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. IX.

How a Wound is to be cured after the Second Intention.

IN the former two Chapters, I have shewed you, how Wounds are to be handled, which are to be cured by Agglutination, or the First Intention: Now order of Do∣ctrine admonishes me to go on, and to teach in like manner, how Wounds are to be dressed, which are to be united by the Second In∣tention, called by the Grecians 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which may be ex∣pressed by this word Concarnation. It is not amiss sometimes to coin vocables of Art to express the matter which is in hand.

Now to cure a Wound after the Second Intention, three curative Indications do offer themselves. The First is, to procure the filling of the Wound by new flesh. The Second is, to abate the Flesh, if it become superfluous: And the Third is, to skin the part wound∣ed, when sufficient flesh is grown.

As for the First Indication, which is the filling of the gaping of a Wound with flesh; of it you are to consider the Motives, which in∣duce you to go about this manner of unition, and the means by which it is brought to pass. In five cases you are to go about the con∣solidation of Wounds by the Se∣cond Intention.

1. The First is, If there be loss of substance, whether it be flesh, or any other substance, as Bone, Cartilage, or Ligament. Neither is this a general rule: for if the parts be loose and flaggy, they may admit unition after the First Intention: as we may per∣ceive in the curing of the Hare-lip, and Wounds of the fore part of the Neck.

Secondly, you are to attempt this kind of Cure, where you can∣not conveniently bring the lips of the Wound together by stitching or rolling: as in great wounds of the Joints, and when the Liga∣ments are cut asunder, as the great Tendon, which is called Nerv••s Hectorius, and is inferted into Os calcis.

Thirdly, this is to be done when we look upon the scaling of a Bone, or the scparation of the piece of a Ligament or Carti∣lage.

Fourthly, we are to take this course, when otherwise a great and dangerous Flux of Blood cannot be avoided, as in wounds of the Neck, where the internal jugular Veins and soporal Arteries are di∣vided.

Fifthly, we are to address our

selves to this manner of Unition, when great store of Quittour is like to flow to the wounded part; and this falls out in four cases.

The First is, when we cannot hinder the influxion of Humors by rolling, as in wounds of the Arm∣pits and Joints.

Secondly, in cacochymical Bo∣dies.

Thirdly, in persons who have a scirrhosity in the Liver and Spleen.

Fourthly, if the wounded party have a contagious Disease, as the Pox. In these cases we are rather to attempt Unition by the Second, than First Intention, especially if we fear no deformity by reason of a scarr: As it happens in wounds of all the parts of the Body, if you except the Face.

The causes which ought to in∣duce you not to attempt Uni∣tion after the first Intention, when there is loss of substance, are these: First, Pain and Inflammation will ensue, by reason of the violent bringing of the lips of the Wound together: Secondly, there will re∣main a great deformity in the part wounded, after that is cured. So much then concerning the oc∣casions, which are to admonish a Chirurgeon, when he is about to cure a Wound, whether he ought to perform this by the Second In∣tention. Now I am to shew you, what means are most apt to ge∣nerate new flesh: These means are in number three: the principal ef∣ficient cause: The causes adju∣vant: The material cause.

The principal efficient cause is the natural Temperature of the whole Body, and of the parts af∣fected also, which ought to incline to driness: If it be present it is to be maintained; but if you find it not, you are to procure it by Phle∣botomy, Purgation, and the right ordering of those things which are called not Natural. But seeing I have amply discoursed of these points, when I set down the methodical cure of Ulcers, I will remit you to that Treatise, and will not trouble you with a fruitless repetition of the same things.

The adjuvant causes are two, to wit, the Chirurgeon, and conveni∣ent Medicaments. As for the Chirurgeon, he ought to dress the party with as much ease as may be. Secondly, he ought to have a care that the applications be ap∣plied to the Wound very neatly: for by want of this, a slubberer and sloven is discerned from a cleanly workman. This the Chi∣rurgeon can hardly perform, if he be not cunning in fitting of Lini∣ments, upon which the Medica∣ments are to be laid, which are to be applied to the wounded part.

Now the Liniments are of three sorts; Turundae, Tentae, and Sple∣nia. Turundae or dosils represent in Olive in Figure Tentae or Tents are long, and somewhat small. Splenia or Pledgets ought to represent the Spleen of living Creatures, from whence they have their denomination.

The Pledgets, which are appli∣ed, ought first to be somewhat larger than the Wound: Secondly, they ought to be armed with Me∣dicaments

which have a moderate tenacity or clamminess, and which ought to have a faculty to stay an Inflammation, to asswage pain, and to repell Humors, which might flow to the part. Such are Dia∣palma dissolved in Oil of Myrtles, Quinces or Roses, Ʋnguentum de Tutia magistrale, Ʋnguentum de Minio. If for the present you be destitute of these compositions, you may use the red astringent Wine, or Tanners Woose, or Smiths wa∣ter clarified, mingled with one of the Oils befor-named: and then it is good to moisten the Rollers in this Medicament. These Lini∣ments are to be made of Lint or Tow; the Tow ought to be with∣out shivers: It dries more than Lint, if it be of Hemp.

