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. VII. Of a CONTƲSION.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Effusio, Suffu∣sio, Sugillatio, Contusio; and in English, a Bruise, or Bruising.

II. It is the pouring forth of Blood or Humors, into the next adjacent spaces, thro' the Veins or Arteries; either by 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, anastomosis; or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, diapedesis; or by 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, diai∣resis, the skin remaining whole; which for the most part comes to pass, either by the vehement pressure of some heavy weight, falls, blows, stoning, or the like. Gal. de Fract. lib. 2. com. 16.

III. The Kinds. Galen. lib. de Tumor. cap. 10. & de Simp. Med. Fac. lib. 10. cap. 9. makes two kinds of Contusions; 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ecchymoma; which is the general name; and is when the Contusion is of a middle colour between red and black, to wit, of a livid or leaden co∣lour; and this the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Pelidna, Lividness.

IV. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Melasma, which is Blackness; and this is most familiar unto old persons, as oft as their Veins are bruised; as the other, to wit, Pelidna is familiar to Children, and such as are young.

V. But Paulus Aegineta, lib. 4. cap. 30. makes three kinds, ac∣cording the diversity of the parts affected; of which, the two first have relation to the Eyes, the last to the Nails of Fingers or Toes: these indeed are particular kinds as they have relation to those particular parts, but can by no means be accounted of, as in a general relation to the whole Body.

VI. The first is that which we

call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, hypopia; but by Hippocrates 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, hyp∣ophthalmia, i. e. subocularia, blewness under the Eyes. This second is 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, hypospha∣gma, called by some suggillatio, an Effusion of Blood into the Adnata, or Cornea-Tunicle of the Eye. The third 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, hyponychos, the Bruising of the Nails.

VII. The Signs. A Bruise is easily known from the preceding external Cause, the Colour it self, and the Swelling, if there is any which are evidently seen: the Physician may also understand it from the relation of the Patient.

VIII. Sometimes the hurt part is not elevated into a Tumor, the Blood only insinuating it self into the spaces of the parts, making the Skin of a red, yel∣low, livid, or leaden colour.

IX. And sometimes the Contu∣sion, by reason of its greatness, and the pouring forth of abundance of Blood and Humors under the Skin, and into the substance of the Flesh and Muscles, is lifted up into a Tumor; with which there is sometimes (according to the nature of the part) Pain, and sometimes Inflammation, and perhaps at length a Gangren may be excited.

X. The Prognosticks. A Con∣tusion is generally without danger, (if the principal parts be not hurt) and the Blood, whil'st it is thin and not coagulated, may easily be dissipated or discussed.

XI. But if it is long deteined in the part, and the Contusion is great and considerable, and near some principal part, it may prove of dangerous consequence; for the corruption of the part af∣fected may be feared, with other mischief to the whole Body.

XII. For the Blood being coagu∣lated, and not insensibly discussed, or turned into Pus, (which is ab∣solutely necessary, where the Contu∣sion is great:) Putrifaction and a Gangren are at length in∣duced, which many times costs the Patient his Life.

XIII. If also the part affected loses its colour of wanness, livid∣ness, or greenness; and becomes very much distended, hard, pain∣ful, and inflamed; great danger is threatned, and a Gangren or Sphacelation is at hand.

XIV. The Cure. If the Con∣tusion is great, care is to be taken in the beginning, to prevent the afflux of Blood to the place, lest an Inflammation should be ex∣cited.

XV. To perform this, some Au∣thors prescribe Venesection; but this intravasates none of the Blood that is already out. However, Defensatives and Repercussives are to be applied near to, and about the part affected; to pre∣vent, as much as may be, the influx of Blood into the same.

XVI. And of this kind are Alum, Bole-Armoniack, Catechu, Terra sigillata, Sanguis draconis, Poppies, roots of Hounds-tongue, Henbane, Hemlock, juice of Hem∣lock, Roses, Myrtles, Cypress∣nuts, Opium, Camphir, Galls, Pomgranate-flowers, roots of the lesser Consound, Saccharum Sa∣turni,

Housleeek, Nightshade, Orpin, Nitre, &c. out of which Compounds may be made.

