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. XIX. Of WOƲNDS by GƲN-SHOT in General.

I. THese kinds of Wounds were wholly unknown to the An∣cient Greeks and Latins, and therefore they have no proper Names by which we can call them: The Moderns who have wrote

in the Latin Tongue, call them Vulnus vel Vulnera Sclopetarum globuli; and we in English, Gun-shot Wounds.

II. There has been a great Con∣tention among Authors concerning Gun-shot Wounds, and many the Arguments pro and con, whether they are Poisonous, or have any de∣gree of Fire or Burning in them, or not; some maintaining the Af∣firmative, others the Negative, which the Learned Sennertus in his Med. Pract. lib. 5. par. 4. cap. 20. has Excellently sum∣med up, and given the Deci∣sive Judgment concerning it, ad∣hering to the Negative Voice: The whole Discourse is too long to be here inserted, they that desire to read it, may have re∣course to the Author himself, where they may have much Sa∣tisfaction.

III. That (says Wiseman) which might be the occasion of their suspecting a Burning and a Poi∣sonous Quality, was the deadly Colour of these Wounds, which in those early Days, when the Invention of Guns was Novel, surprized them, they looking not unlike Poisoned and Burnt Wounds.

IV. Where the Bullet pierces (says he) it extinguishes the Na∣tural Heat, and the Lips of the Wound are livid or blackish; and if they be not rationally drest, they inflame, and are accom∣panied with a Tumor; and Bli∣sters frequently rise about them: in this Condition the Wound is commonly the first Day, and so to the seventh; and if not succoured, it Gangrens, and so the Patient commonly Dies.

V. In former Times Artists were deceived by the appearance of the Wounds, and so drest them as Poisonous Wounds, which occa∣sioned them so to write of them, and in their way of managing of them, it was no wonder that they were so difficult to digest and Cure.

VI. And in Our Times (says Wiseman) tho' they are not cal∣led Poisoned Wounds, yet it is a difficult thing to disswade many of Our Chirurgions, from dressing them with Tinctures of Myrrh, and Honey of Roses, and thrust∣ing in of great Tents; by which way of dressing, these kinds of Wounds have been found undi∣gested on the tenth day.

VII. These lesser fleshy Wounds being undigested, at last Gangren, and it is not to be wondred at: I will (says he) shew you the Experiment every Day in a Fonta∣nel or Issue made with a Caustick: If you cut thro' the Escar, and put a Pea in the middle of it, with Tincture of Myrrh, and Honey of Roses, as some dress Gun-shot Wounds, and the next two or three days after, when you dress it again, it will be to your sight not unlike a Gun-shot Wound: if you continue your dressing with a Pea, and your Tincture of Myrrh, if it does not Gangren, yet it will be inflamed, and slow in digestion; which is from the improper Ap∣plications.

VIII. For if this Escar had been drest with Emollients and Digestives, as ought to be done, it would separate with Digestion in

the worst habit of Body; and so it will in Gun-shot Wounds with little distemper or difficulty, if the Extraneous Bodies be but timely Extracted.

IX. If therefore Gun-shot Wounds be rightly drest, they will as easily digest and heal, as any Complicated Wound; and what is said of Gun-shot Wounds is to be understood, when at Sea, of a Wound by a Splinter; which tho' it may not have force enough to make a Wound, yet oft-times bruises the Skin to the Flesh, so forcibly as to extinguish the Natural Heat, and make it black.

X. In this Case, if it is drest with Spir. Vini, & Ung. Aegyptia∣cum, or lapt up with a warm Stuph, it will grow black, dry, and parcht, and become an Escar; and the Humors which flow plentifully to it will cause an In∣flammation, with Tumor; and an Apostemation is the best which can be expected under∣neath the Escar, and conse∣quently it will terminate in a hollow Ulcer; but for the most part it Corrupts and Gan∣grens.

XI. Whereas if this Contused Escar is dressed with Lenients, according to that Aphorism of Hip∣pocrates, Omne quod contusum, necesse est ut putrescat & in Pus vertatur: viz. All that which is bruised must putrefie, and be con∣verted into Matter: as with Ʋng. Basilicon cum Oleo Liliorum, &c. and the Parts about Embroca∣ted with Oil of Roses mixt with the white of an Egg and Vinegar, and a Defensative applied over all to prevent defluxion, the Escar would separate as easily as those made by a Caustick in an Issue, and afterwards be in∣carnated and cicatrized with a great deal of Ease to the Pa∣tient.

XII. By what has been said, it appears what the Nature of these Wounds is, to wit, that they are only with very great Contusion, and Tearing of those Parts thro' which the Bullet passes. And tho' the Part at a near distance may be burnt by the Flame of the Gunpowder, yet this belongs not unto the Wound it self, nor is the Part burnt within: and tho' it is granted, that Bul∣lets may possibly be Poisoned, yet this is no ways Essential un∣to these Wounds, but meerly Accidental.

XIII. Wounds then made by Gun-shot, are the most Complicate sort of Wounds; for there is not only a solution of Continuity, but there is conjoined with them, Con∣tusion, Rubbing, Tearing in a ve∣hement manner, and sometimes Fractures of the Bones: to which may be added, sometimes vari∣ous Accidents, as Hemorrhage, vehement Pain, Inflammation, Erysipelas, Convulsion, Fever, Delirium, Palsie, Fainting and Swooning, Sinuous Ulcers, Gan∣grens, and Sphacelus.