The material cause of the gene∣ration of new flesh is laudable Blood, answering the temperature of the part wounded. So if a sper∣matick part be wounded, the Blood ought to be somewhat cold, thick, and dry, which is to gen∣der a mean to unite the parts se∣vered. But if a fleshy part be wounded, the Blood is to be hot∣ter and more humid. Having set down the part of the Chirurgeon, whom I affirmed to be the first adjuvant cause, in producing new flesh, now am I to to acquaint you with those Medicaments which are termed by Artists Sarcotical, or apt to engender new and tender flesh.

All Sarcotical Medicaments, as they ought to be of a dry∣ing faculty, so they ought to be void of a sharp and biting quality. The differences of dry∣ing Medicaments are either ta∣ken from the degrees of their dry∣ing quality, or from the diver∣sities of their kinds. From the degrees of drying, these three dif∣ferences are drawn: For either they are of a mean operation, and these will serve when the Quittour is Album, Leve, and Aequate, white, smooth, and of an equal substance, one part of it not being thin, and the other grumous. Or they are somewhat stronger, as when the matter which flows from the Wound is thin and ichorous; for then stronger desiccatives are re∣quired to incrassate or thicken this thin matter. The Third degree comprehends the strongest desic∣catives: As when Sordes or a Sluch appears in the Wound, these Me∣dicaments are called Medicamen∣ta detergentia the Chirurgeon's Mundificatives; and those Medica∣ments according to Gal. 1 meth. 12. ought to be of a drying and penetrating faculty; For those things which are united in the bo∣dies of living Creatures, are uni∣ted by moisture: wherefore dri∣ness spending the Humidity, they are again separated; as we may for an example see in a Table glued together, if it be too much dried by the fire.

Now there be two kinds of these drying Medicaments, for either they are simple or compound. The simple drying Medicaments, ac∣cording to Gal. 3. Meth. 3. are of three sorts.

The First, dry in the first De∣gree, for those who have had but a tender and soft constitution of Body, as are Children and young Gentlewomen. Children are esteem∣ed to be of this constitution, un∣till

they attain the Fourteenth year of their age.

The Second sort is of such as are dry in the end of the First degree, and the beginning of the Second.

The Third sort is of such as are drie in the end of the Second de∣gree: and as these befit bodies of very hard and firm constitution of Body, such as Sailers, and Artifi∣cers of hard Trades have, as Smiths and Felt-makers: So the Second sort of Desiccatives are fittest for such as are of a mean habit of Bo∣dy, neither too loose nor too hard, as Gentlemen in their consisting age.

Unto the First degree of De∣siccatives these may be referred: Thus, Farina Hordei, & Fabarum, ut & Zeae utriusque, Mastiche, Oliba∣num in guttis.

To these of the Second degree you may refer all sorts of Resines, as the yellow, the black Ship-Pitch, and Elemi, clarified Honey, Fari∣na Cicerum, & metallica quaedam; ut Mintum, Lithargarus, Phanbum vstum; sed omnia lota.

To the Third degree you may refer: Farina Orobi amari, Lupi∣norum, Iris, Aristolochia utraque, Myrrha, Sarcocolla, Lapis calami∣naris, Tutia, Aesustum.

Thus those Simples which are drying in the First degree, serve for those who are of a soft habit of body: Those which are in the Se∣cond degree, serve for those who are of a mean habit: but those which are of the Third degree, are fit for those who are of a chur∣lish habit of Body, as I have no∣ted. Now what I have spoken of the habit of the whole body, I would have you to apply it to the habit of every several part: So the fleshy parts are softest, althô there be degrees: amongst them: The Lips are softest of all: The Sinews and Membranes are of a mean hardness, but the Cartila∣ges and Bones are hardest of all.

Of these simple Sarcotical Me∣dicaments, you may frame unto your selves sundry compositions, as occasion shall move you: Only I will set down one for a pattern, and it is this: ℞ Balsam. Hyperic. simpl. lb. ss. Resin. ℥ vj. Cerae ℥ iv. Picis navalis. ℥ iij. gum. Ele∣mi. ℥ ij. Vernic. & sevi ovil. an. ℥ iij. Terebin. Cypr. ℥ iss. Olib. & Myrrh. pulveriz. an. ℥j. This I have termed my Basilicum Ma∣gistrale; I will not stand much up∣on the commendation of it; the ef∣fects will praise it: If variety of such compound Sarcosical Medi∣caments doth delight any one, let him have recourse unto the dis∣pensatories of sundry Men, and Nations: If he be not by them sa∣tissied, I shall think that he hath an Appetitus caninus of the Ima∣gination.

One thing is to be noted, that cathaeretick Medicaments, as Alu∣men ustum, A••s viride, and Vitri∣olum calcinatum, may become Sar∣cotics, if they be mingled in com∣positions with Sarcotics in a small quantity.

