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. XXVII.

Of Wounds of the other parts of the Neck.

HAving delivered unto you in the former Chapter, the me∣thod of curing Wounds which may happen to the vessels seated in the lateral parts of the Neck; I am to shew you how Wounds, which cause a solution of unity in other parts of the same, are to be cured. Now those members are seated ei∣ther in the fore-part of the Neck, or in the back-part: In the fore∣part the Trachaea arteria, or Wind∣pipe is placed; but in the back∣part the Gula, or the mouth of the Stomach, and Spina dorsi, or Spinalis medulla, the marrow or pith of the Back-bone.

If the Aspera arteria, or Wind∣pipe be wounded thorow: First, the breath will come out at the Wound. Secondly, Blood will issue out at the Mouth. Thirdly, the Speech will be hindred. Fourth∣ly, Coughing will trouble the wounded party.

The Wind-pipe hath three parts: First, the uppermost part of it, called Larynx: The Second, Cau∣dex, or the stump: the Third, the Branches spread thorowout the substance of the Lungs.

Wounds of the Larynx, although they be not mortal of themselves, yet by accident they may become such: First, by reason of the ne∣cessary use, for it doth receive and breath out the Air. Secondly, by reason of the fearful Symptomes, or accidents which accompany such Wounds; for this part is near to the jugular Veins and soporal Arteries: so that it can hardly be wounded, unless these parts be wounded also. It hath also sun∣dry Branches of the recurrent Nerves, and besides sundry Muscles; so that a great flux of Blood, Pain, Inflammation, Pursing or draw∣ing together, and at last strang∣ling may ensue. Thirdly, because this part can hardly be cured; for Medicaments cannot easily be ap∣plied or kept to the part.

Wounds of the Caudex, vel Fistu∣la, or of the Stump or Pipe, al∣though they are not so dangerous as those of the Larynx, for the reasons before alleged; yet they are not without danger, for it is framed of a double substance; for the rings called Anuli are cartila∣ginous, but the substance which ties these together, is membra∣nous. Now a Cartilage cut asun∣der, doth not admit unition, ac∣cording to Hip. Aph. li. 6. Aph. 19. Who saith when the Bone is cut, or a Cartilage, or a Nerve, it neither grows again, nor is united; understand this by a middle of the

like substance. He repeats this same lib. 7. Aphor. 28. Galen subscribes to this Aphorism, 5 Method. Med. c. 7. Three causes may be alleg∣ed for this: First, because a Car∣tilage is a part drie, without Blood, and hard. Secondly, because the cold Air doth continually pass tho∣row the stump. Thirdly, because it is seldom at rest, but still in motion. You may add another reason, because the Air doth not freely pass and repass by it, chiefly if the Wound be deep and large. Of these Wounds thus writes Vidus Vidius de curat. Morb. Membrat. l. 8. c. 6. Wounds which pass tho∣row the Wind-pipe most com∣monly cause speedy death, by rea∣son of the Blood which issu∣ing out of the jugular Veins, fal∣leth upon the Lungs, and hindreth breathing: And Forest. Observ. Chirurg. lib. 6. Obs. 4. thus wri∣teth of them: Large Wounds of the Aspera arteria, chiefly those which divide the cartilaginous substance of it, seldom are cured; for this part is hard, and without Blood: besides this, the wounded party draws breath by the Wound, which hinders consolidation.

As for the cure of such Wounds: if the Wound be transverse, then the wounded party must bend down his Head: if the Wound be streight, according to the length of the pipe, then the party is to hold up his Head, that the brims of the Wound may be brough. together: then the Wound is to be stitched as firmly and artifici∣ally as you can: Pins in this case are best, as also in curing a Hare∣lip, for all kinds of thread will easily rot. This being done, ag∣glutinative Medicaments are to be used. Arcaeus his Liniment is good, and the natural black Balsame: Above apply Dinchylon simplex malaxed with Oil of Myrtils or Quinces. In your dressing you must have a care that neither Blood nor Quittour fall upon the Wind∣pipe, lest it procure choaking; but that they be outwardly dis∣charged in the depending part. If after dressing, the party breath with difficulty, and there is dan∣ger of Suffocation, because the cavity of the Larynx, or Pistul••, is filled with Blood, or Quittour, or both; or because it is straitned by reason of a great Imflammation: then the Wound is to be dilated, and a silver pipe, a little bended towards the point, that it hurt not, to be kept in it, until the wounded party be able to breath freely; then let it be taken out. In this Wound Gargarisms are good: Take this as a pattern: ℞ Hord. mundat. Cochl. iij. Flor. Ros. rub. Pug. 1. Sumach. Flor. Granat. an. ʒ ij. Passulonajor. exaci∣nat. Jujub. an. ℥ ss. Glycyrrhiz. ℥ j. Bulliant ista. s. a. in lib. iij. aq. font, ad consumpt, medietat. ac co∣letur decoct, cui admisce Mell. Ros. & Syrup. Myrtin. an. ℥ ij. utatur Gargarismate calefacto. It moistens the Mouth, asswages pain, agglutinates the parts, and causes the party to breath freely.

