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I. WOunds of the Brain are said to be Mortal, upon a twofold Cause; 1. Because it is a Principal Part, and the Ori∣ginal of the Nerves and Animal Faculty. 2. Because it usually induces many grievous, and for the most part, Mortal Sym∣ptoms.
As it is a Principal Part, the Spirits are soon wasted or spent, and the prejudice is im∣mediately imparted to the whole Body. And, as to the Sym∣ptoms, they are Inflammati∣on, hurt of the Animal Facul∣ty, and Convulsions. Now by Wounds of the Brain, we mean, Wounds of the Meninges, which reach to the Substance of the Brain; also Wounds of the Substance it self. Yet some∣times the Meninges have been hurt, the Life being safe, and therefore some Authors will have them to be enumerated among dangerous Wounds.
II. Now when the Brain, or its Membranes are hurt or wounded, Blood comes out at the Nose, and in some, at the Ears; Generally Vomiting of Choler follows, and some have their Senses stupifi∣ed, the Eyes turn strangely in the Head; and on the third (and sometimes sooner) or fifth Day, a Delirium is induced; and some have a Convulsion of the Nerves.
III. But if a Membrane only be hurt, the Patient has a notable violent Head-ach, which is en∣raged by shutting the Jaws, and holding their Breath, the Eyes are hot, the Tongue falters, and there is Dotage.
IV. If the Substance of the Brain is Wounded, the Patient falls down, and the Voice is lost. The Face is sometimes drawn awry, there is Vomiting of Choler, and a white Humour like Pap runs out at the Ears.
V. If the Stomach (says Hip∣pocrates) be Wounded, it is Mor∣tal. Yet Galen seems doubtful in this Case, because some have been wounded in that Part, and have been cured. In my Opi∣nion therefore, it may come a∣mong the dangerous Wounds; for if the Stomach be but slight∣ly wounded, it will agglutinate. And though Celsus (agreeing with Hippocrates) says, Wounds of the Stomach are Mortal, yet Marcellus Donatus relates, how several wounded in their Sto∣machs have recovered; and of late, a Patient of mine in Lon∣don, recovered of a Wound in the Stomach.
VI. A Wound in the Outer Tu∣nicle easily heals; but if it pierces into the Cavity, it will prove more difficult to Cure. A Wound in the bottom of the Stomach has less of Danger; but a Wound in the Mouth thereof, which is of a very nervous Substance, is desperate, not only for the Ex∣cellency of the Part, but for its Communication with the Heart and Brain, and being void of Blood.
VII. If the Stomach then be wounded, the Hiccough follows, with Vomiting of Choler. Meat and Drink are cast up immedi∣ately, the Pulse fails, and there are frequent Swoonings: Cold Sweats follow, and the Extream Parts chill and grow cold; and there is a most vehement pain, more especially if the Wound tends upwards.
VIII. Wounds of the Liver, by reason of a vehement Flux of Blood, are mortal. For the Patient dies by Fluxion of Blood, before agglutination can be made: But this is to be understood of large and deep Wounds, for such as are shallow, and in the edges of it, may be healed. Therefore,
IX. It was the Opinion of Cel∣sus, that Wounds of the Liver, in the Vena Porta, were only Mor∣tal; and that when the thick part of the Liver was wounded, Death generally ensued: That is, when the Concave or Convex Parts thereof are hurt; but other Wounds thereof are only dan∣gerous; and unless happening in a Cacochymick Body, or in one committing some Error, are not hard to heal.
X. Now, when the Liver is wounded, much Blood flows out of the Right Side, and the Bowels are drawn to the Back-bone. There is also sometimes Vomiting of Choler, the Sick looks pale, Coughs, and delights rather to lie on his Belly; he makes bloo∣dy Urine and Stools, languishes in a Fever, and at length the Body consumes away.
XI. These, if they be large, and make a deep solution of Ʋnity, if they waste the Parenchyma of the Part, and hurt the great Vessels, and some principal Branches of the Arteria or Vena Pulmonalis, are said to be Mortal. Because there∣by is made a great Effusion of Blood, and Dissipation of Vital Spirits; besides, the Coagula∣ting of the Blood in the adjacent Vessels, will in some measure impede its Circulation: And tho' the Wounds of the Lungs may be small or superficial, if the Cure be not skilfully managed, they may kill.
