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. I. Of WOƲNDS in General.

I. THEY are called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, plu. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Vulnus, plu. Vulnera; and in English, a Wound, Wounds.

II. The Definition. A Wound is the Solution of Continuity or Ʋnity; new, bloody, and without putrifaction, made by external force: and this, as Joel saith, may be by erosion, incision, cutting off, puncture, biting, impulsion, contusion, fraction, rupture, distention, contusion, collision, and the opening of a closed Orifice.

III. Differences. 1. The first Difference arises from the place wounded; and so a Wound is said to be External, happening to any external part of the Body: or Internal, happening, and penetra∣ting into the Viscera; as the Brain, Stomach, Lungs, Heart, Liver, Spleen, Guts, Reins, Blad∣der, Womb, and the like.

IV. 2. The second Difference arises from the accidents of a Wound, and so it is said to be simple or complex: a Simple Wound is that to which no other Disease, or Symptom is

joined, and without contusion or loss of Substance. A Com∣plex Wound, is that which is compounded with some other Disease; as fracture, disloca∣tion, &c. or some other Sym∣ptoms, as contusion, loss of substance, intemperature, ill conformation of the Part wounded, rotting, inflamma∣tion, flux of Humors, proud Flesh, &c.

V. 3. The third Difference arises from the Effect, or Event; according to which a Wound is said to be, 1. Safe, and of easy cure; which happens to the Skin, and fleshy parts. 2. Ma∣lign, and of difficult cure; which happens to the Nerves, Liga∣ments, Bones, and several of the Bowels. 3. Mortal; which are such as happen to the Brain, Heart, Lungs, Liver, Diaphra∣gma, &c.

VI. 4. The fourth Difference arises from the manner of inflicting it, or the variety of the Weapon wounding: and so it is, 1. By Chopping or Cutting with a sharp-edg'd Tool. 2. By a Puncture, with a sharp-pointed Instrument. 3. By a Bullet shot out of a Gun. 4. By Biting, with the Teeth of Man or Beast. 5. By Stinging of Bees, Wasps, Hornets, &c. 6. By Falling from an High place, or from an Horse. 7. By Contusion with a blunt Instrument; wherein the Skin may be either broken, or not broken. 8. By Burning with Live-coals, or other things red-hot 9. Scaldings with Wa∣ter, Oil, Pitch, Tar, running Lead, &c. 10. By application of Caustick Medicaments.

VII. 5. The fifth Difference is taken from the Part wounded: and so one Wound is said to be of the Head, another of the Eyes, another of the Nose; others of the Arms, Back, Brest, Belly, Sides, Liver, Spleen, Womb, Bladder, Legs, Feet, Nerves, Ligaments, Joints.

VIII. 6. The sixth Difference is taken from the Site of the Wound: from whence it is said to be, 1. Right, according to the Lon∣gitude of the Part: or 2. Trans∣verse, according to the Latitude of the Part: or 3. Oblique, which is in a medium, between the other two.

IX. The Causes. And these are all sorts of External Instru∣ments, or other matters, which by accident or otherwise, are able to make a Solution of Continuity or Ʋnity: from whence, that made with a Sharp-edged In∣strument, is called a Cut; with a Pointed Instrument, a Stab; with a Club, by a Blow, a Contusion.

X. Signs. 1. A Wound of the Ar∣teries is known by the Blood coming forth; which is yellowish, hot, and thin; flowing forth violently, and with leaping.

XI. 2. A Wound of the Veins, chiefly of the greater, is known by its bleeding thick and red Blood; coming forth constantly and smoothly, without leaping.

XII. 3. If the great Arteries and Veins of the Thorax are hurt, there is an immoderate flux of Blood, want of Sense, cold Sweats, Swooning, and Death follows, often in a few Hours.

XIII. 4. If the Nerves are wounded, it is known, 1. From

the Place; Anatomy shewing in what Members the chief Nerves are inserted. 2. From the great Pain, causing Pulsation, Inflammation, Convulsion, and Frenzy: except the Nerve be cut in sunder, and then the Symptoms are not so vehement.

XIV. 5. If the Recurrent Nerves are wounded, there fol∣lows loss of Speech, Sense, and Motion, without recovery.

XV. 6. If the Tendons are wounded, the Signs and Sym∣ptoms are much the same, as when the Nerve is wounded; and are chiefly distinguished by the place.

XVI. 7. If the Ligaments, and Membranes covering the Bones, viz. the Periosteum and Peri∣cranium are wounded; the Signs are the same almost, as if the Nerves and Tendons were wounded, but the Symptoms are not full out so vehement.

XVII. 8. A Wound near the Joints, gives fear that a Tendon is hurt; because the Tendons terminate near the Joints.

XVIII. 9. A Poison'd Wound is known by vehement Pain, and a livid colour; becoming sud∣denly black, having Sym∣ptoms more violent than might be expected, from the quality of the Wound, as Burn∣ing over the whole Body, Faint-ing, Swooning, Trembling Frenzy, &c.

XIX. 10. The biting of a Mad-dog, is accompanied with anger, complaining, sadness, dis∣content, Vertigo, distention of the Members, foaming in the Fits, gnawing of the Stomach, abhor∣ring of Meat and Drink, fear∣fulness of Water.

XX. 11. Gun-shot Wounds are accompanied with Contu∣sion, Pain, Inflammation, Trem∣bling, Convulsion, and some∣times with Gangrene and Spha∣celus.