Wounds of the Gula, oesophagus, or mouth of the Stomach do fol∣low. That the month of the Sto∣mach is wounded, you shall know by these signs: First, if the Wound be deep, the Meat and Drink will come out of the Wound, Se∣condly, the difficulty of swallow∣ing.

Thirdly, the Hicket and vo∣miting of Choler, Fainting, a faint Pulse, cold Sweats, coldness of the Hands and Feet, according to Fer∣nel. lib. 7. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. cap. 8. Fourth∣ly, the vomiting of Meat and Drink according to Celsus lib. 5. c. 26.

As concerning the variety of these Wounds, receive these kinds of them: First, either the whole Gula is cut asunder, or it is only cut in part. Secondly, if it be cut but in part, then it is wounded near to the Stomach, or far from it. Thirdly, it is wounded either streightly or obliquely.

Concerning wounds of the Gula, receive these Prognosticks. First, all wounds of the Gula are dan∣gerous: First, because they cause difficulty of breathing: Secondly because it can hardly be wounded unless the Wind-pipe, the jugular Veins, the soporal Arteries, and the recurrent Nerves be wounded also. Thirdly, these Wounds which are but small, streight, and remote from the mouth of the Stomach; are less dangerous. Fourthly. Wounds great, transverse, and near to the mouth of the Stomach, ad∣mit no cure, according to G••udo tract. 3. Doct. 1. c. 1. First, be∣cause the passing of the Meat and Drink doth hinder the consolida∣tion. Secondly, because the place is still moist. Thirdly, because its office, which is to carry Meat and Drink to the Stomach, is most necessary for the sustentation of the life of Man. Fourthly, because an Inflammation may easily be com∣municated to the upper orifice of the Stomach, which is very ner∣vous, which the Grecians call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 the Heart, and whose pains are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Fifthly, if it be wholly cut asun∣der, the Cure is impossible, for one part shrinks upwards and the other downwards. As for the cure of these Wounds; The first in∣tention is by stitching, to bring the brims of the Wound together: yet care must be had, that an Ori∣fice be left in the depending part, to be kept open with a Tent, that the Quittour may be discharged, and that Meat stick not there, which might cause Inslammation. Then such Medicaments are to be appli∣ed as I set down for the cure of Wounds of the Wind-pipe.

In these Wounds a special re∣gard must be had of the Diet: seeing then the wounded party can hardly swallow, his Food must be liquid, and it must nourish much. Such are Goats and Asses-milk, wherein Saccharum rosatum, or Violatum are dissolved, Broths made of flesh wherein the yolks of Eggs are dissolved, Almond-milk, and Emulsions of the great cold Seeds drawn with Chicken-broth, &c.

If the party cannot swallow at all, then nutritive Clysters are to be ministred: But first of all the Excrements are to be driven out of the Guts by a purging Clyster. Receive this as an example: ℞ Elect. lenit. ℥ i ss. Mellis rosati ℥ ij. Sacchari rubri ℥ iij. deco••t. commu∣nis pro Clysterib. ℥ x. Mise. ut pa∣••••tur Clyster. Then inject Clysters made of such things as have been set down for the Diet. Minister half a pound at a time, that the party may keep it the longer: Into these nutritive Clysters no Oil must enter, because it will

too much lubrifie the Guts; nor Salt or Sugar, because they will procure too speedy expulsion of the Clyster.

