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.

BOOK VI.

Of separating things unnaturally united.

CHAP. I.

Of Cutting Tongue-ti'd Children.

HAving in the First Part of Chirurgery shewn, how to unite solution of Conti∣nuity; in this Se∣cond we must on the contrary teach how to separate Continu∣ity, when it is preternatural. This part of Chirurgery is called by some 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, by others 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Distinction or Separation.

The fiest preternatural Unition, that I shall treat of, is of the Tongue to the parts under it, when the Membranous Ligament or Frae∣num, which connects it, is either too short, or extended to the tip of the Tongue: Then Children are said to be Tongue-tied. But before I meddle with the separation of the Tongue from the parts un∣der it, by cutting the Praenum, I must make some just Animadver∣sion upon the temerity of some

Midwives, who always wear one of their Nails of a great length and being thus ready with an inci∣sion instrument in their hand, wherever they come to do their office, they cut the new born Child's Tongue, and unless they did this, they believe the Children could ne∣ver speak: As if Nature (O strange ignorance!) could not make a Man speak, which is to perform a proper action, designed by her to Man, without the helping hand of a silly Woman. Aquapendent says, he saw a new born Child, which was detained a pretty while, till they got the after-burthen away, and it neither cried, nor perhaps was sensible of any trouble all the while, till the Midwife cut the Fraenum with her Nail, and then indeed it cried, because of the pain. But if this were all, the matter were not great: The worst is, the Child, when this Chirurgery of the Nail has raised an Inflammation, can∣not take hold of the Nipple, nor get any Milk, and so it dies. And which is yet worse, they impute the whole cause of its Death, either to the Birth, or to its ••••ability to take hold of the Nipple, or to any thing, rather than to the true, viz. the Midwives claw. Let all Peo∣ple therefore, that value their Chil∣dren, have a care, that the Mid∣wife meddle not with cutting then Tongues. If the Ligament be such as requires cutting, it may be cut in time enough; but this rare∣ly happens. Because Nature had never designed Man to speak, had she not furnisht him with apt in∣struments. Of many thousands, that are born with this Ligament, searce one requires cutting.

But if it so happen, that the Tongue is too strait tied, the way to cut it is this; the Patient must put his Pongue out beyond his Teeth, then we must take hold of it with a Forceps (Celsus uses a Vosella.) But because we can∣not use these instruments in Chil∣dren, who either know not, or are not willing to put out their Tongue; we first make them cry, then with a thin cloth between the Thumb and fore-Finger of our left Hand we take hold of the Tongue and draw it out, then we hold it up, or turn it back, that the Fraenum may appear: and with our right hand we cut the Fraenum. We take an incision∣knife, a little turning back at the point, then we cut the Fraenum transverse twice or thrice, and the parts on each side, taking great care, that the vessels thereabout be not injured, which a Chirurge∣on that has any skill in Anatomy, will not do, because he knows the vessels under the Tongue. Then the place may be washt with a lit∣tle Claret and Diam••ron, and it will heal of it self. Several when they are well again, speak readily, if the impediment depend only on the Fraemon; but if some inward and abstanse cause concurr, the es∣sect does not follow.

Hildanus C••nt. 3. Obs. 28. says, that a Child of two years old, was brought to him to be cut under the Tongue. When he opened the Child's Mouth, and lifted up the Tongue, he found it very thick, but no nervous Ligament under it. Therefore he sent away the Child, and would not meddle with it. About a Month after, a

Mountebank came that way. The Child was carried to him. He per∣swaded the Parents, that the Tongue was tied with a strong, nervous Ligament, and he boldly maintained that, if they would but give him a sum of Money down, he would make the Child speak in a short time. He got the Money. Then the Impostor places the Child in a Womans Lap, and slashes the Tongue deep before, and on each side; as the by stand∣ers told Hildanus. But the Child, who before could go alone, in the very moment skrieked out and was contracted, so that his Knees were drawn to his Belly, and his Hands to his Breast. And because of the continued pain, and want of due administration of Medicines, the Child was extremely wasted and weakned. When Hildanus visited him, his Legs and Arms remain∣ed contracted, and if they were by force extended, they were im∣mediately drawn back again, and he could not go at all. He said he did recover a little; but does not give account what the final is∣sue of the case was. He gives an account also of his own Brother, who when he was four years old could not speak a word, and by cutting of the Fraenum was able to speak.