XII. And though the great Ves∣sels are not wounded, but only the Bronchia, or Aspera Arteria, the Case is Mortal, but at a greater distance of Time; several Sym∣ptoms conspiring to that End; as, the Communication with the Heart, Putrefaction of the Lungs, Dissipation of Spirits, a Conti∣nent Fever, and Difficulty of Cure, by reason of continual Motion and Cough, still en∣larging the Wound.
XIII. And Galen, Meth. Lib. 5. cap. 2. says, Wounds of the Lungs admit not of Cure, not for that the Part is in continual Mo∣tion (as some before him ima∣gined) but because the Pus or Sanies are difficultly gotten out from thence: And much of this mind was Celsus, lib. 5. cap. 26. who affirms, it is only incurable, when the middle of the Lungs are wounded.
XIV. But if the lesser Blood-Vessels be broken, or the Flesh of the Lungs divided, though the Wound may kill, yet it does not do it suddenly, and possibly a Skilful and Careful Artist may Cure it, unless it be inflamed. And 'tis thought that more danger lies in a Wound of the Substance, than of the Vessels, because they are more difficultly healed.
XV. When the Lungs are wound∣ed, there is Difficulty of Breathing, and frothy Blood comes up at the Mouth, making a noise when he Breaths. He lies easiest on the wounded Side, and then he speaks; but on any other Side he is dumb: If the Wound be wide, frothy Blood comes out at it; but if not wide, it comes up at the Mouth: The Vessels of the Neck swell, the Tongue is discolored, they draw in much Breath, and crave cold things; and if it continue long, a Fever is induced, and with it, a Phthi∣sis, and Death.
XVI. The Events of these are various, according to the variety of its Substance. If a Wound be in its Nervous Parts, which is its Centre, it is Mortal; for its constant Motion hinders Agglu∣tination. If it be in its fleshy Part, which goes round the in∣side of the Thorax, it is possible to be healed, as Galen has ob∣served: But if an Inflammation comes thereon, the Cure will be very Dangerous and Diffi∣cult.
XVII. When the Midriff there∣fore is wounded, the Praecordia are attracted upwards, they breath slowly, and the Back akes. And Paulus affirms, That if breathing be enlarged, it is with Sighing, and Pain all over the Shoulders.
XVIII. Wounds, says Galen, into the Cavity of the Guts, are very seldom healed: And Hippo∣crates, Sect. 6. Aph. 18. says, If the small Guts are wounded, it is Mortal. And this is, not on∣ly because of their Substance, but because we cannot well ap∣ply Medicines to them.
XIX. But the Jejunum being wounded, is said to be most incu∣rable; because of the Magni∣tude of its Vessels; thinness of its Tunicles, its Nervous Sub∣stance, its Proximity to the Liver, and Susception of Cho∣ler: But it is said, That a Wound has sometimes been cured, when it has only touched its Out∣side.
XX. Wounds of the other Guts, if slight, or not cut in two, are apt to heal, because their Substance is very Carnous; and they seldom kill, unless seized with an Ili∣ack, or an Inflammation, or Gangrene supervene. A Proof of this I had in a Negro of my own, who being wounded in the Guts, had his Excrements come through them and the Belly, for near six Weeks toge∣ther; I only applied outwardly an Emplaster to the wounded Parts, and kept him warm, with a Laxative Diet made of Maiz and Milk, and in two Months time he was as well as ever, and went to his Work again.
XXI. But great Wounds, and transverse, or being cut in two, are Mortal. And the reason is, by the great separation of Parts, being kept asunder by a large afflux of vitious Humors: Besides, being cut totally asun∣der, they can never come toge∣ther again to unite; nor can
the Excrements ever after go through the Body.
XXII. The Sign that the Guts are wounded, is, that the Excre∣crements come forth at the Wound. There is a Swelling in the Prae∣cordia, and Choler sometimes comes out at the Mouth: So also, if the lower Guts be wounded, for then the smell, as well as Excrements, shew it.
XXIII. Wounds of the Bladder, are Mortal, says Hippocrates, Sect. 6. Aph. 18. If it be wound∣ed through and divided, with a large Wound, it is Mortal; but a small Wound has been known by Experience to heal up, and that firmly; and if it be incu∣rable, it must be in the Nervous Part.
