A treatise of wounds by Richard Wiseman.

CHAP. I. Of Wounds in General.

A Wound is a solution of continuity in any part of the Body,* 1.1 suddenly made by any thing that Cuts or Tears, with a divisi∣on of the Skin.

THIS definition differs much from what is usually delivered by Authors, and it is fit it should, for they generally defining a Wound by a solution in parte molli, do thereby ex∣clude a Cut made into a Bone; as that into the Cranium by a Pole-Axe, &c. which why it should not be called a Wound I know not? Se∣condly, I say it is made by any thing that Cuts or Tears; other Authors define it to be made by an external Instrument, &c. How then do they call that fracturam cum vulnere, a fracture with a Wound, where the Bone from within makes the Wound, and thrusts it self quite through the flesh? Sennertus adds to his Definition, that it be done à re secante & acutâ; yet he reckons those for

Wounds that are made by Bullets, although it be Canon-shot.

I do therefore think it fit to make my definition more comprehensive, and to take in whatsoever makes a sudden solution of continuity, at least im∣mediately and by it self, on what part soever it light∣eth; so a Cut into a Bone is a Wound, tearing the Flesh, Nerve, Sinew, Tendon or Cartilage, by Bullet, Stone, Splinter, &c. is a Wound; only I add this restriction, that the Skin must be likewise divided: By which last words I exclude fractures that come not through the skin and contusions, if the exterior parts be continuous. But by the word Skin, I understand not only the external cutis, but also the Inward membranes of the Gullet, Ven∣tricle, Guts, Bladder, Urethra, Womb, all which are capable of Wounds from sharp Instru∣ments, whether swallowed or thrust into them.

A Wound thus defined admits of many differen∣ces,* 1.2 of which I know none that can be properly called essential. Great and small, deep and shallow, wide and narrow, streight and crooked, round and Angular, are but Accidental differences. Distincti∣ons taken from the Weapons whether sharp or blunt; Sword, Rapier or Bullet; Cut, prick or Tearing, the likewise Accidental: Those that look most like essential differences are they which are taken from the subject in which the Wound (which is it self but an Accident) inhereth, viz. from the Flesh, Skin, Brain, Nerve, Tendon, Artery, Vein, Gristle, Bone &c. All which being the several subjects of Wounds may well be allowed to specifie them, and so much the rather, because from the nature of them we raise our greatest Indi∣cations

of altering the method of Cure. To this head may also be referred the division of them into Simple or Compound.

Wounds are in themselves so visible,* 1.3 that they need no general marks to be known by. But the pe∣culiar affections of the particular parts hurt, and the methods of discovering what Inward part is Wounded, by observation made of the symptomes that happen, are fully handled in the Treatise of Gun-shot-wounds, to which I refer you: And not they only, but the prognosticks also are there deli∣vered, in w^ch a Chirurgeon ought to be well versed, lest through ignorance of them he undertake the Cure of Wounds that are mortal. I therefore have translated them to that Treatise, because the diffi∣culty of Knowing them in cases of Gun-shot, is much greater than in those of other Weapons. The greater symptoms likewise,* 1.4 as Gangrena, Pa∣ralysis, Spasmus, are there distinctly treated of, as being more frequent and important in Gun-shot-wounds than elsewhere; Hemorrhagiae are spoken of in this present Treatise.

As to Intentions of Cure,* 1.5 the Wound being a so∣lution of continuity doth require to be made One again. Unity being the perfection of whatsoever hath a being. To effect this, is the work of Nature and Art: both must mutually joyn their helping hands, and unless both the vital faculties and nou∣rishment of the part do assist the Art of the Chirur∣geon, it will be lost labour, here must be a joynt meeting and agreement of all in one.

In Simple Wounds the Chirurgeon is to afford his assistance Five manner of ways, the omitting

of any of which will render him negligent or igno∣rant in his Trade.

[ 1] The first is in careful and diligent taking away all such extraneous Bodies, as by their interposition may hinder the true Agglutination of the disjoyned parts, whether they be concrete Bloud, Hair, Sand, Dust, pieces of Bones, Cartilages, or pieces of the Weapons, Rags, &c.

[ 2] The second is performed in bringing the Lips of the Wound even together which were separated.

[ 3] The third is in retaining the Lips so brought toge∣ther, that they may be Consolidation be restored to their former Figure.

[ 4] The fourth is in conserving the Temperament and Natural Heat of the part in order to Ʋnition.

[ 5] The fifth is to prevent ill Accidents, and to correct such as have already seized on the part.

Thus much is required of us if the Wound be only Simple;* 1.6 but if it be a Compound Wound with loss of substance, or Contusion, then he hath somewhat more to do: as where there is loss of substance there he must assist Nature with his sarcotics, for regaining what is lost: And where there is Contu∣sion, there he must promove the turning what is Contused into pus or Matter, which must be per∣formed before there can possibly be Re-union.

As long as there is Alienum quid,* 1.7 some strange Body or different substance to keep off the Unition, you must not hope to make any Cure of a Wound; therefore if any such be to be drawn forth, before you attempt it, consider seriously; first whether it can be done or no; secondly, whether safe∣ly.

For first, sometimes the Weapon sticketh so fast,

that by no Art it can be extracted; then it is of necessity to be left to Nature, who this way some∣times worketh miracles: Mercatus in Lib. Insti∣tut. Chirurg. says, sometimes pieces of Weapons sticking so fast in the Inward parts have lain hid un∣der the cicatrized Wound, and have a long time af∣ter upon the Apostemation of the part come forth of themselves.

Secondly, You are to consider whether you may with safety pluck out the Weapon or no; some will live a day with the Weapon in their Bodies, which would expire upon the moment of extraction; but if your judgment suggest to you that the Patient is recoverable, make haste out with it before the part be inflamed, or else you must stay until digestion.

If the Weapon have not pierced deep,* 1.8 and through great Vessels and Nervous places: If the part opposite be full of Veins, Arteries and Nerves, or have a Bone in it over against the Wound; If there be no great fear of Laceration, pull it out the same way it went in; for the effecting of which, our Masters have left us variety of Instruments, the figure and usage whereof you may see in Scultetus. But if the point of the Weapon have pierced above the half way, and there be no Bones nor notable Vessels to hinder you, (here is use of your Anato∣my, and exact Knowledge of the parts) either thrust the Weapon through, or make way for it by incision on the contrary side; but beware the Wea∣pon be not too big, lest you do make two large Wounds for one.

If the Weapon stick in the Bone,* 1.9 move it up and down to loosen its point, and then pluck it out; but in case it will not move, cut away the Bone be∣fore you extract it.

If a Weapon be fastned betwixt two joynts,* 1.10 make an extension of the parts both ways, as it is the manner in Fractures and Dislocations, that so the Tendons and Ligaments being Elonged, the Weapon may with more ease come out; but do this with moderation, lest you break some notable Vessels, and a flux of Bloud or some ill Accident befall you as you extract it. It will be necessary in this work that you consider the Position the part was in when the Wound was Inflicted. Gesner hath a story in his Observ. de Chirurgiae dignitate & praestantia, of a Chirurgeon, who when he could by no means get forth an Arrow, asked the wound∣ed Patient in what Figure of his Body he received the Wound, understanding it was done on Horse∣back, he placed him in a riding posture, and im∣mediately drew out the Weapon.

The Weapon thus drawn out, cleanse it from Rags or ought else, and permit the Wound to bleed accordingly, as you in your judgment shall think fit, you having respect to the constitution and habit of Body, that what is in the small Veins cut asunder may flow out as well to hinder Inflam∣mation, as the generation of much Matter. The Bleeding stay'd, if there be Hair growing about the Wound, shave it off, then wipe away the clot∣ted bloud with a Spunge dipt in Red-wine, Oxy∣crate or Water. But if it stick in the Wound deep, be not too busie with your armed Probe, for thereby you may stir up a new bleeding; whereas this concreted, keeps the Wound warm, and de∣fends it from the outward Air, and by digestion Nature will thrust it forth.

CHAP. II. THe Second Intention is performed by bringing the Lips of the Wound exactly together.* 1.11

THIS Intention is delivered in a few words, but they are as a Law to be observed,* 1.12 for without that reduction of the Lips a slow and de∣formed healing follows. Nature hath nothing to do here in bringing the Lips together, that is the sole work of the Chirurgeon, who must not lay a Pledgit, or croud a Dossel of Lint or Tent into a little Wound. No, that is the way to keep the Wound open, and make it painful, whereby de∣fluxions are stirr'd up, the Temperament of the part weakned, and the Cure prolonged; contrary to the Intention of all who have writ of them, and to the practice of our Knowing Chirurgeons here: But amongst the pretenders to that Art, we often meet with such work; particularly in a young man Wounded near Highgate in the Back,* 1.13 slanting un∣der the right Scapula, another wound on the Back, and another through the upper part of the other Shoulder, with a long Gash over the forehead, and with other wounds, some whereof not conside∣rable:

The next day I was carried thither to Dress these Wounds, I found them all distended with Tents and Dossils of Lint, disposed to inflame and swell; the Patient exceeding full of pain: after I had taken out these Extraneous Bodies, my endea∣vour was to Dress them so, as I might encline their up-heaved Lips to return to their Natural scite; to which purpose I fomented them with Milk, and drest them with Pledgits spread with my digestive of Tereblnth. cum vitel. ovi, and Em∣brocated them with Ol. Ros. and by Empl. è Bolo, and Bandage with gentle compression I drest him up, and afterwards here in Town Cured him by Sarcotics and Epulotics, as in Compound Wounds, a longer work which at first ought to have been by Agglutination: Parts separated and disjoyned are to be brought together gently and equally, that they may touch one another, and so be prepared for Unition.

This must be done first gently sensim & sensim, as Fallopius hath it, by little and little, not hastily at one pluck: If the parts be equally soft bring them equally together:* 1.14 if the one soft, the other hard, and not to be moved, but with difficulty, bring the soft part to the stubborn. If the part be grown stiff with cold, as if they had been left in the fields all night, which after a Battel hath often hapned, (and particularly to a merry fellow, a common Souldier, that used to wear an Iron Skull under a Cap, and from thence was call'd by a Nick-name; his wounds were large, and the Lips hardened with the cold, and it was well for him his bleeding being thereby stay'd) in this case you are with Milk or warm-Water, and Oyle to supple them by Fo∣mentation or Embrocation, till you perceive the

Lips made soft enough for your purpose, before you endeavour Re-union.

Secondly Equally, that the parts cut asunder may answer one another, as well in profundo, as in superficie, the Top as the Bottom, Brim to Brim; and, if possible, underneath Vessel to Ves∣sel,* 1.15 that Nature may be in a capacity of doing its own work, and by vertue of its Balsam, Reunite, Ag∣glutinate, Consolidate, and Heal the Wounds: In all which Intentions she is the Agent, and the Chirurgeon only the Assistant, which Assistence, that it may be more effectually given, we must go on to the Third.

THe Third Intention is Deligation,* 1.16 or Retaining the parts so joyned together.

For the effecting of this, our famous Masters have left us two principal means, fascias & sutu∣ras, Rowling and Stitching; to which some, nay most of them added fibulas, or Clasps: But I will not put you upon that. If the Wound be small in parte molliore, in a fleshy part in the Limbs, and according to the length of the Fibres and Member; if the Wound be Simple, and in a sound Body, you may perform the whole Cure only by Bandage,* 1.17 for here Nature will truly act her part by application of Bloud and nourishment to both sides indifferent∣ly, and finish the Coalitus without your further assistance: this is that which gives such credit to the Sympathetick Powder. In the application of this, it becomes every Chirurgeon to be much ex∣perienced, in respect of the unspeakable commodi∣ties which the whole Art receiveth by them.

By them not only are parts dextrously accom∣modated for Union,* 1.18 but such also as would unna∣turally grow together kept asunder, in Burnings, Scaldings, &c. The Finger or Ham would many times grow together, the Chin would grow to the Breast, the Arms to the sides, were they not this way hindred. By them are fluxes averted, and the delapse of humors into the inferior parts for∣bidden, and being already lodged they are prest out. By these are good Juice wisely forced into parts Emaciated, as if the Right Arm pine away, Rowl up the Left from the hand to the arm-pit, that the bloud being prest out into the Vena Cava, or rather hindred to flow in so fast by the Artery, may with more eagerness flow into the other side where it was wanting: By these we see great fluxes of bloud, large Hemorrhages every day stayed: By them are ill shaped Ulcers brought into better figures, made more apt to be Cured: By them are the force of your application helpt and furthered, they keeping them close to their proper places, where your care hath bestowed them: By them is the true natural form and beauty of the part com∣monly preserved.

Three especial sorts of Fasciation or Rouling pertaining to our present work have the Worthies of our Profession commended to posterity;* 1.19 the first they term Incarnatrix or Agglutinatrix, the Incarnative or Agglutinative: The second Reten∣trix, or Retentive: The third Expultrix, or Ex∣pulsive.

The Incarnative is that which brings the Lips of the Wound together,* 1.20 and conserveth them in their right Figure; it must be more strict than the Re∣tentive,

and more loose than the Expulsive, and is the most useful in simple, fresh, and yet bleeding wounds; The manner of performing it is thus,

Have in readiness a Rouler of such matter, length and breadth as I shall anon shew you, Roule it up at both ends firmly to the middle; then lay the middle part of the Rouler on that part which is opposite, to prevent pain and Inflammation, and to cherish the heat of the part, you are, after you have made a turn upon the wound with both ends of the Roulers, to go up with the one and down with the other, and take so many turns about the part, according as may be requisite, for the restraining the flux of bloud, or according to the season of the year, to defend from Cold, and yet not keep the wound too hot, for that may weaken the part; you must also be careful that your Ban∣dage be not too hard so as to intercept the Spirits, your Bandage running downwards will press out the matter from the affected part, and by passing upward hinder the Influx of humours and Inflam∣mation.

The Fascia retentrix,* 1.21 is used to keep on close Applications about the wound, for cure of the Patient; and these are they that are only in use, in wounds of the Head: there must be a moderation of this Bandage.

Fascia Expulsiva is performed by a Rouler of one head,* 1.22 the special use of it is to expell matter out of Fistula's, or the Sinuous Ulcers, and also to keep out and stay the descent of Humours, and to expel such as have already seated themselves upon the part wounded, or otherwise; I do it in the manner following.

Begin in the sound part, beneath the seat of the Humours, and then Rowl hard at first, and by de∣grees, as you come nearer the mouth of the Wound gentler and gentler; if you will press out the Matter contained in the Cavity about the Ulcer, Rowl loosely a turn or two, then harder, and yet a little streighter, the higher you go to hinder the descent of Humours, but not too hard for fear of harm, Terminus sit bona laborantis tolerantia, Celsus:* 1.23 Let it be made with such moderation, as the Patient may well endure.

Hippocrates de offic. Medica; Vinculorum aliud per se (saith he) Remedio est, aliud iis quae Re∣medio sunt subservit, amongst Ligatures, some of themselves are Remedies, others are servants to Remedies; and true it is in this, for the Incarnative, and expulsive, are in themselves as you may per∣ceive Remedies, and the Retentrix the common servant to them all.

To this Fallopius in Tract. de vulneribus in Ge∣nere, adds Four more,* 1.24 viz. Fasciam disjunctionis; Secondly, Fasciam directionis; Thirdly, Fasciam facientem Apostema; Fourthly, Fasciam prohi∣bentem Apostema.

[ 1] Fascia disjunctionis. by Rowling keepeth parts from joyning together, as the fingers when they are bared of the Cutis.

[ 2] Fascia directionis, is that which assisteth in making a crooked part straight, or bendeth a part unna∣turally straight to his proper figure.

[ 3] Fascia faciens Apostema, is that which will procure an Apostem, by summoning the matter up into one Body, which might perhaps dangerously flow into many parts, and those more principal.

[ 4] Fascia prohibens Apostema, is that which for∣biddeth the collection of Matter, and by consequent hindereth the Generation of an Aposteme.

For the matter of your Rowlers,* 1.25 they must be fine and even Cloath, white, clean and gentle, but of strong Linnen without Hem, Seam or Threads hanging by.

Let the length be such as the Member affected and the multitude of Circumvolutions require,* 1.26 longer in winter than in Summer: Hieme (saith Celsus,) saepius fascia circumire debet, Aestate quoties necesse est, Rowl on, on, and again in the winter, in the Summer no oftner than needs must; his ground I suppose he had from our great Ma∣ster, Sect. 5. Aphor. 20. Frigidum ulceribus mor∣dax, cutem obdurat, dolorem insuppurabilem facit; Cold nippeth a Wound, makes the Skin hard, and causeth pain, which cannot be digested for the breadth of the Rowler.* 1.27 Petr. Pigreus lib. de vulneribus, is most punctual; let them be for the Shoulder, saith he, of six Inches broad, for the Thighs of five Inches, for the Legs of four Inches, for the Arm of three Inches, for the Fingers and Toes of one Inch broad; but this your judg∣ment will teach you to Alter according to the con∣formation, shape, and positure of parts.

Fasten not your Rowler by tying a knot,* 1.28 nor yet sew it upon the wound, or where you cannot easily come at it again, lest you hurt your Patient; quickness and neatness distinguisheth the Workman from the ignorant and unskilful; as the subject is the more noble you work on, so strive to perform your office more excellently, intending not only your profit but decency in the dispatch, that you may please the eye both in the time of, and when

you have done your work. Thus shall you gain credit to your self, and endear your Patient to submit the more readily to your Rules, which is not the least part of the cure.

The next thing that offers it self for keeping the Lips of the wound together are Sutures,* 1.29 and they are of three Sorts; the Incarnative, the Restrin∣gent, and the third Conserver,* 1.30 the first is that which is in most use amongst us, and is by making so many stitches at a distance.

The Second is the Glovers stitch,* 1.31 and much in use among the Spaniards, they stitch almost all wounds by it; in the Forehead and Face I have seen them bring the wound very close, and the third day they commonly cut the knot off, and draw the Thread out, then with dry stitches keep them so brought together, and so in two or three dayes more the wound is cured.

The Third Stitch is in great wounds to hold them forceably together;* 1.32 it is performed as in Hair-lips.

There are Four sorts of Stitches, mentioned by the Ancients, for the wounds of the Belly, whereof I shall take notice only of one, which I have made use of my self, in the stitching of those wounds; the manner whereof is thus,

You are to take up the Peritoneum on one side, and leave it on the other, and then take it up on the other side, and leave it on this; This is thus made, that the Peritoneum which is a dry Body may be united with the Musculous flesh, otherwise only the fleshy parts would unite, and the Peri∣toneum not, through which a Hernia succeeds, whereby you put the Patient to the wearing a Truss

the rest of his Life, and to other trouble. The Thread, you ought to use for this purpose, is to be a white, strong and round Thread, proportio∣nable to the Needle, and both according to the wound.

You will remember to cleanse the wound of its clotted bloud, if you can; but however go on with your work, that bloud will find its passage out.

In great fluxes of bloud the Glovers stitch is best, be sure in your stitching, you bring the Ar∣tery and Vein to his wounded fellow, so shall you the likelyer secure your self, and make the work more shape-like.

In the Incarnative you are to consider the wound. If the wound be but the length of a fin∣gers breadth or a little more, 'tis not worth the stitching, your Medicaments and Bandage will keep the lips of the wound together, and quickly heal.

If the wound be of two fingers breadth,* 1.33 make one stitch in the middle, if three fingers breadth two stitches, if four fingers breadth three stitches, and so go on making a stitch less than the wound is in number of the fingers, ut semper numerus di∣gitorum uno superet numerum punctorum, so as the number of the fingers breadth always exceed by one the number of the Stitches; sometimes in declining parts we make our stitches at a little more distance.

The time of taking out these Stitches is,* 1.34 when parts are agglutinated, which is sooner or later according to the habit of Body or season of the year; commonly in great Transvers wounds eight days is required, in less wounds not so deep three or four days, in the Face the next dressing, lest the Stitches make so many Scars. But in this work you

must use your Judgment, for sometimes the wound seems to be agglutinated, while the Lips are held together by Suture, which after the Stitches are cut out is not so exactly Cicatrized,* 1.35 but that you might have done better to have left the Stitches a day longer;* 1.36 but thereto the dry Stitches will help you, which is the next way of keeping these wounds together; they are made with little bits of strong linnen Cloath, Triangular or Quadran∣gular, or of such figure as may serve your purpose; these are most in use in the Face to avoid Stitching, and are of use in other parts to preserve the Stitches; These are commonly spread with Sang. dracon. Thuris, Aloes, farinae triticae, Gum-Tragacanth, a part. aeq. mixt with the white of an Egg, Gypsum will will do as much being so mixt; they are to be ap∣plyed at such distance as they may be most strong to perform what they are designed for, they will dry presently if you apply any thing to warm them, then draw the lips together as you do in Sutures.

CHAP. III. Of the Fourth and Fifth In∣tention, and of Compound Wounds, &c.

THE Fourth Intention is in the Pre∣serving the Natural Temperament of the Part,* 1.37 so that thereby Agglutina∣tion may be obtained, and is divided into Universal and particular Regiment.

THE Fourth Intention is in the preserving the natural Temperament,* 1.38 that thereby Ag∣glutination may be obtained, which Agglutination indeed as I have already hinted, is the work of Nature alone, by whose only power all parts woun∣ded, disjoyned and broken are Knit and made one again; but in regard there is a certaim Medium which Answers in proportion to a Glew, required in this work, Nature taketh what is next hand, even the nourishment of the Part which is hurt to make it of;* 1.39 ubi morbus Ibi Remedium is here as an Oracle, where the disease is there is the Remedy; no sooner is the wound made but the Balsame is discovered. Bloud (at lest the serous part of it)

is the Glew, which she useth both in curing by the First and Second Intention; the first being performed per Symphisin,* 1.40 i.e. a re-union of the part without any Medium, by which word I here mean any Callus or flesh, or other body interposed, for in another sense the Balsam of Nature is the Me∣dium, the Instrument of Unity, and Knits the parts together.* 1.41 The Second per Syssarcosin, i. e. with a Medium or Interposition of some flesh or Callous substance, that fills up the space between the Lips of the wound; great care must therefore be taken that the Bloud offend neither neither in quan∣tity or quality, too much bringeth on carnem lux∣uriantem ac supercrescentem, proud and loose flesh; too little doth defraud the part and affordeth not a competency of matter for the work.

If the quality of the Bloud be ill, it cannot pro∣duce good flesh, qualis sanguis talis caro, as the bloud is such is the flesh: the means whereby this Intention is performed is a regiment of the Patient,* 1.42 and that is either Universal as to his diet, or parti∣cular as to the peculiar management of the part it self. As to the Universal we are to consider; first, an victus plenus vulneratis an tenuis, whe∣ther a full, or slender diet? This hath been a dis∣pute in former Ages, but I think no man of common sense but knows, that as a full diet is hurtful for those of a full body, and in wounds where there is great Inflammation and like Symptomes; so when a Bo∣dy hath been exhausted through loss of bloud or the like,* 1.43 it is reason that a greater liberty should be allowed, as Broaths, Cullices, Cordials, &c. Withal I conceive there should be consideration had of their manner of Living; some people have so

accustomed themselves to drinking of strong drink, that without such a proportion they cannot live, I could instance it by many stories if it were necessa∣ry; but one for all, and from abroad,* 1.44 Ed. Br. an old servant to a Person of Honour, was bit by a Monkey in the back of his hand: to prevent In∣flammation I forbid him Wine; he next morning complained he had not slept that night, that he was faint and sick, and that his wound was the least of his ailment; that day he continued faint and ill, and the next morning complained again of his want of rest, and that afternoon he swooned, and complained he could not live without Wine, he had good Broaths, Caudles and such like, and I believe he did drink some Wine (but he was al∣lowed by his Master a Bottle of a quart every morning for his draught, and was seldom sober) his wound was Crude, and Inflamed; I complied with his desire; he drank again as he pleased, his sickness went off, his wound digested and he cured. This I have seen often in some of our Dunkirkers at Sea, who drank extraordinarily, and were full of drink in our Sea-fights, I could scarce ever cure them without allowing them Wine, and thereby their Spirits were kept up, and I had the liberty to bleed them as I thought fit.

It hath been a common saying, a hair of the same Dog, and that Brandy-wine is the common relief to such; what then must become of such a one after a hard drinking for many months together, if he chance in heat of drink to be wounded, and from that time his Chirurgion condemn him to Ptisan for a week together, nay two daies? will he not Faint and languish, his wounds become In∣digested

and Inflamed? you may laugh at my pleading for them, but I hope you will consider I am a water-drinker the while.

In other things such diet is to be observed as their strength will permit, we do not use to purge in wounds with Cathartics lest by stirring matter it flow to the weak part, but allow Lenitives, as Cassia, Tamarinds, Manna, Sena, Rhubarb. with Sal. Prunel. also Electuaries as Lenitiv. diaprun. syr. Ros. sol. de cichor. cum Rhubarbaro, also Broaths wherein hath been boyled Lettuce, Succory, Endive, Sorrel, Purslane, Borage, Bug∣loss, &c. and bleed according to the strength of Body, and as Symptomes Indicate in a direct line of the same side.

Another part of the Regiment of wounded persons will consist in giving of Vulnerary drinks,* 1.45 of which we find many mentioned by Authors, and the Materia Medica very large, witness that great tribe of Vulneraries in Perkinson's Herbal.

The most common Simples with us in England are, Comfrey, Bugle, Ladies Mantle, Agrimony, Sanicle, Pauls betony, Fluellin, Periwinkle, Mugwort, Plantain, Horse-tail, Adders-tongue, Avens, Cinkefoil, Wild Tansie, Vervain, Ground-Ivy, Golden-rod, Herb trinity, Centaury, St. Johnswort, Snakeweed, Knot-grass, Mouseare, Yarrow, Scordium, Strawberry leaves and roots, Tormentill, Bistort, Valerian, Red roses, &c.

