Compleat Surgeon/Bones

Of the Dislocation of the Bones.
What are the Diseases incident to the Bones?

They are five in number, viz. Dislocation, Fracture, Caries or Ulcer, Exostosis, and Nodus.

What is a Dislocation or Luxation?

It is the starting of the Head of one Bone out of the Cavity of another, with an Interdiction of the proper Motion of the Part: Or else it is the disjointing of two Bones united together for the Motion of a Part.

How many causes are there of Dislocation in general?

Two, that is to say, one violent, and the other gentle; thus the Dislocation is made violently in Falls, Strains, Knocks, and Blows; but it is done gently and slowly in Defluctions of Rheum; as also by an insensible gathering together of Humours between the Joints, and upon the Ligaments, the Relaxation or loosening of which gives occasion afterward to the Head of the Bone to go out of its place; whence this Consequence may well be drawn, viz. that a violent Dislocation usually depends upon an external Cause, and a gentle Dislocation upon an internal.

After how many manners doth a Dislocation happen?

Two several Ways; viz. the first is called compleat, total, and perfect; and the second incompleat, partial, and imperfect: But both may happen before, behind, on the inside, and without; and may also be simple or complicated.

What are the signs of a perfect, total, and compleat Dislocation?

It is when a hard Tumour or Swelling is perceiv'd near a Hole in the place of the Joint, great pain being felt in the Part, and the Motion of it abolish'd.

What are the signs of an imperfect, partial, and incompleat Dislocation?

It is when the Motion is streighten'd, and weaker than ordinary, so that some Pain is felt in the Joynt, and a Deformity may be discern'd therein, by comparing the hurt Part with the opposite which is found: This Dislocation is otherwise call'd a Sprain, when it proceeds from an external Cause; or else it is termed a Relaxation, when it happens by an internal.

What is a simple, and what is a complicated Dislocation or Luxation?

The Dislocation is properly simple, when it hath no concomitant Accidents; and it is complicated when accompany'd with some ill Symptoms or Accidents, such as Swellings, Inflammations, Wounds, Fractures, &c.

What are the means proper to be us'd in a simple Dislocation?

A speedy and simple reducing thereof, which is perform'd by stretching out the dislocated or luxated Member, and thrusting back the Head of the Bone into its natural place. Afterward the Joynt must be strengthen'd with a Fomentation made with Provence Roses, the Leaves of Wormwood, Rosemary, Camomile, St. John's-Wort, and Oak-Moss boil'd in the Lees of Wine and Forge-Water, keeping the Part well bound up, and sustain'd in a convenient situation. But if any ill Consequence is to be fear'd, apply Emplastrum Oxycroceum, or Diapalma dissolv'd in Wine.

What is to be done in a complicated Dislocation?

The Accidents must be first remov'd, and then the Bone may be set, which is impossible to be done otherwise; it being dangerous even to make an Attempt before, by reason of the too great Violence with which it is effected, and which would infallibly produce a Convulsion or a Gangrene.

If the Dislocation be accompany'd with a Wound, must the Wound be cur'd before any Endeavours are us'd to reduce it?

No, but the Symptoms of the Wound, which hinder the Operation, must be taken away, as the Swelling, Inflammation, and others of the like Nature; and then it may be reduc'd, and the Wound may be dress'd according to the usual Method.

If the Dislocation be complicated with the Fracture, what is to be done then?

It is necessary to begin with reducing of the Dislocation, and afterward to perform that of the Fracture, by reason of the Extension which must be made to reduce the Dislocation, which would absolutely hinder the Setling of the Fracture.

How is the Inflammation and Swelling to be asswag'd?

With Linnen Cloaths dipt in Brandy and common Water, which must be often renew'd; or else with the Tops of Wormwood and Camomile, with Sage and Rosemary boil'd in the Lees of Wine, wherein the Bolsters and Bands are to be steep'd. But all Repercussives and Astringents must be avoided.