XIV. The Differences. They are taken, 1. From the magni∣tude of the Wound, as it is either great or small, deep or superficial.

XV. 2. From the Part affect∣ed, the Skin and Flesh being some∣times only wounded; sometimes the Nerves and Tendons, some∣times

the Arteries and Veins, and sometimes the Bones are broken. Or thus; The Wound is made either in the fleshy Parts, or in the fleshy and Spermatick Parts both: The Spermatick Parts as they are called, are either soft or hard, the soft are the Mem∣branes, Nerves, Tendons, and Ligaments; the hard are only Cartilages and Bones. The Membranes may be divided and bruised. The Nerves, Tendons, and Ligaments may be contused and torn. The Bones may be fractured, by being broken trans∣verse, or by fissure, or into bits; which last is that which Gun-shot most produces.

XVI. 3. From the Modus or Manner; sometimes the whole Body is wounded, sometimes a part only: sometimes the Bullet sticks in the Wound, sometimes it passes quite through: sometimes it pene∣trates into the Body, sometimes it carries into the Body with it some Extraneous Matter.

XVII. The Signs. What Parts are wounded, are to be discovered by putting in the Probe, or else from the site of the Wound by Ana∣tomical Deductions: If the Ner∣vous or Tendinous Parts are hurt, there will be manifest and vehe∣ment pain: If the great Arteries and Veins, a mighty Hemor∣rhage; yet sometimes the Part being much contused, the Lips afterwards quickly swell, and oftentimes so much, as to stop in a great measure the flowing of the Blood.

XVIII. These Wounds are gene∣rally Orbicular, and either of a blue or livid Colour, or of a blue mixed with green, or of a Violet Colour: Sometimes the Wound it self is black, and the Parts adjacent to it livid.

XIX. There is a heat sometimes in the Part, which arises from the quick and vehement passing of the Bullet, making a great Contu∣sion of the wounded Parts.

XX. There is also a feeling of the Blow, as if a Stone, or some other heavy thing was flung a∣gainst, or entering into the Part.

XXI. If the Wound was made by a Poisoned Bullet, the Colour of the Flesh is more wan and livid, than otherwise it would be; there will be a heaviness and sluggish∣ness of the whole Body, a Trem∣bling, a Palpitation of the Heart, Faintings, Swoonings, and sometimes Convulsions, and o∣ther like Symptoms to these.

XXII. The Colour of the Wound and Parts adjacent will be ill, as if tending to Mortification, the pain will be vehement and prick∣ing, there will be Inflammati∣on, and a Fever of the whole Body, and sometimes dotage and raving withal.

XXIII. If such a Poisoned Wound is slow in maturation, or generating of Pus, if there be an extinguishing of the fresh Co∣lour of the Part, and its incli∣ning to a yellow or livid Co∣lour, if the Pain remits, with∣out any manifest Cause; and if the Part ceases beating, and a stupidity is present, &c. the Wound will degenerate into a Gungren.

XXIV. The Symptoms. If it is an ordinary Wound, they are

chiefly these, Contusion, Pain, In∣flammation, Convulsion, Heat, Palsie, Lividness, and (if the Wound is great, in or near a Joint) sometimes a Gangren and Mortification.

XXV. If the Bullet is Poison∣ed, all these Symptoms will appear, but sooner, and more vehement than if it were not.

XXVI. The Prognosticks. These Wounds for that they are al∣ways made with a considerable Contusion, are much more dange∣rous than those that are made with Sword or Dart, supposing the place to be the same: As to instance, many have recovered of Wounds made with a Sword in the Belly, Guts, and Bladder, whereas scarcely ever any one was Cured of Wounds made in those Parts by Gun-shot.

XXVII. If in a healthful ha∣bit of Body, a fleshy Part is only wounded, and in a good Air, the Wound may be Cured without any great hazard or difficulty.

XXVIII. But if in a Cacochy∣mick habit of Body, the Sperma∣tick Parts are very much lacera∣ted or torn, and it is in a hot and moist Air, viz. the Wind being South, and Signs of Poison do appear, a Gangren, &c. is to be feared.

XXIX. Tho' a Wound seems desperate, yet it is not to be given over while there is Life; for it has been oft-times observ'd, that Nature many times works Mira∣cles, as it were, and that very many, who have seemed to be near to the Grave, have yet notwithstanding recovered and done well.

XXX. If there are many, and those the more Noble Parts, that are wounded, bruised, and torn, and if withal, any Bones are broken or hurt, the Wound is so much the more dangerous, and the Cure the more diffi∣cult.

XXXI. If the Parts are much torn, the Wound then yields a stinking Sanies; and if a flux of Humors then follows, an extin∣guishing of the Natural Heat is to be feared.

XXXII. If these Wounds hap∣pen in such Parts, as can easily draw the principal Parts into con∣sent with them, there is much danger. And such are the Joints and great Vessels, from which many times there arises not on∣ly Vapours, but corrupt and vi∣tious Humors, which being re∣ceived and communicated to the Heart, do easily induce Fe∣vers, Fluxes, as Diarrhaea's, Lienteria's, Dysenteria's, Faint∣ings, Swoonings, Convulsions, and the like.

