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. XX. Of ACCIDENTS of Gun shot WOƲNDS.

I. NOW from the first begin∣ning of the Wound to the eleventh or twelfth Day, these kinds of Wounds may be subject to many and various Accidents or Symptoms, which not only hinder the Cure, but oftentimes destroy the Patient; as, 1. Vehement Pain. 2. Inflammation. 3. Gan∣gren. 4. Hemorrhage. 5. Fe∣vers. 6. Delirium. 7. Faint∣ing and Swooning. 8. Convulsi∣ons. 9. Palsies. 10. A Sinuous Ʋlcer; of all which we shall discourse briefly, (as these Sym∣ptoms may have relation to these kinds of Wounds, having said otherwise enough of them in Chap. 9. aforegoing) that we may lead our young Artist, as it were, by the Hand, thro' the intricate Labyrinths of the Art of Curing.

I. Vehement Pain.

II. If the Pain is vehement, you must outwardly foment with and apply Anodyns, with which you may sometimes mix Spiritus Opii Compositus, and sometimes a small quantity of the Tincture of Opium, Extracted with equal Parts of Night-shade Water, and Spirit of Wine.

III. And Inwardly give Our Spiritus Opii Compositus in some proper Vehicle, or this follow∣ing Mixture: ℞ Poppy-water ℥ii. Syrup of Limons ℥i. Spiritus Opii Compositus ʒiii. mix them. Or, you may give a Dose of Our Theriaca Chymica, which will not fail of giving the due Ease; or Dr. Gardner's Laudanum Tar∣tarizatum, or Our Laudanum Specificum; taking which of them is first at hand.

II. Inflammation.

IV. This proceeds either from an ill habit of Body, or from an ill handling of the Wound in the begin∣ning, which to prevent, you ought to hinder the afflux of Humors, evacuating that which already disaffects the Wound.

V. First, you ought to Purge, and if the habit of the Body, and condition of the Sick will permit it, to bleed, which is in some measure the first Days Work, and if then neglected, to be performed now. Secondly, by Topicks; you must ease the pain by Anodyns, which may re∣press the heat, as is directed in Chap. 9. aforegoing, according as it may be either Phlegmon, or Erysipelas.

VI. In the beginning use Repel∣lers and Refrigeratives; in their state, use moderate Calefactives and Discutients; and lastly, Digestives, which may concoct, or suppurate the Matter.

III. Gangren.

VII. This is an attendant upon an Inflammation, and is much to be feared, when the Phlegmon yields not to Discussives, or Sup∣puratives; for then the natural heat of the Part is suffocated, either thro' the great afflux of Humors, or application of To∣picks too Refrigerative, and Repercussive, which obstructed the motion of the Spirit into the Part.

VIII. It is known by the Gleet and change of Colour, it beginning to look livid; as also by the ab∣ating of the Tumor, &c.

IX. When you see these Sym∣ptoms coming on, you must imme∣diately scarify, not only till the Blood comes, but you must cut deep thro' the Escar to the quick, making it bleed freely, till the Part becomes sensible in its feeling; that thereby you may evacuate that which would suffocate the Natural Heat, and Vital Spirits.

X. Having thus made way for the enterance of your Medicaments, foment the Part with a good Lixi∣vium of Pot-ashes, mixed with Salt and Vinegar: Or you may make a Decoction of Worm∣wood, Southernwood, Centory, and Colocynthis in the said Lixivium.

XI. Bathe also all the places both above and below the Wound, or Mortification with Spirit of Wine Camphorated, and lay double Cloths dipt in the same over them.

XII. The Gaugren it self being fomented with the Lixivium, &c. wash the Scarifications, and ap∣ply to the Wound, Ʋng. Aegy∣ptiacum mixed with Venice Trea∣cle, dissolved in a little Wine Vinegar, adding also a little calcin'd Vitriol; and apply a Cataplasm made of the Flower or Meals of Orobus, of Lupins, of Beans, and of Barley, boiled up with some of the afore-mentioned Lixivium, adding at the end of the boiling a little Oxymel, either simple, or that of Squills, which is better.

