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 ...

II. Of the Bitings of Mad-dogs, Mad-men, &c.

XXII. Whether the Patient is bitten by a Mad-dog, or by a Mad∣man whose Madness came thro' the biting of a Mad-dog, the Signs, Symptoms, Prognosticks, and Methods of Cure are all one, and therefore in Treating of the one, we Treat of the other also.

XXIII. This Poison or Venom which causes this Madness, con∣sists not in the first qualities, as Heat, Coldness, Driness, or Moi∣sture, but in a Specifick Proper∣ty peculiar to this kind of Dis∣ease, which is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, (aquae metus) 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, morbus, quo ali∣quis à Cane rabioso commorsus a∣quam timet; also 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Hydrophobia, & Rabies; a Malady in which the Patient is always extreamly fear∣ful of Water.

XXIV. Now it is necessary in the first place, to know whether the Dog which gave the Wound be Mad, or no, which you may know by these Signs. He refuses his Food, and his Water also, (be∣cause he is afraid of Water) Slaver or Snivel comes forth from his Mouth and Nostrils, he carries his Tail under his Belly, hangs his Tongue out of his Mouth, which looks either yellow, blackish, or reddish, his Eyes are red and fiery, and he looks wild, becomes lean, and barks but little, and that hoarsly; sometimes he runs swiftly, sometimes he stands still, he knows not his Owner, but runs fiercely upon all Crea∣tures, and oftentimes in run∣ning strikes his Head against Posts or Trees, and when in this Condition, other Dogs will shun him.

XXV. The Signs. If the Madness is beginning, the Patient becomes discontented and angry without any just Cause; he feels a gnawing and heaviness in his Stomach, complains of unrea∣sonable Weather, tho' it is fair, his Body also becomes heavy and lumpish.

XXVI. If he sleeps, his sleep is very troublesom, and he is full of fears without any cause; he drinks less than usually, and be∣gins to murmur and speak to himself, and desires Candle∣light in the Day-time.

XXVII. In the place wounded, tho' it is healed, a pain is felt, which ascends towards the Head,

whither when it is come, a Ver∣tigo is caused, so that he cannot walk steadily forwards; now when these last Signs appear, you may be sure that Madness is at hand, or not far off.

XXVIII. If the Madness is present or manifest, the Face then and Body become red, he looks wildly, is very trouble∣som, and foams at the Mouth, and spits upon those that stand by.

XXIX. Sometimes they snarl and bark like Dogs, and many times offer to bite; they vehe∣mently hate or are afraid of Water, and all Liquid things, which if proffered to them, or they come near them, they be∣come more fierce, and are more offended.

XXX. Their Pulses are small and inordinate, their Ʋrine comes away by drops; and the Madness increasing, they Vomit either yellow or black Choler, and become Costive.

XXXI. Their Limbs become more and more lumpish and heavy, their Voice becomes hoarse, and they are troubled with difficulty of breathing, putting out their Tongues as if they wanted Breath, or Air, or were vehe∣mently hot.

XXXII. A Day or two before they Die, some of them are trou∣bled with the Hiccough; and a little before Death with Con∣vulsions, and a dreadful gnash∣ing of the Teeth.

XXXIII. The Prognosticks. The Patient being bitten by the Mad-dog, the Poison is received; but it manifests its self in Madness in some sooner, in others later: some grow Mad in a few Days space, as in a Week, more or less; some in a longer time.

XXXIV. But its general time of manifesting it self, is upon the Revolution of the Moon to the same place of the Zodiack, where she was when the Wound was made, which is a Months time.

XXXV. Yet if the Wound was great or deep, or manifold, and the Dog vehemently Mad, the Pa∣tient may possibly become Mad, upon the next New or Full Moon; or if they escape the New, upon the next Full; or if they escape the Full, upon the next Change.

XXXVI. Sometimes the Poi∣son lyes dormant for a much longer time, as for a Year or two, before it manifests it self in Madness; but this is caused from the weak∣ness of the Poyson first received, or the shallow, remoteness, or hard place where it is lodged; and therefore if it manifests not it self in a Month or two, the Pa∣tient is generally supposed se∣cure or perfectly well, more especially if the proper means both Internal and External have been used beforehand.

