tis but

reasonble to think, that those who were em|ploy'd in Hospitals and Armies, during the late War, by the inumerable different cases which it hath afforded, have discover'd things very surprising, and no less useful in Practice; and have often seen the Strange Ways that Nature takes, to throw off what offends by healthful Evacuations, and to accomplish her Designs.

Such as impart to the Publick their Obser|vations and Experiences, which are the Fruits of their Diligence, and of their Care, have deserved well of Mankind. Many Surgeons there are, who have not the Advantage of Occasions, to accomplish themselves in this sort; and of those that have, few are so cha|ritable as to publish, what they have seen and remark'd that is Extraordinary.

When a Man, does not communicate his Attainments, by Writing, to the Publick, let his Endowments, and his Knowledge be never so great, they are for the most part, if not al|together, buried with himself in the Ground. The Good that a Man can do, lasts but for a time; but the Excellent Advices, that he leaves in writing to Posterity, are useful for ever: We had been still in Ignorance, had not the Writings of the Ancients, come down to our Hands.

Wherefore, I thought my self bound in Conscience, (tho' at the Hazard of being con|demn'd

by the Envious) to impart to the World my Experiences, That, if possible, I might procure, to poor wounded Persons, a more speedy Assistance, than can possibly be af|forded, by the Common Method. If I shall have the Happiness, to succeed in my Design, I shall think my self sufficiently recompens'd for all my Toyl, and will praise the Almighty Father of Lights, who, by small Means, often|times brings Mighty Things to pass.

FINIS.

Notes

• * 1.1

  Mamellons fibrenx.
• * 1.2

  Baume radical