He says, the operation has no danger in it, if it be rightly ad∣ministred, and especial care must be had, that you cut not too deep; he lifts up the Tongue, and with the point of a pair of Sissers he snips the Ligament in two or three pla∣ces: for so it is not so apt to grow together again, as when it is cut only in one place. Then he cuts all that is nervous, so as not to touch any thing that is fleshy. If enough be not cut at first, or if it grow up again, the same opera∣tion may be performed again. when the Ligament is cut, the Nurse must dip her Finger in Ho∣ney of Roses, or common Honey, and raise the Tongue gently with it: for thereby agglutination is hindred. This operation there∣fore ought not to be committed to Midwives, who with their Nails do not only tear the Ligament, but the parts adjoyning, which occasi∣ons Pain and Inflammation; then Children cannot suck, but grow froward, pine away and dye: wherefore we ought to act pru∣dently, and this operation, thô it seem slight, ought not altogether to be neglected. And it ought espe∣cially to be consider'd, whether, when the Tongue is short, there be occasion for cutting or no: for oftentimes upon other occasions besides the Ligament under the Tongue, Children cannot form any articulate voice, even when the Tongue is not tied at all, which the preceding case con∣firms.

CHAP. II.

Of the growing together of Fingers or Toes.

THe Coalition, or growing together of the Fingers or Toes, but especially of the Fin∣gers, falls next under our conside∣ration. It is occasioned either by the error of forming Nature in the Mother's Womb, or by an Ul∣cer on the inside of two Fingers, negligently cured, or by burning.

The Cure may be performed by the Knife, or by an actual or potential Cautery. Dissection is the best way for Fingers that are joyned together by a narrow Inter∣stice, and by burning. On the con∣trary, the actual Cautery, or po∣tential Cautery, for such as are joyned by a broad skin. But espe∣cially the potential, for saint-heart∣ed Men, Women and Children, who had rather venture the worst, than undergo such terrible means.

When you use an actual Can∣tery, the part must be defended with some Cataplasm. Cimolia, or Argilla mollis is the best of all.

By the potential Cautery it is done thus. First, they boil an Hempen thread in a Lixivium of Lime and Ashes; then they take it out of the vessel, and lay it upon a Mar∣ble, wetting it with a little of the Lixivium for an hour. The thread thus prepared, must be laid both on the upper, and under-side; in the interflice of the Fingers or Toes that are to be divided. Or the thread may be fastned to a wooden ring about the Wrist, to make it keep tight to the part that should be cut, without incommo∣ding the sound parts. This is the way of cutting by a thread.

The way of separating by a knife is thus. First, one must feel with his Fingers, all along the co∣herence, especially in a natural one, whether there be any hardness, or suspicion of a Nerve or Vein, which must be avoided; afterwards, when the Section is marked with Iule length-ways, it must be made above half way towards the Fingers ends, and then the other half, viz. from the roots of the Fingers to the place where you begun before. The Knife must be long and small. The next thing is, with Liniments and Diapalma, to cicatrize the Fingers so separated.

CHAP. III.

Of Imperforation of the Hymen.

CElsus performs the cure of this by overthwart incision, in manner of the Letter X, taking great care, that the Urinary pas∣sage be not violated, which lies near above it. I shall give you Aquapendent's way, who saw and cured an imperforate Maid; and that I may be the more exact in it, I shall give it you in his own words.

In the space, says he, of so many years, i. e. of for∣ty, which I have been Professor of Physick here at Padua, I only once saw an imperforate Virgin. And no wonder the case should be so rare, since Nature is seldom wanting or mistaken in things necessary, because of the many inconveniences and hazards of life which usually thence ensue. However, this Maid, from the very day of her birth, had the Membrane called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Hymen, imperforate, which closed up the the whole Orifice of the Womb. The Alae were so little, that scarce any appeared, because they were contracted by the con∣tinuity of the Membrane, and its Tension, caused by the inter∣nal repletion: But when the Vul∣va was perforated, immediately the Alae were formed, as by the Membrane loosed on either side. So that from hence we may con∣jecture, the use of these Alae is to take upon them the defence of the pudendum muliebre, which before was otherwise guarded by the Hymen. This noble Maid was very well till she was Thir∣teen; but from that age she be∣gan to be ill, which illness was occasioned by the keeping in of her Courses, which came down then about. She felt great pains about her Loins, and about the bottom of her Belly, which were communicated also to her Hips. Which made some of her Phy∣sicians treat her as in the Gout, and for the Sciatica. Afterward her Body began to pine away, and consume, she was continual∣ly feverish, and could not sleep, she had lost her Stomach, and was at last delirous; a hard and painful Tumor arose at the bot∣tom of her Belly, in the region of the Womb, and all these Sym∣ptoms grew worse and more vi∣olent, when the time of her Menses approached, At last, when she was just at death's door, I being called, and having be∣held

her case with my Eyes, I made a simple incision upon the Membrane, whereupon, imme∣diately a great quantity of thick, viscous, aeruginous and foetid Blood issuing out, she was forth∣with well, to a miracle. But I made a simple incision length∣way of the Vulva or Scissure; lest, if I had cut Celsus his way, transverse in the form of an X, I might have hindred the form∣ing of the Alae, which results from the Lips of the Hymen be∣ing cut, loosed on either side, and retracted to the place of the Alae. And this is the Chirurge∣ry which I used with the greatest safety and success in a Maid ima∣ginable, whose Hymen was not perforate.

