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

WE have read in John de Vigo, that it is disputed amongst Chirurgeons concerning the conso∣lidation of wounds of the Chest. For some think that such wounds must be closed up,* 1.1 and cicatrized with all possible speed, lest the cold air come to the heart, and the vitall spirits fly away and be dissipated. Others on the contrary think that such wounds ought to be long kept o∣pen; and also if they be not sufficiently large of themselves, that then they must be inlarged by Chirurgery, that so the blood poured forth into the capacity of the Chest may have passage forth, which otherwise by delay would putrefie, whence would ensue an increase of the feaver, a fistulous ulcer, and other pernicious accidents. The first opinion is grounded upon reason and truth, if so be that there is little 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 lest I may seem rashly to determin, I think it not amiss to ratifie each opinion with a history thereto agreeable.

Whilst I was at Turin, Chirurgeon to the Marshall of Montejan, the King of France his General,* 1.2 I had in cure a Souldier of Paris, whose name was Levesque, he served under captain Renovart. He had three wounds, but one more grievous than the rest, went under the right brest, somewhat deep into the capacity of the Chest, whence much blood was poured forth upon the midriff, which caused such difficulty of breathing, that it even took away the liberty of his speech; besides through this occasion he had a vehement feaver, coughed up blood, and a sharp pain on the wounded side. The Chirurgeon which first drest him, had so bound up the wound with a strait and thick suture, that nothing could flow out thereat. But I being called the day after, and weighing the present symp∣toms 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 me to cause the Patient to lye half out of his bed, with his head downwards, and to stay his hands on a Settle which was lower than the bed, and keeping himself in this posture, to shut his mouth and nose that so his Lungs should swell, the midriffe be stretched forth, and the intercostal muscles and those of the Abdomen should be compressed, that the blood poured into the Chest might be evacu∣ated by the wound; but also that this excretion might succeed more happily, I thrust my finger somewhat deep into the wound, that so I might open the orifice thereof being stopped up with the congealed blood; and certainly I drew out some seven or eight ounces of putrefied and stinking blood by this means. When he was laid 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 turn first on the one, and then on the other side, and then again to lye out of his bed as before: for thus he evacuated small, but very many clots of blood, to∣gether with the liquor lately injected; which being done, the symptomes were

mitigated, and left him by little and little. The next day I made another more detergent injection, adding thereto wormwood,* 1.3 centaury, and Aloes; but such a bitterness did rise up to his mouth together with a desire to cast, that he could no longer indure it. Then it came into my mind that formerly I had observed the like effect of the like remedy in the Hospital of Paris, in one who had a fistulous ulcer in his Chest. Therefore when I had considered with my self that such bitter things may easily pass into the Lungs, and so may from thence rise into the Weazon and mouth, I determined that thenceforwards 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 means recovered his health beyond my expectation.

* 1.4But, on the contrary, I was called on a time to a certain Germain gentleman who was run with a sword into the capacity of his Chest; the neighbouring Chirurgeon had put a great tent into the wound at the first dressing, which I made to be taken forth, for that I certainly understood there was no blood powred forth into the capacity of the Chest because the Patient had no feaver, no weight upon the Di••phr••gma, nor spitted forth any blood. Wherefore I cured him in few dayes by only dropping in some of my balsome and laying a plaister of Diacalcitheos upon the wound.* 1.5 The like cure I have happily performed in many others. To conclude, this I dare boldly affirm, 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 dressing,* 1.6 but keep them open for two or three dayes; but when you shall find that the Patient is troubled with none or very little pain, and that the mid∣riffe is pressed down 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 only with lint dipped in some bal∣some which hath a glutinative faculty, and laid somewhat broader than the wound; never apply liniments to wounds of this kind, 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 kinds of wounds may be fastned to the pledgets, and also have somewhat a large head, lest they should be drawn as we said into the capacity of the Chest; for if they fall in, they will cause putrefaction and death. Let Em∣plast. Diacalcitheos or some such like be applyed to the wound. But, if on the contrary, you know by proper, and certain signs, that there is much blood fallen into the spaces of the Chest, then let the orifice of the wound be kept open with larger tents, untill all the Sanies or bloody matter, wherein the blood hath degenerated, shall be exhausted. But if it happen at any time, as assuredly it sometimes doth, that notwithstanding the Art and care of the Physitian, the wound degenerates into a Fistula, then the former evil is become much worse. For Fistula's of the Chest, are scarse cured at any time, and that for divers causes. The first is, for that the muscles of the Chest are in perpetual motion;* 1.7 Another is, because they on the contrary inside are covered only with the mem∣brane investing the ribs, which is without blood. The third is, for that the wound hath no stay, by means whereof it may be compressed, sowed, and bound, whereby the lips being joined together, the wound may at length be replenished with flesh and cicatrized.

