The workes of that famous chirurgion Ambrose Parey translated out of Latin and compared with the French. by Tho: Johnson. Whereunto are added three tractates our of Adrianus Spigelius of the veines, arteries, & nerves, with large figures. Also a table of the bookes and chapters.

CHAP. V. Of the Cure of Wounds in general.

* 1.1THe Chirurgeon ought for the right cure of wounds to propose unto himself the common and general indication: that is, the uniting of the divided parts, which indication in such a case is thought upon and known even by the vulgar: for that which is dis-joyned desires to be united, because union is contrary to division. But by what means such union may be procured, is only known to the skilful Artisan. Therefore we attain unto this chief and prin∣cipal Indication by the benefit of Nature as it were the chief Agent, and the work of the Chirur∣geon as the servant of Nature. And unless Nature shall be strong, the Chirurgeon shall never attain to his conceived, and wished for end: therefore that he may attain hereto, he must per∣form five things;* 1.2 the first is, that if there be any strange Bodies, as pieces of Wood, Iron, Bones, bruised Flesh, congealed Bloud, or the like, whether they have come from without, or from with∣in the Body, and shall be by accident fastened or stuck in the wound, he must take them away, for otherwise there is no union to be expected.

Another is, that he joyn together the lips of the Wound; for they cannot otherwise be agglu∣tinated and united. The third is, that he keep close together the joyned lips. The fourth, that he preserve the temper of the wounded part; for, the distemper remaining, it is impossible to restore it to its unity. The fifth is, that he correct the accidents, if any shall happen, because these urging, the Physitian is often forced to change the order of the cure.

All strange and external Bodies must be taken away, as speedily as is possible, because they hinder the action of Nature intending unity, especially if they press or prick any Nervous Body, or Tendon, whence pain or an Abscess may breed in any principal part, or other serving the principal.

Yet if by the quick and too hasty taking forth of such like Bodies there be fear of cruel pain or great effusion of Bloud, it will be far better to commit the whole work to Nature than to exaspe∣rate the Wound by too violent hastening.

For Nature by little and little will exclude, as contrary to it, or else together with the Pus, what strange body soever shall be contained in the wounded part. But if there shall be danger in delay, it will be fit the Chirurgeon fall to work quickly, safely, and as mildly as the thing will suf∣fer: for effusion of Bloud, swooning, convulsion, and other horrid symptoms; follow upon the too rough and boystrous handling of Wounds, whereby the Patient shall be brought into greater danger than by the Wound it self.

Therefore he may pull out the strange Bodies, either with his fingers, or with instruments, fit for that purpose: but they are sometimes more easily and sometimes more hardly pulled forth, according as the Body infixed is either hard or easie to be found or pulled out. Which thing hap∣pens according to the variety of the figure of such like Bodies, according to the condition of the part it self, soft, hard, or deep, in which these Bodies are fastned more straitly or more loosly: and then for fear of inferring any worse harm, as the breaking of some Vessel: but how we may perform this first intention, and also the expression of the instruments necessary for this purpose, shall be shown in the particular Treaties of Wounds made by Gun-shot, Arrows, and the like.

* 1.3But the Surgeon shall attain to the second and third scope of curing Wounds by two and the same means, that is, by Ligatures and Sutures: which notwithstanding before he use he must well observe whether there be any great flux of Bloud present, for he shall stop it if it he too violent; but provoke it, if too slow, (unless by chance it shall be poured out into any capacity or belly) that so the part freed from the superfluous quantity of Bloud may be less subject to inflammation. Therefore the lips of the Wound shall be put together, and shall be kept so joyned by suture and ligatures: Not truly of all, but only of those which both by their nature, and magnitude, as also by the condition of the parts in which they are, are worthy and capable of both the remedies. For a simple and small solution of continuity, stands only in need of the Ligature which we call incar∣native, especially, if it be in the Arms or Legs, but that which divides the Muscles transversly, stands in need of both Suture and Ligature; that so the lips which are somewhat far distant from each other, and as it were, drawn towards their beginning, and ends, may be conjoyned.

If any portion of a fleshy substance by reason of some great Cut shall hang down, it must neces∣sarily be adjoyned and kept in the place by Suture. The more notable and large Wounds of all the parts, stand in need of Suture, which do not easily admit a Ligature, by reason of the figure

and site of the part in which they are, as the Ears, Nose, Hairy-scalp, Eye-lids, Lips, Belly and Throat.

