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 ...

I. SYNTHESIS.

CHAP. VI. Of FRACTURES.

I. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Compositio, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, quod est, componere. Synthesis or Uniti∣on is that which teaches how to unite parts disjoined, and it is twofold, 1. What regards the hard and bony parts. 2. What regards the soft and fleshy parts.

II. The Unition of Bones, is either the Setting of Broken Bones; or the Reduction of Bones out of Joint: the first is called a Fracture, the other a Dislocation.

III. A Fracture, is the Solution of Ʋnity in the hard or bony Parts of the Body, caused by some exter∣nal Violence upon the Part. Yet sometimes a Fracture may come without any such external force, as when a Bone is corrupted by the Scurvy, Pox, Gout, or Le∣prosie.

IV. The general Causes, are ei∣ther Falls or Blows, and by whatsoever is able to break, bruise, or cut.

V. The Differences. 1. From the manner, some being transverse, which are properly called Fra∣ctures: others according to the length of the Bone, called Fissures: others Comminutions, when the Bone is broken into small parts.

VI. 2. From the Part, it be∣ing sometimes in the Head, Shoulder, Clavicula, Arm, Cu∣bit, Ribs, Thighs, Legs, &c.

VII. 3. From Accidents, as being sometimes accompanied with a Wound, Dislocation, In∣flammation, Gangrene, &c.

VIII. The Signs. If a Bone be transversly or obliquely broken, it may be known by handling it, wherein you will find an inequa∣lity, the Patient being scarce a∣ble to move the part affected, and sometimes that part is short∣er than the other.

IX. If the Thigh, Leg, or Foot be broken, the Patient cannot stand at all (but he may a lit∣tle, tho' with pain, in a Dis∣location,) and this is the surest difference, between a Fracture and a Luxation.

X. A Fissure is discerned by the thickness, pain, and unevenness of the part, which a skilful Chi∣rurgian is only fit to judge of.

XI. A Comminution or Brui∣sing,

wherein the Bones are shattered, is perceived by the Bones being very unequal, and yielding here and there to the Fingers.

XII. The Prognosticks. A trans∣verse Fracture is more easie to Cure than an Oblique, or when accompanied with apparent in∣equalities.

XIII. A Fracture where but one Bone is broken, is easier to Cure than where there are two, or where the Bones are much shat∣tered.

XIV. A Fracture in the midst of a Bone, is also easier to be Cured, than that which happens to the Head, or lower end of the Bone; so also a single Fracture more easie than a Compound.

XV. If it remains undressed be∣yond the seventh Day, there will be danger of Mortification; so also many times, if the Part is too hard bound.

XVI. In Setting of a broken Bone, there is Extention, Con∣joining, Ligature, and well Placing.

XVII. 1. Extention is an O∣peration performed with pain; which being done aright, must be greater or lesser, according to the time of the Fracture, age of the Patient, and magnitude of the Bone. A new Fracture, tender or young Patient, and a small Bone, require a gentler Extenti∣on; an old Fracture, strong Pati∣ent, and a big Bone, a greater.

XVIII. This Extention is to be so done, that the Muscles do not labour; for then it will be with much less pain: The Part must be so laid, as when in Health, they could longest endure it without tiring: But the exact manner of doing this, is better learnt by Practise than by many Words.

XIX. 2. Conjoining the Bones is the next Operation; in doing of which, be cautious lest the Muscles be wrested from their natural Po∣sition and Figure: It is well done, if the Bone be any thing firm, and all the places about the Fracture be found equal.

XX. 3. Ligature is done with a double Rowler: The first is to be thrice rowled about the Fracture, and then upwards: The second (which must be twice as long) is to be once wound about the Fracture, proceeding down∣wards, and then upwards again, a little higher than the first Rowler; to which you may add convenient splints (of Wood or Past-board) round about the Member.

XXI. Let not the bandage be too streight, lest it cause pain, or en∣danger a Gangrene, by robbing the part of its Nourishment: nor too loose, lest the Bones slip out of their Places: This you will find to be well done, if the Patient soon after he is dressed finds his Pain abated, and on or after the third day, the ligatures seem loose, and the place a little below the binding be a little swelled.

XXII. At the second Dressing, it must be bound somewhat closer, and afterwards changed yet but once every four, five, or six days.

XXIII. 4. Well placing is the last of the prescribed Operations, which ought to be softly, evenly, and a little raised; if you lay it too low, the Bone will bend

outwards; if too high, it will bend inwards: This you will find to be well done, if in the second dressing you find all even.

XXIV. Before you rowl the Li∣gature about the Member, bath the Part with S.V. or with Oil S.V. and Vinegar mixt together: Or lay Oxycroceum, Opodeldoch, Ca∣tagmaticum upon it; or lay a Cataplasm of fine Bole, Wheat, Meal, Whites of Eggs, Bole, Frank∣incense, Dragons-blood, and a little Camphir, which let go round the Part, and about three Inches be∣low the Fracture.