Hildanus also Cent. 3. Obs. 61. gives this account, how he opened the closed Orifice of the neck of the Womb.

There was, says he, brought to me a Girl half a year old, who had the Orifice of the neck of the Won •• closed up with a very thick Membrane. This Mem∣brane stuck on all sides to the Nymphe, or Carunculae cu∣ticulares, and in the upper part had a little hole, by which she made water. The Parents therefore imploring my help, the next day I set the Child on a Ta∣ble upon a Cushion, and draw∣ing back and opening her Legs, I put in a Probe, made a little crooked, and hollow on one side, at the fore-mentioned hole, and brought it forwards towards the Perinaeum to the end of the Membrane, then with a little Penknife, resting in the hollow of the Probe, I cut the Membrane, without hurting the adjacent parts, which was prevented by running the point of the Knife along the hollow of the Probe. When I had made incision on the Membrane, thô no Haemorrhage followed, yet I put in a Tent of soft Town, dipt in the white of an Egg, mixt with a little Rose∣water, and applied over it a fold∣ed cloth, wet in the same Li∣quor, to asswage Pain, and re∣pel the afflux of humors. At last I put in a broad and thick leaden Tent, armed with Ʋn∣guentum diapompholygos. And thus the Child was cured in a few days.

CHAP. IV.

Of the growing together of the Labia of the Womb.

SOmetimes a Woman, by rea∣son of the glutination of the Orifice of the Womb, may be un∣sit for Marriage, whether she be born so, or it happen afterwards, by a foul Ulcer or Wound not well healed, as it happened to a certain Man's Wife, who when he came to lye with her, found no admittance, nor could not, till a Chirurgeon had made it for him by separating the Coalition of the Labia. And no wonder, if such a part, when ul∣cerated, grow up, since the Mo∣desty of civil Women is such, that they had rather dye, than expose themselves to a Cure; but

Stultorum incurata pudor malus ulcera celat.

In this Case the Chirurgery must be adminiured in this manner. The Woman must be laid on her Back, her Legs must be brought divari∣cated to her Hips; her Arms must be brought under her Hams, and tied with convenient bandage to her Neck (as Paulus Aeg neta ad∣vises) then with a Knite crooked at the point, very sharp on the edge, but blunt on the back, and a very long handle, Section must be made at once or twice; having first marked a streight line along the middle of the Labia, direct∣ing the instrument with the fore-Finger outwardly, and with a hol∣low Probe before-mentioned, or some such instrument, inwardly. And Midwives, Nurses, and all that are about Women in Childbed, ought to take great care, that if the Woman have received any such hurt in her Travel, it be im∣mediately taken into Cure: Be∣cause Neglects herein often prove fatal, as the following instance will prove.

Hildanus, Cent. 6. Obs. 67. re∣lates, how a Woman at her full time was brought to bed of a dead Child, with much pain and diffi∣culty; and those pains most ex∣quisitely tortured her, at least six weeks after. At last, when he was called to her, he found the Orifice of the Womb quite closed up, and the parts extremely swelled. under the neck of the Bladder there was a great hole, that reach∣ed into the Bladder, at which the Urine dropt out. The cause of this so grievous an evil had been the Inflammation of the genital parts, not regarded by the igno∣rant Midwife, which was turned to

a putrid Ulcer, which had healed up more by Nature's assistance, than the Midwife's skill; but the Orifice remained shut up. He or∣dered her Clysters, Fomentations, anodyne Ointments, internal and external Medicines, whereby the pains were asswaged, the swelling abated, and her strength increased: But the mouth of the Womb could by no Art or Industry Chirurgical be opened again, so that she was ever after incapacitated for her Husband. She lived a long time after, and when he wrote this Ob∣servation, she had not her Menses the usual way; but was sometimes taken with the Gripes and a loos∣ness, and voided Blood with her Excrements.

CHAP. V.

Of the Anus imperforate.

SOmetimes Children are born with the Anus not perforate, which happens in a twofold man∣ner. Either some mark of a hole appears, or none. When it appears, the way to do it is thus. Cut cross ways at right angles, taking heed not to hurt the Sphincter Muscle, as you cut along the appearance of the hole, then put in a pipe of Lead or Silver, armed with some cicatrizing Medicament, till the part is cicatrized. In this case, thô the place of the Anus is co∣vered with a Skin, yet there is some sign of an Orifice, which feels empty, if one touch it. Al∣bucasis l. 2. c. 79. following Pau∣lus l. 6. c. 81. says, it may be per∣forated with the Midwive's Finger; but it is better to do it with an in∣strument, as I have proposed, than to commit such a business to the virulent claw of an ignorant old Woman; unless the Pellicle be so thin, that the Chirurgeon may do it with his Finger without difficul∣ty. Paulus mentions the cure of the Anus not perforate, through an Ulcer ill cured; But I cannot believe that ever such a case hap∣pened; because the Anus must be opened too often for an Ulcer ever to close it up in healing; because agglutination cannot be made in so short a time. Besides, such a mass of Humors and Excrements is always flowing thither, that it must hinder glutination. When a Child has been born with the Anus not perforate in this man∣ner, it has been cured.

