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 ...

Hitherto of Wounds simplex: now a word or two of the Cure of Wounds complex.

CLVI. These kinds of Wounds are not so often seen in times of Peace, as in times of War; in which they are frequent, when the Horse fall in among the In∣fantry, and cruelly hack them; some cutting twice or thrice in or near the same place: whereby the Wound is made large, deep, oblique, and trans∣verse at the same time, the lips being contracted various ways. See Sect. 109. aforegoing.

CLVII. In order to the Cure of these Wounds, where there is loss of Substance, you must first cleanse them, and then as much as may be, bring their lips toge∣ther by the Incarnative-stitch, making so many stitches as may hold them together: and if in some of them you think it not sufficient, you may as in the Hare-lip, pass Needles thro' the lips of the Wound, with little Plates of Lead, to secure them from tearing out.

CLVIII. If the Wound has been long undressed, or was not stitcht at first dressing, whereby it is so stubborn and contracted, that the lips will not be brought near one another; or if it is so deep as you may suspect the Incarnating, you must leave a declining Orifice, for discharge of the Matter; and then foment warm with some Lenient-decoction, made of the leaves and roots of Althea, Mallows, Violets, Lin∣seed, &c. or foment with new Milk, then join their lips to∣gether, and dress them as Wounds so stitcht.

CLIX. But if you leave a de∣clining Orifice, you must keep it open with a small Tent, dipt in some digestive; and after Dige∣stion, then you must withdraw the Tent, and heal up the Wound.

CLX. But the greater Wounds, which cannot be brought together by Suture, must be digested, and so disposed, that new Flesh may be generated to fill up the Ca∣vity; for which purpose, this Digestive is good: ℞ Turpen∣tine ℥iii. Gum Elemi ℥i. Barley-flower ℥i. Frankincense ʒi. mix, and make it up with the yolk of one or two Eggs.

CLXI. To the former Digestive, after a day or two may be added, Honey of Roses, to make it more cleansing.

CLXII. During the former Applications, the Humors ought to be diverted or revulst from the Wound, by gentle Purging; such as we have directed in Sect. 146 aforegoing.

CLXIII. And outwardly apply. Topical refrigeratives, with good Compress and Bandage, to press the lips of the Wound toge∣ther, that it may be the sooner cured.

CLXIV. When you find that the Wound is indeed digested, you may cleanse with this Mundificative

of Quercetan, which is also a good Sarcotick: ℞ Leaves of Smallage, Plantain, A. M. j. red Roses P. ij. red Wine ℥viii. boil to the consumption of one half, then strain out, and dissolve therein brown Sugar ℥ii. Turpentine ℥i. pouder of Juniper-berries, Orobus-meal, A. ʒvi. Aloes, Myrrh, A. ʒi. boil again gently; then add Wax q.s. and make an Ointment.

CLXV. This is excellent. ℞ Juice of Smallage brought to the thickness of new Honey, Melliginous Extract of Juniper-berries, Honey of Roses, A. ℥i. Turpentine, Gum Elemi, A. ℥ss. pouder of Scammony ℥ii. mix them. It is inferior to no ordinary Detersive.

CLXVI. But in these larger Wounds, you may do well to foment with warm Stuphs nipt out of Red or Alicant Wine; wherein the flowers of red Roses and Balaustians, Cortex Peruanus, or Cypress-Nuts, and Catechu, have been infused or boiled.

CLXVII. If these Wounds abound with Maggots, as many times they will, in hot Weather and Summer∣time, if not soon looked after; you may wash them with a Decoction of Carduus Bened. Wormword, Gentian-roots and Myrrh, made with half Water, half Wine: or an Infusion of Aloes and Myrrh in Wine alone: for a mixture of Wine with a half part of Ox or Hogs or Sheeps-Gall. The Worms being killed, you may proceed in the Cure, as before directed.

CLXVIII. If the Wound is with Contusion, endeavour that the contused Flesh be digested, and turn'd into matter; for which purpose is proper, Ʋng. Basi∣licon applied hot upon Lint, or dissolved in Linseed-Oil, or Oil of Earthworms, or the like, an∣ointing the parts about with Oil of Roses and Myrtles, beaten up with the white of an Egg.

