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 ...

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Title
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 ...
Author
Salmon, William, 1644-1713.
Publication
London : Printed for J. Dawks ... and sold by S. Sprint [and 6 others] ...,
M.DC.XCVIII [1698]
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Subject terms
Medicine -- 15th-18th centuries.
Link to this Item
http://name.umdl.umich.edu/A60561.0001.001
Cite this Item
"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 ..." In the digital collection Early English Books Online 2. https://name.umdl.umich.edu/A60561.0001.001. University of Michigan Library Digital Collections. Accessed October 31, 2024.

Pages

Page 100

CHAP. XXXV. CUTTING off a SARCOCELE.

I. WHAT a Sarcocele, or Hernia Carnosa is, we have in part told you in Chap. 8. Sect. 3. But it is more a Fleshy Tumor than a Rupture; unless it be called a Rupture, from the eroding of the Membranes which close the ends of the Capillary Blood Vessels.

II. A Fleshy Rupturethen, is a hard Tumour, slowly increasing, unequal, rough, heavy, and with∣out any thin or floating Humours; and not very painful, unless joined with any sharp Matter.

III. The Cause is chiefly Blood, whether pure or impure, for the most part abounding in Quantity, being cast out of the Capillary Blood Vessels, the Membranes which close them, being either eroded, broken, or dilated; whereby the Nutritious Blood flowing more into the Part than Nature re∣quires, and not Putrifying, it is changed into the Substance of Flesh.

IV. This Flesh sometimes grows to the Testicle, in which case, it cannot be taken away, but by taking away the Testicle it self; but many times it only Circumvolves the Testicle, but grows not to it; in which Case it may be re∣moved, without either hurting, or Cutting the Stone out.

V. This was lately done in a Patient, that came to me, by the Hands of a French man, who slit open the Scrotum very carefully long-ways, took forth the tumi∣fied Testicle; and pulling it down a little, tied it fast, as high as he could above the Stone; then he cautiously cut the Fleshy Sub∣stance long-ways also, so as not to hurt or scratch the Membranes of the Testicle: Which done, he turned the Testicle out with his Fingers, and with one cut, cut off the Fleshy Substance, just below the Bandage (the Patient not crying out for it.) Then he returned the Testicle into the Cod, and in a short time healed it after the manner of a green Wound: The piece of Flesh in this Operation weighed above two Pounds.

VI. The Prognosticks. It is scarcely ever cured by Medicines, and seldom without Manual Ope∣ration: And if the Fleshy Sub∣stance grows to the Stone, not without removing, or cutting it off also.

VII. If the Fleshy Substance ex∣tends its self to the Groins, it is for the most part incurable.

VIII. The Cure. In its begin∣ning, it is many times cured by astrin∣gent and repelling Medicines: Some have been Cured with the Pouder of Doves-foot Roots; o∣thers with the Pouder of Rest∣harrow Roots, taken ʒj. Morn∣ing and Evening in Wormwood Wine, or some other fit Vehi∣cle,

Page 101

for four Months together.

IX. And over the whole Scro∣tum, you may apply Emplastrum de Galbano Crocatum Mynsichti, or de Ranis cum Mercurio, and so tie it up in a kind of Bag-Truss.

X. But if notwithstanding all that can be done, its increase can∣not be hindred, you must come to the Manual Operation, thus; Make a little Orifice to the Scro∣tum, and rather in the Supe∣rior than the Inferior Part; thro' which, by help of Pledgets, let suppurating Remedies be ap∣plied, that, if possible, the Flesh may be wasted.

XI. And every dressing, diligent∣ly wipe away the Matter, but not all of it, that what Flesh yet re∣mains, may the better be consu∣med.

XII. If this succeeds not, draw forth the Testicle, and by Incision cut off as much Flesh as you can, without doing Injury to it. Then restore it to its place, and the remainder of the Flesh con∣trive to consume by Suppura∣tion.

