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. II.

Of Symphysis and Syssarcosis, and the means of staying an immoderate Flux of Blood in a Wound.

HAving in the former Chapter set down the two first Points of the general Doctrine of Wounds, to wit, the Nature of a Wound, and the Fountains from whence Prognosticks of Wounds are fetch∣ed; and having by propounding some Examples shewed the Pra∣ctice of them: Now I am to set down the third general Point, which is the last scope and end which the Chirurgeon proposes to himself, when he goes a∣bout to cure any Wound; and that is the Unition of the parts joyned.

First, then I will set down the divers sorts of Unition or Union of the parts; then the Causes which procure this Union.

Of Union then there are two kinds; the first is called Symphy∣sis, or Agglutination, or Concreti∣on. The second is named Syssar∣cosis, Colligation, or Concarnation. Symphysis is the Ʋnition of parts

disjoyned, no middle substance con∣carring.

This kind of Union is said by Chirurgeons to be performed by the first Intention. And if the team of the first Intention or Scope were not so to be taken, that would be absolutely false, which Hippocrat. 6. Aphorism. 19. af∣firms, that the Praeputium or Fore∣skin being cut asunder, doth not admit Unition. But it is not to be doubted, but that it will admit Consolidation by a fleshy substance ••••iting the parts disjoyned: tho this cannot be done by meer Ag∣glutination. And whereas Galen, 90. Art. Medic. avers Union in the instrumental parts to be im∣possible; to make this good which he affirms, we must observe one thing, that in this place an instru∣mental part is not taken in its amplest signification, by which it comprehends all parts that are mi∣nisterial to other parts: and so Veins and Arteries are instrumen∣tal parts; because they serve the the Heart for distribution of Blood and Spirits for the maintenance and good of the Body. But an in∣strumentary part is here taken as it is opposite to a simple part: for all the parts of the Body are either simple, as the Flesh, Veins, Fibres, &c. or compound or in∣strumental, as a Finger; and so instrumental parts taken in this signification are not united by Sym∣physis, they being wounded; but by Syssercosis, that is, not after the first, but second Intention. And so Galen in 91. cap. following ex∣plains himself: where talking of a Wound in a Bone, he says, But if a Bone suffer Solution of Ʋnity, it cannot be united, as I said: And he addeth this Clause, Yet may be united by the second Scope. He means by the growing of a fleshy substance between the parts of the Bone severed.

But you may demand of me, what parts admit Unition by Sym∣physis, or the first Intention?

I answer, that the fleshy parts disjoyned admit this sort of Conso∣lidation in all the Periods of Life, and the Spermatick Parts before the seventh year be expired, a Bone being excepted: but they are only united by the second In∣tention after the seventh year ex∣pired.

The second kind of Unition of parts severed by a Wound is called by Galen de comp. Med. secund. loc. cap. de plaga, Syssarcosis: and it is nothing else but the Ʋnion of parts disjoyned, by a middle sub∣stance. Now this Substance is sometimes like the parts which it unites, as in Wounds in fleshy parts: or it resembles not the part which it unites, as in Wounds of the spermatick parts after the se∣venth year.

Having delivered unto you the two kinds of the Union or Con∣solidation of parts separated by a Wound, now I come to the Causes of Unition or Consolidation of the parts separated. These Causes are either efficient Causes, or instru∣mental. The efficient Causes are two, to wit, Nature, and the Chi∣rurgeon. Nature out of doubt is the chief efficient Cause; for she ever labouring to preserve her self, sends unto the parts of the Body so much of the natural Balsam of it as is sufficient to unite the parts

disjoyned. If you would know what I mean by the term of the natural Balsam, I mean the Radi∣cal and Alimentary Moisture, the seat of the natural heat, by which two every individuum or singu∣lar person is maintained, and sub∣sists.

Now there are four things which may hinder Nature from effect∣ing of the Union of parts disjoyn∣ed: The first is an evil Conforma∣tion; as when the brims of a Wound are not proportionally and handsomly united and set together. The second is the continuance of this ill Conformation. The third is an unnatural Body remaining in the Wound: this unnatural Bo∣dy is either unnatural by Event, as a shiver of a Bone separated from the whole, or by its own Na∣ture; as when a piece of the Wea∣pon which wounded doth stick in the Wound. The fourth is the Distemperature of the wounded part: for if it be either too hot, or too cold, the Distemperature must be removed, and the natu∣ral Temperature restored, before Unition can be expected or pro∣cured.