XXXIII. If such Wounds hap∣pen to a Cacochymical Body, they are much more dangerous, than if they happen to a Body of a good Ha∣bit; from whence it is, that in Armies and Camps in which Epi∣demical Diseases rage, most of these that are thus wounded, die of their Wounds. For in Camps the Air is for the most part in∣fected with the nastiness of the Camp; and the Souldiers for want many times of wholesom Meat and Drink, drink filthy and corrupt Waters, and eat bad and corrupt Food coming next to hand, so that 'tis no

wonder that such a Constitution is induced, as may render Gun-shot Wounds in such Bodies ve∣ry dangerous.

XXXIV. These Wounds come more slowly to Suppuration than others do; not only because the natural heat is much abated; but also because the Spirits are much wasted and dissipated, by reason of the Contusion.

XXXV. Lastly, If these kind of Wounds are made by a Poisoned Bullet, they are then indeed very dangerous, and for the most part Mortal, and this more especial∣ly, if they penetrate into the interior Parts: and sometimes these Wounds, tho' they are but small to see to, yet they many times destroy and kill the Patient.

XXXVI. The Cure. The In∣dications of Cure (I mean of Wounds not Poisoned, for as to the Cure of them we shall refer you to the for∣mer Chapter) are chiefly three, 1. The drawing forth of the Bullet, if it yet sticks in the wounded Part. 2. The con∣verting the bruised Flesh into Pus, or Matter. 3. The Incar∣nating, or filling the Wound up with Flesh, and then at length cicatrizing it, which is common with all other Wounds.

I. Of Extracting the Bullet.

XXXVII. The Bullet, or any other Extraneous thing carried in∣to the Wound with the Bullet, is first to be taken forth, and this is to be done either at first dressing; but if it is not then fit to be done, you must do it at some other fit time, during the Cure.

XXXVIII. The Bullet is to be drawn forth, either the way it went in, or the opposite way, if it lyes very deep, is much nearer to the opposite place, and may be felt there thro' the Skin and Flesh.

XXXIX. If the Bullet pierces not so deep, then having found it out, by searching with the Probe, &c. being put into the Wound the same way it went in, you must attempt the drawing it out with some fit Instrument.

XL. Now to take the Bullet out the way it went in, you must place the Patient as near as may be in the posture he was in when he received the shot; or if thro' weakness he cannot be so posi∣ted, let him be placed in a po∣sition as near to it as may be, lest some Muscle, Nerve, Ten∣don or Ligament, lye in the way of its passage; the Sick be∣ing thus placed, then search for the Bullet, &c.

XLI. The largeness of the Wound will in some measure shew you the largeness of the Bullet, by which means you may make choice of a fit Instrument for the Extra∣ction.

XLII. Now in Extracting the Bullet, 1. The way must be sufficiently opened by Instru∣ment. 2. That the Bullet be laid hold of. 3. And being laid hold of, that it be drawn forth by the Chirurgion's Hand.

XLIII. The Instrument takes hold of the Bullet as a pair of Scissars, or as it fastens it self into the Bullet, either by com∣prehending it in its Cavity, or

by laying hold of it by its Bill, being made like a Saw.

XLIV. For which reason there is great variety of Instruments; some lay hold on the Bullet and draw it out, as they are fast∣ned into it: Others compre∣hend the Bullet, having a glo∣bular Cavity at the end: Others are nocht like Saws, of which some are straight, some crook∣ed, according as the Wound is either straight or oblique.

XLV. You must endeavour to find out the Bullet; if you fail of it by searching with the Probe, you must try if you can find it by feeling with your Hands a∣bout the wounded Part; for sometimes a Bullet takes such a circular course, that its way is impossible to be followed.

XLVI. Wiseman gives us Examples of this kind: One who being shot in the Cheek, he cut out the Bullet behind in his Neck. Another (says he) was shot in the outside of the small of one of his Legs, the whole Member swel∣led, and was inflamed, and no possibility of finding out the Bullet, at last by chance he felt it, in the inside of the Thigh above the Knee. Another wound∣ed in the outside of the Arm, he cut the Bullet out below the Scapula; and in some Cases the Parts extreamly pained with In∣flammation and Tumor, do sometimes discover the place where the Bullet lyes; and sometimes the pain alone will do it, tho' there be no Tu∣mor, &c.

XLVII. In the very work of Extracting, you must be cautious that you lay not hold of some Nerve or Tendon, and so pluck them a∣long with the Bullet, for then you will cause intolerable Pain, and grievous Accidents; for which reason you must not open or di∣late your Instrument, till you take hold of the Bullet there∣with, without any of the cir∣cumjacent Parts.

XLVIII. Moreover, if the Bul∣let can be found, it will be best, to attempt the drawing it forth whilst the Sick is warm (if in heat of Battel) and the Wound fresh, not being altered much by Air or Accidents, by which means less pain will follow upon the Extraction; for after the first and second Day the Wound swells, and the adjacent Parts are inflamed, and so changed in their Temperament, that they will hide from your fight the Bullet, and what accompa∣nied it, if any thing, so that the place they lye in will be dif∣ficult to be known; or being known, will not be extracted without great hazard, pain, and trouble to the Patient; so that then it may be needful to defer that Work to another time, and by Leniments to hasten the Di∣gestion.

XLIX. To omit the present drawing forth of a Bullet when lodged in a Joint, may hazard a Mortification, because it is lodg'd among the Tendons, and will cause much pain which will not cease; for which reason, the Wound will not digest.

