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 ...

III. Of the Bitings of Serpents, as Vipers, Rattle-snakes, &c.

LIX. The Signs. When one is bitten by an Adder, Viper, Rat∣tle-snake, or Slow-worm, &c. the Part becomes of a leaden Colour, sometimes reddish, or of a reddish black, and very painful; and if it is not pre∣sently Cured, much black and fetid Pus does come forth from the Sore, like as from a filthy Ulcer.

LX. What we shall say on this Subject, we shall chiefly deli∣ver from Monsieur Charas out of his new Experiments upon Vipers. 1. A Dog was bitten in his upper Lip by

an angry Viper; he was not much moved at it at first, but by little and little grew sad, and his Jaw began to swell; a little while after he vomited up the last Food he had eaten, and dis∣charged by Stool: He refused his Food, and would touch none of it, and lay in a prostrate manner without complaining: the place prickt grew livid, and the lividness extended to the Neck and Breast, as also the Swellings, and at length after Forty Hours he died; without nothing was observed but the Tumor and lividness in the Part prickt, and places adjacent; but being opened, in the Trunk of the Vena Cava, a little Blood was found coagulated, and the rest of the Blood in this place, in the Heart, and in all other places, was of a dark Colour, and of an ill Consistence, like Blood in part dissolved and corrupted; the Stomach was of a darkish Colour, but the Me∣sentery and Guts were darker: The Heart, Liver, Lungs, and Spleen were not altered at all, but of a good Colour, and re∣main'd in their natural Condi∣tion.

LXI. A Dog bitten at the Ear. He howled when he felt the bi∣ting, and continued howling for half an Hour, then was quiet. The place prickt grew livid, and swell'd, as also the Parts ad∣jacent, he vomited not, but voided some Excrements, would neither eat or drink, and died ••n 24 Hours after he was bitten: Outwardly nothing was seen but the lividness and swelling. Be∣ing opened, all the inward Parts were in the same Condition with those of the former Dog, save there was found in the Ves∣sels no coagulated Blood, but only it was of an obscure Co∣lour, of an odd consistency, and in a disposition to coagulate.

LXII. 3. A Dog bitten on the tip of his Nose by an enraged Viper. He howled when he felt himself bitten, but was soon appeased, fell to licking the place prickt, and to seratching it with his Feet or Paws. He lay not down, but continued that exercise for some time. The place bitten became somewhat black and blue, but swell'd not; and a little while after the Dog cat and drank, as if nothing ailed him, gradually the lividness disappeared, and he grew as well as ever. In this Case, I suppose the biting of the Viper scarcely pierced thro' the Cutis, which was the principal reason of the Dog's recovery.

LXIII. 4. A Puppy seven or eight Days old, bitten on the Leg by an enraged Viper. He howled as soon as bitten, and so conti∣nued till he died, which was a∣bout an Hour after. The place prickt was swell'd and livid; and being opened, nothing was found but some lividness in the Stomach and Guts, and some blackishness and ill-consistency in the Blood, but all the other inward Parts appeared sound.

LXIV. 5. A Dog bitten on the Belly by an angred Viper. He cri∣ed presently, but not long. The place bitten was very livid, and swell'd much, the Tumor and

lividness reaching over all the Natural Parts: he drank often, but would eat nothing, and was always for two Days in this Con∣dition, without growing worse. (I suppose the Skin was scarcely penetrated). Then he was bitten again, and that twice, near the same place; he howled much, and the Swelling increased, and extended it self over the whole Belly, as also the livid Colour, but it went no farther: The Dog often lickt his Wounds, and drank store of Water, and at length fell to eating, and in five or six Days was Cured per∣fectly, without any other Reme∣dy than that of his Tongue lick∣ing the Wound. (Either the Skin was not perfectly penetrated, or else the Attractive Virtue of the Tongue by often licking, drew forth the Poison).

LXV. 6. A Dog deeply bitten on the Tongue by an inraged Viper. He cried vehemently, so as to be heard a great way, and conti∣nued tossing and vexing him∣self for half an Hour together, and then died. He was open∣ed, his Heart, Liver, Lungs, and Spleen, were found and well; but his Tongue was ex∣ceedingly livid: his Mesente∣ry covered all over with black Spots, some of which were blacker than Lentils, under which there was coagulated Blood; the Stomach and Guts were also grown blacker; the Blood very black, and beginning to coagu∣late in the Heart, and in the Vena Cava, being like Blood curdled and corrupted.