Some of these are made choice of to be boiled in water with white Wine and Honey, of which sort you have a sufficient example in the decoctum Traumaticum of the Dispensatory.

Their principal use is in wounds of the Thorax

and Abdomen, though they be of frequent use in all great wounds. Sometimes also if the disease run out to a length we add Guajacum, Sarsa, and Scorbutical Medicines.

There are likewise Powders made of Crabbs-eyes, Coral, Nutmegg, &c. and Electuaries of the roots and hearbs beaten up with those Powders.

The particular Regiment is in preserving the natural heat and tone of parts,* 1.46 without which we can hope for no union. For the better understanding hereof I must put you in mind that there is not any part of our Body admits of a solution of con∣tinuity without pain; every scratch in the skin and little cut in the finger is painful, much more wounds in the flesh; This pain stirs up a heat which ferments in the Serous part of the Bloud, which readily makes way to the wound, and if not timely prevented distends and raises the part into a Tumor and Inflames. If this happens in a full Body, or one of an ill habit, where the bloud is Serous and more apt to ferment, the mischief is greater; and if the wound be in a declining part, as the legs, the Influx of humours are more a∣bounding, and the member through its weakness not able to assimilate, nor yet expell; whence cru∣dities heap upon the lower parts and makes an oedematous Tumour there.

To make this more plain,* 1.47 I shall give you one Instance of the many that happen daily; A young Gentleman of about 18 years of age, of a good habit of Body, one day sporting in the Country with his Gun and dogs, was prickt with a Thorn on the outside of the Calf of his leg, he takes

little notice of it, returning in the evening to his home, he drest his leg with a little Balsam, the next morning it was more painful, Inflames and Terminates in a Phlegmon; I am sent for after a few days, and find the Tumour large with great Inflammation, and suppurated; In the lower part, about the foot an oedematous Tumour: I opened the Tumour, and discharged a quantity of Matter, and cured the Patient as is usual in Phlegmons. If this Person had been treated according to the uni∣versal Regiment by bleeding and Lenient purga∣tives, &c Nay if only after this particular Regi∣ment in the preserving the Temperament of the part, which ought in this case to have been by re∣frigerants and astringents to have prevented the Influx of humours, and applied some maturative to the festered Scratch or prick,* 1.48 as ung. Basilic. upon a Pledgit of Lint to give a Breathing to the part; this with any of our restrictive Emplasters a com∣press dipt in Oxycrate with convenient Bandage over all, had preserved the tone of the part, and cured the Patient without further trouble.

To proceed rationally, by this Intention in wounds, you are to apply to the Lips of the wound such Medicaments as have an Agglutinative facultie, as Bolus Armen. Sang. Dracon. Thus, Aloes, Gum. Elemi. Colophon. Terebinth. And outwardly, to prevent influx of humours, such as are Cooling, Drying and Corroborative, as fol. plantag. Equi∣seti•• Millefolii••••. vincae per vincae, ulmi••. flor. Ros. rub. Balaust. nucum cupressi. Gallar. Baccar. Myrtillor. far Hordei. fabar. vinum rubr. posca. Aqua font. & oleum. These are the Simple Medi∣caments, which are to be proportioned to the

habit of Body and wound, as it is greater or less, Parva & superficiaria vulnera natura sua sponte nullius Medicamenti indiga sanare solet: Labia solum à nobis contrahantur & Ligamento cir∣cumdentur, ne pilus aut arena aut tale quid illaba∣tur, & ulcus penitus coalescet, Aetius de curatione vulnerum. In small and superficial wounds, as those which are made according to the length of the member, there Nature of her own accord is wont to effect the cure, without the help of any Me∣dicament; from us only is required that the Lips of the wound be brought close together by bandage, that neither hair, nor dust, nor any other thing fall be∣tween them. But in greater wounds that will not so easily be cured by Suture, we keep the Lips together, sprinkling them with this, or some such like Pow∣der, ℞ Bol. Armen. Thuris. Sang. Dracon. part. aquales, and spreading a cloath with some of the same Powder, apply it with a Compress dipt in Oxycrate, and a sutable Bandage over all; This is generally the way. But lest by the adhaesion of this Emplastick Medicament,* 1.49 the Lips of the wound should be torn and disturb'd in taking it off; I chuse rather to apply over the sprinkled Powder, a pledgit of Lint spread with Liniment. Arcei, or this following Ʋnguent. ℞ Terebinth. Venet. ℥ iij. Gum. Elemi. ℥ ij. Sang. Dracon. Thuris. Mastich. an. ʒ j. M. f. Ʋnguent. s. a. or this, ℞ Terebinth. ʒ ij. Resin. Pin. Oliban. Colophon. an. ℥ jss. Mastich. ℥ j. Croci ʒ j. Cerae. ℥ij. Olei. Hyperic. q. s. ut ft. Ʋnguent. Ʋnguentum Aureum in the London Dispensatory is also good in this case; as likewise are the compound Emplasters, Diapal∣ma, Diachalcit. de Lithargyr. de Bolo. de Beto∣nicâ; or you may use this following ℞ Terebinth. lb ij.

Resin. Pini ℥ iiij. Gum. Elemi ℥ iij. Aristoloch. Long. ℥ j. Sang. Dracon. ℥ iss. pulver. omn. subtilissimè, & f. Empla. s.a. igne lentissimo.

In all Wounds where I propose to Cure by Ag∣glutination, and would preserve my Stitches, I forbear the use of Fomentations and slabby Medica∣ments: nor will you have occasion for such appli∣cations, if you proceed rationally as you ought to do; I always accounting these simple Wounds cu∣red, when the Lips are well brought together, and dressed as above-said. Indeed in large and deep Wounds, where the Muscles and Tendons are cut through, there the Wound may require to have a space left open in a declining corner for discharge of Matter, lest it be healed outwardly, and some Matter shut in, whereby it becomes an hollow Ul∣cer. In this case you may use Fomentations and Embrocations. This is to be left to the judgment of the Chirurgeon, who is not to doubt but that Nature will do much towards the Agglutination of the wound; if influx of humors be kept off by his Art. But if the wound be so great and deep that you cannot bring the Lips close together, then in a declining part you may put in a Tent with a Dige∣stive è Terebinth. & vitel. ovi, Turpentine being one of the most proper Medicaments in all Wounds, especially those of the Nervous parts; for it pre∣serves Bruises from corrupting and putrifying, strengthens the part, eases pain; and this it doth by its Digestive Faculty, and is thus commonly used. If you apprehend its acrimony, you may take that off by washing it in Plantain, or other water: where we fear Inflammation we add farin. hordei. Or you may use this Balsam of the Spanish

Priests, known by the name of Oleum Aparici,* 1.50 which is thus made, ℞ Ol. olivar. unc. iij. Te∣rebinth. venet. unc. viij. frumenti Integri, unc. j. sem. Hyperici, unc. ij. rad. Cardui Benedict, rad. Valerianae, an. unc. j. Thuris pulveriz. unc. ij. the Seeds and Roots are to be shread and beaten, put them into a pot, cover them over with White-wine, let them stand two days infusing, then add to them the Oyle and Wheat bruised, boil them to the consumption of the Wine, then strain it out hard, and add to it the Terebinth and Thus, then give it a walm or two, and keep it for your use as a very good Balsam, often used by me. This is to be dropt warm into large Wounds, and prest out again, and the wound brought as close together as you can, with a Compress dipt in Red-wine, wherein hath been infused flor. ros. rubr. Balaust, and such like, over this Compress make your Bandage; these Wounds are to be drest but every third day.

Galen, speaking of Ulcers, says, In Ʋlcers, al∣though Matter flowed much, he Drest them but every third day, and in Winter every fourth day, yet there may be occasion of opening sooner, for the straight∣ning the Bandage, or putting on dry Stitches, or cut∣ting out the true Stitches, lest upon any accident the Suture should relax and the Wound open again.

Thus far I have proceeded in Simple wounds,* 1.51 to the Agglutination of parts, we shall now consider, of Wounds, wherein there is loss of substance by Abcision, or through a redoubling of the blow cutting twice or thrice in one place, or where through the distance, or hardness of the Lips of the Wound, it could not be kept together, but that a Cavity hath remained in the bottom; and herein

we are to regard the habit of body, that there hap∣pen no defluxion or inflammation upon the part. This is done by universal Regiment and Digestion, with Mundification, that a new flesh may be made to fill the Cavity, to which purpose this or such like may be used, ℞ Terebinth. unc. iij. farinae Hordei drach. sex. Thuris Drach. j. s. Vitell. ovi j. to these you may add after a day or two, Mel. ros. aut Mel. com. q. s. and if yet there be required more detersion, or flesh grow lax, you may use Mer. praeci∣pitat. at your pleasure: In these cases I have long pieces of Vitriolum,* 1.52 Roman. & alumen. fitted to Quills, whereby I dry this supercrescency with less disturbance to the Patient. To this purpose you may use this Mundificativum Apii, ℞ Fol. Plan∣tag. & Apii an. M. j. Ros. rubr. P. ij. Vini rubr. unc. viij. decoquant. ad medias in Colat. dissolv. sach. rubr. unc. ij. Terebinth. unc. j. Farin. Lupinor. & orobi an. drach. j. Aloes, Myrrhae an. drach. s. decoq. rur∣sus & addendo Cerae q.s. reducant. ad formam ung. This is Quercetan's. In the use of detergents you must consider the habit of Body, and accordingly add or diminish, making them of a good consistence, and having so disposed the Wound to Incarnation, if what be prescribed do not Incarn, add Pul. Ireos, Colophonia, Mastich, Sang. dracon. Sarcocoll, to make a Sarcotick Ung. and afterwards cicatrize with Ung. Tutiae Vigon. or desiccativum, &c. or with Pledgits dipt in an Aq. Calcis, or Aq. Alu∣min. simpl. factâ solutione in Aq. Rubi, and dried again.* 1.53 If a Contusion be joyned with a Wound, then you are in the first place to endeavour, that the Contused flesh in the Wound may be suppurated and turn'd into Matter, and that cum vitello ovi & Terebinth. & ol. Ros. or Ʋng. Basilici malaxt in

ol. lilior. warm the parts about to be Embrocated with lenients Ol. Lilior. Chameli, Lumbricor. and that the more circumjacent parts about be Embro∣cated with Albumine Ovor. Ol. Ros. Ol. Myrtil. and a little Acet. and some of our restrictive Powders, as Bol. Armen. Sang. Dracon. Flor. Ros. Rub. Ba∣laust, mixt with the above-said to the consistence of a Mel. or Emplast. è Bolo applied over all, to prevent the Influx of serous Bloud into the pained part, and a Compress dipt in Posca, with good Bandage to be made over all, to press out the humors already fallen into the part affected, as also to prevent the access of more, which would be apt to flow thither by reason of the pain; to which purpose you are to let the Patient Bloud, and proceed as is said in preserving the tempera∣ment of the part: If that pain increase, you are to have recourse to Anodynes, as is proposed in the Fifth Intention; but if there be little pain, and the flux of humors restrained in some measure; then you are to apply Discutients to the parts about: The Wound digested, proceed as abovesaid with Detergents, Sarcotics, and Epulotics.

These great Tranverse Wounds are not so often seen here in times of Peace,* 1.54 but in the Wars are frequent, especially when the Horse-men fall in among the Infantry; the Enemy cruelly hacking them, the poor Souldier the while sheltring his head with his Arms, sometimes the one, then the other, until they be both most cruelly mangled, and yet the head fareth little the better for their de∣fence; many of them not scaping with less than two or three Wounds, through the Skull to the Mem∣brains, and often into the Brain, and if he fly and

the Enemy pursue, his hinder parts meet with great Transverse wounds, over the Thighs, Back, Shoulders and Neck. Mr. Sanderson, now one of the Chirurgeons of St. Bartholomews Hospital, was once a fellow-labourer with me in the Dres∣sing such: At Sterling Mr. Chace the Kings Apo∣thecary assisted me in the Dressing many such, and one with such a Gash thwart the nape of the Neck, as it was our wonder that he lived: All these wounds inflicted behind were full of Maggots, they having been some days Undrest: These Wounds I stuped with a decoct. Absinth. Centaur. Scord. Lu∣pinor. Myrrhae, Aloes, and softned the stubborn lips with fomentations of Rad. Althae. Consolid. Maj. Sumit. Malvar. Violar. Hyosciam. boil'd in Broath, or with decoct Hordei, or with Milk, or warm-water, we refresht and disposed them to yield to Suture, or Bandage; we digested them with Terebinth. & Vitell. ovi, with Dossils, Pledgits, or small Tents dipt in a warm Ol. Hype∣rici, keeping some declining part open. 'Tis pro∣per to pour Oyle or Balsam into these Wounds, but then it must run down, or be prest out of them again: the parts about we likewise Embrocated and applied over all Empl. de Lithargyro, with Compress and Bandage: digestion once made, we then deterg'd with Mund. Paracels. and cicatrized, as hath been said elsewhere. Thus I cured all these wounded people, or so disposed them, as with leave they retired to their own home to be cured with more convenience.

Si vero vulnus profundius fuerit, & in superficie, Angustius, scalpello incidatur ut aequalis amplitudo fiat; Aetius, lest Matter corrupt and putrifie in the bottom, or if it happen that a wound is made

so deep, and amongst the Vessels, or that the Uni∣tion is hindred by extravasated bloud, lying in the bottom of the wound corrupting and disturbing the Unition of the part; and that the Matter cannot well discharge this way, you are then to consider, whether you may not pass the Matter by a Perfora∣tion In fundo, which if you may (as I have often done) then do it either by Knife, or a Caustick, or both: First a Caustick, then a Knife, or by a Seton-needle with a twisted Silk or Thread, or upon keeping this open a few days by a Tent or hollow Canula, you shall easily heal the upper part by lea∣ving out that Tent only; it healing up, as it were, of it self, or by the help of Bandage, to compress the parts; and after a few days more, this lower opening will cure by common Applications, your very Roulers with a Compress dipt in Red-wine, or the like will effect it.

Sometimes wounds are made deep,* 1.55 as in the side glancing to the Spine, and run between the Muscu∣lous flesh five or six Inches; and in some of these, before the Rapier is half out of the Wound, a se∣cond thrust is made, by which there is a double Wound, and an attrition of the lower part wound∣ed: the Chirurgeon is to consider well the wound and part wounded, and if this be so made, and is not likely to be cured, by the first Intention, (as it is not if it be by Attrition in fundo) or that a tendinous body be wounded, then consider whe∣ther it may not presently have a way made out be∣low; if it may, and that part kept open by digesti∣on with a small Tent, then the upper part will Unite by Agglutination; but if it may not be opened, then he is to digest this upper Orifice, and keep it

open; and if it be not large enough, he ought pre∣sently by Cutting, to inlarge it, while the wound is warm, and dress with your digestive warm, and let him Embrocate the part, the whole length as it is affected, with Ol. Ros. cum Aceto, and apply a good restrictive Emplaster over all, to hinder influx of humors; to dispose parts to quiet, then bleed, and what else is necessary for conserving the the tone of the part. If after all these endeavours the wound do digest, yet will not Cure, however he ought not presently to open his wound a-thwart the Muscles, nor yet according to the Fibres of them, to such a length, not though it may be done without laming the Patient; but shall in such a wound, at the first while it is recent, make search with a Probe to the bottom of it, and with his fin∣ger without, feel what thickness the skin is from it, and keep this place as a mark in time of need, for to make the Apertion in; and if he do after dige∣stion apply his Caustick there, the Matter will thereby discharge, and the Patient be happily cu∣red; whereas the cutting open such a Wound the whole length hazards his Patients life, and makes a long work for himself.

THE Fifth Intention is in preventing of Evil Accidents, and correcting such as are already fallen upon the part; and these are, Hemorrhagia, Pain, Fever, Intemperies, Convulsions, Syncope, Delirium and Palsie.

We shall begin with Hemorrhagia,* 1.56 as being inci∣dent to all Wounds more or less, and sometimes

the cause of all the other Accidents: wherefore I have treated purposely of the Wounds of Veins and Arteries in a Chapter by it self, so propose here only to speak of it as the stopping of it is made by some Authors the second Intention. The way to stop the flux of Bloud, as it is common in wounds, is by retaining the Lips of the wound together by Suture or Bandage, and by applying such Medica∣ments to them as have a drying and Agglutinative faculty; as Galen's Powder, Aloes p. j. Thuris p. ij. with Hares Furre cut, some of these mixt with a white of an Egg, and applied upon a Pled∣git on the Lips of the wound, and over that some little Bole and Sang. Draconis, with a little Resina added to the former mixture, and spread upon a double cloath, and laid over the wound and parts about with Compress and Bandage, and the mem∣ber placed in such a position as is for the ease of the Patient. This is our first and common way of Dressing wounds, to stop the bleeding and prevent Inflammation, and is not taken off until the third day, by which time the bleeding is stopt, and the wound near Agglutinated; but if the wound be great and deep, so as you cannot bring the Lips of the wound together, then apply those Powders of Galen's upon Dossils upon the bleeding Vessels, and your astringent next, and a Compress wet in Oxicrate, with good Bandage over all, and by the next dressing you may hope that bleeding is stopt by incarnation, if by your Probing you cause not a new flux of Bloud.

You ought to be speedy in the mitigating pain,* 1.57 for that nothing dispiriteth your Patient more, nor makes more disturbance in Wounds, the hu∣mors

flowing abundantly to the pained part offen∣ding in quality or quantity, according as the habit of Body is affected, whence vehement pain ensues, with great Inflammation and Tumor, wherefore you must hasten to succour it; and in the first place Phlebotomia is proposed as the best Anodyne, for that it takes away the cause of pain. Ʋnguent. Nu∣tutum, Refrigerans Galeni, Ʋng. Alb. Camphurat. populeon. Cataplasmes of Far. Hordei, Fabar. Flor. Ros. Rubr. Sambuci pul. decocted in Red-wine; Oxycrate or Oxymel, or Fol. Hyosciami m. ij. boil'd in milk and with white-bread crums, a new-laid-Egg, and a little Saffron, and Ol. Ros. applied as a Cataplasme; Fomentations of the Roots of Althaea Fol. Malvar. Viol. Flor. Chamel. Meliloti boil'd in Broath of a Sheeps-head and feet. If after this it tend to suppuration, then you may proceed that way as in a Phlegmon, but if it yield to none of these, then you may truly conjecture some Nerve is offended, and proceed as is said in the Wounds of the Nerves. But if pain be caused by Matter that wants a passage out, give it one by Knife or Caustick.

If some hot distemper from Choler offend the part, which may be perceived by the pain and ve∣sication, then those Unguents Nutritum, Alb. Cam∣phorat. Refrigerans Galeni, Populeon. are proper, or this following, ℞ Succi Plantag. Solani, Sem∣pervivi an. ℥ j. Boli Armen. ℥ ss. Litharg. loti aq. Plantag. & Tutiae praeparatae an. ℥ j. Ol. Ros. Om∣phac. & Nymph. an. ℥ ij. Aceti Rosacei & Cerae Tan∣tillum. Ft. Ʋnguentum.

If the distemper be oedematous, as will appear by the laxness; then Fomentations wherein Flor. Cham. Aneth. Meliloti Sem. Faenug. &c. such like

boil'd in Wine with good Bandage will serve your purpose.

Fever accompanies great Wounds,* 1.58 especially where there is Inflammation, it is almost insepa∣rable: therefore you are the less to trouble your self thereat: but if in small Wounds it happen or continues after the pain and Inflammation is remo∣ved, and hath Delirium or Syncope with it, then there is great cause to doubt the welfare of your Patient: You are to order in all these distempers a slender and cooling diet, and humecting, and with lenients gently to loosen the Body, and by bleeding and repeating as you see cause, Apozems, Juleps, Emulsions, Epithemes, which by refrigerating and contemperating the heat, are here proper.

For Gangrena, Convulsions and Palsies; I refer you to their proper places, as more accompanying Gunshot than these Wounds.

CHAP. IV. Wounds of Veins and Arteries.

THE next thing that offers it self to our con∣sideration, is the Wounds of particular parts, and first of the Veins and Arteries, which are subject to great effusion of bloud, where∣on the life of your Patient depends. Est enim san∣guis Thesaurus vitae: and therefore requires your speedy help.* 1.59 You may distinguish whether the bloud be from an Artery or a Vein, by the flowing of it, and by its colour. From the Artery the bloud rushes impetuously & per saltum, by reason of the dilatation and constriction of the heart, and is of a florid colour.* 1.60 The Venal bloud flows with a more smooth and even stream, of a gross consi∣stence, and of a darkish colour. Of these Wounds there is no great danger,* 1.61 Galen's Powder with the white of Egg, with the Suture and the formerly proposed way of dressing and Bandage, will cer∣tainly stay the bleeding of Wounds in the greater Veins, and cure the Wound at the same time, or in few days:* 1.62 But those of the Arteries are most difficultly stopt, for that the bloud is in a most vi∣gorous and strong motion.

If these wounds be not with loss of substance,* 1.63

and lips bruised,* 1.64 you are then by Suture to bring the Lips & Artery both together, passing your Needle, with a good strong thred seared through both Arte∣ry and Lips, making Guido's suture, which he calls suppressoria or Glovers-stitch. And having thus secured the Vessels for the present, you are then to apply such as this over all.* 1.65 ℞ Boli Armen. ℥ iij. Sang. Drac. Thuris, Aloes, Glutinis sic. an. ℥ j. Gyp∣si, Farin. Volatilis an. ℥ ss. Hipocystidis, Acatiae Su∣mach. an. ʒ iij. with the white of Eggs make it to the consistence of Honey, apply this upon a double cloath over the wound and parts about, with a compress squeazed out of Oxicrate or Acetum, and roul up the Member, with the Agglutinative Rouler, beginning on the opposite part,* 1.66 bringing both the heads over the wound, and having taken a turn or two there, roul upwards and downwards, so as to press the bloud from below upward, and to hinder the Influx from above. Your Bandage must so be made, as may be to the ease of the Pati∣ent, and the position such as may prevent as much as may be all pain, keeping him cool and quiet,* 1.67 and to a slender diet, and his drink cooling and Incrassating, as Fountain water, with Sal Prunella, or Acetum, or with Gads of Steel quencht in it, sweetned with Syr. of Coral, or Pomegranates, or some of these of Quercitan's, ℞. Croci Martis, Essentiae Corallor. an. ℈ j. Syr. de Ros. Sic. & Mirtill. an. ℥ j. aq. Papaver. Rhead. ℥ iiij. m. or a Decoct, Hordei cum Sem. Papaver. Alb. & Hiosciami, with Rose-water and a little Sugar, as a draught at night, or at present in any great extremity in bleeding; also a grain or two of Laudanum, if the Patient bears it well, in these case is commendable.* 1.68 You are to let bloud from the contrary part as the

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strength of the Patient will permit; only a little at a time for revulsion, as also Cupping, Friction, Binding the remote parts, & the like for derivation.

In such great effusions dress not the Patient again in five or six days;* 1.69 then if all be well, dress him again after the same manner; but if you find the bloud hath made its passage through all, and the Stitches broken, then if you can come to the Arterie, you shall do well to take hold of it by a little hook,* 1.70 and separate the Vessel from its tegu∣ments, and with a twisted thread make a deligation upon the upper and lower-most part of the Artery, and divide it in the middle, so the ends will con∣tract; and as the Artery Incarns, the Ligature will cast off: Then proceed by digestion and Sarco∣ticks, and cicatrize the wound. But if the Artery lies so deep that you cannot possibly come to make deligation upon it,* 1.71 proceed by Escaroticks applied to the Vessel, or by an actual Cautery. If by Es∣caroticks, then you are to cleanse the wound of the clotted bloud, and dip it in some such like Powder, ℞ Thur. Pul. ℥ ij. Aloes, Glutinis Sic. an. ℥ j. Chal∣cant. Ʋst. ℥ ijss. Arsenici ʒ vj. Gypsi ℥ ijss. apply this upon the Artery thick, and fill up the rest of the wound with Galen's Powder, with Hares Furre cut into it, and over all your digestive è Terebinth. & ovo integro, and dress up the wound as before; and at your next dressing, leave the Escarotick stick∣ing, and Incarn as fast as you can, or instead of them, Vitriol powdred and tied in a fine rag, and thrust to the bottom of the wound, and dressings applied over as before.

But if after these former dressings that Artery bleed,* 1.72 and you cannot come to divide the Artery, then you must use the actual Cautery. By

it the Vessel shrinks up at both ends, the flux is im∣mediately stopt, and the part marvellously strength∣ned. You are to convey it down by a Canula, and that it may not heat, cover it over with an Empla∣ster, and wet the outside with the white of an Egg, or mucilage of Quince-seeds. But before you use your Cautery, you should remove the grumeous bloud, or whatsoever else lies in your way, lest it cool your Cautery, and frustrate your endeavours, and pain your Patient to no purpose:* 1.73 Once or twice pressing with your actual Cautery to divide and contract the Artery will be sufficient. Oftner may burn it to a coal, which may cause the falling off of the Eschar before it is Incarned, and a new flux of bloud follow; that done, dress the part with a little of the mucilage of Quince, mixt with the white of an Egg, and Embrocate them about with Ol. Rosar. and apply your Emplaster Diacal∣cith. malaxt with some of the same Oile over all; and after you have allay'd the heat of the part, then digest the Wound, and with Sarcoticks Incarn, and by Epuloticks cicatrize the Wound.