How doth it appear that the Reduction is well perform'd?

By the Re-establishment of the Part in its natural State; by its being free from Pain; by its regular Motion; and by its conformity to the opposite Part which is found.

What Dislocations of Parts are most difficult to be reduc'd?

They are those of the Thighs with the Huckle-Bones, which are almost never perfectly set; that of the first Vertebra's is extremely difficult to be reduc'd; and those of the Lower-Jaw and Soles of the Feet are mortal.

The reducing of Dislocations is perform'd with greater facility in Infants than in Persons advanc'd in Years; but it becomes most difficult when it is deferr'd for many Days, by reason of the overflowing of the Lympha and nutritious Juice.

If an Inflammation shou'd happen before the Member is reduc'd, nothing can be done till it be allay'd, as we have already intimated; but to prevent and mitigate it, the dislocated Joynt, and the neighbouring Parts, may be bath'd with luke-warm Wine, in which hath been boil'd the Tops of St. John's-Wort, Camomile, Rosemary, Stœcas Arabica, and other Ingredients of the like Nature; the Bands must be also steept in the same Liquor.

If an Oedematous Tumour arise in the luxated Member after the Joint hath been set, it is requisite to take internal Sudorificks, and to apply Liniments made with the destill'd Oil of Tartar, and of Human Bones, which may be rectify'd with burnt Hart's Horn, or some other part of Animals, to take away its stink: Or else take yellow-Wax, and very white Rosin, melt the whole Mass, and put into it white Amber and Gum Elemi, a sufficient quantity of each to make a Composition to be incorporated with Balsam of Peru; a Plaister of which may be prepar'd, and apply'd to the dislocated Member; but the Plaister must not be laid a cross, lest it shou'd contract the Part too much. The whole Member may be also anointed with Oil of St. John's-Wort, or with the destill'd Oil of Turpentine; or rather with a simple Decoction of Nervous Plants in Wine.

If the Bone be put out of its place by a coagulated sort of Matter like Mortar or Plaister, Resolutives and Attenuants are to be us'd, such as the volatile Spirit of Tartar prepar'd with the Lees of Wine, volatile Spirit of Tartar destill'd with Nitre in a Retort with a long Neck, or Spirit of Tartar prepar'd by Fermentation with Tartar, and its proper Alkali: This last is the best of all, and the use thereof ought to be continu'd. The volatile Salt of Human Bones is also very efficacious; but it is necessary to begin first with the taking of Laxative and Sudorifick Medicines, appropriated according to the respective Circumstances. The Spirit of Earth-Worms may be also apply'd outwardly, which is made by Fermentation, and may be often laid on the Part either alone, or with the Spirit of Sal Ammoniack.

If a dislocated Bone be not set in good time, a Coagulum or kind of curdled Substance is form'd in the Cavity, which hinders the reducing of it to its place; but this Coagulum may be dissolv'd with the following Medicament, before you attempt to set the Bone. Take one part of the destill'd Oil of Human Bones, two parts of fœtid Oil of Tartar; mingle the whole, and add quick Lime to be destill'd in a Retort: Let the Parts be fomented with this Oil.

If the Dislocation happen'd by the Relaxation of the Ligaments, recourse may be had to universal Sudorificks taken inwardly; as also to such Medicines as are full of an unctuous and volatile Salt, particularly Aromatick Oils, and Spirit of Sal Ammoniack. In the mean while Aromaticks, Resolutives, and moderate Astringents may be apply'd outwardly.

Of the Fractures of Bones.
What is the Fracture of a Bone?

It is the Division of the Continuity of its Parts.

After how many different manners may a Bone be broken?

Three several ways, viz. cross-wise, side-wise, in its length, and perhaps in Shatters or Splinters.

By what means may a Bone be fractured?

