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. XII. Of WOƲNDS of NERVES and TENDONS.

I. THEY are called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin Wounds of the Nerves and Tendons.

II. Nerves and Tendons maybe wounded many ways, as by bruising, rending, tearing, or cutting, or by puncture; and the Cures of them both are performed by one and the same Method: 'tis true, they are of another nature than Flesh, and therefore require other Medicaments than woun∣ded Flesh doth.

III. The Signs. They have also an ex quisit and quick sense; and therefore if they be hurt they bring great Pains, and many times Con∣vulsions; and these Wounds are known, 1. From the Part hurt; if it has many and great Nerves, &c. passing thro' it. 2. By the Symptoms; because there will be vehement Pain, Pulsation, Inflammation, and many times Convulsion or Ra∣ving.

IV. If they are cut thro', they occasion no new Considerations in

Chirurgery, because they wholly cease from Action, and are irreco∣verable; but if they are prickt by a sharp-pointed Weapon, it is called a Puncture, and this is not to be slighted: but this is to be understood of the great great Nerves and Tendons, and their main bodies, not the small Fibres of them, which are in every Wound of the fleshy Parts.

V. Consider the Place wounded, viz. whether near the Joint, in the inside of the Arm or Leg, or near the end of the Muscle, or in the tendinous parts of the Hand or Foot.

VI. Whether the Wound is in the heads of the Muscles, or in the ends of them; whether above the Joint, or in the Joint it self: for if it is in the head of the Muscle, it shews that the Nerve is wounded; but if in the ends, or near the Joints, it is a sign that the Tendon is wounded.

VII. If the Nerve or Tendon is cut transversly thro', the pain is less; but if they are only prickt, there is instantly a vehement Pain, and an Inflammation; by which the Brain being drawn into consent, Convulsions and Deli∣rium's are also excited; yet the sense of a Tendon is not altoge∣ther so exquisite, as that of a Nerve.

VIII. The Prognosticks. All Wounds of the Nerves or Tendons are dangerous, but more or less, according as they are of use: but whether it be Nerve or Tendon, the transverse Wound is most dangerous, and difficult of cure.

IX. They are dangerous, be∣cause of their exquisite sense, and their consent with the Brain: and yet notwithanding a Wound by pricking, is more dangerous than that which is made by cutting: and the Wounds of the Tendons, are less dangerous than those of the Nerves.

X. Hippocrates, Sect. 5. Aph. 2. says, that Convulsion which hap∣pens upon a Wound, is mortal. This is to be understood with∣out doubt of Wounds of the Nerves and Nervous Parts; and signifies not, that it always and of necessity causes Death, but that it is very dangerous, and oftentimes is the forerunner of Death; especially after too great an effusion of Blood.

XI. And tho' commonly a Flu∣xion and Tumor happens in these kinds of Wounds, unless it is driven back to some more inward, deep, and remote Parts, which is generally dangerous: yet there is always a ground of hope, if even to the seventh or Cri∣tical-day, no evil Symptoms shall follow thereupon.

XII. For so says Galen, de Comp. Med. lib. 3. cap. 2. If to the fifth, or even to the seventh day of the Disease, there is no ap∣pearance of a Phlegmon or Inflam∣mation, and that the sick is altogether free from pain; as also that they feel no extension, or stretching in the Part affected, the Patient will always be safe and secure. For it is a sign that Nature has quieted the impe∣tuous motion and violence of the Humors.

XIII. In Wounds of the Nerves, a putridness is also easily generated,

for they contain in themselves but a weak heat, and are of a very dry nature; so that they are easily hurt by things which are cold and moist, as by Water and Oil, which are enemies to the Nerves.

XIV. Nor does this putridness contain it self in the wounded Part alone, but communicates it self unto the next adjacent Parts, and sometimes to Parts that are more remote: as if the Hand, or the Finger only were wounded, the pain may ascend to the Arm and Shoulder: or if the Leg or Foot were hurt, the pain may reach to the Thigh or Hip; and not only Pains, but Apo∣stems may happen in those Parts also: and sometimes the malign Symptoms may extend themselves to other Parts also, yea to the opposit side, and sometimes to whole Body, cor∣rupting all the Humors, whence Rheusmatisms, Fevers, Dysen∣teries, &c. may be excited.