L. If the Bullet is lodged in a less Noble Part, as in the Muscu∣lous Flesh, and it has not been

drawn out at first dressing; in this Case you may more safely stay the Extraction till the seventh Day; or till the vehemency of the Accidents are over, and the Wound digested; but then you must be more careful, for the Wound will be the more pain∣ful, and the more slow in dige∣stion: If the Bullet carries any Rags with it, so long as they remain in the Wound, it will be very painful, inflamed and ve∣xatious, nor will it digest well, or be cured.

LI. But if the Bullet cannot be found out, by the Probe, or other∣wise, as it chances sometimes when Wounds are very deep or oblique; then the Wound is to be kept open for a long time, and sup∣purating Medicines are to be made use of; and if possible, the Member is to be so placed, that the Bullet may fall forth by its own weight, or may be expelled by Nature; and there∣fore in this Case, unto Nature the whole Business is to be com∣mitted.

LII. And tho' Leaden Bullets may lye long, and be carried about in the Body, yet Iron or Brass Bul∣lets must be taken forth in some considerable time, because the first swells mightily, by its rust∣ing; and the other yields Ver∣digrease, both which are very painful, and inimical to the healing.

LIII. If the Bullet is lodg'd in any Noble Part, or a Part that may easily draw the Noble Parts into consent with it, and that by reason of the Wound it self, the Patient's Life is in any dan∣ger; in this Case you ought not to attempt the Extraction, since thereby the Sick can have no Benefit, but that you may pro∣bably hasten on that Death, which otherwise the Wound would have infallibly induced, but in a larger space of time.

II. Of Proper Digestive Me∣dicaments.

LIV. Our first and great Care here must be, that the Contused Substance may be brought to Ma∣turation, and separated from the sound Flesh, and sound Parts; for the bruised Matter easily be∣comes putrid, and Gangrens; so that our ordinary and com∣mon Digestives and suppurating Medicines, which are made use of in other Wounds and Tu∣mors, have simply here no place; more especially if the Nervous Parts are hurt or bruised, which do not well admit of such kind of moist and simply Oily Medi∣caments, but require those that are drier.

LV. Those Medicines then which we are to make use of in these Wounds, must be of that Nature and Quality, that tho' they will bring the contused Flesh into Pus, yet they will not produce any putridness, but by their Anodyn Property ease and alle∣viate the Pain.

LVI. To accomplish this Inten∣tion, Quercetan does to every Ounce of any Digestive or Suppura∣tive add ʒi. of red Precipitate: Yet this is not to be done rash∣ly, but with some caution, as where there is a present putrio∣ness,

and fear of a Gangren nigh at hand; for in most other Cases, these kind of Wounds may be Cured without any kind of Mercury whatsoever: and in Nervous Places, if Precipitate is used, it may be the cause of very much Pain.

LVII. Paraeus commends high∣ly his Oil of Whelps thus made: ℞ Oil of white Lillies lbiv. two young Whelps, which kill, and boil them in the Oil till the Flesh falls from the Bones: add to them Earthworms (washed in Wine) lbii. boil them together, and let them be strained without any strong pressing; then to that which is strained, add of Venice Turpentine ℥vi. Spirit of Wine ℥ii. mix, and make an Oil or Balsam. It has an admirable Virtue to ease Pain, and maturate the Pus. If you apply it to Joints or Ner∣vous Parts, there ought to be more of the Turpentine than of the Oil, because these Parts re∣quire more drying than the fleshy Parts do.

LVIII. Barbett commends this: ℞ Venice Turpentine ℥iv. Calves Marrow, Oil of Hypericon A. ℥ii. Galbanum ℥i. Venice Treacle ℥ss. Roots of Scordium, of Scorzonera, A. ʒiii. yolks of four Eggs: mix, and make an Oint∣ment.

LIX. Sennertus commends this as a thing singularly useful: ℞ Ʋng. Basilicon ℥i. Oil of Lin∣seed, and of white Lillies, A. ℥iii. mix them.

LX. Or this: ℞ Oils of Lin∣seed and of Hempseed, A. ℥iv. Ho∣ney ℥i. Allum ℥ss. mix them.

LXI. Joubertus commends this: ℞ Hogs Lard, or fresh Butter ℥viii. red Precipitate washt and levigated ℥i. Camphir ʒii. dissolved in Aqua Vitae; mix them well together. Now if in∣stead of Lard you take Arcaeus his Liniment, the Medicine will be much more effectual. The Lard, or Butter, or Liniment, are Suppurative; the Precipi∣tate adds to the force of the Suppuration, causing very little pain, and the Camphir helps Penetration, and resists Putre∣faction.

LXII. ℞ Oil of Hemp ℥viii. Linseed Oil ℥ii. Juices of Plantane and Night-shade, A. q.s. boil them till the Juices are consumed.

LXIII. Another of Barbett, more effectual: ℞ Yolks of Eggs-N^o iv. Turpentine, Ung. Aegy∣ptiacum, A. ℥ii. Amber, Euphor∣bium, Mastich, Mummy, A. ℥ss. round Birthwort Roots in Pouder ʒii. Oil of Elder, q.s. mix, and make an Ointment.

LXIV. Sennertus has this: ℞ Oils of Linseed and Hempseed, A. ℥vi. Sal Armoniack, white Vitriol, A. ℥iii. Mithridate, The∣riaca Andromachi, A. ℥iss. mix them together over the Fire: This is of use, when a putridness is supposed near at hand.

LXV. If Putridness and a Gangren is feared, then add some Precipitate, as, ℞ Ung. Basili∣con ℥i. fresh Butter ℥i. red Pre∣cipitate levigated ʒii. mix them together.

