A compleat discourse of wounds, both in general and particular whereunto are added the severall fractures of the skull, with their variety of figures : as also a treatise of gunshot-wounds in general / collected and reduced into a new method by John Brown ...

CHAP. IX.

Of Removing of Symptoms and Accidents.

WE are now come to the last Intention, which is the Correction of Accidents: and these are very various, and do as diversly happen in large and deep Wounds, and do keep up Solution of Continuity. And these are allowed to be nine in number: as Pain, Inflam∣mation, Haemorrhagy, Delirium, Fainting, Fever, Crudi∣ty, Palsey, and Convulsion. And these as they are Sym∣ptoms in respect of their greatness and vehemency, so also in many cases do they threaten Death. The Correction of these Symptoms is to be as much regarded as the Cure of the Wound.

* 1.1 And First therefore, as touching Pain, this by Galen, 2. Aphor. 12. Meth. is allowed to be a sad and heavy sense of change, following a Disease as a shadow doth a sub∣stance. This most generally is the cause of Fluxion, over∣throwing the Faculties, be the temper and habit of the Body formerly never so good: it being Pain's chief pro∣perty, to attract Inflammation, by stirring the Humours into a Combustion: and it falls here as in other cases, the weakest is seen to go by the wall. For generally the wounded Part is forced to see whatsoever Pain puts to it. And therefore is it accounted a great Intention in the Chirurgeon, to allay the fury of this Enemy, and quell this troublesome authour of Fluxion. And here ought he also to remove his Medicines very often, lest by their too

long stay Pain be excited. Then is he to enquire into the cause and occasion of this Pain; and the Species and way of the Humour by which it passeth, and which way Nature intends it; and here with her to join his adjutant helps for its remove.

* 1.2 The Second enemy we meet with is Inflammation: and this ofttimes is occasioned by Pain, and sometimes by the Unadvisedness, Neglect and Ignorance of the Chirur∣geon, when by too strict Ligatures he maketh a great at∣traction of Pain, creating an interception of Spirits, and an extinction of native Heat, purchasing hereby a fair way for a Gangrene and Sphacelus. Inflammation also is most∣ly to be feared in Wounds of the Nerves, Cartilages, and the like; or where but a small Flux of bloud does follow the Wound. In which cases the Chirurgeon is to breath a Vein, and to take away a plentifull quantity of Bloud: for hereby he doth repress the Heat, and extinguish the Flame. If Cacochymy offend, correct and amend this by convenient Purgings, and lenifying Medicines, a good order of Diet, and such as may temper the Bloud, orde∣ring your Patient to shun all manner of Perturbations, which may create or stir up any Passions within him. If Inflammation happen by the puncture of a Nerve, or an incision thereof, wholly divide it; for it is better that Part should lose its motion, then that the whole Body should be robbed of its life, as well as of its sense and motion.

* 1.3 I have been very plentifull in the Third already, and shall therefore remit you thither for this. Save onely by the way, when you come to Wounds of the Veins and Arteries, I shall there enlarge somewhat more thereon.

* 1.4 As touching Syncope or Lipothymia, Galen, 12. Meth. cap. 5. does thus define it; that it is a principal Lapse of all the Spirits, happening by some hurt of the Heart, or injury done to it, when it is quiet in its procreation and

distribution of its vitall Spirits. For then, as Gordonius doth express it, both sense and motion are taken from the whole Body, the Pulse becomes flat and dull, and Death appears in the face. And in these cases the Patients are seen to fall down without either sense or motion. This Syncope which does most commonly intervene in Wounds is for the most part from an Haemorrhagiall cause, the which does make this dissipation of Spirits; or Fear, the which does make a speedy revocation of the Spirits to the Heart, whence followeth that every Part is forced to leave work, whilst this Disturbance is thus in action. A Syncope does ofttimes happen, as Galen does observe, from a ve∣nenate and putrid Vapour passing to the Heart through the Arteries, and to the Brain by its Nerves. And hence by most Authours are granted these three causes of Syncope. The first is made by the dissipation of the Spirits and na∣tive Heat, as in a large Haemorrhagy: then by oppression or obstruction of these Spirits, as in Fear; for thus the Spi∣rits are called back from the Circumference to the Center: and thirdly by Corruption, as in Cacochymick bodies, and venenate Wounds. The first of these are cured, if conve∣nient Medicines be speedily applied and administred; as by sprinkling cold water on the face, laying him on his back, and stopping his Flux. The second by good Cor∣dialls, by cherishing and reviving his Spirits, by clapping sweet Smells to his nostrills, frictions of his Temples. But if a venenate Quality does occasion this, cure this by Mi∣thridate, Venice Treacle, Actuall Cauteries, application of live Pigeons cut in the middle, Cupping-glasses, for de∣rivation and interception of this Matter which is to be fetched out.