For Hildanus, Cent. 1. Obs. 73. has a case of this nature. He was called to a Child, which being born with the Anus not perforate, was till the sixth day grievously tor∣mented with the Gripes, and in

great hazard of its life. For its Belly wat puft up and hard, it faint∣ed, and had cold Sweats; the Anus was covered with a hard Mem∣brane, in which there was not any sign of an Anus, besides a little li∣vid speck. He made an Incision, with an incision-knife (that the Sphincter might not be hurt) wrapt in a linen Cloth: then he put in a Speculum ani, and dilated the rest. The Child presently discharges a great deal of Excrements; where∣upon the Belly immediately fell, and the rest of the Symptoms aba∣ted. He then for several days put in a pipe of Lead, armed with some Desiccatory, as Ʋnguentum de Cerussa, de Minio, Diapom∣phologos, &c. It cicatrized, andlie did well.

When no sign of an Anus ap∣pears, Aquapendent would not meddle with it. Who says, he once saw a Woman born with∣out an Anus, that voided her Ex∣crements at her Womb, there being a hole within near the Os Vulv••e. But he would not attempt a Cure, lest, not well-knowing where the Anus lay, he might have hurt the Sphincter-Muscle, and so have cau∣sed an involuntary excretion of Or∣dure.

CHAP. VI.

Of rectification, or setting streight parts that are distorted.

MAny parts of Man's Body are of a bad conformation: Some from their birth, others af∣terward, either from a Disease, or from some external violence; as from the Rickets and other Disea∣ses, and from a hurt by a fall, blow, &c.

The parts affected are the Mu∣scles, and in them the Nerves and Tendons especially; or the Bone.

The signs of a Distortion are so manifest to the Eye and Touch, that I need not mention any; however, it is good to observe rickety and morbid Distortions, when they first arise: for then they may with the greatest ease be rectified, especially when the Par∣ty is young, and consequently the parts more flexible to a healing Hand.

As for the cure of Distortions; such as come from wounds in the Muscles and their Nerves and Ten∣dons, depend upon the right heal∣ing of those Wounds; and such as come from Fractures, or Dislo∣cations, depend upon the proper reduction of those Fractures and

Luxations: wherefore for such you must have recourse to the Do∣ctrine of Wounds, Fractures, and Luxations. But when the Distor∣tion is connate, or proceeds from the Rickets, or any inward cause, or from an outward cause, and which might have been cured, had it not been neglected; then the method of Cure is this. If the parts by continuance of time be grown hard and stiff, they must be made soft and limber by Emol∣lients, as Fomentations and Bath∣ings, ex radicibus & foliis Althaeae, Malvae, Fler. Chamaem. Melilot. sem. lini. Faenigraec. addit. Be∣tomcâ, ivâ artheti••••, florib••s pri∣mulae veris, & hujusmodi, quae ner∣vos roborant. Emollient Oils, Salves, and Plasters are likewise proper. When the hardened parts are suf∣ficiently softned, we must have re∣course to such things as strength∣en the Nerves and Nervous parts Among things that strengthen the Nerves, Succus lumbricorum, and Oleum Hildani ex floribus are ex∣cellent, and so is the water of Be∣tony, Sage, and Juniper-berries drawn without Wine. For Hil∣danus says, he observed it in him∣self as well as others, that Wine, even outwardly applied, is an ene∣my to the Nerves. When there is an Atrophy in the part, Succus lum∣bricorum is best, of which take this account. Johannes Wierus in tract. de Scorbuto takes fat Earth∣worms out of a Churchyard, these he washes first in water, then in Wine very well, he shreds them small, and puts them in a Glass covered with Paste, he bakes them in an Oven with Bread, when the Glass is cold he sets it in wa∣ter, and when the Paste grows soft, and parts from the Glass, the Worms are found dissolved into Liquor. This Liquor strained must be preserved for use, but it must be renewed every other day: for it quickly corrupts, especially in Summer time. Nicolaus de Me∣tri prepares this Liquor the same way, only he adds a little Oil Olive to the Worms. Cosmas Slotanus took these Worms, cleansed as a∣foresaid, put them in a large Re∣ceiver, and poured to them a good quantity of Oyl of Sweet Almonds and Violets, then he dissolved them into Liquor upon Embers, which after strong expression he used. This last composition seems to me the best, because so the Virtue both of the Oyl and the Worms is kept entire. The juyce of the Worms by its proper and peculiar virtue penetrates immediately, and passes to the Nerves, and all that is nervous, and therefore to the Veins and Arteries, whose coats consist of a nervous substance; and this juice strengthens, nou∣rishes, and moderately heats these parts, by removing the obstructi∣ons that are there. Besides, in this composition there is a viscous quality from the Oyls, by means whereof, as soon as the juice has penetrated, the Oyls shut the Pores, and so the innate heat is kept in, and as it were pent up, in the part affected. But before these things are used, universals, as Purging, Bleeding, &c. to cleanse the Body, must first be used. Yet when all is done, the whole stress of the Cure lies upon the right contrivance, making, and appli∣cation of Instruments. For un∣less

