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. XXXV. Of the WOƲNDS of the WIND-PIPE and GƲLLET.

I. THEY are called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Vulnera Asperae Arteriae, vel Fistulae Spiritalis; in English, Wounds of the Wind-pipe. Also, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Vulnera Gulae; and in English, Wounds of the Gullet, or Swallow.

II. These Members or Parts are seated either in the forepart of the of the Neck, or in the back∣part of the same: in the fore∣part of the Neck is the 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Aspera Arteria, or Wind-pipe; in the back∣part is the 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Oeso∣phagus, Gula, Swallow, or Mouth of the Stomach.

I. Wounds of the Wind-pipe.

III. It has three parts: viz. 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Larynx, the upper∣most part of it. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Bronchus, Caudex, Fistula, the great Pipe it self. 3. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Branchiae, the Branches of the Bronchus, which are spread throughout the sub∣stance of the Lungs.

IV. The Signs. If the 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or Aspera Arteria is wounded through, then 1. Wind, or the Breath will come out at the Hole. 2. Blood will come out at the Mouth. 3. The Speech will be hurt. 4. Coughing will come upon, and trouble much the Patient.

V. The Prognosticks. Tho' Wounds of the Larynx are not mortal of themselves, yet they may be such by accident: 1. Be∣cause of its necessary and con∣tinual use, it making the Inspi∣ration and Respiration of the Air. 2. Because it it difficult to be cured, for that Medicines cannot ca•…•…ly be applied or kept to the Part. 3. Because of the fearful Symptoms many times accompanying such Wounds.

VI. For, 1. It is near to the Jugular Veins and Soporal Arterie; so that it can hardly be wounded, unless these parts be also hurt. 2. It has several Muscles, and divers Branches of the Recurrent Nerves: so that besides a great flux of Blood, there may be vehement Pain, Inflammation, and Convulsion of the parts, so that Strangling may at last ensue.

VII. VVounds of the Bronchus, or Pipe it self, tho' they are not so dangerous as the former, yet they have some danger also: for being made of a double sub∣stance, as the Annuli, or Rings, which are cartilaginous; and the Medium of the conjunction of these Rings, which is mem∣branous, they seem to be of difficult cure.

VIII. For Hippocrates, Lib. 6. Aph. 19. says, A Bone or a Car∣tilage cut asunder, or a Nerve, it neither grows again, nor is united: viz. we are to understand, that the Medium of Unition is not by a like substance: and this he repeats again, Lib. 7. Aph. 28. to which Galen. Meth. Med. lib. 5. cap. 7. assents.

IX. Vidus Vidius, de Curat. Morb. Membr. lib. 8. cap. 6. says, That Wounds which pass thro' the Windpipe, cause most commonly present death; for that the Blood issues out of the Jugular Veins, falls upon the Lungs, and causes suffication.

X. Forestus, Observ. Chirurg. lib. 6. Obs. 4. says, That large Wounds of the Bronchus, chiefly those which divide the Cartilagi∣nous substance, are seldom cured, because it is dry, hard, and with∣out Blood; and withal the Pa∣tient draws his Breath by the Wound, which hinders conso∣lidation.

XI. The Cure. The Wound is either transverse, or acccording to the length of the Bronchus or Windpipe: if it is transverse, then the Patient must bend his Head downwards; but if ac∣cording to the length, then he must hold his Head upwards, that the lips of the Wound may be brought together.

XII. Which done, it is to be stitcht as firmly as you can possibly do it: some say Needles, as in the stitching of a Hare-lip, are best, because all sorts of Thread will easily rot.

XIII. After the Wound is stitcht up, Agglutinative Medicaments are to be used: you may apply Bal∣sam de Chili, Balsam de Peru, or Arcaeus his Liniment, or some other good Artificial Balsam: and over all you may apply Diachylon simplex, malaxed with Oil of Ben, or of Myrtles, or of Quinces.

XIV. You must beware in dres∣sing, that neither Blood, Sanies, or Pus fall upon the Windpipe, lest it causes Suffocation: but that they be outwardly discharged in a descending Part.