XXI. 12. If the Meninges of the Brain are wounded, there are most sharp Pains; especially upon the moving of the Jaws, with frequent vomiting, and sobbings, or sighings, and a profusion of Blood.

XXII. 13. If the substance of the Brain is wounded, Blood comes forth many times by the Nose and Ears; with vomiting Choler, voiding of Excrements, a ghastly Face, senselesness, and a Fever: and in a little time after, Convulsion, Delirium, or Raving, and Death.

XXIII. 14. If the Marrow of the Back-bone is wounded, there is a Convulsion, which takes away sense and motion, senseless evacuations of Excrements, Pu∣trifaction, and Death.

XXIV. 15. If the Gullet is wounded, there's difficult of breath∣ing and swallowing, with Hic∣cough, and a vomiting of Cho∣ler, Meat and Drink.

XXV. 16. If the Lungs are wounded, the Blood issuing forth is yellowish, and frothy; with a Cough, difficulty of breathing, and pain on the wounded side, yet lying thereon, is easiest.

XXVI. 17. If the Heart is wounded, there comes forth Blood thick and black, Pulse weak, Face pale, universal

Tremblings, cold Sweats, Swoon∣ing, and in short time, Death.

XXVII. 18. If the Brest is wounded, the Air comes out at the Wound; and the Patient finds the taste of things applied to the Wound, in his Mouth.

XXVIII. 19. If the Stomach is wounded, there follows Vo∣miting, Swooning, Fainting, Sickness at Heart, and Death.

XXIX. 20. If the Membra∣nous part of the Diaphragma is wounded, the Flank draws up, pain is in the middle of the Back, difficulty of breathing, coughing, acute Fever, raving, and death: but if it is hurt in the Fleshy part only, there is hope of life.

XXX. 21. If the Liver is wounded, there is vomiting, flux of Blood, pain, continual Fever, raving, Convulsions, cold Sweats, Swoonings, and at last, Death.

XXXI. 22. If the Spleen is hurt, the same Symptoms ap∣pear, but on the contrary side: yet we have seen the Spleen cut out of a living Dog, and the Dog to recover, and live many years after it.

XXXII. 23. If the Intestines or Guts are hurt, or wounded, the Excrements come thro' the Wound.

XXXIII. 24. If the Loins are wounded, they breathe with difficulty, void frothy Blood at the Mouth and Wound, and cave, having a high colour.

XXXIV. 25. If the Reins or Kidneys are wounded, there is a suppression of Urine, pain in the Groin and Testicles, pissing Blood, great Swelling, and danger of Death.

XXXV. 26. If the Bladder is wounded, the same Symptoms with the former appear, unless the Nervous part is hurt; then vomiting, voiding Urine at the Wound, loss of Sense, and lastly, Death it self ensues.

XXXVI. 27. If the Womb is wounded, there is great pain in the Hips and Thighs, and a flux of Blood, with loss of Speech, Reason, and Sense, and at last Death.

XXXVII. The Symptoms. The Symptoms follow, for the most part, according to the nature of the Parts wounded; which in the Cure of Wounds, are no less to be regarded than the Wound it self.

XXXVIII. And as we have in several other places taught, that almost no Disease, no Tumor preter∣natural, no Ʋlcer can be well cured; except first a regard be had to the Symptoms conjoin'd; either to diminish, or take them away. So also, the same thing is to be understood in the curing of Wounds.

XXXIX. The Symptoms in Wounds are manifold; but the most material are, 1. Hemor∣rhage. 2. Pain. 3. Inflamma∣tion. 4. An Erysipelas. 5. In∣digestion of serous Humors, which is made of good Blood, or Lympha converted thereinto; for want of good binding, or application of proper Medica∣ments. 6. A Fever. 7. Faint∣ing. 8. Convulsion and Deli∣rium. 9. Palsy. 10. Gangrene, or putrifaction of the Part.

XL. As to an Hemorrhage, it not only hinders the Cure, but also weakens the Body, and brings Death, if it is not suddenly stop∣ped; which in the greater Ves∣sels, especially the Arteries, is very hard to do: for which cause, those Wounds are for the most part mortal; since Medi∣cines which stop Blood are too weak, and hard ligature may endanger a Gangrene.

XLI. The Prognosticks. Be∣fore we go about the Cure of a Wound, we ought to judge whe∣ther it is curable, or incurable: and if Curable, whether the Cure will be easy or difficult, and will take up a shorter or longer time. And when Cure∣able, whether the Patient will have his perfect soundness re∣stored; or suffer by the hurt of the action of some other part.

XLII. For a Tendon being cut asunder, it oftentimes happens, that the Motive-faculty of some Part is wholly lost; the Menin∣ges being wounded, the Me∣mory or Rational-faculty is thereby hurt, &c.

XLIII. Again, whether it is absolutely mortal; or it be not more probable, that it will degenerate into some long-continuing Ulcer, which may induce a Marcor or Consum∣ption, and at length, Death.

XLIV. If therefore you would make true Prognosticks of Wounds, you must consider, 1. The Part affected, its dignity, substance temperature, situation, number, and use of the Part.

XLV. 2. The Adjuncts of the Wound; which are its magnitude, figure, situation, symptoms; and whether simple, or complicate with some other Disease, as French-pox, Dropsy, &c.