XV. And yet this you are to take special notice of, that tho' an Inflammation or Putridness is, or or may be induced, yet that many times no signs of their coming do appear before-hand; and often∣times there are present no ve∣hement Pains; but that very often they secretly and sudden∣ly (as also Convulsions) invade the wounded Person.

XVI. The reason is, because the depraved and vitious Matter is thin, and is hiddenly conveyed thro' the Nerves unto the Brain; as is manifest in the Epilepsy, in which a malign, poisonous Va∣pour ascends to the Cerebrum from the extream parts of the Nerves, without any sense of Dolour in those Parts thro' which it passes; but only a seeming coldness, like that of cold Water, rising up gradually to the Head.

XVII. And therefore in Wounds of the Nerves, tho' there shall be no Pain felt, nor any Inflammation appear: yet you are not to trust to this, but you must manage the Cure with all the care, cir∣cumspection, diligence, and skill imaginable.

XVIII. Now the Wounds of the Nerves are truly dangerous, as, 1. Because the Membrane with which they are covered, proceeds from the Meninges of the Brain, and that they are filled with plenty of Animal Spirits. 2. Because they act by consent with the Brain and Spinal-Marrow; which as Galen says, De Ʋsu Partium, lib. 12. cap. 11. are the great Fountain and River, from whence the Nerves as Rivulets only run. 3. By reason of the dreadful Symptoms, (before enumerated) which are apt to ensue.

XIX. The Cure. Seeing then that in all Wounds of the Nerves, pain and Inflammation are easily induced, we must endeavour that the pain may be mitigated, and the Inflammation prevented: These Authors do, 1. By bleeding and purging out sharp and thin hu∣mors. 2. By keeping the Wound also open, that the excrements may the more freely flow forth.

XX. The chiefest cause of pain in these Wounds, is the excrementi∣tious humor shut up, which being too long kept, degenerates into

a malign, or at least acrimonious quality, by which it bites the Nerves, and at length putrifies them.

XXI. Hippocrates, Sect. 5. Aph. 18. says, that every thing that is cold, is an Enemy to the Nerves, Brain, and Spinal Mar∣row; but that which is warm, is a Friend to them: and the rea∣son is, because the Nerves, &c. are Parts void of Blood, and have in them but little natural and innate heat; so that they are soon, and easily offended with any thing which is cold, it causing Pain.

XXII. And Galen, de Comp. Med. lib. 6. cap. 2. says, Let the Oil with which we cherish the Wound be sufficiently hot, lest that it offend the Wounded Part; for as that which is cold is most of all contrary to these kind of Affects, so that which is but blood-warm, does them but little good: for this reason, (says he) I my self chuse rather to make use of a Fomentation of Oil which is suf∣ficiently hot, always shunning that which is but lukewarm; but wholly refusing that which is quite cold.

XXIII. Yet Galen, in Meth. Med. lib. 6. cap. 6. seems to say, that if a Nerve is discovered, or made bare, then such things as are but tepid, or lukewarm, are rather to be applied, than such things that are very hot.

XXIV. Now as to asswaging of the Pain, things hot and somewhat moist, are most fit; yet because those things which moisten the Nerves, do easily putrify them; therefore such Medicaments as are heating, and drying withal, are rather to be chosen, being also of thin parts, and strength∣ning the weak heat of the Nerves, by consuming and dry∣ing up the Excrements.

XXV. Galen, de Comp. Med. lib. 3. cap. 2. and Meth. Med. lib. 6. cap. 2. says, The faculty of the Medicines to be applied to wounded Nerves, ought to be both thin, and also moderately heating, and such as may dry without any sharpness or pain; for that this alone can draw the Sanies from the bottom of the Wound, without either contracting or biting. And a little after he says, The wounded Nerves require such Medi∣cines, which may excite a gentle heat, but may dry strongly; and which from the nature of their own substance, may have the power of Attraction, and be also of thin parts.

XXVI. Also regard is to be had to the strength of the Patient, and habit of Body: for the stronger Medicines are to be applied to hard and strong Bodies, the weaker Medicines to the more soft and tender Bodies: so also you must consider the Matter to be dried up, and according to the store of Humidities, you are to chuse the more drying Medicaments: for the Medicine ought to an∣swer in driness to the quantity of humidity offending.

XXVII. Also Medicaments which are drying, but of thin parts, and carry with them a notable heat, with a kind of biting, (which is apt to excite Pain, and a Flux of Humors;) as distilled Spirits, Oils and Balsams,

are many times to be mitigated by mixing them with other things of a milder temper. What Me∣dicaments are necessary in this case, we shall shew anon, when we come to treat of Punctures, or Prickings of the Nerves.

