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 ...

CVIII. The Cure of a SIMPLE WOƲND. There are five principal Intentions of Cure, 1. The re∣moving things Extraneous, as coagulated Blood, Splinters of Bones, pieces of the Weapon, Rags, Hair, Sand, Dust, &c. which may hinder Unition. 2. To join the lips of the Wound even together. 3. To retain the lips so brought to∣gether, 'till they are consoli∣dated. 4. To conserve the native heat of the Part, in order to unition. 5. To prevent or correct ill accidents, which may intervene.

CIX. Thus much is required, if the Wound is only simplex; but if it is complex, with loss of substance, or contusion, then there is something more to do: as in loss of substance, with Sar∣coticks, to assist Nature in re∣storing what is lost: and if contused, the converting the contused substance into pus or matter, which must be done, before there can be possibly any healing.

CX. As to the first Intention, there must be a removing all things that are extraneous, or of a dif∣ferent substance; for so long as they remain, they will hinder unition; nor 'till then, can you hope in the least to make a Cure of the Wound. But before any thing of this kind is done, you are to consider, 1. Whether it can be done, or not. 2. Whether if it can be done, it can be done safely.

CXI. For sometimes the broken Weapon or Matter sticks so fast, that it can by no means be extracted; then you must of necessity leave it to Nature, who, in this case, does sometimes wonderful things. Splin∣ters, &c. have sometimes stuck so fast, or have been so in∣closed, that by no Artifice they could be gotten forth; yet at length, upon Apostemation of the Part, they have been thrust out.

CXII. If it may be done, whe∣ther it may be done with safety? For some will live a Day or more with the Weapon in their Bodies, who would otherwise dye, upon the moment of ex∣traction. But if you find the Patient is recoverable, then make haste with the extraction, and let it be taken forth before the wounded Part is inflamed. How extraneous things are in particular to be drawn forth, we teach at large, in Chap. 5. following.

CXIII. The Extraneous mat∣ters being now drawn forth, and the Wound cleansed by washing it with a little White-wine mixt with a third part of Spirit of Wine; you may permit the Wound to bleed, according as in judgment you shall see fit, respect being had, 1. To the

strength, and habit or consti∣tution of the Body. 2. To hinder Inflammation, as the generation of much matter.

CXIV. The bleeding being staid, (whether naturally, or by Art, it matters not much) let the Hair about the Wound (if any be) be shaved off; and wipe away the clotted Blood with Spunge dipt in Red-wine or Alicant, Oxy∣crate or Posca, (which is Vin∣egar and Water mixt together, or Wine mixt with Water, &c.)

CXV. But if the clotted Blood sticks deep in the Wound, be not too busy to remove it with your armed Probe, lest you stir up a new Hemorrhage or Bleeding: and understand, that this coagulated Blood keeps the Wound warm, and defends it from the injuries of the ambient Air; and that Nature will cast it out in due season, by Dige∣stion.

CXVI. The second Intention, is the exact Joyning of the Lips of the Wound together: for with∣out this exact conjoining, a slow, and a deformed Healing will follow: and this truly is the sole work of the Artist, for Nature has nothing at all to do in this business.

CXVII. You must not lay a Pledget, or a Dossel of lint, or put a Tent into a little Wound; for those are the ways to keep the Wound open, make it painful, cause defluxions of Humors, weaken the native heat of the Part, and prolong the Cure, which is diametrically contrary to the true intention of Healing.

CXVIII. The parts, or lips of the Wound then separated, are to be brought together gently and equally; that they may just touch one another, and so be prepared for Unition.

CXIX. It is to be done, as Fal∣lopius says, by little and little, not hastily, and at once: if they be equally soft, bring them equally together; if the one is soft, and the other hard, or immoveable, or not to be moved but with difficulty, then bring the soft part to that other.