The second efficient Cause of U∣nition of parts severed by a Wound, I affirmed to be the Chi∣rurgeon: he is the Minister, not the Lord of Nature, and is only to further her designs, and to la∣bour to remove the Lets and Im∣pediments which may hinder her from attaining her purpose, which is the Restitution of the parts dis∣joyned to their natural Union. The Chirurgeon then is to perform some Duties. Now these Duties are ei∣ther common to both kinds of U∣nition, to wit, Symphysis and Sys∣sarcosis, or they are proper to each. The common Duties are in num∣ber seven, First, the staying of Blood. Second, the removing of strange Bodies from the Wound. Third, provision that no such Bo∣dies fall into the Wound. Fourth, that he maintain the natural Tem∣perature of the part. Fifth, that ••e restore it, if it be lost. Sixth, the consideration of the Quittour and Excrements, which flow from the Wound. Seventh, is the removing of general Acci∣dents.

In the staying of Blood the Chi∣rurgeon is to set two things before his Eyes: The first is, how much Blood he is to suffer to flow be∣fore he stay it, if the wounded person must lose any Blood? The second is, by what means the Blood is to be stayed?

As for the quantity of Blood which is to be suffered to flow; you may suffer it to flow plenti∣fully, if the party be of a sanguine constitution, have a sleshy habit of the Body, if the Veins be large, and if the Season be hot; for this hinders Inflammation to ensue. If you find Indications contrary to these, then it must flow but sparingly; for it is the Treasure of Life.

The means of staying of the Blood are in number eight.

The first is, the application of Pledgets, or Dosils of Lint or ••••ow mo••stned either in the Whites of Eggs beaten, or in Vinegar and Water, taking in tender Bodies one part of Vinegar, and three of Water; but in hard Bodies you

may take one part of Vinegar, and two only of Water. This mix∣ture is called Posca: it must be applied warm; for cold Applica∣tions are hurtful to Wounds. Ap∣ply not dry Lint, or Two dry, to a Wound bleeding in any way; for they cleave so firmly to the brims of the wounded parts, that they procure often a new flux of ••ood, when they are removed: see∣ing they must with some force be remored: Unless Fomentation with some moistning and malaxing ••••••or be used, as with Milk or ••••tter, and Beer warmed: which ••e not to be used in Wounds in ••e fleshy parts.

The second is the Deligation of the Vessel, which sends forth ••ood, whether it be a Vein or Artery: This is to be used when geat Vessels are wounded. Am∣••••se Parey lib. 11. c. 20. would ••••••e this mean to be used after the Amputation of a Member, 〈◊〉〈◊〉 you may read: but in my ••••dgment his practice is but a ••••blesome and dangerous toy: a be shall find, who shall go to ••de trial of it. In the Deligation 〈◊〉〈◊〉 a Vessel, two things are to be ••••fidered.

The first is, that if a Nerve ac∣••••pany the Vessel, which sends ••uth Blood, (as you may see in the 〈◊〉〈◊〉 Artery, which hath the ••••••rent Nerve annexed to it,) 〈◊〉〈◊〉 are with your Nails to sepa∣••••e the Nerve from the Vessel; 〈◊〉〈◊〉 the part into which the ••e••e is inserted shall be deprived 〈◊〉〈◊〉 ••••••ing, and feeling; and ex∣••••••dnary pain will be caused.

The second thing to be consi∣dered, in the deligation of a Vessel is, that the binding be not too strait, because so the Vessel shall be cut asunder too soon, and so a new fluxion shall be pro∣cured.

The Thread, wherewith the Vessel is bound, must be either of strong Silk or Steel-hemp, as they term it, such is sealing Thread: For these are not so subject to pu∣trefaction, and so there is less fear of a new Hemorrhage, which would prove more dangerous than the first.