CLXIX. And with that mix∣ture, you may make a Restrictive; by adding fine Bole, Terra sigil∣lata, Dragons-blood, and pouder of red Roses; which mix, and apply over all.

CLXX. But if the Wound has been neglected for some days, then foment it with Discussives; and embrocate the contused Parts with this: ℞ Oil-olive ℥i. Oil of Lavender and Limons, A. ʒi. mix them well, by shaking in a Glass: and be sedulous in the application of Suppuratives, after the manner we have taught in Lib. 3. cap. 5. sect. 134, 135, 136, 137, 145, 146, 147, 148, 149. aforegoing, of this Work.

CLXXI. After the separation of the contused Flesh, the loss of substance must be supplied or restored by Sarcoticks or In∣carnatives, and then healed up with Epuloticks.

CLXXII. If the Wound is deep, and the orifice narrow, yet capable of being made larger, it ought to be laid open in proportion; that the Matter may not be kept in to create a greater hollowness, and putrify the adjacent parts.

CLXXIII. But if the Sinus is of any great length, and so de∣scending, that the Matter cannot be discharged by the Wound; you may then make a perforation in the lower part thereof, for that purpose, by Incision-knife,

or Caustick, or both; first the Caustick, then the Knife: or by a Seton-Needle, or Syringotomus, as we shall shew in Sinuous Ʋlcers.

CLXXIV. As to the time of Dressing of Wounds, the second dressing ought not to be till the third Day; by which time, they may be supposed to be somewhat di∣gested: and from that time, every other day may be sufficient.

CLXXV. Galen, discoursing of the Dressing of Ʋlcers, says he drest them but every third day, tho' the Matter flowed very much; and but every fourth day in Winter.

CLXXVI. 'Tis really true, that too frequent dressing of Wounds is hurt∣ful, and hinders the speedy Cure: yet there may be occasion of opening them sooner, than what we have here proposed; either for strengthning the Bandage, or for preserving the Stitches, by using the Dry-suture; or for the vehemence of some Sym∣ptom inforcing it; the consi∣deration of which is left to the judgment of the Artist.

CLXXVII. After the Wound is filled up with Flesh, you may Cicatrize with Epuloticks; as Ʋnguent. Desiccativum Rubrum, Aqua Calcis vivae; or with Vi∣triol and Alum-stone, and dry Lint, or some proper Styptick-Water.

CLXXVIII. A word or two now, of Tents: they are not necessary in Wounds which are superficia∣ry, streight, and breed but little Pus; nor ought the Cure of Wounds to be retarded by put∣ting them in.

CLXXIX. But if the Wound is deep, oblique, and breeds much Pus; they are sometimes necessary, that a passage may be kept open by them, for the purulent Matter to pass out; and for Medicines to enter into the inside of the Wound, that the orifice may not be closed up, before the lowest, and most inward part of it is digested, deterged, and in∣carned in order to healing.

CLXXX. And tho' Tents are useful and necessary, yet are they many times less necessary in green Wounds; yea hurtful, and hin∣derers of the Cure: concerning which, Tulplus, Lib. 4. Obs. 22. has a very remarkable History.

CLXXXI. A young Woman having six Wounds, rather by pricking or stabbing, than cutting, was according to custom, tented; but these Tents were so uneasy to her, that the same night she was forced to take them out; unless she should have been kept all night from sleeping, into which she fell, so soon as they were taken out; and linnen Cloths being dipt in Spirit of Wine were only outwardly applied; by the benefit whereof, before the twelfth day, her Wounds were both happily filled up with Flesh, and healed.

CLXXXII. From this Obser∣vation, Tulpius wonders at the folly and madness of some Men; who that they may be thought to do something, fill green Wounds up with Tents, thereby hindering them from healing: for that the mutual contact being prevented, they hinder the necessary coalition; (which is directly against the first Intention of Cure.) Another

Remark I make, which is on the mighty healing power and vir∣tue, of Spirit of Wine.