Now I am come to the Wounds of the Spina dorsi, the Back-bone seated in the back part of the Bo∣dy: If the Wound pass not to the Spinalis medulla, sometimes it di∣vides the Muscles, and then the Wound is to be dressed, as those which happen in fleshy parts: If the Bone be hurt also, then it is to be dressed as Wounds of the Head wherein is a Fracture, of which I have discoursed heretofore at large.

If the Spinalis medulla, or the Marrow of the Back-bone be wounded, then it is either wholly cut asunder, or but in part only: If it be wholly cut asunder, then the whole Body is deprived of mo∣ving and feeling, and by conse∣quence breathing it self must be hindred, and so death must ensue. If it be not wholly cut asunder, but wounded only, then a fearful Convulsion must of necessity en∣sue, and so for the most part death.

Celsus lib. 5. c. 26. hath these signs: A Palsie or Convulsion fol∣loweth, Feeling is lost, and after a while the party cannot retain Seed, Urine, or Excrements of the Belly, yea, a total suppression of the Excrements sometimes will ensue. The same signs hath Ferne∣h••s lib. 7. Patholig. c. 8. If the Spinalis medulla (saith he) be wounded, the inferior parts be∣come paralytick, their Feeling, Moving, and Functions are lost; so that the Excrements, Urine, and Seed, now and then come from the party against the will. If the Convulsion happen to the Arms, then it is likely that the Nerves whick spring from the fifth, sixth, and seventh Vertebrae of the Neck are wounded; if the Legs suffer these accidents, then the Nerves of the Vertebrae of the Loins, and Os sacrum are offended.

As for the Prognosticks; seeing the Spinalis medulla is of the same nature whereof the Brain is, Gal. l. 3. de Temperamen. c. 3. and near unto the Brain, lib. 3. al. facult. and is derived from the Brain, lib. 16. de usu part. c. 2. and resem∣bles a compact Brain, lib. 1. de mot. Muscul. c. 1. and seems to be as it were another Brain under the Head and Neck, lib. 12. de Ʋs-Part. c. 11. & 15. The Wounds of it are no less dangerous than those of the Brain. First, because it hath its original from the Brain. Secondly, by reason of its compo∣sition, because 'tis covered with the Dura and Pia mater. Thirdly, by reason of the Nerves which spring from it. Fourthly, by rea∣of the consent which it hath with the Brain. Fifthly, by reason of its action and use, because it doth communicate moving and feeling to the parts Sixthly, by reason of the situation of it: for it lies deep in the Body, so that the force of the Topicks can hardly reach to it. Seventhly, by reason of the Symptoms; for it being wounded, a Palsie, Convulsion, and privation of moving and feeling do ensue.

Forrest. lib. 6. Chir••ag. Obs. c. 6. de his ita promanc••at. If the Spina••is medulla be wounded about the beginning of it, death of a necessity must ensue, because a Convulsion of the whole Body

will follow; but if it be wounded in the lower parts, the Wound is not always deadly, unless the wound be a large one, or it be a puncture, although a Convulsi∣on doth alwaies ensue; so that it is not so dangerous as that which is received about the beginning; and Fallop. de Vulnerib. capit is cap. 2. hath these words: wounds of the Spinalis medulla are ac∣counted deadly by Hippocrates in Coac. Praenot. yet I have seen them sometimes cured; but if the wound happen to be in the upper part, death and a Convulsion of the lower parts must ensue.

Howsoever, seeing the wound∣ed must be dressed, thus you shall go to work: you are to pour in∣to the wound such things as as∣swage pain, stay Convulsions, and which procure Digestion without biting and sharpness: Such are un∣ctuous and fat Topicks, as this Medicament is: ℞ Ol. Hyper. & de luteis ovor. an. ℥ j. Terebin∣thin. ℥ss. Theriac. Andromachi. ʒ ij. Misceantur. Secondly, you must anoint the whole Back-bone with such a Medicament. ℞ Ol. Vulpin. Hirundinum & Lumbricor. an. ℥ j. Ol. Mastichini, & de Ca∣stor. an. ℥ ss. Misc. Thirdly, you must embrocate the whole Scalp with this or the like Medicament: ℞ Ol. Chamaemel. ℥ j. Ol. Lumbri∣corum ℥ ss. Misc. These means are to be applied warm.