XLVI. 3. The Habit of the Body; whether it is good and healthful, or evil and cachectick, scorbutick, strumatick, hydro∣pick, plethorick, cacochymick, intemperate, gross, or consum∣ptive, &c.

XLVII. If therefore a Wound is made in a noble Part, which is continually in motion, and the fountain or original of some Fa∣culty, and that it is large or deep, and accompanied with evil Symptoms, in an evil habit of Body, it is generally mortal.

XLVIII. Whereas a Wound made in some ignoble Part, or remote from the principal Parts, in a place where the loss may be suffered, and the Wound it self not very big, nor having many ill Symptoms, nor in an evil or scorbutick habit of Body, is generally without danger.

XLIX. Wounds of the Heart do of all others most speedily bring on Death: because the Heart is a noble part, and the Store-house of Vital Spirits, and innate heat: which being extinguished, either by Suffocation, or Dissipation, Death immediately ensues: if the Wound penetrates into the Ventricles of the Heart, espe∣cially, to the left, the Patient of necessity dies quickly: but if the Wound terminates in the sub∣stance of the Heart, life may be continued for a while, but Death will be the end of the Work.

L. Wounds of the Brain are in

like manner deadly, if they pe∣netrate to the Basis: because it is a principal Part, the Fountain of the Animal-faculty, in continual motion, Inflammation and a sharp Fever ensuing. But if it is su∣perficial only, it is then said to be dangerous, because it is a principal Part; but with hopes of Recovery, because its soft substance admits of speedy con∣solidation.

LI. Wounds of the Lungs, with hurt some of the Vessels; as the Vena arteriosa, in that part of the Lungs next the Heart, are mortal: for that out of them a great quantity of Blood is poured forth unto the Heart, overwhelming it, and suffo∣cating the heat thereof: other Wounds of the Lungs are not mortal.

LII. Wounds in any of the greater Vessels, which cannot by any Art be closed up, are mortal; for that thro' pouring forth of great quantities of Blood (whe∣ther from Veins or Arteries) there will be of necessity a speedy suffocation of the woun∣ded person.

LIII. Wounds of the Eye, pene∣trating thro' it to the Brain, are mortal: for there is great in∣flammation, with vehement pains, fainting and swooning, and at length, strong Convul∣sions, and Death.

LIV. Wounds of the Aspera Arteria, where the Cartilaginous Rings are cut in sunder, are incu∣rable: for by reason of the hardness of their substance, they cannot be made to grow toge∣ther again; yet such Wounds do not cause a sudden Death, but a slow and lingring one: other Wounds of this Part are curable.

LV. Wounds of the Vena cava, within the Belly or Brest, are mortal: 1. By reason of the place, that cannot possibly be come at. 2. By reason of its substance; for being nervous, it hardly admits of consolidation.

LVI. Wounds of the Liver, tho' small, yet are dangerous, but they will admit of Consolidation: 1. Because the substance of the Liver is like coagulated Blood, and so may easily be united. 2. Because, if one part of it is wounded, other Parts will do their Office; as is seen in the Livers of such as are Scir∣rhous.

LVII. Wounds of the Diaphra∣gma in the Nervous parts are mortal; for a Delirium, by reason of the Inflammation, ensues always and sometimes Convulsions. But in the fleshy part of the Dia∣phragma, tho' we say not that they are mortal, yet they are dangerous: 1. Because they cannot be come at, to be drest. 2. Because it is in continual motion. 3. Because the parts within the Brest are easily inflamed.

LVIII. Wounds of the Spleen, if they be not great, or procure an Hemorrhage, are not mortal: for the Spleen is neither a principal part, nor the fountain or origination of any Faculty; but only a receptacle of black, melancholick, or fermentative Blood.

LIX. Wounds of the Stomach,

are not to be accounted amongst those which are simply mortal, which do suddenly destroy a Man; because we have had several Examples of Wounds in the Stomach, which have been cu∣red: but those Wounds which happen on its superior Orifice or Mouth, are especially mortal; because it has Nerves, which spring from those of the sixth Conjugation of the Brain; whereby it has a very near con∣sent with the Brain, and with the Heart also: so that it being wounded, vehement Symptoms, as Fainting, Swooning, Con∣vulsions, &c. presently arise.

LX. Wounds of the Gall-bladder are mortal, tho' not so presently as other mortal Wounds: but we cannot come to apply any thing to it; then it is of a Nervous substance, which does not easily admit Unition; and lastly, the Humor which it ought to con∣tain 'till Excretion, corrupts the parts amongst which it is spilt.

LXI. Wounds of the Reins, if they pass not to the cavity, bring not inevitable Death; but if they enter once into the cavities, are certainly mortal, yet at some little distance of time; there going before Vomitings, Sickness at Heart, Faintings, Swoonings, and Convulsions, often repeated.

LXII. Wounds of the Bladder are by Hippocrates accounted mortal. But here is a difference to be made: for a small Wound is soon healed by the interve∣ning of the Flesh, as experience does teach us. But if Hippo∣crates his Diacope happens, (which is, when the Bladder does happen to be cut quite thro') it is most perilous, and especially that which happens at the bottom of the Bladder, and the nervous part thereof; for by reason of the sharpness and vehemency of the pain, inflam∣mation follows, with a conti∣nent Fever, and Death soon after. But Wounds in the neck of the Bladder, which is fleshy, are curable; as we see even in cutting out the Stone.