XXVIII. Now to ease the Pain, preserve the Temperament of the Part, hinder the Afflux of Hu∣mors, and prevent the Inflamma∣tion, Medicaments are to be applied upon the Part affected; as also on all the Parts that lye in the midst, from the Wound to the original of the Nerves: and they are to be anointed and cherished with hot Oils, as Oil of Earthworms, of Foxes, of Whelps, of Castor, of Costus, and the like; using these of themselves, or mixing them with Oil of Turpentine.

XXIX. If the Nerves affected are those of the Neck, then the Arm, from the Wound even to the Armholes and the Neck, is to be anointed: if the Nerves affected are those of the Leg, then the Groins must be anointed, and we must ascend from them by the Back-bone, all along up to the Neck and Head.

XXX. The incision of a Nerve is either streight and direct, or transverse; if it is transverse, it is cut either quite asunder, or but in part: now a Nerve quite divided, is less dangerous than that which is only cut in part; as Galen, Meth. Med. lib. 6. cap. 2. and Guido, Magn. Chir. Tract. 4. doct. 1. cap. 4. affirms: the rea∣son is, because a Nerve quite cut asunder, cannot cause any hurt in the Brain.

XXXI. Yet being cut quite asunder, it can never be consoli∣dated again, according to the first Intention; as we have hinted at Sect. 4. aforegoing: and so says Hippocrates, Sect. 6. Aph. 19. When the Bone is wounded, or the Cartilages, or a Nerve, or the thin part of the Cheek, or the Praepu∣tium, it does not unite, or grow together again.

XXXII. As to the Cure of these Wounds, Galen, de Comp. Med. lib. 3. cap. 2. & Meth. Med. lib. 6. cap. 3. advises to Topicks which dry with little biting; as Ʋng. de Calce lota, Ʋng. Dia∣pompholigos, and the like.

XXXIII. If the whole Nerve is cut asunder, no Convulsion can ensue, because both ends give way: this kind is cured by Sarcoticks, of which we have wrote abun∣dantly before, in Cap. 2. Sect. 31. ad 46. now in this kind of Wound, the motion of the Part into which the Nerve is im∣planted to move, is abolished.

XXXIV. If the Nerve is cut asunder, but in part, it is first to be dressed with the Medicaments afore prescribed: but if Pain, Inflammation, Putrefaction, Fe∣ver, or Convulsion are like to ensue; the best course is to cut the Nerve or Tendon asunder, rather than by deferring the Incision, to hazard the Life of the Patient.

XXXV. This being done, you must apply anodyn and drying Me∣dicaments, and the Wound being dressed, apply over the Dossels or Pledgets, Diapalma, or Dia∣chylon simplex, softned with Oil of Myrtles, Quinces or Roses;

because the tenderness of the Part will scarcely admit of any stiff Emplaster.

XXXVI. Then rowl up the Part with the Fascia Expulsiva, of which we have treated before in its proper place; that thereby, the Sanies which does gather in the place, and a new afflux of Humors may be prevented.

XXXVII. If a Nerve, &c. is contused without a Wound, foment it with hot Oil-olive, applying over a Sheeps or Lambs Skin, new taken off: but if it is with a Solution of Unity, then Medicaments anodyn, drying, and congluti∣nating are to be imposed; as Ceratum Album, Emplast. Cata∣gmaticum, malaxed with Oil of Hypericon.

XXXVIII. If the Nerve is dis∣torted by a Fall, or the like, which may hinder the motion of the Part, you may apply Emplastrum Album mixed with Gum Ammo∣niacum, or Diachylon simplex, or cum Gummis.

XXXIX. If afterwards a hardness shall remain, which may cause a numbness of the Part, you must mollify with Oil of white Lillys, of Hypericon; or with Goose, or Capons, or Vipers Grease, mixt with Ammoniacum or Bdellium; also with Oil of Sheeps-Trotters, or of Neats-Feet, mixed with Mucilage of Fenugreek-seed, Lin-seed, or Marshmallow-roots; the Part may also be embrocated with emollient Oils hot; but nothing exceeds golden-coloured Palm-Oil mixt with Oil of Aniseeds, ana: which resolves to a Mira∣cle, so also Spiritus Mirabilis: lastly, you may lay over all Dia∣chylon cum Gummis, mixed with a quarter-part of liquid Storax.

