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 ...

VI. PROSTHESIS.

CHAP. XLIV. Of BALDNESS.

I. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Prosthesis, addi∣tio, à 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, appono, is that part of the Art, which teaches how to add to, or supply Parts which are wanting; which are chiefly, 1. Hair, in Baldness. 2. A Lip, in a Hare-Lip. 3. Eyes, Nose, Teeth. 4. Arms and Legs; of which in order.

II. Baldness falls under the Title of Defedation; and therefore what relates to the Medicinal Cure, shall here be omitted, re∣ferring you to the Chapter of Baldness in Lib. 2. following.

III. There are several kinds of falling of the Hair, as, 1. Tinea, when the Hair falls off one by one, being eaten and consumed by certain Worms, known by the Hairs being one shorter than another, and uneven, small Worms sticking in their Ends.

IV. 2. Area, the falling off the Hair, from certain parts of the Head, and is threefold; 1. Alo∣pecia, a Fox-like shedding of the Hair, in Patches, without any kind of Figure. 2. Ophiasis, a Serpent-like shedding of the Hair, beginning in the hinder part of the Head, and creeping to the fore part of the Head. 3. Leprous, accompanied with Scales, Scurff, Dandriff, Morphew.

V. 3. Defluvium, wherein all or most of the Hair falls off, in most places of the Head; which is caused, 1. From Defect of Nourishment, as in Persons Consumptive, and such as are sick of Hectick or Malign Fevers. 2. From evil Humours, which eat and corrode the Roots of the Hair. 3. From the Rarity and ill Disposition of the Pores of the Skin.

VI. 4. Calvities, Baldness, when the Hair falls off wholly from the fore-part of the Head; caused from a defect of Nourishment, driness of the Brain, either thro' Age, or some violent Causes, as too much use of Coition.

VII. Many of these are very dif∣ficult to Cure; the last is said to be uncurable: The remedy in this Case, is an Artificial covering, being Hair made up into a Per∣riwig, according to the Barbers Art; of which we shall say no more in this place.

CHAP. XLV. Of a HARE-LIP.

I. IT is known by sight, being sometimes single, sometimes double; sometimes in one Lip only, and sometimes in both Lips.

II. Sometimes the Lip is much cleft, shewing two or three Teeth of the upper Jaw; sometimes 'tis less, and sometimes double cleft, there remaining only a piece between both, which, unless it be callous, need not be taken away, though its usual so to do.

III. Sometimes with these, not only the upper Jaw, but also the Roof of the Mouth is divided in two, one side of the upper Jaw-bone standing out, with a Tooth or two more than the other, without the Lip.

IV. The Cause. It is usually from Frights, and strong Fancies in the Mother, whilst she goes with Child; which are also many times the cause of Monstrous Births.

V. The Prognosticks. 'Tis more dangerous to be done upon a grown, than a young Person, tho' haply, it has sometimes been done in Persons of Thirty Years of Age.

VI. The younger Children are when they are Cut, the better and the safer it is; yea, if it may be, whilst they are Infants, un∣less they be sick or weak.

VII. The Cure. You ought to consult whether the loss of the part of the Hare-lip can be help'd by reunion, otherwise it is not to be meddled withal. It is a work of Art to excoriate the Parts, and keep them close together, that by the Blood they may unite.

VIII. Chuse a very clear place, and put the Patient into his proper Seat, (if a Child, into the Lap of a strong and discreet Person;) and let one stand behind to hold the Head, the Childs Hands be∣ing tied down; and, if possible, let it be kept from Sleep for ten or twelve Hours before the O∣peration, that it may be dispo∣sed for Sleep presently after it.

IX. Have also in readiness, a Glass of generous Wine, or some good Cordial, in case of Fainting; together with a Bason of Blood∣warm Water, Sponges, Pledgets, Bolsters, Bandage, Incision-Knife, cutting Pincers, Scissars, and five or six three-square Needles, threaded with Red Silk.