Instruments be rightly adapt∣ed, all will be in vain, whether E∣mollients or Corroborators. Where∣fore first of all you must get your Instruments made, and then as soon as you use your Emollients, your Instruments must be applied. Thus by the fore-mentioned To∣picks, Bandage and Splenia, may a wry Neck be reduced.

CHAP. VII.

Of the reduction of the Fingers.

HAving in the fore-going Chapter given you the ge∣neral method in curing of Di∣stortions, I thought it in the next place necessary to apply this me∣thod to particular cases, which you will find exactly done in the following case by Hildanus, Cent. 1. Obs. 83.

There was brought to me, says this excellent Author, a Child fourteen Months old. He had, when he was about half a year old, fallen with his right Hand upon burning Coals: His four Fingers and the external part of the Metacarpus were so burnt, that the ends of his Fin∣gers were drawn back to their first articulation, or roots. The Father had committed the Cure to unskilful persons, so that the Fingers, with the skin of the Metacarpus, were shrunk up in∣to the form of a Globe, and grown together. About seven Months after the Cure was made, they brought him to me. I first purged him with Manna in broth, and then I proceeded to Chi∣rurgical Topicks. Then I used the following Emollient Deco∣ction, and Unguent for several days; ℞ radic. Althaeae cum to∣to, Rad. Bryon. lil. Alb. an. ℥ j. flor. Chamaem. Melilot. Hyperic. Chamaepit. Chamaedr. an. M. j. Sem. Faenigraec. lin. an. ℥j. co∣quantur in jusculo pedum & ca∣pitis vervecis aut vituli pro fotu. Then I anointed the whole Hand and Arm with the following Un∣guent; ℞ Ʋnguenti Dialthaeae ℥ j. axungiae humanae, gallina∣rum, anseris, ursi an. ℥ ij. succi lumbricorum ʒ ss. M. f. Ʋn∣guentum. Then I wrapt the Hand in Emplastrum de Muci∣laginibus. By these means the Sinews and the Callosity contract∣ed from the shrunk skin of the Metacarpus, and the Fingers grown together on the outside of the Hand, being sufficiently mol∣lified; I then with a Razor cut away the Callus between the Fin∣gers and the Metacarpus and

next I separated the Fingers. Then I strowed on my Powder to stop Blood, and applied whites of Eggs mixt with Rose and Plantain water, and Oyl of Ro∣ses. I applied also a Defensative to the Wrist, and anointed the whole Arm with Oleum Rosa∣coum, Myrtillorum, and Lumbri∣corum. The next day I laid up∣on the Incisions the following Digestive with soft Lint, and anointed the Arm, as before, with the abovesaid Oyls, ℞ Tere∣binth. lotae in aq. Rosacea & Plantaginis ℥j. Oloi Rosacei & de vitellis ovorum an. ℥ij. croc. ℈ss. vitellum unius ovi. Misce.

The Fifth day I applied an Instrument, and began by de∣grees to draw the Fingers to their natural site. It was made of a Splint three Inches broad, long enough to reach almost from the Elbow to the Wrist. At the end next the Wrist, it had a stick fastned across it with four round pegs standing up. The Splint was tied in two places round the Arm with a string. The Instrument there∣fore being tied on, and well guarded with Lint and Cotton, I put Finger-stalls of Leather upon the ends of the Fingers, with strings fastned to them. Then I drew the strings tight, and fastned them to the four pegs afore-mentioned: And every day I bent them more and more. And that I might the better do it; I anointed the Arm and Hand with the foresaid Unguent, as oft as I dressed the Wounds. But, that the Fingers might not grow together again, I put Plates of Lead between the Fin∣gers. Thus by little and little the Fingers were reduced to to their natural site. In the mean time I healed and cicatri∣zed the Wounds, not with very great Driers, but with Medica∣ments, that were also somewhat emollient. And by GOD's Blessing the Hand was perfectly restored.

CHAP. VIII.

Of shrunk Sinews, and crooked Arms and Legs.