XL. How the Pain is to be eased, we have already shewn at Sect. 28. and 29 aforegoing; we come to shew how to resist the Inflammation. This is done by imposing things cooling and drying; for they both abate the Inflammation, and correct the Putrifaction: of which kind are, Barley and Bean flower, meals of Vetches, Chick-Pease, and Indian Maize, boiled with Oxymel q.s. to the consistence of a Cataplasm; which is to be applied after Embrocating with Oil of Elder, mixed with Rose-Vinegar.

XLI. If a Convulsion affects the Patient, tho' it is many times mortal, yet something (whilst there is Life) is to be done; you must Embrocate all the Spinal Marrow, from the Head to the Coccyx, with this Mixture, hot: ℞ Oil of Ben ℥vi. Chymical Oils of Lavender, Limons, Juniper, Rosemary, Sage, and Savin, A. ʒvi. mix them; upon which apply a Sheep-skin newly drawn off, to the Part.

XLII. Then the Part wounded is to be dressed; and if the Wound is in the Hand, you must Embro∣cate upwards to the Armpits by which the Nerves pass, and so proceed to the Vertebrae of the Neck and Thorax: but if the Foot is wounded, you must Embrocate upwards from the Wound to the Leg, Thigh, and Os Sacrum, even to the Vertebrae of the Loins; giving inwardly in the mean season this Mix∣ture: ℞ Our Aqua Bezoartica,

or Spiritus Cordialis ʒvi. Spiritus Opii compositus, à ʒss. ad ʒi. mix for a Dose.

XLIII. These things, as to Me∣dicines, whether Topicals or Inter∣nals, we have said in short upon the Cure of a Nerve or Tendon cut, or other wounded than by Pricking: we shall next treat of the Cure of a Wound of the Nerves, &c. made by Puncture; out of which, those things which in general seem necessary to be said, concerning the Wounds of the Nerves and Tendons, (of what kind soever) will be plain∣ly and evidently seen.

II. Of the Puncture or Pricking of a Nerve or Tendon.

XLIV. The Puncture or Prick∣ing of a Nerve or Tendon, is either inconspicuous, not to be discerned by sight, which is called Punctura caeca: or, it is conspicuous, or manifest, and is discernible out∣wardly, and is called Punctura aperta.

XLV. The Signs. This disaf∣fection many times happens in let∣ting Blood, as well as by other Accidents: and it may be known by its Symptoms, which are sudden, vehement Pain, deflu∣xion of Humors, Faintings, and Convulsions.

XLVI. Nor does it terminate presently in Suppuration, but gleets, and will not yield to a simple Ano∣dyn-Cataplasm, made of White-bread and Milk, &c. but will be accompanied with a throbbing Pain, Inflammation, Fever, and Con∣vulsions as aforesaid; which Sym∣ptoms do never happen where the Nerve is wholly, and trans∣versly cut asunder; because then the Nerve, &c. no longer continues its commerce with the Brain, nor can it draw the same into a consent with it; whence no vehement Pain, nor Convul∣sion can be excited.

XLVII. It is known also, whe∣ther it is Cut or Prickt, from the kind of the Weapon it self which made the Wound, and the form and nature of the Wound, as narrow, manifest, or scarcely to be seen.

XLVIII. The Prognosticks. A Puncture is the most dangerous, among all the Wounds of the Nerves or Tendons; for so says Galen, Art. Med. cap. 92. as we have cited the Passage in Cap. 9. Sect. 82. aforegoing.

XLIX. And Galen, Meth. Med. lib. 2. cap. 6. also says, If a Nerve is prickt, Pain must needs invade the Person, greater than the Pain which is in any other Part; and then of necessity a Phlegmon will soon follow there∣upon.

L. If in a Puncture of the Nerves a Tumor appears, and then it suddenly disappears and vanishes again, a Convulsion and Delirium will ensue; as appears out of Hippocrates, Sect. 5. Aph. 65.

LI. Also the Pricking of a Nerve or Tendon is so much the more dangerous, by how much the Body it happens to is impure, or 〈◊〉〈◊〉 disposed, viz. Cacochymical, Cachectical, Strumatick, or Scor∣butick.

LII. The Cure. Tho' the Indi∣cation of Ʋnition has place here, as in all other Wounds; yet by

reason a Puncture has a greater sense of Pain and Acrimony, with danger of an Inflammation. There∣fore the first Intention here, is, by Anodyns to ease the Pain, and that by all means the Inflammation may be pre∣vented.