XXIV. Wounds in its Carn∣ous Parts are curable; for we daily see, that Wounds made there, by Cutting for the Stone in the Bladder, are made with Safety, and soon cured, if the Body be not Cacochymick: But Wounds are with difficulty cu∣red, if made in that Part, where the Bladder is tied to the Os Sacrum.
XXV. When the Bladder is wounded, there is Pain in the Groins, and they swell above the Os Pubis: Blood comes away with the Urine, and the Urine runs out at the Wound: There is Sickness of Stomach, and in∣clination to Vomit, and they are cold and dry, vomiting Choler, or having the Hiccough.
XXVI. These are said to be as Mortal as those of the Brain; and Galen tells us, It is a kind of Brain to all the Parts which are below the Head. For, from it many Conjugations of Nerves spring, which give Sense and Motion to most of the other Parts of the Body; and there∣fore, from it many grievous Sym∣ptoms arise: It also Communi∣cates with the Brain and other adjacent Parts, and is of Diffi∣cult Cure; and the higher the Wound is in the Spine, the more Mortal it is.
XXVII. If the Spinal Marrow be totally hurt in any of the Ver∣tebrae, all the lower Parts are resolved, or suffer a Paralysis, as Galen affirms. But if only one side is hurt, and the other re∣mains whole; the Paralysis af∣fects only the lower Parts on the same Side hurt.
XXVIII. But in respect to the Nature of the Part, a Wound in the lower Part of the Spinal Mar∣row, is far worse than that in the upper. Because, as Colum∣bus observes, the Marrow above is soft, and perfectly of the Sub∣stance of the Brain, whereas that below is almost Nervous: Yet such Wounds must be very great, to make them Mortal.
XXIX. If the Spinal Marrow be cut transversly asunder, it is certainly Mortal. But, if the Weapon has not run deep into it, there is a possibility of Re∣covery.
XXX. If therefore the Spinal Marrow be wounded, there is a Paralysis of some particular Part or Parts, and a Convulsion of the Nerves: Sense is also lost; and at some times there is an invo∣luntary voiding of Seed, Ordure, or Urine.
XXXI. If they be in the Ar∣teria Magna, or Vena Cava, or other great Vessels in the inside of the Body, as the great Arteries and Veins about the Neck and Throat, Arm-pits, Thighs, Legs, they are Mortal. And they must needs be Mortal, because of the large Effusion of Blood, and the impossibility of stopping it.
XXXII. And by how much they run less out of the Body, by so much they die sooner, because the Patient is Suffocated. Their Nervous Substance, and deep Situation, shew the great difficulty of Cure, because nothing can be exhibited, which can carry its full Virtue to them; besides, the great exhausting of the Vital Spirits.
XXXIII. When these great Ar∣teries or Veins are wounded, a great quantity of black Blood is cast forth, the Patient immediate∣ly looks pale, and Death is at hand. The Pulses presently alter and fail, and the Arteries cast forth a thin, yellow, frothy Blood.
XXXIV. If they be great, they are always Mortal; and the Pa∣tient dies of them, not because the Breath has a Passage out at the Wound, but because their Substance, or Matter, is Carti∣laginous, and in perpetual Mo∣tion, so that it can never be healed. And it is observed, that Wounds in the upper Part of the Throat, where divers Nerves, Arteries and Veins meet, are most dangerous.
XXXV. But if it be Cut any where else, it may be Cured; for in a dangerous Quinsey, we of∣ten order Laryngotomia, and that successfully: And therefore slight Wounds of the Aspera Arteria are many times cured.
XXXVI. In these Wounds but little Blood comes forth, because of the nature of the Part, and many times the Breath comes forth at the hole. But by degrees the Throat is filled with Blood; there is great Pain backward, the Voice is hoarse, and the Tongue dry.
XXXVII. Wounds of these Parts are generally Mortal: For many Vessels are spread through the Kidnies, and they receive a perpetual Afflux of Recre∣ments; besides, they are of ne∣cessity for the Conservation of Life.
XXXVIII. But if the Wounds reach only to the thick and fleshy Part, and are slight, they are sometimes curable: But the Cure is very difficult, if they be deep.
XXXIX. When the Reins therefore are wounded, the Pain reaches to the Groins and Testicles: There is also difficulty of making
Water, and it is bloody, or all Blood.