WHen, upon the falling down of some Humors the Sinews shrink, and the Joynts are bent, so that one cannot ex∣tend them, it ought well to be considered, before the Cure be undertaken, whether the Joynt be joyned with a Calius, or no, (the two ends of the Bones having been eroded by some Humor, and by an intervening Callus grown into one, as in Fractures) for then, let the Chirurgeon do what he can, he can do no good, as to the redu∣ction of it; only if he perceive it in time, as it is in growing, he may keep the Limb in the most con∣venient posture; but it will ever after be stiff and useless. If it is not joyned by a Callus, the me∣thod of Cure is this. First, a good Diet must be observed. Then the Body must be gently purged. Thirdly, the Nerves and nervous parts must be mollified and moistned by all means possi∣ble. The following Fomentation will do good. ℞ rad. Althaeae, li∣liorum alborum, Bryoniae, ebuli an. ℥ss. foliorum & florum Beto∣nicae, ivae artheticae, rorismarini, Majoranae an. M. ss. florum Cha∣maem. Melil. Sambuc. an. M. s. Sem. lin. Faenigraec. an. ℥j. ams. aneth. an ℥ ij. Incidantur & con∣tundantur omnia grosso modo, co∣quantur{que} in jure capitis & pedum vituli aut vervecis. The disaf∣fected Limb must be held an hour or two twice or thrice a day in this Decoction, as the Patient pl••••∣ses. Or a Bag may be made of the foresaid Herbs, which may be boiled in the foresaid Broth, and applied hot, and left on all night. When the Bag is taken off, and the Limb wiped with warm Clothes, it may be anointed with the fol∣lowing Liniment hot. ℞ Olei de Ranis (cujus descriptio haec est, ℞ ranas viventes man. XII. lumbricorum in aqua lotorum M. iij. storum & foliorum Betonicae, ivae Artheticae an. M. ij. roris marini, Majoranae, Florum primulae veris, Lavandulae, Salviae, Chamaemel. Melilot. an. M. j. Omnia cuni ranis & lumbricis incid••ntur, & in mortario conquassentur, prose∣ctis postea in cucurbitam assunde aq. Juniperi sine vino distillatae lb vj. Olei Olivarum lb. vij. a••∣ung. human. felis, canis, muris Alpini an. ℥ij. Maneant in infu∣sione horas 24. postea cucurbita suo capitello tecta ponatur in arenam, & tamdin coquatur, donec tota fore aqua fit extillata. Oleum ad∣huc

tepidum per praelum exprima∣tur, & reservetur ad usi••n) Ol. ex floribus an. ℥ j. Ol. Lumbric. vulpin. am••gdal. dulc. pinguedi∣nis muris. Alpini an. ℥ss. Misce. Or, ℞ Ʋngu. de Althaeae ℥ j. pin∣guedinis humanae, anseris, caponis, an. ℥ ss. ol. lumbricorum ℥ j. Ol. granor••an Juniperi ℥ ij. M. After anointing, let some very emollient Plaster be applied, as Empl. de Me∣liloto, de Mucilag. cum Gum. Or Empl. Oesypi Philagrii. It must be dressed twice a day in this man∣ner, till the Tendons and Joynt are soft enough. Then an Instrument must be fixt to it, well guarded with Tow, Cotton, or Lint, which must be kept on night and day, and as you think good, or as the Patient can bear it, it must be extended. But every, or every other day the Instrument must be taken off, the Limb must be a∣nointed, and the Plaster also must be renewed. By means of this Instrument, the crooked Limb must be exterded; but gently, lest Pain and bad Symptoms arise. For all violence is dangerous. In the mean time, while the Instrument is fixt to the Knee, the Patient must walk gently upon it, if he be in any measure able. But if the Arm be crooked, then he must stie it sometimes forward, and sometimes backward. The de∣scription of the Instrument is thus. There must be a wooden case, or cradle made hollow, and fit to receive the Thigh about the mid∣dle, and the small of the Leg a little above the Ankle. Then there must be an Iron hoop fit to receive the Knee, with an hinge to open and shut, that it may let the Knee in, and with a Button, and several holes to strai∣ten or widen, as there shall be oc∣casion. Then a male Skrew must be put through a hole in the hoop, just in the Ham, and a hole in the wooden Cradle which is placed be∣hind, and fastned with strings to the mid Thigh, and the small of the Leg. This male Skrew must rest by a Shoulder in the Hoop, then the female Skrew must skrew on behind the wooden Cradle, by turning of which the Hoop is brought to the Cradle, and there∣by the Leg extended as much as the Chirurgeon shall desire. Hil∣danus says, that without the help of this Instrument he has reduced several crooked Elbows in the man∣ner following. He ordered, be∣sides the foresaid Emollients, that the Patient should every hour take some heavy things in his hand, as a Kettle full of stones, and walk about with it. Though this be an easie remedy, yet he would not have it neglected, because he has found the great success of it.

CHAP. IX.

The Cure of a distorted Foot.