XXV. But at any time you may apply this following, ℞ Mastich, Catechu, a. ʒiij. Oliba∣num, Frankincense, a. ʒij. Aloes, sanguis Draconis, fine Bole, Gum Tragacanth, Lapis Haematitis, Talck calcined, a. ʒj. Whites of Eggs and Oil of Roses, a. q.s. make a Plaster.

XXVI. If there is an Inflam∣mation in the Fracture before Ex∣tention, foment it with an Emol∣lient Oil; or lay the part in warm Cow-dung, which will digest and ease pain.

XXVII. If the Fracture is ac∣companied with a Wound, then ex∣tend the Part first, (but gentler than in a simple Fracture) next join the Bones together; then have respect to the Wound, to unite the Lips thereof with Plasters, rather than with the Needle, and to guard it with a defensa∣tive; lastly, bind up the Part with Rowlers, and lay it conve∣niently, or easily.

XXVIII. If it be a Commi∣nution, or shattering of the Bones, joined with the Wound; those which are small and loose remove with the Forceps: Those which are any ways fixed, leave to Nature, for she will throw them out of her own accord, though somewhat later; and if they be not too much displaced, she will sometimes unite them again (by a Callus) to the whole.

XXIX. But to make the mat∣ter the more easie, you may assist Nature with the following things, ℞ Ashes of Earthworms, Bone-ashes, a. ʒiv. Olibanum ʒij. Myrrh ʒi. Honey ℥ij. mix, and make an Ointment. Or this, ℞ Pouder of Comfrey roots, round Birthwort, a. ℥ss. Olibanum, Ma∣stich, a. ʒiij. Euphorbium ʒijss. Aloes, Myrrh, Catechu, a. ʒjss. Wax, Turpentine, a. q.s. which with a little Oil of Ben, make into an Ointment.

XXX. If the Bone it self be naked, cover it with its own Skin and Muscles, and defend it from the Air as much as is possible.

XXXI. If it be naked and start∣ed out, endeavour to reduce it a∣gain into its place; but if be na∣ked, and too far, take away the piece or pieces thus started out with a proper Saw, or a pair of Nippers.

XXXII. These four Manual Operations being this well perform∣ed, you must now come to act the Part of a Physician, prescribing to the Patient a good Diet, and some proper Purge, according to the Quality of the Humour a∣bounding.

XXXIII. In Fractures of the lower Parts, Purging is not so convenient; but if the Patient is Costive, a Suppository may be exhibited.

XXXIV. But in Fractures of the upper Parts, Purgings and Cly∣sters may be often necessary, ac∣cording to the following Dire∣ctions, and which you are to observe in all other Accidents and Cases, wherein the skilful Artist sees need of Purging.

XXXV. These among Simples are said to Purge Choler, Rhu∣barb, Cassia, yellow Myrobalans, Tamarinds, Manna, Scammony. Among Compounds, Syrup of Suc∣cory with Rhubarb, washed A∣loes, Angelick Pills of Grulingius, Diacatholicon, Hiera Picra, Le∣nitivum, Pilulae de Aloe Rosata, Rudii, Ruffi, &c.

XXXVI. Among singular Compounds we have these; ℞ Lenitive Elect. Cassia extracted a. ʒij. Cremor Tartari ʒj. Spirit of Sulphur gut. x. ad xx. black Cherry-water q.s. mix, and make a Potion.

XXXVII. Or this, ℞ Rhubarb, Sena a. ʒij. Cremor Tartari ʒi. Aniseeds ʒss. Water q.s. mix and Infuse scalding hot for two hours, and at last give it a walm or two; strain out and give it.

XXXVIII. Our Family Pills are inferiour to no other for this purpose; but if the Sick is in great pain, and wants rest, you may give this: ℞ Angelick Pills of Grulingius à gr. xv. ad ℈i. of our Volatil Laudanum gr. ij. iij. or iv. mix for a Dose. Give it over Night, it will give pleasant Rest, and a Stool, two, or three the next day.

XXXIX. A Purging Pouder may be thus made: ℞ Resinous, Scammony a gr. vi. ad x. or xij. Sal Prunellae, Cream of Tartar An∣timony diaphoretick a. gr.xij. Tar∣tar vitriolated gr. vi. mix for a Dose.

XL. These following Purge Flegm and Watery Humours: Roots of Asarum, Mechoacan white and black, Colocynthis, Myrobalans Belliric, Emblic and Chebuls, Agarick, Turbeth. Among Com∣pounds these, Syrup of Diacar∣thamum, Electuary of Hiera with Agarick, Diaphoenicon, Diacar∣thamum, Confectio Hamech, Pilulae Cochiae minoris, ex duo∣bus; our Family Pills, our Pan∣chymagogue Pills, Troches of Agarick, of Alhandal.

XLI. Among singular Com∣pounds we have these: ℞ blew Flower-de-luce Roots, Troches of Agarick, Sena a. ʒi. Aniseeds ℈ij. Mechoacan ʒss. Water, or Parsly-water q.s. Infuse three hours, boil a little, strain, and sweeten with Syrup of Roses solutive, or with Manna ℥i, and then give it for a Dose.

