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. V.

Of the fifth and sixth Duties belonging to a Chirur∣geon in curing a Wound.

IN the former Chapter I shewed you as briefly and plainly as I could, how the natural Tempera∣ture of a wounded part is to be preserved by the right ordering of those things which are called Non naturales, or not natural. Now I am to shew you how this same is to be effected by the application of local Medicaments: for in Plethorick or Cacochymical Bodies, all means be∣ing used according to Art, will sometimes, but with difficulty pre∣vail.

Seeing, as I shewed you, that the natural Temperature of the part is nothing else but the natu∣ral siceitie or driness of it: It is out of all controversie, that the Medicaments which are to be ap∣plied to wounded parts, ought to be siccantia or drying.

But seeing there are sundry de∣grees of drying Medicaments, ••on may demand of me, in what de∣gree of driness those Medicaments ought to be, which are to be ap∣plied to wounded parts?

I answer, that both the Tem∣perature of the whole Body, and of the part affected, will declare this unto you. One thing is to be no∣ted, that the Medicament which is to be applied to a wounded part, ought ever to be somewhat driet than the part it self.

As for example, if the Cheek of a Boy or Girl be wounded, you are to apply Medicaments which are drie in the first degree, at St. John's-wort, Avens, Chamae∣mil, Melilot, Saffron, Barley and Bean-meal: But if a Boy be wound∣ed in a Joint, or Nerve, you are to apply such things as are dry in the Second degree. If these things happen to an aged person, or a strong clown; then you are to ap∣ply such Topicks as are drie in the Third degree. Wherefore in seft parts wounded, as in the bellies of Muscles, and fleshy parts, a Medi∣cament is to be applied, which is of the strongest in the First degree. In parts which are hard, as in the Tendons, or Cartilages wounded, you are to apply to the parts wound∣ed such Medicaments as are strong∣est drying in the Third degree. But to parts wounded, which are of a mean Temperature, neither too soft nor too hard, you are to ap∣ply

for Medicaments the strongest Deficcatives in the Second degree.

From what has been said you may gather, that neither Spring-wa∣ter nor Oil, are fit to be applied to wounds: because both do moisten and relax too much. Besides this, if cold Spring-water be applied, it may procure a Gangrene by too much refrigerating the part, and quenching the natural heat. Let me warn you of one thing, that these desiccative Medicaments must have a moderate astriction: for so the Blood being ingrossed, more shall fot flow to the part than is requi∣site for the nutrition of it. See∣ing I have made mention of such simples as are fit to be ap∣plied to Wounds, to procure their unition, you will expect (no doubt) Thrief enumeration of such as are accounted the most effectual. I kill only name them, leaying their description and other effects, to be gathered out of the Monu∣ments of such as have published Herbals, and have discoursed of Animals or living Creatures, and Minerals, from whence these means are fetched.

If you are desirous to know the nature of Plants, have recourse a∣mongst the Ancients to Dioscori∣des, who was a stipendiary Soldier under Cleopatra Queen of Aegypt, who was overcome by Augustus Caesar in Fight by Sea at Actium the Promontory, about 42 years before the birth of Christ. As concerning Minerals, Fallopius hath left a Treatise of them, who hath delivered so much of them as is re∣quisite for a Chirurgeon to know: If you have a mind to know what ••••fiety of living Creatures there be, peruse the Monuments of Conradus Gesnerus, Ʋlysses Aldrovandus, and Rondeletius, who have written of these Subjects. The Simples then which are most effectual for the consolidation of Wounds, are de∣duced either from Vegetables, Animals, or Minerals. As for those which are taken from Vegetables, I commend unto you these; St. John's wort, St. Peter's wort, Betonie, Agrimony, Birthwort, Vervein, both sorts of Avens, Pome∣granate-flowers, Horse-tail, Plan∣tain, Knot-grass, Milfoil, Lunaria the greater and lesser, Shepherds∣purse, Perwincle, Larks-heel, both the Centauries (but the greater is more effectual) Dittanie, Com∣frey, Ladies-mantle, Self-heal, Clowns All-heal, Serpentaria, Ad∣ders-tongue, Loose-strife, Hore∣hound, Myrtil, Red Rose, Myrrhe, Mastick, Elemi, Olibanum, Frank∣incense, Solomon's Seal, Turpen∣tine, Pitch, Rosin, Willow, Rue, Sarcocol, Borax, Ladies-Torch, Birdlime, wild bastard Saffron, Carduus benedictus, and Tobacco. Of these Simples taking the Juices and the Herbs stamped, you may make Balsams; and if you add Swines-grease, Wax, Rosin, and Gummt Elemi, you may make Unguents effectual for the cure of Wounds.