LXVI. Another of Barbett's, more Excellent than any of the former, which also resists Putre∣faction: ℞ Oils of Linseed and Roses, (Hempseed I think is bet∣ter)

Tar, Turpentine, Galbanum, A. ℥ ii. Mastich, Frankincese, Nitre, Sal Armoniack, A.℥i. Oils of Worms, and of Turpentine, Verdigrise, white Vitriol, Camphir, pouder of Earthworms, A. ʒi. Alum ʒss. mix them together over a gentle Fire. If the Part is not Nervous, in a great Putrefa∣ction, you may add some red Precipitate.

LXVII. ℞ Turpentine, Honey, A. ℥iii. yolks of Eggs N^o vj. boil them with a gentle Fire, to the thickness of a Liniment.

LXVIII. ℞ Oils of Linseed and Hempseed, A.℥iii. Oils of Roses and Mastich, A.℥i. Oil of Camphir ʒi. mix them well together by boiling, and use it warm.

LXiX. ℞ Turpentine, Honey, A. ℥ iv. round Birthwort root, Aloes, both in fine pouder, A. ℥ss. Allum, Crocus Martis, A. ʒii. mix them.

LXX. ℞ Unguent. Nicotianae, Ung. Basilicon, A.℥iii. Gum Elemi, pouder of Virginia Tobacco, A. ℥i. mix them.

LXXI. ℞ Oils of Linseed and Hempseed A. ℥iv. Ung. Nicotianae ℥iii. Ung. Basilicon ℥ii. Oil of Turpentine ℥i. mix, and melt them together.

LXXII. ℞ Yolks of Eggs N^o.ii. Turpentine ℥iv. Oil of Hypericon ℥ii. Frankincense, Mastich, Oils of Linseed, Eempseed, and of Eggs, pouder of Tobacco, A. ℥i. mix them.

LXXIII. If any Putridness is feared near at hand, then you may use some of the following Compositions. ℞ Oils of Hemp∣seed and Linseed, A. ℥ vi. Sal Armoniack, white Vitriol A. ʒii. Gum Sandrach ℥j ss. mix them over the Fire. Or you may use the Compositions at Sect. 63, 64, 65, and 66 aforegoing.

LXXIV. Or this. ℞ Oils of Linseed and Hempseed, A. ℥iii. Tar, Turpentine, A. ℥ii. Frankin∣cense, Galbanum, Mastich, Sal Nitre, Sal Armoniack, A. ℥i. Oil of Earthworms ℥ss. Oil of Turpen∣tine ʒii. Alum, pouder of Earth∣worms, Camphir, white Vitriol, Verdigrise, Tobacco, A. ʒi. mix, and melt them over the Fire.

LXXV. And to prevent the Afflux of Humors, this following Defensative is to be applied. ℞ Fine Bole, Catechu, Dragons∣blood, pouder of dried Ox-blood, A. ℥i. Nut-galls in pouder, Frank∣incense, Rosin, Crocus Martis, A. ℥ss. Vinegar of Roses ʒiii. whites of Eggs q.s. mix them, and apply it over the Wound.

LXXVI. Or: ℞ Oils of Roses, of Elder-bark, and of Mastich, A. ℥i. fine Bole, Rosin, Catechu, all in fine pouder, A. ℥ss. Vinegar of Roses, q.s. mix, and make an Ointment.

LXXVII. Or this of Barbett: ℞ Pouder of red Roses, of Scor∣dium, A. ℥iii. Bean-meal, crumbs of Rye-bread, A. ℥j. (these two boiled in a little Milk) yolks of Eggs N^o.vj. Oils of Roses and Violets, A. ℥ii. Wax, q.s. mix, melt over a gentle Fire, and make an Emplaster.

LXXVIII. And over the Wounded Part it self, it will be good to lay the following Cataplasm; which cherishes the Heat of the Part, prevents Putridness, and facili∣tates the Suppuration. ℞ Roots of Althea, of Comfrey, A. ℥i.

flowers of Camomil, of Hypericon, tops of Wormwood, A. M. ss. boil in Milk to softness, then mash them together, and add of Barley-slower, or else meal of Althea-roots and of Beans, A.℥jss. Wine q.s. mix, and make a Cataplasm.

III. Of Abstersives, or Cleansers.

LXXIX. If the Wound pierces quite thro', some use the Flamula, or Seton; but this both Senner∣tus and Barbett disapprove of, as not safe, and advise to the use of Tents put into both Ori∣fices; which Penecilli or Tents ought not to be over-thick, lest they hinder the coming forth of the Pus, and cause Pain.

LXXX. At first, dressing the Wound once a day will be enough; because in Gunshot-Wounds, there is scarcely any thing which requires Evacuation, sel∣dom before the third or fourth day: but when-ever the Pus begins to flow, it is then to be opened and drest twice a day; and when it flows in such abundance, that unless it is often emptied or cleansed, it may cause grief and pain, then you must open it, and cleanse it from the Pus or Purulent-matter thrice a day; but the Acrimony of the Matter will direct you best, whether it is to be drest and cleansed once, twice, or thrice a day.

LXXXI. But when the Pus begins much to diminish, twice a a day will be enough to open and cleanse the Wound: and when it flows forth very little, and be∣gins to be filled up with Flesh, once a day will be enough, as at first.