CLXXXIII. The fifth and last Intention of Cure of Wounds, is either the preventing of Symptoms, before they arise; or the correcting and removing them, after they once appear: for as much as no sin∣cere Healing can possibly be, whil'st they are present.

CLXXXIV. There are many Symptoms and Accidents of Wounds, such as we have enume∣rated in Sect. 39. of this Chapter aforegoing: of which we shall treat at large in Chap. 9. of this Book following. But because the three first of them, viz. Hemorrhage, Pain, and Inflam∣mation, are incident to almost all Wounds, and many times nearly as old as the Wound it self, we shall speak something to them here.

CLXXXV. 1. Hemorrhage. This is incident to all Wounds, more or less, and sometimes the Cause of all other Accidents. Outwardly, you must bring the lips of the Wound close together by su∣ture, and then apply such Medicines as have a drying and agglutinative faculty: as Galen's Pouder, made of Aloes ℥i. Frank∣incense ℥ii. white of an Egg, q.s. to make it of the thickness of Honey: in this dip the wool of a Hare, and apply it: also a Plaster over it, made of the same Re∣strictives, with Compress and Bandage.

CLXXXVI. But if the Wound is such, as you cannot bring the lips of it together, apply the aforesaid Pouder; or this fol∣lowing, upon Dossels, on the bleeding Vessels.

CLXXXVII. ℞ Salt extracted out of the Cap. mort. of Vitriol, calcin'd almost to blackness, pou∣der of Man's. Blood, of the flesh of a Toad, Catechu, Saccharum Sa∣turni, A. ℥ss. Opium in pouder ʒii. mix them.

CLXXXVIII. And over the Dossels, put next, your astringent Emplaster, with Compress and Bandage over all: which done, place the Member in such a position, as may be most for the ease of the Patient.

CLXXXIX. 2. Pain, is the next thing to be considered; in easing of which we ought to be as speedy as may be, because nothing dispi∣rits and weakens the Patient more; nor in Wounds espe∣cially, causes more disturbance, inducing an Afflux of Humors, Inflammation, &c.

CXC. Outwardly, apply Ano∣dyns; made of the roots and leaves of Mallows, Henbane, Hemlock, flowers of red Roses, Camomil and Melilot, Linseed, White-Poppy-seed, Opium, &c. which may be made into Fo∣mentations, Cataplasms, &c. being boiled in Sheeps-head-broth, Oxycrate, or new Milk; and the Cataplasm may be brought to a thickness with Barley-flower.

CXCI. And Inwardly, give Our Specifick Laudanum, or Guttae Vitae, in a proper Dose; which in extream pains in Wounds, re∣stores Nature, by giving re∣spite, and causing gentle rest; strengthens her in her Faculties, and accelerates her Operations

of Digestion, Suppuration, De∣tersion, Incarnating, &c.

CXCII. But if the Pain is caused by Matter which wants a passage forth; you must give it a vent by the Knife, or by Caustick, or by both, as you may see rea∣son.

CXCIII. 3. Inflammation. If an Inflammation is already in∣duced, hasten Revulsion by Vesi∣catories, Clysters, and Lenient Purges, to loosen the Body; and lay upon the Part already in∣flamed, this: ℞ Henbane-leaves, boil them in Milk; add thereto a new-laid Egg, Camphir in pou∣der ʒi. Saffron ℈i. Oil of Poppy∣seed ℥i. and with Barley-flower make a Cataplasm, which apply.

CXCIV. If after this Applica∣tion, it shall seem to tend to suppuration; then you must pro∣ceed exactly as we have taught in Lib. 3. Cap. 5. aforegoing of this Work, and to which I refer you.

CXCV. Thus have we com∣pleated this our Discourse of Wounds in General, which we thought not at first to have made half thus long: but the matter multiplied upon us; and we were the more willing to be large here, be∣cause it is the true Ground or Foun∣dation of the whole Art of Curing Wonuds of all sorts: and therefore this being at first well under∣stood, the whole Superstructure following, which is built upon it, will become very easy, and intelligible.