XLII. Or this: ℞ Syrup of Roses solutive ℥i. Pouder of Jallap ℈i. Cream of Tartar ℈ij. Scam∣mony gr. vi. Decoction of Aniseeds q.s. mix, and make a Potion.

XLIII. Or you may give Our Family Pills from ℈i. ad ij. Or this, ℞ Scammony in fine Pouder à gr. x. ad xvi. plus minus; of our Volatil Laudanum à gr. ij. ad iv. or vi. mix, and make Pills: Give it over Night, it will make the Patient easie, and not work, or but rarely, till the next Day.

XLIV. Or thus; ℞ Pilulae ex duobus ʒss. of our Laudanum Vo∣latile gr. ij. ad vi. mix for a Dose. Or, ℞ Scammony gr. viij. Tro∣ches Alhandal gr. ij. ad iv. of

our Laudanum Volatile gr. ij. ad vi. mix, and with the Pap of a reast∣ed Apple make a Dose to be given over-night.

XLV. These among simple Me∣dicaments are said to Purge Me∣lancholy; Sena, Roots of black Hellebor, Indian Myrobalans, Lapis Lazuli. Among Compounds, Syrup of Roses solutive with Sena, Diacatholicon, Confectio Hamech, Pulvis Diasena, Tro∣ches Alhandal.

XLVI. Among singular Com∣pounds we have these. ℞ Sena ʒij. Indian Myrobalans ʒi. Ani∣seeds ℈ij. Liquorice bruised ʒss. Water q.s. Infuse two hours, then boil a little, strain out, and add Syrup of Roses with Sena ʒvi. Tartar vitriolate gr. x. mix for a Potion.

XLVII. Or this, ℞ Syrup of Sena ℥i. Scammony, Jallap, a. gr. x. Cremor Tartari ℈ij. Deco∣ction of Aniseeds ℥iv. mix and make a Potion.

XLVIII. Or you may Purge with our Family Pills à ℈i. ad ij. Or you may give this, ℞ Sena in Pouder ʒi. ad ʒiss. Ginger gr. xij. Sal Gem gr. vi. Laudanum vola∣tile gr. ij. ad vi. mix, and with Honey, or pap of an Apple, make Pills, to be given over Night, which will work kindly the next Day.

XLIX. Or thus; ℞ Sena in Pouder ʒss. Scammony gr. vi. Co∣locynthis gr. iij. Aniseeds, Ginger a. gr. viij. Sal Gem gr. iv. Vola∣til Laudanum gr. ij. ad vi. mix and with Honey make a Dose of Pills, to be given over night, if the Patient be in much Pain.

L. Lastly, this is to be noted, that in all these Prescriptions, the Dose is to be proportioned according to the Age and Strength of the Patient; the Quantities here in these Recipes prescribed, being for Men, and such as are grown to their full Strength.

CHAP. VII. Of DISLOCATIONS.

I. A Dislocation is the forcing of a Bone out of its Place or Cavity, or natural location, into another hindring voluntary Mo∣tion.

II. The Causes. They may be said to be two-fold, 1. External, from Falling, Beating, Running, Wrestling, vehement Extention and over-straining, as it often happens in flinging of Stones, Leaping; and to Women in La∣bour, through the unskilfulness of Midwives, &c.

III. 2. Internal, by the Afflux of Humours, which falling upon the Joints, relax, and resolve the Ligaments, thereby causing the Bones to slip, or fall out of their places.

IV. The Differences, 1. From the manner; for sometimes the Bone is altogether forced out of its place, and that is properly called a Luxation or Dislocation: Sometimes its out but a little, or half way, and that is called Subluxation, or Elongation.

V. 2. From the Cause, some are from external Accidents, as Falls, Wrestlings, &c. some are from internal Causes, as the Afflux of Humors.

VI. The Signs. If the Disloca∣tion be in a lean Body, it is plain enough. The Bone causes a Tu∣mor to be in the place to which it is forced; and a Cavity in that from whence it is forced.

VII. If there is a perfect or compleat Dislocation, the Member will be drawn up as it were, and shorter, unless it be caused from the Laxity of the Ligaments, and then it will be longer; the part is painful, chiefly in motion.

VIII. In a Subluxation or Elon∣gation, the Accidents are lesser, and not often all together.

IX. The Prognosticks. In Chil∣dren and other delicate and tender Bodies, the Bones may be reduced the more easily; but are kept in with more trouble and difficulty, & è contra, in full grown and strong persons.

X. If the Dislocation be of the Head, it is mortal; that of the Vertebrae is dangerous; and that which is inveterate, or of long standing, is hard to be cured.

XI. If it proceeds from an in∣ward cause, the Cure is very slow; and when restored, it is apt to come to its old state again.

XII. The Cure. In Dislocations or Bones out of Joint, you make the reduction, by those four manual Operations used in Fractures, which you must perform either by Hand or Instrument, as the na∣ture of the part affected will de∣clare to you.

XIII. Extention must be made so great, that there may be a Ca∣vity between the Bones disjointed; to the end that in Setting, the one may not rub against the o∣ther, whence oftentimes arises extream, and sometimes incura∣ble Accidents.