CXX. If the Parts are grown stiff with Cold, (as some are, who have lain in the Field all Night;) in this case, you are to supple them with a Fomen∣tation of hot Milk, or warm Water; or embrocate them with Oil, till the lips are soft enough, and then endeavour their reunion.

CXXI. They are also to be con∣join'd equally, that the parts cut asunder may answer one another, both in the top and in the bottom; brim to brim, lips to lips, vessels to vessels; that Nature may be put into a condition to do her own work; and by virtue of its innate Balsam, reunite, agglu∣tinate, and consolidate or heal the Wound: in all which Intentions she is the Agent, the Chirurgeon only is the Assistant.

CXXII. The third Intention of Cure, is to retain the lips so brought together, 'till they be con∣solidated; and this is done by deli∣gation, which is the dressing and binding up of the Wound: for the accomplishing of which, the

great Masters of this Art have left us two principal means; viz. 1. Suturae, Stitching up the Wound. 2. Fasciae, Binding of it up.

CXXIII. As to Sutures, they they are said to be of three sorts; viz. 1. The Incarnative. 2. The Restringent. 3. The Conserver: to which add one more, which is called the Dry-stitch, or Suture.

CXXIV. The first of these is most in use with us, and is done by making so many Stitches at a set distance. Now you are to con∣sider the Wound; if it is but an Inch, little more more or less, in length, 'tis needless to be stitched; your Medicaments and Bandage will be enough to keep the lips together, and heal it.

CXXV. But if it is two inches or more in length, make one stitch in the middle; if it is three inches long, make two stitches; if four inches long, make three stitches, and so on; making the stitches less by one, than are the inches it is long: and in declining Parts, we many times make the stitches at a little more distance.

CXXVI. The Restringent-stitch, which is called the Glovers-stitch, is much in use with the Spaniards, who stitch almost all Wounds with it: in the Fore∣head and Face, it brings the lips very close; the third day they draw the Thread out, and with the Dry-suture they keep the lips together 'till the Wound is well, which is commonly in two or three days more. This Stitch is best in great Fluxes of Blood; but then in stitching, you must endeavour to bring the wounded Arteries and Veins to their wounded fellows.

CXXVII. The Conserver, or third Stitch is mostly of use in great Wounds; as those of the Oesophagus, Hare-lips, &c. to hold the parts forcibly together, and is performed with Pins or Needles, &c.

CXXVIII. The Ancients make another Stitch in Wounds of the Peritonaeum, which is thus: Have a fit Needle, with a long, strong, round, white Thread in it, and therewith take up the Peritonaeum on one side, and leave it on the other; then take it up on the other side, and leave it on this. It it so made, that the Peritonaeum, which is a dry Body, may be united with the Musculous Flesh: otherwise the fleshy parts would only unite, and the Peritonaeum lye open; upon which a Hernia would certainly succeed, and the Patient put to the perpetual trouble of wearing a Truss the remaining part of his life.

CXXIX. The Dry-suture, is the last kind of Stitch, which is proper chiefly to the Face, to keep the lips of those wounds close together, and avoid as much as may be the making Scars; and to be applied also after some of the former Stitches, to keep the lips together, 'till the Wound is perfectly congluti∣nated.

CXXX. As to the time of taking out the Stitches, it ought

to be when the lips are aggluti∣nated; which may be sooner or later, according to the habit of the Body, season of the Year, and nature of the Wound.

CXXXI. In transverse Wounds eight days are required; in lesser Wounds not so deep, three or four days: in the Face, it ought to be done the next dressing, lest the Stitches make so many Scars; but in this, every Man must use his own Judgment. As to the man∣ner and way, how these Stitches are to be performed, we leave you to the Directions of Chap. 6. following.

CXXXII. Now we come to the Bandage, or Binding the Wound up. If the Wound is small, and in a fleshy part, Bandage alone, without Stitching, will do the work: for Nature in giving nourishment to both sides of the lips equally, will finish the Unition, without any more to do.