LXIII. Wounds of the small Guts are for the most part mortal. 1. Because they are of a mem∣branous substance. 2. Because they are of an exquisite sense; more especially if they be cut transversly asunder. Wounds of the Jejunum, are more especially mortal; by reason of the great∣ness of the Vessels, and the almost nervous substance of the Tunicle of that Gut; from whence for the most part there follows vehement sharp Pains of the Bowels, Sobbing, Fainting, Swooning, and sometimes strong Convulsions, and Death.

LXIV. Wounds of the greater or thick Guts are less dangerous, and more easily cured, especially if they be not great; because their substance is more thick, and so admits more easily of agglutination; and being not so sensible as the small Guts are, Faintings, Swoonings, and other fearful Symptoms do not so usually invade.

LXV. Wounds of the Mesen∣tery, are inevitably mortal; be∣cause there must be a great flux of Blood, by reason of the great

number of Veins in it: because we cannot approach it to apply Topicks; and because it is an hinderance of the Chylous Juice passing on, to mix with the Blood; whereby San∣guification is hindered, without which the Body must certainly dye.

LXVI. Wounds of the great Joints, if they are so deep as to let out the Glarea or humid sub∣stance, which is found in the said Joints to moisten them, much like to the whites of Eggs, the Joint grows stiff, and so the motion is impaired.

LXVII. As for Wounds in the vest of the Parts, Hippocrates truly pronounces them not mortal: and Experience teaches us, that the greatest and most dangerous Wounds have sometimes been cured; (of which Valeriola, lib. 4. Obs. 10. gives us many Histories, also Guil. Fabric. Hildanus, in his Writings and Observations:) and that very many dye, even of the most slight and inconsiderable Wounds.

LXVIII. A Wound made with a Poisoned Weapon, or Biting of a Mad-dog, Viper, &c. tho' it may seem little in it self, and very slight, yet many times brings Death with it.

LXiX. The Habit of the Body is also to be considered: for robust and healthful Bodies bear the most grievous Wounds, and are often cured without much to do, and beyond all hope and expectation, (when you would think them ready to dye) recover again.

LXX. Whereas the like Wound, or a lesser, happening in a Caco∣chymick or Evil Habit of Body. Nature being thereby irritated and stirred up, is wont to pro∣trude those vitious Humors to the Wound, which (tho' in a strong and sound, or pure Body might be cureable, yet) in a Body of this Evil Habit, will here become mortal.

LXXI. Those Wounds also which are grievous, dangerous, yea and mortal in an Old Man or Child; are many times not mortal, yea slight and inconsiderable, when they happen in a strong Young Man, of a good Habit of Body.

LXXII. Wounds of the Brain, Nerves, and Joints being unskil∣fully, and negligently handled, may have an Inflammation, Convul∣sion, Gangrene, &c. befal them, and so the Patient may mis∣carry and perish: when not∣withstanding that, the Wound, had it been rightly managed, was in it self absolutely cure∣able.

LXXIII. A Wound may happen in a Part ignoble, but yet of very exquisite sense; from whence comes vehemency of Pain, which causes presently an Afflux of Humors; and that Afflux, an Inflammation; the Inflamma∣tion, a Fever, a Gangrene, and Death it self: and this happens the more easily, when a Part that is noble may be drawn into consent with it.

LXXIV. By how much more principal and noble the Part affected is; or which may like∣wise bring a more noble Part into consent with it, by so

much the more dangerous is the Wound.

LXXV. Great Wound are more dangerous than small ones, all things else being answerable.

LXXVI. A Wound joined with a Contusion, is the more dan∣gerous; and therefore it is of the two, better to be wounded with a sharp-edged, or sharp-pointed Weapon, than with a blunt or dull one.

LXXVII. Wounds which have past beyond the last and utmost term of Acute Diseases, viz. the fortieth Day, are not in them∣selves mortal: but if the Patient dies, it is either from an ill Habit of Body, or from Errors committed in Diet, or from want of Skill in the Physician: however, such wounds are not cured without much difficulty; for that they indicate some grievous cause to be present, which hinders conglutination of the Wound.

LXXVIII. If an Inflammation should supervene upon a great Wound, it is not to be wondred at, nor should it terrify us, if it con∣tinues not long: but an Inflam∣mation to follow upon a small Wound, and it continuing long, is very dangerous indeed, be∣cause it is wont to excite Convulsions, and Delirium or Doating.

LXXIX. A vomiting of Choler (not voluntary or accustomed to be done) so soon, or presently after a Man is wounded; or while an Inflammation is pre∣sent, is an evil sign; for it shews, that the Nervous parts are wounded.

LXXX. The greater the Wound is, the more time (all things else being answerable) is required for the curing thereof: and the less it is, the less time it requires: so that some Wounds may be cured in 24 hours time, when others may require as many days to be perfectly healed.

LXXXI. All Wounds compli∣cated with other Affects, are so much the more difficultly cured: for the more the Affects are, the more Nature is hurt; and it is easier for her to correct or take away one only Affect, than many: and the more the con∣joined Affect does hurt the tem∣perament of the Part, so much the more difficult will the Cure be.

LXXXII. Wounds that are in the Muscles, far from the Joints, and Temples, are more easily cured than those that are in the Nerves, Tendons, and Mem∣branous parts and Joints.