A person of a good habit of body, about 35. years of Age, wounded in a Duel on the right side the Aspe∣ra Arteria;* 1.74 being run through his neck below the last Vertebra of that side behind: The Wound was small, yet he bled with a full stream, but it stopt by holding a finger upon it while I made dressings ready, which was with a few of our common astrin∣gent Powders, with the white of an Egg, and a little Acet. upon a thick Pledgit of Lint, with an Emplaster after of the same, with Compress and such Bandage as it would bear: The Wound be∣hind bled, when that before was drest. I applied

the said Medicaments to that, and we held them on with our hands, until they were dried on, then we put him to bed in the same house, and kept him cool and quiet. I used all my endeavours for the contemperating his bloud, as is usual in such cases, and drest him but once in four or five days, unless I were necessitated by the bursting out of the bloud from his wound; he bled at times about 16. or 17. days; his wound by the Vertebrae of the neck was cured in few days: and this near the Aspera Ar∣teria was cured by this way of Agglutination the nineteenth or twentieth day.

A man wounded in the Artery under the right Eye,* 1.75 was at that instant drest by Mr. Fawcet Chi∣rurgeon, the next day in the afternoon it burst out impetuously; I was sent for, and found it bleed∣ing with a strong impulse, the wound very small, not so big as a silver penny, made by a blow with the corner of a Trencher; I drest the Wound with Pulv. Galeni, and applied an Emplaster over it made up with my common restrictive Powders, cum Albumin. Ovor. and a little Acetum, with good Compress and Bandage bound it up: The next day his Wound bled again, and upon stopping of that little wound with my finger, the bloud was seen to beat all along the Artery under the Eye to the Tem∣poral Muscle, with a greater force than is com∣monly seen in an Aneurisma; I then with a crooked Needle peirc'd through both the Lips and Artery, and by Deligation restrained the bleeding, and with Emplastricks drest it up as before, concluding I should have very little more trouble from this wound; but within two or three days after, it burst out bleeding again; then I being absent, some other

Chirurgeon was call'd in, and after at another bleed∣ing Mr. Fawcet drest him, and at another time Mr. Aris drest him, the wound was now grown large, with the crowding of Dossils, and being in a very inconvenient place for bandage, it bled often, and was drest by such Chirurgions as they could meet with in their necessity; Escaroticks being thus frequently applyed to stop the flux of bloud, his Eye was very much inflamed, so as it was verily believed by us, that if he did recover of his wound, yet his Eye would be lost, his continual bleeding thus for many dayes had so exhausted his Spirits, that there was small hopes of his sur∣viving.

At the last bursting out of this Vessel, Mr. E. Mo∣lins deceased, Mr. Fawcet and my self met together at his Chamber, we found him lying as dead, with his hand out of his bed upon his breast, we felt for his pulse but it did not beat, we concluded him dead, and took the dressings hastily off the wound, it did not bleed though it was open, we supposed the bloud exhausted, the Artery lay in the wound torn by the Escaroticks, we took up the Ends and tyed them, and drest the wound with Liniment Arcei and an Empl. over it, not believing that the man would ever recover, but from this time, the bleed∣ing of the wound ceased, and the wound by very common remedies daily Incarned to my admiration, and he was in less than a month perfectly cured, both of his wound and eye. This Patient was subject to the like bleeding upon every Scratch.

A Butcher was wounded in the Artery between the Thumb and Fore-finger, with a large wound,* 1.76 after he had been drest three or four days by some body, the wound continuing still to bleed, he came

to me late one night from Westminster bleeding, with dossils crouded in the wound, I threw them out, and with a needle and a thread stitch't up the wound and the Artery with it, sprinkling my ag∣glutinative Powders upon the Suture with my Empl. and Bandage, as in the former wounds is said; in three or four dressings I cured him, but after there remained some pulsation extraordinary under the Cicatrix, which proceeded from the too lax Incarnation of the wound, wherefore with a pledgit dipt in a dulcified Tincture of Vitriol prest out, and Applied with a good Compress, and rouled over the affected part, it was dried and shriveled so as from that Application there was seen no more pulsation in the skin from the Artery.

One in the New Exchange had an Aneurisma in the palm of his hand,* 1.77 lying a-long to the third and and fourth fingers, which at last broke out, and bled at times the space of eight or ten daies, and being at a loss he sent for me, with this Tincture of Vitriol as above-said, I cured him not only by stopping the bloud, but by making a firm Cicatrix, I drest these Eruptions, but seldom once in four or five days.

A Sedentary young Gentleman of an ill habit of Body,* 1.78 wounded by a puncture in the Inside of the calf of his leg into the Surall Artery, bled much, a Chirurgion is call'd for; he fills up the wound with his Dossils dipt in albumine ovi, and astrin∣gent pouders, wherein was Escarotics calchantum ustum, &c. Applying over this his Emplaster and Bandage, by which he stopt the flux of bloud, and left the Patient to rest: The next day I am cal'd

in to dress the Patient. Upon a relation of the wound and this manner of dressing, I propose not to open the wound in four or five daies, unless some Acci∣dent happen I visit him daily, he keeps his bed, complains of a disturbance in the wound, as burn∣ing, throbbing, and pain at times, not constantly, and is very apprehensive of its bleeding; looks himself often upon the Bandage, and Alarums me by messages as often. The third morning his Chi∣rurgion and my self meet, we find the Bandage all bloudy; we propose to dress, The Appara∣tus being made we take off the dressings, and find the bloud fresh in the Roulers, but upon taking off the Emplaster see the Dossils come out, and with such a foul bloudy sanies, as is usual in such wounds after the filling them with such Pow∣ders. I consider with my Brother Chirurgion, whether the putting in a Tent with Escarotics may not stir up flux of Humours, and be attended with Inflammation, &c. and whether that way we may be sure of meeting with the Artery; and if we do whether our Medicaments will restrain its bleeding; and if not, then whether by pressing upon that Ar∣tery we may not raise a flux of bloud anew? To avoid all such I resolve to dress the wound with our common digestive, with Tereb. vitell & ovi with pul∣vere Galeni, and so we apply it upon a thick pledgit of Lint, and Embrocate the parts about with ol. Ros. & Aceto, & Empl. è Bolo over all with good Com∣press and Bandage; by this I suppos'd the parts would be at ease, the wound at liberty to dis∣charge the sloughs and sanies which was made and choaked in by the last dressings; and the Unition of parts within furthered, and the bloud in the Artery restrained. If it did not thus answer ex∣pectation,

yet I concluded we had done what be∣came good Chirurgions, and that at the next dres∣sing it would be in our power more easily to lay open the wound, and divide the Artery without hurting the nervous or tendinous bodies near it. For a wound so drest up would either unite or di∣late its lips, there being a pledgit proportionable to receive a small quantity of matter, such as might be expected from such a wound, well-condition'd, but a greater quantity, or a new flux of bloud that could not get out so, must necessarily distend the lips, we resolving not to dress the wound again in less than 3 or 4 daies: Thus we left the Patient easie; but the next day I found him unsatisfied how this wound could cure so dress without a Tent, and oft murmuring that it would rancle; yet he con∣tinued pretty easie, and did not bleed all these three dayes. The Fourth day at the opening, we found no bloud but what was mixt with matter, and the wound lookt well; but by his importunity I com∣plyed with him, and put in a short Tent spread with digestive and dipt in praecipitate, and drest him up again; and the third day open'd, and upon the dressings there was a fresh bloud again, which was followed by a thick white Matter, as from a Phlegmon, more than might reasonably be expected from a small puncture, not above half an Inch deep; wherefore fearing a cavous Ulcer, I resolved to dress without a Tent, and by good com∣press and bandage to press out thit Matter from within, and defend the part from Influx of Humours from above: to which purpose I drest with pled∣gits as before with my digestive, &c. and open'd the wound once in three dayes, and altered not this method, though I chang'd the ung. upon the pled∣git

as I thought fit: Thus I kept the part without tumor or Inflammation, and the matter lessened each dressing, but was not well digested nor free from bloud, but his feet swell'd, and himself ill-disposed; Scorbutic and such like affections, with loss of Appetite, fainting, &c. To relieve him in these Dr. W. was consulted, and after a while I caused a straight stocking to be laced on both legs, and got him out of Bed at least for some little while every day, and when he was able he retired into the Country, but hath not yet got off of the disease he heightned, by keeping within doors with this little wound. Doubtless this cure had been shorter, if immediately in the first dressing he had been bound up with an Agglutinative bandage, and the whole committed to nature.

A Cooper living near Maidenhead in the County of Bucks,* 1.79 accidentally in letting bloud was prickt in an Artery, the Arm swells and is pained, he puts himself into another Barber Chirurgions hands dwelling in Windsor, who by unfit applica∣tions, Relaxes the part, then supposing the soft Tumor he had made was a Suppuration of Matter, (though indeed it was the Arterial bloud) he with his Incision knife or Lancet cutts into it, at which an impetuous flux of blond rushes out, to the quan∣tity of four flaggons, he fills up the opening with Lint, and makes a hard bandage round it, which somewhat restrains the flux of bloud, but the Arm swells, and threatens a Gangreen: While this poor man lay thus afflicted, We his Majesties and Royal Highness Chirurgeons attending the Court, did vi∣sit him, and proposed to make an apparatus for the taking up this Artery, or in case of failing to

take off his Arm by Amputation; We met the next morning, the Patient is taken out of bed and placed in a Chair towards the Light, one of his friends held him in the Chair: Mr. Whittle stood behind his Arm, and held his Elbow with his left hand; and with the other hand was ready to help me in the operation; Mr. L. holds the lame hand: In the first place I viewed the Arm, where finding no Gangreen according to the report of the Chi∣rurgeon, but rather (as I thought) an Aneuris∣ma, I made a bandage above the wound, to hinder the Influx of bloud into it: Upon this bandage Mr. Pearce made the gripe; I then untied the Li∣gature from about the wound, and found that also free from Mortification; I put my finger into it, and finding the skin made thin by distention from the bloud, I call'd for a Knife, which while I was searching in the wound, Mr. Whittle took into his hand: I prayed him to cut through the length of the hallowness. It being done, I with my finger thrust out the Grumous bloud and an Abscess from the lower part of the Arm. When I had cleared the parts more distant, which would have fallen in and blinded my Work, I then made way to the Ar∣tery, removing from about it the clotted bloud; upon which it immediately burst out, I prayed Mr. Whittle to hold his finger upon it, he did so; then I separated it from the parts about it, and passed a crooked Needle under it; and being ready to tye it, I desired Mr. Whittle to hold off his finger, that I might be the more sure it was the Artery, upon the doing of which it spurted out: I tyed it; but in tying the Thread broke: This caused a mur∣muring in some of the by-standers, as that the Patient would die under our hands while I was endeavour∣ing

deligation, which by a new wounding of the parts would hasten Mortification and Death; I de∣sired they would continue their places, and Mr. Whittle his finger upon the Artery, that it bled not; he did so; in the while I made a strong Ligature of some twisted Threads, seared it, and put it into the eye of one of our common silver searching Probes. Gentlemen, said I, you shall see me pass this probe under the Artery, and thereby you may be assured I shall wound no parts; I imme∣diately did so and tyed the Artery, Mr. Whittle took off his finger, it bled not; then Mr. Pearce took off his hands, I then loosened the Bandage, which was all the time before under his hands, It bled no more; I told them there was more to be done in order to the binding that Artery; but in continuation of the continual Fainting of the Pa∣tient, we would defer it to the next dressing: then calling for dressings, they brought me what was designed for Amputation, which I refused; and ordered the common digestive è Terebinth. cum Vitell. ovi, which they fetcht.

I cut off the ends of the Ligature, and dipt some of the pledgits spread with the Liniment in Galen's powder, and applyed them next the Artery, and the rest of the pledgits dipt in ol. Ros. warm, and light∣ly fill'd up the wound, then Embrocated the Arm with the same oyl, and laid a Diacalcitheos Em∣plaster over the wound and that part of the Arm, and over the hand and Arm below which was Oede∣matous, a mixture of Diacalcith. & Paracels. Then with bandage began at the hand and rouled up the wound, and taking a turn or two there, I rouled up to the Axilla. This was the Ligatura Expulsiva, by which I proposed the thrusting back the Influx of

humors, and to give strength to the inseebled Mem∣ber; He being now again in his Bed, I placed his hand upon his breast in much ease to the great joy of the Patient. At the next dressing, only Mr. Whittle and the Countrey Chirurgeons were present with me, we opened the Member, found the tumor al∣lay'd, the wound fresh and tollerably digested, we now passed another Ligature upon the Artery above the first, and in pulling the first to cut it off be∣tween the Ligatures, it broke, which was as well: We drest it up with the same digestive, only leav∣ing out the Powders; Embrocated and applied our Emplaster, rouled up parts as before; The next time Mr. Whittle and I undrest the member, and found the wound in a very good condition, with assured hopes of curing it in a few weeks, the Lips of the wound being more digested and contracted, we drest it up with Mund. Paracels. And now being Impatiently expected at London, with my diseased Patients, I return, leaving it to Mr. Whittle, who drest it for the space of 10. dayes, it healing up without any return of bloud; In his absence Mr. L. dresses the Patient; but whether in wiping off the knot or what else, it burst out again; Serjeant Knight came in, dresses it with Calcanth. ust. and from that time it bled no more.

The Ancient way of tying this Artery is as I have already said by tying it in two distinct places, and cutting it off between, but here the Patient often fainting interrupted us in that work, and the break∣ing between saved us the labour.

The cutting in pieces the Arteries hath often been performed by me in Strumous ulcers, where they ride over the Carious bones; in doing which I never see the Artery break out in bleeding after the day I cut it.

CHAP. V. Wounds of the Nerves, Ten∣dons and Ligaments.

NErves may be many wayes wounded, viz. Caesim or Punctim,* 1.80 the former way they are usually cut through, and then occasion no new consideration in Chirurgery, because they wholly cease from action and are irrecoverable; but when prickt by a sharp pointed weapon, which is call'd a puncture, they are much to be regarded; so also Tendons, not the small Fibres of them (which are in every wound of the fleshy parts, when they are largely cut, whence they become painful) but the main body of them, which usually make up the tail or head of a Muscle, if you would know whe∣ther these are wounded or not, consider the place wounded, viz. whether near the Joint, in the inside the Arm, or Leg, or the end of the Muscle, or if in the Tendinous parts of the hand or foot, whence immediately arise great pains and Inflamma∣tion, also a contraction and hardness in the Nerve or Tendon follows. But if the Nerve be quite divided, the pain is little, a kind of Stupor or Numness, and the particular part is Lame.

The most frequent wounds of Nerves,* 1.81 and most to be taken care of in Chirurgery being Punctures; I shall instance in them, and chuse the most common, viz. those which are made accidentally by letting bloud: and here by the way you must take notice, that in letting bloud, sometimes the Apertion hap∣pens to be made when the skin, by the Bandage or position of the Arm, lies equal with the Vein, yet afterwards is not so, or the Apertion is made too small in the skin; so as part of the bloud is choakt, and lies there extravased, whence a Phlegmon is made, or it happens in those that are well Let bloud, yet through the Indisposition and ill habit of Body, the part prickt festers (as they usually say) and is a day or two after sore, and if neg∣lected makes a Phlegmon: all these Phlegmons do Inflame and swell the part, and contract the Arm; if a Boyl in a fleshy part be painful, then much more these in the Joynts, amongst the Nerves and Tendons, and this accident hath happened to all that do use to Let bloud, whether Physicians or Chirurgeons.

This was the reason that some of our old Master Chirurgeons did after Letting bloud, always apply a pledgit of Basilicon upon the Apertion with an Emplaster over it, this breathed the part, and se∣cured it from corrupting. But we by a contrary way, as by a little Compress dipt in water, endea∣vour to restrain the bloud, and should be laught at if we should continue the old way of Basilicon.

At the time we Let people bloud, they are com∣monly labouring under some great fermentation, or apprehend it so; no wonder if it sometimes fall upon the part where it was invited by bandage.

I have been sent for into the Countrey to a Per∣son, that after a Letting bloud, was seized with a great Inflammation the whole length of the Arm, this was an Erysipelas, the Apertion in the Vein might possibly be the cause, but that place was not affected at all; Dr. R. complained once of a Chi∣rurgeon, who was so unconscionable as he said, to ask five pounds for curing an Arm he had made sore by his Letting bloud; but I hope no person is so ignorant or malicious, to impute these acci∣dents to a Puncture of the Nerve and Tendon.

But when they are really prickt, their Sym∣ptomes,* 1.82 as you may read in all those that have writ of them, are suddain with vehement pain, faintings, convulsions, and are attended by great defluxions; they do not terminate presently in a Suppuration with good Matter, until great Endea∣vours have been used, these yield not to the simple anodyne Cataplasme of white bread and milk.

Here are other considerations; and in the first place whether they lie open, or the Apertion in the skin over them be small, or that the Nerve or Tendon lie covered under the Membrane Adiposa;* 1.83 if it be so, then you are to open the skin that the Medicaments may penetrate to the wounded Nerve or Tendon, and hereto those Medicaments are pro∣per, which are of hot dry and subtil parts to con∣sume that Ichorous water, which first affects the Nerve or Tendon, and will cause putrefaction: ol. Ros. with a little bay-salt dissolved in it and dropt into the part scalding hot, dressing it with a pledget spread with Basilicon dipt in the same oyl, and the part Embrocated about with ol. Lumbric.

with an Empl. diasulp. over, and this cataplasma over that, ℞ farinae Hordei, & fabar. an. ℥iiij. sem. lini & foenugraeci pul. an. ℥j. flor. ros. rub. flor. cham. Sambuci, & sumit. Absinth. an. ℥iij. boyl this in red Wine, or the com. lixivium, adding oxymellis ℥iij. ol. Ros. ℥j. M. So roul up the part gently; if there be much pain dress it twice a day, and if the part requires Medicaments of more drying and subtle parts dress with Balsam sulphu∣ris Terebinthinati, or ol. Sabinae & Terebinth. an. ʒij. Misce or ol. Costinum, Ruthae, Sabinae, Aneth. scorpion. &c. These are all proper Medicines to dress the affected part, they having the quality required to dry and consume that matter which lyes cor∣rupting in them, if applyed actually hot, the Ap∣plication of the former oyl of Roses and Salt hath alway served my purpose.

In your Application of your Medicaments, you are to consider what degree of heat and Siccity is proper for the offended Nerve or Tendon; if in your use of these Medicaments your Patient feels not the heat of them,* 1.84 or feels it vehemently, it is then not rightly fitted; For in the former case it doth not enough dry up that sanies, or in the lat∣ter it doth withal inflame the part;* 1.85 if the Patient feel the heat moderately, the medicine is good, but if from the use of the Medicine the part Itch and Smart, and the Apertion made by the Puncture gape as at first, then the Medicament is stronger than it should be; if the hardness go off and the contraction, and the orifice not too open, 'tis a good sign: if the Nerve be cut according to its length it is the least dangerous, but if transverse most dangerous, all these wounds are accompanied

with gleet and great pain which stirs up fluxion; if they yield not in their cure to such Medica∣ments as have been proposed, then you are to di∣vide them, to prevent convulsions, spasma's, and Gangren, after which they cure as other wounds, but do require more care in their position to keep the member steady, if it be in such a Joint where there are Nerves and Tendons, that move contra∣riwise; otherwise the member will not yield to that contraction, and become more difficult in their cure, and of less use when cured.

The Ligaments require much one method with the Tendons,* 1.86 only your Medicaments are here to be more drying, as Euphorbium, Sulphur vivum, calx lota Tutia, &c. without acrimony.

A Youth about ten years of Age,* 1.87 one day in the Sessions yard leaning over the spiked pails to see the Malefactors, was suddainly frighted down by the Marshals men; in his falling was catcht by one of these spikes in the inside of his wrist; it passing between the bone and Tendons, he hung thereby until he was taken down, they carried him home, I was sent for, I found the Tendons stretcht out to a great length, and some of them broken; others torn, and one of the bones of the carpus lying loose in the wound. In the dressing this wound there was trouble how to place these Ten∣dons; I began in taking out the loose bone, and cleansing the wound, and placing these shatter'd and overstretcht Tendons within the lips of the wound, and made my first Stitch in the middle of the wound, bringing the lips as close together as I could, then I made two stitches more, one of each side the middle

stitch, dressing him up with my digestive è Tere∣binthina, &c. dipt in this following Balsam, ℞ Tere∣binth. lb ij olei olivar. lbiij. ol. Laurini ℥ iiij. Cinnam. ℥ iij. Euphorbii Garyophil. Baccar. Juniperi an. ℥ j. Gum hederae, sagapeni, Ammoniac. opoponac. Galbani an. ℥j ss. Myrrhae, Mastich. Colophoniae pul. an. ʒ iij. distillentur pro usu. Over this I applyed my Empl. è Bolo, with a compress dipt in Oxycrate, and so rouled up the member, and some hours after let him bloud, and gave him that night a draught of Aq. Paralyseos with syr. de meconio. & aq. cardiac. C. iij. that night he rested ill, and in the morning was full of pain. I took off the Bandage, and bathed the affected part with a decoct. radic. Althae, Malvar, violar. cham. verbasci hioscyami, and ap∣plied a Cataplasma with farina Hordei, fabar. flor. Ros. rub. Balaust, decocted in Oxymel, with the addition of ol. Lumbric. & rosar. over the former dressing; the next day his pain was much mitigated, the Tendons all drawn up, and the stitches laxe: I thought to have drawn the Lips close, but found them too painful to admit of it, therefore I cut the stitches out, and brought them as close as they easily would, and drest up the wound as before. After some few days, the wound being tolera∣bly digested, I drest it with this unguent. dipt in the former Balsam, and applyed over the wound the Empl. Diasulphuris Rulandiae, with bandage and compress as before, ℞ Terebinth. Resinae, pini, ol. Hyperici, an. ℥ iiij. sarcocollae, myrrhae, Thuris, an. ʒ iij. Cerae q. sufficit; dissolve them, and bring it to the form of an unguent: Thus I happily deterg'd and incarn'd, and by ung. Tutiae and my ordinary Epu∣lotics cicatrized the wound, and he some while after was restored to the use of his hand.

A Coach man wounded transverse over the back∣side of the wrist, deep into the Joynt,* 1.88 so that his hand doubled inward, was carried into the next Inn: I caused a ferula to be placed under his hand the better to support it, and placing the fingers crookt over the ferula, I searcht the wound and pul'd out many fragments of Bones, and after cleansing the wound brought the lipps together by three stitches, leaving a discharge for Matter in the ends of the wounds which were both depending, dressing those ends with a digestive è Terebinthina cum vitel. ovi & far. Hordei with a little crocus. Upon the Suture I sprinkled the powders of myrrhae, Aloes, Thuris, & sang. dracon. and applyed the unguent mentioned in the former Chapter: then taking Bolus Armen. with some of the former Powders, made up with Alb. ovor. Acet. & ol. Ros. mixed to the consistence of a mel. applyed it as a restrictive over the wound and parts about, and placed his hand again upon the ferula, with a soft folded cloath under it, bringing his fingers over the end of the ferula, that they might be in some capacity for future use: Thus having placed his hand I roul'd it upon a good compress dipt in Oxycrate, and after∣ward Let him bloud, and gave him ʒ vj. syr. de me∣conio in a draught of Mace-Ale for his Supper, and setled him to rest, but he slept little that night. The next day I ordered him a Clyster and a slender diet; the day after I opened his hand again, and fomented the wound and parts about with an Anodyne de∣coction, as in the former Chapter, and drest up his wound as before, Embrocating patts well about with ol. Lumbric, and applyed my Emplast. è Bolo, over the wound and adjacent parts; it digested in

the declining ends a little, but continued painful, yet much more pained in the fingers: the next days dressing I cut out the stitches, and drest the wound with my digestive è Tereb. dipt in my former mentioned Balsam, and applyed a Cataplasme warm over all the wound and hand, as in the for∣mer Chapter, and roul'd up the member again: This wound did not digest kindly, nor was it easie during the whole cure, but the Inflammation went off with the Tumor about the wounded Lips; but in the fingers and back of the hand remained an oedematous Tumor. The day following I took off the dressings, and finding the Lips which I had stitcht lye open, and a white flesh within them, I dropt in some of my Balsam warm into the wound, and fill'd the crude Lips with mer. praecipit. and laid pledgits spread with the above-mentioned unguent, with some succ. Centaur. & Chelidonii, with mel Ros. boyled it gently to a good consistence, and laid the Cataplasma as before over all: Thus I deterg'd and cured this wound, sprinkling the Lips with calx lota, which cicatrized it. After this I put on a Catagmatick Emplaster, and kept the maimd hand still upon the ferula, and afterwards caused a Glove to be made to lace upon his hand and fingers, to take off that pituitous Tumor, which did accordingly answer my expectation. But his pain continued, and so weak, as he kept it upon the ferula a good while after; since the writing of this I am informed he continues in the same service, his wrist is stiff, but he drives his Coach.

A Person of a good Age and ill habit of Body walking in the street,* 1.89 passing by a Coach one of the Horses snapt off the end of his finger the Glove

with it: I drest the stump with the common di∣gestive dipt in a little ol. Ros. warm, and with Emplast. diacalcitheos, malaxt with a little of the same oyl, roul'd up the stump. This Patient kept not his house with this little hurt, but came to me to be drest once in a day or two, and sometimes drest himself, he not thinking it worth the obser∣vation of diet, bleeding, or the like: one day when neither of us suspected ill he came to me, the Ulcer was crude, an Ichor dropt from it, and the part about it was blistered, I scarified the part blistered, and dabbled the wound and about with ol. Terebinth. warm, and strewed mer. praecipitate over all, and with pledgits dipt in Basilicon with a little ol. Terebinth. and with Empl. diacalcith. over it, roul'd it up; and that night came to his Lodging with a fomentation, and other Medica∣ments prepared for a mortification, but found it better disposed; so continued the dressing, and afteward Let him bloud, and the next day purg'd him with an infusion of Senn, &c. the wound digesting well from that time, I Incarned and Cicatrized the stump. Thus sometimes great mischiefs attend little wounds, through the con∣tempt some of our Patients have of them.

CHAP. VI. Wounds of the Face.