XIV. In the Conjoining, you must be careful not to wrest the Bones or Muscles, but that they may keep their natural Fi∣gure.

XV. Before binding up, be sure to preserve the part from Inflam∣mation, and Flux of Humours, by applying Emplasirum Metroprop∣to icon, Gummosum Paracelsi, or ad Herniam Schroderi.

XVI. Or this which is excel∣lent: ℞ Olibanum, Mastich, Frankincense, Dragons blood, Ca∣techu, Terra sigillata a. ʒvi. white Starch ℥i. Comfrey roots ℥ss. Goats suet ℥iv. Wax q.s. mix and make a Plaster.

XVII. Or thus; ℞ Ceruse, Wax, Frankincense a. ℥iv. Oliba∣num, Mastich a. ℥i. Turpentine ℥ij. Oil of Ben ℥iij. mix and melt, and add to them Comfrey roots in Pouder, Catechu, white Starch, Terra sigillata a. ℥iij. Tragacanth ℥i. mix and make a Plaster.

XVIII. If the vehemency of the pain, or other Symptoms, do not require it, you are not to unbind it before the fifth, sixth, or seventh day; and then it is to be done

with as little trouble or motion, as possibly may be.

XIX. And the part is to be laid in such an even and easie posture, as the Patient can find most repose in, which is mostly that, when sound, it can remain longest in without trouble.

XX. If the Dislocation is ac∣companied with Inflammation at first, beware of extending the Part, or making any progress to the re∣duction, before that be removed, which you must first do with Emollients, as Balsamum Vulne∣rarum Samaritanum, Ʋng. de Althaea Compositum, or Laurinum Vulgare, and then with Discu∣tients, as Emplastrum de Minio Simplex, de Mastiche, or de La∣pide Calaminare.

XXI. An Emollient Oint∣ment: ℞ Veal fat ʒvi. Sperma Ceti ʒiij. Oil of Ben q.s. mix and make a Liniment, adding Oil of Fennel-seeds gut. xxx. A Dis∣cutient Emplaster: ℞ Frank∣incense, Rosin, Gum Elemi, Ma∣stich, Pitch a. ℥i. Galbanum, Am∣moniacum a. ʒvi. Cummin and Fennel seeds a. ℥i. Wax, Oil a. q.s. mix and make an Emplaster.

CHAP. VIII. Of RUPTURES.

I. RƲptures are of several kinds, of which some be Proper, some Common, others Remote.

II. Proper Ruptures are three∣fold, viz. 1. Hernia Intestinalis seu Enterocele, a falling down of the Bowels into the Cod. 2. Hernia Inguinalis, seu Bubonocele, a Rupture or falling down into the Groin. 3. Hernia Omentalis, seu Epiplocele, a falling down of the Cawl, called also Hernia Epi∣ploica.

III. Common Ruptures are six∣fold, 1. Hernia Aquosa, seu Hy∣drocele, when Water falls down into the Cod: 2. Hernia Ven∣tosa, seu Pneumatocele, or the Wind-Rupture: 3. Hernia Car∣nosa, seu Sarcocele, a fleshy Rup∣ture: 4. Hernia Varicosa, seu Cir∣cocele, a dilatation of the Veins which nourish the Testicles: 5. Hernia Humoralis, seu Hygrotocele, a repletion of the Testicles by a defluxion of unnatural Humors falling on the Cods: 6. Hernia Vasis deferentis, seu Spermatocele, which is when the Vas deferens falls twisted into the Scrotum.

IV. The Remote are chiefly two, 1. Hernia Gutturis, seu Broncho∣chele, a Swelling in the Throat: 2. Hernia Ʋmbilicalis, Exom∣phalos, seu Omphalocele, a Rup∣ture of the Navel.

V. Now of all these there are but four, which are the proper Sub∣jects of this Chapter, viz. the three Proper, and the last, viz. the Hernia Ʋmbilicalis: The o∣ther Eight belong to another

place; where we intend to de∣scribe and treat of them.

VI. We shall begin with the Synthesis, or Re-unition of the broken Peritonaeum, which some∣times gives way to the Intestines, sometimes to the Cawl, and often to both, letting them fall out of their natural places into the Groins or Cods; where if the Guts come out, it is called En∣terocele. or Hernia Intestinalis, as abovesaid: But if the Cawl be out, it is called Epiplocele, or Hernia Omentalis.

VII. The Causes of a Rupture are either Proximate or Remote. The Proximate is the stretching, enlarging, or bursting of the Peri∣tonaeum, which is made up of two strong, yet soft Membranes, which so hold in, all that is included in the Abdomen, or Belly, that no∣thing may fall out: In Women it terminates as it were at the Os Pubis: In Men, its outermost Membrane reaches farther, and constitutes the first proper Coat of the Testicles; and in the Groins, it comprehends the Se∣minal Vessels as in a sheath, called Processus seu Productio Pe∣retonaei. The Groins then, and this Process, are the usual places of Ruptures; but a Rupture may happen (though seldom) above the Navel, also beneath it, and on either side of it; which Barbett says he has often seen, and which some Chirurgians mistaking, have dressed like an Abscess, as not thinking them to be the places of a Rupture.

