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. IV. Of an HAEMORRHAGE in Wounds.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Haemorrhagia Vulneris; in English, the Bleeding of a Wound; which is always to be understood of a violent and symptomatical Bleeding.

II. And it is distinguished from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, from the Part and Occasion; this latter being for the most part a spon∣taneous bleeding at the Nose.

III. The Kinds. It is three∣fold: 1. That which proceeds from wounded Arteries. 2. That which proceeds from wounded Veins. 3. That which proceeds from a Wound or hurt of both those Vessels.

IV. The Causes. The chief cause is declared in the Kinds, which is from a hurt of one or more of the Vessels; which then always produces some notable

Haemorrhage; from whence proceeds oftentimes Faintings, Swoonings, and other dangerous Symptoms.

V. Now tho' the Wound in∣flicted upon the Vessels is the prime or principal Cause; yet it hap∣pens, and that oftentimes, that the Blood may be now and then stopt for a season; and that it may afterwards suddenly break forth again.

VI. This is many times caused from trouble or commotion of Mind, anger, vexation, or (if the Wound was made by an Enemy) the presence of the Adversary; by which the Spirits being per∣turbed, give a sudden motion to the Blood, and so induces a new and fresh Haemorrhage in the Wound.

VII. Sennertus gives an Ex∣ample, in two Brothers, the one of which had wounded the other: while the Wound was binding up, the Brother which gave the Wound came in to visit the the other; whereupon (tho' they were now reconciled) the Blood presently broke forth afresh; which was without doubt from some secret commo∣tion of the Mind: for upon that Brother's departure, and being forbidden any more visits, the Blood immediately stanched.

VIII. The Signs. It is known by sight: if it is from an Artery, the Blood is seen to come forth by leaping, and with violence; being more hot, fervent, thin, yellow, and frothy, than that which comes out of the Veins; and is always accompanied with some notable alteration of the Pulse, weakness, and dejection of strength.

IX. If it is from a Vein, the Blood is more thick, black, dark, and less hot; coming forth with∣out any violence or rushing, smoothly, and with an equal pulse; far less dejecting the Spirits, than that which comes forth by the Arteries.

X. If the greater Vessels are wounded, the Blood flows forth in greater abundance, and with greater violence; but with far less, if it is one of the lesser Vessels which is hurt.

XI. The Prognosticks. An Ar∣terial Haemorrhage is more dan∣gerous than a Venal; because an Artery wounded, is more diffi∣cult to be cured and consoli∣dated, than a wounded Vein, because of its hardness, perpe∣tual motion, and violent leaping forth of the Blood.

XII. An Haemorrhage from an Artery wounded longwise, obliquely or transversly; is much more difficult to be stopt, than where the Artery is cut perfectly asun∣der.

XIII. An Haemorrhage from an Artery cut transversly asunder, is more easily curable; because the Artery will be again contracted, and its Orifices close and shut again, and more easily meet, and grow together again, and be the sooner covered and consoli∣dated, with the circumjacent Flesh lying round about it.

XIV. An over-great Haemor∣rhage in Wounds, in what kind soever, is very dangerous, because the Blood is the Fountain and

Treasure of Life: for when the Vital Spirits are called forth, it causes a weakness of the Pulse, with a frequency and in∣equality, and sometimes an in∣termission; also a Syncope, or fainting and swooning, Chilness of the outward parts, extream Coldness, inordinate Sweats, Convulsions, Sighings, Sobbings, Delirium, and sometimes at length Death it self.

XV. Hence Hippocrates, Sect. 5. Aph. 5. says, that a Convulsion or Sighing, happening upon an abun∣dant Flux of Blood, is always very evil and dangerous.

XVI. And in Sect. 7. Aph. 9. that a Delirium or Convulsion hap∣pening upon a great Hemorrhage, is evil, and full of danger.

XVII. And this is more espe∣cially caused by an Arterial Hae∣morrhage; because therewith, there is a greater effusion and dissipation of Native Heat, and Vital Spirits.