XIII. If in making the Scari∣fication you should cut some Vessel, whereby there should be a flux of Blood, you must be wary not to choak the heat of the Part, by crouding in Dosils, for so the Gan∣gren may be increased: In this Case, the better way is to use the Actual Cautery, for thereby you not only stop the bleeding, but also resist the Putrefaction; af∣ter which, you must dress up the Wound, as if it was made by burning.

XIV. You must also be wary in this Work, that while you are ae Curing one Gangren, you make not another, by the too long use of sharp Medicines; therefore when the Ulcer grows warm, and it ceases gleeting, forbear their use, and then dress it with warm Dige∣stives, as Ʋng. Basilicon, with Oil of Turpentine hot; after Di∣gestion cleanse it with Abster∣sives, as Mundificativum ex Apio, &c. according as the removal of the Sloughs require, and then with Sarcoticks and Epuloticks compleat the Cure. See more hereof of lib. 3. cap. 11. and

cap. 9. of this Book, afore∣going.

IV. An Hemorrhage.

XV. It oftentimes happens that in separating of the Contused Parts, that great Hemorrhages succeed, as also after the separating of an Escar: in this Case you must stop the Orifices, by applying some Astringent Pouder; some use that of Galen, made of Aloes, Frankincense, and Hares-wooll.

XVI. Others use Dr. Gardner's Styptick, rouling up the Wound with a good Compress, dipt in some Styptick Liquor, such as this: ℞ Colcothar, Burnt Allum, Su∣gar-candy, A. ℥i. Ʋrine of a young Person, Rose-water, A.℥xvi. Plantan-water ℥xxxii. mix, and stir the Liquor for a long time, then let it settle, keeping it upon the Faeces, and pour off the clear by Inclination, when you have occasion to use it.

XVII. Bolsters, or double Cloths, &c. may be dipt in this Water, and laid upon an open Artery, and held close with the Hand, till the Blood stops; also a small Tent, (according as the Wound may be, may be dipt or soak'd in it, and put into the Part) this Li∣quor taken inwardly, stops also the Bloody-flux, and all Hemor∣rhodial and Menstrual Fluxes, being given à ʒss. ad ʒii. in Knot-grass, or Comfrey water.

XVIII. Lastly, over all some common Defensive may be laid, and the Wound is not to be o∣pened till three or four Days af∣ter. See lib. 3. cap. 15, and 16. and cap. 4. and 9. of this fourth Book.

V. Of a Fever.

XIX. The Fever is either Con∣tinent or Remitting, seldom Inter∣mitting: If it is Continent, such things must be given, as may upon the spot repress the preternatural heat, and hinder the farther pu∣trefaction of Humors, of which kind is Our Tinctura Cordialis, Elixir Proprietatis, Spiritus Sul∣phuratus, Spiritus Nitratus, Spi∣ritus Vini Basilii, Spiritus Mira∣bilis, Spiritus Opiatus composi∣tus, Sal Absinthii, Sal Cornu Ceryi Succinatum, Sal Mirabile, Sal Nitrum Nitratum, & Vi∣triolatum, Sal Vitriolatum, & Sal Prunellae, Antihecticum Po∣terii, &c.

XX. If the Fever is Remit∣ting, it is to be considered as in the Fit, and as in the Remission of the Paroxysm: as in the Fit, you may exhibit any of the Medica∣ments in the aforegoing Section, but chiefly those which are Sa∣line.

XXI. As in the Remission of the Paroxysm, the great Medicine which is to be exhibited, is either the Pouder, Tincture, or Ex∣tract of the Cortex Peruanus: give a Dose of it immediately upon the remission of the Fit, and repeat the Dose every four or six Hours, till the Fit re∣turns, and then forbear it, till the Remission; after which re∣peat it again as before, conti∣nuing its use, till you are sensi∣ble the Fever is utterly destroy∣ed by the use thereof.

VI. Of a Delirium.

XXII. If the Body is Costive, it ought to be opened with Sal Mi∣rabile, Syrupus Catharticus, Pulvis Cornachini, or some other proper Purge; and afterwards it is to be kept open with Our Laudanum Catharticum, giving two or three Doses of it every Night at Bed-time.

XXIII. Outwardly let the Head, Forehead, Temples, and Nostrils, be bathed with Spiritus Anodynus, or with Tinctura Opii; and let Cloths dipt in the same, be laid or bound upon his Temples and Forehead.