LXXXII. At first we admit Tents, to open a passage for the Sanies; at length Splenia, made of Linnen-rags, four, six, or eight times doubled, or rather Bolsters may be used, and ap∣plied to the bottom of the Sinus, (if possible;) that by their means, thro' a harder Binding, the Sanies may be pressed forth, which will much advance the Cleansing.

LXXXIII. But if there is a vast quantity of Sanies, and the Sinus is deep and winding, that it cannot all flow or be pressed forth; in this case, the Sinus is to be cut or laid open, that the Wound or Ulcer may be the better cleansed.

LXXXIV. And whether the Wound or Ʋlcer seems contuma∣cious or not, Vulnerary-Potions, or Wound-Drinks, are of extraor∣dinary Ʋse in the Cure; for they cleanse the Ulcers, and free them from the filth of the Excre∣mentitious Humors, causing all things in the Wound which are Heterogeneous to be easily, and the sooner cast forth, assisting Nature therein: if they are useful in any other kind of Wounds, then certainly they are most of all necessary in these; variety of which you may see Cap. 3. Sect. 28. ad Sect. 43. aforegoing.

LXXXV. After Concoction or Digestion begins to appear in the Wound, which is scarcely before the third or fourth day; for that by reason of the Contusion, the native Heat was much weakned, and the

Spirits exhausted; and that there is neither much Pain, nor any Inflammation; but that the greatest part of the bruised substance is turned into Pus, then the Wound is to be cleansed, and after filled with Flesh; which with what things it is best to be done, we now come to shew you.

LXXXVI. Among the number of Cleansers, that which first offers it self is Ʋnguentum de Apio, or Ointment of Smallage, both the simple and the com∣pound; nor have Authors com∣mended them in vain.

LXXXVII. Sennertus has this: ℞ Decoction of Barley, juices of Smallage, Plantan, Agrimony, Centory the less, A.℥iii. boil them, and at the end add Venice Turpen∣tine ℥ix. Honey of Roses ℥vi. Frankincense, Mastich, A. ℥ss. Saffron ʒi. mix them.

LXXXVIII. Mindererus his Ʋnguentum Decameron. ℞ fuices of Arsmart, Celandine, Century, Dock sharp-pointed, D•…•…es-foot, Groundsel, Hypericon, Plantan, To∣bacco, Yarrow, A.lbi. mix, and digest for some days, for the Mix∣ture to settle: decant the clear, and add thereto fresh Butter lbiii. green Liquorice well bruised, Comfry-roots, Tormentil-roots, Hounds∣tongne, all well bruised; Oil of Myrrh, Deers-suet, A.lbj. boil them all well'till the crackling ceases, and the consumption of the Humi∣dity, then strain hot by Pressing thro' a strong Canvas-bag; and to the strained Matter add Venice-Turpentine, Gum Elemi, A. ℥ix. Wax q.s. melted, so as to bring the whole to the consistence of an Ointment, or very soft Cerat; adding after all to every Ounce of the Ointment ℈i. or ʒss. of pure refined Verdigrise.

LXXXIX. Or, ℞ Meal of Orobus ℥ii. Myrrh, Frankincense, A.℥i. juice of Smallage, Turpentine, A. ℥iv. Ung. Aegyptiacum ℥ i. mix, and make an Ʋnguent.

XC. Or, ℞ Ung. Nicotianae ℥iii. pouder of Tobacco ℥i. Gum Elemi ℥ss. mix, and make an Ointment.

XCI. Among the number of the Abstersives, nothing has yet been found to exceed Ʋng. Fuscum Wurizii; the Composition and Preparation of which, see in its proper place.

XCII. Ʋnguentum Apostolorum is commended by some, but this may be trusted to: ℞ Aegyptiacum, Apostolorum, A. ℥jss. Gum Elemi ʒvi. pouder of Tobacco ʒii. mix them.

XCIII. Or this: ℞ Ung. Ni∣cotianae ℥iii. pouder of Scammony, Tobacco, A. ℥. Gum Elemi ʒvi. Honey q.s. mix over a gentle Sand-heat, and make an Ointment.

XCIV. ℞ Meal of Orobus ℥iii. pouder of Florentine Orrice, Frank∣incense, A. ℥jss. juice of Smallage ℥viii. Honey, q.s. mix, and make an Ointment over a gentle Fire, or a gentle Sand-heat.

XCIV. An Abstersive Pouder. ℞ Scammony ℥iv. fine Aloes ℥ii. Tobacco in fine pouder ℥i. round Birthwort-root in pouder ℥ss. mix them, and keep it for use.

XCVI. ℞ Fine flower or meal of Barley and of Lupins, Honey, A. ℥ii. Turpentine ℥iv. juices of Smal∣lage and of Wormwood, A. ℥vi. fine Aloes, Frankincense, Myrrh,

Orrice-root in fine pouders, A. ℥i. mix, and boil gently to the con∣sumption of the Juices: to which you may add Ʋng. Aegyptiacum ℥ii. if you use it in a Wound which is very foul.

XCVII. ℞ Ung. Nicotianae ℥iv. Unguent. Aegyptiacum ℥i. pouders of Aloes, Scammony, To∣bacco, A. ʒvi. mix, and make an Ointment; which is inferior to none of all the foregoing Com∣positions.

IV. Of Incarnatives, or Flesh-breeders.

XCVIII. When the Wound is become clean, it is then very ne∣cessary that Flesh should be gene∣rated or bred: because that when all the bruised Flesh is converted into Pus, the Wound will become empty or hollow, and therefore it ought to be filled up again.