HIldanus, Cent. 6. Obs. 90. has an observation of the Cure of a distorted Foot, which may serve as a pattern in the like case, viz. A Woman big with Child, as she was going in Pattens, stumbled, and was disturbed, and out of order at it. She was after∣wards brought to bed of a Boy, whose right Foot was so Distort∣ed, that his Toes, and all his Foot turned inwards towards the inside of his Ankle. So that when he walked, he trode more upon the out-part of his Ankle, than the sole of his Foot. Many means had been used by excellent Phy∣sicians and Chirurgeons, but all in vain. When he was above three years old, and all hope of resti∣tution was past, they wrote to me, and begged that I would use my utmost diligence and skill about the Child. When I had viewed and considered the case well (to speak the truth) I despaired of restoring the Foot, the Distortion being now old and confirmed. However, at the Parents entreaty, I attempted the Cure in this man∣ner.

First of all, because the Child was lusty and fat, I purged his Body with Manna, and Syrupus Rosarum solutivus by turns, lest by Bathings and Fomentations I might draw the superfluous Hu∣mours to the part affected. When the Body was purged, I every day twice or thrice used the following emollient Decoction, for ten or twelve days; ℞ rad. Althaeae, Malvae. an. ℥ss. herb. & flor. Betonicae, ivae artheticae. flor. Cha∣maem. Melilot. am. M. j. Sem. lin. Faenigraec. an. ℥ j. coquantur in decocto capitis & pedum verve∣cis, fiat{que} fomentum, cui bis in die ad semihoram us{que} pedem immer∣gat. After Fomentation I a∣nointed the Leg and Foot all over with the following Unguent; ℞ Ol. Lil. Alb. Amygd. dulc. an. ℥ss. Ol. Lumbric. ℥ j. Ol. Granor. Ju∣niperi ℥ ij. Misceantur. Then I ap∣plied the following Plaster. ℞ Em∣plastr de mucilaginibus ℥ijss. Gum∣mi Ammaniaci in Spiritu Juniperi∣no dissoluti & percolati, iterúm{que} ad spissitudinem cocti ℥ j. cerae novae ℥ ss. Ol. de Vitellis ovorum ℥ j. dis∣solvantur lentissimo igne; deinde admisce pulv. flor. Betonicae, ivae Artheticae, Rosarum Rubrarum, an. ℈ ij. croci, pulv. Lumbrico∣rum terrestrium, Masticis, Olibani an. ʒj. Misce, & fiat secundum artem Emplastrum, addendo pa∣rum

Olei Rosacei, si opus fuerit. This Plaster wonderfully mollifies and strengthens the nervous parts.

The Foot being in this manner sufficiently mollified, I left off E∣mollients, and applied Corrobo∣rants.

In the mean time while I used Emollients. I applied a Serpera∣strum or Boot, hereafter descri∣bed.

Moreover, althô the Foot was wonderfully distorted; yet after the use of Emollients, it was easily reduced into the natural form, and that without pain: but as soon as ever the hand was off it, it re∣turned to its former monstrous Fi∣gure.

And whenever I extended the Foot (which I took special notice of) and reduced it to its natural posture, I felt a great hollowness between the inner Ankle and the sole of the Foot. For the Pro∣cess of the lower Appendix of the Os tibiae, which makes the inner Ankle, because it had rested a long time upon the Os calcis, was de∣pressed, and stood at a distance from the Os calcis. And the Pro∣cess of the Fibula, which makes the outer Ankle, was preternatu∣rally prominent, and twined the whole Foot inward.

Therefore to reduce the Foot to its natural posture and form, it was necessary to depress the Pro∣minence of the Fibula, and a lit∣tle to prolong the defect of the Process of the Appendix of the Os tibiae. That was done by Art and Industry; this by the benefit of Nature. And that Nature is wonderfully sollicitous for the maintaining her Individuum; I can visibly demonstrate by an in∣stance in my Study. For there I have the Sceleton of a Capon, in which the wonderful providence of the Creator may be observed. This Creature had broke its left Thigh-bone short off, and the one end of the broken Bone grew over the other by a firm Calius, and there∣fore that Leg must have been short∣er than the other: but provident and wise Nature made the Os tibiae of that Leg so much longer than the Os tibiae of the right, as the left Thigh-bone was shorter than the right; and thus no inequality or deformity was left. And if it was thus in Brutes, why not so in Children, while they are growing; especially if they be of a good ha∣bit of Body, as this Patient was? But to return to him; the Foot being thus sufficiently mollified, I was to think of something else. I then therfore anointed the Foot and all the Leg with Succus Lum∣bricorum, aqua Betonicae, ivae Ar∣theticae, Sa••viae & Juniperi mixto, and applied the following Plaster, which strengthens admirably; ℞ Emplastri Slotani ℥ iij. Gummi El••mi purissimi, Cerae novae an. ℥j. pulv. Mastic. Olibani, pulv. lumbricorum aquâ communi lote∣rum & exsiccatorum an. ʒ ij. Ro∣sar. Rubr. Balaustior. nucum cu∣press. an. ʒ j. cum s. q. Olei Lum∣bricorum fiat Ceratum, quod supra alutam extendatur, applicetur, & renovetur, de sexto in sextum di∣em. Afterwards, having replaced the Foot in its natural posture, which, (as I said before) might be done without pain, I applied the following instrument so neatly to the Foot, that the Foot could