XVIII. A Venal Haemorrhage is without danger, if it is in an external place; where Applica∣tions can be easily made, and the smaller Veins only are wounded.

XIX. The Cure. The Indica∣tions of Cure are twofold: 1. The union and consolidation of the wounded Vessels, of which we shall say nothing in this Chapter; it belonging to Chap. 11. following. 2. The stopping of the Haemorrhage, or stanching of the Blood; which where it is very great, dejecting the Spirits, Strength, and Powers of the Body, ought first to be done, before the unition and conglutination of the Vessels; that the Patient may not run a manifest hazard of his Life.

XX. Now an Haemorrhage may be stopt by application of fit Reme∣dies, and well Binding-up: but if by this means the Blood cannot be stanched, but shall yet break thro' the closed Wound and Bandage, by reason of its impe∣tuous violence, then all those things which do induce that violence, are to be removed and forbidden.

XXI. As Anger, vehement Joy, Drinking of Wine, Brandy, or other hot Liquors; hot and thin Humors of the Body fermenting, violent motions of the Body, or action of the Part wounded; the declining, and downward-position of the Mem∣ber, and the motion of an Ar∣tery not wholly cut asunder.

XXII. There are several ways by which Blood may be stanched: 1. By the application of Dossels or Pledgets of Lint or Towe, moist∣ned either in the glair of Eggs; or in a mixture of Vinegar p. i. with Water p. iii. in tender Bo∣dies: or Vinegar p. i. with Water p. ii. in more hardy Bodies.

XXIII. This Mixture is called Posca, and is to be applied warm; because cold Applications are hurt∣ful to Wounds. Dry Lint or Towe must be avoided, because they stick so fast to the lips of the wounded Parts; that by re∣moving them, (which must be with some force) a new flux of Blood is often caused; and if fomenting with some fit Liquor is used, as Milk, Butter and Beer warmed, &c. it is often prejudicial in Wounds of the fleshy Parts.

XXIV. 2. By the application

of Crepitus Lupi, than which there is scarcely any thing to be named, which can more powerfully and cer∣tainly do it.

XXV. For it being of a nature extremely dry, and drying, as it will no way admit of the flowing forth of the Blood; (which those Medicaments do which are na∣turally moist, and therefore are less useful in stanching of Blood;) so it will likewise subsist, and stick fast in the Vessels.

XXVI. But it will be most use∣ful for this purpose, if it is first with a Thread tied round, and then pressed hard together in a Screw-Press, letting it lye therein for some certain time: for so when it comes to be im∣posed upon the Wound, it again dilates it self, and puts a stop to the Haemorrhage or flux of Blood.

XXVII. 3. By Deligation of the Vessels (where it may be) whether Vein or Artery: this is only used when great Vessels are Wounded. Now here is to be observed, first that if a Nerve accompanies the Vessel, (as in the Soporal-Artery which has the recurrent Nerve annexed to it) you must separate the Nerve therefrom, for otherwise, that part into which the Nerve is in∣serted will be deprived both of moving and feeling, besides the great pain which will be exci∣ted.

XXVIII. Secondly, in the de∣ligation of the Vessel, the binding is not to be too strait, because the thread will cut the Vessel asunder too soon, and so cause a now He∣morrhage: the thread ought to be either of strong Silk, or Steel Hemp, as they call it, such as is Sealing thread, which will not easily rot, whereby there will be less fear of a new flux of Blood, which latter may prove more dangerous than the for∣mer. Ambrose Parey lib. 11. cap. 20. used this way after Am∣putation, but it is very trouble∣som, and not mightily appro∣ved of now.

