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 ...

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Title
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 ...
Author
Salmon, William, 1644-1713.
Publication
London : Printed for J. Dawks ... and sold by S. Sprint [and 6 others] ...,
M.DC.XCVIII [1698]
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Subject terms
Medicine -- 15th-18th centuries.
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http://name.umdl.umich.edu/A60561.0001.001
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"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 ..." In the digital collection Early English Books Online 2. https://name.umdl.umich.edu/A60561.0001.001. University of Michigan Library Digital Collections. Accessed October 31, 2024.

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CHAP. XXXVII. Of WOƲNDS of the BRAST and HEART.

I. THey are called in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Vulnera Thoracis; and in English, Wounds of the Breast. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in La∣tin Vulnera Cordis; and in Eng∣lish, Wounds of the Heart. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in La∣tin, Vulnera Diaphragmatis; in English, Wounds of the Midriff.

II. The Kinds. They do either not penetrate, and then they are to be healed according to the common Method of ordinary Wounds of the fleshy parts; or they do penetrate, and then we must consider the depth, and whether any Wound is inflicted upon any of the parts contained within, or that they are free from any Damage.

III. The VVound is also either in the Mediastinum, in its hollow Cavity in the lower parts of the Brest, or it penetrates into the lower part of the Thorax.

IV. The Signs. You may know whether the VVound penetrates or not by searching with a Probe, or Searching-Candle, which will enter into the Cavity.

V. And when the VVound pene∣trates, if the Patient does but hold his Breath, by shutting his Mouth and Nose, the Breath will come forth with a Noise, so as it will move, or extinguish the Light of a Candle.

VI. And sometimes 'tis known by the large quantity of Blood, dis∣charged by the Mouth, or Wound, or both; and the Patient will have also a great difficulty of brea∣thing.

VII. If the Heart is wounded, much Blood will come forth, the Pulse will be small or fail, the Face will be pale with cold Sweats, and a trembling of all the Members of the Body; the Patient will be troubled with frequent Swoonings; and when the Limbs grow cold, Death is at hand.

VIII. If the Diaphragma or Midriff is wounded, the Patient has a Heaviness on that part, dif∣ficulty of breathing, a sharp pain, a Cough, with a Fever also; and there is a Raving, by reason of

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the Branches of the Nerves of the sixth Conjugation of the Brain, which are spread thro' the Body of it; and sometimes the Stomach and Guts will, by the vehemency of breathing, be drawn up into the Capacity of the Thorax, as Paraeus, lib. 10. cap. 30. does seem to affirm.

IX. If any of these Vessels are wounded, there will be a vehement Hemorrhage, difficulty of brea∣thing, and Fever, which will in∣crease; Blood in abundance will be poured forth into the Cavity of the Thorax; there will be vo∣miting of Blood; and the Blood being putrified, the Breath will stink, Appetite will be lost; he will be uneasie in sitting up, and subject to often faintings, from noisom Vapours assaulting the Heart, rising from the putrified Blood.

X. The Prognosticks. Wounds which either pierce not into the Ca∣vity; or if they penetrate, hurt not the Vessels nor Bowels, are not mortal, but may be soon and ea∣sily cured.

XI. If they be in the hinder part of the Thorax, they are dan∣gerous, because of the Nerves and Tendons; and if they penetrate that way, there is another great Danger from the great sanguife∣rous Vessels, which are sooner met withal this way, than when the Wounds are more forward.

XII. But all wounds of the Brest are dangerous, by reason of the continual motion of the Lungs, and of the Blood which falls down on the Diaphragma, and corrupts it.

XIII. Hippocrates, Prorrhet. l. 2. and Celsus, lib. 5. cap. 26. say, That if the great Vessels, whether Veins or Arteries, be wounded, the wound is mortal, by reason of the vast effusion of Blood not easie to be stayed: 1. Because they lie so deep, that no Medicine can be applied to them, nor can they be bound up. 2. Because their Coats are membranous, and so not to be healed by the first In∣tention.

XIV. If an Artery is divided, the wound is yet more dangerous: 1. Because the Blood it contains is more spirituous than that in the Veins. 2. Because their Coats are harder than those of the Veins, and sometimes Cartila∣ginous. 3. Because of an Aneu∣rism, which often remains after the wounded Artery is cured. 4. By reason of the manner and impetuosity of the flowing of the Blood. 5. Because of the Motion of the Arteries in their Systole and Diastole, which makes their Consolidation dif∣ficult.

XV. In wounds of the Heart, either the Pericardium only is wounded, or the Substance of the Heart also. If the Pericardium only is wounded, the Wound of it self is not mortal, because it is but a subservient and ignoble part, having but sew and small Vessels and Nerves; nor does it cleave to the Heart, but is at such a distance, as to give li∣berty to the Pulsation of the Heart, and is fitted to contain a waterish Humour.

XVI. But by accident they may be mortal: 1. If the Wound is great. 2. If all the watery Hu∣mour

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flows out; for then an Hectick Fever seizes upon the Patient, because Nature has or∣dained that Humour for cooling and moistning of the Heart.