XVII. ℞ Bole ℥iv. Vinegar q.s. mix, and boil them; then add Balaustians, Red-roses in fine pouder, root of Consound in pouder, A. ℥ss. Oil of Myrtles q.s. mix, and make a Cataplasm.

XVIII. Or: ℞ Terra sigilla∣ta, Chalk, A. ℥ii. Vinegar q.s. mix and boil; then add pouder of Pomgranate-peels, Nut-galls in pouder, A. ʒvi. Sanguis draconis ʒii. Nitre ʒjss. Saccharum Sa∣turni ʒi. Oil-omphacine q.s. mix, and make a Cataplasm.

XIX. Or: ℞ Whites of Eggs ℥ii. Rose-water ℥i. Saccharum Sa∣turni ʒi. shake or beat them well together, and with Towe, apply them to the place affected.

XX. Or: ℞ Whites of Eggs ʒii. Rose-water ℥i. beat them well together, then add Oil of Myrtles ℥jss. fine Bole ℥i. Caput Mort. of Vitriol, Dragons-blood, A. ℥ss. Vinegar q.s. mix, and make a Cataplasm.

XXI. But this is to be observed, that you are not to apply many moist and clammy Medicaments; lest the extravasated Blood be putrified, from whence ma∣ny dangerous Symptoms may ensue.

XXII. If the Contusion is from some vehement cause, as a fall from some high place, crushing of a Cart, &c. whereby the Blood is poured forth in some extraor∣dinary manner; and that not only the external part may be hurt and bruised; the Blood will then be apt to coagulate or clot together; thereby inducing many evil Symptoms, extreamly dangerous, as Inflammations, violent (even the worst of all) Fevers, and very oft Death it self.

XXIII. When therefore there is the least fear that the Blood is extravasated, and faln into the more inward parts, and that it cannot be dissipated by external Medicaments; you must then endeavour to hinder its coagu∣lation; and if it be begun, that it may be dissolved, and that with all possible speed it may be carried off by Stool, Urine, or Sweating.

XXIV. For when once the Blood and Humors become putrid, the Disease will not be so easily cured; and sometimes not at all with∣out extraordinary and specifick Remedies, and great care, pains, and industry, and ap∣plication.

XXV. For this purpose, Phy∣sicians commend these following Simples; Winter-cherries, Pelli∣tory of the Wall, Fumitory, Hype∣ricon, Scabious, juice of Citrons, or Limons, Carduus benedictus, Vinegar, Chervil, Parsley, Hydro∣piper-water, Madder, Rhapontick, Rhubarb, Terra sigillata, fine Bole, Sperma Ceti, Crabs Eyes, Mummy, Volatil Sal-Armoniack, Salt of Harts-horn, Spirit of of Sal-Armoniack, and Spirit of Harts-horn.

XXVI. Sperma Ceti is given à ʒi. ad ʒii. dissolved in Vinegar, or Parsley, or Hydropiper-water.

XXVII. ℞ Hydropiper-water ℥iijss. Parsley-water ℥ii. Vinegar, or juice of Limons ℥ss. mix for a Dose.

XXVIII. ℞ Hydropiper-water ℥iv. Spirit of Harts-horn ʒj. mix for a Dose. Or: ℞ Parsley-water (in which Onions have been infused) ℥iv. Spirit of Sal-Armoniack ʒi. mix for a Dose.

XXIX. Or: ℞ Of Our Aqua Bezoartica, or Spiritus Cordialis ℥i. Hydropiper-water ℥iv. Spirit of Harts-horn ʒi. mix for a Dose. These things may be given upon the spot.

XXX. Then at night you may give of Our specifick Laudanum, à gr. ii. ad iii. or iv. drinking after it a little mull'd Sack. The next night, that the Body may be a little opened, you must give a Dose of Our Cathar∣tick Laudanum; so will the Patient have a gentle Stool (without pain, or griping) the next day in the afternoon.

XXXI. Some give this. ℞ Rhubarb ℥ii. Terra sigillata, Crabs-eyes, Ox-blood dried, Sper∣ma Ceti, A.ʒi. Nutmegs ℈i. mix, and make a Pouder. Dose, ʒi. or ℈iv. at a time, in Milk-water, or Hyodropiper-water.