* 1.5 Neither is Delirium in Wounds less dangerous, which is a perillous Affect arising from some principall or noble Part, as the Nerves, Brain, Heart, Diaphragma, and the like, these, or any of these, being wounded. For this Delirium is nothing else but a deprivation of Motion, and

an alienation of Sense, contained in the wounded Brain by essence or consent. Hence is it, that we so oft see in such as are bit by a mad Dog, that venomous Vapours do ascend upwards into their Heads, and fill the porosities of the Brains, which makes them so frantick and idle. It does arise from a vehement Pain and Inflammation; and there∣fore such Medicines as may cure Pain and Inflammation are very proper here. If it ariseth from Poyson, Alexi∣pharmicks are the best engines to remove it. For deriva∣tion and interception of the matter which doth excite this Delirium, alterant and evacuating Clysters are here pro∣per. Phlebotomy, Cupping-glasses, Actuall and Poten∣tiall Cauteries are here most requisite. Setons and Fon∣tinells are fair Orifices for letting out its venome. Cordi∣alls, Emulsions and good Decoctions may defend it from the Heart. Hordeaceous and Papaverall Decoctions may banish it, by procuring Rest. And as it is a deprivation of the principall faculty of Motion, so are we to take care of it.

* 1.6 But because this more properly does belong to a Phy∣sician to examine and advise about, I shall briefly shut up this Symptome, onely acquainting you, that Avicen, fen. 1. does call that a Fever, which is an extraneous, adventiti∣ous, accensive heat in our Heart, by which the Veins and Arteries therewith sharing, it's carried through the cir∣cuit of our whole Body, and hurteth its actions. Neither is there any Fever allowed where the Heart is not affected, either primarily, or secondarily, being a Disease in In∣tempereity.

But to come to that which more properly does relate to large Wounds: and here, as Hippocrates offereth, untill a good Digestion be procured, both Fever, Pain and In∣flammation do attend the Part: for whilst the Matter is making, the Heat does increase. Sometimes a Fever does arise from the Bite of a venomous creature; and therefore as it does carry this poysonous quality to the Heart, there

endeavouring to infect its Spirits, it very readily runs in∣to a Fever and Inflammation. Now where this happens, cool the body by Phlebotomy: if ill Humous do joyn in the combate, dispatch these by convenient Catharticks. And in respect of the Poyson, you must use Alexiphar∣micks: for the Pain and Inflammation, prepare Anodynes; shunning all things which may procure a vehement motion, disturbance and perturbations of the mind; and use your greatest industry to bring every part to its due order, tem∣per and habit.

* 1.7 Crudity also is a great enemy to the healing of Wounds; for it does afford no laudable Matter, without which ex∣pect no good new Flesh. And this by many Authours is allowed to happen by these six means: by a continuall * 1.8Flux of bloud, where no good Digestion is; by an Instru∣ment contusing the Part, as happens in Gunshot-wounds; by the nature of the Part, such as deep Wounds in the Joynts; by coldness of the Air; by applying of unfit Me∣dicines; and lastly, by too strict Ligature. As for the first, this you have already shown. The second is to be digested as contused Wounds. Astringent Medicines are to be applied to the Articulations, to preserve their Tem∣per. The Air is to be corrected; the Part to be furni∣shed with convenient Medicines; and the strict Ligature to be relaxed. And thus may you cure these six Causes of Crudity. The other two remaining Symptoms I shall speak of a little more largely, they being of great conse∣quence.

Notes

• * 1.1

  I. Pain.
• * 1.2

  2. Inflammati∣on.
• * 1.3

  3. Haemorrha∣gy.
• * 1.4

  4. Fainting.
• * 1.5

  5. Delirium.
• * 1.6

  6. Fever.
• * 1.7

  7. Crudity.
• * 1.8

  Six things causing Cru∣dity.