XCIX. This following Sen∣nertus commends, as useful in these kinds of Wounds. ℞ Betony, Comfrey, Horsetail, Hype∣ricon, Plantan, Tormentil, A. M.ss. Earthworms (washt in Wine,) Oil of Mastich, A. ℥ii. Pine-Rosin, Manna Thuris, or the finest white Frankincense, A. ℥ss. Wine q.s. boil'till the Wine is consumed, then Strain out by a strong Expression; and add thereto Wax, Goats or Sheeps suet, A.℥iv. Aloes, Frank∣incense, Mastich, Myrrh, A. ℥ss. mix, and make an Ointment.

C. We will not trouble you with any more Sarcoticks in this place, having already given you an ample number and Variety of them in Cap. 2. Sect. 31. ad 46. aforegoing; in the forms of Oils, Ointments, Balsams, and Emplasters. The Sarcotick or Incarnative being laid upon the Wound or Ulcer, you may cover all with Empl Diapalmae, or Our Empl. Album.

V. Of Gunshot-Wounds, with Fracture of the Bone.

CI. If with a Wound, there be a Fracture of the Bone, which sometimes is broken into many pieces, wherein for the most part, the Nervous Parts are hurt; when these I say, are to be cleared from these Fragments of Bones, there will be many times sharp and acute Pains, Convulsions, and sometimes a Gangren it self: which makes some Artists come to Amputa∣tion with all the speed that may be; which yet ought not to be done, so long as there is any hopes of a Cure without it; for that Nature oftentimes even in these Wounds, is wont to work Miracles as it were.

CII. The Way of Curing these is the same, as in curing Fractures with a Wound; of which we shall speak more largely, in Lib. 6. Cap. 5, 6, 7, 8 following: and in Cap. 23. of this present Fourth Book: however, we think it fit to say something thereof in general terms in this place.

CIII. In the first place there∣fore, it is necessary that the great Fragments of the Bones be restored again into their places, that they may be joined together by a Cal∣lus: but in the application of

Splinters, you must use great caution, lest by them you excite more pain than otherwise would be; and so cause Convulsions, Inflammation or Gangren, which otherwise by due care, might not have happened.

CIV. Some apply Glutinating Cataplasms, (which here indeed have no place) which stick so close and fast unto the Part, and bind it so straitly together, as to cause very much pain, and many times other ill Symptoms: those are not rashly and inconsi∣derately to be made use of, but in their due time and ap∣pointment.

CV. After therefore that the Bones are set again, or composed, or conjoined; the Member is to be placed either in a thin Plate of Lead, or in a Skin moistned with Wine; or in the hollows of those Chips which are bored out of Pumps and Water-Pipes in making, being first moistned with warm Water.

CVI. For all these things, as they hold the broken Parts toge∣ther; so they do it in such a manner, and so easily, that they may notwithstanding them, be be bent as much as you please, and prevent any new access, or cause of Pain: but instead of these things, you may lay on some of the following Cerats or Emplasters.

CVII. ℞ Mucilage of Comfrey-roots, Cherry-tree or Plum-tree Gum, or Gum-Arabick, A. ℥vi. juice of Comfrey, fine Bole, Terra Sigillata, A. ℥iii. juice of Doves-foot, pouder of Catechu, A. ℥ iv. Turpentine lbj. Oil of Earthworms ℥vj. yolks of Eggs N^o xxx. or more: mix them.

CVIII. ℞ Fine Bole, Catechu, A. ℥iij. Turpentine, juice of Doves-foot, or of Comfrey A. ℥iijss. Rosin, Wax, A. ℥viij. mix, and make a Cerate.

VI. Of Dressing Gunshot-Wounds.

CIX. The Bullet, and other extraneous things, as Splinters, Rags, &c. being extracted, you must come to the Dressing up of the Wound; which is to be per∣formed as a Contused Wound, with Oleum Catellorum Paraei; the Recipe of which you have at Sect. 57. aforegoing, which is to be applied hot, as the Part will bear.

CX. In this case, you are not to heed what any shall say to the the contrary, who object against it, as a Greasy Medicine; no tho' it be near a Bone (says Wiseman,) for the Gleet (says he) will foul it much more than Greasy Medi∣caments.

CXI. If you have not the Oleum Catellorum, you may use this. ℞ Oils of Hempseed and Linseed, A.℥iv. Oils of Lillies and Camomil, A. ℥ij. Turpentine ℥j. mix them. Or this: ℞ Stras∣burgh Turpentine ℥iv. Gum Elemi, Frankincense, A.℥ij. Oils of Hemp∣seed and Linseed, and of Earth∣worms, A. ℥iij. Oil of Elder ℥jss. Mastich, Olibanum, A. ℥ss. mix them.

CXII. Or you may use this: ℞ Linseed-oil, Oil-olive, Turpen∣tine, A. lbss. Gum Elemi ℥iij. purified Verdigrise ʒij. mix them.

Or this: Take Turpentine, Balsam Capivii, Oils of Linseed and of Hypericon, Spirit of Wine, A.lbss. Sanguis Draconis in very subtil pouder ℥j. mix them.