XXIX. 4. By Application of Sarcoticks or Incarnatives. Ga∣len, Meth. Med. lib. 5. cap. 4. Prescribes this. ℞ fine Aloes ℥iii. Frankincense ℥ii. make them into a pouder, and mix it with doun of a Hare, and white of an Egg, so much as to bring it to the consistence of Honey. Spread this upon Dossels of Tow, and so lay it upon the Vessel, and the whole Wound; the Vessel be∣ing first closed with the finger, and then cleansed from the Clot∣ted Blood and moisture, with a piece of Sounge dipt in red Wine, or some astringent De∣coction, and the parts of the Wound about your Finger be sprinkled with the former Pou∣der.

XXX. The Pledget or Dossel armed as aforesaid, being laid on, presently press it down with your finger; which keep so, till you have filled up the Wound with more ar•…•…ed Pledgets or Dossels.

XXXI. This done, apply a dou∣ble Cloth over all, moistned in some astringent or styptick Liquor, and wrung out; and then in a fit and convenient manner bind up the Wound with Swaths or Rousers,

beginning to rowl below the Wound; but when you are come to the Wound, you may com∣pass it with three or four Cir∣cumvolutions, then ascend and roul the part above the Wound, to press the Blood out of the Vessel, that the flux of Blood may be stayed; and open not the Wound till the third or fourth day.

XXXII. When you come to dress it, all the Pledgets or Dossels are to be taken away, except the first, which imediately sticks to, and closes the Vessel; which done, the Wound is to be sprinkled with more of the pouder, as before, and then over it new Armed Dossels are to be apply∣ed; and thus the Wound is to be drest every other day, till it is incarnated, and no fear is left, of another Hemorrhage.

XXXIII. But if after the first dressing, the Blood shall begin again to flow, and the Pledgets of their own accord grow loose; then with your Finger, press down gently upon the Vessel that nothing may flow forth, and take away the former moistned Pledget very carefully, dry the Wound, strew on more of the dry pou∣der, and then apply new Arm∣ed Pledgets, binding it careful∣ly up as before; for so long as the Pledgets or Dossels shall be softned by the Blood, the He∣morrhage cannot be said to be sufficiently stopt.

XXXIV. These following compositions are also commend∣ed in this case. ℞ Aloes, Frank∣incense, white Starch, fine Bole, doun of a Hare, Cobwebs, A.q.s. mix and make a pouder. ℞ Archangel, Moss of the Sloe-tree, Nettleroots, Dragons, A. q.s. make a pouder and strow upon the Wound.

XXXV. Guilielmus Fabrici∣us, commends this following. ℞ white Starch ℥iii: Water-frogs dryed and poudred ℥i: Whites of Eggs dryed and poud∣red, new Spunge torrified and pou∣dred, Sanguis draconis, Frank∣incense, moss of a Mans Skull Parget, A. ℥ss. fine Bole, Ter∣ra Sigillata, A. ʒii: Doun of a Hare torrified and poudred ʒi: make all into a very fine pouder.

XXXVI. ℞ Catechu, Cor∣tex Peruanus, fine Aloes, Oliba∣num, Myrrh, Pouder of Toads-Flesh, A. ℥i: Sanguis Draconis, ashes of an old Hat, Saccharum Saturni, Man's Blood dryed, Cro∣cus Martis astringens, Nut-galls, Opium, A. ℥ss: make each into a fine pouder, and mix them. Now here is to be noted, that these Medicines are to be used, till so much flesh is bred about the Vessel, as to close up its Orifice; for till then, the fear of an He∣morrhage will not be over. See lib. 3. cap. 7. sect. 16. ad 20. and cap. 15. sect. 24, 25.

XXXVII. 5. By application of Astringents and Stypticks, which are yet the more powerful stoppers of an Haemorrahage. Sennertus, lib. 5. par. 4. cap. 14. com∣mends this. Take Roch-alum, q.v. pouder it, and put it into an Ox-bladder, and so put it into a Kettle of hot Water to be dis∣solved; distil this Water by an Alembick, and continue the Work so long, till the Faeces are dry:

these Faeces dissolve again in an Ox-bladder as before, and distil again; and repeat this Work till the whole substance of the Alum shall be converted by Distillation into Water.