XXXVII. If the Wound is not deep, nor has offended a Nerve, Artery, or Vein, there is great hope of Cure, and that the Pa∣tient may do well.

XXXVIII. But if the Person who is bitten, begins to have the fear of Water before him, and be∣comes Mad, the hope of Reco∣very is very small; nor did I ever know one such to escape.

XXXIX. The Cure. There are three Intentions of Cure;

1. To draw forth the Poyson out of the Wound, that it may not get deeper into the Body. 2. To strengthen the principal Parts, that they may be able to resist and repel the Poyson. 3. To destroy the power of the Poyson it self.

XL. The first intention is an∣swered in some measure by applying a Ligature, three or four Inches above the Wound: but Celsus, lib. 5. cap. 27. advises, that it be not too strait, lest the Part be∣comes benummed.

XLI. If it is in a place which will not admit of Ligature, then you must apply a Defensative, made of fine Bole, Terra Sigillata, Catechu, Sanguis Draconis, mix∣ed with Whites of Eggs.

XLII. Then you must scarifie the Wound, if it is not large e∣nough already; or apply Cup∣ping-glasses with much Flame and Scarification, to make the stronger Attraction.

XLIII. If the place is such as cannot be Cupped, yet it is always to be scarified, and the Blood to be drawn by a dry Sponge, not wet in Water: after which you may ap∣ply hot Pigeons or Chickens, being first cut asunder.

XLIV. After these things are done at the first, you must apply other Topicks of a very strong At∣tractive quality, as Cataplasms made of Garlick, Shelots, Leeks, Onions, Mustard-seed, Cresses, Rue, Salt, Leven, Honey, Mi∣thridate, Pigeons-dung, Tur∣pentine, Burgundy-Pitch, &c.

XLV. Galen, de Antidot. lib. 2. cap. 1. very much commends an Emplaster made of Opopanax, Pitch, and Vinegar; and he af∣firms that he never knew any that died, upon whom this Em∣plaster was applied: the Com∣position is this. ℞ Pitch lbi. which melt, and add thereto Opo∣panax dissolved in the sharpest Vinegar, strained, and reduced to a just consistency ℥iii. mix, and make a Plaster.

XLVI. Now these Attractive Medicines are to be applied in three or four Days after the Wound is made, otherwise they will be unprofitably used.

XLVII. Bleeding in this Case is very pernicious, for it strongly draws the Poyson into the Blood, and so corrupts the whole Mass, whereby, at length, it seizes both Heart and Brain: Purging, in like manner, is also as delete∣rious, especially in the begin∣ning, because it draws the Poy∣son from the outward Parts, to the inward.

XLVIII. But if the Poyson has already possessed the inward Parts, Purging will then be necessary, for the evacuating of the empoisoned Humors, or morbifick Matter, and it ought often to be repeated, and that with the strongest Eme∣ticks, or Catharticks, or both by turns, which ought to be begun after the 20th Day, and before the 40th Day, with Tartarum Emeticum, Vinum Antimoniale, Infusion of Crocus Metallorum, Wine or Vinegar of Squills, Our Family Pills, Pilulae Panchyma∣goge, Pil. Catharticae, Pulvis Cornachini, Sal Mirabile, &c.

XLIX. The second Intention is performed, by giving inwardly Mi∣thridate or Venice Treacle, mixt

especially with a proportionable Dose of Volatile Sal Armoniack, or Salt of Hartshorn, or Salt of Amber, giving ʒiss. every Morn∣ing fasting, and every Evening at bed-time; but for this pur∣pose Our Theriaca Chymica al∣most a Thousand times exceeds them, which you may give eve∣ry Night going to Bed; and every Morning a Dose of Our Tinctura Cordialis, in a Glass of Canary, both which are to be continued for Forty Days at least together.

L. In this Case, Galen, de Antidot. lib. 2. cap. 11. and Dioscorides, lib. 6. cap. 37. commends the Antidotus de Can∣cris fluviatilibus, thus made. ℞ Ashes of River Crabs ʒii. Gen∣tian in Pouder ʒi. generous Wine half a Pint: mix them for a Draught; which is to be taken every Morning for Eleven Days. Galen affirms that none ever died, who rightly used this Pouder of Crabs.