not get back into its former prae∣ternatural posture, unless the swathes and bandage happened to be loose. The Instrument was made thus of Iron; it was shaped like half a Boot, but parted about the mid Leg, and held together by two pins of Iron running into two Loops, and a Skrew between them, to let the lower part down, or to draw it up right, as there should be occasion. This lower part was so made, as to take hold of the Foot, and keep it from starting any way out of its proper place. This was for the outside of the Leg. It was fastened to a piece above the Knee by a pin to run on, for the motion of the Knee. The inside of the Leg was cover∣ed with Splints, lined with Tow or Cotton, and so the Instrument on the outside was fastned round the Leg by strings.

The Foot being tied streight and fast in this manner, the Prominence of the Fibula was depressed, or at least hindred from starting out. And the Process of the lower Ap∣pendix of the Os tibiae, since there was an empty place, might grow out, and so by degrees fill up the hollowness about the inner Ankle. Thus the deformity of the Foot was rectified, so that when he walked no deformity appeared.

But Cures of this nature require a long time and great care. For violence does no good, it is Na∣ture's work to correct such defor∣mities, with the assistance of the Chirurgeon's skill and industry. I found this true in the foresaid Pati∣ent. The case was inveterate and deplorable; wherefore he wore the foresaid Instrument a whole year. And I contrived another for him to wear afterwards. For Chil∣dren when they are growing, must have new ones fitted to them, as they out-grow the old ones.

The reason why the former Phy∣sicians, thô expert persons, could do no good, was not for want of proper Medicines, but for want of Serperastra. Wherefore in such cases a Physician must set all his Wits to work to invent apt Instru∣ments, without which, the best Medicines are used to no purpose.

CHAP. X.

The Cure of a crooked Back.

A Crooked Back most com∣monly proceeds from the Rickets, and may, if minded when the Party is young, be cured. But then it must be done by Chirurgi∣cal means. I shall therefore give you Hildanus his method of Cure in the following Process, viz.

A Girl of eighteen Months of age, had the Vertebrae of her Loins beginning to grow in a bunch out∣ward. When some Barhers had for several Months endeavoured in vain to cure her by Ointments, Baths, and thin plates of Lead, but still the Spine grew more and more into a bunch; at length Hildanus was called. He found the third and fourth Vertebrae of the Loins extuberant, as big as a Ducks Egg, which were followed a little by the second and fifth; so that the Spine was grown into a huge bunch, especially towards the left Side: which made the left Leg far weak∣er than the right. In the Cure he proceeded thus.

First of all he chafed the Back, and the whole Thigh and Leg with the water following, to strength∣en the Nerves. ℞ Aq. Granor. Ju∣niperi sine vino distillati, Aq. Sal∣viae, Betonicae, lavandulae, an. ℥ ij. Pulv. radic. tormentillae, Rosarum an. ʒ ij. Misce, fiat{que} infusio in ampulla magna per dies octo vel de∣cem. Dein per inclinationem à pulveribus praedictis separata aqua ad usum reservetur. After chasing, he applied the following Plaster, which he often uses in Fractures of the Bones. ℞ Empl. Slotani ℥ v. Cerae novae ℥ ij. lapidis sabu∣losi, sive osteocollae ℥ j. Pulv. ra∣dic. consolid. maj. Terrae sigillatae an. ʒ iij. pulv. balaustiorum, nu∣cum cupressi, Rosar. odoriferar. an. ʒ j. Misceantur lentissimo igne, fi∣at{que} Emplastrum addendo Olei Ro∣sacei aut Masticis, q. s. But all the skill in curing a Gibbus consists in repressing the Extuberance of the Vertebrae. To this purpose there∣fore he made an Iron plate a little bent, long and broad enough to cover the whole Gibbus, and quilt∣ed it into a Bodice between two Clothes. But he covered it first with a course Cloth, that it might hurt the Child the less. The Bodice was worn upon the naked Body, and so sitted, as to comprehend all her Belly to the Muliebria. It was tied on with a long strap over the middle of the Belly. About the Breast it was tied gent∣ly, lest it might have straitned the Ribs or Midriff. But below the

bastard Ribs to the bottom of the Belly, it was tied pretty tight, that the Iron plate might repress the extuberant Vertebrae. And lest the Bodice should have slipt upwards, two straps an Inch broad, were fastned on each side of the Groin, to go under the Perinaum, and to turn up again upon the Buttocks, and so were fastned by straps to the Bodice on each side. He re∣newed the Plaster and the Chasing every fourth or sixth day. But he ordered all from the Hip to the Foot, to be chafed with the afore∣said water every day. So by GOD's Blessing the Gibbus was cu∣red in six Months. But she wore the Bodice and the Plate, by rea∣son of the weakness and softness of the parts, two years, in which time she grew pretty well.