Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

CHAP. III. Of the Larger Instruments for the Closet and Chest.

I. THE Dismembring Knife, has an use according to the Title, viz. in Amputation, or to take off any Member or part of Mans Body, so far as re∣spects the fleshy or soft parts, even to the Bone. One may serve for the Chest, provided it be sharp, well ground, of good Metal, and not too thin edged Tab. 8. F.

II. The Trepan is of use for Fractures of the Skull, where there is Contusion, and a de∣pression of both the Tables. §1. Be sure the Instrument be good, and without faults, and clean from Rust. §2. The place where the blow was given is not always to be chosen to set the Trepan upon, sometimes the Fracture is found at a good di∣stance off, and therefore you must consider the complaint of the Patient, with respect to the feeling of your Fingers. §3. When the place is found, the Hair is to be shaved off a∣bout the breadth of four Fin∣gers round. §4. This done, have in a readiness all fit Medi∣cines and Instruments to apply to, and bind up the Wound a∣gain, as Spunges, Ligatures, Hot-water, &c. and if a Flux of Blood hinder not, foment with Posca, or Wine and Ho∣ney. §5. It will do also well to have a Restrictive ready made with Bole, Water, Vinegar and an Egg; or the Pulvis Astrin∣gens, as also Oleum & Mel Rosa∣rum, Linimentum Arcaei. §6. The Germans seldom or never use this Instrument: nor is it to be used too hastily; for we dai∣ly see many dangerous Fractures healed without it; there is not one in ten that justly requires it. §7. Therefore by reason of the danger, the young Artist may first make Experience upon a Calves or Sheeps Head, till he can well and easily take out a piece of the Bone. See the fur∣ther use hereafter. The Instru∣ment, see Tab. 1. Let. A. B. C. D. E. F. G. H. I. M. The Male Trepan E. F. The Female G. H. I. M. the point of the Male. A. B. the head of the Trepan.

III. The Trafine is an Instru∣ment only of Iron; the use thereof is necessary in pricking of the Skull, that does not pe∣netrate both the Tables, that with them the print made upon the Skull may be taken away. See Tab. 1. Let. K. L. Tab. 7. Lev. K. which is the Instrument it self. One of the Shanks may be Triangular, and then it may be used for the small Trepan.

IV. The Levatory large. It is an Instrument used in the de∣pression of the Skull: this raises

with more force than that little one before described for the Pla∣ster Box; because it hath firm∣ness, not only in the Hand of him that raiseth it, but also in its Head. See Tab. 5. L. L. Some make the Levatory with three parts, having three spears or points to thrust forwards.

V. The Head Saw. It is an Instrument with which a vent may sometimes be given thro' the Cranium, whereby the use of the Trepan is sometimes hap∣pily forborn. Sometimes a small ragged piece of the Skull may so hang, that this Instru∣ment may be used to saw it a∣way. But the young Artist ought not to be too busie in sawing, plucking away, or raising the tractured Bone, more than meer Necessity urges to, lest dread∣ful Accidents (not to be reme∣died) follow: If the Bone be nearly loose, or in sight, take it away, if not, forbear to pluck much at first; for Nature is ex∣ceeding helpful in ejecting un∣natural things in that part. See Tab. 5. H. I. Tab. 7. A. B.

VI. The small Head Saw. It is that with which some Men cut away the distances between the holes made in the Skull with the Trepan, as also rifts like Hairs that do not penetrate, and scrape away the rottenness of the Cranium. Tab. 3. L.

VII. The Dismembring Saw. It is a great and terrible Instru∣ment, ordained only for Am∣putation, or dismembring: It ought always to be ready and clean kept, with two Blades thereunto, though one good Blade well used, may serve the Artist his whole Life. Tab. 8. E. E.

VIII. The Lenticular. It is an Instrument which Levigates the Brims of the Hole made, lest pricking the Membranes, they might cause Pain and In∣flammation. See Tab. 7. I.

IX. The Rasour-Knife, or Pen-knife. It is used as an Incision-knife, and when there is no fear of the parts underneath, name∣ly in dividing the Scalp of the Head as far as the Skull, and in opening Nodes of the French Pox, especially upon the Shin-bones and elsewhere, and in dividing the Caruncles of the Matrix. See Tab. 2. O.

