The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. XXX. Of the cure of the Wounds of the Chest.

WE have read in Iohn de Vigo, that it is disputed amongst Chirurgions * 1.1 concerning the consolidation of wounds of the Chest. For some thinke that such wounds must bee closed up, and cicatrized with all possible speed, least the cold ayre come to the heart, and the vitall spirits flye a∣way and bee dissipated. Others on the contrary thinke that such wounds ought to be long kept open; and also if they be not sufficiently large of themselves, that then they must be enlarged by Chirurgery, that so the blood powred forth into the capa∣city of the Chest may have passage forth, which otherwise by delay would putre∣fie, whence wound ensue an increase of the feaver, a fistulous ulcer, and other pernicious accidents.

The first opinion is grounded upon reason and truth, if so bee that there is lit∣tle or no blood poured forth into the capacity of the Chest; But the latter takes place where there is much more blood contained in the empty spaces

of the Chest. Which least I may seeme rashly to determine, I thinke it not amisse to ratifie each opinion with a history thereto agrecable.

Whilest I was at Turin, Chirurgion to the Marshall of Montejan, the King of France * 1.2 his Generall, I had in cure a souldier of Paris, whose name was L'evesque, he served under captaine Renouart. He had three wounds, but one more greevous than the rest, went under the right brest, some what deepe into the capacity of the Chest, whence much blood was poured forth upon the midriffe, which caused such difficulty of breathing, that it even tooke away the liberty of his speech; besides, though this oc∣casion he had a vehement feaver, coughed up blood, and a sharpe paine on the woun∣ded side. The Chirurgion which first drest him, had so bound up the wound with a straite and thicke suture, that nothing could flow out thereat. But I being called the day after, and weighing the present symptomes which threatned speedy death, judged that the sowing of the wound must straight be loosed; which being done, there instantly appeared a clot of blood at the orifice thereof; which made mee to cause the patient to lye halfe out of his bed, with his head downewards, and to stay his hands on a settle which was lower than the bed, and keeping himselfe in this posture, to shut his mouth and nose that so his lungs should swell; the midriffe be stretched forth, and the intercostall muscles and those of the Abdomen should be compressed, that the blood powred into the Chest might be evacuated by the wound; but also that this excrescion might succeede more happily, I thrust my finger some-what deepe into the wound, that so I might open the Orifice thereof being stopped up with the congealed blood; and certainely I drew out some seaven or eight ounces of putrified and stinking blood by this meanes. When he was layd in his bed, I caused frequent injections to be made into the wound of a decoction of Barly with honey of Roses and red Sugar, which being injected I wisht him to turne first on the one, and then on the other side and then, againe to lye out of his bed as before: for thus he evacuated small, but very many clots of blood, together with the liquor lately injected; which being done, the symptomes were mittigated, and left him by little and little. The next day I made another more detergent injection, adding thereto worme-wood, * 1.3 centaury, and Aloes; but such a bitternesse did rise up to his mouth together with a desire to cast, that he could not longer endure it. Then it came into my mind that formerly I had observed the like effect of the like remedy in the Hospitall of Paris, in one who had a fistulous ulcer in his Chest. Therefore when I had considered with my selfe that such bitter things may easily passe into the Lungs, and so may from thence rise into the Weazon and mouth, I determined that thence forwards I would never use such bitter things to my patients, for the use of them is much more troublesome than any way good and advantagious. But at the length this patient by this and the like meanes recovered his health beyond my expectation. * 1.4

But on the contrary, I was called on a time to a certaine Germaine gentleman who was runne with a sword into the capacity of his Chest; the neighbouring Chirurgion had put a great tent into the wound at the first dressing, which I made to bee taken forth, for that I certainly understood there was no blood powred forth into the ca∣pacity of the Chest because the patient had no feaver, no weight upon the diaphrag∣ma, nor spitted forth any blood. Wherefore I cured him in few dayes by onely drop∣ping in some of my balsame and laying a plaster of Diacalcitheos upon the wound. * 1.5

The like cure I have happily performed in many others. To conclude, this I eare boldly affirme, that wounds of the Chest by the too long use of tents degenerate into Fistula's.