XVII. If the Substance of the Heart is wounded, the Wound is accounted mortal; as Hippocrates, lib. 5. Aph. 18. Celsus, lib. 5. cap. 26. & Aristotle de Parte A∣nimal. lib. 3. cap. 4. have de∣clared. See also lib. 1. cap. 50. sect. 42, 43, & 44. and lib. 4. cap. 1. sect. 49. of this present Work.

XVIII. And the chief Reasons seem to be: 1. Because it is the very Store house of vital Blood. 2. Because the Hemorrhage is vastly great, and the Blood fal∣ling into the Cavity of the Brest, causes Suffocation. 3. Be∣cause it is the very Elaboratory of the Vital Spirits. 4. Because it is a very hot Bowel, and so subject to Inflammation. 5. Be∣cause it is the Original of Motion or Pulsation. 6. Because it is in continual Motion, which hin∣ders Consolidation; for that Consolidation requires Rest, as Galen. Meth. Med. lib. 5. cap. 8. has observed. 7. Because its Substance is compact, hard and dry, which does not easily ad∣mit of Agglutination.

XIX. Superficiary Wounds of the Heart, do not so soon kill as deep Wounds: but a Wound in the left Ventricle sooner termi∣nates Life, than a Wound in the right.

XX. Wounds of the Diaphrag∣ma or Midriff, but chiefly if they be in the nervous Center, are said to be mortal; as Hippocrates, lib. 6. Aph. 18. and Galen in his Comment. also Celsus, lib. 5. cap. 26. do affirm. 1. Because it is membranous, and in continual motion. 2. Because the Wounds thereof are very painful, by rea∣son of the Branches of Nerves it receives from the lower Ver∣tebrae of the Neck. 3. Because the Pericardium is tied to it.

XXI. And tho', if the fleshy Circumference of it be only wound∣ed, whereby some hopes of recovery are afforded; yet even those Wounds are not without great Danger.

XXII. And the Reasons are: 1. Because some principal parts must suffer also; as, the Brain, from the Nerves which are in∣serted in it; the Heart, by rea∣son of its Proximity and the Ar∣teriae Phrenicae; and the Liver, because of its Contiguity and Venae Phrenicae. 2. Because the whole part is in continual moti∣on. 3. Because breathing is much hindred. 4. Because the Blood flows forth into the Ca∣vity of the Thorax, which may cause Suffocation. 5. Because of the dreadful Symptoms which may ensue; as, difficult brea∣thing, sighing, Cough, Pain of the Back, pulling up of the Heart-strings, Fever, and Ra∣ving, from the Affinity which it has with the Heart and Brain. See Celsus, lib. 5. cap. 26. Fer∣nel. Patholog. lib. 7. cap. 8. and Forrestus Observ. Chirurg. lib. 6. obs. 47.

XXIII. The Cure. If the Wound penetrates without hurt of any internal part, the danger is the less: and these, for the most

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part, are left to be cured by Nature, which here (as in some other Cases) does Miracles.

XXIV. The Patient being laid in his Bed, his Feet stretched out at length, and the Orifice of the Wound downwards; the first thing then to be done is, the stopping of the Haemorrhage with some proper Styptick.

XXV. Then the extravasated Blood is to be discharged, which is said (by Physicians) to be done three ways: 1. By the Wound. 2. By the Mouth through Ex∣pectoration. 3. By Urine.

XXVI. 1. By the Wound. Tents and Pledgits are here hazardous, lest they should fall into the Cavity of the Thorax, and so do more mis∣chief; for which Reason a Flam∣mula or Seton-string may be used, which may be anointed with this Liniment.

XXVII. ℞ Oils of Mastick and of Pine-rosin A.℥i. Gum Elemi ℥ii. Manna of Frankincense ℥ss. roots of Tormentil, and of Comfrey in Pou∣der, A. ʒii. Saffron, Earthworms in Pouder, A. ʒi. Sherry Sack ℥i. mix them, and evaporate to the consumption of the Wine.

XXVIII. Or, ℞ Turpentine or Balsam of Peru ℥ss. which mix with the Yolk of one Egg; then add thereto Oil of Hypericon ℥i. and make a Liniment. This Flam∣mula may be continued, if need require, even to the fortieth Day.

XXIX. Or instead of a Flam∣mula, you may use a silver Pipe, with large Ears or Stays on both sides, such as is used in Paracen∣tesis, that a Thred of reasona∣ble Length may be fastned to it, to keep it in its Posture.

XXX. The Wound and the Pipe may be anointed with the former Liniment or Balsam, or with Ar∣caeus his Liniment melted in a Spoon, or with some other ar∣tificial Balsam; and over it Di∣achylon Simplex may be applied.

XXXI. Where note, That if it is in Winter-time, a Chafing-dish with hot Charcoal may be conveni∣ent in time of dressing to hold near the Wound, to preserve the na∣tural Heat, and hinder the In∣tromission of the cold ambient Air.