XXXII. Or this. ℞ Rhu∣barb ʒiii. fine Bole, Goats blood prepared, Crabs eyes, Sperma Ceti, Mummy, Comfrey roots, round Birthwort root, Nutmegs, A. ʒi. make a Pouder. Dose, ℈iv. in Syrup of Limons: after these Examples you may make a thou∣sand other Mixtures.

XXXIII. Some give Balsams inwardly; the chief of which are Lucatella's Balsam, as also Balsam de Chili, Capivii, Peru, Tolu, &c.

XXXIV. This following is commended by some Practisers. ℞ Angelica, Bawm, Bugle, Be∣tony, Cinquefoil, Fennel, Ground-Ivy, Hyssop, Ladies-mantle, Parsly, Peniroyal, Sanicle, Sage, South∣ernwood, Smallage, Tormentil, Yarrow, A. M. i. fresh new made Butter lbiv. being gathered green, shred them, and boil them in the Butter till they are crisp, adding Wine lbi. then press forth the Li∣quor, and add again the same quantity of Ingredients, boiling as before, and pressing out: to the pressed Liquor add Strasburgh-Turpentine, Balsam Capivii, Bal∣sam of Tolu, Sperma Ceti, A. lbss. mix, and make a Balsam. Dose, ℥i. in Syrup of Vinegar or Li∣mons, and outwardly you may also anoint with the same.

XXXV. For Liquors, Mum that is choice, and Spruce-beer, are much commended; drinking some one of them, half a pint at a time, blood-warm, morning, noon, and night.

XXXVI. As for Topicks, at the beginning Astringents are to be mixt with Discussives, that the bruised Tunicles of the Vessels out of which the Blood is poured, may be strengthned and bound up; lest new mat∣ter flows thither thro' the pain.

XXXVII. For if Discussives be only used, they will by their heat be apt to drive more Blood into the contused Part, before the contused Vessels can be possibly restored to their natural state.

XXXVIII. For this purpose therefore the Skin of a Lamb or Sheep new taken off, is many times applied, before it is cold, sprinkled with a Pouder made of Myrtle-berries, Bay-berries, fine Bole,

Catechu, and Salt: and this is chiefly for external Contusions, made by beating, whipping, and the like.

XXXIX. And where it cannot be got, a white drest Sheepskin may be got to lay over the place; it being first drest with this: ℞ Balsam of Peru and Chili, A. ℥iii. pouder of Myrtle-berries, Bay-berries, Catechu, A. ʒvi. Salt finely ground ℥ss. mix them.

XL. And the next day you may dress the place with Balsam de Chili or Peru, or Lucatella's Balsam, or with some of those mixed with Ʋnguentum Nico∣tianae; because these things pre∣vent the flux of new matter, hinder putrifaction, and also sufficiently discuss.

XLI. If the Contusion is par∣ticular, and external, (the Skin not being broken) foment it with the Spiritus Ʋniversalis blood-warm; or with that Spirit, in which Camomil, Fennel, Fe∣therfew, Southernwood, Tansey and Wormwood have been five or six hours beforehand infused.

XLII. Then bathe it with Powers of Amber, and after that apply Balsam de Chili or Peru, and so bind it up. Some commend the root of Solomons-seal new gather'd, applied in form of a Cataplasm; or if in Winter, and dry, to be made into a Ca∣taplasm with Wine; which is said in one nights time to do the Cure, and cause the native heat to return to the Part con∣tused.

XLIII. Over the place also you may apply Clothes dipt in the following Liquor. ℞ Spiritus Universalis ℥xx. one Bulls Gall, Catechu ℥iv. in pouder, roots of Aron ℥jss. of Solomons-seal ℥iv. cut all small, digest six or eight hours, then apply it with the Clothes.

XLIV. But if by the use of all these things the Cure succeeds not, nor the matter is discust, you must then apply Cupping-glasses, and for the most part, with Scarification; because these extract whatever is contained in the Part, tho' the matter lies deep, and by the means of Scarification some of the Blood is also drawn forth.

XLV. If all these things avail nothing, but that signs of Suppu∣ration appear, as the swelling up a little of the place, a beating pain, a redness beginning to appear round about, with a softness to the touch; then you must promote the Suppuration by such things as we have declared in the Cure of a Phlegmon or Inflammation.