A Lady was wounded down the whole length of the forehead to the Nose, and then trans∣verse under the left Supercilium towards the Tem∣poral Muscle, her Eye and Face much bruised. This hapned to her travelling in a Hackney Coach, upon the Jetting whereof she was thrown out of the hind-seat, against the forepart of the Coach.

At the first sight of the wound in her forehead, seeing the bone bare and her self so disturb'd, I doubted whether I should stitch it, or keep it open with dossils; but seeing no fissure or Ine∣quality in that part of the bone that was bare, and con∣sidering the deformity in that place would be great, being the whole length and middle of the forehead, I resolved to make one stitch in the middle of the forehead to bring the lips close together; so as if any Symptome prognosticated ill, I might at pleasure by the cutting off the stitches lay it open again, but if there was no cause, then the next dressing, I pro∣posed by dry stitches to bring the Lips of the wound close together; the upper Eye-lid hung down upon the Eye, reaching from the Inner Canthus of the Eye more than half an Inch beyond the outward, it was bruised, excoriated, and much swell'd,

not capable of the dry stitch, nor in that place of Bandage, it being all along under the Brow, where∣fore I made four stitches at such distance as they might be able to keep the Lips close together, and the last stitch towards the Temporal Muscle, I took in the piece of skin that was divided by a wound above it, as in a double Hair-lip; and over these Sutures and Wounds I sprinkled a little of these powders, Terra. Sigill. Sang. Dracon. Aloes & Thus, and my Pledgits spread with Arceus his Oyntment, and over these my Empl. è Bolo, and with Compress dipt in Oxycrate, and made my Bandage over from the wound, the two heads of the Roulers meeting behind; this I did to keep the wound in the forehead from uniting too close, I still fearing some Fissure or mischief there, she complaining much of her head; I having thus drest her wounds, I caused some Aq. Ros. Rubr. cum Alb. ovi to be beaten together, and dropt in her Eye, and little foulded cloaths doubled and wet in the same to be laid over that part, and over the Cheek my Empl. è Bolo, and forbore the bleeding her that night, in consideration that nunc fluebant catamenia, and she bled the space of five miles com∣ing back.

The second day after I drest her again, and find∣ing less suspition in the wound of her forehead, of fracture or fissure, I brought the Lips of that wound together with dry stitches, with a little of the powder forementioned, with the white of an Egg, and strengthened those sutures of the Supercilia by the same Medicament, lest the continual motion of the Lid should relax them, and then drest it up, and brought the Bandage now from behind, with both the heads forward, passing one by another

to bring the Lips of the wound in the forehead close together, and drest her Eye with Aq. Pomor. Ma∣tur. with a few grains of Vitrioll. Alb. this warm to remove the suffusion upon the Cornea; and upon her bruised cheek I applied a Cataplasme of the roots of Orpen beaten in a Mortar, with the white of an Egg.

Two days after I drest her again, and finding that the dry stitches kept those Lips of the wound close together, I cut off the other stitches from out the Lips of the wound, and drest her with my Sar∣coticks composed of some of those powders fore∣mentioned, which supplied the place of Epuloticks, and that morning I let her bloud, taking away about 10. ounces with a rotten Serum upon it.

The next day she was purged, this was done for the carrying off the flux of humor from her Eye and Face; thus was she Cured and disposed to go out of Town, the same day seven-night she was woun∣ded, she was hurt upon the Munday, and the Sa∣turday afterward she was cured.

A Servant of the L. B. was wounded on the right Cheek, from under the Eye over the Os Zy∣goma down the Muscles of the Cheeks; In clean∣sing of the wound, I felt a piece of the same Bone which was cut off by a slanting blow, and hung only by some fleshy fibres in the wound; it was cut over the whole breadth of the Bone; I took it out, & for that the part would not well admit of Bandage, I made two stitches in the wound, bringing the Lips even and close together; I drest this Patient as the former, and the third day after drest him again, and found his wound agglutinated; I cut out the stitches, and drest him with the same agglutinatives

as before, and the second day after I opened his wound again, and found it perfectly cured.

And so I have cured all the wounds of the Face as happily; in a Hair-Lip of the Nether-Lip, I cut a little Boy (who lay in London, and lived at Green∣wich) of about seven or eight years of Age, and cured him in ten or twelve days, though this Lip by reason of slavering, and a childish trick he had of sucking his Lips in his sleep, was the more troublesome to me; yet he is so well cured, as I believe 'tis scarce discernable.

Whilest I served amongst the Dunkirkers,* 1.90 where Snick and Snee was, as it were, a fashion, I had much of this kind of work, and for your diversion shall set you down one of them.

Whilest our Squadron rode at Anchor in the Groine, there came in some Hollanders, under the notion of Hamburgers, with three Ships new trim'd up for the King of Spain's service; a Boat∣swain of one of these Ships hapned in company a-shore with some of our men, after a little drink the Hollander began to speak of Religion, upbraid∣ing our men for their wearing a Cross, and after a little more drink became quarrelsome; and that Sacramenta he would not wear a Cross, no the Di∣vil take him, repeating this often, one of our men beat him down and fell with him, kneeling upon his breast, holding his head down, he draws out a knife sticking in his Sash, and cuts him from the Ear down towards the Mouth, then from under the Eye from that Cheek-bone to the nether-Jaw, now said he you shall wear a Cross that the Devil do not carry you away. I was sent for from the next house as a friend to the Cause, and drest him; I brought

the corners of the Wound close together and even by stitches, then a stitch in each of the slits brought the Lips of the wound together, then drest him, sprinkling a little Pul. Galeni finely powdred, which we always had in our Pockets, over this a Pledgit with some Emplastick Ʋnguent, so with a Com∣press spread with a mixture of the same pow∣ders, cum Albumine ovi over the wound, bound him up, he keeping temperate the first three days, feeding only upon Bread and Bear boiled to∣gether, with a piece of Butter and a little Sugar in it: The next morning he was let bloud, and the third day after I took off the dressings, and finding the wound as it were agglutinated in the slits, I cut out the stitches, and sprinkled the wound as at first, drest him up with Pledgits and my Empl. è Bolo, with Compress and Bandage; and the second day after drest him again, and cut out all the stitches, and in a dressing or two more he was cured, the stitches brought close together, any thing of a dry∣ing quality without acrimony cicatrizes; these, your Suture does all it self, if the part be defended from influx of humors: The Patient was well plea∣sed with his cure, though there remained some marks of a Cross.

Some of these kind of people wearing them with much pride in their Faces, as marks of their courage.

CHAP. VII. Wounds of the Limbs.

ONe of our Mariners abroad in Spain fighting a-shore,* 1.91 was thrust into the outside of the Arm, through the Biceps with a Rapier: A Chi∣rurgeon in the Town seeing him bleed much, stitcht the wound with the Glovers-stitch close, and ap∣plied over all his restrictives, and rouled up the part well: After three or four days, the Patient belonging to our Ship, came a-board, and being in pain desired me to dress him, the Arm was swel∣led and inflamed a little, but did not bleed. I cut the stitches open, their issued out a bloudy Sanies in some quantity, and after followed a digested Matter; by search with my Probe I found the wound wanted little of passing through; I Embro∣cated the wound, and drest it up with a short Tent with my common digestives, to see whether it would by good Bandage and the help of Sarcoticks Incarn, but it would not; whereupon I passed a Seton-needle through, and that way dis∣charged the Matter, and after that Apertion was digested, I dilated it, and kept a Tent there a few days: In the while, the upper part of the wound healed up, and the wound below digested well with

little Matter. I also healed it up. This I insert, not that I approve of stitching Punctures, but this way without stitching wounds, in a good habit of body, by good applications and Bandage, does sometimes agglutinate them in a few days, when drest by Tents they are of longer and difficult cure.

While I was in the King's service in the time of the War in the West-country,* 1.92 I was fetcht to Cap∣tain M. who in fighting a Duell was run through the Thigh, with a broad sword; I was also fetcht at the same time to the other, I hastily drest this Of∣ficers Thigh, with Pledgits spread with my Agglu∣tinative, and some Astringent powders mixt with the whites of Eggs, applied it over both the orifi∣ces, bringing the Lips of them close, and with Compress and Bandage rouled it up, and left him to go to bed; from whence I went to dress the other, who had many little wounds, as his fingers, hands, and head cut. At my return I visited my Patient, whom I found in his bed with little pain: the second day after I drest him again, and finding all in good temper without pain or swelling, I drest the wounds as before; well satisfied that his wounds would heal up by agglutination, there be∣ing little or no Matter, pain or swelling: If it had appeared inflamed with tumor or pain, I ought then to have kept the Orifice most distempered open; and if they had both suffered, to have kept them both open with small short Tents, drest with the common digestives, and have let him bloud, and have proceeded as in a body ill-disposed; but there was no need, there was only required a quiet position of the part which he submitted to. He

was happily cured in seven or eight days. This was truly performed by the Balsam of his bloud, I nei∣ther bleeding nor purging him in the time of his Cure or after.

A person wounded in the in-side of the Arm,* 1.93 the sword passing over the joynt, and through the out-side of the Arm, he was first drest by a Chi∣rurgeon near the place where he was hurt; he bled much. The next day I opened the wound in the presence of Dr. T.C. one of the Kings Physicians, I found the wound Tented at both Orifices, the Arm swelled, and a little disturbed, as wounds in that place are subject to be, when the bloud is shut in by Tents, and not drest rationally by refrigerants and astringents, and good Bandage. The swelling most between the two orifices, and was from bloud choak'd in the part, which was now more straitned from the influx of humors, so not likely to yield to other than suppuration; yet we foment the wounded parts with discutients and dissolvents, and keep both the orifices open with small Tents dipt in the common digestive, and Embrocated about the wound with Ol. Ros. & Gutt. aliquot Aceti, and over all my Empl. è Bolo, rouled it up: the third dressing there appeared bloud from that orifice in the in-side of the arm, which I fill'd with Precipi∣tate and a dossil upon it, then drest the parts up as before. This time I acquainted the Patient with my thoughts of opening the swelled part, between the two apertions; there being no likelihood the Matter there could discharge it self by either of these openings, yet it was not safe to heal them up, wherefore I proposed the opening of that tumor by a little Caustick, after a day or two D. C. was

acquainted with it, and it was opened as was afore proposed, and a corrupt Serum was discharged: from that time I threw my Tents out of the wound, and healed them up in four or five days after, and as the Escar separated and the Ulcer digested, I cured that in few days. That the bone was bare under the tumor, may I suppose yet be felt from the Adhesion of the musculous flesh to that bone.

A person was wounded in the out-side of the Right Leg,* 1.94 below the Gartering-place, the wound running upward; after six weeks dressing by the neighbouring Chirurgeons, the part being much disturbed by a flux of humors, I am call'd in; I find the wound sinuous (some two inches) undi∣gested, and inflamed with a tumor about it up∣ward; the small of the leg and foot Oedematous, the whole member so weakned by the influx of hu∣mors, that it was neither able to assimulate its ali∣ment, nor yet to resist the crudities that fell upon it, so would be difficult to cure; as all such wounds are where the Patient is ill ordered, as to his diet and dressings in the beginning of the disease: I propose in order to the cure to dissipate this flux about the wound, and to digest the wound by Leni∣ents, to mitigate inflammation, and to discuss and breath out that pituitous tumor on the foot and parts about, and with the help of good Bandage to restore the tone of the parts, and then if this sinu∣ous Ulcer yielded not to agglutination, to lay it open: To which end I proposed a fomentation of Summit. Absinth. Scordii. Flor. Ros. Rubr. Chamom. Sambuci, Bacc. Myrtillor. Balaust. Nuc. Cypress. these boiled in Aq. Font. adding Vini Rubr. lb ij. and some Spir. Vini; with this I foment the parts,

and dress the wound with Ʋng. Basil. Mag. adding Precipitate to it, and Embrocate the parts about with Ol. Ros. cum Aceto, over this I applied Ce∣rat. Galeni, and over the Oedematous tumor be∣low, Empl. Diacalcith. p. ij. Empl. Stict. Paracels. p. j. and over all these a good Bandage, not open∣ing the Oedematous tumor more than once a week, and then to give a breathing to the part, The wound I continued to dress daily as I had begun, and happily freed the part from inflammation and influx of humors: But the wound would not di∣gest as I desired, wherefore I laid it open a little more than an inch, and drest it up with dossils spread with the same medicament as before, and incarned and cicatrized it in three weeks or a month after, but not without some difficulty, and the help of a strait Stocking. This person had been long kept in his chamber by this wound, and now sup∣posing himself well, he rides to his Country house, unknown to me, seventeen miles off, but that night his Leg swells much, the Cicatrix scarce confirm∣ed breaks out again, with great excoriation and in∣flamed redness. Thus this Gentleman returns again to his house, and sends for me. To allay this pain and inflammation, I foment the part cum decoct. Malvar. Violar. Plantag. Solan. & Flor. Ros. Rubr. and laying a fine Lawn wet in a solution of Troch. Alb. Rhasis made in some of the same de∣coction. I also dress'd it with Ʋng. Alb. Camph. over this Lawn, and spread some of it upon the edges, lest the Matter should be shut in by the Lawns adhesion to the Lips, and the fretted Cuti∣cula raised more up. Thus I dress twice a-day, and keep the Leg upon the bed; after some few dressings, that the heat and acrimony were allay'd,

then in the place of the former Unguent, I apply Ʋng. Tutiae Mag. Vigon. and dipt the Lawn in a decoction of Fol. Plantag. Summit. Rubi, Equiseti, & Flor. Ros. Rubr. to which I added some Lapis Calaminaris, Tutiae Com. Cervi ust. & Calx lota pul. ostrear. combust. this was set in Balneo, and after∣wards strained out, and applied upon Pledgits over the Lawn: Thus with much difficulty I cicatrized this wound and Ulceration, which at first possibly might have been cured by the way of our ancient Masters in few days.

CHAP. VIII. Wounds of the Breast.

WOunds of the Breast are penetrating or not, if they do penetrate, then we are to consider the depth, whether it be only between the Mediastinum in the hollow cavity of that in the lower part of the Breast, or if it pierce into the cavities of the Thorax, or what the parts are that be hurt. How the Breast is circumscribed, with the symptoms of each part when hurt, you may find in the Treatise of Gun-shot.

The signs of the wounds penetration are discove∣red by the proportion of the searching Candle or

Probe, which enters into the Cavity;* 1.95 you may also when it penetrates the cavities of the Thorax perceive it by laying a Down-feather upon the wound, or by holding a lighted Candle near the wound, the Patient holding his breath the whilest, in this case it will move the feather or flame, if it do not blow away the one, and extinguish the other; as also the Air makes a noise in its issuing forth; sometimes it's discovered by the quantity of bloud discharged by the wound or mouth, or both with difficulty of breathing.

Wounds in the hinder part of the Thorax are reckoned dangerous by reason of the Nerves and Tendons, and if they penetrate that way,* 1.96 there is another danger from the great vessels of bloud which are nearer to the weapon in this case, than in those wounds which are made forward. Yet all wounds in the Breast are dangerous, by reason of the bloud that falls down to the Diaphragma and corrupts.

If the Lungs be wounded deep amongst the great vessels, though they escape the first nine days, yet they commonly terminate in a Pthisis or Fistula.

A Wound in the outer part of the Breast is cured as a simple wound; if it penetrate,* 1.97 you are to en∣deavour first the restraining the bloud, then that the extravased bloud be discharged, and that either by the mouth by expectoration, or by the Wound, or by Urine.

The way by Urine Fab. Aq. Pend. says, is by a branch of the Azygos, which, saith he, passes near the Diaphragma, by the Spine to the Emul∣gents. Those that own the circulation will hardly allow of his Hypothesis; however if the matter of fact be true, that there is sometimes a discharge by

Urine, which I confess I have not yet observed in my own practice, it will be reasonable to propose as he doth: In this case Diureticks, as the Decoct. Capill. Veneris, Polytrichi, Rad. Petroselini, Be∣ton. Apii, Faenicul. Asparag. To prevent inflam∣mation, Ptisans with Ol. Sulphuris, Vitrioli, Bar∣ly-creams, Emulsions, &c. The Ancients gave Acetum with warm water for dissolving the con∣crete bloud, and restraining the present flux.

The second way is by Expectoration, & thereto our Decoctum pectorale, Lohocs, Syr. Capell. Ven. Jujub. Glycirrhiza, Oxymel. &c. whereof our Pharmaco∣peia Lond. is full. This I have mentioned for their sakes who cannot have a Physician; but here I leave this work to them, these cures consisting much in their well ordering and prescribing internal Reme∣dies, and content my self in the dressing of the Wound,* 1.98 as it appertains to Chirurgery. In the treating these Wounds there is a question, whe∣ther the Wound shall be kept open, or agglutina∣ted; they that are for a speedy agglutination do urge it, lest the external Air corrupt parts within, and the heat expire: they that propose the keeping them open, do design thereby a readier discharge of Matter; for, says Aq. Pendens, if the Matter be to be discharged by Urine, it must first pass into the substance of the Pleura, then into the Vein Azy∣gos, so into the Emulgents, then to the Kidneys, and through the Ureters and Bladder. If by Ex∣pectoration; then it must also first pass into the substance of the Lungs, then into the Aspera Ar∣teria or Weazond, from thence cought up by the Mouth.

In my practice in these Wounds of the Breast,* 1.99 I

consider the wound how it is capable of discharging the extravased Bloud and Matter, if it was inflict∣ed so as that the Bloud or Matter may be there discharged, then it is to be kept open, the well-fare of the Patient depending mainly upon the well-dressing and governing it; but if it do not lye well for evacuation of that extravased bloud, then it may do hurt, so ought to be healed up.

A person of about 23. years of Age,* 1.100 of a good habit of Body, wounded into the Breast, upon which followed immediately great effusion of bloud, almost to the exhausting of his Spirits. Mr. R. Chirurgeon, and my self, were presently sent for, we find him lodg'd in an Inne near Fox-Hall, we view'd his wound, it was four fingers above the Cartilago ensi-formis a little to the left side; he laboured under a small pulse, fainting of∣ten: Dr. W. & Dr. Wed. came in while we were pro∣viding dressings,* 1.101 the wound was large and pene∣trating, we made a foft Tent with a thread fastned to it; which in these wounds you must be sure to do, lest you lose it in the body: This Tent we dipt in a mixture of a powder composed of Bol. Armen. Sang. Dracon. Thuris, Mastich, &c. with a new-laid Egg and a Pledget spread with the same over all, with Empl. è Bolo, and Compress with conve∣nient Bandage. The Phycisians prescribed such things as restrained the bleeding, and were proper to resolve the concrete bloud, and withall to re∣lieve his fainting spirits: that night he rested ill, the next day when we met, seeing him labour un∣der great difficulty of breathing, with pain above the Diaphragma, his Pulse quick, little Urine, and that high, we agreed he should be let bloud pre∣sently,

which was done accordingly in the left Arm, the bloud flowed with a quick stream, we took about six or seven ounces, a meer Serum, but the Patient was relieved by it; we took off our dres∣sings to look upon the wound, whereon we found some bloud and Sanies discharged: we then drest him with Terebinth. Lot. in Succo Lamii adding some of the former powders with Vitell. ovi, this upon a Tent as before, with an Emplaster and Ban∣dage over: Thus we continued to dress him, until we see the bleeding cease. In wounds within the body, I have always endeavoured to preserve the native heat of the part, and further the discharge of Matter from within, by keeping the wound open, until it lessened, and the ill symptoms went off; but shun the casting in of liquid Medicaments which are not easily to be gotten out again, they commonly proving very destructive. Here the Physician is to act by Internals, we only to assist by keeping a way open, if it may be, for the discharge of what is extravased and corrupted within the ca∣vity, and commit the cure to Nature. In this Person here was a great effusion of bloud upon the receipt of the wound, and the orifice large to dis∣charge the extravased bloud and Matter; the Physi∣cians careful in restraining accidents, and remo∣ving what he laboured under; through all which our work succeeded prosperously, so as parts within united; we threw out our Tent, and by Sarcoticks cured this wound without, and the Pa∣tient was restored in few weeks to perfect health, and continues so.

Another person was wounded into the Breast be∣low the fourth Rib on the right side,* 1.102 coughed up

much bloud at times; Sir Fr. Pr. was his Physici∣an, he prescribed him Ptisans, Pectoral decocti∣ons, &c. by which, and by often Phlebotomy the symptoms went off, the wound digested, the Pati∣ent rambled abroad, and was cured by such dres∣sings as I left for him at his Chamber, I seeing him no more until he was wounded again.

Another wounded in the right Breast,* 1.103 coughing up much bloud, with great pain and difficulty of breathing, I took away ten ounces of bloud pre∣sently, and ordered him (it being then night) some Syrup de Meconio & Jujub. in a draught of Aq. Papaver. with a few drops Sp. Sulphuris, he slept well that night; against the morning he had the Decoct. Pectorale (the hotter herbs left out) and it I sweetned with Syr. de Ros. Sic. & Jujub. with Sp. Sulph. this he drank in the morning, and at other times as he listed; by his disorder, he cought up bloud at times, and I let him bloud as oft, in the while I kept his wound open and digested: Up∣on another relapse I began to be sick of him, and perswaded him to send for a Physician, Sir Ed. Graves was call'd in, who see his wound almost cured, we agreed and let him bloud: and from that time he continued well.

A person run through the Body the breadth of three fingers under the right Clavicle,* 1.104 and out be∣low the Scapula, was first drest by the Chirurgeon near the place where he was wounded: I found him in his bed faint and weak, but without pain or diffi∣culty of breathing, Dr. Bacon his Physician: The next day I met him and Mr. Sh. Chirurgeon to his Highness Pr. Rupert. The patient had rested very

ill the preceding night, had bled from his wound in his back through the bed, and fowled many Nap∣kins that night in coughing up bloud, we took off the dressings from the wound in his Breast, from whence there was bloud discharged, and more came out in the dressing: I drest up the wound with a short Tent dipt in a little Terebinth. with Farina Volatilis, a few of our Agglutinative pow∣ders cum Vitello ovi, with an Empl. Diacalcith. over it; the other wound under the Scapula was painful, but so small as it was not reasonable in our judg∣ments to keep it open; we laid a Pledgit of the same mixture with an Emplaster upon that, and drest it no more; this method of dressing I conti∣nued, and let the Patient bloud: The third day he coughs up bloud, and some little issued from his wound for a few days; after four or five days I waited upon him to his lodgings in London, by the way he cought some bloud, and so more or less day and night; but by the care of his Physicians it lessened, his wound digested, and I now kept in it a hollow Tent made of a Sparadrap, which was composed of Resina, pini, Gum. Amoniac. Bdelli. Galb. Terebinth. & Cora, with Pul. Ireos, dipt in a little Mel. Ros. Rubr. This way of dressing I con∣tinued until the coughing of bloud diminished from twelve Napkins in a day and night, to ten, eight, seven, four, two, one, and but one Napkin in a week, and after that in a weeks space I see no bloud one way or other, nor any symptom of ill. I then call'd in his Physicians together, and seve∣rally, and had all their positive judgments for throwing out the Tent, and healing up the wound: I did so, and in a week more cured him; five days after, or thereabouts, he sent me his thanks by his

servant; and within few days after I made him a visit, and there met Dr. Willis, who enquiring of me whether his wounds were cured, I desired that person that he would shew the Doctor whether they were or not, he presently stript himself of his shirt, and shewed the Doctor, who both see and felt their scars, and replied they are well.

A young man wounded in the Breast,* 1.105 labouring under very great pain and difficulty of breathing, with a cough, sent for me late one night, he shewed me some little bloud he had then cought up: he had been wounded the night before by a man stand∣ing at a door some steps higher than himself, as it were over him, thrusting his Rapier from within the breadth of two fingers of the right Clavicle downward into the Lungs, the Patient run into that house bleeding much, and was seised with such difficulty of breathing, as he was forced to stretch his arms at length over his head, without which doing he could not breathe; he had been let bloud twice, and prescribed Ptisans, &c. But for all this he was little relieved, I presently let him bloud about ten ounces, and ordered the Apothe∣cary to give him a draught of Aq. Papaver. with Syr. de Meconio & de Ros. Siccis, with a little Aq. Cordial. frig. Sax. and against the next morning to send for a Physician to meet me, they did so; when I came in the morning, I found the Patient marvellously relieved, and resolved to remove his lodging, which was now by Scotland-yard to his own in Wildstreet: in the presence of his Physician Dr. St. I took off the dressings, found his wound small and shut up from within, but not skin'd, and if it had not, yet the wound within

was so much below this without, as it was not ca∣pable of discharging the Matter: So this was not worth my attendance, the wound within was the work of the Physician, however he continued me with his Physician, and we agreed to bleed him again; we did so, taking away about ℥ viij. of bloud, and the Physician proceeded by Clysters and Internals proper in his case: That afternoon the Patient, unknown to me, pursued his intention of removing to his old lodging in Wild-street, where going up three pair of stairs to his chamber, he re∣lapst into the former difficulties of breathing with pain and coughing bloud, and in the morning after where I met his Physician, the Patient seemed to me quite tired, labouring under great oppression; and by his pains about the Diaphragma and Back there was suspition of extravased bloud; to relieve him there was a necessity of taking away a little bloud; we took away some four or five ounces, and proceeded with Embrocations, Lohocs, Pe∣ctoral Decoctions, &c. and got off this difficulty in five or six days, then I left him: But after that, by disorder he relapst again, and was freed again the same way by his Physician, and since holds well, but I never see him since.

Of all these wounded Patients, and many more I have helpt to cure,* 1.106 I never see one that I could say passed their disease by Urine, nor many of them that passed their Urine well during the time of their lying under these wounds; nor have I often seen them who recover, expectorate any such quan∣tity of Matter, as might be thought to proceed from the great quantity of bloud extravasated: They cough fresh bloud most of them, like to what

they discharge from their wounds, but more florid.

