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 ...

I. Of Wounds of the Head in General.

VIII. The Prognosticks. A Contusion, if there is no Fracture or Fissure of the Cranium, is less dangerous than a Wound, or a Wound with Contusion.

IX. Wounds Contused are more difficultly cured, than Wounds made by Incision; because they require Suppuration.

X. Wounds of the fore-part of the Head are more dangerous than those of the hinder parts: 1. Be∣cause the containing parts are thinner in the fore-part. 2. Be∣cause the fore-part has more Sutures than the hinder-part. 3. Because a greater part of the Brain is contained in the fore-part. 4. Because in Mortal Wounds of the Head, if it is in the fore-part, the Patient Dies sooner than if it is in any other Part. 5. Because the Meninges have Sinuosities in the fore-part but not in the hinder-parts, 6. Because more offending Mat∣ter is apt to be gathered in the∣fore-part, which may offend the Brain, than in the hinder∣part.

XI. The smallest VVounds of the Head are not to be neglected tho' without Fracture of the Skull; for sometimes dreadful Sym∣ptoms may ensue, as Fever, Vo∣miting, faltering of the Tongue, Raving, Convulsion, Palsie of one Arm or Leg, &c. which may be from Concussion of the Brain, or some other internal unknown Cause.

XII. In Mortal VVounds, the Patient lives longer in the Winter than in the Summer, because un∣natural Heat is not then so pre¦valent.

XIII. These VVounds in Chil∣dren prove sometimes Rebellious, because they are of a hot and moist habit, which is most apt to pu∣tridness; and because their ha∣bit is thin, whereby they lose more of their Spirits.

XIV. Hippocrates, Sect 7. Aph. 2. says, it is an ill sign, if the Flesh of the Brims look livid; for it is a sign of the decay of Na∣tural Heat.

XV. If the Patient has no Fe∣ver, is in his right Mind, sleeps well, has his Body soluble, finds himself well when he takes any thing, if the Wound looks of a fresh and lively Colour, and it yields a good sort of Pus or

Matter, there is then no fear of danger.

XVI. Hippocrates, Sect. 5. Aph. 66. says, If the brims in these Wounds tumify not a little, it is an ill sign. And in Sect. 3. Aph. 67. If the Tumefaction is soft, it shews Concoction; and if hard, Crudity.

XVII. Evil may be presaged, if there is blackness in parts near the Wound; a Convulsion, Palsy, loss of Appetite, much watching, and coldness of the extream Parts of the Body.

XVIII. If a Fever invades while Suppuration is procuring, viz. before the seventh day, it is less dangerous than that which invades after the seventh day: because about the first Crisis, ill Accidents may ensue.

XIX. A Wound in or upon a Suture is dangerous: 1. Because the Scull is there parted, and so more apt to open, than a solid Bone. 2. Because in the Suture, there is a Ligament by which the Meninges are tied to the Pericranium; whereby a Wound being inflicted there, may easily be communicated to them.

XX. If Reason fail, Speech ceases, Sight is lost, there is a continual Fever, his Tongue is black and dry, the brims of the Wound blackish and dry: if the Patient suffers an Atrophy or Palsy, with an involuntary ex∣cretion of Excrements, or an absolute suppression of them, especially of Urine, or there is a Phrensy, with a Convulsion, 'tis to be feared that Death is near at hand.

XXI. Symptoms appear sooner in Summer, than in Winter; be∣cause in a hot Season, the Hu∣mors are sooner apt to putrify than in a cold, the unnatural Heat being more easily excited: for in Summer-time we expect them at or before the first or second Crisis, viz. the seventh or fourteenth Day.

XXII. If the Patient is Ca∣chectick, Scorbutick, has the Pox, Leprosy, Dropsy, Phthisick, Con∣sumption, or Hectick-Fever, or a Cacochymick Habit of Body; the Wound will be the more diffi∣cult to cure, the Blood being corrupt or deficient, and so unfit for Unition.

XXIII. If a Tumor in these Wounds does suddenly vanish away, it is an ill sign; unless some eva∣cuation has gone before, or some discussive Medicine has been applied.

XXIV. If a Fever, with a previous coldness, does appear on the seventh or fourteenth day, it is dangerous; for it may be feared that a Putridness has possessed the Brain, the Menin∣ges, or the Scull; which you may know by a yellowishness of the Wound, and an Ichor like to Water, in which raw Flesh has been washed.