X. If the Deformity be great, be very cautious, lest you make it worse; if it sticks, or grows un∣to the Gums, which sometimes it does, you must divide them, putting Lint between, &c.

XI. Then taking up that part of the Lip which must be ex∣coriated, with the left hand, take off the Skin equally, either with a very sharp Knife, or else with a pair of good Scissars; so as it may become perfectly raw;

or as a green Wound, cutting to the very Angle of the Hia∣tus; doing the same in like manner on the other side, cut∣ting away so much as is need∣ful.

XII. Then with your Hand, draw the Parts together, and stitch them, observing this, not to take the Stitches superficially, but through all; passing the Needle straight through the Lip, from the outside inwards, on the one side; and from the inside out∣wards, on the other side.

XIII. Then tie the Threads, and fasten the ends, and cut them off; but observe, not to take your Stitches too near the edges of the Wound, but at a good distance, lest the hold should break: The number of which is to be determined by the ampli∣tude of the Wound.

XIV. After the Stitching is done, let Compresses, or Bolsters be dipt in Whites of Eggs and Rose-water beaten together, and applied, both to the inside and outside of the Wound.

XV. Then a fine, soft, and smooth piece of Linnen, of about half an Inch broad, dipt in Posca, must be applied to the inside of the Lip, to keep it from Fluxion: And a fine, soft, and smooth Rowler, of about three Inches broad, dipt also in Posca, must be brought along obliquely a∣bove the Ears, and must be tied tightly behind the Head.

XVI. When a Day, or some∣thing better is past, remove the Compresses, and apply Congluti∣nants, with Lint and Unguentum ex Cerussa, and a Plaster of Ceratum ex Cerussa applied over it.

XVII. But to the Inside, you must apply Syrupus ex Rosis siccis, Syrup of Myrtles; and if there is much foulness, Julep of Violets with Mel Rosarum, which used either alone, or mixed, hasten the Coalition, or Uniting.

XVIII. Or you may use this. ℞ Honey of Roses ℥v. Syrup of dried Roses ℥i. Myrrh in fine Pouder ʒiss. mix them; spread it on a Rag, and apply it often to the inside of the Lip.

XIX. When the Parts seem well united, which may be at the end of the third day, you may loosen some of the Stitches; but then you ought to hold the Parts easily together, with a sticking Emplaster, till there is a per∣fect Coalition: And then, as soon as the Glew sticks, the Stitches may wholly be loosed.

XX. This is a good Glew. ℞ Glair of Eggs q.v. Chalk in impalpable Pouder q.s. mix them.

XXI. Or this. ℞ Glair of Eggs N^o ij. Gum Tragacanth, Gum Arabick, Mastich, Frank∣incense a. ʒ v. the other Ingre∣dients being in fine Pouder, mix them with the Glair to a Con∣sistency.

XXII. Then get two double∣pasted Cloths, about three Inches long, and as broad as the Lip; with Threads fastned at small, but equal distances in both, in each a like number.

XXIII. Spread these Cloths with the sticking Emplaster; ap∣plying the ends where there are no Threads, wet to the Lip,

but so as the outmost Edges of the double Cloth, meet not by about four Inches, from the edg of the Wound.

XXIV. About six Hours after the Plasters are applied, they will be fast and dry; at what time you may tie the Threads gently, so close, that the Lips of the Wound may seem close, and there be no pain.

XXV. Which done, dress the Wound with drying and healing Balsams, which while it is doing, loosen the Threads, wipe the Wound, apply the Balsam, and then tie the Threads again; over which put a thin Cloth, and a Rowler; which work do twice a day, till it is perfectly healed.

XXVI. But some advise to ap∣ply at Bed-time, Ceratum ex Ce∣russa, binding it on with a Row∣ler: Which, since there is a difference in Flesh, as to heal∣ing, I should rather advise you to make use of that which will best agree.

