The surgeons mate or Military & domestique surgery Discouering faithfully & plainly ye method and order of ye surgeons chest, ye uses of the instruments, the vertues and operations of ye medicines, with ye exact cures of wounds made by gunshott, and otherwise as namely: wounds, apos fumes, ulcers, fistula's, fractures, dislocations, with ye most easie & safest wayes of amputation or dismembring. The cures of the scuruey, of ye fluxes of ye belly, of ye collicke and iliaca passio, of tenasmus and exitus ani, and of the calenture, with A treatise of ye cure of ye plague. Published for the service of his Ma. tie and of the com:wealth. By John Woodall Mr. in chyrurgerie.

Of the Cure of Gangrena.

* 1.1 TO the performance of the cure of this disease, there must be [ 1] first a due consideration had of the cause. Secondly, of the [ 2] part affected. Thirdly, of the fitting apt remedies for the [ 3] Cure, and how to proceed in the curing that disease, and of the

Symptomes thereof; and lastly, of the removing the cause, which if [ 4] that may be effected, health doubtlesse will follow, according to that Axiome of the Philosopher, Abla••a causa, tollitur effectus; but that must be expected in his due time, in which there must be first considered,* 1.2 whether the disease proceed of repletion, and if so, then a general eva∣cuation with a cooling and spare dyet must be prescribed the Patient: Viz. Water, with the milk of Almonds, and thin brothes with cool∣ing herbs, as Lactuca, Spinachia, Portulaca, Sorr••l, or the like; as also advising with the learned Physician, where time and place serveth: Barley waters also are good, and the sick must be forbidden all wine and strong drink, and must be contented with posset-drink, Barley water, and small Beer: it were also fitting that there were prescribed to the patient some preparative medicaments, as these, Syrup. Acetos.* 1.3 Simp. Syrup. Endiviae, Syrup. Citri, Violar. any of these mixed with waters as may be convenient in such a disease, and after these prepara∣tives, may be used such purgatives as may purge and cleanse the blood, viz. Confect. Hamech. Caria costrirum, Diacatholicon, Cassia fistula, or some one of them, being according to Art performed.

* 1.4 And if you perceive further occasion, you may reiterate the use of any of them: and further, you may not omit the use of Phlebotomy, scarrification and application of Ventoses, Leeches or Vesicatories up∣on or nigh the part affected, and according to the Patient his strength, let him blood moderately: and observe, that in scarrification regard is to be had, concerning the gangrenated part, whether it penetrate or be superficial, and so accordingly is scarrification to be used: as for the application of Leeches, it may be done upon any part thereto adjoyn∣ing, or upon the part affected it self: and further note, that if a Gan∣grene follow a contusion, for the most part it proceeds either by the vehemency of the contusion, whereby eruption of the capillar veins, yea, and the larger veins also, blood is forced into the Muscles con∣fusedly, as by the Echymosis may appear of the evil disposition of the Patient; or it may also proceed for want of a Surgeon to apply fit and artificial applications in due time: not seldome, under favour, by over∣hard ligature.

But if the Gangrene appear to have proceeded by inanition, that case is pitiful, and the cure very doubtful; but neverthelesse, where it so falleth out, all nutritive and comfortative remedies are to be appoint∣ed, as namely, if it proceed of cold either in frost, or by want of due and sufficient food, consideration is to be had by adding warmth of food and rayment, with cordial and comfortive remedies: also the Artist must truly inform himself, whether this disease be a Gangrene, or a Sphacelus, whether a partial or a total privation and mortification, with the utter losse of the sense of the fleshy and nervous parts; and if he find sense in the parts, there is life and hope.

* 1.5 But suppose a Gangrene proceeds of a venomous cause, as many times it doth, and namely, in time of contagion, as of Carbuncles in the Plague, the small Pox, or by other malignant Feavers, when as the Artist may neither purge his Patient, nor open a vein safely, but with

fear, except he may be well warranted, either by good and grave ad∣vice of the expert, where such may be had; in want of which, the Artist ought to search by authority of the most ancient Writers, that he can come at, for the avoiding of the eminent danger of death, to ensue upon his Patient, and to go warily in the want of better advice:* 1.6 viz. If the grief proceed of fulnesse, which seldome it doth at Sea, or in Camps, then his first rule in Art must be, as is said, that a thin dyet and cooling be prescribed his Patient, and that he be admitted no wine nor strong drink: also that he may be appointed some cooling Julep to be made him, namely, if the Patient be in Ship or Camp, he is there confined and constrained to the Surgeons Chest, and then let the Surgeon examine his provisions; and if he find he have any cooling waters and Syrups fitting thereunto, he may proceed to take as follow∣eth:

* 1.7 ℞. Aq. Lactuc. Acetos. Endiviae, Buglos, Borag. Frag. Plantag. Lujulae. or some one or more of the most fitting aforesaid waters, viz.

℞. Aq. Lujula, 2 l. Syr. Limon. vel Violar. ℥. ij. Ol. Vuri••l. gut. 12.* 1.8 Misce, give the Patient every two or three hours, two or three spoonfuls hereof, the glasse being ever shaken when it is poured out; and if he hath not been at stool that day in which he is to take the Julep, you may give him a Supposi••ory: and having had one stool, give him a* 1.9 Diaphoretick, viz. ℞. Aurum vitae gr. 8. or Mithridat. ʒ. 1. Elect. de Ovo, ℈ 1. Confect. Alcherm. ℈ ss. Ol. Vitriol. gut. 4. in Aq. Borag. Lujulae Acetes. vel Buglos. viz. of any one of these, ℥ 4. with Syr. Limon. Citri. Lujulae.* 1.10 Violar. or some of them, Misce, fiat haustus, give it the Patient being laid warm in bed, and cover him warm, and provoke him to sweat gently; and as you find his strength, continue his sweating for an hour, two hours or more: which done, keep him in a moysture one other hour at the least; which ended, let him cool and dry paulatim, and warily, and having so done and refreshed himself, till four or five hours ended, then you may, if you see cause, give him the like Cordial again, and proceed again as before, to sweat him the second time, and give him 8. grains of Aurum vitae ••or a Diaphoretick: which done, you may then admit him rest and respite again for a fitting time, wherein you may advise what further is requ••site to be done, in which time, not omitting in any case, both before his laying down to sweat and after, as also betwixt his sweating, ever to apply all fitting topical helps, viz. by scarifications and hot fomentations of some good lixivium, such as aftrr the taking off members in the mortified place, hereafter are described. Thus much in brief of the Gangrena.

Notes

• * 1.1

  Cure.
• * 1.2

  What to be con∣sidered in the cure of a Gan∣grene. Diet to be used for a Gan∣grene.
• * 1.3

  Preparatives necessa••y.
• * 1.4

  Phlebotomy usefull.
• * 1.5

  Rulis to be ob∣served if the Gangrene is caused by veno∣mous diseases.
• * 1.6

  What to be ob∣served if it be caused by ful∣ness••.
• * 1.7

  A receit to be administred to the Gangre∣nated.
• * 1.8

  The Dose of it.
• * 1.9

  The Receit of a Diaphoretick.
• * 1.10

  The order of the applying of it.