XL. Simple Wounds of the Spleen are not Mortal, if a Skil∣ful Artist has the Cure in hand. For we have often known the whole Spleen to have been cut out of living Animals, and yet they still survived. I had some Years since, a Bitch whose whole Spleen was cut out, and I kept her several Years after, and she had several Litters of Whelps; only she became dull, and as if dis-spirited: But if any great Vessels be wounded withal, there is danger, according to the Magnitude and Excellency of the Vessels hurt.
XLI. When the Spleen therefore is only Wounded, there will come forth from the left Side, black Blood; and on the same Side, the Stomach and Praecordia will grow hard, with vehement Thirst, and Pain in the Throat, like as when the Liver is wound∣ed. These are the chief Signs shewing the Viscera to be wound∣ed; if none of them are mani∣fest, then none of these Parts are hurt, but you must inquire else∣where for the Cause of the Dis∣affection.
XLII. Wounds of the Heart are generally Mortal: If the Ventri∣cles be wounded, the Patient in∣fallibly dies. But if the Wound penetrate not so far as to the Ventricles, but stays in the Sub∣stance of the Heart, whereby Inflammation ensues, the Sick may possibly live a day or two. If the Wound reaches to the Ventricles, Death must necessa∣rily follow, because of the great Effusion of Blood, and vast Dis∣sipation and Exhausting of Spi∣rits. And though it may be objected, that Tumors and Ul∣cers have been found in the Heart, yet seeing these arise and grow gradatim, Life may some∣times for a while, subsist to∣gether with them, but in the end they bring a Syncope, Con∣vulsions, and Death. But Wounds, in regard that they suddenly disturb the very Frame and Oeconomy of the Heart, the Life cannot long subsist with them.
XLIII. If the right Ventricle be wounded, the wounded person may in this Case lengthen out his Life for some short time: But if the left Ventricle be wounded, the Person immediately Perishes; be∣cause the left Ventricle is the Store-house and Treasury of the Blood and Vital Spirits. But as to Wounds of the right Ven∣tricle, Sennertus in his Praxis, lib. 5. par. 4. cap. 3. has given us an Historical Relation of a Soldier, who was wounded into the right Ventricle of the Heart, and yet lived to the Sixteenth Day; this Soldier was opened by Nicholaus Mulerius, two other Chirurgians, Luke and Gasper Hullen, being also present with many more Spectators. The Man was a Soldier at Groningen, under the Most Illustrious Count Wil∣liam of Nassaw; he received his
Wound the 22 of August 1607, and died the 8 of September fol∣lowing; which strange, but true History, is found written on a Table, hanging up against a Wall, in the Library of the Uni∣versity of Groningen aforenamed.
XLIV. When the Heart there∣fore is Wounded, much Blood is found to come away: If it be the right Ventricle, the Blood runs black: If the left, the Blood comes forth more florid and light coloured: The Arteries or Pulses also flag, the Colour is pale, with cold, ill scented Sweats; then Coldness encreases upon the extream Parts, and immediate Death.
XLV. From all that has been said, it appears, that the Signs of the Disaffections of internal Parts, are to be deduced from, 1. The Hurt of the Action. 2. The Site of the Parts. 3. The Ex∣creta. 4. The Kind of the Grief. 5. And from proper Symptoms. So that, if in a wounded Per∣son Respiration is hurt, conclude the Lungs, Thorax, or Vertebrae are hurt. If Excrements come forth, the large Guts are wound∣ed; if Chyle, the small Guts: If Ʋrine come out at the Wound, the Reins, Ureters, or Bladder are hurt. As to the Site; if the Wound be in the right Hypo∣chonder, the Liver may be sus∣pected to be hurt; if in the left, the Spleen; if in the Pecten, or Share, the Bladder, &c. As to the Kind of the Pain; if it be dull, the Lungs, Liver, or Spleen are hurt; if sharp and pricking, their Tunicles and Vessels; it violent, the Stomach, Guts, and Nervous Parts. As to the Sym∣ptoms, consider what are proper to each Part. If a Frensie, Epi∣lepsie, &c. be present, the Brain is hurt. If Nauseousness, Vomiting, Hiccough, the Sto∣mach. If Respiration, the Tho∣rax. If Swooning, the Heart. If Convulsions, the Nerves, &c.