Chirurgorum comes, or, The whole practice of chirurgery begun by the learned Dr. Read ; continued and completed by a Member of the College of physicians in London.

CHAP. XXVI.

Of Wounas of the vessels of the Throat.

HAving dispatched Wounds which may happen to the Head, I must now fall to those wounds which may offend the Neck. Now these Wounds cause solution of continuity either in the common parts of the Body, or the parts proper. The parts com∣mon are the Cutis, and Membra∣••a carnosa. The parts proper, are the vessels and the other parts. The vessels are three, the jugular Veins, the soporal Arteries, and the recurrent Nerves. The other parts are the Larynx or Wind∣pipe, and the Gula, or the mouth of the Stomach, and the Spinalis medulla: Of these I will discourse in order, as they are set down. Those Wounds which happen to the common parts, the Skin, and the Membrana carnosa, require no particular tractation; for they are cured by joyning together the parts dif-joyned, and by application of agglutinative Topicks. Seeing these parts are loose and flaggy, you may stitch these parts, althô there be some loss of substance. The rest of the Wounds which befall the other parts of the Neck, requi••e a special consideration.

First then to come to the wounds of the vessels: If the internal ju∣gular Veins, and soporal Arteries, be deeply and largely wounded, the wounded party can hardly escape. First, because the wound∣ed party doth flux to death most commonly, before any Chirurge∣on can come to stay the bleeding. Secondly, because no strait Liga∣ture can be applied to these Wounds, because it might choak or strangle the wounded party. Cels. l. 5. c. 26. saith, Periculosa sunt vulnera ubicunque venae ma∣jores sune: those Wounds are dan∣gerous wheresoever great Veins are. Hip. prorr. l. 2. affirms those wounds to be deadly, whereas the thick, that is the great and large Veins, are wounded in the Neck and Groins. Of the danger of these wounds, Forest. Obs. Chirurg. l. 6. c. 4. thus warneth us: The jugular Veins receiving a great Wound, hardly and very seldom are cured, because they deprive a man of the vital spirit, by reason of the large effusion of Blood; and because these Wounds will not admit such rolling for the staying of bleeding as is necessary. Guliel.

Fabric. Cent. 4. Observ. 2. makes this manifest by an example: When a certain Empirick went about the cutting out of a Stru∣ma in the Neck of a Genevan Maid, which had inclosed the jugular Vein, and the recurrent Nerve, so great a flux of Blood issued, that the Maid died in the very ope∣ration. The like chance happened to one Mr. Blackwell, who going about the like operation in a young Gentlewoman, then lying in Alder∣man-bury, had no better success. Doctor Gwin and I were then pre∣sent. Let these and the like ex∣amples procure wariness when you go about to deal with Tumors in the lateral parts of the Jugulum, or Throat.

In such Wounds, a Wound of the Artery is more dangerous than of the Vein. First, because the Blood of the Artery is more fluxi∣ble and more spirituous: Second∣ly, because the coats of the Artery are hard, and are in continual mo∣tion.

You shall know an Artery to be wounded by these signs: First, the Arterial Blood gusheth out sorcibly and leaping, when the Artery is dilated, but in the con∣striction the Blood is drawn back. Secondly, the Arterial Blood is thinner; but the Venal thicker. Thirdly, the Arterial Blood is of a bright red colour; but the Venal is blacker. Fourthly, the Arterial Blood is much hotter than the Ve∣nal. Fifthly, the Arterial Blood when it issueth out, is more full of spirits than the Venal.

As for the cure of such Wounds, the first scope is to stay the flux of Blood, which is the store-house of the vital spirit: the Second is, to agglutinate the Wound.

The Bleeding is staied two man∣ner of waies; by Medicaments and by Deligation: The Medicaments are either restrictive or escharoti∣call.

This restrictive Medicament may serve instead of all others: ℞ Thur. ʒ ij. Aloes, Sanguinis draconis, Te∣larum aranearum, quae in molis plenae sunt farina volatili, Hypo. cystidis, Mastiches, Sarcocollae, T••r∣rae umbrae, pulveris volatilis Fungo∣rum an. ʒ j. siat ex omnibus pul∣vis subtilis.

The escharotical means are ei∣ther Medicaments which procure a Crust, or an actual Cautery. This Medicament which follows, shall serve for all other escharotical means, ℞ Pul. praedi••l. ʒ ij, Calc. vivae ʒ j. Arsenic, sub••mat. & Au∣ripigmenti. ʒss. fiat pulv. s. a.

These powders, according to Ga∣len, lib. 5. method. c. 4. must be mingled with the whites of Eggs, so that the Medicament be of the consistence of Honey: Then the hairs of a Hare are to be added; you must sill the Wound with do∣sils armed with these Medicaments, and apply large pledgets above the dosils, and about the Wound, armed in like manner with the same.