X. The Membrane Preserver. It is a Silver Plate (for it must never be made of Iron, because of the Inbred cold thereof, which is hurtful both to the Du∣ra and Pia mater, which cover the Brain) made firm, some∣what crooked and smooth on the outside, used in great depressi∣ons of the Skull three or four times with the Trepan, and to cut forth the spaces between the holes: for then the Plate is let down between the Skull and Du∣ra mater, that the outward part of it may be nearest the Brain, lest by the sharpness of Pincers and Saws, the Membranes of the Brain should either be pricked or cut unawares. Celsus calls it 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Meningophylax. See Tab. 5. K.

XI. The Dismembring Pincers. They are intended for the im∣mediate separation of Fingers and Toes. See Tab. 3. Let. G.

They are now much out of use, because they often introduce ill Accidents, a fine little Saw be∣ing introduced in their place.

XII. Dismembring Chizel. Their use is the same with the former, and much more commendable: but a fine Saw as aforesaid, is used in place of them both, be∣ing much more safe. See Tab. 3. I. Tab. 8. D. G. H.

XIII. The Mallet or Hammer. It is commonly made of Wood, some have them made of Lead, and some of Iron: it is gene∣rally used with the Chizel, See Tab. 3. K. You may also have it made of the common fashion.

XIV. Speculum Oris. It is an Instrument which takes hold of the Tongue, and under the Chin at once, being a very ne∣cessary Instrument to hold open the Mouth for the better apply∣ing Medicines to the Throat, as also to the Uvula, and other parts. Tab. 8. O. P. Q.

XV. Speculum Ani. It is an Instrument by which the Disea∣ses of the Intestinum Rectum, and Neck of the Womb are seen by opening of those parts. If there happen in the Orifice of the Fundament, or Neck of the Matrix any excoriation or exul∣ceration, Medicaments cannot well be brought to the grieved part, but by the help of this In∣strument; nor can the grief be seen without it. See Scultetus Tab. 17. fig. 2. and 3. Yet let not the young Artist be too bu∣sie in using of it, without Ne∣cessity, or where an Injection may do the feat. For if the Sphincter Muscle should not easi∣ly give way, but make resistance, (as in many Patients it will a∣gainst their Wills) it may ea∣sily be bruised or hurt, and so thereby you may create a new Disease. It has a Male part for Men, and Female for Women. Tab. 8. M. N.

XVI. Speculum Matricis. It is an Instrument only used for Women, when the dead Child is to be cut out, or some Ulcer of the Matrix is to be viewed, for which purpose it is of excel∣lent Service. Tab. 7. C.

XVII. Actual Cauteries. The Use of these are very needful in Amputation, for the Cauteri∣zing of any Vein or Artery, in strong fluxes of Blood, which cannot otherwise be stayed. In the Epilepsie, or Falling-sick∣ness, they are often used with good success; as also to make a Fontanel or Issue in the Neck or hinder part of the Head, and in the Cure of the Lethargy and Apoplexy. Anciently they were used for the opening of Apo∣stems, but now that practice is quite laid aside. When a Mem∣ber is amputated, sometimes the whole end of the Stump is Cau∣terized, and sometimes but the great Vessels only. Tab. 6. A. B. C. Tab. 8. A. B. C.

XVIII. Actual Seton Cautery. It is also called the Needle for the Seton, which must neither be too long, lest the point should miss the opposite hole, (but a∣bout a Hand breadth in length:) neither must it be very small or gross, but answerable to the Holes of Seton Pincers, only a little smaller, and so being made

very red hot, it passeth through most nimbly, making the Seton without almost any pain. See Tab. 3. E.

XIX. Cautery for the Ranula. The Ranula is a Tumor under the Tongue which corrupts the Speech: this if it be any other∣wise abated, except by the burning Iron, it will grow a∣gain: It is thus used, first frame a plate of Iron (hollowed on the inside) having a hole in the midst, which (the Mouth be∣ing wide open) apply to the Tumor, so that the hole therein may fall just upon that part of the Tumor which you would o∣pen: then with this Instrument red hot pierce the Tumor, which with your Thumb under the root of the Chin, a little bear up by strength and force, that it may pierce the deeper. Tab. 5. S. T.