The third mean to stay bleed∣ing, is the application of Sarco∣tical, or Incarnative Medicaments. Such is that which Galen prescribes, 5. Method. 4. of Aloes, Frankin∣cense, the Down of a Hare, and the White of an Egg, all being brought to the consistence of Hony. In tender Bodies, take one part of Frankincense, and two of Aloes: In hard Bodies, one part of Aloes, and two of Frankincense. In those, who have a mean habit of Body, use equal parts of both. Olibanum in guttis is better than Frankin∣cense. Apply this Medicament up∣on Pledgets or Dosils of Lint or Two. The manner of dressing is this. Couch the Vessel with the Finger, then cleanse the Wound from the clotted Blood, and all moisture, with a piece of Sponge wet in red Wine, or any astringent Decoction. Afterwards besprin∣kle the parts of the Wound about your Finger, with the Powder of Aloe and Frankincense. Then ap∣ply a Pledget or a Dosil armed with the forenamed Medicament, which presently press down with

your Finger. Last of all, keeping down the Applications either with your Finger, or with a Probe, fill up the Wound with Pledgets or Dosils armed. This being done, nothing remains, but to apply a double Cloth moistned in some astringent Liquor, and wrung, to the wounded part, and to roul it up; begin to roul below the Wound; when you are come to the Wound, compass it with three or four Circumvolutions: Then ascend and roul the part above the Wound, to press the Blood out of the Vessel, and so the flux of Blood will be stayed. You are not to open the Wound afterward, but either upon the third or fourth day. Then all the Pledgets or Dosils, except the last, which im∣mediately cleaves to the Vessel, are to be taken away, and new ones to be applied; the wounded parts having been besprinkled with more of the Powder. Thus you are to dress the Wound every o∣ther day, until the part be incar∣nate, and no fear be left of any more bleeding.

The fourth way to stay bleed∣ing, is the injection of astringent Medicaments; if we cannot come to reach to the Vessel with the Finger, by reason of the depth of the Wound, such are Bole Arme∣nick, terra sigillata, marking stone, Hypocystis, sanguis Draconis, new Galls, Juice of Sloes, Plantain, Comfrey, Knotgrass, Milfoil, Horse∣tail, and Leeks; of these you may frame such Compositions as this is: ℞ Succi consol. Major. Poygon. Equiseti an. ℥ss. Succi fol. porri ℥j. Bol. Oriental. ʒj. Sanguin. Dracon. ℥ss. Misc. Such Medica∣ments are powerful, when the Menstrual Courses in Women flow immoderately.

The fifth way to stay bleeding is in the tranverse section and cut∣ting asunder of a great Vessel, which pours out the Blood. When∣soever a horrible essusion of Blood follows after a Wound, you may gather that the Vessel is not cut asunder tranverse, unless there be an enormous separation of the parts wounded, not differing much from dismembring: for if the Ves∣sel be cut tranverse wholly asund•••• by a sharp Weapon, that part o•• it which is next to the radication of it, shrinks up towards its be∣ginning, and is covered with th•• flesh of the adjacent parts. If suc•• a case be presented to you, follo•• Gal. his counsel, who 5 Meth. •• advises, that you lift up the Vess•• from the subjacent parts with 〈◊〉〈◊〉 silver Hook, and so divide it being separated; and that afterward yo•• twist the upper part of the Vesse•• which is easily done by laying ho•• of that part of the Vessel which without the Hook. That kind 〈◊〉〈◊〉 silver Hook which is used in Anat••∣mical dissections, is sittest: for th•• wreathing of the Mouth of th•• Vessel hinders the effluxion 〈◊〉〈◊〉 Blood.

The sixth way to stay Bleedi•• in a Wound, is to cause an Esch•• Now this may be done either 〈◊〉〈◊〉 an actual Cautery, or by an 〈◊〉〈◊〉 charotical Medicament: But 〈◊〉〈◊〉 ought not, but upon great nec••∣sity, to have recourse to Usti•••• First, because it is horrible to t•• sight and apprehension; for it do•• in a manner exanimate cowar•• persons. Secondly, because the be••

fit of it is uncertain: for often∣times after that the Crust or Es∣char is fallen, a new Hemorrhage ••••sues. If you be driven to use the actual Cautery, then you are to observe two things in the Acti∣on: The first is, that you cleanse the Wound from closted Blood, that the Vessel may plainly ap∣pear, otherwise you having burned only the coagulate Blood, you shall think the burnt Blood to be a Crust caused in the Vessel, which is not so; and so the next day it being ••••ffolved, will give way to a new f••••••ion. The second is, that you apply the Actual no more than ••••ce, or twice at the most: for by the first impression of the Cautery, the Vessel shrinks together; but by the second it is wrinkled, if you apply the actual Cautery a third time, it is turned into a Coal, which being dissolved by the ••••istore of the Blood in the Vessel, will fall away, and so ••••ke way for a new fluxion of ••••ood.