XXV. The General Cure. It consists in two principal Indica∣tions. 1. By Internals, to avert a Flux of Humors. 2. By To∣picks, to induce the Healing.

XXVI. The Internals are ei∣ther Cathartick or Dietetick: the Cathartick is performed, 1. By things given by the Mouth. 2. By Clysters. 3. By Suppositories.

XXVII. There are three Cases in which Purges are to be given: 1. If the Body is Cacochymical. 2. If a Tumor or Inflammation appears, as Fallopius advises. 3. If there is an Headach, Sleepiness, Drowsiness, or Le∣thargy.

XXVIII. And they are to be given, 1. Lest the Fever increase, to prevent it. 2. To divert the Humors as soon as may be from the Head. 3. Before the strength is prostrated.

XXIX. As to the kind of Purge, it ought to be such as may purge the Humor abounding: yet some Physicians speak abso∣lutely for Chologogues, because Inflammations and Fevers are the Smyptoms most apt to en∣sue upon these Wounds.

XXX. But strong and eradica∣tive Medicaments at first are to be avoided; lest by a too vehement commotion of the Humors the Strength becomes prostrate, or Pain, Inflammation, and Fever be induced.

XXXI. Therefore Infusion or Decoction of Myrobalans are com∣mended, either alone or mixed; Elect. Lenitivum, or De Succo Rosarum, or Diaprunum Soluti∣vum, or Our Syrupus Cathar∣ticus.

XXXII. Some time after the use of these things, you may purge with Pulvis Catharticus, Pulvis Cornachini, Electuarium Catharticum, or Pilulae Cathar∣ticae; which may be repeated twice a Week, or as you see necessity requires. Arcaeus, lib. 5. cap. 4. is of opinion, that no other Cathartick Medicament but Syrup of Roses solutive ought to be used.

XXXIII. As to the Dietetick Course, 1. It consists in the use of the Non-naturals. 2. In the use of proper Wound-Drinks.

XXXIV. As to the Non-naturals, Fallopius in Hippo∣crat. de Vulner. cap. 11. says it ought to be temperate and thick: for a hot and thin Air does melt the Humors, and make them apt for fluxion; and a cold Air is hurtful to the Brain, Bones, Nerves, and Marrow of the Back-bone: and therefore Medicaments ought to be ap∣plied blood-warm.

XXXV. As to Meat and Drink, Flesh nor Fish are to be permitted for the first seven Days, especially if a Fracture; nor Wine, before the second Crisis, or fourteen Days are past; because in this space of time all the Symptoms usually cease: small Beer or Ale may be permitted for Drink; to weak Stomachs, Oxysaccharum, or Syrup of Violets, or Red-Roses simple, or Syrups of the juice of Limons or of Citrons, or Syrup of Vinegar, mixed with Milk-water, &c. And their Food may be Panada, Ptisan, stewed Prunes, Raisons, Aspara∣gus, Lettice, Endive, Succory, or Spinage boiled; and after Meals, Marmalade of Quinces, preserved Quinces, Conserve of Barberries, baked Pears and Apples, Saccharum Violatum, Caraway and Coriander-com∣fits. And when Meat is to be permitted, let it be of Chickens, Pullets, young Pigeons, Veal, Lamb, Mutton, Kid, Partridges,

Pheasants, Turtles, Black-birds, Thrushes, Larks, &c. with Ver∣juice-sawce, or juice of Oran∣ges, Limons, Citrons, Pomgra∣nates, or Sorel and Mint, with white Sugar. If they will eat Fish, let it be of Trouts, Whi∣tings, Soals, with the afore∣named Sawces.

XXXVI. As to Sleep, let it be in the Night-time, and not by Day, unless an Inflation hath seized the Brain or the Meninges, the Signs of which you will have in their proper Chapters: and too much Watching corrupts the Tem∣perature of the Body, causes Crudity, Heaviness and Pain of the Head, and makes the Wounds dry and malign: in which case, you may Embrocate the Forehead, Temples, Ears, and Nostrils, with Oils of Poppy or Poppy seeds, of Henbane-seed, or of Mandrakes, or ra∣ther with Our Spiritus Anodynus, or with Tinct. Opii ℥ss. mixt with Fumitory-water ℥ ii. doing it blood-warm; or rather with the same quantity of Vinegar: and inwardly you may give Tinctura Opii, à gutt. vi. ad xii. or more, in some proper Vehicle: or Syrup of Poppies ℥ss. in Fumi∣tory-water ℥ ii. or in place thereof, you may give Our Guttae Vitae, à gut. xx. ad xl. or Our Specifick Laudanum, à gr. j.ad iii. in some proper Vehicle.