LXVI. 7. A Pigeon and a Pullet were bitten by an angry Vi∣per, almost at the same time, in the most fleshy Part, viz. under the Breast. Soon after in both there was observed a very swift and extraordinary beating of the Heart, which continued, still increasing, so much, that in less than half an Hour they were both dead. They were opened, and in both there was found a little Blood coagulated in the Heart, and Vena Cava, and all the rest of the Blood blackest, and ready to be coagulated, and as it were, to be corrupted; but the Heart, Liver, and all the inward and outward Parts were of a very good Colour, and in a very good Condition, ex∣cept the lividness which appear∣ed only upon the place bitten.

LXVII. 8. Another Pigeon bit∣ten on the Leg twice, a little The∣riaca being given it beforehand. Upon the first bite, it went too and fro in the room, and shew∣ed not any sign of Illness: but upon the second bite, it grew Sick by little and little, and died in half an Hour after. The Place which was first hitten, was much more livid than the Place which was bitten the second time.

LXVIII. When I was in Caro∣lina, I had a Dog bitten by a Rat∣tle-snake upon his Throat. The Dog cried out immediately, presently grew Sick, Vomited up all that was in him, and re∣fused his Food, and then ran home, and laid himself down. He would sometimes cry, some∣times whine, and sometimes groan bitterly; outwardly the

place bitten was livid, his whole Neck was extreamly swelled, as also his Head, and Eye-brows, which seemed to hang over his Eyes. He died in the space of 24 Hours, but at times, to the last moment groaned vehement∣ly, as if he had been Heart-sick, and with frequent Convulsions wonderful to behold: Being o∣pened, the Heart, Liver, Lungs and Spleen seemed to be well, the Stomach, Mesentery, and Guts were spotted all over with livid and blackish Spots; and the whole Mass of Blood both in the Heart, Arteries, and Veins was every where coagulated, and looked almost of a black Colour.

LXiX. The Causes. From what has been observed, it appears, that in the biting of a Viper, Rat∣tle-snake, &c. the Poison goes not directly to the Noble Parts, for that no alteration was ever ob∣served therein, but the Cause of Death is from the Poison imme∣diately entering into and work∣ing upon the Blood, coagulates it, and corrupting it, separa∣ting its Parts, and disturbing its Circulation, thereby hindering the Communication of the Spi∣rits thro' the whole Body, de∣priving the Noble Parts of them, and destroying or contamina∣ting them, with its deleterious Gas.

LXX. The progress of the Poison is from the place bitten; and the swiftness of its motion from the magnitude of the Arteries or Veins, which receive it, or which the Teeth did light on. As in the Tongue of the Dog which was bitten; the Tongue being full of Veins and Arteries, 'tis no wonder that the Poison meeting with them, and finding a large way, and very short, should so soon produce its Effects, and cause Death so much the more speedi∣ly, than that which meets with small, slender, long and wind∣ing Branches, tho' in this latter Case, it will not fail to do the Work at last.

LXXI. The Vomiting and ex∣tream Pains in any Part, chiefly in the Viscera, proceed either from the coagulated Blood, or its dispo∣sition to Coagulation, hindering it in its course of Circulation, for that the Spirits contained in the Circulating Blood, finding their passages stopt by the Congela∣tion, and endeavouring to make way for themselves, do Vio∣lence to the Viscera and lateral Parts, and so excite those ex∣tream Pains which the Patient reels; as also Vomitings, by weakening the Tone of the Sto∣mach, &c.

LXXII. And the Cold Sweats, Faintings, Swoonings, and Con∣vulsions with which such Patients are assaulted, are caused from no∣thing else, but the defect and di∣minution of the Spirits, and the obstruction of their concourse to the more Noble Parts, with the weakness and putridness of the Blood, which is destinated as their Vehicle to convey them.

LXXIII. The Prognosticks. The biting of any Poisonous Serpent, as the Viper, Slow Worm, Rattle-snake, &c. is always dangerous; and if it is not immediately pro∣vided for, is for the most part Mortal.