XXIV. And inwardly give this Julep oftentimes in the Day∣time: ℞ Poppy-water 〈◊〉〈◊〉 Damask Rose-water, Angelica-•…•…ater, A. ℥iii. 〈◊〉〈◊〉 of Limons ℥iiss. Spi∣ritus Opii compositus ℥ii. mix them; of which give new and then two or three Spoonfuls at a time.

XXV. And at Bed-time (if you find the Patient does 〈…〉〈…〉 to 〈◊〉〈◊〉 by what has 〈◊〉〈◊〉 been given) give•• •…•…node•…•…re Dose of Tinctura Op•…•… S••rupus de Mae∣conio, which may 〈◊〉〈◊〉 ••ixed with a little of Our The•…•…a••a Chymica; I have constantly used this Me∣thod for many Years past, and never without Success, in two or three Days times at most; and sometimes, it recovered my Patient from his Dotage in 24 Hours.

VII. Fainting and Swooning.

XXVI. You may give the Pa∣tient Our Aqua Bezoartica, ad ℥i. or Spiritus Cordialis, or An∣gelica-water Compound, mixt with a little Syrup of Limons, and of∣ten repeated, till the Fainting or Swooning goes quite away.

XXVII. If the Fainting or Swooning Fits follow thick, and that the former Prescription will do no good, you must give this: ℞ Spiritus Cordialis ℥ss. Aqua Angelicae simplex ℥iii. vola∣til Salt of Harts-horn ℈i. Tin∣cture of Saffron ʒss. mix for a Dose, which repeat as oft as you see occasion.

XXVIII. If this yet prevails not, take this: ℞ Spiritus Cor∣dialis ℥i. volatil Salt of Harts-horn fixed with Spirit of Salt, and evaporated to driness ℈i. vo∣latil Salt of Amber ℈i. mix, for a Dose, which repeat as oft as need requires.

VIII. Convulsions.

XXIX. Convulsions in this Case are said to arise from Putrid Vapours, or Acrid Humors offend∣ing the Nerves, with which Humors these Wounds do often abound.

XXX. The Parts affected are frimarily the Nerves in loco; secundarily their Original, or the Brain, by consent, which being irritated, causes an involuntary Contraction or Convulsion, in the Parts affected, as near the Knee or Shoulder, where the Convulsion is only to be discern∣ed by a Trembling, which is the more manifest, the nearer it is to the Joint.

XXXI. It sometimes follows

great Inflammations, especially in the Nervous Parts, and is here for the most part Fatal; a Con∣vulsion upon a Wound, being generally the Prodromos, or Forerunner of Death.

XXXII. If you will attempt any thing, give inwardly this Mixture: ℞ Potestat. Virtutum ʒi. Spiritus Gordialis ʒiv. Syrup of Citron-peels ℥i. mix them; and at Bed-time give ʒi. of Our Theriaca Chymica.

XXXIII. Outwardly bathe the Parts with this Mixture: ℞ Powers of Rosemary, Limons, Ju∣niper, and Turpentine, A. ʒii. Tinctura Opii, Spiritus Vini Camphorati, A. ʒi. mix them; and apply to the Wound it self this: ℞ Linimentum Arcaei, Ung. Basilicon, Balsam de Chi∣li, Peru, & Tolu, A. ʒii. mix them.

IX. Palsies.

XXXIV. Palsies which arise from Wounds, immediately affect the Nerves of that place only; they do not simply take away the Life of the Patient, but do sometimes threaten a Gangren or Mortification, thro' a defect of Natural Heat in the Member.

XXXV. Inwardly give Spirit of Harts-horn, or of Sal Armo∣niack in some proper Vehicle; and outwardly, foment the Part with this Mixture: ℞ Oil Olive ℥iii. Oils of Amber ℥ii. of Turpentine ℥iv. mix them, and Embrocate therewith, and round about the adjacent Parts, apply this: ℞ Balsam de Chili, Capivi, Peru, Tolu, A. ℥i. Camphir ʒii. mix them, and apply the Mixture with Lint.

