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. XV. OPENING of the BREST.

I. THIS Operation is perform∣ed in two Cases: 1. In a Hydrops Pectoris vel Pulmonis, wherein Water is collected into the Cavity of the Thorax, either by Rupture of the Lymphaeducts, or too great a waterishness of the Blood. 2. In an Empyema, which follows an Inflammation of the Throat, Lungs, Pleura, &c. where in Matter is collected; which upon the breaking of the Apostem, falls also into the Ca∣vity of the Thorax.

I. Of a Dropsie of the Brest.

II. Signs. It is known by a dry Cough, a painful heaviness, and a difficulty of Breathing, even to Suffocation; there is also great Thirst, little Appetite, and a paleness of the Countenance; sometimes there is a swelling of the Legs; and now and then it is accompanied with a Fever.

III. The Causes. They are be∣fore declared, to which add an Obstruction of the Lymphaeducts, as it often happens.

IV. The Prognosticks. If it be recent, it is easier cured than when inveterate: So also, if it be in a Person Young than in one Old: But in whom soever, and though Recent, yet it is a thing of dif∣ficult Cure.

V. It often degenerates into an Ascites; and if the Bowels be hurt, it is incurable.

VI. If the Water cannot be ex∣pelled by Diaphoreticks, Diureticks, nor by Purging Medicines, then we must come to the Manual Operation, as at Sect. 18. fol∣lowing. See the Third Edition of Our Synopsis Medicinae, Lib. 4. Cap. 26. throughout.

II. Of an Empyema.

VII. The Signs. When the In∣flammation of the Lungs or Pleura, will not, upon Bleeding or other fit means, be removed, you may then judge a Collection of such Matter to come, within 12, 14, or 16 days.

VIII. The Patient finds a great heaviness in his Brest, without con∣siderable Pain; but if it be with Pain, it is commonly with a new Afflux of Humours, which they divert by Revul∣sion.

IX. There is a difficulty of Breathing, and in Motion the Pa∣tient finds a rumbling; and is sensible that the Matter changes place, and the side affected is hotter than the other.

X. He casts up, with violent Coughing, a purulent Matter, ha∣ving a continual Fever, or rather a Continent; (for such as I have seen afflicted with this Disease, had no remission of the heat:) The Appetite is depraved or weak, and he finds Anxiety or Pain at Heart.

XI. The Cause. It proceeds from a Fever, which many times putting the Blood and Humours into violent Motions, lodges them in the Lungs, Membranes of the Pleura, or Parts adjacent.

XII. The Differences. One is in the Lungs it self; another in the Membranes of the Pleura: Or, One arises from a Peripneumonia; another from the Pleurisie. One is from a Rupture of some pre∣ceding Apostem, as aforesaid. Another from a Vein opened, broken, or gnawn asunder; whence comes Blood, which issuing forth, is converted into Pus, forming it self a Cystis. A∣nother from an afflux of Rheum, or Humours, into the Thorax.

XIII. The Prognosticks. All Empyema's are dangerous, and Death is rather to be feared, than Life hoped for. But that, in a strong Person, and on the right side, and where the Pus is voided white, and without any great Pain or Coughing, it is the more hopeful.

XIV. So also, if, upon opening, the Sick has an Appetite to Meat, the Thirst goes away, and the Fever leaves the Sick the same Day, there is hopes; and con∣trariwise.

XV. Between the thirtieth and fortieth day, the Apostem common∣ly breaks; and if it be not spit forth in Forty Days, it com∣monly turns into a Consumption.

XVI. But, if upon opening, the Pus be of an ill Colour or Savor,

somewhat Bloody, or Water flows forth in great quantity, or it co∣lours the Probe red, the Sick, for the most part, dies. See the Third Edition of Our Syn∣opsis, Lib. 4. Cap. 22.

XVII. The Cure. If now the Humours collected connot be expell∣ed by Expectoration, nor by Ʋrine, or Medicines, we must then come to Manual Operation, which is performed according to this following Method.

XVIII. The way and manner of Opening the Brest, both in a Hy∣drops Pectoris, and an Empyema. The place of opening, is said, by some, to be between the third and fourth Rib; by others, be∣tween the fourth and fifth; and others say, between the fifth and sixth (reckoning upwards;) this last is thought safest; for if higher, the Pericardium may be hurt, if lower, the Midriff.

XIX. But as in other Tumors, so in this, the most raised place is most fit. So that if a Tumor ap∣pear on either side, make the Apertion four or five inches from the Sternon, and nearer to the lower, than the upper Rib, be∣cause under each Rib there lies an Intercostal, Vein, Artery, and Nerve.

XX. First, mark the place to be cut, with Ink; and charge the Sick to hold his Breath, as long as he can, mean season make an Oblique, but small, Orifice, in∣to which put a Pipe of Silver or Lead; at which suffer ℥iv. or v. to run out in a day.