Living creatures put to their helping hands: of them you have Mummia, Earth-worms, Snails, the fat of a Horse, Sheeps Suet, Swines Grease, Deers Suet, Goats Grease, the extract of Mans Blood, the Spiders web, Bones burned to white ashes, and Harts-horns cal∣cined; if they be brought to an impalpable Powder, being grownd

upon a Painters stone, and made up into the form of Trochisces, with the distill'd water of Snails, and then being beat to powder, and mingled with Ʋnguentum Basili∣cum, or aureum, they exceedingly further the curing Wounds of the Joints, Nerves, and Tendons.

The Minerals also are no nig∣gards in this case. The Litharges present themselves first, without which hardly can any Emplaster be brought to a laudable consist∣ence. That which is called Li∣tharge of Gold, affords a brighter colour to Emplasters, than that of Silver: yet the effect is all one. Copper affords Aes ustum, Squam∣ma aeris, and Aes viride, all very useful in the practice of Chirurge∣ry. Jupiter or Tin, yields his flow∣ers by sublimation, or if he be dis∣solved in a convenient Liquor, Cry∣stals: which being dulcified and brought to Powder, and mingled in a due proportion with conveni∣ent Unguents or Emplasters, fur∣ther exceedingly the healing of Wounds and Ulcers. Mars or Iron affords unto us his Crocus, as 'tis termed: How powerful it is not only to hasten Consolidation of solution of Unity; but in loos∣nesses, Gonorrhaeas and other diseases also, there is none ignorant, who hath had but a reasonable practice in Physick or Chirurgery. What shall I speak of Minium, both the Corals, Tutia, Calaminaris, and the Load-stone. By the enume∣ration of these few means taken from Vegetables, Animals, and Minerals, for the curing of Wounds, you may perceive how bountiful Nature is to Mankind in supplying his wants. O that he were not wanting or deficient to himself▪ If we would take pains only to prepare those things, whereof Na∣ture hath left us no small store, and judiciously according to the prescript of Art apply them, we should find in our practice a bet∣ter success than sundry times falls out: Neither should we have need to blame the irregularity of Pati∣ents, and the ill correspondence of those things, which are called Non naturales, or not natural. Whoso∣ever thinks that he may without any stop or stay, go through the curing of all wounded persons, in what part soever the Wound is in∣flicted, with the ordinary Un∣guents, carried about in Salvato∣ries, he deceives himself.

These for the present use must be in a readiness; but if he find these after application not to an∣swer his expectation, he must have recourse to others. Which Medi∣cantents are sittest, the collation of the part wounded, and the To∣picks will shew, as I have told you before.

Having delivered unto you, how the temperature of the part is to be preserved by the right order∣ing of those things, which are called Non naturales, or not natu∣ral, as Air, Meat, and Drink, Eva∣cuation and Retention, Sleeping and Watching, &c. As also by the application of fit Topicks to the part, you may require according to my promise, how the natural temperature, if it be altered, may be reduced to its own tenor again? Let me tell you, that by the same means, it is to be reduced, by the which it is preserved. Only this is to be observed, that the means

which cure, must be more forcible, and more intended in their quali∣ties, than those are, which are ap∣plied to maintain the natural Temperature.

As for example, if a wound prove very moist, and send out much Quittour, you must labour strongly to drie the habit of the Body, by Bleeding, Purging, a slender Diet, Watching, and such like, and by applying to the wounded part Medicaments, which strongly dry, and are endued with a certain astriction. If other elementary qualities, as heat, cold, driness appear, they are to be re∣moved by their contraries, but intended in their qualities above that degree which was sufficient to maintain the natural Tempe∣tature of the part wounded.