XXXVIII. This Recipe is the same, and differs not much in the Preparation from the Alumen dulce liquidum in Our Pharma∣copoeia Bateana, lib. 1. cap. 9. sect. 10. § 5. pag. 376. a. which is a Magisterial Spirit of Alum, and is accounted one of the best Stypticks known in the World.

XXXIX. And to this you may add the Aqua Styptica, and its Succedaneum; also Stypticum Regis, or Royal Styptick, Terra Vitrioli dulcis, Arcanum Alumi∣nis: which you may see in Our Pharm. Bateana, lib. 1. cap. 1. sect. 56. & 57. pag. 29. & 30. cap. 9. sect. 12. pag. 378. & sect. 104. pag. 581. and those described in lib. 3. cap. 11. sect. 111, 112. aforegoing, of this Work.

XL. If you cannot come to reach the Vessel with your Finger, you may inject some astringent Liquor; made of fine Bole, Terra Sigil∣lata, red Oker, Sanguis Draco∣nis, new Galls, Hypocistis, juice of Sloes, Acacia, juices of Plan∣tan, Comfrey, Knotgrass, Horse∣tail, Leeks, Bistort, Docks, Yar∣row, &c. out of which you may make such a Liquor as this is.

XLI. Take Smiths-forge-water lbjss. juices of Comfrey, Knot∣grass, Horsetail, Bistort, Yarrow, A. ℥ii. Vitriol-stone in fine pouder ʒi. fine Bole, Terra sigillata, Roch-Alum, Saccharum Saturni, A. ʒii. mix, and make an Injection; which inject softly into the Wound with a Syringe.

XLII. 6. By Application of Specificks. Some things are said to stanch the Blood by a spe∣cifick property; for which pur∣pose, Strawberry-water is com∣mended in all Haemorrhages. So also the root of Pseudomelanthium, which some call Lychnis, sive Lychnoides Segetum, sive Nigella∣strum, Cockle, or Corn wild Campion, being held under the Tongue, is said to stop an Haemorrhage.

XLIII. And there are some which recommend to us for this purpose, the roots of Succory with the white flower; and it has been found by experience, that holding the Jasper-stone in the hollow of the Hand, the Blood has been stopt: others have been cured, by holding Lapis Haematitis, or the Blood-stone in the Hand, or tying it to the brawny part of the Arm.

XLIV. Others have been cured, by applying to the Part affected the pouder of the Blood-stone in good quantity; also the pouder of the Loadstone, and Crocus Martis astringens: but nothing stops a Haemorrhage more power∣fully, that we have yet met with, than the Moss which grows up∣on Humane Sculls, Human Blood dried, Pouder of Toads, and Catechu.

XLV. 7. By applying Revul∣sives, and Interceptives or Repel∣lers. Revulsives, are Cupping-Glasses, both without and with Scarification; which, as need shall require, are to be put upon remote and opposite places:

and some Authors prescribe Bleeding in opposite places, yet this can be, but when the strength of the Patient is but little impaired; and then to be taken away by little and little, and not at once.

XLVI. Interceptives are ap∣plied, to drive back, or hinder the Afflux, and incrassate the Blood while it is flowing: and these are to be applied unto the Vessels by which the Blood flows unto the wounded Part; but above upon the Part, to∣wards the root of the Vessel, and more especially (where it may be done) on the exterior Parts, where only the Veins ly hid under the Skin, and not covered with much Flesh.

XLVII. We ought (says Hip∣pocrates, Sect. 5. Aph. 23.) to make use of some cold Medica∣ment, in those who have any Haemorrhage, or are likely to be troubled therewith; and this Me∣dicament is not to be applied unto the some place, but to those places from whence it flows.