It may happen to be done by three sorts of Instruments, viz. such as are fit for bruising, cutting, or wresting; that is to say, a Bone may be divided in the Continuity of its proper Parts, by Contusion, Incision, or Contorsion.

How is the Fracture of a Bone discover'd?

Divers ways, viz. by the ill Disposition of the Part, which becomes shorter; by its want of Motion; by its flexibility or pliantness elsewhere than in its Articulations; by the unevenness that may be perceiv'd in its Continuity; by the cracking which is heard; sometimes also by the shooting forth of one of its ends thro' the Flesh which it hath open'd; and lastly by a Comparison made thereof with the sound Part on the other side, as that of the Right Arm with the Left.

What kind of Fracture is most difficult to be discern'd?

It is that which happens in the length of the Bone, commonly call'd a Cleft or Fissure, which gives occasion to very great Symptoms when it is unknown: But it may be found out by the Pain and Swelling felt at the bottom of the Cleft in touching it; besides the Conjectures which may be made from the Relation of the Person who hath had a Fall, and might have heard the cracking of the Bone.

What sort of Fracture is most difficult to be cur'd?

The shattering or splitting of a Bone in Pieces, by reason of the great Number of Splints which daily cause new Pains and Suppurations.

What is a simple and what is a complicated Fracture?

The simple Fracture is that whereby the Bone is broken, without any other Accident; and the complicated Fracture is that which is follow'd by some Accident; as that in which there is a splitting of the Bone in pieces, or where the Bone is broken in two several places, or else when the Fracture is accompany'd with a Luxation, a Wound, an Inflammation, or other Circumstances of the like Nature.

Are old Men or Children most subject to these Fractures of the Bones?

Old Men, because their Bones are drier; whereas those of Infants are almost Cartilaginous, and yield or give way to the violence offer'd to 'em; from whence proceed the sinkings and hollowness that happen in their Skulls, especially in the Mould of their Heads, or elsewhere; for which a Remedy is found out by the means of Plaisters, Splints, and Bandages, fitted to the shape of the Parts. It is also on the same Account that Bones are more easily broken in the Winter than in the Summer.

In what Parts are the Fractures of Bones most dangerous?

They are those that happen in the Skull and Joints; in the former by reason of the Brain; and in the latter in regard of the Nervous Parts.

What Course is to be taken by a Surgeon who is sent for to cure a Fracture?

He ought to do three things, that is to say, at first he must incessantly endeavour to reduce it, to the end that Nature may re-unite the Parts with greater Facility, and that its Extremities may be brought together again with less trouble, before a Swelling, Inflammation, or Gangrene happen in the Part. Afterward he is to use means to retain the Parts in their proper Figure, and natural Situation, and to prevent all sorts of Accidents.

How is the setting of a broken Bone to be perform'd?

When the Fracture is Cross-wise, it must be reduc'd by Extension and contra-Extension; and when it is in length, the Coaptation or bringing together again of the Sides, is only necessary.

What is to be done in a Fracture complicated with a Wound?

The Operator must first reduce it, and then administer the other Helps, as in a simple Fracture.

How may it be known that the reducing of the Fracture is well perform'd?

When the Pain ceaseth; when the Part hath resum'd its natural Shape; when no Unevenness is any longer perceiv'd therein; and when it is conformable to the sound Part on the other side.

What are the Signs which shew that the Splints remain in the Fracture after it hath been reduc'd?

They are the secret and continual Workings of the Fibres, or twitchings, that are felt by Intervals in the Part, with great Pains, which are the Indications of an Abcess arising therein; and when a Wound is join'd to the Fracture, the Lips of it are puff'd up, and become more soft and pale, the purulent Matter abounding also more than ordinary.

When the Splints appear, must they be drawn out by force?

By no means; for great care ought to be taken to avoid all manner of violent Operations; it being requisite to wait for their going out with the purulent Matter; or at most to facilitate their Passage by the use of Injections of the Tincture of Myrrh and Aloes; by the application of Emplastrum Andreæ Crucii, and by the help of the Forceps.