XXXII. Wiseman puts a Que∣stion, Whether the wound should be kept open, or agglutinated? They (says he) who are for a speedy Agglutination, do urge it, lest the intromitted Air should corrupt the parts with∣in, and the Heat expire. They that are for keeping ir open, do design thereby a readier Dis∣charge of the matter.

XXXIII. In these Wounds of the Brest (says he) I consider the Wound, how it is capable of discharging the extravasated Blood and Matter. If it is inflicted so, as that the Blood and Matter may be thereby discharged, then it is to be kept open, the Wel∣fare of the Patient depending chiefly upon the well-dressing and governing of it: but if it does not lie well for Evacuation of that extravasated Blood, then it may do hurt, and so ought to be healed.

XXXIV. The second way of evacuating the Blood and Matter, is by Expectoration; and then they say, it must first pass (into the Pleura, say some, and so) into the

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substance of the Lungs, than into the Aspera Arteria, or Wind-pipe, and from thence it is coughed up, and spit out by the Mouth.

XXXV. And then Galen ad∣vises to further Expectoration by Exhibition of Posca, or Vinegar and Water, warm, because it pow∣erfully dissolves clotted Blood; and if the Sick coughs with Difficul∣ty, Pectorals are to be admini∣stred, as Syrup of Vinegar, of Limons, and of Juice of Citrons, Syrup of Coltsfoot and of Li∣quorice, Decoctum Pectorale, Pe∣ctoral Lohochs, Oxymel, Syrups of Alehoof, of Maidenhair, of Jujubes, &c.

XXXVI. The third way of e∣vacuating the Blood and Matter is by Ʋrine; and then they say, it passes first into the substance of the Pleura, and then into the Azy∣gos, or Vena sine pari, near to the Diaphragma, by the Spine, whence a Branch comes, through which it passes by a streight Course to the Emulgents, and so to the Kidneys and Bladder, as Aqua∣pendens, part. 2. lib. 2. cap. 42. affirms.

XXXVII. But if we acknow∣ledge the Circulation of the Blood, this Passage is not allowable; for it is impossible to come to the emul∣gent Arteries, but by a prior tran∣sition through the Heart.

XXXVIII. However, if the matter of Fact is true, that there is sometimes a discharge of the matter by Ʋrine, then it will be necessary that Diureticks be given, to promote the same; as, Infusi∣sions, Decoctions, Syrups, Es∣sences, &c. of Maidenhair, Be∣tony, Roots of Parsley, of Smal∣lage, of Fennel, of Asparagus, &c. Also Ptisans made with Barley-Cream, Emulsions, Spi∣rit of Sulphur, Liquorice, &c.

XXXIX. But says Wiseman, I never saw any that I could say, that passed their Disease by Ʋrine; nor many of them that had a free passage of their Ʋrine, during the time of their lying under these Wounds.

XL. Nor have I often seen them (says he) who have recovered, to expectorate any such quantity of matter, as might be thought to proceed from the great quantity of Blood extravasated. They cough'd fresh Blood most of them, like to what they discharged from their Wounds, but more florid.

XLI. Arcaes, lib. 1. cap. 1. administers this Vulnerary Po∣tion. ℞ Juyce of Pomegranates, Waters of Scabious and Bugloss, A. ℥i. Rhubarb in Pouder ʒss. Mad∣der, Mummy, A.℈i. Terra Sigillata, ℈i. mix for a Dose.

XLII. And to cause easie brea∣thing, be gives this pectoral De∣coction:Hull'd Barley ℥iiii. Bu∣gloss-roots ℥iii. Liquorice bruised ℥ii. Jnjubes, Prunes, A. No xx. Raisons stoned ℥i. Rain-water lbxiv. boil to the Consumption of a third part, strain out, and aromatize with Cinnamon ʒiii. dulcifying it with Sugar-candy ℥iiii. Sugar Pe∣nids ℥iii. Syrup of Roses simple, and of the two opening Roots, sine Aceto, A. ℥ii. Dose ℥vi. every fourth hour.

XLIII. Fambesarius advises, to give Morning and Evening a vul∣nerary Potion, made of Leaves and Roots of Comfrey, Bugloss, Plantane, boiled in Water with

Page 978

some Vinegar, which being strained, is to be sweetned with Sugar of Roses, dissolving also in it some fine Bole.

XLIV. And outwardly Inje∣ctions may be made with Honey of Roses, thus: ℞ Decoct. of Liquorice ℥iiii. Sugar of Roses ℥ii. Honey of Roses ℥i. mix them. But you must be sure, that all the In∣jection comes forth again; for if any of it should stay behind, it would putrefy.

XLV. Lastly, According as the quantity of the Quittor is, less or more, so dress it once or twice a day; and when the Patient breaths freely, has but little Pain, finds no Weight towards the Midriff, and there is but small quantity of Pus flowing out of the Wound, and that good, you may then, with all the speed that may be, induce the Healing.

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