CXIII. Quercetan commends this. Take juices of Coltsfoot and Sorrel, A. ℥iv. fresh Butter lbss. Oleum Visci Pomorum com∣positum, (which see in Querce∣tan. rediviv. Tom. 3. pag. 259.) lbj. Larch-Rosin ℥ ij ss. Frankin∣cense, Hens and Goose grease, A. ℥ij. pulp of xx. fat Figs: put all into a Vessel, which stop close; and boil on a gentle Fire for six hours, then strain out hot, and evaporate to a consistence. Where note, if you cannot get the Oleum Visci, &c. you may use in the place thereof Oils of Lin∣seed, of Earthworms, and of Hypericon, A. ℥iv.

CXIV. Or this, of the same Quercetan. Take Oil-olive, or Linseed-oil lbj. new Wax, Rosin, Ship-Pitch, A. ℥iv. Goats-suet, Veal-marrow, A. ℥ij. Oesopus ℥j. melt all together, and strain, keeping the Ointment for use; to every Ounce of which he adds ʒi. of Precipitate: yet in recent Wounds the Precipitate is not necessary; for by experience we know, that these Wounds will digest and suppurate without it, which frees them from pu∣tridness.

CXV. Now to these Wounds you ought to use a soft Tent, and Pledgets dipt in some Digestive pretty hot, but not so hot as to seald them: the Parts about you may Embrocate with Oils of Earthworms, of Roses and Myr∣cles, A.℥iij.mix'd with Vinegar ℥i.

CXVI. Let the Applications over the Wound be of that nature or quality, as to refist Defluxions of Humors, and such as may strengthen the weakned Parts. As, Take Bean and Barley flower, A. ℥vj. Catechu ℥iij. mu∣cilage of Gum-tragacanth ℥j. which boil in Posca, or Water and red Wine to a Cataplasm, adding at last Eggs N^o ij. Oocymel ℥iij. or you may add Oil of Roses, and Wax, A. q.s. and make it into the form of a Cerat.

CXVII. Above the Wound lay this Defensative. Take Terra Sigillata ℥vj. Catechu ℥iij. Lith∣arge, Sanguis draconis, juice of Sloes or Acacia in ponder, Comfrey-roots in pouder, A. ℥ij. Oil of Myrtles, Vinegar, A. ℥xij. mix, and boil to the consistence of a Cerat.

CXVIII. Or, Take fine Bole, Ceruse, A. ℥vj. Catechu, Litharge, A. ℥iij. Oil of Roses omphacin ℥xij. Vinegar ℥vj. juice of Plan∣tan and Nightshade, A. ℥ij. Wax q.s. mix them: apply the Compress dipt in Vinegar, and let the Bandage be equal and gentle, to keep on the Dres∣sings, and hinder the Afflux of Humors.

CXIX. If much Blood has not been lost, Revulsion may be made on the same side, as Galen advises, otherwise not: the Bowels may be emptied with a Clyster made of Mutton-broth or Posset-drink lbj. and brown Sugar or Molosses ℥iv. giving inwardly now and then a dram or two of Our Aqua Bezoartica, or Spiritus Cordialis.

CXX. The Air ought to be

temperate, because Cold is an Enemy to Wounds; the Diet ought to be spare, as thin Mutton-broth, Barley-broth, Water-gruel, Pa∣nado, potched Eggs, &c. because it prevents Inflammations; and he ought to rest quietly, for which purpose you may give this this Dose. Take Poppy-water ℥iij. Angelica-water compound ℥j. Syrupus de Meconio ʒvj. mix them. Or this: Take Guttae Vitae Nostrae ʒj. Spiritus Cor∣dialis ℥ss. Syrup of Limons ℥j. mix them.

CXXI. The second Dressing is next to be considered, where∣in a Fomentation is to be pro∣vided, made thus. Red Port-Wine lbij. Spirit of Wine ℥iij. Powers of Wormwood, Juniper, and Angelica, A. ℥ ss. Scurvy∣grass-water lbj. mix: and being very hot, wring Stuphs out of it, and apply them, which will defend the Wound from the Air.

CXXII. If the Wound is in a good condition, continue the use of Digestives; but if it is affected with vehement Pain, foment it with this. Take white Port-Wine, Decoction of Althea-roots, A. lbj. Spiritus Anodynus ℥j.ss. Broth of a Sheeps Head lbss. mix them: and afterwards apply over all this Cataplasm. Take Barley and Bean flower, A. ℥iv. Orrice-root in pouder ℥ij. Ung. Basilicon, & Nicotianae, A.℥jss. Eggs N^o iv. yellow Palm-Oil q.s. mix, and make a Cata∣plasm: it promotes the Suppu∣ration and is Anodyne.

CXXIII. This being done, it is to be bound up, as before; and this course may be continued to the eighth or tenth day, 'till the Sloughs are separated, the Wound digested, and a good sort of Pus, (which is white, equal, smooth, and not stinking) is generated.

CXXIV. If the Pus is wanting in any of these Qualities, you may mix a little Precipitate with your Digestive or Suppurative, or Ʋng. Apostolorum.

CXXV. You may cleanse by an Injection, made of the Juices of Smallage, the lesser Centory, Plantan and Agrimony, mixt with Barley-broth and Honey, in which you may dissolve a little Venice-Turpentine; first well mixt with the yolk of an Egg.

CXXVI. Or you may apply this Unguent. Take juices of Adders-tongue, Agrimony, Centory, Wormwood, Parsley, Plantan, and Smallage, A. ℥j. mucilage of hull'd Barley ℥iij. boil them together, to nearly the consumption of the juice or humidity; then add Venice or Strasburgh Turpentine ℥iij. Oney ℥ij. Barley-flower ℥j. Saffron ʒss. mix, and make an Abstersive.