XXVII. Scultetus does the Work after another manner, and I think as well, or better. Tab. 35. Fig. 8. The Cloven Lip must be taken hold of, on both sides; and if growing to the Gums, must be separated with a fit Knife, and a Linnen Cloth must be put in between the Lip and the Gums, that they may not grow together again.

XXVIII. Then sticking Em∣plasters must be applied on both sides the Cleft, with Strings; which being done, and dried fast on, the Lips of the Fissure must be renewed, or made raw with a pair of Scissars, and being re∣newed, they must be brought to touch one another with stitch∣ing, which will not so soon break forth again; but being by the Strings drawn together, will be kept so, till the Coali∣tion is perfect, by the help of Spanish Balsam.

XXIX. Or thus. Having cut both sides of the Hare-lip, so much as is needfull, pass through them a Needle or two, as there may be occasion, leaving them in, and wind the Thread about the ends of the Needle, as Taylors do, when they stick them on their Sleeves.

XXX. Then anoint the Lips first, and Wound with Spanish Balsam, Lucatellus Balsam, or Balsam de Peru, de Chili, or any other proper Unguent, which you may strengthen with the dry Stitch, as before direct∣ed.

CHAP. XLVI. PARTS of the HEAD Supplied.

I. THAT Supply which is made of Flesh taken from a living Body, learnedly treated of by Gasper Taliacotius, the Bono∣nian Professor of Anatomy, is so difficult and painful, besides the necessary preparation for the Work, the Symptoms that fall out in the doing of it, and the danger that follows the least neglect; that it is seldom or never attempted in our Days: And therefore, by reason of the Difficulty and Unsuccessfulness thereof, we shall wholly preter∣mit it; referring those which are curious in that kind, to the Author himself.

II. However, Artificial Eyes, Nose, Palate, Teeth, &c. may be made to supply those Defects, of several other Materials; of which, Ambrose Parrey, lib. 23. cap. 1. ad 7. has spoken at large.

I. Of the Eyes.

III. If therefore, the Eye hap∣pen to be broken, or put out by any Violence or Inflammation, or if it waste or consume, by reason of a Consumption of its proper Sub∣stance, there can be no hope to restore the Sight or Function of the Eye; but you may cover the Deformity of the Eye so lost, by another Eye Artificially made of Gold, Silver or Glass, coun∣terfeited and Enamel'd, so as it may seem to have the Bright∣ness, Decency, and Life of the Natural Eye; which may be put into the place of the Eye so lost.

IV. If it cannot be worn, being put into the place, you must make a stiff Iron or Brass Wire, like unto Womens Ear Wires; which may be so formed, as to bind the Head harder or looser (as the Patient shall see reason) from the lower Part of the Head be∣hind, above the Ear, unto the greater Corner of the Eye.

V. This Wire ought to be cover∣ed with Silk, and made somewhat broad at both ends, lest that the sharpness thereof should hurt any part it comes to; but the end in which the Artificial Eye must be put, ought to be broader than the other, and covered with a thin piece of Leather, that up∣on it the Colours and liveliness of the Eye may be shadowed and Counterfeited.

II. Of the Nose.

VI. If the Nose be lost, it is requisite to make a Nose-Artificial of Gold, Silver, Tin, Paper, or Linnen Cloth glewed together; and it ought to be Coloured, Coun∣terfeited and made, both for Fashion, Figure and Bigness,

that it may as much as possible, resemble a natural Nose.

VII. This Artificial Nose must be stayed with little Threads or Strings, unto the hinder part of the Head, or a Cap upon the Head: And if any part of the upper Lip is lost with the Nose, you may shadow it with an Appendix to the Nose, and Counterfeit it according to Art, like the for∣mer.

III. Of the Ears.

VIII. The Ear is gone, either wholly or in part: If it be wholly wanting, another must be made of Paper Artificially glewed to∣gether; or else of Leather, which is much better, and so fastned with Laces from the top or hin∣der part of the Head, that it may stand in the appointed place.