LXXIV. Our Common Vulgar Snake is without danger, tho' it bites never so deeply: and the biting of the Chicken-snake, or long black Snake of Carolina, is also safe, my self was bitten in the Night-time upon two of my Fingers, by one of those large black Snakes, making in all five Wounds, which bled, and were sore, but healed of their own accord, without any more than the first pain or trouble.

LXXV. If the biting of a Viper or Rattle-snake is deep, and in a considerable place, if no Remedy is presently applied, they Kill in a few Hours time. A Rattle-snake bit a young Man in the Woods in Carolina upon one of his Legs, and no Remedy being ready, he was Dead in about half an Hours space.

LXXVI. If Remedies be appli∣ed both outwardly and inwardly, and not almost immediately upon the receiving of the Wound, they oftentimes prove abortive: and if timely used, yet many times the hazard of Life is not small: and where the Patient recovers, it is sometimes three or four Days before he is fully out of danger.

LXXVII. The Cure. The An∣cients bound Ligatures three or four Inches above the Wound, held up the Member as high as might be, scarified, and if they could, ap∣plied Cupping-glasses with Sca∣rification; where they could not be applied they only scari∣fied, and applied Defensatives about the Part.

LXXVIII. Then they drest the Wound with Antidotes, Electua∣ries and Treacles mixt with Oil of Scorpions, Orvietanum, and the like, mixt with Pouder of Vipers.

LXXIX. And inwardly they gave Simple and Compound Anti∣dotes, as you may find in Dios∣corides, lib. 7. in Nicander in his Theriaca and Alexipharmaca; in Grevinus, de Veneris, lib. 1. cap. 36, and 37. where he has ga∣thered them together. Petrus de Abano, in lib. de Venenis, cap. 4. commends these following, viz. Hypericon, Swallow-root, Elecam∣pane-root, Radish, Dittany, Birth∣wort round and long: and these he affirms to be equal in Power and Virtue with Theriaca Andro∣mach; it self against Poyson.

LXXX. But there are many other particular Simples as good or better for the purpose intended, than those before enumerated, as Angelica, Bawm, Bay, and Bay-berries, Contra-yerva, Camo∣mil, Gentian, Germander, Ju∣niper-berries, Lavender, Master∣wort, Myrrh, Pyrethrum, Rue, Rosemary, Sage, Savory, Scor∣dium, Southernwood, Saffron, Tansy, Time, Wormwood, Marsh and Roman, Virginian Snake-root, Zedoary, &c. of which you make Pouders, Ele∣ctuaries, Tinctures both Spiri∣tuous and Saline, Volatil or Chymical Oils, Spirits and Wa∣ters, &c.

LXXXI. The Ancients, before Mithridate and Treacle were in∣vented, used only the Juices or Pouders of the Herbs and Roots inwardly, and applied the same outwardly to the Sores, as the Native Indians in the Continent

of Florida do at this Day, when they make use of the Virginian Snake-root, with which, in this kind of Cure, they do Won∣ders: After the Invention of Compounds, the Ancient Greeks and Romans used Mithridate, Theriaca Andromachi, Diatessaron, and other the like Composi∣tions.

LXXXII. The Viper-catchers, if they are bitten, they apply to the Wound the Pouder of Vipers, or the Vipers Head beaten to a Mass in a Mortar, and take the same Pou∣der inwardly: others use Tro∣ches of Vipers; and others a∣gain commend the Pouder of Tin as a Specifick in this Case, both, or either of which may be mixed with a little Mithridate, and so taken or applied.

LXXXIII. But after all, the Medicaments that are proposed, I am confident none of them exceeds, nay, comes not up to, the three fol∣lowing Medicaments, with which I have Cured several who have been bitten with Vipers and Rattle-snakes, viz. 1. Our The∣riaca Chymica. 2. Volatil Salt of Vipers. 3. Virginian Snake∣root.

LXXXIV. The Theriaca Chy∣mica you may give from ℈i. to ʒi. either alone, or dissolved in Ange∣lica-water, or some Syrup or other fit Vehicle; it may be given, 1. Upon receiving the Wound. 2. Morning and Evening daily. 3. If Fainting, Swooning, or Convulsions are induced. 4. If there is present a Vomiting, and it is constantly Vomited up, it is to be repeated till it will stay.

