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 ...

I. Hernia Intestinalis.

VII. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in La∣tin, Enterocele, Oscheocele, Hernia Intestinalis, Hernia in Scroto, Hernia Peritonaei; in English, a Rupture of the Peri∣tonaeum, wherein the Guts fall into the Cods.

VIII. It is either perfect, when the Guts fall quite into the Scro∣tum; or imperfect, when they fall down but part of the way, and this latter is called only a Relaxation.

IX. The Peritonaeum is the Membrane that is either broken or relaxed, and lines all the inside of the Abdominal Muscles; then passing to the Back, does there involve, and give Coats to the Viscera: it is strong, and every where double; in the duplica∣tures of which, all the Viscera are hid, and thro' which all the Vessels do pass.

X. The lower part of it is the strongest, to enable the Belly the better to bear the weight of the Intestines: and being every where double, admits not of a perfora∣tion, for the transmission of the Seminal-vessels; but does so re∣ceive them between its Coats, as that passing between the first Coat, leaves it every where intire, even both at Navel and Groin: in which latter place, the Seminals do take the outer Coat of the

Peritonaeum along with them; which containing them in it self, does at length make that Tu∣nicle which involves the Testi∣cle, and is called Elytroïdes, or Tunica vaginalis.

XI. Here then, if the inward Lamina, or Coat is strong, it keeps the Guts and Humors with∣in the capacity of the Abdomen; so that tho' it is full of Water, yet it transmits none into the Scrotum: for the watery Tu∣mors of the Cods in Hydropical persons are generally Anasar∣cous; as coming outwardly into the Membranes of the Scrotum, and not passing from the cavity of the Abdomen thither.

XII. But if this inward La∣mina or Coat is thro' force, or any weakness broken or relaxt; then the Intrails are protruded to the Scrotum; and if broken in the top of the Process, the Bowels fall down into the lower parts of the Cod: but if the said top of the Process suffers only a relaxation, then the Mem∣brane being extended contains the Guts, and that membranous Partition that lies between the Guts and Scrotum, is visible.

XIII. The Causes. In Chil∣dren it may proceed from much crudity or moisture, vehement cry∣ing, strugling, and holding their Breath too strongly.

XIV. In elder persons it is caused from violent Exercise, jumping, leaping, vaulting, falling from a high place, blows, carrying great burthens, hard riding, vomiting, straining at stool, or exceeding great weight of the Bowels in fat People.

XV. The Signs. If the Peri∣tonaeum is broken, it is known by the sudden rise of the Tumor; whether made by blow, fall, overstraining, and the like; in which case, the Guts slide down into the Scrotum, or lye in a great Tumor in the Groin.

XVI. If it is caused by a blow or fall, Blood is sometimes extra∣vasated, and the Tumor is pain∣ful, whether in the Groin or Cods, and it soon falls from the Groin to the Cods; where, by laying your Hand upon the pro∣duction of the Peritonaeum, just at its going forth from the Abdomen; and withal causing the Patient to sneeze or cough; you may distinguish it from a Sarcoma, or Hernia carnosa, by perceiving the motion of the Gut, when it is there.

XVII. The Prognosticks. In young Children it is easily cured, if carefully managed; but in youths, with more difficulty: if under twenty, or while growing, they are curable, tho' the Guts are fallen down into the Cods.

XVIII. In people of full growth, the edges of the Peritonaeum sel∣dom or never unite, because they many times grow callous: and if the Gut is not speedily reduced, grievous pain succeeds, with Colick and Fever, because of the detention of Excrements; from whence many times comes inflammation, vomiting of Ex∣crements, yea sometimes Gan∣grene, and Death it self.

XIX. If the Rupture is very large, the Guts many times do their duty, as safely in the Scrotum, as if they were in their

true and natural places in the cavity of the Abdomen.

XX. If it is only a relaxa∣tion of the Peritonaeum, as it is least dangerous, so it is the easiest cured of them all.

XXI. If a Hernia Intestinalis be neglected in Women-kind, it will make a round Tumor near the Pudenda.

XXII. The Cure. In the first place, you must cause the Patient to lye upon his Back, and en∣deavour the reduction of the Gut; let his Head be declining, and his Hips raised high, causing his Heels to be drawn up to them.

XXIII. Then with your Hands, and warm Cloths, try to reduce it, by pressing moderately and gra∣dually upon it; but taking care withal, that you do not hurt or bruise the Testicle.

XXIV. If it will not yield to these, there being a repletion of hard Excrements, you must give Clysters of fat Broth, with much Salt; or Posset-drink lbi. with brown Sugar ℥iv. or the ordinary Turpentine-Clyster: or this; I•• Fat Broth lbi. brown Sugar ℥ii Aloes ʒi. mix and dissolve, and exhibit it warm; which repeat, till the Bowels are em∣ptied.

XXV. In the mean season, foment the Scrotum with a De∣coction of Camomil in Whitewine, applying hot Stuphs dipt in, and s•…•…eezed out of the Liquor; for some considerable time: and if the Excrements seem to be hardned therein, soften it, by applying after the Fomenta∣tion some emollient Cata∣plasm, made of Figs, Onions, Lilly roots, and Mithridate.