XLVI. The Suppuration being accomplished, the Apostem must be opened and cleansed, as we have before taught; and then the Ulcer is to be filled up with Flesh, and at length cicatrized, as is usual.

XLVII. But in this case, Sup∣puration must be used with cau∣tion; viz. that they be not of the stronger sort, but such only as are gentle and mild; lest a ca∣coethick, sordid, or putrid Ulcer be induced.

XLVIII. And therefore when we perceive the Contusion degenerates into an Apostem, we rarely wait for a present Suppuration; lest

the pus or purulent matter, being too long kept in the place af∣fected, should excite vehement Pains, malign Fevers, and a great Putrifaction; so as to cor∣rupt the adjacent Parts, Muscles, Nerves, Ligaments, and Bones, and cause cacoethick and putrid Ulcers, Fistula's, &c.

L. You must then never apply emollient and suppurating Cata∣plasms and Emplasters; because they, by reason of their moisture, are apt to induce putridness, and other evil Symptoms.

LI. In this case, Authors ad∣vise us, that the Apostem excited by coagulated or congealed Blood, be forthwith opened with an Incision-knife; and then a Tent put into the Wound, dipt in Ʋnguentum Aegytiacum; defen∣ding the whole part affected, and laying over it some proper Emplaster, which may preserve the native Heat, and kept it from putrifaction: and this is more especially to be observed if the Contusion is in the Belly, Hypochonders, Sides, or Back.

LII. For then the third, fourth, or fifth day, you must observe, whe∣ther there are any signs of an Apo∣stem (as swelling, with pain in∣creasing, pulsation, uneasiness, not enduring it to be touched, and a redness in the circumference:) for where-ever they appear, (tho' no lividness, blewness, yellow∣ness or blackness appear in the external parts) they demonstrate that purulent matter is gene∣rated, and an Apostem produced.

LIII. Ʋpon which, the place is speedily to be opened, that the Pus may be brought forth, lest it retires unto the more inward parts; making (as it were) Coney-boroughs, and eating asunder the Nerves, Ligaments, Muscles, and Vessels, thereby causing either speedy death, or some lingring Disease.

LIV. Then the Wound is to be ordered, as before directed; and during the whole course of the Cure, Vulnerary or Traumatick Potions are daily to be given.

LV. But if the hurt is great, or some error has been committed in the managing of the Cure, so that the place begins to look black or blew, and that by reason of the suffocation of the native Heat, a Gangrene and Mortifica∣tion is feared; you must then immediately scarifie the part, and apply Cupping-glasses, that so the putrid Blood may be evacuated.

LVI. This done, the part is to be fomented with Powers of Am∣ber, or Spirit of Wine, mixed with a little Spirit of Sal Armoniack, or with the Spiritus Ʋniversalis; or with the Liquor at sect. 43. aforegoing.

LVII. Or you may use warm. Vinegar, or the Decoction made of roots of Radishes, of Aron, of Solomons-seal, of Virginia Snake∣root, and Winters Cinamon, in Wine, or their Infusion in Spiri∣tus Ʋnversalis: for that these things dissolve and draw forth the clotted Blood from the very bottom of the Affect.

LVIII. After which you may apply Diachylon Simplex, or cum Gummis; or for want there∣of, any other drawing Emplaster.

LIX. Or this Cataplasm: ℞

Camomil, Smallage, Southernwood, Tansy, A. M. ss. juice of Aron or Musterwort q.s. mix, and make a Cataplasm; adding a little Spirit of Wine.

LX. If the Contusion is in the Muscles, chiefly those about the Ribs, the Flesh generally swells a little, with a kind of purulent Matter; which being pressed down, sends forth a kind of flatulent Air, with a little noise, leaving for a time the print of the fingers after it; which if it be about the Costae or Ribs, endangers a putrifaction or mortification, with a separation of the Flesh from the Bones.

LXI. In this case the Remedy must be speedy, by applying things which cleanse and restore the na∣tural Heat; after which it must be strongly drawn together, and firmly bound up, with Emplast. Diachylon, made up with a little pouder of Myrrh, or some other like Digestive.