Those who do cough great quantity of Matter from these wounds made by a sharp Weapon, or avoid it by their wounds, do seldom well: They usually terminate in a Tabes, with or without a Fi∣stula: Yet by the ninth day one may truly predict their present recovery, if all things have been rightly administred.

CHAP. IX. Wounds of the Abdomen.

A Man wounded with a Rapier into the belly,* 1.107 through the Right Hypocondrium out to the side of the Back, is brought to my house one night to be drest, he had bled much; I considered the wound, see it had past through, the orifices were small, little advantages to be made by keeping them open, yet I put in two small Tents dipt in a little Digestive è Terebinth. & Vitell. Ovor. and drest up with Empl. è Bolo, and a Bandage over, and advised him to go to his bed and keep quiet. I gave his friend ʒ vj. Syr. de Meconio, mixt with a draught of Aq. Papaver. with a little Cordial-water for the Patient to take in bed: The next morning I found him hot, and his Pulse a little di∣sturbed, but without symptoms of any part of the

Viscera wounded within:* 1.108 neither Tension of the Belly, Collicke, Vomiting, or ought by Urine or Stool. However I Let him bloud about 10 ounces, and ordered him to keep his bed, and a Clyster of Milk in the afternoon with Sugar, and at night his haust us again. The next day I opened his wounds, and considering here was no Symptome of hurt within by Urine or Stool, nor Tension nor Swelling, only the wound a little heated by the Tents, I threw them out, and drest both the wounds with pledgits spread with the same digestive, Embrocating the parts with ol. Ros. drest him up as before, and de∣sired him to keep his bed six or seven dayes. Two daies after I drest him again and found all well, with Inclination to cure; from that time I drest him no more, but ordered him to keep a spare diet, and to lie quiet in bed, and if there were occasion I would see him again: my servant drest him afterward, and before the seven days were expired he was well and walkt abroad not complaining more of that wound. So I have happily sometimes cured such wounds through the body; in this wound here was no con∣siderable part toucht, yet if the wound had been kept tented with long tents,* 1.109 they might have stir'd up inflammation, or so the Air might have altered the parts within, or the Matter offended them, whereby putrefaction, Collicke and Ill accidents would have followed: But what could the Chirur∣geon have advantaged the Cure of his Patient, if bloud had extravasated within, by keeping such little wounds open? Yet if it be not done, he is usually condemned by the common Vogue; there∣fore it is, that against their own Judgments they keep them tented often to the ruin of their Patient.

If in these wounds of the Belly the small Intestines be wounded, there follows a continual vomiting of Choller with Griping, and death within few daies;* 1.110 if in the first dressing these wounds a Chirurgeon should propose a cutting open the wound, to seek the wounded Intestine to stitch it,* 1.111 the friends would not permit it, nor in truth have we Authority or Example for it, so we have nothing to do but stitch up the wound, and refer the Cure to Inter∣nal remedies, yet at last when he is dying, they will wish we had attempted it. In the great In∣testines where they are fleshy, if the wound be not great enough, you are to enlarge it and seek the Intestine, and stitch it up with the Glovers stitch, and cleanse the Bowels from the Excrements, and sprinkle the Sutures with some of your Incarnative powders, and reduce them to their places, and stitch up the belly, as you shall see presently: you are in these cases to give your Patient Clysters made with Chicken or Veal-broath, wherein Barly flor. Ros. rubr. Chamom. hath been boyled, adding the yolks of Eggs to it, with Mel. Ros. & sacchar. Ros. an. ℥ j. and Internals such as are glutinative, as decoct. plantag. Equesiti, pimpinellae, pilosellae, Rad. Consolid. ma. these sweetned with Sugar of Roses, spec. diatragacan, cons. Cydon. Cons. Ros. rubr. boli. Terrae, sigill: their diet must be sparing, drying and agglutinative: they must be Let bloud, and after some days their Clysters must be agglutina∣tive and often repeated. After this manner the wounds of the Viscera are to be treated, only in them you are to keep the wound open in some declining part, whereby they may be drest if occa∣sion be, and discharge their Matter. If a flux of bloud happen as in wounds of the Liver and Spleen,

the Ancients commonly commend succ. pilosellae, pimpinell. plantag. Pologoni; with pul. Bol. Terr. si∣gill. sang. Dracon. Thuris, and such like mixt, and put in by Tents, and after the like mixt with syr. Ros. suc. and parts about Embrocated with ol. Ros. Mirtyl. & Empl. Diacalcith. over all, or a Cata∣plasme ex farin. Hord. fabar. flor. Ros. Rubr. coct. cum hydromelite and treat them by Internals as I have said, such as are agglutinative, exsiccant and detergent, I refer you to the treatise of wounds made by Gun-shot, where you shall see their various Symptomes and way of Curing.

A Man wounded and brought to Lambeth sent for me one morning early,* 1.112 he was wounded trans∣verse the belly a little below the Navel, on the left side the Omentum, and Intestines thrust out, and kept close with a Hankerchief in his hand, I see parts fresh; the Omentum or Call much out, but not altered. I caused warm cloaths presently to be held upon them very close, and the Patient to be laid low with his head, his Hips raised up, and by the help of his friends raising them up and shaking his body, I reduced them. Then they leaving his Hips high, and he declining with his body on the Right side, by the help of one pressing with his hand a little above the wound (by which the Lips of the wound were a little turned upward, and the viscera kept down;) I with a strong Needle a little crookt at the point with a strong Thread seared take hold of that lower lip,* 1.113 and near the end past my Needle first through the Peritonaeum, and then on the opposite side through the flesh and skin, leaving the Peritonaeum, and so go along passing the Needle from without Inward, till I

sewed up the wound, which cannot be very close, then I pulled the stitches as close together as I could,* 1.114 and fastened my Thread. If any part of the Omentum had been altered in its Colour, I should have tyed it hard and cut it off, and placed it with the Thread hanging out, and so I would have served a great part of it, if I could not have reduced it, I having done so heretofore often; but if the Intestines had been so swell'd,* 1.115 as by no way of fomenting or po∣sition I could have reduced them, I ought then to have cut the wound more open, but these were easier reduced, and the wound stitcht, I then sprink∣led them with pul. Aloes, Colophoniae, sang. Dracon. Mastic, sarcocolla, Bol. &c. and over them pled∣gits of my Incarnative, and with some of these powders mixt cum Albo ovor. to strengthen my stitches, I applyed them upon a cloath over all, and with compress and a strong Towel bound all fast, then after a while let him bloud, and ordered him to ly quiet upon the well side, and to a spare diet, and to keep his body soluble by Clysters; every other day I drest him after the same manner, and after the wound seemed to be Cicatrized, and that my stitches began to fret, I cut them out the Eighth or Ninth day, and after with the continuance of my sarcoticks, I cured him very well. These wounds are not subject to great Inflammation or defluxion, but by reason of the fatness and thick∣ness of the Lips, and manner of sewing, 'tis a troublesom work; and yet if they be not so stitcht as the Peritonaeum and fleshy parts may unite to∣gether, a Rupture follows to the great trouble of the Patient, and shame of our profession: the Peritonaeum bears a great stress, therefore you must be sure to take good hold with your stitches,

and if you doubt their holding, make dry stitches over them and good Bandage.

CHAP. X. Of Wounds in the Head.

WOunds in the Head according to Hippo∣crates and our daily experienced are full of danger, how slight soever they may appear to a common eye.

In this discourse I propose to write of them, not only as they are made by cut, stab, or bruise, but also of those made by Gun-shot, and so by Anticipating part of the discourse next ensuing, to give you the full doctrine of wounds of the Head made by what Instrument soever without the ne∣cessity of future repetitions, and that you may understand the Basis whereon these cures are wrought, I shall represent the head to you as it is framed.

The Head according to Galen. de usu part. is the noblest Member of our Body,* 1.116 the principal facul∣ties being there seated, for the use of which it was ordained: and is so contrived as to be the foun∣tain of the Animal spirits, and also to contain the principal Organs both of the Internal and Exter∣nal senses.

In the first part,* 1.117 the hairy scalp presents it self to our eye, and therein is to be considered its Thickness, Sense and Vessels, with the Muscles that lie under it. The Hairy Scalp is thinnest on the top of the Head, nor is there any Muscle between it and the Skull in that part, unless you will call the membrana carnosa a Muscle, (which some men of late do, and possibly not improperly;) and here the rather, because by it many men move the whole Scalp. If you doubt of a fracture there, you may boldly cut into the Hairy Scalp, it is of an obtuse sense and easily healed up again.* 1.118 But be cautious how you make your Incision in the forehead, where a transverse Incision may cause the Eye-brows to fall over the Eyes; therefore if you are forced to make Incision, let it be accord∣ing to the length of the Fibres, and avoid the vena frontis, lest its bleeding disturb your work. And be careful that you make no Incision upon the Temporal Muscles,* 1.119 for thereby Convulsions and other ill Accidents may happen.

Under the Hairy Scalp lyes the Pericranium,* 1.120 which we are to cut through, in making way to the Cranium; you are to raise them both together when you lay bare the Cranium for the use of the Terebra; for if in perforating you tear this Mem∣brane, Inflammation and Fever may follow, the Pericranium arising from the dura mater through the Sutures; by which continuity that may also partake of the Inflammation.

The Cranium follows,* 1.121 which is a Bone com∣posed of many joyned together by Sutures, of

which there are five concern us Coronalis, Lamb∣doides, Sagittalis, &c. two false ones. In perfo∣rating the Cranium, you are to shun these, (if you may) for through them the dura mater passes, being continued unto the Pericranium. The Su∣tures divide the Bones of the Cranium, by which one part of the Cranium may be preserved entire while the other is broken, which otherwise would be in hazard; These Sutures are weak in resisting Blows, and upon them also Matter may be easily contracted and make a Caries the sooner, and sooner worke through to the brain than in either parts of the Skull. It is necessary to know them well, lest as Hippocrates well cautions, you take them for Fissures.* 1.122 The way of finding them is, by passing one string from ear to ear, and another from the Nose to the Crown of the head; the former of these shews you the Coronal Suture, the second the Sagittal, which usually begins at that point where these lines intersect, being the part where we make Fontanels, and reacheth to the Crown of the head where the Lambdoides begins; sometimes it be∣ginneth quite at the Nose. The Lambdoides begins at the end of the Sagittal, and goeth forked down the two sides of the occiput: of the Suturae nothae: the two chiefly to be regarded are the Squamosae, which run under the temporal Muscle of each side, round about the outermost verge of the ear.

You are also to take notice that the Cranium is thinnest in the middle part of the head,* 1.123 and thickest in the hinder part, and of a middle thick∣ness in the fore part: Hence it is that wounds are most dangerous in the Crown of the head, where the Skull by reason of its Tenuity easily communi∣cates its hurt to the brain, and also for that the upper

part of the brain lyes there high, one of the largest Sinus being immediately under the Skull, and many Capillary veins running so close with it, as to make themselves Trenches in the Internal part of the Cranium: Wherefore upon a blow or concussion in this place, the veins may easily be broken, and the bloud extravased between the Cranium and dura mater, and ill Accidents follow.

The dura mater, a strong Membrane,* 1.124 is placed under the Cranium, which being wounded is at∣tended frequently by Palsies, and in progress of the distemper by Convulsions and other ill Symptoms; and the greater if wounded in the middle part of the head according to its length, there being many Vessels, which if they chance to be cut, will fill the vacant space between the Cranium and dura mater with bloud.

The Pia mater lies upon the body of the Brain so close,* 1.125 that a wound cannot be made into the Pia mater and the Brain escape; and from its many veins a flux of bloud must follow.

The Brain lies under the Pia mater,* 1.126 in whose ventricles is lodg'd the Plexus choroides, and under whose Basis ly large numerous branches of Ar∣teries and Veins, which by great blows of the head may be broken.

From the Description of the head we shall pro∣ceed to the Description of its wounds,* 1.127 which are strictly so call'd, when any part of the skin, flesh, bones, membranes or brain is either cut or torne, or when more of these are hurt together.

Contusions and Concussions do not truly belong* 1.128

to this place, yet for the better Information of the young Chirurgeon, I shall say something of those also, and shall treat of all these things by the sol∣lowing degrees.

[ 1] First, there may happen Contusions, or great and violent Concussions of the Brain from a blow, fall, &c. when there is no visible wound either in∣ward or outward.

[ 2] Sometimes this Concussion is accompanied by a ruption of the Vessels of the Meninges. Some∣times a fissure of the Skull, or a spill broken off from the inside of it, &c. the skin all this while remaining whole.

[ 3] Other while the wound begins on the outside being made by Sword, Bill, or Bullet, &c. and either goeth no further, or else penetrates some∣times to the Skull, sometimes into the first Table, sometimes through both, or yet further through the dura or pia mater, or into the brain it self.

[ 4] Some are meer cuts, others contused wounds, and in Gunshot, the very outward parts of the head, as hair, skin, flesh, bones, &c. are often driven by the violence of the Bullet into the Brain it self.

[ 5] Of Fissures some are directly under or near the place of the Blow; some on the quite contrary side, and are called contra fissurae.

Celsus in his 8 lib. & 4 ch. gives you the signs;* 1.129 when you are call'd to such a Patient, presently saies he, you shall enquire num vomuerit, &c. whether he vomited, or was stupified at the first receipt of the Blow or Fall, or a Resolution of the Nerves followed, or tor∣por, or delirium, or raving; these shew the Membrane of the brain affected, and the Patient in great danger.

But if none of these were, you may then dubitare an os fractum, doubt whether the Bone be broken: then it is to be considered, whether it was Stone, Iron, or Lead, that he was hurt withal, and with what force the Blow was given. But if there be a wound, nothing is more sure than the finger or Probe; if it feel smooth or slippery, the Cranium is safe: But if you feel any Asperity or roughness, if it be not the Suture, then you may be assured of a Fissure or Fracture, the holding a Tread between the Patients Teeth, or biting of a Crust, is men∣tioned as a sign of a Fracture, but this way is very uncertain: To find hair cut in a wound may be a sign, if you consider, no small force will cut a hair there.

If by your Probe you make no discovery of the fissure, and yet the Symptomes be grievous, then lay it open, and if the Fissure do not then appear, rub the bared Cranium with Ink, and wiping it off again, you will see the Ink remaining only in the Fissure or crack, then Rugine it.

If no breach of skin appear, you must consider the outer side, numquis locus mollior sit, & tument, eumque aperire; whether any part be softer and swell, which you must open and see whether there be any Fissure, non tam magno negotio, cutis sanescit etiamsi frustra dissecta est, it being no great matter to heal it again, though it should be laid open in vain.

In the Prognostick,* 1.130 wounds by much how nearer the Brain, are so much the more dangerous; the solution made by Incision is of less danger than those made by puncture, this of less than those made by Contusion; and those of Gun-shot worst

of all wounds. In the middle of the head most dangerous, the hinder part least dangerous, the fore part of a mediocrity between both, it having passages near for discharge of its bloud and matter: Wounds of the Sutures are dangerous, but those are more or less as they fall into good or bad Chi∣rurgeons hands, and as the Patient submits to the method of cure. A simple wound by a Blow hath been through ill Chirurgeons, &c. the cause of much danger, that in skilful hands would easily have been cured: All wounds save those of the Brain are curable, if the Chirurgeon be timely call'd in, and that it be discovered in such place where he may lay open safely.

We begin with the cure of Contusions of the Cal∣varia,* 1.131 where the outer skin is whole, yet with great attrition of the Musculous flesh and membrane underneath; which often happens from blows or Falls, and are subject to great pain, tumor, In∣flammation, and Apostemation, &c. caused through the Ill habit of body, or untimely applications, therefore it requires your special care in the first place to prevent the afflux of humors and pain, which is performed presently in the beginning by repellents and astringents, which are to be often re∣newed, lest they heat the part affected. You are in the first place to shave the hair, if there be any, then Embrocate with ol. Ros. & myrtil. cum aceto, and apply this or such like over the contused parts; ℞ farin. hordei, fabar. an. ℥ vj. pulv. Nucis, Cupressi, balaust, Alum Rochae, Ros. rubr. an. ʒ j. ol. Ros. ℥ iij. Alb. ovor. nu. ij Aceti q. s. ft. Cataplasma. You are to make your Bandage over this, to further the expulsion of the serous humors from the grieved part, therefore your Bandage begins there, and

terminates where it may resist the Influx; then bleed, &c.

The second day you are to foment with Red wine, wherein hath been boyled flor. ros. rubr. Bacc. myrtill. fol. beton. & flor. Chammol. and if much pain Embrocate with ol. Ros. & Chamom, or decoct. beton. ros. rubr. Rad. Althe. sem. Lini, fenugraeci: If after these your endeavours the part affected do tend to Apostemation, you must then use suppura∣tores, and open it in the declining part, and digest it as in a Pphlegmon; but if the pain do mitigate, then it will be proper to discuss and breath out the Serosity by such like, ℞ farinae hordei fabar. an. ℥ iij. flor. ros. rubr. Bacc. Mirtill. pulv. an. ℥ j. sumit. Absinthii, fol. beton. slor. sambuci & chamom. pulv. an. ʒ iij. sem. Cumini, pulv. ʒ j. mel. ℥ ij. coq. in vino Austero, ft. Cataplasma, addendo ol. Cham. Ros. an. ℥ j. apply it; then in the next place comes in the use of Emplastr. Vigonis.

If there happen a Concussion from some great Fall or blow without a wound,* 1.132 we cause the head to be shaved, Embrocate with ol. Ros. & myrtill. cum Aceto, all the head, neck and behind the ears, and apply a Cataplasm with farin. hordei. fabar. bacc. Mirtill. flor. ros. rubr. decocted in Red wine or Oxycrate, adding mel. ros. to it or Empl. vigonis, or such as this which is his, and hath been often used by me in such cases, ℞ furfuris Tritici ℥ iiij. far. lentium ℥ ij. flor. ros. rub. Bacc. Myrtillor. Balaust. an. ʒ j. Calami Aromatici ℥ j ss. flor. chamomel. Melilot. pulv. an. ℥ ss. nuc. Cypress. no. 6. pulver. omnia coq. in vino Austero q. s. ad consistent. Cata∣plasmatis addendo olei Rosati Chamom. an. ℥ iij. or add wax to it, and make it into the form of a Cerott;

you may make fomentations of the like; you must remember in these Concussions to bleed largely, even to defailancy of spirits, according as the Symp∣tomes do shew to you the greatness of the Malady, and as strength of body will permit, and keep the body soluble by Clysters, also Julips, Emulsions, and what else may allay fermentation of the bloud,

In the cure of wounds of the head,* 1.133 if it be a simple wound only to the Pericranium, the lips are to be brought close together; the stitching these wounds is objected against by some, lest there∣by Matter should be pent in,* 1.134 and Inflammation and caries of the Skull follow, but done judiciously; it is safe, if you can satisfie your self that the wound ought speedily to be healed. Abroad I have seen them as commonly stitcht as other incised wounds, and do my self in great wounds of the Scalp make a few stitches to keep it close; however you are not to croud those wounds with dossils, but having shaved the hair bring the lips close together, and cure it by the first Intention, vid. Agglutination; as in simple wounds, by Arceus's Liniment or some incarnative, and keeping the lips close by Empl. è Bolo, or with some of your Astringent powders mixt with album. ovor. Thus in a few days all these simple incised wounds may be cured.

In a wound in the right Temporal Muscle,* 1.135 where the Artery was wounded, I have often stitcht them up without any ill Accident. Smith a Tanner some∣times in Chester, Captain of a Company of Dra∣goons pickt up in hast to disturb us in our flight from the Battel at Worcester, was bleeding almost to death, by a wound he received from some of our routed Forces; when I was brought a prisoner to his

Quarters, I stitcht up his wound, taking the Artery up with the lips and with a little wheat-meal, and the white of an Egg, laid over all upon a Compress dipt in aceto, bound his head up; this was upon a necessity, but this served to keep my stitches close; after two or three days, I dressed him again, and found all quiet, I now sprinkled the lips with pul∣ver. Thuris, sang. dracon. an. p. aeq. and applyed a pledget with Linim. Arcei & Empl. diacalcit. all which I was now supplied with from Warrington; and the next dressing cut out the stitches, and drest him up again with the same as before, and from that time he was cured: which was before he had recruited his spirits from his loss of bloud.

In wounds of the head where you cannot cure by the first Intention,* 1.136 as where the wound is contused or some part of the Hairy Scalp torn off, there you are to digest with Terebinth. and the yolk of an Egg, I commonly boyl the Turpentine a little to make it thick, otherwise it is too slabby; add a little farin. Hordei, After Digestion I add a little Sarca∣coll. Myrrhae, Aloes, pul. Ireos, with mel. Ros. by which it serves to deterg, I commonly In∣carn with this of vigoes, ℞ ol. Rosat. ℥ vj. ol. mastich, ℥ ij. pinguedinis vitulin. porcin. an. ℥ iiij. fol. plantag. matrisylvae, Beton, pimpinellae, pilosellae, flor. Anthos. an. Mss. vini odorif. cochl. iiij. coq. ad Con∣sumpt. vini in colat. add mastich. Gum. Elemi, Resin. pini, an. ℥ j. litharg. Auri & argent. an. ℥ ij. Minii ʒ x. Terebinth. venet. ℥ iiij. cerae q. s. ft. vng. S. A. or with Lin. Arcei; touching the lax flesh, as I think fit with either of the stones, and by the help of ung. Tutiae mag. Lint dry or dipt in sp. vini. Aq. calc. Alum, and prest out, I cicatrize these and all such like wounds.

If in a wound of the head by Incision the Pericra∣nium be bared,* 1.137 if there be no fissure, you are to keep the Air from it by bringing the lips of the wound close together, that the bone may Incarn: But in these wounds Fabr. ab Aq. Pend. says, and by the authority of Galen, that you ought to Exfo∣liate the bone; for says he, it is not likely so thin a membrane as the Pericranium, adhering to the bone, can be cut, and the bone not hurt; and if the Cranium be but a little hurt, there is a necessity of Exfoliation: In my Practice I have often met with wounds in the head, where the Pericranium hath been cut, and the bone only bare; sometimes also the bone is cut: But if I came into the first dres∣sing, it hath for the most part Incarned without any difficulty, and the better for the little cut made in∣to it. But where the bone hath been bared by a Contusion, the bone is commonly altered by the Air, or Gleet from the contused flesh, and doth for the most part require Exfoliation; yet in this case I have cured without Exfoliation, but with great difficulty.

If a Contusion be made by a blow or musquet-shot,* 1.138 when the force is spent, or when the head is armed, if there be no wound or symptom of fra∣cture, or the like, you are to shave the hair off, and Embrocate the part well, and apply over all a Cataplasm, è Farin. Hordei, Flor. Ros. Balaust. decocted in Oximell, adding some Ol. Ros. and let your Patient bloud, and if there be a wound joyned with it, and made by shot or blow, you are to di∣gest that wound as in contused or Gun-shot wounds: If there be not a way for discharge of Matter, you are to make one, that it be not shut

in, and cause inflammation in Pericranio, and Fe∣ver follow. After digestion and separation, you are to proceed to Exfoliation of the bone; for in such wounds the bone is Altered, both by Air and Matter. In order to Exfoliation you are to consi∣der, that if the bone were not hurt, it is smooth and slippery, as it were polished, and flesh diffi∣cultly grows upon it; wherefore by the Authority of Galen and your own reason, you are with Ru∣gines to make it rough and thin, that you may make way for the Callus to sweat out of it: In this case if you rasp it here and there thin, till you see the bloud ready to come out of it, the bone will there∣by be sooner supplied with materials for generation of flesh; but if your Patient will not admit of Ru∣gines, as in children it will not be allowed, then you are to keep your dossils with Sarcoticks close to the lips of the wound, and make your Exfoliati∣on from the edges, that the sound part may thrust off the rotten bone; for neither Crabs-eyes, nor any Medicine inwardly prescribed, or wine out∣wardly with Lint or other medicament applied to the middle of a bone, will signifie any thing to the Exfoliation; nay the while you are so trifling, the matter from the edges will rot the bone under∣neath, and in continuance pierce through the first table, and run underneath betwixt the two tables, and do much mischief, and put you upon the use of the Terebra, in the curing of your Patient. If therefore you propose Exfoliation, then according to the Ancients you are to use Rugines to scrape the bone, and after the use of them, the bone requires its proper medicaments, Sarcoticks most drying in potestate & actu, as ℞ Rad. Ireos, Aristoloch. Rot. Thur. an. prt. aeq. in moister bodies Thus alone; I

suppose that bones raspt require digestion, and therefore dress it with liniment Arcei, and such like spread upon Pledgits of Lint, and so common∣ly Incarn them, then proceed with Ʋng. Tutiae, &c. to cicatrize.

Hitherto we have written of wounds and contu∣sions of the hairy scalp and Pericranium,* 1.139 and of the Cranium laid bare, as also of concussion: now follow those wounds of the Cranium it self, whe∣ther by cutting or puncture, by sharp or pointed weapons, which cannot be without solution of Con∣tinuity of the hairy scalp, but by a musquet-bullet shot at a distance, by a fall or blow the skull may be fissured or fractured, and the hairy scalp whole, and this fracture or fissure under the Contusion, or in some other part: If the symptoms do demon∣strate that there is a fracture or fissure, you are then without delay to open the hairy scalp, accord∣ing as the part will admit, Angular, or in the manner of a Cross, or of the letter T, that the fracture may be discovered by the raising up of the hairy scalp with its Pericranium: For if you shall in doubtful fissures or fractures make a round Incisi∣on,* 1.140 and take out the whole piece, then if there chance to be no fissure, you have made your self a long work to little purpose; and if your fissure run farther than your Incision under the Calvaria, not discovered sufficiently, you are to cut it open that length, by which it will appear you have through mistake laid it open more than was necessa∣ry in one place, and too little in another, doing that which neither Hippocrates nor any of the Judi∣cious would ever allow: Whereas if you made it without cutting off a piece, but only raising the

scalp, you might, I say, if reasonably judged, have laid it open, so as you might have discovered the fissure or fracture; and if yet part of the fissure or fracture had lain undiscovered, you might have stretched your Incision to it; and in case after all, there had been no fracture or fissure which often happens, as in counter-fissure, then you might have laid the hairy scalp down again, and easily cured it, which by an excision of part of the scalp you have made, you cannot do.