XV. If after dressing, the Patient breathes with difficulty, there is danger of suffocation: because the cavity of the Larynx or Bronchus is filled with Blood, or Pus, or both, or by reason of great Inflammation.

XVI. In this case, the Wound is to be dilated, and a Silver

Pipe, a little bended towards the point, that it may not hurt, and Wings on the outward end, that it may not fall in, is to be kept in, 'till the Patient is able to breathe freely, and then to be taken out.

XVII. And in the time of the Cure, this following Gargarism ought often to be used. Take Barley-water of the second de∣coction lbiii. in which Red-roses, Balaustians, and Sumach, A. ʒii. Raisons stoned, and Figs, Liquo∣rice bruised, A. ℥i. have been well boiled: strain it, and add thereto Tincture of Catechu, Syrup of Myrtles and Mel Rosarum, A.℥ii. and let it be used warm.

II. Wounds of the Oesophagus, or Swallow.

XVIII. The Signs. Fernelius, Pathol. lib. 7. cap. 8. says, If the Wound is deep, Meat and Drink will come out at it, there is diffi∣culty of swallowing; also the Hiccough, Vomiting of Choler, Fainting, weak Pulse, cold Sweats, with Coldness of the Hands and Feet.

XIX. And Celsus, lib. 5. cap. 26. says, There is a Vomiting of Meat and Drink.

XX. The Differences. Either the whole Gullet is cut asunder, or it is only cut in part. If it is cut but in part, then it is either wounded near the Stomach, or far from it. It is also wounded either straight, or obliquely.

XXI. The Prognosticks. These Wounds, if small, straight, and remote from the mouth of the Sto∣mach; are less dangerous, than if large, deep, and near the mouth of the Stomach.

XXII. If they are great, deep, transverse, and near the mouth of the Stomach, they are uncura∣ble, as Guido says, Tract. 3. doct. 1. cap. 1. 1. Because the passing of Meat and Drink, does hinder consolidation. 2. Because an Inflammation may easily be communicated to the mouth of the Stomach, which is very ner∣vous. 3. Because, being wholly cut asunder, the Cure is im∣possible; for that the upper part shrinks upwards, the lower falls downwards.

XXIII. The Cure. The first Intention is, by stitching to bring the lips of the Wounds together; yet leaving an Orifice in the de∣pending part, to be kept open with a Tent, that the Pus may be discharged, and that the Meat might not stick there, lest an Inflammation ensue.

XXIV. This done, Agglutina∣tives are to be applied, such as we have mentioned at Sect. 13. aforegoing: and a great respect is to be had to the Diet of the Patient, because the swallowing is with difficulty: and there∣fore it ought to be liquid and thin: as strong Broths made of Flesh, Gellies made of Sheeps∣trotters, Calves and Oxes feet, Harts-horn, &c. Cows and Goats Milk sweetned with Saccharum Rosatum, Chicken-broth, and Cordials made with yolks of Eggs, &c.

XXV. But if the Patient can∣not swallow at all, then nourishing Clysters are to be exhibited; (the Excrements being first removed

by Purging Clysters, several times administred, till the Bowels are sufficiently cleansed.)

XXVI. A Purging Clyster. ℞ A Decoction for Clysters, or Mutton-broth ℥ x. brown Sugar ℥ii. Honey of Roses ℥ii. Milk of Scammony ℥ss. mix them.

XXVII. A Nourishing Cly∣ster. ℞ Strong Mutton-broth ℥x. good Brandy ℥ii. white Sugar∣candy in pouder ℥i. mix for a Clyster. Or, ℞ Gelly of Calves∣feet ℥x. yolks of Eggs N^o ii. white Sugarcandy in pouder ℥ i. mix them. Or, ℞ New Cows∣milk ℥ x. (hot enough for a Clyster) yolks of Eggs N^o ii. Gelly of Harts-horn ℥jss. white Sugarcandy ℥i. mix them for a Clyster.