LXXXIII. Wounds of the Nerves and Nervous parts, are for the most part dangerous; for that by reason of Pain; Inflammations, Convulsions, and other vehe∣ment Symptoms do easily happen.

LXXXIV. Celsus, lib. 5. cap. 26. says, the Age, habit of Body, the order and course of Life, with the time of the Year are to be considered. For a Child, Youth, or young Men, are sooner cured than one that is Ancient or in years: one of a strong constitution, is easier and sooner cured than one of a weak and infirm Body: one not over-fat nor over-lean, sooner than one that is either

of them: one of an intire and sound habit, than one that has an unsound and corrupt habit: one given to exercise is sooner cured, than one that is slothful and sluggish: and a sober and temperate Man, than one that is given to Wine and Women.

LXXXV. Those Wounds are most safe and easy to be cured, which are made in a streight and direct Line: but those with more difficulty, that are oblique; and those with most difficulty, which are round, and orbicular.

LXXXVI. That Wound is al∣ways evil, in which there is some∣thing cut off, or taken away; and by which the Flesh that is cut off from one Part, hangs upon some other.

LXXXVII. Celsus, l. 5. c. 26. says, the Inflammation will shew it self on the fifth day, how great it is like to be; on which day the Wound is to be uncovered, and the colour thereof to be well considered: if it is pale and wan, leaden coloured, of various colours, or black, it is certain that the Wound is evil and dangerous: but this, when∣ever we well consider it, is not much to terrify and af∣fright us.

LXXXVIII. A Wound in Arm, Hand, Thigh, Leg, or other Part; being so great, that by reason of the Arteries and Veins cut asun∣der, it cannot possibly receive any farther influx of Blood; the ex∣tream part then dyes; and therefore lest a Gangrene should happen to the sound part, the other is with all speed that may be, to be cut off.

LXXXIX. That Wound which is not purged and cleansed, but with much difficulty, is hard to cure, and slow in curing: because that which is an hinderance of the Cure, cannot be removed with∣out much difficulty.

XC. All things extraneous, or coming from without, sticking fast in the Wound; if they cannot at the very first be drawn or taken forth, they will much retard the Cure.

XCI. All the Wounds of the internal parts are much more dangerous, than are the Wounds of the external parts.

XCII. Wounds are more easily cured in the the Spring time, than in the cold of Winter, or heat of Summer.

XCIII. If a Nerve, Artery or Vein be wholly cut, or cut thro', there is less danger impending, than if but cut only in part: pro∣vided always, that they are none of the more principal or notable Nerves, Arteries or Veins, and situate in the deeper parts of the Body.

XCIV. For if a Nerve is wholly cut asunder, there is then no danger of a Convulsion; which we may always fear, if the Nerve is cut but only in part.

XCV. And so if a principal Artery or Vein be wholly cut, the danger of an Hemorrhage is wholly taken away, upon the contraction or drawing together of the Vessel: but if an Artery or Vein be only wounded, and not cut asunder, very dangerous He∣morrhagies do then often arise.

XCVI. But if it is one of the larger, or most notable of the Arteries or Veins, which is cut asunder; this then often befals the Part, that it is deprived of much of its usual native heat, and somtimes also is the cause of an Atrophy of the Part.

XCVII. Celsus, lib. 5. cap. 26. says, For a Wound over-much to swell up, is something dangerous; but not at all to swell up, is much more dangerous, yea the most perilous of all: the former being only the evidence of a great Inflammation, the latter a sign of a mortified or dead Body.

XCVIII. Hippocrates, Sect. 5. Aph. 65. Such, as together with their Ʋlcers are troubled with manifest Tumors, are not subject to any dangerous Convulsion, or Madness.

XCIX. But those in whom those Tumors presently vanish and disappear, if this happens on the hinder-part, then Convulsions and Cramps follow: but if on the fore-part, then comes Madness, sharp Pain of the Side, an Empyema and Dysentery, espe∣cially if the Tumor is redder than ordinary. Ibid.

C. Hippocrates, Sect. 5. Aph. 2. says, That a Convulsion in a Wound is very pernicious.

CI. Wounds happening unto Cachectical and Hydropical per∣sons, are cured with very much difficulty.

CII. A Wound in such a Part as is apt and ready to receive an Influx of Humors, is cured also with very much trouble.

CIII. Wounds being considered simply as Wounds, can have nothing to do with Critical Days; but as they may happen in conjunction with acute Diseases, so Critical Days may have some respect to them: for that Nature her self up∣on some certain and fixed Days, both concocts that which ought to be concocted, and allays the disturbance of the Humors.

CIV. Touching which, Hippo∣crates in Coacis, saith, That in Wounds of the Head, if a Fever begins on the fourth, or seventh, or eleventh days, it is very fatal or dangerous: but it is for the most part to be Judged of, if it begins on the fourth day of the Wound, and continues unto the eleventh: or if it begins on the seventh day, and con∣tinues unto the fourteenth or seventeenth: or if it begins on the eleventh, and continues unto the twentieth.

CV. And in his Book of Wounds of the Head, he saith, That when any Errour is committed in the Cure of a Wound; then for the most part, if it is in Winter time, a Fever comes upon it before the fourteenth day; but if it is in Sum∣mer, after the seventh day: and there he also asserts, That in Summer-time, some perish before the seventh day; and in Winter, before the fourteenth.