XX. The Catheter. It is a kind of Probe, by which being thrust into the passage of the Yard, and into the Bladder, way is made for the Urine, or the Stone is felt and removed: When therefore you have occa∣sion to use it, put it in gently, so far as it can well go, being first anointed with Oil of Al∣monds or of Roses: thrust it in without much force; then feel by the root of the Yard near the Fundament, where the Cathe∣ter resteth or bears out, and so by guiding, thrust it in farther towards the Fundament, pres∣sing or bearing down (as it were) a little, the lower part of the Instrument, with the up∣per hand, which stays the Cathe∣ter, then (with the help of the lower finger of the other hand) turn the Catheter upwards, put∣ting it also withal forward a lit∣tle, so will it slip into the Blad∣der. Then draw out the inner Wier, and the Urine will come forth; keeping still the Instru∣ment carefully within the Blad∣der till all be run out, which will come without forcing; moreo∣ver, you may by putting up your finger in Anum, the Catheter be∣ing in the Bladder, and the Wa∣ter drawn out, easily feel the Stone in the Bladder, if any be, the Sick standing and bending his Body also forwards. It is made of Silver that it may be bent; and very smooth that it might not hurt; with many lit∣tle holes perforated at the end, that the Pin being drawn back, the Urine may freely come forth. Tab. 4. A.

XXI. The Directory. It is a Silver Probe, which must be so bent, that its fissure, which it hath in the middle, as far as the end of it, may be on the back∣side, or Gibbous part thereof. It is called a Directory, because being thrust into the Yard, it doth most exactly shew the Neck of the Bladder; and upon that must Incision be made, to take out the Stone. See Tab. 4. D.

XXII. The Dilatatory. It is an Instrument used for inlarging of a Wound, when Arrow∣heads, Bullets, or other Foreign matters are to be taken forth, out of the Fleshy or Brawny parts. Tab. 7. H.

XXIII. The Wound Hook. It is of use in all such Wounds

where there may be some pieces of a Link of a Chain, or Mayle, or other like matter lodged therein, to pull them out. It is called the Hooked Probe, and is useful in Wounds made with Gun-shot. Tab. 6. O.

XXIV. Terebellum Hildani. The Wimblet of Hildanus for bringing forth Bullets, and such like. It consists of three Parts, to wit, a Piercer, in a double case: We shall mention it, and shew the Use thereof hereafter, See the Figure it self. Tab. 2. A. B. C. D. and E. F. G. H.

XXV. The Scalpra. Scraping Tools, to scrape or shave Bones withal, where there is occasion; you ought to have divers of them, and of several Fashions: Those for the Head are com∣monly of one Fashion, those for other Bones of another. When a rotten Bone is to be scraped in the extream Parts, as the Thigh Bone, Shin Bone, Shoulder Bone, Arm-bone, greater and stronger rasping Tools must be provided for them. Now every rasping Instrument is made of most pure Steel, that it may have an Edge, that will perfectly rasp away. The Ancients did fit proper hafts to every scraping Instrument; but our modern Artists provide one handle of Wood, Bone, or Ivory, which they fasten to the Instrument by a Screw. See Tab. 2. N. Tab. 7. N.

XXVI. The File. It is an In∣strument of common Use in cleansing, smoothing, and ma∣king even the Teeth. See Tab. 4. H.

XXVII. The Pliers. It is an Instrument to take out an Arrow head, or the head of any Wea∣pon which is hollow, for the shanks being divided in that hollowness, will hold the Arrow head firm and fast, and so draw it out. Tab. 7. G.

XXVIII. Pliers with a Screw. It is an Instrument having a Screw running though its han∣dles, or cross its shanks. The end of which is like the Crows Bill, or a little flatter. This Screw doth open and close the Crows Bill, as you please to take hold of the Head of the Weapon, though it be buried in the Flesh. See Tab. 7. D.

XXIX. Hooks to draw out the dead Child. They are made of various Fashions, according to the Use and Place of application; but are never to be made use of, unless the Child be dead; nor then, if Nature be able to expel it, as many times she is. See Tab. 2. I. K. L. M.

XXX. Hook to draw Stones out of the Bladder. It is to be used when the Stones are many, or little, or in pieces, or cannot be easily brought to the Neck of the Bladder. See Tab. 4. E.

XXXI. Decussorium, an Instru∣ment to press down the Dura Mater. It is used after Trepanning the Skull, as often as you dress the Wound; wherein, pressing it down to the Dura Mater, you must bid the Patient to strive to put forth his breath, stopping his Mouth and Nose, so that the Matter may more easily be eva∣cuated. This Tool must have the end round, polisht and smooth. See the Fig. Tab. 7. M.

XXXII. The Gouge or hollow Chizel. It is of use to make an entrance into the Bone, for the fixing of other Instruments, as the Trepan, &c. The use here∣of is common with Carpenters and Joiners. See the Figure, Tab. 3. H.