XXVI. The Guts being thus emptied, let them be reduced as before directed; and apply over the Part, Emplast. ad Herniam, or Our Empl. of an Ox-gall: Or this; ℞ Loadstone in fine pouder, Aloes, Dragons-blood, Bole Armo∣niack, Terra sigillata, Crocus Martis astringens, Mastich, Oli∣banum, Sarcocolla, Frankincense, A. ℥ss. Ox-galls evaporated to the consistence of an Extract, Tur∣pentine, Wax, A. q.s. make an Emplaster; which apply, and renew it, when you find it will stick no longer.

XXVII. Then bind up the Part with a Bag-truss, made with Bol∣sters stuft with Cotton, and fitted with a steel Spring to keep the Bowels up, and all things close and firm. Or the Bolsters may be be fixed with steel Plates, having Worms and Screws therein; by which the Bolsters may be made to sit closer, or or more distant; and keep the Gut up, without pressing upon the Spermatick-vessels, or Os Pubis: and these may also be useful in an old Rupture, and where the hopes of Cure are vanished.

XXVIII. Where the Rupture is very large, thro' the often fal∣ling down of the Bowels, a Bag∣truss is to be proportioned, with a hole for the Penis to pass through; which is to be put on whilst the Patient is in Bed, and in a declining posture: by which means the falling down of the Bowels will be much hindred, and the Patient much eased in his going abroad; and if he

is young and growing, may be in the possibility of getting a Cure.

XXIX. Rest is of exceeding great advantage to the Sick; and therefore the Patient is required to keep his Bed 40 or 60 days: for by this means great Ruptures have been cured, to which all other means had been applied in vain, and the Patient ac∣counted as desperate.

XXX. And if the Patient has any need to sneeze, or cough; and upon going to stool, or any other violent motion, he ought to feel, and lay his Hand hard upon the place affected; that if there should be any danger of a Prolapse, or Relapse, it may thereby be prevented.

XXXI. As for Internals, and the remaining part of the Cure, we refer you to Lib. 1. Cap. 8. of this Book; and to the third Edition of Our Synopsis Medi∣cinae, lib. 5. cap. 14. afore∣mentioned, where you may have abundant satisfaction: tho' after all, it is my belief that rest, lying in bed, and a good Truss contribute more to the Cure, than all other things in the World, whether inwardly given, or outwardly applied.

XXXII. For things inwardly given can never come to the Part, but pass with the Ordure thro' the Bowels, without making any stay there: unless the virtue of the Specifick, by mixing it self with the Chylous Juice, and so joining with the Blood, does by circu∣lation approach thereto, when it is consign'd for the nourish∣ment of the Part. Which Con∣sideration, in my opinion, signi∣fies not much to the Cure; but only makes the Bloody and Nutritious Juices somewhat more consolidative and agglutinating.

XXXIII. Nor can things out∣wardly applied come directly to the Part hurt, any more than the other; there being the Scarf∣skin, Skin, Flesh, Membranes, &c. between, and interposing be∣tween the substance of the Agglutinatives and the Rupture it self.

XXXIV. If the Compress or Bolster sits uneasy, let a Quilt be made to lye under it, or brown Paper doubled, and soaked in Smiths Forge-water, wherein some Astringents have been boiled; by which the Truss will sit the easier, and the better retain the torn or relaxed parts to∣gether, for their more speedy agglutination.

XXXV. But if the Gut by reason of its long prolapsion, and the Excrements being hardned therein, cannot be reduced by the methods before prescribed; let the Patient be put into a half Bath, keeping on the Bag-truss the while: after which, coming out of the Bath let him be set on his Head, or carried with his Head downwards; by which means many times the pro∣lapsed Bowels are often re∣duced.

XXXVI. But if yet all endea∣vours should prove ineffectual, and the Patients Life is in apparent danger; which is manifest by manifold Vomitings, Sickness at Stomach, Inflation of the Belly, thro' the Patient's not going to

stool; it is better doubtless then to lay open the Production, whilst there is strength; than to let the miserable Patient perish under the force of his Disease: since the Operation may be done without any matter of difficulty or danger.

XXXVII. The way of doing it is thus. Lay the Patient flat on his Back, on a Table or Form, and bind him thereon; then make incision upon the upper part of the Scrotum, to the Production of the Peritonaeum; which must also be divided, without touching the Guts or Omentum: then pass in a Cannula, like the common Director, but as large as a Goose-quill, which put into the cavity under the Process of the Peri∣toneum upwards, avoiding the Guts: then make an incision of such a length as may be sufficient to put your Fingers into the Scrotum, and raise the Intestines and Omentum, which then reduce into their natural places within the cavity of the Abdomen.

XXXVIII. The Bowels being thus reduced, you must stitch up the Wound, as in a Wound of the Abdo∣men, taking up with your Needle so much of the Production as may shut up the Cavity, and hinder the falling down again of the Bowels. This done, you must Cure the Wound, as we shall hereafter shew in Lib. 4. fol∣lowing, where we treat of Wounds of the Belly; this being not so large or dangerous, as many of them are.

XXXIX. There are many other ways of doing this Operation, two of which are by Incision; the first of which divides the length of the Process, laying the Seminal Vessels bare: the other is Castra∣tion. There is another way, which is by Puncture, taught by Paraeus; and two other ways also, the one by the Actual Cautery, the other by the Potential: but as they are all of difficult performance, with much hazard, and great cruelty; so we never meet with a Patient which will submit to any of those ways of Cure; for which reason sake, we here totally omit them.