LXXXV. The Volatil Salt of Vipers or of Rattle-snakes, which is inferior to no other thing in the World, and may be given from ℈i. ad ʒi. three, four, or six times a Day, or as oft as need shall require; or instead thereof the Volatil Spirit of the Viper, &c. which is the Volatil Salt dissolved in the Flegm, and is made exactly as you make Spirit of Harts-horn. Indeed all Volatil Animal Salts, have a power to resist and de∣stroy the Poison of Serpents of all kinds.

LXXXVI. The Virginia Snake∣root does incredible Cures of this kind: you may give the Pouder à ℈i. ad ʒi. in some fit Vehicles, twice or thrice a Day: or the Tin∣cture thereof extracted with Sp. Vini, à ℥i. ad ℥ii. in a Glass of Wine, twice or thrice a Day: or the Elixir thereof extracted with the Powers of Angelica, Rosemary, or Juniper-berries, in the same proportion. I Cu∣red a Dog which was bitten in the Foot with a Rattle-snake, by giving the Pouder inwardly, in a strong Decoction of it in Milk, and applying the green Root beaten to a Cataplasm outward∣ly to the Wound, in less than three Days the Dog perfectly re∣covered.

LXXXVII. These things being said, we will give you two Histo∣ries or Observations of Cures of this kind, performed by two very knowing Men, viz. Ambrose Pa∣raeus, and Monsieur Charas, which are well worth the reading, and so conclude our Discourse upon this Title.

LXXXVIII. Paraeus, lib. 20.

cap. 23. says, A Man was bitten on the Hand (as he was gathering Hops on a He dge) by an Adder or Viper: He suckt the Wound im∣mediately with his Mouth, thereby to ease the Pain, and draw out the Poison; but as soon as the Tongue touched the Wound, presently it so swell'd, that he could not speak: His Arm swell'd also, even to his Shoulder, and his Pains were so sharp and acute, that he twice Swooned away in the presence of the Chirurgion.

LXXXIX. His Countenance was yellowish and livid, like to a Dead Man, so that his Recovery was despaired of: yet his Mouth was washed with Theriaca dis∣solved in White-wine, adding to it a little Aqua Vitae; the Arm was scarified with many and deep Scarifications, and the Blood which was waterish, and sanious, was suffered to flow forth plentifully from the Parts about the Sore; and the Scari∣fications were washed with Mi∣thridate and Theriaca, dissolved in Aqua Vitae.

XC. The Patient was laid in his warm Bed, and made to sweat, but not suffered to sleep, lest there∣by, the Poison should have been drawn into the inward Parts. These means so prevailed, that the next Day, all the malign Symptoms vanished: wherefore to finish the Cure, I (says he) thought good that the Wound should be kept long open and washed with Theriaca Androma∣chi; nor was I (says he) de∣ceived, for within a few Days after he recovered.

XCI. Charas in his new Expe∣riments upon Vipers, cap. 1. has this Observation. A certain Man by handling an enraged Viper was bitten on the lateral inside of his right Thumb, with one of the great bent Teeth. The pricking was no more than that of a Pin, it seemed not deep, and on the surface there was only a very small hole, with a very little redness, so that it was not dis∣cernable but by its Colour: nor was there either on or about this little hole any sign of the yel∣low Liquor contained in the Bags about the great Teeth, which is wont to be cast upon the Wound when a Viper bites deep.

XCII. Strong Ligatures were made above the place bitten, the Part wounded was scarified, and an Iron Spatula heat red hot, and often repeated, was held very near to the prickt place, to keep the Pores open, and attract back, and draw out some of the Poi∣son: and Theriac. Androm. ʒii. was given in a Glass of Wine.

XCIII. In less than a quarter of an Hour after the biting, the Patient felt some debility, and cal∣led for a Chair, he grew very pale, his Pulse grew quick, low, and almost interrupted: after which followed Convulsive mo∣tions, and a kind of Tetanos, for he had a stiffness of his whole Body, chiefly of his Neck, and Muscles of his Head.

XCIV. He then complained of a great pain about his Navel; he was cold in his extream Parts, and in his Face; which was all over covered with little drops of cold sweat; and his Lips, espe∣cially

the lower, was also swell'd: a while after he went to Stool, and then swooned away.