VIII. The Remote or External Causes of a Rupture of the Peri∣tonaeum, are Falling, Leaping, Wrestling, Blows, violent Strain∣ing, carrying heavy Burthens, vehement Coughing or Vomi∣ting, straining at Stool, and Wind pent up that it cannot get out, with other vehement Mo∣tions of the Body.

IX. Most commonly it is the Ileon which falls down, yet some∣times the other Guts fall with it, and press into the Scrotum; in this case, it cannot be a simple distention of the abovesaid Pro∣cess; but certainly, in all such great Ruptures it must be bro∣ken.

X. The Signs. A Rupture is known by the Tumor being some∣times bigger, sometimes lesser, sometimes wholly gone, but easily returning upon the least Motion.

XI. And though the Intestines or Cawl, be never so much fallen down, they may easily, without any pain, be thrust in again, un∣less Wind or Excrements hinder, in which case it is very pain∣ful.

XII. If it proceeds from Wind, it is known by hardness of the Belly, and breaking Wind upwards, and downwards, and the swelling, weight, and hardness gradually increase.

XIII. If the Peritonaeum be only stretched and relaxed, the Tumor or Swelling is but little at first, and grows bigger by de∣grees; but if it be broken, it suddenly descends.

XIV. The Prognosticks. Rup∣tures happening in Infants and little Children, are easily cured, and Nature many times does the work alone. But in middle aged, or old People, it is slowly

cured, and many times not at all.

XV. If the Bowels be filled with Wind or Excrements, so that there is vehement Pain, and no Reduction can be hoped for, or that it cannot suddenly be removed, Inflammation and Gangrene is to be feared, and at last Death it self.

XVI. The Cure. In this Case you must lay the Patient upon his Back, with his Legs elevated, and a little opened, by which the Cawl of the Intestines may return of its own accord, or o∣therwise be prest up gently with your Fingers.

XVII. But if through hardned Excrements or Wind, you cannot do this, you must first exhibit Enema ad Iliacam Passionem Myn∣sichti (See Our Pharmac. Lond. lib. 5. cap. 8. sect. 5.) once or twice, giving mean season Dia∣cassia with Manna ℥iss. or ℥ij. Bath the Bowels for half an hour with Oil of Roses, applying over the Bowels and Tumor Cataplas∣ma Resolutivum Foresti (Pharm. Lond. lib. 5. cap. 7. sect. 11.)

XVIII. If Wind seems to afflict, anoint with this Oint∣ment against Flatulency: ℞ Oil of Ben ℥iij. Veal suet ℥i. distilled Oil of Juniper ʒvi. mix them. Or this, ℞ Oil of Nutmegs by ex∣pression, Oil of Mace a. ℥i. Oil of Fennel ℥ss. mix them. And in∣wardly give the Powers of Anise, Carraways, Fennel, or Juniper-berries, in whatsoever they drink.

XIX. After anointing with the former Ointment or Oil, you may apply the Cummin Plaister, or this following: ℞ Sticticum Pa∣racelsi, Tacamahacca, Galbanum, Ammoniacum a. ℥i. melt and mix; to which add Chymical Oil of Fen∣nel seed ℥ss. and make an Empla∣ster.

XX. This done, after some 12 hours, attempt the reducing of it: which being performed, with convenient Bands or Trusses, keep the Bowels so long up, till the broken Peritonaeum be firm∣ly knit together, or conjoined to the Muscles of the Belly, that nothing may fall out any more.

XXI. For this purpose you must apply over the Rupture Empl. ad Herniam, or Catagmaticum, first or second, or ad Herniam Schro∣deri, or ad Herniam Nostrum, re∣moving and applying a new Pla∣ster once a week, or when it ceases sticking.

XXII. Inwardly let the Patient take Blood of Comfrey, Morning, Noon and Night, in a glass of good Alicant, or Balsam of Sal Gem, Pouder of Parsly-seeds, shell, or black field Snails, or Rupture-wort.

XXIII. To this purpose also, a continual Diet of Gelly of Ho s, Calves, or Neats Feet, made strong, sweetned with Sugar, and aroma∣tized with Cinnamon, is inferior to no one thing yet known.

XXIV. Let the Sick eat Bread well baked with Anise, Fennel or Caraway-seeds; his Food light, meat roasted; and let his drink be Alicant, Rod-wine, Tent, or some such astringent Liquor; let his Diet be slender and spa∣ring, keep his Bed during the Cure, and if it be an old Rup∣ture, lie on his back for the space of forty days.

XXV. If his Belly should be bound, give him new damask Prunes raw, taking once a week the Angelick Pills of Grulingius. After forty days are past, let the Patient rise, yet continuing his Plaster and Truss, for at least sixty days longer.