CVI. And therefore when-ever on the Critical Days, there is no change or alteration for the worse, but that all things proceed in a right manner, and that the Symptoms which before were present, are now quieted and allayed, it then presages great hopes of a happy Cure.

CVII. But if on the contrary,

in those days there happens any evil, as Pain, Inflammation, Con∣vulsion, or Fever; or if those Symptoms which were before pre∣sent are not lessened, but are rather become more intense, and greater than before, it then pre∣sages either Death, or a very difficult, long, and tedious Cure. See the third Edition of Our Synopsis Medicinae, lib. 1. cap. 50. sect. 1. ad 27.

CVIII. The Cure of a SIMPLE WOƲND. There are five principal Intentions of Cure, 1. The re∣moving things Extraneous, as coagulated Blood, Splinters of Bones, pieces of the Weapon, Rags, Hair, Sand, Dust, &c. which may hinder Unition. 2. To join the lips of the Wound even together. 3. To retain the lips so brought to∣gether, 'till they are consoli∣dated. 4. To conserve the native heat of the Part, in order to unition. 5. To prevent or correct ill accidents, which may intervene.

CIX. Thus much is required, if the Wound is only simplex; but if it is complex, with loss of substance, or contusion, then there is something more to do: as in loss of substance, with Sar∣coticks, to assist Nature in re∣storing what is lost: and if contused, the converting the contused substance into pus or matter, which must be done, before there can be possibly any healing.

CX. As to the first Intention, there must be a removing all things that are extraneous, or of a dif∣ferent substance; for so long as they remain, they will hinder unition; nor 'till then, can you hope in the least to make a Cure of the Wound. But before any thing of this kind is done, you are to consider, 1. Whether it can be done, or not. 2. Whether if it can be done, it can be done safely.

CXI. For sometimes the broken Weapon or Matter sticks so fast, that it can by no means be extracted; then you must of necessity leave it to Nature, who, in this case, does sometimes wonderful things. Splin∣ters, &c. have sometimes stuck so fast, or have been so in∣closed, that by no Artifice they could be gotten forth; yet at length, upon Apostemation of the Part, they have been thrust out.

CXII. If it may be done, whe∣ther it may be done with safety? For some will live a Day or more with the Weapon in their Bodies, who would otherwise dye, upon the moment of ex∣traction. But if you find the Patient is recoverable, then make haste with the extraction, and let it be taken forth before the wounded Part is inflamed. How extraneous things are in particular to be drawn forth, we teach at large, in Chap. 5. following.

CXIII. The Extraneous mat∣ters being now drawn forth, and the Wound cleansed by washing it with a little White-wine mixt with a third part of Spirit of Wine; you may permit the Wound to bleed, according as in judgment you shall see fit, respect being had, 1. To the

strength, and habit or consti∣tution of the Body. 2. To hinder Inflammation, as the generation of much matter.

CXIV. The bleeding being staid, (whether naturally, or by Art, it matters not much) let the Hair about the Wound (if any be) be shaved off; and wipe away the clotted Blood with Spunge dipt in Red-wine or Alicant, Oxy∣crate or Posca, (which is Vin∣egar and Water mixt together, or Wine mixt with Water, &c.)

CXV. But if the clotted Blood sticks deep in the Wound, be not too busy to remove it with your armed Probe, lest you stir up a new Hemorrhage or Bleeding: and understand, that this coagulated Blood keeps the Wound warm, and defends it from the injuries of the ambient Air; and that Nature will cast it out in due season, by Dige∣stion.

CXVI. The second Intention, is the exact Joyning of the Lips of the Wound together: for with∣out this exact conjoining, a slow, and a deformed Healing will follow: and this truly is the sole work of the Artist, for Nature has nothing at all to do in this business.

CXVII. You must not lay a Pledget, or a Dossel of lint, or put a Tent into a little Wound; for those are the ways to keep the Wound open, make it painful, cause defluxions of Humors, weaken the native heat of the Part, and prolong the Cure, which is diametrically contrary to the true intention of Healing.

CXVIII. The parts, or lips of the Wound then separated, are to be brought together gently and equally; that they may just touch one another, and so be prepared for Unition.

CXIX. It is to be done, as Fal∣lopius says, by little and little, not hastily, and at once: if they be equally soft, bring them equally together; if the one is soft, and the other hard, or immoveable, or not to be moved but with difficulty, then bring the soft part to that other.

CXX. If the Parts are grown stiff with Cold, (as some are, who have lain in the Field all Night;) in this case, you are to supple them with a Fomen∣tation of hot Milk, or warm Water; or embrocate them with Oil, till the lips are soft enough, and then endeavour their reunion.

CXXI. They are also to be con∣join'd equally, that the parts cut asunder may answer one another, both in the top and in the bottom; brim to brim, lips to lips, vessels to vessels; that Nature may be put into a condition to do her own work; and by virtue of its innate Balsam, reunite, agglu∣tinate, and consolidate or heal the Wound: in all which Intentions she is the Agent, the Chirurgeon only is the Assistant.

CXXII. The third Intention of Cure, is to retain the lips so brought together, 'till they be con∣solidated; and this is done by deli∣gation, which is the dressing and binding up of the Wound: for the accomplishing of which, the

great Masters of this Art have left us two principal means; viz. 1. Suturae, Stitching up the Wound. 2. Fasciae, Binding of it up.