XXXIII. Seton Forceps. They are of several Forms, the two principal of which we have ex∣hibited Tab. 3. A. and Tab. 4. P. The first is a pair of Pincers, having holes in their upper Part, with a certain Cavity, which is closed by the Chirur∣gians hand; with these hold is laid on the Skin of the Neck, and with the Needle Tab. 3. E. be∣ing red hot, the Skin is perfora∣ted through the holes at B. The latter are of the same use as the former, save they have a hold∣fast at R. which of its self binds, or holds close the Instrument or Pincers. These are only of use when the Chirurgian has no Ser∣vant, which may deliver to him the red hot Needle.

XXXIV. Seton Needles. These are to be used, either red hot, or cold: that which is used red hot, is that before mentioned, Tab. 3. E. That which is used cold, is sharp and with edges, being only first anointed with Oil of Roses. See it Tab. 3. F.

XXXV. Needles for a Hare Lip. They ought to be made of Steel, sharp, three square, and of about two inches and a half long. The thread must be well waxed, that it break not; the Needle must be run through both sides of the Wound or Breach, taking up all the Flesh of both Lips, and in the same manner, another short Needle (as the place will bear) must be thrust in the midst, cross the former, and under the Flesh as the former is. Then the Thread which was in the Eye of the first Needle, must be strained cross about all the four ends of the two Needles, 7 or 8 times or more, to hold the Lips of the Breach firmly toge∣ther, till the union be perfected, after which the Needles must be taken away, and the Wounds they made, healed according to Art. See Tab. 8. I. K. L.

XXXVI. Needles for Wounds. These are chiefly for Wounds of the Peritonaeum, but they are made use of in other Wounds also. The manner of the using of these Needles, we have at large declared in Cap.. Sect.. following, and in other pla∣ces. Tab. 6. D. E.

XXXVII. Needles for Couching Cataracts. They are often made of Silver, but in my Opinion those made of Steel are much better. See Tab. 4. L M N O. they are commonly inserted in∣to a handle of Silver, which is an Octagon, that on both sides has a perforated glans or Ivory head, through which the Needle pas∣ses. L. is a Silver Case; M. is the Needle with a Haft and Case of Silver, fitted for the curing of a Cataract or Suffusion; O the Needle in its haft, and its Cap∣sula or Cover. The way of u∣sing see Cap. 31. Sect.. follow∣ing.

XXXVIII. Hollow scraping Levatorie. It is of singular use

after trepaning to take away the Splinters, and smooth the in∣ward edge of the Skull, least the little bits or splints should hurt or prick any of the Membranes: It is smooth on the outside, and hollow within, that it may re∣ceive and hold whatever it shaves off, from falling in upon the said Membrane. See Tab. 6. K.

XXXIX. Forceps to break off Bones of the Skull. These may supply in part the use of the for∣mer, for want thereof, as also to take out bits, splints, and such like, which are already fallen down upon the Membranes: See Tab. 1. N. The Crows Bill, with∣out Teeth. And P Q. the Hollow Forceps, or Parrots Bill.

XL. The Crows Bill Forceps with Teeth. They may be for the former use in Fractures of the Skull: But their chief In∣tention is in Amputation, to draw the Vessels out of the Flesh, that thereby they may be tied up to stay their Bleeding, which is done with a double and strong thread: after which you shall with a sharp Needle and Thread, take four stitches deep into the Flesh, which makes a cross, like the Letter X; sow up the Flesh and Skin, somewhat loosely to cover the end of the Bone, that it take not the Air; for if you should endeavour to draw it close to make the Skin meet, the Skin would break, and your work would be spoiled. See Tab. 1. O. and Tab. 5. M.

XLI. Cranes Bill Forceps straight. They are the straight Instrument of Hieronymus Fabri∣tius ab Aquapendente, for to draw forth a Polypus, being made of Steel, Convex outwardly, but inwardly Concave, having an edge inwardly bent backwards, wherewith we can cut nothing but the Polipus now laid hold on. They are of use also to take forth small Bullets, and other strange Bodies, gotten into Wounds. See Tab. 6. I, L. and Tab. 2. P.

XLII. Goose Bill Forceps. Their general use is in Wounds, to take forth Bullets which are large, and other things of an Orbicular or round form. Their Magnitude and Forms may be various, according to the di∣versity of the occasion, and sci∣tuation of the Wound, as little, great, straight, crooked, broad, narrow, toothed or smooth. See Tab. 4. F. G. Tab. 6. G.

XLIII. Crooked Forceps or Pli∣ers. They are an Instrument wherewith the Polipus is cut and drawn forth, which by the holes of the Nostrils, leads in the Pal∣let to the Throat, thereby threatning to choak the Sick: They are also of use in taking Bones or Splints out of Wounds, whose Cavities make an Ob∣lique Angle. Tab. 6. H.