Now the sixth Duty, which I affirmed to be required of the Phy∣sician or Chirurgeon, when he is called to cure a wounded person, was the observation of the excre∣ments, which flow from the wound, and their true and natural causes: I will deliver first unto you the diversity of Excrements or Quit∣tour, which a wounded part sends out, and then I will shew unto you the causes of them.

The Excrements which flow out of a Wound, are in number three; liber, Sordes, Pus: Ichor is a thin Excrement. The cause of it is In∣coction. Of it there are two kinds: for either it is an Excrement, issuing from the Veins themselves or else it proceeds from the wound∣ed part: If it issue from the Veins, then it is a waterish and thin Hu∣midity, flowing from the capillary Veins not altered, and without my noisome smell, by its colour shewing which of the four Hu∣mours has dominion in the mass of Blood. Wherefore if the Blood be very pure, it has a certain bright redness representing Water, where∣in flesh has been washed. If yel∣low Choler be predominant, then the Ichor is of a bright yellowish colour: If Phlegm abound, then the Ichor is whitish: if Melancho∣ly surpass, then the Ichor or thin Humidity is of a darkish swarth colour. If this thin Humidity spring from the part wounded, be∣cause it is altered and corrupted by the part which sends it out, it has an unpleasant smell, being an Excrement of the part. As the first kind of Ichor is called serum Sanguinis, the waterishness of the Blood, which is mingled with the Blood, that so being made more fluxible, it may the more easily be distributed to the habit of the Body, to nourish it; so the Ichor which is an Excrement of the wounded part, is called Sanies and Virus, and according to the degree of the corruption of the part, it is more or less stinking. If it flow from a part possessed with a Cancer, it is wonderful ma∣lign and stinking: If it issue out of a part siderate or mortified by reason of a Sphacelus, it is cada∣verous. By the exhalation which is breathed out of the pores of the Skin, raised from the serum San∣guinis by the natural heat, Dogs find out their Masters, and will constantly hunt after that game, which they are first set about: This be wrays the complexion of the Individuum; but Sanies and Virus shew the corruption of the part.

The Second kind of Excrement is called Sordes: This is a compact and viscous Excrement, so cleaving to the wounded parts, that it will not be removed without the use of a firm instrument: for lint upon a probe will not bring it away.

Of this thickness three causes may be assigned: the First is the drie constitution, both of the whole Body, and the wounded part also: the Second cause may be the error of the Chirurgeon, who hath applied too drying Me∣dicaments to the affected part: the Third cause may be the cold Air, which having been let into the Wound, by the carelesness of the dresser of it, hath condensed, and thickned the Pus.

The Third Excrement which wounded parts fend forth is called Pus. This is an Excrement white, smooth and equal or uniform, without any grumous or knotty substance, having no ill sinell, not so liquid as Sanies, nor so thick and viscous as Sordes. See Hippo∣crates lib. de Praedictionibus. Galen. 2. ad Glaucon. 8. & 5. Method. 10.

Now to come to the causes of the Excrements which are sent forth from Wounds, which was the Second point propounded con∣cerning these Excrements, note these Aphorisms. First, the cau∣ses of these three Excrements are either the efficient or material causes. Secondly, the efficient causes are two, the natural and unnatural heat. Thirdly, the na∣tural heat is the cause of con∣coction, whereby a laudable Put is engendred: but the unnatural heat working upon Humidity, causes putrefaction, and an evil smell. Fourthly, the material causes are two, to wit, contused Flesh, which by digestives must be turned to Quittour, and a Hu∣mor, which most commonly sym∣bolizes with the complexion of the party wounded, whether it be na∣tural or accidental. If then the natural constitution of the party wounded be good, the Pus is lauda∣ble: but if by reason of errors committed in the use of those things which are called Not Natural, in the course of life a sickly Com∣plexion be acquired: As for exam∣ple, if one become Hydropick, Pocky, or Leprous; then the Wound is like to cast out no good Excrements; but either Sanies, Virus, or Sordes.