Wherefore if you at any time shall undertake the cure of wounds which penetrate into the capacity of the Chest, you shall not presently shut them up at the first dres∣sing, but keep them open for two or three dayes; but when you shall finde that the pa∣tient is troubled with no or very little paine, and that the midriffe is pressed downe with no weight, and that he breathes freely, then let the tent be taken forth, and the wound healed up as speedily as you can by covering it onely with lint dip∣ped * 1.6 in some balsame which hath a glutinative faculty, and layd some what broader than the wound; never apply liniments to wounds of this kinde, lest the patient by breathing draw them into the capacity of the Chest. Wherefore also you must have

a care that the tent put into those kindes of wounds may be fastened to the Pledgets, and also have somewhat a large head, lest they should be drawne as we sayd into the capacity of the Chest, for if they fall in, they will cause putrifaction and death.

Let Emplast. Diacalcitheos or some such like bee applyed to the wound. But if, on the contrary, you know by proper, and certaine signes, that there is much blood fallen into the spaces of the Chest, then let the orifice of the wound bee kept open with larger tents, untill all the Sanies or bloody matter, wherein the blood hath de∣generated, shall bee exhausted. But if it happen at any time, as assuredly it sometimes doth, that notwithstanding the Art and care of the Physition, the wound degene∣rates into a Fistula, then the former evill is become much worse. For Fistula's of the * 1.7 Chest, are scarse cured at any time, and that for divers causes. The first is, for that the muscles of the Chest are in perpetuall motion; Another is, because they on the contrary inside are covered onely with the membrane investing the ribbes, which is without blood. The third is, for that the wound hath no stay, by meanes whereof it may be compressed, sowed, and bound, whereby the lips being joyned together, the wound may at length be replenished with flesh, and cicatrized.

But the reason why wounds of the Chest doe every day heape up and poure forth * 1.8 so great a quantity of matter, seemes to be their vicinity to the heart, which being the fountaine of blood, there is a perpetuall effluxe ther eof from thence to the part affected. For this is natures care in preserving the affected parts, that continually and aboundantly without measure or meane it sends all its supplyes, that is, blood and spirits, to the ayde. Ad hereto, that the affected parts by paine, heate and conti∣nuall motion of the Lungs and midriffe, draw and allure much blood to themselves. Such like blood defiled by the malignity and filth of the wound, is speedily corrupted; whence it is that from the perpetuall affluxe of blood, there is a continuall effluxe of matter or filth, which at the last brings a man to a consumption; because the ulce∣rated partlike a ravenous wolfe consumes more blood by the paine, heate and moti∣on than can be ministred thereto by the heart. Yet if there bee any hope to cure and heale the Fistula, it shall bee performed, (after the use of diet, phlebotomie, and according to the prescript of the Physition) by a vulnerary potion, which you shall finde described when we treate of the Caries or rottennesse of the bones. Wherefore * 1.9 you shall make frequent injections therewith into the Fistula, adding and mixing with it syruput de rosts ficcis and mel rosarum. Neither doc I, if the putrefaction bee great, feare to mixe therewith Aegyptiacum. But you must have a care to remem∣ber * 1.10 and observe the quantity of the injected liquor, that you may know whether it all come forth againe after it hath performed its detergent office. For if any there∣of remaine behinde in the corners and crooked passages, it hurts the part, as corrup∣ted with the contagion thereof.

[illustration]

The for me of a Syring fit to make injection, when a great quantity of liquor is to be injected into any part.

After the injected liquor is come forth, a pipe of gold, silver or lead, shall bee put into the fistulous ulcer; and it must have many holes in it, that so the filth may passe forth at them; it must be fast tyed with strings, that it may not fall into the capacity of the Chest.