CXXXIII. And by Bandage, as the union of Parts cut asunder are promoted, so also such as would unnaturally grow together, are kept asunder; as in Burnings and Scaldings, the Fingers would many times grow together, were they not by the binding up, hindred.

CXXXIV. There are three several kinds of Fasciation, Rowling, or Binding-up: viz. 1. Agglutinatrix, or Incarnatrix. 2. Retentrix, or Retentive. 3. Expultrix, or Expulsive.

CXXXV. By the Fascia Ag∣glutinatrix, or Incarnatrix, the lips of the Wound are brought to∣gether, and conserved in their right form: it is more strict than the Retentive, and more loose than the Expulsive; and is most of use in simple, fresh, and yet-bleeding Wounds.

CXXXVI. The Fascia Reten∣trix is used to keep Dressings on, close about the Wound. This for the most part is of use in Wounds of the Head; and is moderately to be bound on, not so hard as the former.

CXXXVII. Fascia Expultrix, which is done by a Rowler of one head; whose special use is, to force or expel out of sinu∣ous Ulcers or Fistula's, the Pus or Matter lodg'd therein: as also to prevent the afflux of Humors, and to press out of the substance of the Part wound∣ed, and places adjacent to it, such Humors as have already seated themselves there.

CXXXVIII. For the matter of your Rowlers, they must be made of good, strong, even, white Cloth, clean and gentle, without hems, seams, or threads hanging by: let the length be such as the place affected requires: and their breadth; for the Shoul∣ders about 6 inches, for the Thighs 5 inches, for the Legs 4 inches, for the Arms 3 inches, and for Fingers and Toes, 1 inch broad.

CXXXIX. Concerning Ban∣dages, Hippocrates saith, Vincu∣lorum aliud per se remedio est, aliud iis quae remedio sunt sub∣servit: among Ligatures, some are Remedies of themselves, others subserve to them which are Remedies. And so it is; the Incarnative and Expulsive

are Remedies in themselves; the Retentive is as the common Servant to the other. Now as to the way and manner, how this Ligature or Bandage is to be performed, you may see at large in Chap. 7. following.

CXL. The fourth Intention, is to preserve the native heat of the Part; that thereby agglutination, incarnation, and healing may be obtained; which tho' it is affirm'd to be the work of Nature alone, yet she generally acts by the help of a Medium, which answers in power to Glew, or things of a glewing nature.

CXLI. As soon as the Wound is made, there is a Balsam of Nature ready at hand for the Cure; which Balsam is Blood, at least the lymphatick, or serous part of it, by which Nature does the Cure, both by the first and second Intention.

CXLII. A Cure performed by the first Intention, is done per Symphysin, by Symphysis; which is a reunion of the parts, without any Medium, viz. without any Callus, Flesh, or other Body interposed; but in this case, the Balsam of Nature is the Medium, the Instrument of Unity, which knits the parts together.

CXLIII. A Cure performed by the second Intention, is done per Syssarcosin, by Syssarcosis; which is a reunion of the parts, by, or with the help of a Medium, viz. with Flesh, or a Callous substance, in∣terposing, or filling up the space between the lips of the Wound.

CXLIV. And therefore great care is to be taken, that the Blood may not offend either in quantity or quality: too much is the cause of proud and loose Flesh; and too little affords not a sufficiency of matter for the Work. And as to its Quality, if it is cacochymick or evil, it cannot produce good Flesh; for such as the Blood is, such will the Flesh be.

CXLV. Now to make the Blood such as it ought to be, the Patient is to observe a good Diet: which ought to be rather slen∣der than full; because a full Diet is hurtful in Wounds, espe∣cially in gross Bodies, where there is danger of great Inflam∣mations, Pain, and other evil Symptoms.