XIII. If the former ways pre∣vail not, take out the Hernious Testicle, as far as you can; then pass once or twice a Silken Thread above the Tumor, by the process of the Peritonaeum, and pass both ends of the Silk through the Ori∣fice it self; so that that which was on the right side, may be on left, and that on the left, may be on the right: So tying the Process of the Peritonaeum with a Knot, Cut off the Testicle, letting both ends of the Silk hang out of the Scrotum, then Cure it as another Wound.

XIV. But here you ought well to consider the Cause, before you Ope∣rate; for sometimes you may be deceived by a Scirrhous, swelling of the Parastates: And sometimes the Spermatick Vessels are de∣tained in the S•…•…, where oftentimes they may exceed in Magnitude the Testicles them∣selves, cauting no other incon∣veniency, but Fear.

XV. Lastly, when you come to Operate, make the Ligature as near to the Tumor as possible; for the higher the Process of the Peritonaeum is perforated, so much the thicker it its, by which the suppuration, and falling of the Thread will be hindred; in which time, if Convulsions fol∣low, they foreshew Death.

An Appendix, concerning Cutting an Oscheocele.

XVI. Although this Discourse does not properly belong this place, but rather to Chap. 8. aforegoing; yet, because the Operation of Cut∣tin; was not there taught, we were necessitated to refer it to another place: And here, having an opportunity, under a Branch of the same Head, we thought good to resume that part which was there wanting, and to de∣liver it here.

XVII 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Oscheocele, Hernia Scroti: Hernia intesti∣nalis vel Omentalis, in quae, ob Rupturam, aut Lesi•…•…m ali∣quam Intestinum aut Omentum, in Scrotum delabitur, Lind. Ex. 4. § 45. It is a Rupture in which the Guts or Caul, through

Page 102

a Breach of the Peritonaeum, fall down into the Cods.

XVIII. By reason Cutting of an Oscheocele is not only dreadful, but also hazardous, it is seldom in use, except when the Substance fallen into the Scrotum, cannot be reduced; yet some have made use of it, to prevent a falling down any more, and so for a perfect Cure.

XIX. To perform this, (when the Guts cannot be reduced, either from the hardned Excrements there, or Narrowness of the Pas∣sage) the Patient must be tied fast to a Form or Table, and In∣cision must be made in the upper Part of the Scrotum, not touch∣ing the Guts; then putting in the Directory at the Incision, and under the Production of the Peritonaeum, with your Knife, cut such a space as is necessary, towards the Belly; after which, reduce the Intestine, and stitch up so much of the Peritonaeum as may be sufficient to hinder the fall of any thing again into the Cod, after it is healed.

XX. But unless the Patient be very strong, this is not to be done; much less the following Operation, which is performed either with, or without taking away the Te∣sticle.

XXI. That, with taking away the Testicle, is so horrid and bloody, as Scultetus has related it, (by which way the famous Gelders of Italy did Cure a Hernia Inte∣stinalis) that we shall forbear to teach it, and come to shew you that Operation, which saves the Testicle intire.

XXII. The Incision is to be made about the Share-bone, into which the Directory is to be put, thrusting it long-ways under the Process of the Peritonaeum, which lift up, and separate it from the adjoining Fibres and Nervous Bo∣dies, to which it adheres: Then forthwith draw aside the Se∣minal Vessels, with the Cre∣master, or hanging Muscles of the Stones, and then draw the Process aside above, and take so much from it as is too loose, with a small Mullet perforated in the midst: and, with a Needle, having Five or Six Threads, thrust it through, as near as you can to the Seminal Vessels and Cremaster; after which, put the Needle again through the midst of the Rem∣nant of the Process, taking up therewith the Lips of the Wound; then tie the Thread with a strait Knot, and cut off the Needle, leaving so much of the Thread, as may hang forth of the Wound; which is not to be drawn out, till there is a sufficient Conglu∣tination, which then heal up ac∣cording to Art.

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