LI. The third and last Intention is to destroy the power and force of the Poyson it self; and this is done chiefly by the help of Volatile Alkalies: Volatile Salt of Beans is an Admirable Thing in this Case, so also the Volatile Salts of Hartshorn and Sal Armo∣niack, also the Volatile Salt of Vipers: but that which exceeds all other things, is the Volatile Salt of the Livers of Mad-dogs, which radically destroys the Poison, and may be given daily a gr. x. ad ℈i. in any fit Ve∣hicle.

LII. But because every one can∣not attain this, or it is not ready at hand, you may make use of the substances of the Liver and Spleen, by drying them, and re∣ducing them to Pouder; of which Pouder you may give à ℈ii. ad ℈iv. in a Glass of Choice Cana∣ry in the Morning at Ten a Clock, and in the Afternoon a∣bout Five a Clock; this is known to be a Specifick.

LIII. As to the Volatile Salt of the Livers and Spleens of Mad∣dogs, because it will be difficult to be gotten in any considerable quan∣tity; you may make it of the Flesh of the Dog, joined with them, which is to be cut into very thin slices, and then dried in the Sun, or an Oven, till they are perfectly dry, and being cut into bits, is to be put into a Glass Retort, and distilled in all respects as you distil Volatile Salt of Vipers.

LIV. Guil. Fabricius Hildanus, Cent. 1. Observ. 78. has this fol∣lowing Cure. A Young Man was on the 30th of July, 1602. wounded in the Arm by the Bite of a Mad-dog. On the first of Au∣gust (says he) he came to me; I scarified the Bite, applied a Cupping-glass with much Flame, and extracted as much Blood as I could, then I washed the Arm in Posca, in which Venice-Trea∣cle and a little Sea-sait were dis∣solved; for the slaver of a Mad∣dog, if it dries upon any part of the Skin, unless it is quickly and diligently washed and wi∣ped off, may cause Madness; and after this he cauteriz'd the Bite all over, very deep, with an actual Cautery.

LV. And by the way he advised

Young Chirurgions, that they take special Care, that they cauterize not such Bites superficially, but ra∣ther to err in the excess of their depth, than in the defect, because as it is a dangerous and desperate Disease, it must have a severe and desperate Cure; and he knew one who had no Benefit by an actual Cautery, because it was not made to enter deep e∣nough.

LVI. After the Cauterizing, he was not careful to asswage the Pain, because unctuous things, as Butter, Oil, &c. which relax the Eschar, he approved not of, in such Ʋlcers, they hindering the evaporation of the Poison, and re∣pelling the Blood, and with it the Venom to the Noble Parts: And since Pain, as Galen says, at∣tracts the Blood and Humors, out of the Body to it self, it is probable that if it is moderate, it may do good in such a Case as this is; therefore after the Burning, he applied Cotton dipt in Aqua Vitae, in which Theriatae Andromachi was dissolved, to the Ulcer.

LVII. Afterwards he laid to it the following Plaster spread upon Cloth. ℞ Onions a little boiled, Leven, Mustard-see, A. ℥ii. Theriaca Andromachi ℥ss. Rue, Scordium, A. Mss. beat them to∣gether in a Mortar, with a little Honey. The next Day he cut the Eschar every where, as much as he could, and repeated the Ap∣plications of the aforesaid Medi∣cines, and so proceeded till the Eschar fell off: afterwards, lest the Lips of the Ulcer should close, he put Pease into it twice a Day, applying the prescribed Plaster, keeping the Ulcer thus open for three Months.

LVIII. But in the interim, he strewed twice or thrice a Week, the following Pouder upon the Ʋlcer: ℞ Red Precipitate levigated, Pouder of Bezoar-stone, and of Angelica-root, A. ʒi. mix them: This, says he, wonderfully at∣tracts the malignity from with∣in to it self: and inwardly he gave Alexipharmicks, as Venice-Treacle, Mithridate, Bezoar, Burnt Harts-horn, and the fol∣lowing Pouder in Borage and Bugloss Water. ℞ Ashes of River Crabs ℥v. Gentian-root in Pouder ℥iiss. Olibanum in Pouder ℥ss. mix them. He neither bled, or purged him, lest he should have drawn the Poison inwards, but by this means he was per∣fectly Cured. See the Third Edition of Our Synopsis Medicinae, lib. 3. cap. 21.