The Medicaments which stay ••••eeding by causing of an Eschar, ••ethese, Vitriol, Alume, Ae••yptia∣•••• sharpened with calcined Vi∣••••••, Oyl of Vitriol, and Oyl of S••phur, Aqua Fortis, and Aqua 〈◊〉〈◊〉, the Trochises of Minium ••••••bed by Vigo. But a Medica∣tant made of Umber, an Earth, which the Painters use, and Calx 〈◊〉〈◊〉, exceeds all these: for it c••••ses little pain, and mighti∣ly closes the Mouths of the Ves∣sels.

About twenty years ago return∣••••g from the Bath in Sommerset∣scare to the Howlt five Miles from Chester, where then I remained, having lodged in Newport in Shrop∣shire by the way, I was called by the Lord Gerrard to Gerrards Bram∣ley, to take a view of his Taylor, who had fractured both the Fo∣cils of the Leg, a little below the Knee, about the breadth of a palm, When I beheld a Fracture with a Wound, and an extenuati∣on of Body (for the Accident fell out ten Weeks before) neither were the Bones united; and be∣sides, there was a great Tumor in the Knee; I pronounced a lingring death to the party, unless he were out of hand dismembred above the Knee. Being intreated by the sick party and the Earl, to perform this Operation, I yielded unto their request; but having by me neither Instrument nor Me∣dicaments, thus I supplied the de∣fect of both: I made a Medica∣ment of Umber and unslaked Lime, taking equal parts of both, which I found there, the House then being in reparation; I used a Joyners Whip-saw newly touched: And in the presence of two Chi∣rurgeons, Mr. Cole, who dwelt in L••chfield, and Mr. Heywood, who dwelt in Newport, I dismembred the Lord's Taylor, to whom the Lord gave ten pounds a year during his life time; who lived many years afterward. When I dressed the Wound the fourth day, I found the Mouths of all the Vessels shut by incarnation, so powerful was the restrictive Medicament, made of equal quantities of Umber and unslaked Lime, rubbed to a fine Powder, and reduced to the form of a Liniment by the addition of the Whites of Eggs beaten, and the Down of an Hare. Fallopius in

his Book of Wounds hath an in∣genious device, which is this. He will have you to take a Reed, which in bigness is answerable to the capacity of the Wound. The one end being stopped with a Cork, he will have you to fill it with German or Hungarian Vi∣triol melted; when the Vi∣triol is cold, it is to be thrust in one end an inch without the Reed, and to be kept to the Vessel for the space of an hour; in which space of time the Mouth of the Vessel will be shut firmly.

Seventhly, a Flux of Blood is stayed by opening of a Vein in the opposite side, tho much Blood hath been lost; but the Blood must be drawn leisurely; Besides this, the extremities of the Body must be bound with reasonable strait Ligatures, where it shall seem best to the skilful Chirurgeon.

The eighth way to stay Blood, is to cool tho whole Body: for so the Blood is congealed, and made unapt to flow: This is performed two manner of ways: First, in letting down the wound∣ed party, laid in a Sheet, into a Bath of extreme cold Water, to procure a Lipothymy or Fainting; and by this the Spirits return from the extremities of the Bo∣dy to the Center. Secondly, this is performed by Narcotical Medicaments: Receive this one as a Pattern: ℞ Diascord. ℈ iij. Philon. Persici ʒ ss. Syrup. Papav. albi ℥ j. Aq. Papav. errat. aut spermat. ranar. ℥ iij. Mise. ut si••t P. sumenda frigida: After the Patient hath taken the Potion, let him be kept quiet, and let him compose himself for sleep. Al∣though this Dose of Narcoties may seem too large, yet it may be given again after twelve hours are expired, if need shall require: These two last practices are excel∣lent in immoderate Hemorrhages at the Nose.