Objection. As to what may be objected, that the raised up Lips may be troublesome to the Chirurgeon in his work, and are painful to the Patient; there is no such thing; for if the Incision be made the way pro∣posed by the Ancients, and that the fracture or fis∣sure be all in your view, you may order the lips of the wound as you please.

The Cranium laid bare, you are to fill up the place opened with dossills, pressed out of Red Wine or Oxycrate, or a Spunge prest out of either of the same liquors, and apply an Emplaster over all of Diacalcith. malaxt with Ol. Ros. cum Aceto, and bind it up.

The next day you are to consider the fissure,* 1.141 if it be so small, as you doubt whether it be one or not, then wet it with Ink, and wipe it off again, and where the fissure is, the Ink will discover; but if it do not, then this Emplaster is proposed; ℞ Cerae novae flavae, Thuris, Laudani, an. unc. ij. Farinae Fabar. Terebinth. Aceti an. ℥ j. Misce ad Ignem: you are to apply it on the suspected part, and the next day where it is found moist, that there you are to Rugine.

Fallopius tell us, that where the Cranium is con∣tused, certain spots will appear red, not unlike those white ones which are seen in the nails of the fingers; but after the third day the bloud exhales, and that redness ceaseth: If by the former you dis∣cover the fissure, or that the bone be contused, you are to Rugine the contused bone, and the whole length of the fissure; To which purpose and for that use to supply your self with various forms of Rugines: Whilest you are working with them, the lips of the wound are to be covered, that neither you hurt them, nor the Air offend them; sometimes these very small fissures, how inconside∣rable soever they may seem, are the cause of the Patients death, there being often found extravased bloud upon the Dura Mater, the Veins being broken either by the concussion from the blow, or by the rough edges of the inner table next the Membrane: Therefore you are to consider the symptoms, and accordingly lay open either by Ru∣gines or cutting into it, so as the Sanies may be discharged, and the Asperity taken away: But if there be a fracture of the Cranium in one or both tables with a depression of the bone and a fissure al∣so,* 1.142 which often happens, you are presently to make a way to relieve the Membranes underneath, for they cannot be without great disturbance and in∣flammation, and a putrifaction will follow, whence those symptoms of Fever, Delirium, Coma, Con∣vulsions, Palsies, and Death ensue, if neglected. In this case you are to consider, whether the fissure do discharge the serous bloud or Sanies, and whe∣ther by cutting that fissure open, the deprest and fractured bone may not be raised up; if it may, then you are to proceed by inlarging that fissure,

and there with your Levatory raise up the deprest bone, and remove the fragments, and cleanse the membrane from the Raspings or ought else hath soiled it: But if the fracture doth not penetrate so far into the bone, nor there be any such depression or fear that Sanies is detained underneath, then you ought not to perforate the bone, nor expose the membrane to the Air, or more than is necessa∣ry; in this your eye and symptoms will guide you.

In order to perforation of the Cranium,* 1.143 the bone is to be cleared of its Pericranium, least in setting on the Terebra (or Modiolus, which are two se∣veral names for a Trepan) you tear the membrane, then the lips of the wound to be covered, and the Terebra set on the breadth of a finger distant from the edge of the fissure, on the side which is most depending; if it may be with convenience, when you have set it on, press upon it with your left hand, and turn it round with your right, you must use a little Ol. Ros. or Milk, to cause it move the easier, and as it fouls brush it, in the doing of which it will cool, or you may dip it in water to cool; when you come to the second table, which you will know by the bloud that appears, it will be required that you take out the pin & proceed more warily, not listning to the pratling of the standers by, but often lifting up your hand, lest by your compres∣sion or haste you unawares fall upon the Dura Ma∣ter and wound it. All this while it is fit his ears were stopped, lest the noise disturb him, and the room close. The perforation made in Cranio, and the bones taken out, you are to smooth away the Aspe∣rity, which remains in the lower part of the main bone, and this is to be done by the Lenticular in∣strument made for that purpose.

If after this the membrane be fouled by the saw-dust, from the bone you are to wipe it off with a little Lint upon your Probe; the part cleansed, you are to dress the membrane:* 1.144 About this first Appli∣cation Authors differ, Avicen drest the Patient with Lenients, as Ol. Ros. Celsus he dressed the part with Siccantia, as with Aceto acerrimo, you may find him positively for it in these words, His factis, the perforation made, ea Membrana acri aceto, respergenda est, ut sive aliquid sanguinis ex ea profluit cohibeatur, sive intus concretus Cruor re∣manet discurtiatur; The Membrane is to be sprink∣led with sharp Vinegar, to prevent the flowing of bloud from the part, and that if there should remain any clotted bloud, it may be discust. But the most part of the Ancients and many of the Moderns do propose Lenients, as Ol. Ros. that the crude Sa∣nies descending upon the Dura Mater, in pus con∣vertatur, may be digested into Matter: In this you are to be guided by your eye: If there be Sanies or putrifaction, Mel. Ros. Spir. Vini, and higher detergents are to be used, as the putrifaction is more or less. If there be much bloud extravased, or that you fear bleeding, that of Celsus may be proper; but if the bloud exceed not in quantity as it seldom doth, and if it be recent, it possibly hap∣pened from some scratch of your Terebra or little asperity of the inner bone or Table, or if there be neither of these, but the membrane fresh, and of its natural colour, then you are not to grieve that membrane, new exposed to the Air with deter∣gents, nor by the Acrimony of the Vinegar; for if you shall by scratching of the membrane make it bloudy, and then dress it with either Acetum or Mel. Ros. & Spir. Vini, you shall then proceed

contrary to the common Indications in Chirurgery, which teacheth to digest recent wounds before you deterge: And indeed what would you deterge?

Therefore I do propose to you Lenients, not on∣ly by the Authority of those Ancients and Moderns, but by my own Practice. Galen proposed Sang. Columb. and the bloud of Turtles dropt warm from their wings, Fallop. and Fabric. Aq. Pend. pro∣pose, as I said, Ol. Ros. with Resin. Abietis, and afterward they increase the Resina and lessen the Oil; but if there be putrifaction through the long lying of concrete bloud, then Mel. Ros. & Spir. Vini are proper;* 1.145 yea Mel. Egyptiac. and higher as occasion shall offer; otherwise in common cases of recent Terebrations by the Emplastick quality from the Resina; the concoction is better made, and the part secured from inflammation, &c. It is to be proportioned to the habit of body; dry bodies re∣quire more of the Resina and less of the Oil, and by this simple Medicament, I never failed of good digestion, and afterwards by the tempering this, (as I have said) have deterged and incarned, con∣tinuing it until the membrane was well incarned, not finding the least prejudice the bare bone had received from it; but you must take care, you do not too much relax parts; therefore after digesti∣on, Mel. Ros. with the Resina instead of the Oil will be answerable to your intentions, both to de∣terge and incarn; or you may use this to both pur∣poses, its composition will commend it self, ℞ Terebinth. Venet. ℥ j. Ol. Ros. ʒ iiij. Mel. Ros. Colat. ʒ iij. Croci ℈ j. Granor. Kermes ʒ ss. Sem. Hyperici ℈ ij. Vini Hispanici ℥ iij. Coq. ad consumpt.

Vini Colat. add Aloes ʒ j. m. In the use of Medica∣ments, you are to consider the part and habit of bo∣dy, and add or diminish your simples accordingly, and so they will perform all intentions; if the wound be made by Gun-shot, then you are to dress the wounds as is said in simple Gun-shot wounds, and take out the Eschar, and afterwards deterge, as I have said, or with this, ℞ Terebinth. Opt. ℥ iij. Mel. Ros. ℥ ij. Succ. Plantag. & Apii an. ℥ ss. Coq. simul ad succor. consumption. add Farin. Hor∣dei ℥ j. Sarcocollae ʒ jss. afterwards add Aloes ℥ ss. Myrrhae ʒ iij. Thuris ʒ ij. and so it will incarn; and apply this Cataplasma, ℞ Farin. Hordei, Flor. Ros. Rubr. Fol. Beton. cum Ol. Myrtill. decoct it in Red-wine, and apply it over all. The Ancients used to the bone after digestion, Pul. Aristoloch. Rot. Rad. Iridis Pucedani, Myrrhae, as their Sar∣coticks to sprinkle on the bone, which are very good, but Pledgits of Lint dipt in Spir. Vini, and prest out hard, will at such a time serve your pur∣pose well; and an Empl. de Beton. over all, or de minio Mag. or the like; and where the flesh is luxuriant, touch it with either of the stones, or this Pulv. Balaust. Ros. Rubr. & Alumin. an. prt. aeq. Thus at Worcester,* 1.146 a day or two before the Bat∣tel, a Gentleman attended the Earl of Derby thi∣ther, with a large wound cut with a sword to the Dura Mater, he had no other dressings on but a Linnen cap, the membrane covered with the shivers of the bone, it had not been drest, and may be the better for him, for if dossils in haste had been prest in the wound, he would have laboured under some severe symptoms; but the shivers lay loose upon the membrane, and he felt not his danger. I took

these lightly out, cleansed the wound, and drest him up with lenients, the short time we were toge∣ther. Authors have set us a limited time to dress with this or that Medicament, as to the fourth day so, and from that to the seventh to deterge, and so the fourteenth day Sarcoticks, but herein you must make use of your own judgments, persisting to che∣rish the native heat of the part.

If the wounds penetrate to the Dura Mater, you must consider the sorce of the Weapon, and make haste to relieve the parts under the Cranium.* 1.147 But where they are made with Bullets or heavy blunt things, there they are often pasht into one another; there you are presently to lay open the hairy scalp, & raise it up from the Cranium, and relieve the opprest membrane; but if the flux of bloud should be so great as it will not permit, fill up the part with dossils dipt in Wine or Vinegar; accordingly open it again as soon as you may, and in the while dress it up as hath been already said. These bones are to be hastened out with as much speed as may be, and the part afterwards drest with Lenients, as hath been said: If the opening in the fractured Crani∣um be not sufficient, make one in the most decli∣ning part, and raise up the bones, and free the membranes of whatever may offend it, but do not take out more bones than needs must, like some of those Chirurgeons I have met carrying them about, boasting in that which was their shame; for these bones in recent fractures do unite as those in other parts, therefore having raised them up, dress them lightly with the Catagmatick powders, and they will happily agglutinate and make your cure more facil. In these wounds of the Dura Mater, the lenients of Ol. Ros. or warm Pigeons-bloud are

proper, they are Anodyne and digest; Ol. Hyper. and Mastich are also good mixt with Resina, for the curing these wounds, Fabric. Aq. Pend. cites Galen, and he Archigenes using the Succus Cala∣menthae dropt into the wound, and sprinkling Pul. Milii over for incarnating them, the Milium mo∣derating the heat of the other, he delivers them to us as siccantia, detergentia, & incarnantia. The unition and incarning of the Lips of the Dura Ma∣ter is performed by a fleshy substance that ariseth upon the membrane, which afterwards as it in∣creaseth, doth unite over it, and becomes one bo∣dy, and grows firm; mean-while the bones within Exfoliating thrust from the side a Callus, which uniting with the forementioned flesh becomes one body with it, & filling up the place that was perfora∣ted, is in time more firm than the bone itself was; but in the while, you must be careful that your Le∣nients make not the part too lax by their greasi∣ness, for so a Fungus will thrust out thence which may be vexatious to you; This in the beginning by desiccants, as Pul. Cort. Granat. Balaust. Ros. Rubr. Alum. ust. with a soft dossil and compressi∣on by Bandage, will be taken down, or if it grow very big by ligature it is taken off: But to tell you truly, I never met with any such like disturbance as is represented to us by Authors, nor shall you, if you use your desiccants timely: The Vitriol or Allom-stone insensibly takes this off, and disposes the part to cicatrize if daily used.

The Pia Mater is a most delicate fine membrane, and adheres so close to the brain, that it can scarce be wounded without a wound in the Brain; and these are most commonly mortal, for that it is full

of Veins, and subject to great effusion of bloud; the Brain wounded and exposed to the Air corrupts by reason of the external cold which soon extin∣guishes the little heat of this part. And by reason of the fluidity of the Brain, and contraction of the Meninges (or membranes) caused by the constant pain and irritation, the brain perpetually ouseth out upon you, till the whole wounded Lobe be spent. You must make way to these wounds by re∣moving the shattered flesh and extraneous bodies and bones: but if they will not come easie away, leave it to nature, lest he die under your hands, and you be thought to hasten his death. Your dressings must be with Galen's powder, with Hares Furre, with the white of an Egg to restrain the bleeding, and retain the brain within its bounds, and over them your dressings, as in the wounds of the Dura Mater, and over the wound digestives; remembring in all these Gun-shot wounds to cut off the shattered lips of the Calvariae,* 1.148 lest a Gleet drop from them upon the Meninges and brain, and heighten the inflammation: If the brain be retain∣ed within its membranes Pia & Dura Mater, and they digest and incarn, then you are to proceed in the rest of the cure as in fractures of the Cranium, as hath already been said.

In all hurts of the head what sort soever they be of, the Body is to be emptied, and the rather,* 1.149 if there be Plethora or Cacochymia; for in such ha∣bits of body humors are apt to stir up ill symptoms, especially if the wound be great; therefore you are the first day to open a Vein in the Neck or Arm on the same side, and bleed according to the exigency and strength of body; also cupping with scarifica∣tion of the Neck and Shoulders, with Fontanels

under the Ears is necessary: Then Lenient medica∣ments, such as may evacuate the serous bloud, which by reason of its tenuity and heat readily flies to the affected part. These are such as have been proposed in the Fourth Intention of Wounds in General, to which I refer you. In these cases cor∣dial Species and Electuaries, with Juleps and Emul∣sions may be proper, if they be proportion'd to their temperature, hotter or colder, as there are Fever or other Accidents joyned with the malady. Vulnerary drinks are sometimes in use here, if they be fitted according to the nature of the part, and the ingredients, for these are Beton. Artemis. Ca∣ryophilat. primula veris, Lillium convallium, Sal∣via: Hypericon. Sanicula, Veronica. Plantag. Flor. Ros. Rubr. Nux Moschat. &c. as in the Chapter forementioned: Of these you may make drinks with Wine and Water or small-Ale, as ℞. Sanic. Beton. Veronic. Artemis. an. ℥ j. Cons. Ros. Rubr. Caryophillat. an. ℥ ss. Torment. ʒ ij. Coquantur in Aq. Pur. & Vini Rhenani an. lb ij. Vase clauso in B. M. colentur per manicam Hippocratis; give ℥ iiij. of this morning and evening, or take ℥ j. of all these Plants well dried and cut, boil these as you do Thè, sweeten it with Mel. or Saccharum to the palate of your Patient, and give them a dish of it to drink twice or thrice a day, you may Aromatize it with Saunder. Cassia Lig. or Sassafras, &c.

In the External Applications to the part affected,* 1.150 you are in the first place to prevent flux of humors, which is performed by refrigerants & exsiccants, which also dries up what is already extravased in the part; to which purpose Hippocrates proposes Far. Hordei ℥ viij. Ol. Ros. ℥ iiij. Coct. in Acet. or

Oxycrat. and made into a Cataplasma; In Winter he added Flor. Ros. Rubr. Pulv. ℥ ij. and decocted it in Vino, others have since added Bac. Mirt. Ba∣laust. to corroborate the relaxt parts, then they Embrocated the head and about the Jugulars, with Albumin. Ovor. Acet. & Ol. Ros. &c. sometimes only with the latter, but without the Acet. the Ol. Ros. seems to me not to penetrate enough. The want of these Embrocations is sometimes the cause that tumors arise behind the Ears. To contused and great wounds speedy digestion is required, not only in the Calvaria, but Meninges of the brain, and these ought to be humectantia & emollientia; and herein, as I have elsewhere said, Terebinthina is the most proper medicament, and in these Ner∣vous parts you may use it washt or not; in dry bo∣dies they add Thus, in humid bodies and recent wounds Vitel. Ovor. & Ol. Ros. also Farin. Hord. Cribrat. others Terebinth. Venet. ℥ jss. Ol. Hyperic. ʒ vj. Thuris ʒ ij. Vitel. Ovi j m. or R. Resinae Abi∣et. ʒ vj. Vitel. Ovi; or R. Terebinth. Lot. in aq. Salviae ℥ j. Ol. Ros. ℥ jss. Gum Elemi cum olco super Ignem dissoluti & colat. ℥ ss. Vitel. ovi ʒ j. Croci ℈ j. m. and if there be much pain a Cataplasma ex Ra∣dic. Althae, Flor. Meliloti, Farinae Hord. Ol. Ros. Vitel. Ovor. and a little Crocus, but you must have a care by your slabby medicaments you cause not putrifaction; wherefore Matter thus made, which happens in three or four days, you are then to de∣terge by adding Mel. Ros. or Mel. Com. or this, R. Terebinth. ℥ ij. Mel. Ros. ℥ j. Pul. Myrrhae, Aloe, Mastich, an. ʒ ss. m. Discutients are now re∣quired outwardly by Cataplasmes, Cerots, and Emplasters, as Empl. Vigonis de Beton. Gum Elemi de Matrisilva, Cerat. Isidis, or R. Succi Beton.

℥ ij. Ol. Ros. ℥ iiij. Mastich, Myrtillor. an. ℥ j. Pin∣gued. Hirci ℥ jss. Coq. ad Succ. consumption. Colat. add Gum Elemi, Tacamahaca an. ʒ x. Terebinth. ℥ ijss. Cerae Alb. qs. Iterum Buliiant ad consistent. Cerat. or ℞ Gum Elemi ℥ iij. Opoponac. ℥ ij. Bdellii ℥ ss. Resinae pin. ℥ j. Cerae qs. Ft. Ceratum. In all wounds of the head Gum Elemi is much commend∣ed, it mitigates pain, and corrects the evil temper of the part, by a peculiar vertue it hath thereunto. Fab. ab Aq. Pend. commends this Empl. R. Beton. Virid. m. viij. Contund. Contus. addantur Ol. lb iiij. Cerae, Terebinth. an. lb j. coquantur, & expriman∣tur suc. add Beton. virid. Contus. m. viij. Iterum co∣quantur & exprimantur pro usu.

The use of Spir. Vin. is much commended in these wounds of the Meninges,* 1.151 as having such a siccant quality, as is requisite for them; but in recent wounds where there is fear of pain and inflamma∣tion, it is not to be admitted, but amongst deter∣sives is of great use and proper for the Bones: Vi∣go commends this, ℞ Spir. Vini ℥ vj. Myrrhae ℥ ss. Aloes ℥ j. Sarcocol. Thuris an. ʒ ij. or this Bal∣sam. ℞ Spir. Vini lb jss. Vin. Malvatici ℥ xvj. Myr∣rhae, Thuris an. ʒ x. Pul. Rad. Consolid. ℥ j. Pul. Centaur, Min. ℥ jss. Flor. Hyperici Pul. ℥ ss. Te∣reb. lb ss. set this in Balneo a month, then reserve it for your use, drop of it warm upon the Meninges, or mix it with your other medicaments for your use. If the Dura Mater have changed his colour, and do not deterge with what is proposed, then this is commended to you, ℞ Tereb. Lot. in Vin. Alb. ℥ iij. Mel. Ros. Spir. Vin. an. ℥ j. Myrrhae, Aloe, Sacchar. Alb. an ʒ ij. m. If there be yet such ill quality in these wounds that they tend to putri∣faction,

scarifie the Lips of the wound, and apply this or such like, ℞ Mithridatii ʒ vj. Theriac. ve∣net. ʒ ij. mel aegyptiac. ʒ j. pul. scord. myrrhae, an. ℈ j. sp. vin. qs. The putrefaction got off, and the Mem∣brane recovered in its colour, you may then dress with the above mentioned, or you may dress it with this of Johan. Andr. à cruce, ℞ ol. Terebinth. venet. mel Rosar. p. aeq. apply it warm, all these Me∣dicaments are to be applyed upon a Sindon to the Membranes. A Sindon is a piece of Silk, or fine Lin∣ing cut round proportionable to the perforation made in the Cranium, and is to be placed in under the edges of the Cranium by the Lenticular In∣strument, that the edges of the fractured or per∣forated Cranium hurt not the Dura mater: A Thread or Silk is to be fastned to it to pull it out at plea∣sure; over this you are lightly to place soft dossils of Lint dipt in some convenient Medicament, to fill up the void space in the Bone, this serves to cherish the native heat of the part, and to keep the dura mater from rising above the Bone, whereby your Patients life would be in great hazard: the Tin∣cture of Myrrhae forementioned is proper to dip the dossils in after digestion.

In wounds of the membranes of the Brain,* 1.152 and Brain it self, this is good, ℞ succ. Beton. ℥ iiij. succ. calamenth. ℥ ij. flor. Centaur. min. p. jss. hyperici, con∣tus. ʒ ij. vini odoriferi lb j. Infuse these three days, then boyl them to the consumption of the Juices, then strain it, and add to it Terebinth. clarae ℥ iij. Gum. Elemi ℥ j. dissol. in sp. vini ℥ ij. ol. Hyperi. ℥ jss. mel. Ros. ℥ iiij. boyl these a little, then add pul. myrrhae, Aloes, Sang. dracon. Thuris an. ʒ j. and re∣serve it for your use; oleum Aparici prescribed in

wounds in general is an excellent good Medica∣ment in recent wounds of the Meninges and Brain.

Fabr. ab Aq. pend. proposes this in wounds of the Brain,* 1.153 ℞ farinae milii ℥ ss. olei aparici ℥ j. Mi∣thridati ʒ vj. Bals. pervan. ex Aegypto ℥ iij. sp. vini ʒ v. and if more desiccant be required, he adds olei de chalcanto ʒ jss. drop this (saies he) warm and your digestives over the wound, and to Em∣brocate the head and parts about with ol. Ros. and lay this Emplaster over all, far. Hordei ℥ viij. pul. chamel. ℥ iiij. pul. spicae Scenanthi an. ʒ iij. pulv. Be∣ton. staechad. an. ʒ ij. ol. Mastich. lb ss. ol. Ros. ℥ iiij. oxy mel. simpl. ℥ v. vini albi medioc. potentis. qs, ft.

If the bones be carious and do not readily exfo∣liate, you are to Rugine them and dress them with ung. Arcei, and if they do not incarn by that, then ℞ sp. vini ℥ x. Myrrhae ℥ j. Aloes ℥ jss. rad. pucedan. Aristoloch, cort. Thuris, an. ℥ ss. pulveriz. & misceantur pro usu. It is to be used with Lint; In dry Bodies this ℞ pul. Aloe pumic. ust. pomphol. an. ʒ ij. Myrrhae. ʒ j. pul. ostre. combust. ℈ ij. this to be mixt with mel. Ros. & sp. vini. And this Em∣plaster over it, ℞ cerae, Resinae pini, amoniaci, Elemi, an. ʒ vj. Terebinth. ℥ iij. pulv. Myrrhae, mastick, Aristoloch. rot. Ireos, Aloes, opoponac. Euphorb. an. ʒ j. ol. Ros. q. s. ft. Emplastrum, after parts are in∣carned you may cicatrize with one of these or such like, ℞ plumbi usti cum sulphure & loti Litharg. aur. an. ℥ ij. Antimonii usti & loti cerussae, an. ℥ j. ol. Ros. q. s. ft. ung. or thus, ℞ pulv. Aristoloch. ust. flor. Ros. rub. Balaust. cupress. ustor. ostrearum. an. p. aeq. ft. pul. or thus, ℞ calcis testarum ovor. calcinat. ℥ ss. Alum. usti ʒ j. croci martis ℥ j. ft. pul. Thus I

have set you down variety of Medicaments, whereof you may fit your selves according to the exigency, and shall now shew you some of my work, wherein I used but a few.

Observations of the Wounds of the Head.

[Observ. 1] A Poor woman near Ludgate, coming out of Chamber one Night, * 1.154 pulling the door to her by the Key, it slipt out, and she tumbling down stairs, cut and raised up the Hairy Scalp; from the beginning of the Lambdoides downwards; I was sent for, and having caused the hair to be clipt and shaved away from about the wound, I cleansed it from the bloud, and brought the lips close together by three or four stitches, and held them so, then sprinkling them with some of my agglutinative pow∣ders, I applyed a pledget over the Suture, and Em∣brocated the parts about cum Alb. ovi, Aceto with ol. Rosar. and adding some of my agglutinative powders with the foresaid mixture, I applyed it over all and roul'd up her head. I gave her after∣wards ℥ iiij. Aq. Papaveris with Syrup. de miconio and a little Aq. Cinamom. hordeat. and left her to rest. The next morning I took off my Bandage and restrictive Emplaster, and Embrocated with ol. Ros. & Aceto. and applyed a Cataplasm of farin. Hordei & fabar, dedocted in Oxycrate, adding ol.

Ros. and took away a little bloud by the opening a Vein in her Arm, and prescribed her a Clyster of Milk and Sugar that afternoon: Thus, I continued the Cataplasma and renewed it morn, and night; but drest not the Sutures till the third day, and by that time the tumor diminished, and the wound in∣clined to agglutination. I Embrocated the parts about, and drest up the wound again as before, the next dressing I cut out the stitches, and drest up with my Agglutimative and Sarcotic, with my Empl. Beton. over all instead of the Cataplasma, and in a few days cured her of that wound by Agglu∣tination.