XLIV. Crooked Toothed Cranes Bill. It is an Instrument, altoge∣ther like the straight Cranes Bill at Sect. 41. save the Bill of the Instrument makes with the shanks an oblique Angle: The uses of it also are the same, tho' used in different kinds of Wounds: The straight Cranes Bill, is only used in straight Wounds; the crooked Cranes Bill in such as are the Oblique,

being directed to take forth Bullets, or other strange Bodies from Wounds having an oblique Angle.

XLV. Myrtle Leaved Pen-knife. It is a Knife with two edges; and resembling the form of a Myrtle Leaf, used with its proper Pincers, to cut a Seton in the Neck. Tab. 4. I. K.

XLVI. Seton Point. It is a long narrow Point, to the end of which is fastned a Seton, or round line of Purple Silk, which being, drawn to the middle, is left in the hole: to the point at D. is fastned a small button of Wax, that it may pass through without delay or pain. See Tab. 3. C. D.

XLVII. Terebellum for the Head, or Head Piercer. It is used in the same manner as is the Trepan or Trefine; but chiefly in those cases where a single hole may be of service enough to dis∣charge the purulent Matter from the Meninges of the Brain. Tab. ••. K. L.

XLVIII. Lapidillum. It is a Spoon made of Latten, where∣with the Stone is taken forth out of the Urinary Passages; name∣ly a Probe, which on that part, where it is made hollow like a Spoon for the Ears, is put into the Conduit of the Yard, so that it may pass beyond the small Stone above it, and may lay hold on it with its Lips and Cavity. This done, Oil of sweet Almonds is poured through the hollow Pas∣sage (which hath a large Orifice) into the Urinary Passage, that it may become slippery: After∣wards the Probe is gently drawn forth, and the Conduit is pressed behind the Stone with the finger, till it be driven forth. Tab. 3. M.

XLIX. The Goose Bill Spatula. It is an Instrument provided to receive and take forth Bullets, or other round Bodies, out of Wounds, for such like Intenti∣ons. See it Tab. 4. B.

L. Fistula Syringe, with a long slender Pipe. It is used to inject Lotions, into hollow Wounds, Ulcers and Fistula's, and to wash other obscure Parts, which can no otherwise be come at. Tab. 9. D.

LI. The Ear and Yard Syringe. It is altogether like the former, save the Pipe at the end is all of one piece with the Body of the Syringe, short, viz. about an inch long, and so thick as to fill the Cavity of the Ear and Yard. The chief uses of it, are to inject liquid Bodies into the Ears, Nose and Yard. By this Instrument, if well made, you may inject into the Bladder it self. Tab. 9. A.

LII. The Womb Syringe. It is a straight hollow Cane, made of Pewter, of about seven or eight inches long; smooth, equal, and about the thickness of a Mans Thumb; having its end perfo∣rated with five or six small holes. It serves to cast in injections to wash the Womb, cleanse it, and to deterge Ulcers, Fistulas, and such like, stop the Whites, &c. Tab. 9. B.

LIII. The Clyster Syringe. It is a Syringe with a long Pipe, like that at Sect. 50. save the Pipe is much thicker, and has a larger Orifice: And the Body of the Syringe is so large, as to hold near a Pint: It is a most admi∣rable

Instrument to exhibit a Clyster with, casting it in much farther than can be done by any Clyster-pipe. You may have them of several sizes. Tab. 9. C.

LIV. Clyster Pipe. It is an Instrument made of Box, Bone or Ivory, about three Inches and a half long, hollow, having its least end (which enters into the Anus) perforated in the sides thereof with five or six holes: the larger end is tyed fast to a Bladder with a Cork and thread; which Bladder holds the Clyster till it is administred: Its use is to exhibit Clysters, instead of the Clyster Syringe, if it be wanting.

LV. Weights and Scales. These are Instruments so necessary, that the Artist can in no ways be without them, the Life of the Patient often lying at stake, for a little fault or error, commit∣ted by a Mistake in the Dose of a Medicament. The Scales ought to be Gold Scales, bright, smooth, equal, with a delicate Beam, which may turn with the tenth part of a Grain. The Weights are gr. ½ j. ij. iij. iv. v. vj. half Scruple ℈ss. ℈j. ℈ij. half a Dram ʒss. ʒj. ʒij. half Ounce ℥ss. ℥j. ℥ij. all which Weights ought to be dou∣ble, lest any should be lost.