CXXIII. As to Sutures, they they are said to be of three sorts; viz. 1. The Incarnative. 2. The Restringent. 3. The Conserver: to which add one more, which is called the Dry-stitch, or Suture.

CXXIV. The first of these is most in use with us, and is done by making so many Stitches at a set distance. Now you are to con∣sider the Wound; if it is but an Inch, little more more or less, in length, 'tis needless to be stitched; your Medicaments and Bandage will be enough to keep the lips together, and heal it.

CXXV. But if it is two inches or more in length, make one stitch in the middle; if it is three inches long, make two stitches; if four inches long, make three stitches, and so on; making the stitches less by one, than are the inches it is long: and in declining Parts, we many times make the stitches at a little more distance.

CXXVI. The Restringent-stitch, which is called the Glovers-stitch, is much in use with the Spaniards, who stitch almost all Wounds with it: in the Fore∣head and Face, it brings the lips very close; the third day they draw the Thread out, and with the Dry-suture they keep the lips together 'till the Wound is well, which is commonly in two or three days more. This Stitch is best in great Fluxes of Blood; but then in stitching, you must endeavour to bring the wounded Arteries and Veins to their wounded fellows.

CXXVII. The Conserver, or third Stitch is mostly of use in great Wounds; as those of the Oesophagus, Hare-lips, &c. to hold the parts forcibly together, and is performed with Pins or Needles, &c.

CXXVIII. The Ancients make another Stitch in Wounds of the Peritonaeum, which is thus: Have a fit Needle, with a long, strong, round, white Thread in it, and therewith take up the Peritonaeum on one side, and leave it on the other; then take it up on the other side, and leave it on this. It it so made, that the Peritonaeum, which is a dry Body, may be united with the Musculous Flesh: otherwise the fleshy parts would only unite, and the Peritonaeum lye open; upon which a Hernia would certainly succeed, and the Patient put to the perpetual trouble of wearing a Truss the remaining part of his life.

CXXIX. The Dry-suture, is the last kind of Stitch, which is proper chiefly to the Face, to keep the lips of those wounds close together, and avoid as much as may be the making Scars; and to be applied also after some of the former Stitches, to keep the lips together, 'till the Wound is perfectly congluti∣nated.

CXXX. As to the time of taking out the Stitches, it ought

to be when the lips are aggluti∣nated; which may be sooner or later, according to the habit of the Body, season of the Year, and nature of the Wound.

CXXXI. In transverse Wounds eight days are required; in lesser Wounds not so deep, three or four days: in the Face, it ought to be done the next dressing, lest the Stitches make so many Scars; but in this, every Man must use his own Judgment. As to the man∣ner and way, how these Stitches are to be performed, we leave you to the Directions of Chap. 6. following.

CXXXII. Now we come to the Bandage, or Binding the Wound up. If the Wound is small, and in a fleshy part, Bandage alone, without Stitching, will do the work: for Nature in giving nourishment to both sides of the lips equally, will finish the Unition, without any more to do.

CXXXIII. And by Bandage, as the union of Parts cut asunder are promoted, so also such as would unnaturally grow together, are kept asunder; as in Burnings and Scaldings, the Fingers would many times grow together, were they not by the binding up, hindred.

CXXXIV. There are three several kinds of Fasciation, Rowling, or Binding-up: viz. 1. Agglutinatrix, or Incarnatrix. 2. Retentrix, or Retentive. 3. Expultrix, or Expulsive.

CXXXV. By the Fascia Ag∣glutinatrix, or Incarnatrix, the lips of the Wound are brought to∣gether, and conserved in their right form: it is more strict than the Retentive, and more loose than the Expulsive; and is most of use in simple, fresh, and yet-bleeding Wounds.

CXXXVI. The Fascia Reten∣trix is used to keep Dressings on, close about the Wound. This for the most part is of use in Wounds of the Head; and is moderately to be bound on, not so hard as the former.

CXXXVII. Fascia Expultrix, which is done by a Rowler of one head; whose special use is, to force or expel out of sinu∣ous Ulcers or Fistula's, the Pus or Matter lodg'd therein: as also to prevent the afflux of Humors, and to press out of the substance of the Part wound∣ed, and places adjacent to it, such Humors as have already seated themselves there.

CXXXVIII. For the matter of your Rowlers, they must be made of good, strong, even, white Cloth, clean and gentle, without hems, seams, or threads hanging by: let the length be such as the place affected requires: and their breadth; for the Shoul∣ders about 6 inches, for the Thighs 5 inches, for the Legs 4 inches, for the Arms 3 inches, and for Fingers and Toes, 1 inch broad.

CXXXIX. Concerning Ban∣dages, Hippocrates saith, Vincu∣lorum aliud per se remedio est, aliud iis quae remedio sunt sub∣servit: among Ligatures, some are Remedies of themselves, others subserve to them which are Remedies. And so it is; the Incarnative and Expulsive

are Remedies in themselves; the Retentive is as the common Servant to the other. Now as to the way and manner, how this Ligature or Bandage is to be performed, you may see at large in Chap. 7. following.

CXL. The fourth Intention, is to preserve the native heat of the Part; that thereby agglutination, incarnation, and healing may be obtained; which tho' it is affirm'd to be the work of Nature alone, yet she generally acts by the help of a Medium, which answers in power to Glew, or things of a glewing nature.