[Observ. 2] Some while after I had a young man my Patient, who by a such like Accident was so wounded on the right Sinciput, whom I cured the same manner as abovesaid. It hath often hapned abroad, that upon a fall from their horse, or blow by a Pole Axe or the like, the Patient hath been stunned and did vo∣mit, by which Symptomes I have suspected a Frac∣ture or Fissure, so have presently laid open the calvaria, very large by cross or the like Incision, and after the raising up the hairy Scalp, seeing all well, I have laid it presently down again, and by Agglutinatives, and sometimes by Suture with two or three Stitches at a distance to keep the lips of the wound close, have by agglutination cured it in few days, applying refrigerants and exsiccants with bleeding, Clysters, &c. and have happily gotten them off in a little while.

[Observ. 3] A Young fellow a servant to a Horse-courser, was cast off his Horse against some of the Bars in Smithfield,* 1.155 whereby the calvaria or hairy Scalp

was torn up from the Coronal Suture to the Tem∣poral Muscle on the left side, the Skull was bared between two and three Inches broad, he was led to the next Barber-Chirurgeons, who cut the piece off, and hang'd it up in his Shop; the next day the poor fellow was brought to me, I caused the hair to be shaved off from about the wound, and drest the Bone and Lips with Linim. Arcei warm, Embrocated parts about cum ol. Ros. & Chamamel. and applyed Empl•••• Rolo over the wound, and with compress and bandage rouled up his head. He had been Let bloud the day before without considera∣tion of the great quantity which he had lost from his wound. I continued the former dressing to the Lips of the wound and Bone, untill they were digested well, in which time the edges of the Bone Incarned round, the middle of the Bone I Rugined. whereby I disposed a callus to put forth. After di∣gestion I deterged with mund. Paracell. and after the callus grew up from the Bone, I drest the part with pledgets dipt in sp. vin. prest them out drie and applied them over the Bone. After detersion I drest the wound with one of my Sarcotics men∣tioned in the fourth Chapter of wounds in Gene∣ral, and afterwards by Epuloticks as ung. Tutie, &c. cicatrized the Lips of the wound even with the callus, as it rose from the Bone, and as the Bone shel'd off here and there in thin Seales I Cica∣trized the wound, and about that time to dispose it the better to do so, he was purged sometimes, Thus he was cured as a wound with loss of Sub∣stance, a troublesome and vexations work to the Patient and Chirurgeon, which might at first have been cured by agglutination or with a less Cicatrix and have enjoyed its natural treatment with the

hair, whereas now it remain'd Bald & very unseemly.

[Observ. 4] A Cook-maid, by the fall of a great Jack-weight from its full height without doors upon her head,* 1.156 was beaten down, and stunned for some while by the blow, she vomited and was carried in doors with great pain, there were three wounds to the Crani∣um, the flesh pasht, with a great tumor, the bone seemed to me to be deprest all under and to have a fissure, I presently made a Circular Incision, and raised up that part of the hairy Scalp in Order to Terebration, and fill'd up the wound, and the bone with dostils of dry Lint, shaving the hair from about the wound. I applyed pledgets spread with my digestive upon the Lips of the wound, Embrocated parts about with ol. Ros. & Aceto, & Empl. è Bolo over, then with compresses dipt in Oxicrate rouled up her head. Some hours after I caused her to be Let bloud about eight ounces, and that night gave her ʒ vj. syr. de meconio, in a draught of Aq. Papaver. with a little Aq. Cardid••a. The next day I took off dressings, and viewing well the bared bone, I found neither depression or fissure, I was deceived by the shape of her head, viz. double crowned, the tumor great, and the saggittal Su∣ture running underneath, I fomented the parts af∣fected with vin. Rubr. wherein was decocted flor. ros. rubr. Chamom. fol. Beton. scabiosae, sumit. Ab∣sinthii, Bacc. Myrtil. &c. drest the bone and Lips, the former with my Unguent è succis, and the latter with my digestive è Terebinth. dipt in ol. Hyperici warm, and having Embrocated her head well with ol. Ros. & chamom. I applyed a Cataplasma, sarir, hordei, pulv. balaust. & ros. rub. decocted in Oxycrate with ol. Ros. over all with convenient Bandage, this

method I continued till the wound was digested, and pain mitigated, and the tumor discussed, then I deterged the wound, and continued the former ung. to the Bone, as also to the Lips as a sure Sar∣cotick, and drest over all with one of Vigo's Ce∣rots instead of the Cataplasma; by this method the bone Incarned, she returning with Medicaments to be drest by some of her fellow servants at her Masters house a few miles off, sometimes coming to me, the Bone and Lips Incarned, I Cicatrized them as in the former Laceration of the Calvariae, I did not believe so great a blow could be without a Fracture and great Accidents, otherwise I should not so presently have raised off the hairy Scalp.

[Observ. 5] A Tradesman returning from visiting some of his friends in the Countrey, near Knights-bridge, * 1.157 fell off his horse to the ground bruised and wounded his Forehead and Face, was taken up as dead. After he was a little revived, they put him into a Coach and brought him to his house, they sent for me, I found him in his bed labouring under a Concussion, a Stupor upon his Spirits, not capable of giving any account of his ailment, his Face & Nose much bruis'd with a wound to the Bone upon the os ••ribrosormis, reaching from the upper part of his Nose, to the os frontis: I caused the bloud and gravel to be washt out of his wound, and with my Knife laid open the wound a little higher up the forehead, viewed the bone and see it without Fissure, I then brought the lips close together, and drest the wound with my agglutinative, with an Empl. è Bolo over it and his Face; I then caused the hair to be shaved from the forepart of the head, from the Coronal Suture down to his Ears forward, and Embrocated

the parts shaved with ol. Ros. cum Aceto, and ap∣plyed a Cataplasme of farinae Hordei with pulv. flor. Ros. rubr. Balaust. & Bacc. Myrtil. boyled in Ox∣ymell, and by Bandage retained dressings close, then I let him bloud, between Ten and Twelve ounces, a Neighbouring Physician visited him that night, and prescribed him what he thought necessa∣ry; he lay dozing all that night, groaning and troubled, and was not better in the morning; he spake not willingly to any of us, nor so as we could understand what he said, that day I took off dres∣sings, viewed and felt the parts about, the left eye was Inflamed, the lid swell'd, and the forehead bruised, I was not able to make out any thing, whereby I might take new Indications, I drest him up again as before, ordering a little breast milk to be dropt warm into his eye, and renewed the Embrocation and Cataplasme, that day he was Let bloud again, and a Clyster given him, and what else his Physician thought necessary, the next day he was not better, old Mr. Boune a Chirurgeon was consulted, we took off dressings and consider∣ed parts, opened the Lips of the wound again, and viewed the Bone, it was fair without the least Im∣pression, Mr. B. did conclude that the wound should be cured without farther enquiry therein, which ac∣cordingly was done in few daies after without ex∣foliation. Blistering of his Neck and Shoulders, and Cupping with Scarification was resolved by us, and accordingly performed with Fontinells behind his ears, Fomentations and Emplasters were ap∣plied as in Concussions; but the relief was small yet by these, purging, fomentation and Emplasters with otherlike applications, he after a moneth or six weeks was so well as a little to folow his occa∣sions

abroad, but was not well: his eye was cured, but after he had followed his affairs some while, of a suddain that eye-lid fell down, and recovered not its strength again, but in some moneths after he lost the sight of that eye, without any outward soreness, which I imputed to the obstruction from within, it being the effect of his Concussion: He was a live at the time of the Fire, and may be so still for ought I know; if ought was omitted it was further bleeding.

[Observ. 6] A Gentleman of about 30 years of Age, coming out of Hartfordshire in passing through To∣tenham,* 1.158 rode upon the Causey near an Inn. One emptying a Chamber-pot out at a window, just as he was passing by, his horse started, and rush'd violently between a Sign-post and a Tree which sup∣ported it. The poor Gentleman was beaten off his horse by that Tree, and lay stunned on the ground: The people sent Immediately for Mr. Torner, a Chirurgeon from London; Sir T. B. upon notice of his friends mishap sent me thither also, where I found the Gentleman lying stunned upon the ground, the people and Chirurgeon gazing upon him. I felt his Pulse much opprest, the right Brow bruised, I inquired whether they had Let him bloud, the Chirurgeon replyed he had opened a Vein in his Arm, but it would not bleed; I replyed we must make him bleed though it be by slitting his Veins. I turned his head on one side, proposing to open the Jugular Vein on the bruised side. I did so, and he bled freely; after I had taken about twelve Ounces of bloud, the bloud run down from his Arm, which was opened before; we bled him till he came to life. Then he raved, beat us from

him; we staid the bleeding by Emplaster and Bandage, and caused the people to carry him into the Inn, and put him into a Bed. All the while they carried him and were making him unready, he roared and was very un∣ruly, especially whilest they were pulling off his Stockings from his right Leg, which inquiring more particularly into, we found broken short in the middle of the Thigh-bone,* 1.159 close by a Bony wen of the bigness of a Tennis-ball; they put him into Bed, and we prepared dressings for setting and reducing the fracture, he opposed us mainly in the Setting and dressing it up, but some of the people holding him down in his Bed, we set and drest his Leg as is said in the Lecture of simple Fractures; but he was no sooner at liberty, than he endeavoured to loose the Bandage which we had put on for keeping the Fractured bones toge∣ther, and would not be quiet until he had done it. We contented our selves in what we had endeavoured, and from that time left his Leg to lye unset or drest, not so much as an Emplaster over it, and prepared the application for his head, shav∣ing the hair from that side of the Temporal Muscle, and Embrocated the part which seemed to us af∣fected, cum oleo & Aceto, and applyed a Cataplas∣ma of Bean-meal which was speediest to be had, and with aceto & mel. & oleo, and four whole Eggs, which he permitted patiently. That bound on, I left my Brother Chirurgeon to stay with him and re∣turned to London: The next day, Sir T. B. sent for Sir Ch. Scarborough, and carried us with him to To∣tenham where we found the Patient raving as by their report, he had done all night. We under∣stood not one word he spake, his pulse was now

intermitting, no Indication for bleeding, what was necessary for him to take the Physician then pre∣scribed, and concluded that there was no Indication to do more at present; his bruise was upon the Tem∣poral Muscle, a part not to be laid open, upon a bare surmise, nor shall I ever allow the laying it open though a Fissure were under it, but content my self, as Ambr. Par. did in such like cases, to o∣pen above it, and make discharge that way, where∣fore we renewed our Embrocations and Cataplas∣mes, and continued to dress his head daily as hath been said in Concussions: Then we left the Chirur∣geon to wait upon the Patient; Sir Ch. Scarborough was going a journey farther into the Countrey, I to London, but with promise to return daily to this Patient while he lived. I did so, and the next day finding the Patient raving as I left him, his pulse troubled and intermitting, I resolved to attempt a doubtfull remedy rather than suffer him so to lan∣guish, and that was bleeding him: his distemper proceeding from Inflammation of the Membrains of the Brain, the oppression was certainly there; to which purpose I let him bloud from the same Jugu∣lar about Ten ounces, and so proceeded every day or second day at least. The Patient bare it well, and seemed to be relieved, his pulse rising upon it, and he slumbring sometimes, and taking his nourish∣ment which before he did not; about the 17 day I coming to him near Totenham met his Chirurge∣on going to London, he told me that if he had met me at the Patients Lodging, we might have set his Leg, he being now more sensible of the Fracture. I perswaded him back, much rejoycing to hear that the Patient was so well; but when I came near his Chamber I heard him hollowing. It troubled

me what to do, I knew his bleeding had much re∣lieved him, but the People as also the Chirurgeon disliked my so often Letting him bloud, and did a∣busively say, Now you shall see this Chirurgeon Let him bloud again, and that I would be the death of the Gentleman; however I resolved to Let him bloud once more, and no more. This I de∣clared with the necessity of doing it, and accord∣ingly opened the same Vein again, and held a white stone Porringer to receive the bloud, which flow∣ed with a sprightly stream, the Patient lying as quietly the while upon his back, I put the Porrin∣ger into Mr. Turners hand, and seeing the bloud flow with much vigour, I catcht up hastily a pewter Porringer, proposing to take a little in that. In bleeding these Veins in the Neck, we usually hold∣ing the Poringer close to their Neck it serves us as a Bandage to intercept the descent of the bloud. I put this Porringer into my brother Chirurgeons hands, with pretence to make a dressing to lay upon the Vein, but stood at a little distance, looking my Patient in his Face, with a resolution to bleed him until I saw his Countenance change; which I did, and then stept to the Patient to stop the Vein: The while the Porringer was taking away, the bloud run out of the Porringer, it having been melted in the side, and the hole so covered by the Sawder as I did not see it before; in the while he was bleeding I thought him long in bleeding, and won∣dred to see so little quantity gathered from so full a Stream, and now seeing the bed so bloudy, it was evident that when the melted hole prest not against his Neck, the bloud ran into the bed which deceived me. But the Patient upon the taking a little of his Cordial Julip, refresht his Spirits, I

sat a while by him, and left him pretty hearty. The next day I returned sooner than I used to do, being doubtful how I should find him, but to my wonder, he was perfectly well in his Sences, and discoursed soberly of what passages he remembred in the time of his delirium.

We presently prepared now to set this fractured thigh bone, after it had lain 17 daies unset, it was without Inflammation Tumor or pain. The Callus I suppose was thrust out at the ends of the bones, and that had covered the Asperity of the fractured ends of them; as the large bleeding and disease had made revulsion and evacuation. We by an easie ex∣tension brought the ends of the bone together, and drest it up as I usually do in simple fractures, and in less than twenty daies the Callus was dryed, and his Leg so strong as to bear him again, and some weeks after he went abroad about his Affairs.

[Observ. 7] A Youth about Ten years of Age, was struck down by a blow upon the forehead,* 1.160 his Father fetcht me to him, I found him lying upon a bed deprived of his speech with a loss of the use of his legs: I took off the Emplaster which was upon his fore∣head, there was no wound, nor considerable swell∣ing, but searching with my fingers I felt a de∣pression of the bone, upon which having advertised the Parents of the danger of the child, and the way of my proceedings, I sent for the Chirurgeon at next dore, who had applyed the first Emplaster, I de∣siring to retain him for more constant attendance, shewed him the way of making dressings ready in order to dilatation: Then causing the hair to be shaved, I made an Incision so large as to set on the Terebra, if an occasion should be, for the raising up

the deprest bone. Upon the raising this Calvaria upwards toward the Coronal Suture, I espied a fissure running up from the fractured Bone beyond my first Incision; wherefore I followed the fissure laying it open the whole length near to the Coro∣nal Suture, out of which I see a serous bloud flow in a good quantity, by which I promised my self a suddain remission of these Symptomes which the child laboured under. The depression was a piece of bone as broad as a three pence sunk in below the first Table: I fill'd up the opening with dossils of dry Lint, and applyed over all my di∣gestive, è Terebinth. vitel. ovi upon pledgets with Empl. è Bolo, and made a Bandage to keep my dressings on, after I had Embrocated parts about with ol. Myrtill. & Ros. cum Aceto; The next day in the presence of Dr. Barwick and some Countrey Physicians with Mr. Arris Chirurgeon, I took off the dressings, and set the Terebra above the fractur∣ed bone for to avoid the great Scar which must have been, had I made it below the fracture, be∣sides that poriness of the bone below. Here in this wound, I also cut that Vein, which in the former discourse I gave you caution to avoid, which could not be here, the fracture being just under it, and in such cases even the Artery it self is not to be spared. The Terebra set on, the bone taken out, and the inner edges smoothed by the Lenticular Instrument I put in a Levator, and raised up the deprest bone even with the rest: That done I placed in a Syndon with a bit of Thread or Silk fastened to it, first dipt in ol. Ros. with a third part Resinae warmed, then with a round dossil dipt in a little Lin. Arcei, which fill'd up the opening, out of which the bone was Terebrated. Then I opened the fissure

with my Rugines, scraping away its edges that no sanies or matter might be detained there to hurt the bone. Then I drest up the bone with Linement Arcei warm, in that long wound which I made to give a breathing to the fissure, keeping it open by a single dossil giving way to the lips to fall in, and digested them with the same Linement: I de∣siring no more opening than was necessary for dis∣charge of matter from within the Cranium, tak∣ing care that the fractured bone should not be in∣tangled with lax flesh, lest it become carious. Over these dressings I applyed Empl. Diacalcith. malaxt with ol. Ros. cum Aceto, and with compress Ban∣dage concluded that second dressing; and from this time, all our threatning Symptomes vanished: Indeed the first opening and Letting bloud that same night recovered his Speech, and after this second dressing his Legs became well again, yet we kept him in the dark, and to a slender dyet allowing no flesh. What concerned Internals Dr. Barwick took care of, the other Physicians and Chirurgeons com∣ing no more; I continued the same method in my dressing until digestion, which was made in 4 or 5 days, then I added Mel. Ros. instead of the Oyl, and afterwards incarned by increasing the Resina and lessening the Mel. Ros. The flesh rising in little grains presently after the digestion was compleat∣ed, after a few days did more cover up the Dura Mater; Then I hastened the exfoliation of bones, deterging the wounded lips with Mund. Paracels. from this time the work being rather to keep down the lax flesh, than to seek how to make it grow; to which purpose I drest the Cranium with pledgets dipt in sp. vini, and the Lips of the wound with ung. Tutiae, sometimes touching them with my

Vitr. and Allom-stone, which were of great use, and do hasten the cicatrize with much safety: In less than six weeks the bones were Exfoliated, and the wound ready to cicatrize, at which time I left it to the neighbouring-Chirurgeon; the Patient was cured, and is now a man.

[Observ. 8] A person wounded near the Vertex by a blow, sent for a Chirurgeon,* 1.161 who drest his wound, the Patient going daily abroad kept ill hours, without any Consideration had of his wound, whether it was drest or not. After seventeen days towards the full moon, coming from abroad home one morn∣ing, he felt his legs faulter, and before he was got up stairs into his chamber his tongue failed him, his friends and servants put him into a bed and sent for me. They declared to me how he was wounded so many days since, and how he was seized with a Paralisis of his legs and tongue. I saw a necessity of laying open the hairy scalp, for the setting on a Terebra, I offered to go away that I might send for some of my servants to help me: He apprehending that I was leaving him as deplorable, catcht hold of me, would have spoke but could not: he made signs for pen, ink and paper, he endeavoured to write but could not form one letter, he threw him∣self down in his bed, breathing out Jes. I pray'd his patience, telling him I would return suddenly: but before I went I let him bloud ten ounces, then hastened away, and returned again within an hour, and found that he had lost the use of his Arms. I considered the wound, and concluding a necessity of setting on a Terebra, and thereto having caused his head to be shaved, I made a circular Incision

about the wound, and rais'd up the Calvaria with my Spatula, bringing the Pericranium smooth off. I both saw and felt the bone, but could discover no fault in it, with Spunges dipt in Aceto I dried up the bloud, and raised up with my Spatula the edges round from the bone, and with a fresh Spunge dri∣ed up the bloud, and lookt again under them, but could discover nothing ill in the bared Cranium. I fill'd up the wound with dossils of dry Lint with my digestive over the lips, and Embrocated the parts about with Ol. Ros. and an Emplaster over the wound, and a Cataplasme è Farin. Hordei, Flor. Ros. Rubr. Balaust. in Vino Rubro, with Sy∣rup. de Ros. Sic. & Ol. Chamomell. and bound it up. That day Sir Fr. Pr. gave him a Visit, and pre∣scribed him a Clyster, with Cordials, Juleps, and what else he thought necessary. The next day was full Moon, at which time the brain is thought to rise high, and the Vessels turgid; wherefore I de∣ferred the setting on the Terebra, contenting my self with the letting him bloud again. All this while he was in a Fever, and deprived of speech and limbs; the next morning about ten or eleven of the clock in the presence of Sir Fr. Pr. Serj. Pyle, Mr. Arris and Mr. R. who thought himself con∣cerned for his servant who had first drest him, I took off dressings and lookt into the wound: we found no fissure, however there was a necessity of the Terebra. Wherefore without delay I pro∣ceeded, and in order to it covered the lips of the wound with a fine Lawn dipt in Oil of Roses, & be∣gan to work with that Instrument commonly called a Trepan, w^ch I much prefer, it being an Instrument that suffers you to turn lightly, and cut equally or how you please, without shaking or pressing so

hard on the head: In the performing this or any operation amongst our brethren the standers-by are very apt to be teaching, one cries not so fast, the other thinks you move too slow, but of these I took no notice but proceeded, and brought out the bone, taking out the pin, when I came to the first table. You shall perceive your self to be entring it, when you see the raspings change, or begin to be blou∣dish, from that time proceed very gently, and take out the head of the Trepan often, and cleanse it by a brush: The Bone out, I lookt into the part, and see the Dura Mater of its natural colour with∣out Matter or Bloud, I drest it up with a Sindon dipt in Ol. Ros. with a little Resina dissolved and warm; this way of dressing was objected against by Mr. R. as I expected. I smil'd and drest it up with it, and assured the Person that I would cure this Patient without applying any other remedy to the Dura Mater than these two simple medicaments: But withal was much unsatisfied in my self, that such grievous symptoms as loss of speech and limbs with a Fever should afflict the Pa∣tient, and yet no deprest bone or fissure, nor ought of Matter or Sanies appear upon the Dura Matter; this troubled me much, fearing some other place, or that the bloud lay putrified under the Dura Ma∣ter. But I drest up with a soft round dossil dipt in the same medicament, and placed it in next the Sindon lightly, and drest the bone with linement Arcei, and continued the digestion to the lips of the wound, and my Empl. de Beton. Mag. over all, I placed him down in his bed. Going presently out of this close room, where I was crouded up with great lights burning near me, into the fresh Air, I burst out with a violent coughing of bloud, but the

next day drest the Patient again, and found his speech and limbs restored, but he was hot, and his pulse quick: I opened his wound and found all well, as I could expect: I drest him up again as before with the same, and after I had bound him up, as is usual in these cases, I let him bloud ten ounces, and gave order to repeat his Clysters, &c. From the first opening there came no more any of the Chi∣rurgeons; I retained the Chirurgeon that had first drest him in his little wound, he dwelling near the Patient. After three or four days dressings these wounds digested, and all symptoms went off well: I then lessened the quantity of the Ol. Ros. and in∣creased the Resina, and made good my word in cu∣ring him with these simple medicaments. I de∣terg'd and incarned as firm and speedily by this, as any Sarcotick I ever used, and as the bones cast off proceeded to cicatrize, as in the former Patient, dressing the lips of the wound with my Basil. Vi∣gon. adding a little Merc. Precipit. to it; coming one day after the Exfoliation of the bone my Pati∣ent was abroad, so from that time I left him to his neighbour-Chirurgeon to dress, but see him twice or thrice after at times, and drest him then again; he was well cured, and remained well, and is yet so.

[Observ. 9] I was call'd to consult with Dr. T. C. one of the Kings Physicians, * 1.162 in a Gentlewoman who labour∣ed under a great pain between the Coronal and Sa∣gittal suture, from a blow she had many months before received riding under a Penthouse. The blow stunded her, she was brought to London, was viewed by some Chirurgeons of the City, who cured her wound, it being small, but from that

time her pain was excessive, and now we were to consider what to do: Her pain seemed to arise from that blow, and we suppose the extravased and pu∣trified bloud caused this pain, with a Vertigo; we considered the pained part, as she toucht it with her fingers (the scalp was swelled thick) and pro∣posed the laying open that part, which we thought necessary, but she would not consent to it: Other things were then proposed as Fomentations and Cataplasmes discutient, blistering, cupping, bleed∣ing, purging, and such like, all which she submit∣ted to, but without success. She then at last yielded to the making a Fontanel in this part affected by a Caustick, which I did, and by Dr. C. consent I made it to the bone, and so large as that I might afterward set on a Terebra; upon the cutting out the Escar there was neither fracture nor fissure; we rubb'd the part with Ink, and rubb'd it out again, no mark remained; I Rugined the bone, but all was smooth, I put some Pul. Aloes, Myrrhae, and Mastich upon the bone, and drest the Escar with Basilicon. Simpl. cum Ol. Terebinth. to hasten digestion and separation of the Escar, and in few days it separated, but her pain still increased, with other indispositions which threatned her life, if something more were not done. Much unwillingly she heard of the opening this bone, but at last it was referred to old Mr. Arris, he is call'd in and ap∣proves of it, the thing is resolved upon, we met, I opened it with a Terebra, and find the Dura Mater of its natural colour, but a scent from with∣in, as in corrupt wounds of the brain; I drest it up with Lenients as the former, viz. Ol. Ros. and a little Resina: Her pains still increased, she kept her bed, her pulse was all a-long weak and troubled;

I drest her again: Next day I find her wound digest which I wondered at, considering what ill symp∣toms she laboured under.

The third day I drest her again, and in the open∣ing I find good digestion a beginning to incarn, a little red flesh sprouting up out of the Dura Mater.

The next day it was increased, and so the next: but then when I opened the next dressing after, I find the Calvaria sunk, the lips flat and little Mat∣ter, but it was of good colour, the Dura Mater did seem no better, the little ruddy flesh was not increased, began to change the colour and look palish, I then left off the Ol. Ros. and added Mel. Ros. to the Resina, with a little Pulv. Myrrhae, and a little Ol. Terebinth. and drest the lips with my Basilicon. Mag. Vig. with precipitate and Ol. Terebinth. warm, laying over the bared Cranium lint dipt in a tincture of Myrrhae, Aloes, Rad. Aristoloch. Rot. Ireos, mixt with a little Extract. Scordii & Empl. Melilot. with a good compress out of a Lixivium, wherein was boiled some of the greater Cephalicks, as Flor. Anth. Beton. Mago∣ranae, Origani, &c. But that night she was seized with Convulsions and a Sopor, and the day after the lips of the wound were without heat, & the flesh upon the Dura Mater altered, and no hopes left. She dying within a day or two after, we would fain have opened her head, but she had forbid it in her life: I turned her head downward the next day, there did run from her nose a purilent Matter of a brown colour, with the same scent that was when I opened her skull: I do believe this putrifaction was from the corrupt bloud extravased between the Pia and Dura Mater, and at first by large bleeding and proper applications might have been relieved,

and if here we had timely opened the Dura Mater, this Matter would have there discharged itself; But this tender sex does not admit of that part of Chi∣rurgery which consists in opening the skull or cut∣ting their flesh, unless it be too late.