XLVIII. Now these Intercepters are made of things cold and astringent; as Posca, rough and acid Wine, Rose-water, Plantan-water, Oak and Nightshade Waters, Barley-meal, Henbane-seeds, pouder of Myrtle-berries, fine Bole, Terra sigillata, Dragons-blood, Mastich, Olibanum, red Roses, Balaustians, whites of Eggs, &c.

XLIX. Out of which, and others of like kind, which we have enu∣merated more at large, in Lib. 3. cap. 5. sect. 57. ad 78. afore∣going; you may compound and make various Forms, as you shall see fit; of which you have also various Examples in the places before cited, so that no more need be said thereof here.

L. The Interceptive being laid on, the Part is to be bound up with a Swath or Rowler, which may bind close the Vessel towards the root thereof: and the Ligature is not to be loosned before the third or fourth day; or indeed it is not to be removed, till the Haemorrhage is throughly stopt.

LI. 8. By cutting the Vessels quite thro', or asunder, where the Haemorrhage is made by a Wound of the Vessel oblique, or transverse. This is known by the great effu∣sion of Blood, which follows upon the Wound; which is al∣ways greater, than if the Vessel was wholly cut asunder.

LII. In this case, you must cut the Vessel compleatly thro', or asunder; for so you will the more easily stanch the Blood: for the Vessel will be drawn back, and on both sides contracted within it self; and so its Orifice will be covered, and shut up with the Bodies which lye round about it.

LIII. And then you may apply those things which we have before directed for stopping the Haemor∣rhage; whereby the Orifices of the Vessel will be perfectly closed, and the Patient secured against a future Flux.

LIV. 9. By application of Esca∣roticks. One of the chief of these things, is Vitriol, which some beat into pouder, and

apply crude, sprinkling it upon the Wound, for stopping the Haemorrhage: others dissolve it in Water, and then moisten linnen Cloths therein, and lay them upon the Wound.

LV. Others apply Calcanthum, Atramentum Sutorium, or English Copperas, either in pouder, or else dissolved in some Styptick-water; which is of good use in Wounds, where the Orifice of the Vessel cannot be closed by compression, or the application of the Crepitus Lupi.

LVI. Now this Calcanthum being dissolved in Liquor, pene∣trates even thro' the wounded Vessel: for which reason we are to beware, that the Nerves (if any be near) be not hurt: and therefore that into such deep Wounds, where Nerves are pre∣sent, other more safe Stypticks are to be injected.

LVII. Some Authors, besides Vitriol, in this case commend Alum, Aegyptiacum acuated with calcin'd Vitriol, Oils of Vitriol and Sulphur, &c.

LVIII. This of Barbett is of good use, because it operates with little or no pain. Take unslakt Lime, black Soap, A. q.s. mix, and make a Cataplasm, and apply it.

LIX. Or thus. Take Ʋmber (with Spanish-Brown) in fine pouder, unslakt Lime rubbed to a fine pouder, A.q.s. whites of Eggs beaten into glair; mix them into the consistence of a Liniment, ad∣ding also the doun of a Hare. This causes little pain, and also mightily closes the Mouths of the Vessels.

LX. Fallopius in his Book of Wounds, advises to take a Reed answerable in thickness to the ca∣pacity of the wounded Vessel; and stopping one end of it with a Cork, then to fill it with German or Hungarian Vitriol melted: which when cold, is to be thrust in at the one end, so as it may be an inch without the Reed at the other end; and then to be applied to the Vessel, and held there for the space of an hour, in which time the mouth of the Vessel will be compleatly closed.

LXI. Colcothar (which is Vi∣triol calcin'd to redness) being also applied to Wounds, does imme∣diately stop their bleeding; and its Salt being dissolved in Water, and injected into deep Wounds, does also the same thing: but in this case, care ought to be taken of the Nerves. See its Preparation in Our Seplasium, or Druggist's Shop, lib. 2. cap. 12. sect. 14.