CXLVI. But a greater liberty may be given to those, who have thin and exhausted Bodies; so that they may be allowed new-laid Eggs, strong Broths, Jellies, &c. also some Wine, where the Body has been long accustomed to the plentiful use thereof; or the total forbidding thereof, may very much hinder the Cure: and for other things, such Diet is to be observed, as their strength or weakness may re∣quire, and their Stomach permit.

CXLVII. As to Internals; Purging with strong, hot, or violent Catharticks is not fit; lest stimu∣lating or stirring up the Matter, it should flow to the weak or wounded part: but in gross and cacochymick Bodies, Lenitives are allowed; as Cassia, Manna, Tamarinds, Rhubarb, Sena with Sal Prunellae; also Syrupus Cathar∣ticus, and Broths, wherein Bor∣rage, Bugloss, Endive, Fumitory,

Lettice, Purslane, Sorrel, Suc∣cory, &c. have been boiled.

CXLVIII. And at set times of the day, they may take Vulnerary-Drinks; made of Adders-tongue, Agrimony, Avens, Bis∣tort-roots, Bugle, Cinkfoil, Cen∣tory, Comfrey, Fluellin, Ground-Ivy, Golden-rod, Herb-trinity, Horse-tail, Hypericon, Knot∣grass, Ladies-mantle, Mouse-ear, Mugwort, Pauls-Betony, Per∣winkle, Plantane, red Roses, Sanicle, Snakeweed, Scordium, Strawberry leaves and roots, Tormentil-roots, Vervain, Vale∣rian, wild Tansy, Yarrow, &c. as we shew more at large, in Chap. 3. ensuing.

CXLIX. Now in particular, for preserving the innate or native heat, and tone of the Part, without which no Ʋnition can be hoped for, Topicks are usually applied: it is true, that in small and simple Wounds, which are superficial, Nature of her own accord com∣monly does the Cure, and seldom requires more of us, than to bring the lips of the Wound close together, and defend it from fluxion: a Pledget of Linimentum Arcaei may be laid on, and over it Emplast. Diapalma; and then bound up, to keep all things on.

CL. But in greater Wounds, which will not so easily be cured, you must stitch the lips together; and then strew upon them the following Pouder. ℞ Fine Bole, Terra sigillata, A. ℥ss. Sanguis Draconis, Frankincense, A. ℥i. mix them: over which lay some of the same Pouder mixt with the white of an Egg, and over that a Compress, squeezed out of Oxycrate, and a suitable Bandage over all. This is the general use.

CLI. But lest by the sticking-to of the Emplastick-medicine, the lips of the Wound should be torn or disturbed, in taking off the Dres∣sing; you may apply over the sprinkling of the Pouder, the following Sarcotick-Ointment. ℞ Strasburgh-Turpentine ℥ iii. Gum-Elemi ℥ ii. Frankincense, Mastich, Olibanum, Sanguis Draconis, A. ʒii. mix, and make an Ointment; which spread upon a Pledget, and apply.

CLII. And over the former Pledget you may put Emplastr. Diapalmae, Empl. de Bolo, Cae∣saris, or the like; and then bind it up, as before directed.

CLIII. Or, applying first this Pouder: ℞ Aloes, Galls, red Roses, fine Bole, Sanguis draconis, Olibanum, Rosin, Catechu, A. ℥i. mix them; and mix some of the same Pouder with Turpen∣tine, Gum Elemi, A. q.s. which spread upon a Pledget, and put over the Pouder.

CLIV. And if there is any fear of an Afflux of Humors, or Inflam∣mation, dip Stuphs in juices of Plantain, Horse-tail, Yarrow, Perwinkle; or in red Wine, or Oxycrate: over which lay Em∣plast. Diapalmae, è Bolo, or some other like Emplaster; and lastly, bind it up, as before.

CLV. But if you design to cure by Agglutination, forbear the use of Fomentations, or other humid Medicaments; and preserving, your Stitches, you will find,

that Nature will do her part towards the consolidation of the Wound; nor will you have occasion for such Applications, if you have proceeded metho∣dically.