XXVI. This Emplaster is much commended: ℞ Catechu, fine Bole, Myrrh, Mastich, Olibanum, Galls, pouder of Comfrey Roots, a. ℥i. Dragons-blood, Aloes, pouder of Earthworms, Sarcocol, Mum∣my, a. ℥iss. Loadstone, Crocus Martis, Rosin, a. ℥ij. Pitch ℥iv. Frankincense ℥viij. Turpentine q.s. make an Emplaster.

XXVII. Barbett commends this Apozem to be taken ℥v. at a time, and two or three times a day. ℞ Osmund Royal, Rup∣ture-wort a. M. i. Roots of Com∣frey, Bistort a. ℥iss. Flowers of Hypericon M.i. Aniseeds ʒij. Red Wine q.s. boil to a pint and half, then strain, and add Ferne∣lius his Syrup of Comfrey ℥ij. mix and make an Apozem.

XXVIII. He also commends these Pills: ℞ Galbanum dissol∣ved in Vinegar. ʒij Mummy ʒi. pouder of Earthworms ℈ij. Myrrh, filings of Steel, dried. Hares-dung a. ʒss. make them into Pills a∣bout the bigness of great Pease.

XXIX. This Cure in old Rup∣tures and aged People is seldom or never performed, because the edges of the burst Peritonaeum are ma∣ny times Callous, that though they be never so well brought close to one another, yet they will never grow together; in this Case Bands will do the best.

XXX. But in young Children they easily grow together, and here Trusses are better than the best Bands. Those made with Steel Springs are best; which if they be well fitted to the Patients Body, are of good use.

XXXI. If by a Wound the Intestines come out, reduce them before the natural heat is ex∣hausted, if you intend to pre∣serve Life: If the Bowels them∣selves be wounded, stitch the Lips together with a waxed thread, and gently return them into the Body.

XXXII. So also the Omentum being slipt out, unless it has lost its natural Colour and Heat; in which case, tie it in the place which is sound, cutting off the part which is putrid, then re∣duce it into the Belly, leaving the thread hauging out of the Wound, that being suppurated, it may be drawn out without trouble.

XXXIII. This being done, stitch together the Wound and Perito∣naeum, thus; Thrust a needle with a waxed thread, from with∣out, through the Skin and Mus∣cles, into the very Peritonaeum, leaving it on this side untoucht, but laying hold on the other side: and pierce it through, the Muscles and Skin also; draw the Lips together; and passing over the space of an Inch, put in the Needle on the same side again, on which it was drawn out last, leaving again the Peri∣tonaeum, on the same side un∣toucht; but holding it on the other side, thrust it through the Skin and Muscles, and so on∣wards.

XXXIV. Now, by reason of the motion of the Belly, and haste here used, the stitches may easily be un∣done; for which cause sake, you must always apply over the wound a sticking Emplaster.

XXXV. Exomphalos seu Her∣nia Umbilicalis, a Rupture of the Navel: It may be, 1. From Blood, Aneurisma; 2. From Flesh, which is hard; 3. From the Caul, where the Tumor is soft; 4. From the Guts, which is unequal.

XXXVI. The two first admit no Cure: the latter two must be reduced, by laying the Patient backwards, and proceeding as at Sect. 16. aforegoing.

XXXVII. But it is to be ob∣served, that the Peritonaeum sel∣dom breaks in this part; for the learned Barbett divers times found, and shewed in Dissected Bodies, that the Navel, toge∣ther with the Intestine follow∣ing, stood out bigger than a Mans Head; insomuch, that the right Muscles of the Belly were pressed to the side, and se∣vered from one another; and yet the Peritonaeum was but stretched, and no where broken.

XXXVIII. Dr. Thomas Gard∣ner, chief Chirurgian to the Kings Houshold, healed a famous Exom∣phalos, of so great a Magnitude, that it is almost incredible; It was done upon one Mr. Stiles, at the Lock and Key in Smithfield: It mortified, and broke of its own accord outwardly, out of which a Worm peept, which he taking hold of, pull'd out about 38 Feet in length, which then breaking off, was alive, and craw∣led upon the ground; (Mr. Horse∣nail a Chirurgian being also pre∣sent:) his Food and Excrements coming forth of the Wound, for some Weeks. That Excellent Ar∣tist, Dr. Gardner, heal'd it up, and he walkt several times after it, to Ha••nstead on foot; after which giving him a Specifick Medica∣ment against Worms, viz. a strong Infusion of Garlick, he voided a∣bout 20 Yards, or 60 Feet more of the same Worm dead, (which kind are called Lati) and so be∣came well beyond all expectation.

XXXIX. After the Exom∣phalos is reduced, you are here to observe, that upon the Emplaster, which ought to be round, you must put Bolsters of Leather or Wax, or some other hard thing, accord∣ing to the bigness of the Rup∣ture; for so by this means it will with good Bandage or a Truss, be sufficiently and perfectly kept in.

CHAP. IX. STRUTTING out of the EYE.

I. IT is said to strut out when it comes forth beyond its C•…•…it, so as the lid cannot cover it, or not well cover it.

II. It is known by Sight: The Causes are mostly inward, as In∣flammation,

Blows, hard La∣bour, Straining vehemently, Strangling.