Seeing you cannot use strait rolling about the Neck for fear of choaking, you are to have in rea∣diness three or four Servants to keep to the Wound the Medica∣ments, that they fall not off by their turns, these Medicaments must lie to the Wounds three days; then when you go about to removo them, when you are come to the

lowermost dosils in the Wound, if they stick, you are not to re∣move them, lest a fresh flux be caused; only the rest of the Wound is to be filled up with fresh stuff.

As for the actual Cautery, it must be red and glowing hot; for then it procures a crust most spee∣dily, and that the thicker. This being done, we are with all expe∣dition to procure incarnation, lest the crust fall before flesh be en∣gendred, and so the breach be∣come greater, and the flux of Blood larger. If you labour to engender flesh above an Artery, you are to use sarcotical Powders, which strongly drie.

When the flesh is engendred, if you by applying your finger feel strong beating, you are to fear lest an Aneurisma ensue: when you have performed all these directi∣ons, it will not be amiss, above and round about the Wound, to apply this Cataplesm: ℞ Fol. Sola∣••••, Hyosc••ami, Mandragor. con∣tus. an. man. j. Far. Hord. & Pulv. Malicer. an. q. s. ut parecur Cataplasma sine ullà coctione.

If these means will not prevail, then you are to bind the vessel which bleeds: First then you are to lift up the vessels from the sub∣jacent and adjacent parts with a small silver hook; then you are to bind them above and under the Wound strongly, and to cut them asunder between the Deligations: This is the surest way, seeing there are innumerable Anastomoses of the vessels in the body of Man, and so Blood may easily flow from ei∣ther side of the Wound: where∣fore it is necessary that they both be bound. Seeing these Wounds are extreme dangerous, you can∣not be too circumspect in curing of them: if therefore a learned Physician cannot be had, you must see that he use a convenient Diet.

His Diet then must be sleader, cooling, glutinous, and somewhat astringent, that no great store of Blood be engendred, that it may be cooled, made thick, and so less apt to flow; wherefore Flesh, Eggs, and strong Drink are to be shun∣ned. The party may eat Lettuce, Purslain, Endive, Spinach, So••el, Barly-cream, Pompions boiled. As for Fruit, he may eat Quinces, Medlars, Pomegranates, Prunes baked or stewed, Sloes stewed. As for flesh, he may eat Calves and Sheeps-feet stewed, Calves and Sheeps-heads boiled, and their Brains with Green-sauce made of the common Sorrel, and Wood-Sorrel, Vinegar of Roses, and a little Sugar; Let the Bread be course and leavened: Let the Drink be Spring-water, wherein Steel hath been quenched, Beve∣redge of Vinegar and Water, the juice of Pomegranates, Barley∣water, Juleps of Roses and Vi••∣lets, Spring-water and Verjuice. If the party be weak, let him, or her feed upon Mountain-birds, poched Eggs, Partridges. In Spring∣water, wherein the bottom of a loaf hath been boiled, dissolve Sy∣rup of Succory, Purslain, red Ro∣ses, Myrtil, and such like: If Wine be required, let it be deep coloured and astringent: such are the red Wines, whereof here they make their Clarets and Allegant. The Body must be kept soluble, and all perturbations of the Mind,

but chiefly vehement anger, are to be abandoned. If the party sleep not well, it is to be procu∣red by Art: this Medicament which follows is very convenient and fit: ℞ Diascor. ʒ j. Philon. Persici ℈ j. Syrup. Papav. albi ʒ vj. Aq. Pa∣pav. cirat. ℥ iij. Misc. ut pare∣tur petio bib••nda fri••ida horâ ix. vespertinâ you may minister this potion every third night.

The third vessel which is to be sound in the lateral parts of the J••gulum, or Throat, which is re∣markable, is the Recurrent Nerve, so called, because it comes down from the sixth pair of Nerves, and returns upwards towards the M••i∣scles of the Larynx, using in the lest part the trunk of the Aorta, and on the right Side, the axillar Artery, as Pulleys. If one of the recurrent Nerves be cut asunder, the voice becomes house, but if both be divided, the Speech is ta∣ken away; and seeing they great∣ly further the Speech, if they be whole, and hinder it, if they suf∣fer solution of unity, they are cal∣led not only Nervi recurrentes, Recursivi, and Reversivi, but Vo∣cales also.

To consolidate these, and the wounds of the Veins and Arteries, this Balsame of Ambrose Parey set down, lib. 10. c. 29. is excellent: ℞ Ol. Hyperic. simpl. ℥ iiij. Gum. Elemi. ℥ iij. Terebinth. Venet. lb. ss. liquescant ista simul ac colen∣tur. Cum frigere incipiunt, adde Boli Armen. Sang. Drac. an. ℥ j. Irid. Florent. Aloes, Myrrh. Ma∣stich. Pulverizat. an. ʒ j. Aq. vit. ℥ ij. Misc. ex. l. a. Apply the Balsame warm. Above the Bal∣same apply Diapalma malaxed in Oil of Roses to hinder all Inflam∣mation.