LIII. That this may be done, care must be taken that Excre∣ments may not be heaped up in the Wound; which may be hindred, by not permitting the vitious Humors to flow to the wounded place, and Part affected; and by not suffering the Matter already in the Wound to continue there.

LIV. For which reason, the Skin, as also the Flesh which lyes upon the Nerve, must be kept open: but if the Wound is not open enough, you must make it yet wider, by incision of the Skin at right Angles, and of the Flesh, according to the ductus of the Fibres of the Muscle; that so the passage of the Excre∣ments forth, may be the more free.

LV. The Body is to be purged from vitious Humors, with some Lenitive Cathartick; or with Pulvis Cor∣nachini, or Our Family Pills; one or two small Pills being taken every Night going to Bed, as you shall see fit: or with some proper Purge, as Our Syrupus Catharticus, &c.

LVI. Now as to Topicks, you must consider whether the Nerve or Tendon lies bare, viz. open in view, or is covered with a Skin: if they lye covered under the Skin, or Membrana adiposa, then the Skin is to be opened, that the Medicaments may penetrate to the Puncture.

LVII. These Medicaments ought not to be cold, nor hot and moist, nor warm Water; for Water, and all cold things are Enemies to the Nerves; and things which are hot and moist, easily excite a putridness in the Nerves, &c.

LVIII. But we ought to use things which are hot and drying, and of thin and subtil parts; to digest, dry, and resist Putrefaction, but void of any acrimony or sharp∣ness.

LIX. And, the Wound (says Barbett) is also to be kept open, 'till the Cure is absolutely per∣formed; that the Matter may flow freely forth; which if kept in, will increase the Pain, and cause Putrefaction of the Nerve; which if it should happen, the corrupt Part is to be cut off, or removed by an Actual Cautery.

LX. If the Nerve is bare, warm Medicines only are conve∣nient: but if covered, hotter Me∣dicaments are required, Purging in the mean time not being neglected.

LXI. Medicines for this purpose are, old Oil-olive, of Earth-Worms, of Dill, of Rofemary, of Costmary, of Hypericon, of Castor, of Turpentine, of Wax, of Marjoram, of Sage, of Savin, of Sassafras, of Aniseeds, of Caraways, of Juniper-berries, of Lavender, of Oranges, of Limons, and of Tyme; most of them Chymically extracted; to to which add Spirit of Wine, Potestates, &c.

LXII. Of Gums and Bal∣sams; Gum Elemi, Tacamahacca,

Bdellium, Camphir, Caranna, Euphorbium, Frankincense, Opo∣balsamum, Balsam of Sulphur, Balsam Capivii, de Chili, of Gilead, of Peru, of Tolu, and all the kinds of Turpentine, liquid Storax, liquid Amber, Petroleum, &c. are to be chosen.

LXIII. Be sure to proportionate the Topicks to the vehemency of the Symptoms, which you will know by the pleasantness of the Heat; as that of the Sun, in temperate Weather: and by the pleasing∣ness of the Medicine, causing a kind of Itching: if there is no Heat, there can be no Attra∣ction: if it is immoderate, it will draw Humors, and cause Inflammation.

LXIV. When the Puncture is bare, either by the Wound, or made so, you need not apply Medicines so very hot, dry, and piercing, as when it is hid: in this case, some common Artificial Balsam, or some Natural Balsam, as of Capivii, Chili, Peru, or Turpen∣tine, dropt on warm, will serve the turn; for by their Unctuo∣sity they smooth the Part; and by their Heat, they make At∣traction, and ease the Pain, discharging the Place of its Sanies; and lastly, by their Moisture, they both open, and keep open the Orifice.

LXV. The Medicament (says Wiseman) ought to be hot, dry, and of subtil parts; that it may consume the Ichorous Water, which first affects them, and causes the Putrefaction.

LXVI. In the beginning, he used Oil of Roses with a little Bay-Salt dissolved in it: this he dropt into the Part scalding-hot, upon which he applied a Pledget spread with Basilicon, dipt in the same Oil; and em∣brocated the Part about with Oil of Earth-worms; and put over it Empl. è Bolo, as a De∣fensative.