XXXVII. Rest and Quietness is very necessary; immoderate Exer∣cise disturbs the Spirits, weakens the Body, and puts the Humors into motion; for which reason, gentle walking about the Room, when he is able, is enough.

XXXVIII. As to Excretion of Excrements, the Body is to be kept soluble, and if it is not so, Nature is to be provoked with Supposito∣ries, or Clysters: for ordinary use, ℞ Posset-drink, or Mutton-broth lbi. brown Sugar ℥iv. mix, and give it warm; which repeat so oft as you see occasion: if the Body is bound, add to it Tincture of Sena made in Wine ℥ss. or Aloes ʒss. ad ʒi. which may be dissolved therein. But Venery is above all other things to be avoided, chiefly if there is a Fracture withal; for a great store of Spirits are contained in a small quantity of Seed, whereby all the Fa∣culties, but chiefly the Animal, are resolved and weak∣ned, Paraeus, lib. 9. cap. 14. says, that he has known Death to have ensued in small Wounds of the Head, by reason of Venery.

XXXIX. Perturbations or dis∣turbances of the Mind, whether from Sorrow or Joy, are wholly to be avoided; because thereby the Spirits, both Animal and Vital, are either contracted, or too much dilated, or dissipated; whereby a great Indisposition may happen to the Body.

XL. Washing and Bathing, as they ad to cleanliness; so being prudently done, they open the Pores, and cause a dissipation of dark and fuliginous Vapours, and ma∣lign Humors, whose natural course is to the Head; but finding a vent this way, are stopt in their career; whereby the Spirits are cheared and enlivened, and the Matter contributing to evil

and malign Symptoms, is in part taken away.

XLI. The last things which we shall take notice of here, are proper Wound-drinks, of which you have Examples enough in Chap. 3. Sect. 28. ad 43. But two things are to be observed: 1. That the Simples of which this Wound-drink is composed, ought to be chiefly Cephalicks and Neuroticks. 2. That it is not to be given, 'till all the Sym∣ptoms are past; it being mostly used, as an Induction to the Healing.

XLII. The second Indication, is directed to the application of proper Topicks. The first thing is Bleeding, (if so be a sufficient quantity did not flow out of the Wound when it was first inflicted:) which is used chiefly in great Wounds, and where the Patient has a sufficient strength of Body; or where a great Inflammation or Fever has made an invasion.

XLIII. If it is incised only, and not contused, Curing by the first Intention is only requisite, and therefore Agglutination is to be induced with what speed may be; as with Linimentum Arcaei, and other Glutinatives: if there is a Contusion withal, you must use Digestives, 'till the Matter becomes laudable.

XLIV. If an Inflammation is feared, the following Cataplasm of Hippocrates, which Fallopius in Hippoc. de Capitis Vulneribus, cap. 39. commends above all others, is to be applied. Take Barley-flower ℥iv. Posca ℥vi. boil to the consistency of a Cataplasm; adding to it Oil of Roses ℥ii. or instead of Posca, you may use Red-wine ℥iv. Vinegar ℥ii. either simple, or Vinegar of Roses, which is better; which use to the seventh or fourteenth Day, as you see cause.

XLV. Or, ℞ Barley and Bean flower, A.℥ii. Vinegar of Roses ℥ii. boil them to the consistency of a Cataplasm; adding Oil of Roses ℥ij. This cools, drys, repells, eases Pain, allays Inflammations, and hinders the afflux of Blood or hot Humors.

XLVI. Or, ℞ Crums of Bread, white or brown, ℥iv. new Milk ℥vj. boil to the consistency of a Cataplasm; adding Ung. Popul∣neum ℥ii. Saffron in pouder ʒi. These Cataplasms are to be applied above the Agglutinating Emplaster, or other Medica∣ments with which the Wound is drest; the Hair being first shaved off a good compass about the Wound.