IX. Or you may have an Arti∣ficial Ear made of Leather, and Counterfeited or Painted, so that it may resemble the Shape and Co∣lour of a Natural Ear; which may be retained in the place where it ought to stand, with a Steel or Brass Wire coming from the top, or hinder Part of the Head, as we have before spoken of the Eye.

X. If the Ear be only lost in part, it ought not to be neglected; but you must make many holes in the remaining part, with a Bodkin; and after that the holes are cica∣trized, or healed, let some con∣venient thing be artificially for∣med, like unto the part of the Ear lost, which being shadowed and Painted, let it be tied, or fastned, unto the remaining part by those holes.

IV. Of the Palate.

XI. If a part or portion of the Bone of the Palate being broken by any accident, is lost; or corroded, through the Virulency of the Pox, falls away (as is usual,) where∣by the Patients cannot easily pro∣nounce their words, but ob∣scurely, and with snuffling; this is to be remedied by an Artifi∣cial Palate, or a Plate filling the Vacancy in the Roof of the Mouth.

XII. It ought to be made of Gold or Silver, a little bigger than the Cavity it self is, as thick in the middle nearly as a Crown-piece, and in form like unto a Dish: On the upper side, which shall be towards the Head or Brain, a little Spunge must be fastned, which when it is moistned with the moisture distilling from the Head and Brain, will be swollen and puffed up, so that it will fill the Cavity of the Palate, that the Artificial one shall not fall down, but stand fast and firm, as if it stood of it self.

V. Of the Teeth.

XIII. If the fore Teeth are broken, or come forth of their places, causing a Deformity to the Mouth, or causing a Lisping, and hindring a right Pronounciation; other Teeth are Artificially made of Bone or Ivory, which may be put in the place of those which are wanting.

XIV. They must be joined fast one to another, and also so fastned unto the Natural Teeth adjoining,

which are whole; And this must be done with fine Gold or Silver Wire; or, for want of them, with a common well twisted Thread of Silk, throughly wax∣ed for strength sake.

CHAP. XLVII. ARTIFICIAL ARMS and LEGS.

I. IT is Necessity which investi∣gates the Means whereby we may help and imitate Nature, and supply the Defects of Members, which are perished and lost; which in the Case of Arms or Legs, may well be done with Silver, Latten, Steel, Copper, Wood, or other fit Matter.

II. And some have been made by Ingenious Smiths, or other Artifi∣cers, with which the Party which wore them, have performed the proper Functions of going, standing, and handling; and with their Artificial Legs, Feet, Arms and Hands, have done other necessa∣ry Flexions and Extensions, be∣yond what can possibly be ima∣gined, by any but such as have seen them.

III. These, says Ambrose Par∣rey, are not only profitable for the Necessities of the Body, but also for the Decency and Comliness thereof; whose Forms or Figures you may see in the said Author, lib. 23. cap. 12. Page 532, 533, & 534.

IV. Arms, Hands, and Fingers must be made of Iron, or Latten, with many Wheels and Screws, to make the required Motion, that they may be the more useful, when applied to the Intention; and they are to be conveniently fixed to the Shoulder, Elbow or Wrist, and be tied on with Strings.

V. Legs, Feet and Toes are more frequently made use of, espe∣cially the first; some being made in the form of natural Legs, others all small downwards, with a Seat, wherein are put small Pillows or Bolsters for the Knee to rest on; which also are to be fastned with Strings to the Thigh.

VI. Sometimes also it happens, that the Patient who had the Nerves or Tendons of his Leg wound∣ed, long after the Wound is whole and consolidated, cannot go but with very great Pain and Misery, by reason that the Foot cannot follow the Muscle which should draw it up.

VII. To remedy this, you must fasten a Linnen Band (moderately strong) unto the Shooe which the Patient wears on his pained Foot; and at the Knee it must have a slit, where the Knee may come forth in bowing of the Leg.

VIII. This Linnen Band, or Strap, coming thus up above the Knee, must be trussed up fast un∣to the Patients Middle, that it may in some measure move, lift up, and erect the Foot in going.