LXVII. If the Inflammation and Tumor is great, he applies this Cataplasm. ℞ Barley and Bean flower, A. ℥iv. pouder of Linseed and Fenugrek seeds, A.℥i. flowers of Red-roses, of Camomil, of Elder, and Wormwood, A.ʒiii. Wine, or common Lixivium, q.s. boil to a consistency, adding Oxymel ℥ii. Oil of Roses ℥i. mix them, and rowl up the Part gently.

LXVIII. If the Wound requires Medicines of more drying and sub∣til parts, you may use this Mix∣ture: ℞ Chymical Oils of Savin and Turpentine, A.℥ss. mix them. Or you may dress it with Tur∣pentine-Balsam of Sulphur, or with Oil of Costus, or of Rue, or of Savin, or of Dill, or of Scor∣pions, &c. these are all proper Medicines to dress with; but Oil of Roses, and Salt (says Wise∣man) have always served my purpose.

LXiX. If there is much pain, you may dress it twice a day with the Cataplasm at Sect. 67 above: if the hardness goes off with the contraction, and the lips of the Wound relax, it is a good Sign.

LXX. Barbett commends Oils of Wax, Lime-water, and Ung. Fuscum Wurtzii, being rightly used: also this following Oint∣ment. ℞ Oil of Hypericon, Venice Turpentine, Tears of the Fir-tree,

A. ℥i. Tacamahac, Balsam of Peru, A. ℥ss. Propolis ʒvi. Ca∣ranna ʒii. mix, and make an Ointment.

LXXI. Sennertus says, we ought to use Oils of a thin sub∣stance, as that of Earth-worms, or of Whelps, or Foxes; if these ease not the pain, to apply a Cataplasm, made of flowers of Barley, Beans, Orobus, and Lu∣pins; adding Betony, Camomil-flowers, and Oil-olive; for this eases Pain, dries, discusses, strengthens the Native Heat, and resists Putrefaction.

LXXII. But if the Nerves begin to be inflamed, or to pu∣trefy, the Cataplasm is to be made with Oxymel, or with the common Lixivium; and the Wound is to be managed almost in the same manner, as in the Cure of a Gangren in begin∣ning.

LXXIII. Oil of Turpentine may be used alone of it self, in Chil∣dren, Women, and such persons as are of a cold and moist habit of Body; but in such as have drier Bodies, some Euphorbium may be mixed therewith; also Ammoniacum, Galbanum, roots of round Birthwort, and all Roots that are bitter, without Astriction.

LXXIV. Propolis may also be used alone; or with Sagapenum, or with Oil of Turpentine, or Tears of the Fir-tree, and other Artificial Balsams, which have power to extract the Excrements from the bottom of the Wound; and withal to corroborate and augment the native heat of the Nerves, which of it self (but more especially in wounded Nerves) is very weak.

LXXV. The Ancients com∣mended Sulphur vive, unslaked Lime, Arsenick, Sandrarcha, Pompholyx, Verdigrise, Chalcitis burnt, &c. which are not safe to be used, especially, if the Nerve is bare or naked: we have now found out better things, and Medicines prepared by the Chy∣mical Art, which do their Office without any pain or danger, and which may be safely ap∣plied, whether the Nerve, &c. is naked, or otherwise.

LXXVI. Many of them we have enumerated at Sect. 61 and 62 aforegoing, and other places follow∣ing them in this Chapter; all which obtain that Faculty which Galen and the Ancients have proposed, and have in them no corroding quality at all, but a true Balsamick Virtue, which those of the Ancients wanted; absterging the Wound from the Excrements, agreeable to the Nerves, and greatly strengthning the Native Heat of the wounded Part.

LXXVII. If the Medicament is of thin and volatil parts, which may easily be dissipated; as Oil of Turpentine, or Spike, or Sa∣vin, &c. then you may mix with it Gum Elemi, Capivii, Turpen∣tine, Tacamahacca, dissolved in Oil of Hypericon, simple, or compound.

LXXVIII. Caesar Magatus, de Vulner. lib. 2. cap. 5. has given these following Compounds or Mixtures. ℞ Ammoniacum, Opo∣panax, Sagapenum, (dissolved in warm Water) Propolis, Turpentine,

A.℥ ss. Oil of Earthworms, made with old Oil-olive ℥jss. mix, and make an Ointment.

LXXIX. ℞ Opopanax, Pro∣polis, Sagapenum; A. ℥ss. Oil of Turpentine, or Tears of the Fig∣tree ℥jss. Tacamahac ʒiii. Sulphur vive ʒjss. mix them for an Oint∣ment.