A great spunge steeped in aqua vita and wrung forth againe, shall bee layd hot to the end or orifice thereof, both to hinder the entrance of theayre into the Fistulous ulcer, as also to draw forth the filth thereof by its gentle heate, the which thing the

Patient shall much further if often times both day and night hee hold his breath, stopping his mouth and nose, and lying upon the diseased side, that so the Sanies may bee the more forcibly evacuated; neither must wee leave putting in the pipe, before that this fistulous ulcer shall bee almost dry, that is, whole, as when it yeelds little, or no matter at all; then it must be cicatrized. But if the orifice of this fistulous ulcer being in the upper part hinder the healing thereof, then by a chirurgicall Section a passage shall be made in the bottome, as we sayd before in an Empyema.

[illustration]

The delineation of the pipes with their strings and spunges.

The reader must note that the pipes which are fit for this use, neede not have so many holes as these here exprest; but onely two or three in their ends: for the flesh growing and getting into the rest, make them that they cannot be plucked forth without much paine.

A wound made in the Lungs admits cure, unlesse it bee very large; if it bee without inflammation; if it bee on the skirts of the Lungs, and not on * 1.11 their upper parts; if the patient containe himselfe from coughing much, and con∣tentious speaking, and great breathing: for the wound is enlarged by coughing, and thence also arises inflammation; the Pus and Sanies whereof, whilst the lungs againe endeavour to expell by coughing, by which meanes they are onely able to expell that which is hurtfull and troublesome to them, the ulcer is dilated, the inflamma∣tion * 1.12 augmented, the Patient wastes away, and the disease becomes incureable.

There have beene many Eclegma's described by Physitions for to clense the ulcer; which when the patient useth, he shall lye on his backe, to keepe them long in his mouth, so to relaxe the muscles of the Larinx; for thus the medicine will fall by * 1.13 little and little alongst the coates of the Weazon, for if it should fall downe in great quantity, it would be in danger to cause coughing. Cowes, Asses, or Goates milke with a little honey, least they should corrupt in the stomacke, are very fit remedies for this purpose; but womans milke exceedes the rest.

But Sugar of Roses is to be preferred before all other medicines, in the opinion of Avicen, for that it hath a detergent, and also an astrictive and strengthening faculty, * 1.14 than which nothing is more to bee desired in curing of ulcers. When you shall thinke it time to agglutinate the clensed ulcer, you must command the patient to use emplasticke, austere, and asttringent medicines, such as are Terra sigillata, bolus arme∣nus, hypocystis, plantaine, knot-grasse, Sumach, acacia and the like, which the patient shall use in hisbrothes and Eclegma's, mixing therewith honey of roses, which serving for a vehicle to the rest, may carry away the impacted filth which hinders agglutination. But seeing an hecticke feaver easily follows upon these kindes of wounds, and also upon the affects of the Chest and lungs, it will not be amisse to set downe somewhat concerning the cure thereof, that so the Chirurgion may know to administer some helpe to his patient, whilst a Physition is sent for, to overcome this disease with more powerfull and certaine remedies.

Notes

• * 1.1

  Vigo tract. de vul. therat, cap. 10.
• * 1.2

  A History.
• * 1.3

  Why bitter things must not be cast in to the Chest.
• * 1.4

  Reade the History of Maryllus in Galen, lib. 7. de Anatom. admis∣mistra.
• * 1.5

  What harme ensues the too long use of tents.
• * 1.6

  No liniments must be used in wounds of the Chest.
• * 1.7

  Wounds of the Chest ea∣sily degenerate into a Fistula.
• * 1.8

  Why there flowes such planty of mat∣ter out of wounds of the Chest.
• * 1.9

  The cure ofa Fistula in the Chest.
• * 1.10

  When Aegyp∣tiacum must be put into the in••ections.
• * 1.11

  What wounds of the Lungs cureable.
• * 1.12

  The harme that ensues up∣on coughing in wounds of the Lungs.
• * 1.13

  How Ecleg∣ma's must be swallowed.
• * 1.14

  The utility of Sugar of roses in ulcerated or wounded Lungs.