III. The Cure. Let it be gent∣ly put into its place (otherwise, if it cannot be reduced, it is to be removed:) and being reduced, let it be kept in its place by a fit Bandage; a Bolster being also applied, dipt in our Aqua Ophthalmica, described in our Pharm. Lond. Lib. 5. Cap. 1. Sect. 14.

IV. Or you may dip it in our Aqua Regulata, described in our Phylaxa, Lib. 1. Cap. 1. Others advise to dip it in a Decoction of Sloes; or in this: ℞ Pomgra∣nate Peels and Flowers, Nut-galls, Sumach Berries a. ℥i. red Wine q.s. boil and make a Decoction.

V. The Bolster you may make of red Rose-leaves, Rosemary-flowers and Camomil-flowers; which be∣ing put into a Bag, may be moistned with any of the afore∣named things.

VI. Apply to the Forehead a Defensative; for which purpose you may use Mynsichts Cataplasm of a Swallows Nest: Afterwards apply to the Forehead and Tem∣ples Emplastrum Cephalicum.

VII. An Eye hanging out of its Orbit the breadth of a Finger, was put into its place, and cured with the following Cataplasm, without offence to the Sight. ℞ leaves of Mallows, Marsh∣mallows, Rue, Housleek a. M. i. whites of Eggs N^o iv. Meals or Flower of Barly, Beans, and Lin∣seed a. ℥ss. Camphir, Saffron a. ʒss. Oil of Roses ʒiss. Breast-milk ℥ij. Rose-water q.s. mix and make a Cataplasm, by only mixing, with∣out boiling; and apply it warm.

VIII. At opening of it, drop into the Eye our aforemention∣ed Aqua Regulata; or put in this Ointment: ℞ fine Aloes, Camphir, long and round Birth∣wort-roots a. ʒi. red Coral, Pearl prepared a. ʒiss. Sief Album ʒij. Crocus Martis, levigated Calx of Flints a. ʒiij. Glass of Antimony ℈i. white Sugar-candy ℥ij. clari∣fied Honey ℥iv. boil a little, and make an Ʋnguent.

CHAP. X. FALLING out of the WOMB.

I. PRolapsus seu procidentia Ʋ∣teri, is next to be consi∣dered: But the Womb does not easily fall down by Relaxation, much less by Laceration of its broad Ligaments, as most Au∣thors imagin.

II. But by hard Labour, or a violent and unskilful bringing a∣way of the Afterbirth; it has been of ten seen, that the bottom of the Womb has been plainly in∣verted, so as the most inward Parts have shewed themselves outwards.

III. Or rather, the wrinkled part of the Sheath, whose inner∣most wrinkled Tunicle, by Re∣laxation, may fall down, which is often taken for the Womb it self.

IV. The Causes. They are, 1. External, from the Rash laying hold of it by the Midwife, mi∣staking it either for the Child or the Afterbirth, and so draw∣ing it strongly, causes it to re∣cede from its proper place.

V. 2. Internal, by the vehe∣mency of the Pangs, or the Childs Head being bigger than ordinary, displacing it; which happens in diseased Bodies, and where there is much weakness, and a great Flux of moist, watery, slippery and slimy Humours, flowing to it; whereby it is made to sink more and more, till at length by its bigness, it comes forth of the Body.

VI. It is known by sight, and feeling of the Part, with the Hand of the Midwife, or the Patients own hand.

VII. The Prognosticks. In the beginning some think it to be easily cured, by Astringents used for a Month, the part being put up for a Month: But this is very rare to be seen; for though ta∣ken in the beginning, the Cure is very difficult to be perform∣ed.

VIII. If it is great, and the Protrusion far out, and of long con∣tinuance, it can never be cured; but being replaced, it may be kept up with a Pessary.

IX. If it cannot be put up, by reason of its bigness, but shall chance to Gangrene, it is to be cut off; which you may do thus: Draw out the hanging part, so far as to tie it with a Tape, or Silk string, to hinder bleeding; which done, cut it off at once with a Knife, which will be with little effusion of Blood: Then it is to be healed with such things as digest, cleanse, and resist Pu∣trifaction.

X. That this thus cut off, is not the Womb, appears from these Words of Barbett. We have found (says he) especially in those who were subject to Costiveness or Belly-ach, that the Membranes of the Pu∣denda, or Vagina, were so far stretched out, that the Ʋnskilful had taken it for the Womb it self, and do so still. But though many Authors have dared to write, that the Womb may be cut off, without danger of Life, seems altogether Impossible to a Skilful Anatomist.

XI. To reduce it, lay the Pa∣tient on her Back, her Knees high, and Legs asunder, and so, if pos∣sible, put it up gently with your Hand; if it be tumified or in∣flamed, so as it will not go up, follow our Directions for a Rup∣ture, Sect. 16. Ch. 8. aforegoing. Then reduce it; putting up a Pessary, that may in bigness and proportion answer the end.