LXXX. ℞ Fir-tree-tears, Opo∣panax, Propolis, Tacamahac, A.ʒii. Artificial Balsam ʒvi. mix, and make an Ointment.

LXXXI. ℞ Diacyhilon cum Gummi ℥i. Carana, Propolis, Ro∣sin of the Pine, Sagapenum, Ship-Pitch, Tacamahac, A. ʒiii. Arti∣ficial Balsam ℥ss. Euphorbium ℈ii. mix, and make a Cerat.

LXXXII. ℞ Oil of Turpentine, or Tears of the Fir-tree ℥i. Pro∣polis, Sagapenum, A. ℥ss. Euphor∣bium ʒi. mix them.

LXXXIII. Galen, Meth. Med. lib. 6. cap. 2. commends an Emplaster made of Euphor∣bium, where he takes a great deal of pains, and is very exact and large in treating of Euphor∣bium in Wounds of the Nerves; the Composition of which is this: ℞ Wax ℥jss. Turpentine, Pitch, A. ʒvi. Euphorbium ʒ i. mix, and make a Cerat.

LXXXIV. Now you ought to consider whether the Euphorbium is new or old: if it is new, it is to be mixed with a triple quan∣tity of Wax: as ℞ Oil-olive ʒx, or ʒxii. Wax ʒiii. Euphorbium ʒi. mix, and make a Liniment.

LXXXV. But if it is old, (which is very hard and dry) it ought to be mixed in somewhat a greater proportion: as, ℞ Oil-Olive ʒ xii. Wax ʒiii. Euphor∣bium, à ʒi, ad ʒiii. (ac∣cording to its Age, which is much to be minded) mix, and make a Liniment.

LXXXVI. If at last, the Pun∣cture yields not to a Cure, by such Medicaments as have been proposed the Nerve or Tendon is to be di∣vided, to prevent worse accidents; as Convulsions, Spasms, Gan∣grens, &c. after which, the Cure is to be done as in other Wounds; this only requiring more care in the position, and keeping the Member steady, if it is in such a Joint, where there are Nerves and Tendons which move contrariwise.

LXXXVII. An Observation from Wiseman. A Tendon being prickt in letting Blood in the Sa∣phena, near the Ancle, it was drest with Oil of Turpentine hot; the Pain increased, and I was consulted, and saw the Chirurgeon ready to apply his hot Oils: but on sight of the Wound, the lips being turgid and dry, and the parts about it inflamed, I shewed him his error, and caused it to be dressed with Ʋng. Basilicon, warm; and to embrocate with Oil of Roses; and to apply over Diapalma, malaxed with some of the same Oil, and to forbear dressing it for some two or three days: during which time, it was cu∣red. The over-using hot Oils, has in some cases been very hurtful and mischievous to many.

III. Contusion of the Nerves, &c.

LXXXVIII. This is often by a

Fall or Blow, the Skin suffering a solution of Ʋnity; whence comes an Ulcer, and many other Sym∣ptoms, from the afflux of Hu∣mors.

LXXXIX. If the contused Nerve is not bare, which may be discerned from the more continual Pain, than is usual in a simple Contusion of the Flesh; great care must be taken to resolve the coagulated Blood, as soon as may be.

XC. For should it suppurate, the Nerve would easily putrify, and other ill Symptoms ensue; so as to force you to cut the Nerve asunder, or do something worse.

XCI. In such a Contusion of a Nerve therefore let a Cloth be dipt in Oil of Castor, or of Worms, or of Whelps, or of Foxes, of Dill, of Rue, of Camomil, or of Rosemary.

XCII. Or you may foment the Part very hot with Sponges, dipt in this Fomentation: ℞ Roots of Orrice, Zedoary, A. ℥i. Hyssop, Fetherfew, Marjoram, Mint, Southernwood, Tansy, Savery, A. M.ss. White-wine q.s. boil, and make a Fomentation; to every Pint of which add S.V. ℥jss.

XCIII. Or you may apply this Emplaster: ℞ Propolis, Turpen∣tine, Caranna, Opopanax, roots of Sowbread in pouder, A. ʒiv. Oil of Castoreum, of Hypericon, A. q.s. mix, and make a Plaster. And if Convulsions happen, give in∣wardly Chymical Oil of Laven∣der, à gut. ii. ad vi. dropt into white Sugar, in a glass of white Port-wine, or Canary.