XXI. If the Matter run not well, place the Sick on the wounded side, and make him Cough. If yet it will not come, by reason of its toughness, inject into the Cavity some abstersive, healing, and drying Medicine, as Decoctum Vulnerarium, Decoctum Fumaria compositum. See Pharm. Lond. Lib. 4. Cap. 14. Sect. 8, and 17. or Infusum seri Lactis Mesuae; let∣ting the Patient take inwardly, Decoctum Vulnerarium Mynsichti (at Sect. 30. of the aforecited place) of which he may drink often in a day, about two ounces at a time.

XXII. If the Sick be weak, and the inward parts corrupted, this Operation is more dangerous, other∣wise it has proved more effe∣ctual, than in the Paracentesis, for a Dropsie in the Belly. But before you do it, first try all o∣ther means, as Expectoration, Purging by Vomit, Stool and Urine, Sweating, &c. and if they fail, then make use of Chi∣rurgery.

XXIII. If the Matter runs not, by reason of its toughness, Bar∣bett advises to inject this: ℞ Goats Whey ℥xviij. Honey of Roses ℥iv. Juices of Celandine and Smal∣lage a. ʒvi. mix.

XXIV. Or this; ℞ Comfrey-roots ℥i. Roots of Sanicle ℥ss. Leaves of Agrimony, Betony, Bur∣net, Periwinkle a. Mss. the Cor∣dial-flowers P. ij. Seeds of Hype∣ricon, Carduus, Roman-Nettle a. ʒss. boil in Water and Honey q.s. to a pint and half, then strain out; with which Inject, letting him drink also a little of it twice or thrice a day.

XXV. Sometimes the collected Matter is contained in a Mem∣brane of its own, and by its rising,

manifests it self from without. This the Latins call Vomica Pul∣monis. In this case, you must not stay till the Membrane breaks of it self: For, by delay, the Matter flowing up and down, will be more difficulty got out of the Brest; but it ought pre∣sently to be opened, chusing no other place for the Apertion, but the most raised part of the Tumor.

III. Of a Pleurisie.

XXVI. And because an Empy∣ema mostly follows a Pleurisie, I shall shew in this place, so much concerning it, as is necessary for a Chirurgian to know, because many of them are apt to mistake any Pain in the Side, though arising from Wind only, for a Pleurisie.

XXVII. A Pleurisie then is an Inflammation of the Pleura, and many times of the Lungs them∣selves (but that is rather a Pe∣ripneumony) arising from an Af∣flux of Blood, attended with, 1. Pain; 2. Cough; 3 Short∣ness of Breath; 4. Spitting of Blood; 5. Continent Fever; 6. And a quick Pulse.

XXVIII. The Cause. It is chiefly from Blood, or Blood and Humours, over-heated, and put into a violent Fermentation in the Lungs or Pleura.

XXIX. The Differences. It is, 1. Sincere, when it proceeds from Blood alone. 2. Bastard, when it comes from Blood mixt with other Humours. 3. Of the Lungs. 4. Of the Pleura.

XXX. The Prognosticks. If the Patient Spit not the third or fourth day, he will scarcely live to the seventh: And therefore the sooner the Matter is con∣cocted, and the whiter and ea∣sier it is ejected, the sooner and safer will be the Cure.

XXXI. And if upon a plentiful Expectoration, the Cough and Dif∣ficulty of Breathing lessen not, it is an evil Sign: So also, if upon Bleeding, or other proper ap∣plications, the Pain ceases not; for then the Sick must either die, or the Pleurisie will turn to an Empyema, or a Consumption.

XXXII. The Cure. Authors prescribe Bleeding largely, as one of the most necessary and safest means of Cure. However, Ex∣perience has confirmed the ad∣mirable use of the volatil Salt, or Spirit of Mans Blood, or Mans Flesh, and for want there∣of, the same Preparations from Bulls Blood or Flesh; Spirit of Sal Armoniack, and many other things of like nature.

XXXIII. But if a Vein be opened, let it be on the same side the Pain is of; for thereby the Sick is much more and sooner relieved, than when it is done on the opposite side: If the Pain ceases not in twenty four hours, they sometimes Bleed twice or thrice on the same Arm, but with respect to the Patients strength.

XXXIV. After Bleeding, some∣times Purging, Sweating, and Ex∣pectorating Medicines are very good; this is commended by Barbett, (after once Bleeding) by an Experimental Success: ℞ Juice of Dandelion ••iss. Plantane-water ʒij. Waters of Carduus and Sca∣bious,

Syrup of Corn Poppies a. ℥i. Crabs Eyes ʒss. mix them: and give the Sick every half hour, two Spoonfuls of it, for some time: The rest of the Cure seek out in the Third Edition of Our Synopsis Medicinae, Lib. 4. Cap. 27.