[Observ. 10] A little Girle was brought to me with a swelling upon the left Sinciput, * 1.163 the breadth of about two fingers off the Temporal Muscle, about the bigness and shape of half a great French Walnut, and be∣hind the Ear a little swelling: This greater swel∣ling hapned from a fall down a pair of Stairs some weeks before, but whether through ignorance or negligence the fracture was not suspected by them, though there was visible symptoms of a fracture or fissure, as vomiting oft, and great indispositions, with pains, &c. The Child even languisht with it: I acquainted the Mother with the deplorable condi∣tion of her Child, and that the only way to relieve her was by opening that tumor wide, and after∣ward I believed there must be as much done to the Skull, that I feared through the not timely doing this, her child would now die. She prayed my help, and submitted to what I should propose; this tu∣mor was soft, and without doubt replete with a Sanies, and the bones underneath fractured or fis∣sured: The way had been in a stronger body to have cut this tumor round, and raised it off from the Skull, and so have made present way to the bone; but the Child was so weak, as I feared it might die under my hands, or if it did live, yet if after such a bloudy work, if the Child should not be cured, the Mother would never forget my cru∣elty, (as she would call it) Wherefore in such cases I use to work in a more calm manner with that sex,

and do that by an Emplaster, which in others we do with a Knife: To which purpose I applied my Ung. Catheraet. and with an Emplaster over it, the Mo∣ther bound up her Childs head, and carried it home: And about two hours after I call'd to see the Child, and found it had been very easie, these parts being of an obtuse sense, and the less sensible for that the skin was distended by the Matter; I took off the Empl. and found it had workt well, I open∣ed it, and discharged about three or four spoonful of a filthy Sanies; I took off this Caustick the sooner here, suspecting lest it should by longer ly∣ing penetrate through, and by its salts offend the parts within: Upon dividing this Escar the bone was seen bare, and by a Probe I felt it to the whole length; upon which I cut it open, and afterward a-thwart over, and then by turning the Escar aside, I see a long fissure the whole length of the Tumor, running transverse over from the Temporal Muscle backward, the Skull very thin, yielding to the least pressure of my finger, as a piece of Vellum, so as I might have inlarged it with my Knife if I had thought it necessary. I laid the Childs head upon one side and dropt in a little Mel. Ros. with a little of my Tincture of Myrrhe, Aloes, &c. as prescri∣bed in this Treatise, and with Pledgits dipt in the same, lightly covered up the same bone, and with Pledgits dipt in Basilicon. with a little Ol. Lilior. and a little Ol. Terebinth. drest up the Escar, and laid a Cephalick Emplaster over all, and bound up her head, and thus drest her daily, sprinkling my Cephalick powder upon the bone for the space of many days. I see pieces of the Dura Mater purge out, and hang in the fissure, and for some while a thin Ichor came out of the fissure; the Escar sepa∣rated,

I drest the lips with Mund. Paracels. and the bone with my linement Arcei, dropping into the fissure the Balsam prescribed for these wounds by Vigo, pag. 105. Thus I proceeded, and happily cured this Child: The Tumor behind the Ear and part about I Embrocated with Ol. Ros. warm daily, by which that Tumor went off, it arising from this of the fissure; but about a year after this Child grew lame of her left Leg, and was strumeous: How I proceeded in this you may read in the Treatise of that disease, she being the product of a diseased Mother.

[Observ. 11] A Gentlewoman falls with her little Daughter, a Child of half a year old in her Arms,* 1.164 the Mother is hurt, and the Child a little scratcht on the left side of her head; it's viewed by a pretender to skill in such things, and slighted as inconsiderable; but from that time the Child grew indisposed and vo∣mited often, especially after the receiving its suste∣nance, & as it grew able to speak complained of a pain in her head, and through her often vomiting she languisht: After Ten years a small Tumor ap∣peared in that part of the head where it had been hurt by the fall so many years before: They now again consult and bring the Child to me, a very starveling; I viewed the tumor and felt in it a pul∣sation, which at first I thought an Aneurisma, but pressing my finger more into it, I felt the brain without any skull, the breadth of an old English shilling: This at first a little amused me, but upon consideration of the fall and symptoms succeeding, it was evident to me, that by the fall the skull was fissured; and being of a thin Cartilaginous sub∣stance at that time of her infancy, had been by length

of time mouldred away, and from that Erosion the Dura Mater inflamed, and thrust out from with∣in; and by adhesion to the Pericranium had become one body; It is usual for parts inflamed to adhere to the next adjacent part: This I supposed the case: The presage here was a sudden death if the cure was not attempted, and in the attempting it she was in great danger: To begin this by a Circu∣lar Incision from the compass of the skull, was not difficult; but then to separate these two mem∣branes, the Dura Mater from the Pericranium, or this from that (they being become one body) was a difficult work even in a dead body, here in a weak Child much more, where the bloud would be apt to blind me, and the impatiency of the Child would make it hazardous; this work requiring a steadi∣ness: Then I consider'd of a Caustick, and having predicted the danger either in leaving it to die by its malady after a few weeks, which was certain, or in attempting the cure doubtfully; I referred it to them: They had consulted before, and were not ignorant of the danger the Child was in by its dis∣ease; Therefore they readily put the care of ma∣naging this great work to me, and lodged it near me, in Suffolk-buildings: I presently caused the hair to be shaved off from about the grieved part, applied the most gentle Caustick I could propose; and at such time as I thought it might have made its way in the Superficies of the Calvaria, I took it off, and with a Caustick-stone rubb'd into the Musculous part of it; then I washt out the salts well with Wine first, then Milk, after that with warm Oil, then with a Knife I cut into the Eschar, and Embrocated the part warm, and drest it up with Ʋng. Basilic. with Ol. Ros. and applied my Empla∣ster

over all, and roul'd up the part with good Compress and Bandage: that night she was seized with a fit of Convulsions, Vomited, and was very ill; Dr. Fisher was sent for, he prescribed her a Cordial-Julep, proper in that her case, and relie∣ved her: The next morning I took off dressings to look upon the part, and raised up the hairy scalp round from the skull through my Eschar, which gave the wound a breathing, and discharged a little Ichor; from this time her vomiting ceased, she had no more Convulsive fits, she began to be more lively than in Ten years before: We kept her in bed warm and close, with a slender diet, allowing her only Spoon-meats: Her Physician took care in what concerned her health by Internals: I proceed∣ed to hasten digestion, and by Fomentation and the like to cherish the native heat of the part, and as the Calvaria separated, so I endeavoured digestion sometime, otherwhile detersion interchangably; as the one medicine corrupted, so the other deterg'd: It was a nice work to separate the Pericranium from the Dura Mater, but I happily effected it, while the latter slough was separating, the Callus rising up in the mean time: The Patient being free of all the former ill symptoms, and brisk, and in a sure way of recovery. I invited Sir Charles Scarborough and Dr. Walter Needham, who did me the honour to see her. It was a rare case, not mentioned by any Author, nor scarce to be seen again: Since that time the bone Exfoliated, the Dura Mater incar∣ned, and the wound cicatrized and contracted to a very narrow compass. The Child returned to her friends perfectly in health, is a witty Girle, but it's doubted she will be but a dwarf.

An Additional discourse of Wounds of the Brain.

THE greater symptoms that are usually said to attend the Wounds of the Brain,* 1.165 do shew themselves more uncertainly than a speculative Chi∣rurgeon would imagine. And in Cuts or Wounds made by sharp weapons, or sudden strong force more uncertainly than in Contusions, Concussions, & Depressions of the Skull. The highest of them, viz. Vomiting, Stupor, loss of speech, with a Paralysis of Legs and Arms arising more suddenly in these latter cases, than in the former. These symptoms have appeared in one of the forementioned Observations, where there was nothing of fissure or extravased bloud seen upon the Dura Mater, after the Tere∣bration or Perforation of the Cranium. Nay, we see many die suddenly from a box of the Ear, and from small blows or wounds: In some upon open∣ing the Cranium there is much bloud extravased, in others none at all, or ought else that may be thought to have kill'd the Patient.

A Young man from a blow with a Cudgil upon the forehead, presently takes his bed, becomes de∣lirous, a Sopor follows, and after some days he dieth. I am sent for to see his head opened; in laying open the forehead, I see a small hair-like fissure, running from the great Canthus of the eye upward: we took off the skull and Dura Mater, and found but little bloud extravased, the Pia Mater as little

altered. Others I have been call'd to see opened, where there had preceded only a contusion of the Calvaria, without fissure or extravased bloud, more than is usually seen in every opening, or ta∣king off the Cranium: yet the Patient lay, as I am informed, under all those symptoms of Delirium, Coma, &c.

Then again I have drest many that have been cut through the skull, the shivers of bones and pasht flesh, and hair lying upon the Dura Mater, yet the Patient without any symptom of such a wound; some whereof you have read of in this preceding Discourse,* 1.166 some other I shall instance. At Ster∣ling Mr. John Chace was present, when a poor Servant-maid came to me to be drest of a wound she had received on her head by a Musquet-shot, in the taking of Calander-house by the enemy; there was a fracture with a depression of the Skull: I set on a Trepan for the elevation of the deprest bone, and for discharge of the Sanies: She had laboured un∣der this fracture at least a week before she came to me; yet had none of those symptoms afore-menti∣oned, but after perforation, and raising up this de∣prest bone, and dressing the wound, she went her way, and came daily thither to be drest, as if it were only a simple Gun-shot wound of the hairy scalp: Mr. Penycuke an eminent Chirurgeon of that Nation did assist me in this work; I think the Brain itself was wounded: I left it in his hands, who I suppose finished the cure.

At the beating up of some of our out-guards near Truro, the enemy pursuing them, a Trooper wounded between the Right Brow and Ear, on the Sinciput; espying me amongst the flying croud, importuned me earnestly to dress him; he would

admit of no excuse, we stopt at an Apothecaries house on the right hand, going out of the Town towards Pe∣rin. I call'd to the Apothecaries servant to bring some∣what to dress him,* 1.167 in the while hastily I lifted up the bloudy hair, and see a quantity of the Brain lye a∣mong it, I took it up with my fingers, and shewed it him, the sight whereof calmed his passion, whereby I had liberty to fly from the Enemy who was entred the Town. Here the Prognostick was certain, yet none of those cruel Symptoms which accompany Concus∣sions or lesser fissures.

From Battails and Sieges of Towns and Garisons, we meet with many such wounds;* 1.168 in them we hasten our way to the Extraction of the Extraneous bodies, by cutting off the shat∣tered calvaria first, then pulling out what ever was carried within the Cranium; if this be well perform∣ed, we then dress up the Brain and Membranes with a Sindon of Silk or soft linnen, of a bigness pro∣portionable to the wound; this is dipt in a warm di∣gestive, such as is proper for the wounded Mem∣branes, for however Chirurgeons have proposed to dress the Brain with one kind of Medicaments, and the Membranes with another, that is not possible to be so done, but that the Membranes or Meninges will be washt with the same Medicaments, and if they be offended by that Acrimony, Inflammation, Fever, Delirium and death will the speedier follow: In the Cure of these wounds of the Brain, I do consider the Brain as an Insensible body, and that their cure con∣sists in keeping it within its Membranes, and dressing them as wounds of the Membranes with Le∣nients, &c. if this can be done, as in small wounds of the Brain it doth sometimes happen, (and the better if the fracture of the Skull hath not been very large,) then the Patient may recover.

But if the fracture in the Skull be large, and the wound in the Brain proportionable, that the Brain cannot be contained within, then it corrupts by the external cold, and gets between the Meninges, and offends them by its putrid Acrimony, whence Con∣vulsions, Palsies, and other ill accidents follow, and death. They sometimes live until that Lobe be consumed, or hath wrought it self forth; as for In∣stance,

At the Siege of Mellcome Regis, a foot-souldier of Lieut.* 1.169 Coll. Ballards by the grazing of a Canon∣shot, had the fore-part of his head carried off, and the Skull fractured into many pieces, driving some of it with the hairy Scalp into the Brain: The man fell down as dead, but after a while moved, and an hour or two after his fellow Souldiers seeing him endeavour to rise, fetcht me to him. I pull'd out the pieces of bones, and lacerated flesh from amongst the brain, in which they were intangled, and drest him up with soft folded linnen dipt in a Ce∣phalick Balsam, with Empl. and Bandage bound him up, supposing I should never dress him any more. Yet he lived 17. days; and the 15. day walkt from that great corner Fort over against Portland to the Bridg, which separates Waymouth from Mell∣come Regis, only led by the hand of some one of his fellow Souldiers; the second day after he fell into a Spasmus and dyed,* 1.170 howling like a dog, as most of those do who have been so wounded.

About the same time a maid servant was shot into the right side of the Sinciput by a Musket bullet deep into the Brain, she lived as long, viz. until the Lobe of the Brain was wrought out or corrupted.

At the Seige of Taunton one of Coll. John Arundell's men in Storming the Work was shot in the face by Case∣shot,

he fell down as dead, and in their retreat was carried off amongst the dead, and laid into an empty house by the way until the next day, when in the Morn∣ing early the Coll. marching by that house, heard a knocking within against the door, some of the Officers desiring to know who it was, lookt in, and saw this man standing by the door without Eye, Face, Nose or Mouth: The Coll sent to me, (my quarters being nearest) to dress the man, I went, but was somewhat troubled where to begin; The door consisted of two hatches, the uppermost was open, and the man stood leaning upon the other part of the door which was shut, his Face with the Eyes, Nose, Mouth, and forepart of the Jaws, with the Chin was shot away, and the remaining parts of them driven in: one part of the Jaw hung down by his Throat, and the other part pasht into his Throat; I see the Brain working out from under the lacerated Scalp from both brows, I could not see any advantage he could have by dressing, to have cut away the lacerated parts here, had been to expose the Brain to the Air; But I helpt him to clear his throat, where was remain∣ing the root of his tongue: he seemed to approve of my Endeavours, and implored my Art by the signs he made with his hands. I askt him if he would drink, and proposed a sign by the holding up a finger, which he presently held up and immediately both his hands ex∣pressing his thirst, a Soldier fetcht some milk, & brought a little wooden dish to pour some of it down his throat, but part of it run down on both sides; he made signs to have the dish in both his hands, they gave it him full of milk, he held the root of his tongue down with the one hand, and with the other poured it down his throat, (carrying his head backward) better than I had done, and so pour∣ed down more than a quart; After that I bound his wounds up, the dead were removed from thence to their graves, and fresh straw fetcht for him to lie upon, with an old Blanket to cover him, it was in the Sum∣mer; there we left that deplorable Creature to lodge, and while we continued there which was about 6 or 7 dayes, all that while he was drest by some of the Chi∣rurgeons

with a fomentation made with our Vulnerary decoctions, with a little Brandy-wine in it, then with Stu∣pes dipt in our common Suppurative we bound him up.

I could tell you of many wounded into the Brain, but do think these may serve to prove what I would declare of them, viz. that the Brain is of it self insensible, that those Symptomes which accompany these wounds proceed from the pain which the Meninges, Dura and Pia Mater suffer: which if oppressed by extravasated bloud, or a depression of the Skull, do quickly suffer the greatest Symptomes, as Vomiting, Stupor, Paralysis, &c. much more if they be pricked by any spill of a Bone, or other Extraneous sharp body. When the Brain it self ouzeth out between them in the manner already mentio∣ned, it is a mild soft substance and lenient to them, so that the accidents appear not till that begins to corrupt be∣tween them, and with it the Membranes themselves pu∣trifie, upon which their follows Convulsions, Howlings, and a suddain dispatch of the Patient. From which very Observation, may be seen the folly of dressing these wounds with powerful desiccatives, which so far as I could observe, did hurt the Membranes, but never either digest or Incarn the Brain. According to Hip. non Coalescet, but as it gets liberty, works it self forth like unto Barme, and as I have said corrupts, and the Meninges suffering from that putrefaction, Spasmus follows, and the Pati∣tient dies; At Sea these Patients wounded in the Brain died presently, we having no conveniency of lodging them, or dressing them so warm as they require. In the wars my Imployment did not permit me to see the finishing of their Cures, and here in my Practice in and about the City, I never was called unto any such wounds, therefore must leave that to others to treat off: But by what I have seen from them heretofore, their Cure consists in dressing them, as in wounds of the Dura Mater, and in keeping the Brain within its membranes, without which no Incarnation can be made on the Membranes.

Notes

• * 1.1

  A Wound defined.
• * 1.2

  Differen∣ces of Wounds.
• * 1.3

  Signs and progno∣sticks.
• * 1.4

  Symp∣toms.
• * 1.5

  Intentions of Cure.
• * 1.6

  What is required in Com∣pound and Contused Wounds.
• * 1.7

  The First Intention in taking out Extra∣neous Bo∣dies.
• * 1.8

  Which way the Weapon is to be drawn out.
• * 1.9

  Weapon stuck in a Bone.
• * 1.10

  Weapon stuck be∣tween the Joynts.
• * 1.11

  The Se∣cond In∣tention.
• * 1.12

  Unition is to be made.
• * 1.13

  Observa∣tion con∣cerning Dossils in Simple Wounds.
• * 1.14

  First Gent∣ly.
• * 1.15

  Secondly, Equally.
• * 1.16

  The Third Intention retaining the parts United.
• * 1.17

  Bandage.
• * 1.18

  Their Use.
• * 1.19

  Three sorts of Especi∣al Use.
• * 1.20

  1. Incar∣native.
• * 1.21

  2 Reten∣tive.
• * 1.22

  3 Expul∣sive.
• * 1.23

  How hard to bind.
• * 1.24

  4 Other Bandages added by Fallopius.
• * 1.25

  Of what Roulers are to be made.
• * 1.26

  Their Leng h.
• * 1.27

  Their Breadth.
• * 1.28

  How to be fastned.
• * 1.29

  Sutures 3 Sorts.
• * 1.30

  Incarna∣tive.
• * 1.31

  Restrin∣gent or Glovers Stitch.
• * 1.32

  Conserver.
• * 1.33

  The di∣stance of Stitches.
• * 1.34

  Time of taking out these Stitches.
• * 1.35

  Caution.
• * 1.36

  Dry Stitches.
• * 1.37

  Fourth In∣tention.
• * 1.38

  Fourth In∣tention preserving natural Tempera∣ment.
• * 1.39

  Nature the agglutina∣tor of wounds. Healing.
• * 1.40

  1 per Sym∣physin.
• * 1.41

  2 per Sys∣sarcosin.
• * 1.42

  Regiment, 1 Univer∣sal.
• * 1.43

  Considera∣tion from their man∣ner of living.
• * 1.44

  E. B. cured by allow∣ing Wine.
• * 1.45

  Of Vulne∣rary drinks powders and Electu∣aries.
• * 1.46

  Second Particular.
• * 1.47

  A Person prickt with a Thorn in his leg.
• * 1.48

  Medica∣ments pro∣per in the beginning of a Phleg∣mon.
• * 1.49

  The Au∣thors way.
• * 1.50

  Ol. Apari∣ci.
• * 1.51

  Com∣pound Wounds.
• * 1.52

  Vitriol and Allom-stones.
• * 1.53

  Contus'd Wound.
• * 1.54

  Transverse Wounds.
• * 1.55

  A Wound double in the bottom with At∣trition.
• * 1.56

  Of He∣morrhage, or Bleed∣ing.
• * 1.57

  Of Pain.
• * 1.58

  Of Fever.
• * 1.59

  Signes of the Artery wounded.
• * 1.60

  Of the Vein wounded.
• * 1.61

  Progno∣stick of Vein and cure.
• * 1.62

  Progno∣stick of Artery.
• * 1.63

  And cure.
• * 1.64

  Suture.
• * 1.65

  Applica∣tives.
• * 1.66

  Roulers.
• * 1.67

  Ordering the part and diet.
• * 1.68

  Bleeding, where,
• * 1.69

  Qu. if the Stitches break.
• * 1.70

  Deligation and Ab∣cision.
• * 1.71

  Escaro∣ticks, &c.
• * 1.72

  Cautery.
• * 1.73

  Cautim.
• * 1.74

  Observ. 1. Wound of the inter∣nal Juga∣lar.
• * 1.75

  Observ. 2. An Artery wounded.
• * 1.76

  Observ. 3. Artery wounded.
• * 1.77

  Observ. 4. Aneurisma broken open.
• * 1.78

  Observ. 5. Wound of the Surall Artery.
• * 1.79

  Observ. 6. Artery wounded in a Coo∣pers arm at Windsor.
• * 1.80

  Wounds of Nerves and Ten∣dons.
• * 1.81

  Ill conse∣quences of bleeding not alway from a prick of Nerve or Tendon.
• * 1.82

  Signs of a Nerve prickt.
• * 1.83

  Cure.
• * 1.84

  Caution.
• * 1.85

  Progno∣sticks.
• * 1.86

  Cure of li∣gaments wounded, the same with Ten∣dons.
• * 1.87

  Wound in the inside of the wrist
• * 1.88

  Wound on the inside of the wrist into the Joint.
• * 1.89

  A finger bit off by a Horse.
• * 1.90

  A Dutch Hambur∣ger markt with a Cross on the Right Cheek.
• * 1.91

  Observ. 1. Puncture of the arm.
• * 1.92

  Observ. 2. Wound in the Thigh.
• * 1.93

  Observ. 3. A Wound in the arm.
• * 1.94

  Observ. 4. Wound in the Leg.
• * 1.95

  Signs of penetra∣ting wounds.
• * 1.96

  Progno∣stick.
• * 1.97

  Cure.
• * 1.98

  Whether the wound is to be kept open or not?
• * 1.99

  The Au∣thors judg∣ment.
• * 1.100

  Observ. 1.
• * 1.101

  How to order Tents in penetra∣ting wounds of the Breast.
• * 1.102

  Observ. 2.
• * 1.103

  Observ. 3.
• * 1.104

  Observ. 4.
• * 1.105

  Observ. 5.
• * 1.106

  The Au∣thors ob∣servation concerning the dis∣charge of the Sanies of the Breast by Urine.
• * 1.107

  Observ. 1.
• * 1.108

  Signs of the inward Viscera hurt by a wound of the Ab∣domen.
• * 1.109

  Digression concerning the ill use of Tents.
• * 1.110

  Signs of the gutts wounded.
• * 1.111

  Of open∣ing the bel∣ly in wounds of the In∣testines. Cure of wounds of great In∣testines.
• * 1.112

  A wound in the Abdomen. Observ. 2.
• * 1.113

  Manner of sewing the Peritone∣um in this case.
• * 1.114

  What to have been done in case the Omentum had chang∣ed Colour.
• * 1.115

  What if the In∣testines were swel'd.
• * 1.116

  Parts of the head considered.
• * 1.117

  The Hairy Scalp.
• * 1.118

  Forehead.
• * 1.119

  Temporal Muscle.
• * 1.120

  Pericrani∣um.
• * 1.121

  Cranium and Su∣tures.
• * 1.122

  The way to find the Sutures.
• * 1.123

  Thickness of the Cra∣nium.
• * 1.124

  Dura ma∣ter.
• * 1.125

  Pia mater.
• * 1.126

  Brain.
• * 1.127

  Wounds of Brain.
• * 1.128

  Contusions
• * 1.129

  Signs.
• * 1.130

  Progno∣sticks.
• * 1.131

  Contusions of the head.
• * 1.132

  Concussi∣ons.
• * 1.133

  Cure.
• * 1.134

  Simple in∣cised wounds.
• * 1.135

  Observ. 1. Wound in the Tem∣poral Muscle.
• * 1.136

  Contused wounds.
• * 1.137

  Pericrani∣um laid bare or cut.
• * 1.138

  Cranium laid bare by contu∣sed wounds.
• * 1.139

  Cranium wounded, or fra∣cture.
• * 1.140

  Against round in∣cisions up∣on surmise.
• * 1.141

  Trial of Fissures.
• * 1.142

  Depressi∣on.
• * 1.143

  Perforati∣on.
• * 1.144

  First dres∣sing after perforati∣on.
• * 1.145

  The thin∣ner part.
• * 1.146

  Observ.
• * 1.147

  Gun-shot.
• * 1.148

  Note.
• * 1.149

  Internal medicines.
• * 1.150

  External.
• * 1.151

  Spir. Vini of what use in these cases.
• * 1.152

  Medicine in wounds of the Meninges.
• * 1.153

  Qu. whe∣ther the dose of ol. chalcanth. be not mistaken, at least if by it he mean ol. vitriol.
• * 1.154

  A large wound of the Calva∣ria.
• * 1.155

  Of the Cal∣varia torn off.
• * 1.156

  A great contused wound.
• * 1.157

  A Con∣cussion.
• * 1.158

  Another Concussion
• * 1.159

  A great Bony Wen.
• * 1.160

  A Fracture with a long fissure and depression of the Cranium.
• * 1.161

  A contused wound by a blow on the crown of the head.
• * 1.162

  A Concus∣sion of the Brain.
• * 1.163

  A large Fissure, the Dura Ma∣ter putrifi∣ed.
• * 1.164

  A Caries through the Crani∣um, where∣in the Pe∣ricranium and Dura Mater be∣come one body.
• * 1.165

  Uncertain∣ty of symp∣toms in Wounds of the Brain.
• * 1.166

  Observa∣tion.
• * 1.167

  Observa∣tion.
• * 1.168

  Manner of dressing the Brain.
• * 1.169

  Observa∣tion.
• * 1.170

  N. B.