XCV. At the same time he Vomited the Treacle before given, and all he had eaten at Dinner, undigested; and he became so weak, that he was not able to get up to his Chamber again, from whence he came down.

XCVI. And by reason of the quickness, weakness, lowness and inequality of his Pulse, and his frequent swoonings, as well as his cold sweats, Viper Pouder ʒi. was given him in Treacle-water and Carduus-water; and a great Cataplasm of Theriaca Androm. was applied upon the Heart and Stomach.

XCVII. The Mixture he Vo∣mited up presently; Pouder of Vi∣pers was then given in some Orvie∣tan; this he also Vomited up: during all this time, he had his Senses, and the use of his Reason. This Vomiting not giving time to the Remedies to be resolved, and communicate their Virtues to the Noble Parts, it was thought proper to have recourse to the Volatil Salt of Vipers, be∣cause that being exceeding Sub∣til, and Volatil, and very quick∣ly transmitted to all the Parts, even the most remote, the Pati∣ent might thence feel its Effects with more speed and efficacy, than from all the other gross Medicines, which had been cast up, as soon as they had been taken down, whereby they were made ineffectual, by not im∣parting their Virtue to the Blood, where the necessity re∣quired.

XCVIII. For this Cause-sake then, there was given of Salt of Vipers ʒi. in Treacle and Car∣duus Waters: and about a Quart of this Mixture was given him: he kept it a little while, and then cast up a part of it, mixed with store of Viscous Phlegm. He took another like quantity of the same Mixture, which he also kept for some time, and then Vomited up as much of it as might be remaining in his Sto∣mach, and therewith much Phlegm.

XCIX. More of the same Com∣position was still continued to be gi∣ven him, as fast as he Vomited it up; he had also several Cly∣sters, to mitigate the violent and rebellious Pains, which he felt in his Belly about his Na∣vel.

C. His Lips remained yet swel∣led, his Pulse ill, his Sweats cold, and his Faintings continued very long; but persisting in the use of the Volatil Salt of Vipers, his Vomiting at length ceased, and he kept the Eighth Dose in his Stomach, which was given him about Four Hours after he received the Wound.

CI. From that time the Sym∣ptoms lessened, and the coldness began gradually to retire, and give place to the natural Heat, which was manifestly restored about Five Hours after the biting, his Pulse also returned, and was even and strong, but somewhat high.

CII. I left him not (says Charas) before the Mortal Sym∣ptoms ceased, and then he was carried to his Lodgings, whither I

accompanied him, and he was put to Bed, and there was given him a Mixture made of Confect. Hyacinth, Confect. Alkermes, A. ʒi. Syrup of Limons ℥i. Carduus-water ℥iv. mixt together: it was given him at three times, from Three Hours to Three Honrs.

CIII. He had also Citrons to smell to, and now and then he took some slices of them with Sugar: he took also good Broths, and drank Ptisan made with Roots of Scorzonera, and Raspings of Harts-horn, made pleasant with Syrup of Limons: a little Wine was also given him sometimes: and Confectio Alkermes was dis∣solved sometimes in his Broth, sometimes in his Ptisan.

CIV. During all the great Ac∣cidents or Symptoms, his Finger was not changed, nor any swelling upon it; but that began when those Symptoms ceased: the Pains a∣bout his Navel still continued, but a little abated, for which reason Clysters were prescribed: his Belly was a little stiff, but not swell'd, his Tongue whi∣tish, not dry, his Eyes faint and wan, his looks pale, and his Lips still tumified.

CV. The Tumor of the Finger extended it self that Night over the whole Hand, which was often anointed with Matthiolus his Oil of Scorpions, mixt with Hungary-water: but for all this anoint∣ing, the Tumor went forwards to the Arm the next Day, with pain and redness, and ascended to the Eye.

CVI. Then Fomentations made of the Roots of Angelica, of Ma∣ster-wort, of Carline Thistle, and of Birth-wort, with the Tops of Centory, Calamint, Hypericon, Scordium, and Wormwood, boiled in White-wine, which were con∣tinued for some time, with a∣nointings with Oil of Srorpions between whiles.