LXII. 10. By exhibition of Inter∣nals, which are Coolers, Iucrassa∣tives, and Narcoticks. Coolers, are Barberries, Bole-armoniack, Co∣rans, Coral, Lettice, Purslan, Pom∣granates, Pears, Quinces, Roses, Succory, &c.

LXIII. Incrassatives, are Myr∣tle-berries, Terra sigillata, Hypoci∣stis, Acacia, Sloes, Acorns, Com∣frey, Lapis Haematitis, Crocus Martis, Jesuits Bark, Bistort-root, Tormentil, Catechu; which last is inferior to no other thing in the World.

LXIV. Narcoticks, are Man∣drake apples and roots, Hen∣bane juice, roots, and seed;

juice, flowers and seeds of Pop∣pies, Opium; which last among Physicians is instar omnium, and the most powerful thickner, not only of the Blood, but of all the other Juices.

LXV. Cut of these things you may prepare Waters, Syrups, Lo∣hochs, Po••ions, Juleps, Pouders, Electuaries, Pills, Tinctures, &c. which may be easily given, and in small Dose: Our Tinctura mi∣rabilis, given to one or two spoonfuls, in Ale or Wine and Water, stops Bleeding to a miracle, and upon the spot; which may be repeated as often as need requires.

LXVI. This following Potion is also of singular use. Take Diascordium ʒi. Philonum Per∣sicum, Acacia, A. ʒss. Tinctura mirabilis ʒiii. Syrup of white Poppies ℥i. Corn-poppy water ℥iv. mix, and make a Potion.

LXVII. You may also give Our volatil or specifick Laudanum; or Dr. Gardner's Laudanum Tar∣tarizatum, à gr. i. ad gr. iv. liquid Laudanum, à gut. x. ad gut. xx. or xxvi. or Our Guttae Vitae, à gut. 20. ad lx. or more; according to the age and strength, &c. in some fit Ve∣hicle.

LXVIII. When the Blood is fully stanched, and shall become clotted, then we must use the best of our skill to prevent its putrifying; and endeavour to dissolve it, as we have taught in Lib. 3. cap. 7. sect. 23. ad 29.

LXiX. Or you may give this: Take Rhubarb, fine Bole, Terra sigillata, Mummy, A. ʒi. make a Pouder. Dose, ʒ i. in Chervil or Parsley Water. Or, Take Terra sigillata, Madder, Mum∣my, Comfrey, Rhubarb, A. ʒi. make a Pouder. Dose, ʒi. or more.

LXX. Or, Take Terra sigil∣lata, Crabs-eyes, A. ʒi. Goats-blood dried, Sperma Ceti, Ange∣lica and Gentian roots, Rhubarb, Snakeroot, A. ʒss. Salt of Beef, Cloves, A. ℈ss. make a Pouder, for six Doses, in Hydropiper-Water.

LXXI. Or, Take Crabs-eyes, Mummy, Madder, Goats-blood dried, roots of Madder, Rhubarb, round Birthwort, sweet Fennel seed, A. ʒi. make all into a pouder. Dose, ʒi. in Syrup of Sorrel, or Juice of Citrons, or in Oxycrate, or Posca.

LXXII. And Posca, which is a mixture of Vinegar and Water, is an excellent thing of it self: but the Vinegar ought not to be mixt in so large a quantity with the Water, as to excite a Coughing: being given warm two or three times a day, it dissolves coagulated Blood.

LXXIII. Donatus commends this. Take Rhubarb ʒi. Mummy gr. vi. Madder gr. iv. make a Pouder; which give in Posca, or Red-wine.

LXXIV. The Diet also should be so ordered, to contribute to the stopping of the free course of the Blood: for which purpose, Meats ought to be made of Rice, Amylum, fine Wheat-flower, Barley-flower, Biscuit, Corans, Medlars, Pears, Quinces, Services, &c. and to abstain from Wine, and all hot and

spirituous Liquors, violent Mo∣tion and Exercise of the Body, Anger, Vexation of Spirit, and all Trouble, and Commotion of Mind, &c.