XXXVI. After those things have been applied for ten or twelve Days, or longer, as you see oc∣casion, then apply an Emplaster made of Burgundy Pitch, Ship Pitch, Gum Elemi, Frankincense, A. ℥i. Turpentine, q.s. which will stir up heat in the Member, and attract Life and Spirits into the Part.

X. Sinuous Ʋlcers.

XXXVII. Sometimes after the Separation of the Escar, the Ʋlcer becomes Sinuous, especially after a great afflux of Humors; and where Bandage cannot be used to preserve the Tone of the Parts, as in the upper Parts of the Thigh and Hip, &c. or from the large∣ness of the Wound, Contusion of the Flesh, &c. or Laceration of Parts, whereby there is a great loss of Substance, and an Acrid Matter, inducing such a like Ulcer.

XXXVIII. Sometimes also it becomes Sinuous from a Cacochy∣mical or Scorbutick habit of Body, or may be induced from Lues Venerea being joined with it; in which Cases, you will scarce∣ly ever Cure the Patient, with∣out exhibiting Antifcorbaticks or Antivenereals, &c.

XXXIX. If the Wound is in∣flicted on the higher part of a Mem∣ber, whereby the Pus cannot dis∣charge it self, but may be apt to lye and create a Sinus, you must perforate it thro' the bottom, ei∣ther with a Syringotomus, or with a Seton-Needle, retaining a

twisted Thread or Silk in the Ulcer, till the lower Orifice is digested, and then drawing out the Silk, to keep it open by a Tent for some time, 'till the upper part is healed; and then as the Matter diminishes its flow∣ing out of the depending Ori∣fice, the Tents may at length be removed, and the Wound heal∣ed up.

XL. But to prevent Sinuosi∣ties, you will do well to enlarge the Orifice at first, and to keep it so wide open, that the Pus may have a free passage out; which if it cannot be by the way the Bul∣let went in, you must then con∣sider so as to find out the best place to open it, so as it may be discharged, as we have before directed.

XLI. But before you do this, it would be also well to consider, whether it cannot be done without such an Apertion; as by altering the position of the Part, Com∣pression, Bandage, hollow Tents, &c. and therefore you must endeavour by Stuphs, Sponges, Compresses, and good Bandage to force out the Matter, that the hollow sides may ag∣glutinate.

XLII. These Stuphs, Sponges, &c. may be dipt and wrung out of an Infusion or Decoction of Baiau∣stians, red Roses, Sumach, Pom∣granate-peels and Catechu, made in red Wine, and that the Mat∣ter may the better discharge between whiles, you ought to dress it the oftner.

XLIII. And Injections are to be made with a Decoction or Infusion of Roots of round Birthwort, Flo∣rentine, Orrice, of Zedoary, Ca∣techu, Aloes, Myrrh, Sarcocolla, and Allum in Aqua Calcis, to which Spirit of Wine and Ho∣ney of Roses may be added.

XLIV. If the Orifice is small, and the Sinus lyes shallow, as un∣der the Skin, and in a place where it may be safely opened; you may widen it with Crepitus Lupi, Gentian-roots, Elder Pith, or prepared Sponge, and after∣wards cut it open with a pair of Probe-Scissars, or with an Inci∣sion-knife, the Director being placed within; or you may lay it open by a Caustick.

XLV. The Sinus being thus di∣vided or opened, you may digest it with Turpentine mixed with yolks of Eggs; or cleanse with some proper Abstersive, variety of which you may see when we come to Treat of Ulcers in General: Af∣terwards Sarcoticks are to be used, which that they may be made the more drying, Pouders of Frankincense, Myrrh, Rosin, and Orrice-roots with Honey, may be added.

XLVI. If the Sinus runs trans∣verse Arteries, Veins, Nerves, Tendons, &c. the best way will be to make the position of the Part, so as its Orifice may be depending, (for Cutting will there be dange∣rous) and by Digestive, and Ab∣stersive Injections to dress it for some time, and afterwards by Sarcotick and Styptick Injecti∣ons, with good Bolsters, Com∣press, and Bandage, keeping the Orifice open with a Tent, and so compleat the rest of the Cure according to Art: But if after all your Endeavours the

Ulcer grows Fistulous, you must then Cure it, as we shall here∣after teach in lib. 5. cap. 10, 12, and 20.