CVII. This was done with great Care, but no great Effect succeed∣ed upon it, and he again Vomited up even his Broth; but this Vomi∣ting continued not, yet the Pain in his Belly remained obstinate, and the swelling, and redness of the Hand and Arm still encreased: and from the beginning of the third Day, it seized on the Shoulder of the same side, descending to the Arm-pit, upon the whole Breast, and all the adjacent Parts, even to the whole Region of the Liver, the continual use of the Fomentation, and Oil of Scor∣pions doing nothing.

CVIII. And since the External Remedies proved succesless, we had recourse to Internal Ones: In the Evening of the third Day, Pou∣der of Contra-yerva ad ʒi. was given in Cordial Waters, mixt with as much of Confect. Al∣kermes, for all which, we saw no abatement of the Redness, Tumor, or Pain; but on the contrary, the swelling seemed to seize on the Left side.

CIX. For this reason, we found it necessary to return to the use of our first inward Remedy, the Vo∣latil Salt of Vipers, which had an apparent good Operation, and struck at the Root of the Mischief: Thus in the Morning of the fourth Day there was given Salt of Vipers ʒss. in Carduus-water ℥iv. he was well covered, and made to Sweat.

CX. The Dose wrought accord∣ing to expectation, for the Sick sweat not only abundantly, but found also a great amendment in all the ill Symptoms which remain∣ed. His Pain about his Navel was almost insensible, the swel∣ling of his Lips, and that which was in the Region of the Liver, Breast, and Arm-pits, vanisht; the other also of the Shoulder, Arm, and Hand, was much a∣bated, together with the Red∣ness and Pain.

CXI. Finding the Symptoms thus to abate upon giving the last Dose, the next Morning another like Dose was given him, and all the Symptoms still much more a∣bated, he sweating powerfully with∣al. And tho' the Patient found himself exceedingly amended, yet the next Morning he had such another Dose again, and the Morning following one Dose more, whereby all the Symptoms vanished, and were perfectly taken away.

CXII. In the interim there was applied to the Finger, a little Emplaster to cicatrize the Scarifi∣cations which were at first made, and were healed in a few Days af∣ter. Thus in about a Weeks time, the Patient went abroad, and did his usual Business, and was as well as if he had never been bitten of the Viper at all.

CXIII. From this Observation, which deserves to be kept ad per∣petuam rei memoriam, and writ∣ten in Letters of Gold, the mighty Virtues, Power, and Force of the Volatil Salt of Vipers is manifest, in overcoming the Poison which so violently exercised its fury over the Natural Heat, and all the Noble Parts: and its activity and pe∣netration is manifest, in pursu∣ing the Poison, and expelling it from the remotest parts of the Body, where it had fortified it self, and endeavoured to regain the place it had lost, and where, in the mean time it seemed to despise and profligate, all other the most generous and power∣ful Remedies.

CXIV. And now we are speak∣ing of the Volatil Salt of Vipers, (tho' it is forreign to this present Discourse, yet) we will give you one other Observation of the same Charas, of a certain Man who had such a vehement and continual pain of the Head, upon the Forehead near the Temples, which was even so doubled and redoubled, that he could not chew, nor so much as open his Mouth to swallow a little Broth, but with extream Pain and Anguish: and tho' all things were done to him that could be imagined, as Bleeding in the Arm and Foot, Purging often, Frictions of Neck and Shoul∣ders, Vesicatories and Attra∣ctives behind the Ears, opening the Temporal Artery, exhibiti∣on of powerful Sudorificks, which were continued Morning and Evening for many Days to∣gether, by which he sweat very plentifully, pulling out one of his upper Teeth which was sound, thinking thereby to give some vent to the Humor, &c. yet these means were used in vain, and left the Patient as bad as they found him.

CXV. At length it was resol∣ved, that a Dose of the Volatil

Salt of Vipers should be given him, in Wine: this one Dose presently removed all the Pain, which caused as great a wonder in the Assistants and Standers by, as satisfaction to the Patient. And by this so surprizing an Effect, with what hath been said afore∣going, the power, forces, effi∣cacy, and virtue of this Salt is better demonstrated, than by all the Rhetorick and powerful Reason imaginable to be offered in the World. Action demon∣strates better than Words; and the Effects of things, more than the most florid Harangues.