It is not enough in curing by the Second Intention to procure the growing of new flesh in Wounds; but we must be wary that it do not overgrow. If this happen, we must take order with it. The cause of superfluous flesh is too much Blood sent unto the

part. This is abated by appoint∣ing a strict Diet, and the use of Aliments, which do not feed much. Secondly, cooling and astringent Medicaments are to be applied to the sound parts adjacent to the Wound. Thirdly, we are to use hard Frictions and strait Li∣gatures to the opposite part: for by all these means the im∣moderate influence of Blood is stayed.

Now superfluous or proud Flesh is taken away three manner of ways. First, by an Instrument, as an Incision-Knife or a Rasor, Se∣condly, by rubbing it away by a rough Linnen Cloth. Thirdly, it is removed by Cathaeretical Medi∣caments: such are Alumen ustum, Vnriclum calcinatum, Mer. prae∣cititatus. If the party wounded be of a tender habit of Body. Merc. lotus will serve, being thus mingled: ℞ Ʋng. Basilic. magi∣siral. ℥ j. Merc. praecipitati loti ʒ j. exquisitè misceantur: But if he or she be of a hard and stub∣born habit, let this Medicament be made: ℞ Merc. praecipitat. non liti ʒ ij. Aluminis usti ʒ j. Super ••ar••••••r Pictorum levigentur: po∣stea. ℞ Hujus compos. ʒ j. Ʋng. Basilici magistral. ʒ vj. Optimè Misc. If you apply the aforesaid Powders unmingled with an Un∣guent they will cause an Eschar if need be. Whoever he be that has brought a Wound to that pass, that the supercrescent Flesh requires a stronger Ca∣theretical Medicament than these, he must be a novice in his Art.

The Wound being thus suffici∣ently incarnate nothing remains, but to cicatrize it. Concerning Cicatrizations these three Questi∣ons may arise. First, what manner of skinning is most laudable? Se∣condly, when we are to go about skinning? The third shall be of the causes which procure skin∣ning. To the first I answer, that the Cicatrix which in colour and conformation best represents the natural Skin, is most laudable. To the second Question I answer, that we are not to go about the skin∣ning of the Wound before the Flesh be somewhat higher than the natural Skin: for otherwise the Cicatrix will be hollow, which is unseemly. If a piece of a Bone ei∣ther be taken out or cast, we can∣not shun a hollow Cicatrix. As for the Causes;

The efficient Cause is a faculty resident in the sound Skin, adjacent to the Wound: So we see skinning to begin from the Brims of the natural Skin.

The material Cause is Flesh hardned.

The adjuvant Causes are E∣pulotical or skinning Medica∣ments.

As concerning the Medicaments, we are first to consider their fa∣culty; Secondly, to set down their kinds. As for their faculty, they ought first to dry strongly, and to reach the end of the third degree of Desiccation; because such Medi∣caments ought not only to consume the extraneous Humidity, but the natural also. Secondly, seeing they

are to stay the influxion of more Blood, which might ingender more new Flesh, they ought to be very astringent, so that it may be discerned by the Tongue and Palate. Yet they are to have no Acrimony, for then they would ••rode.

These Medicaments are of two sorts; for they are either Simple or Compound. For wounded Per∣sons of a soft Habit, these will serve; Frankincense, the bark of the Pine-tree, Lead calcined and washed, Oyster-shells burned and washed: for those who have a mean habit of Body these will serve, which are drying in the be∣ginning of the third degree; as are unripe Galls, the Flowers and Rinds of wild Pomegranates, Su∣mach, Myrtil berries, Sanguis Dra∣conis, Terra Ʋmbra, Rubrica fa∣brilis. For those who have a very hard habit of Body, use Aes ustum, Alumen ustum, Capue mortuum Vi∣trioli distillati ablutum.

The compound Epuloticks are in like manner of three degrees: For some are for tender Bodies, as Ʋnguentum de Minis, Ceratum de Minio, Ʋnguentum de Tutia: Some are for Bodies of a mean habit; these will serve for such: Diapalma, Ʋnguentum de Tutia magistral. cujus haee est composi∣tio: ℞ Ol Ros. ℥ xij. Ol Myrtin. & Ʋng. Popul. an. ℥ iij. fol. Plan∣tag. & Solan. hortens. contus. an. man. ij. evaporet lento igne humi∣ditas aquea, atque instituatur co∣latura, in qua liquescat cer. alb. Quum incipit Medicamentum fri∣gescere, insperge Litharg. auri ℥ vj. Tutiae praepar. ℥ j. Ce••uss. ℥ ij. Minii ʒ vj. Caphur. ʒ j. Omnia haec pulverizentur. Ducatur hoe Ʋnguentum per hor. 2. in morta∣rio plumbeo. For those that are of a hard habit of Body, use this Ʋn∣guentum de Tutià magistrali, add∣ing to every ounce of it, Abis usti ʒ j. or Vitrioli. ad rubed. cal∣cinati ʒss. You have in the Apo∣thecaries Shops Ʋnguentum de bolo Armen.