There are three sorts of Ligatures, by the joynt consent of all the Ancients.* 1.4 They commonly call the first, a Glutinative, or Incarnative; the second Expulsive; the third Retentive. The Glutinative, or Incarnative, is fit for simple, green and yet bloudy Wounds.* 1.5 This consists of two ends, and must so be drawn, that beginning on the contrary part of the Wound, we may so go up∣wards, partly crossing it, and going downwards again, we may closely joyn together the Lips of the Wound. But let the Ligature be neither too strait, lest it may cause inflammation or pain; nor too loose, lest it be of no use, and may not well contain it.

The Expulsive Ligature is fit for sanious and fistulous Ulcers, to press out the filth contained in them. This is performed with one Rowler, having one simple head;* 1.6 the beginning of binding must be taken from the bottom of the Sinus, or bosom thereof; and there it must be bound more straightly, and so by little and little going higher, you must remit something of that rigour, even to the mouth of the Ulcer, that so (as we have said) the sanious matter may be pressed forth.

The Retentive Ligature is fit for such parts as cannot suffer strait binding; such are the Throat,* 1.7 Belly, as also all parts oppressed with pain; For the part vexed with pain, abhorreth binding. The use thereof, is to hold to local Medicines. It is performed with a Rowler, which consists somewhiles of one, some whiles of more heads. All these Rowlers ought to be of linnen, and such as is neither too new, nor too old, neither too coorse, nor too fine. Their breadth must be proportionable to the parts to which they shall be applyed; the indication of their largeness, being taken from their magnitude, figure, and site. As we shall shew more at large in our Tractates of Fractures and Dislocations.

The Chirurgeon shall perform the first scope of curing Wounds,* 1.8 which is of preserving the temper of the Wounded part, by appointing a good order of diet by the Prescript of a Physitian, by using universal and local Medicines. A slender, cold and moist Diet must be observed, until that time be passed, wherein the Patient may be safe and free from accidents which are usually feared. Therefore let him be fed sparingly, especially if he be plethorick; he shall abstain from Salt and spiced flesh, and also from Wine: if he shall be of a cholerick or sanguine nature, in stead of Wine he shall use the Decoction of Barly or Liquorice, or Water and Sugar. He shall keep himself quiet; for Rest is (in Celsus opinion) the very best Medicine. He shall avoid Venery, Contentions, Brawls, Anger, and other perturbations of the mind. When he shall seem to be past danger, it will be time to fall by little and little to his accustomed manner and diet of life. Uni∣versal remedies are Phlebotomies and Purging, which have force to divert and hinder the de∣fluxion, whereby the temper of the part might be in danger of change.

For Phlebotomy it is not alwayes necessary, as in small Wounds and Bodies,* 1.9 which are neither troubled with ill humors, or Plethorick: But it is only required in great Wounds, where there is fear of defluxion, pain, Delirium, Raving and unquietness; and lastly, in a Body that is Plethorick, and when the joynts, tendons, or nerves are wounded. Gentle purgations must be appointed, be∣cause the humors are moved and inraged by stronger; whence there is danger of defluxion and in∣flammation: wherefore nothing is to be attempted in this case, without the advice of a Physitian.

The Topick and particular Medicines are Agglutinative,* 1.10 which ought to be indued with a dry∣ing and astrictive quality, whereby they may hold together the lips of the wound and drive away defluxion, having always regard to the nature of the part and the greatness of the disease. The Simple Medicines are Olibanum, Aloes, Sarcocolla, Bole-Armenick, Terra sigillata, Sanguis Dra∣conis, Common & Venice Turpentine, Gum, Elemni, Plantane, Horse-tail, the greater Comfry, Pari∣na Volatilis & many other things of this kind, which we shall speak of hereafter in our Antidotary.

The fifth scope of healing Wounds, is the correction of those Symptoms or Accidents which are accustomed to follow Wounds, which thing verily makes the Chirurgeon have much to do; For as he is often forced to omit the proper cure of the disease, so to resist the accidents and symptoms, as Bleeding, Pain, Inflammation, a Feaver, Convulsion, Palsie, talking Idly, or distraction, and the like. Of which we shall treat briefly and particularly, after we have first spoken of Sutures as much as we shall think sitting for this place.

Notes

• * 1.1

  The general Indication of Wounds.
• * 1.2

  Five things necessary for uniting wounds.
• * 1.3

  Ligatures and Sutures for to conjoyn and hold together the lips of wounds.
• * 1.4

  Three sorts of Ligatures.
• * 1.5

  What an in∣carnative Li∣gature is.
• * 1.6

  What an ex∣pulsive.
• * 1.7

  What the re∣tentive.

  What the row∣lers must be made of.
• * 1.8

  Why and how the temper of the wounded part must be preserved.
• * 1.9

  In what wounds blood-letting is not necessary.
• * 1.10

  What medi∣cines are to be judged agglu∣tinative.