CXLI. As soon as the Wound is made, there is a Balsam of Nature ready at hand for the Cure; which Balsam is Blood, at least the lymphatick, or serous part of it, by which Nature does the Cure, both by the first and second Intention.

CXLII. A Cure performed by the first Intention, is done per Symphysin, by Symphysis; which is a reunion of the parts, without any Medium, viz. without any Callus, Flesh, or other Body interposed; but in this case, the Balsam of Nature is the Medium, the Instrument of Unity, which knits the parts together.

CXLIII. A Cure performed by the second Intention, is done per Syssarcosin, by Syssarcosis; which is a reunion of the parts, by, or with the help of a Medium, viz. with Flesh, or a Callous substance, in∣terposing, or filling up the space between the lips of the Wound.

CXLIV. And therefore great care is to be taken, that the Blood may not offend either in quantity or quality: too much is the cause of proud and loose Flesh; and too little affords not a sufficiency of matter for the Work. And as to its Quality, if it is cacochymick or evil, it cannot produce good Flesh; for such as the Blood is, such will the Flesh be.

CXLV. Now to make the Blood such as it ought to be, the Patient is to observe a good Diet: which ought to be rather slen∣der than full; because a full Diet is hurtful in Wounds, espe∣cially in gross Bodies, where there is danger of great Inflam∣mations, Pain, and other evil Symptoms.

CXLVI. But a greater liberty may be given to those, who have thin and exhausted Bodies; so that they may be allowed new-laid Eggs, strong Broths, Jellies, &c. also some Wine, where the Body has been long accustomed to the plentiful use thereof; or the total forbidding thereof, may very much hinder the Cure: and for other things, such Diet is to be observed, as their strength or weakness may re∣quire, and their Stomach permit.

CXLVII. As to Internals; Purging with strong, hot, or violent Catharticks is not fit; lest stimu∣lating or stirring up the Matter, it should flow to the weak or wounded part: but in gross and cacochymick Bodies, Lenitives are allowed; as Cassia, Manna, Tamarinds, Rhubarb, Sena with Sal Prunellae; also Syrupus Cathar∣ticus, and Broths, wherein Bor∣rage, Bugloss, Endive, Fumitory,

Lettice, Purslane, Sorrel, Suc∣cory, &c. have been boiled.

CXLVIII. And at set times of the day, they may take Vulnerary-Drinks; made of Adders-tongue, Agrimony, Avens, Bis∣tort-roots, Bugle, Cinkfoil, Cen∣tory, Comfrey, Fluellin, Ground-Ivy, Golden-rod, Herb-trinity, Horse-tail, Hypericon, Knot∣grass, Ladies-mantle, Mouse-ear, Mugwort, Pauls-Betony, Per∣winkle, Plantane, red Roses, Sanicle, Snakeweed, Scordium, Strawberry leaves and roots, Tormentil-roots, Vervain, Vale∣rian, wild Tansy, Yarrow, &c. as we shew more at large, in Chap. 3. ensuing.

CXLIX. Now in particular, for preserving the innate or native heat, and tone of the Part, without which no Ʋnition can be hoped for, Topicks are usually applied: it is true, that in small and simple Wounds, which are superficial, Nature of her own accord com∣monly does the Cure, and seldom requires more of us, than to bring the lips of the Wound close together, and defend it from fluxion: a Pledget of Linimentum Arcaei may be laid on, and over it Emplast. Diapalma; and then bound up, to keep all things on.

CL. But in greater Wounds, which will not so easily be cured, you must stitch the lips together; and then strew upon them the following Pouder. ℞ Fine Bole, Terra sigillata, A. ℥ss. Sanguis Draconis, Frankincense, A. ℥i. mix them: over which lay some of the same Pouder mixt with the white of an Egg, and over that a Compress, squeezed out of Oxycrate, and a suitable Bandage over all. This is the general use.

CLI. But lest by the sticking-to of the Emplastick-medicine, the lips of the Wound should be torn or disturbed, in taking off the Dres∣sing; you may apply over the sprinkling of the Pouder, the following Sarcotick-Ointment. ℞ Strasburgh-Turpentine ℥ iii. Gum-Elemi ℥ ii. Frankincense, Mastich, Olibanum, Sanguis Draconis, A. ʒii. mix, and make an Ointment; which spread upon a Pledget, and apply.

CLII. And over the former Pledget you may put Emplastr. Diapalmae, Empl. de Bolo, Cae∣saris, or the like; and then bind it up, as before directed.

CLIII. Or, applying first this Pouder: ℞ Aloes, Galls, red Roses, fine Bole, Sanguis draconis, Olibanum, Rosin, Catechu, A. ℥i. mix them; and mix some of the same Pouder with Turpen∣tine, Gum Elemi, A. q.s. which spread upon a Pledget, and put over the Pouder.

CLIV. And if there is any fear of an Afflux of Humors, or Inflam∣mation, dip Stuphs in juices of Plantain, Horse-tail, Yarrow, Perwinkle; or in red Wine, or Oxycrate: over which lay Em∣plast. Diapalmae, è Bolo, or some other like Emplaster; and lastly, bind it up, as before.

CLV. But if you design to cure by Agglutination, forbear the use of Fomentations, or other humid Medicaments; and preserving, your Stitches, you will find,

that Nature will do her part towards the consolidation of the Wound; nor will you have occasion for such Applications, if you have proceeded metho∣dically.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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