* 1.8But the reason why wounds of the Chest do every day heap up and pour forth so great a quan∣tity of matter, seems to be their vicinity to the heart, which being the fountain of blood, there is a perpetual efflux thereof from thence to the part affected. For this is Natures care in preserving the affected parts, that continually and aboundantly without measure or mean it sends all its sup∣plyes, that is, blood and spirits to their aid. Add hereto, that the affected parts by pain, heat, and continual 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 perpetual afflux of blood, there is a continual efflux of matter or filth, which at the last brings a man to a consumption; because the ulcerated part like a ravenous wolf consumes more blood by the pain, heat and motion, than can be ministred thereto by the heart. Yet if there be any hope to cure and heal the Fistula, it shall be performed, (after the use of diet, and phlebotomy, according to the prescript of the Physitian) by a vulnerary potion, which you shall find described when we treat of the Caries or rottenness of the bones.* 1.9 Wherefore you shall make frequent injec∣tions therewith into the Fistula, adding and mixing with it syrup. de rosis siccis and mel rosarum. Neither do I, if the putrefaction be great, fear to mix therewith Aegyptiacum. But you must have a care to remember & observe the quantity of the injected liquor, that you may know whether it all come forth again after it hath performed its detergent office. For if any thereof remain be∣hind in the corners and crooked passages, it hurts the part, as corrupted with the contagion thereof.

[illustration]

The form of a Syringe 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 be put into the fi∣stulous ulcer; and it must have many holes in it, that so the filth may pass 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-vitae, and wrung forth again, shall be laid hot to the end or orifice thereof, both to hinder the entrance of the air into the Fistulous ulcer, as also to draw forth the filth there by its gentle heat; the which thing the Patient shall much further, if often times both day and night he hold his breath, stopping his mouth and nose, and lying upon the diseased side, that so the Sanies may be the more forcibly evacuated; neither must we leave the putting in the pipe, before that this fistulous ulcer shall be almost dry, that is, whole; as when it yields little, or no matter at all, then it must be ci∣catrized. But if the orifice of this fistulous ulcer being in the upper part hinder the healing there∣of, then by a chirurgical Section, a passage shall be made in the bottom, as we said before in an Em∣pyema.

[illustration]

The delineation of the Pipes with their Strings and Spunges.

The Reader must note that the Pipes which are fit for this use, need not have so many holes as these here exprest; but only two or three in their ends: for the flesh growing and getting into the rest, makes them that they cannot be plucked forth without much pain.

A wound made in the Lungs admits cure,* 1.10 un∣less it be very large, if it it be without inflamma∣tion; if it be on the skirts of the Lungs, and not on their upper parts; if the Patient contain himself from coughing much, and contentious speaking, and great breathing: for the wound is inlarged by coughing, and thence also arises inflammati∣on; the Pus and Sanies whereof,* 1.11 whilst the lungs again endeavour to expel by coughing, by which means they are only able to expel that which is hurtful and troublesome to them, the ulcer is dilated, the inflammation augmented, the Patient wastes away, and the disease becomes incurable.

There have been many Eclegma's described by Physitians for to clense the ulcer;* 1.12 which when the Patient useth, he shall lye on his back, to keep them long in his mouth, so to relax the muscles of the Larinx; for thus the medicin will fall by little and little alongst the coats of the Weazon, for if it should fall down in great quantity, it would be in danger to cause coughing. Cows, Asses, or Goats-milk with a little Hony, lest they should corrupt in the Stomach, are very fit remedies for this purpose; but Womans milk exceeds the rest.

But Sugar of Roses is to be preferred before all other medicins, in the opinion of Avicen,* 1.13 for that it hath a detergent, and also an astrictive and strengthening faculty, than which nothing is more to be desired in curing of ulcers. When you shall think it time to agglutinate the clensed ulcer, you must command the Patient to use emplastick, austere, and astringent medicins, such as are Terra sigillata, bolus armenus, hypocystis, Plantain, Knot-grass, Sumach, Acacia, and the like, which the Patient shall use in his Broaths and Eclegma's, mixing therewith Hony of Roses; which serving for a vehicle to the rest, may carry away the impacted filth which hinders agglutination. But see∣ing an hective Feaver easily follows upon these kinds of wounds, and also upon the affects of the Chest and Lungs, it will not be amiss to set down somewhat concerning the cure thereof, that so the Chirurgeon may know to administer some help to his Patient, whilst a Physitian is sent for, to overcome this disease with more powerful and certain remedies.

Notes

• * 1.1

  Vigo, tract. de vuln. thora••. cap. 10.
• * 1.2

  A History.
• * 1.3

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

  Read the His∣tory of Ma∣ryllus in Galen. lib. 7. de Ana∣••om. administra.
• * 1.5

  What harm 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 easi∣ly degenerate into a Fistula.
• * 1.8

  Why there flows such plenty of mat∣ter out of wounds of the Chest.
• * 1.9

  The cure of a Fistula in the Chest. When Aegyptiacum must be put into the injec∣tions.
• * 1.10

  What wounds of the Lungs are curable.
• * 1.11

  The harm that insues upon coughing, in wounds of the Lungs.
• * 1.12

  How Ecleg∣ma's must be swallowed.
• * 1.13

  The utility of Sugar of Roses in ul∣cerated or wounded Lungs.