XII. Make it with Cork, which cover, with Wax, mixed with a little Castoreum and Assafoetida: Let it not be too thick, but perforated long ways for the Humour to pass through: This continue there, and let it be kept with a fitting Bandage, ap∣plying over the Belly Empla∣strum ad Herniam, Catagmaticum, or that of Schroder.

XIII. Let the Patient be still for ten or twelve days, with her Legs a cross, forbear loud speaking, and as much as may be Coughing or Sneering, or whatever may occa∣sion violent Expulsion. Inward∣ly observe the Method in Rup∣tures, except in the time of the Courses.

XIV. Barbett, after he has advised the Patient to be laid on her Back, as before directed, or∣ders to take a Wax Candle of a competent thickness, and to mix therewith some Castoreum, or Assaf••etida, and with it gent∣ly to press the Womb inwards; and having fastned the Candle with a Bandage, to apply out∣wardly to the Belly Emplastrum Barbarum, or this following: ℞ Roots of Cypress, Bistort a. ʒi. Galls, Acacia a. ʒss. Cypress-nuts, D••te-stones, Myrtle-berries a. ʒi. Pitch, Colophony a. q.s. mix and make a Plaster.

XV. Great care is also to be taken, that your Wax-Candle be not too thick: lest by its conti∣nual Friction it should cause the Whites, and so weaken the Body.

XVI. Others advise (after it is put up with the Hand) to sup∣port it with a Ball of the bigness of a Ducks Egg, or bigger, dipt twice or thrice into some streng∣thening Emplaster, in which there may be a hole to discharge the Menses; through which may also be put a Copper Wire, with a string fastned to it, to draw it the more easily out of the Body.

XVII. But that which exceeds all these things, almost a thousand fold, is a Ring which may be made of Silver, Pewter, or Wood, as of Box, Cocus or Elder-wood, from an Inch and half to two Inches and a quarter in Diameter, from out∣side to outside; and the turned Substance of the Limb of the Ring, ought to be as thick as the round part of the largest Swans Quill, or rather thicker.

XVIII. This Ring thus made, may be smeared with some proper Emplaster, and so put up: It is without trouble; nor will it fret or gall the Part, or obstruct the Act of Generation, and withal may easily be taken forth when the Patient pleases. See the Third Edition of Our Sy∣nopsis Medicinae, Lib. 5. Cap. 72. throughout.

XIX. This (though the Cure is never performed) so absolutely serves the Patient, that she goes up and down, and performs all her other Duties, and lives as much at Ease, as if she ailed no∣thing at all, and answers all the Ends and Intentions of any pre∣scribed Medicine whatsoever: So that now, it would be labour lost to use them.

CHAP. XI. FALLING out of the FUNDAMENT.

I. PRolapsus seu Procidentia Ani, is known by Sight, and it proceeds from the Loose∣ness, or Relaxation of the Sphin∣cter Muscle.

II. The Cause. It is from Cold, or Weakness of the Tone of the Part, too much straining, &c. usual in Tenesmus, Dysenteries, Diarrhaeas, &c. As also from Blows, Leap∣ing, and Ulcers in or near the Part; and is common to Chil∣dren.

III. Prognosticks. It is not of difficult Cure if it be recent, or in one young, and of a good Habit of Body.

IV. But if it be of long stand∣ing, accompanied with a perpetual Costiveness, or a constant Diar∣rhaea, and in aged People, of a cold and moist Constitution, it will be of Difficult Cure, and sometimes not to be done at all.

V. The Cure. The Gut being fallen down, anoint it with Oil of Roses and Myrtles, mixing a lit∣tle Pouder of Sumach, Galls, or Catechu with it; and then with your Fingers, and a small Linnen Rag, put it up.

VI. If there be Pain, Tumour, and Inflammation, which may hinder the reducing of it, then bath or anoint the Anus with this mixture. ℞ Oil of bitter Almonds ℥ss. Oil of Mace by ex∣pression, ʒij. Oil of Amber ʒj. mix. them. Or with this; ℞ Oil of Ben ℥i. Oil of Nutmegs by expres∣sion ℥ss. Oil of Rue Chymical, or of Aniseeds ʒiss. mix them.

VII. Being well anointed, strew over it astringent Crocus Martis, or Catechu in fine Pouder, and then endeavour its Reduction. If all these things will not do, you must foment it an hour or longer with red Wine, by the help of Spunges, applying them as hot as the Patient can well endure.

VIII. But you must take great care that the Part takes no cold, lest Putrefaction or a Gangrene ensue, with which you may be surprized sooner than you are aware of; for which cause you must do your utmost to put it up again with all imaginable speed; endeavouring in the mean time, with the former Prescribed Medicines, by Bath∣ing, Fomenting, and Anoint∣ing, to preserve its Natural Heat.

IX. Being put up, wipe the Part very clean, and apply a Spunge dipt in this following Liquor: ℞ Red Wine ℥viij. A∣lum ℥ss. Tincture of Catechu ℥ij. mix, and dip the Spunge therein, being warm, and apply it as hot as may be endured.

X. And bind it on with a Swathe, which put about the mid∣dle, and from the same let fit Ligatures come between the Legs, and fastned well to the Swathe, both before and behind.