How is a simple Fracture to be dress'd, after it hath been reduc'd?

The Parts are to be strengthen'd and consolidated with Liniments of Oleum Lumbricorum, or of Oil of St. John's-Wort mingled with Wine, Brandy, or Aqua-Vitæ; with Fomentations of Red Roses, Rosemary, and St. John's-Wort boil'd in Wine; and with Emplastrum contra Rupturam, or de Betonica, carefully wrapping up the broken Member, but after such a manner that the two Extremities may not cross one another; and that a small Space may remain open between both. Afterward the Splints and Bands are to be apply'd, taking care to avoid binding 'em too hard, and to take 'em off every three Days, in order to refit 'em, to abate troublesome Itchings, and to give Air to the Part; by these means preventing the Gangrene, which might happen by the Suffocation of the natural Heat. If the Thighs or Legs are broken, Scarves are to be us'd to support and stay 'em in the Bed.

What space of time may there be allow'd for curing the Fracture of a Bone?

The Cure will take up more or less time, according to the variety of the Parts, or the different thickness of the Bones: Thus to form the Callus of the broken Jaw-Bone, twenty Days may well be allotted; for that of the Clavicle, or that of the Shoulder-Bone, twenty four; for that of the Bones of the Elbow, thirty; for that of the Arm-Bone, forty; for that of the Wrist-Bone, and those of the Fingers, twenty; for that of the Ribs, twenty; for that of the Thigh-Bone, fifty; for that of the Leg-Bone, forty; for that of the Bones of the Tarsus and Toes, twenty.

What ought to be done in particular to promote the formation of the Callus?

The fractur'd Part must be rubb'd with Oleum Lumbricorum and Spirit of Wine heated and mingled together: The Decoctions of Agrimony, Sayine, and Saxifrage are also to be us'd, and the Lapis Osteocolla is a Specifick: It is usually given in great Comphrey-Water, or in a Decoction of Perewinkle made with Wine, and is often re-iterated.

Of the particular Fractures of the Skull.
What is a Fracture of the Cranium or Skull?

It is a Wound of the Head complicated with a Fracture of the Skull-Bone.

After how many manners may the Skull be fractur'd?

Three several ways, viz. by Contusion, by Incision, and by Puncture.

What is the most dangerous of these Fractures?

It is that which happens by Contusion; because the Concussion and Commotion is greater.

Do all the Fractures of the Skull require the use of the Trepan?

No, the Fractures must be deep which stand in need of the help of such an Instrument; for those that are superficial may be cur'd by a simple Exfoliation.

What is that deep Fracture, wherein the use of the Trepan is absolutely necessary?

It is that which is made in the two Tables of the Skull, penetrating to the Meninges of the Brain; upon which at that time the Blood is diffus'd, and must be taken away by the Operation of the Trepan.

How may it be discover'd that the two Tables of the Skull are broken?

By the Eyes, and by Ratiocination.

Are not the Eyes sufficient alone, and are they not more certain than Ratiocination?

Yes; but forasmuch as things are not always seen, there is often a necessity of making use of rational Deductions to find out that which the Eyes cannot discern.

When doth it happen that the Eyes alone discover the Fracture?

When the Wound is large and wide, so that it may be immediately view'd.

When doth it happen that Ratiocination supplies the defect of the Eyes?

When the Wound is so small that the Bone cannot be seen, and nothing appears but the Accidents.

What are the Accidents or Signs of the Fracture of the Skull?

They are a dimmness of the Sight, and loss of the Understanding, which happen at the very Moment when the Fall or Blow is receiv'd; with the Phlegmatick Vomittings that follow soon after: These Signs are call'd Univocal. And there are others that bear the Name of Equivocal, and which confirm the former; as a Flux of Blood thro' the Nose, Eyes, and Ears, redness of the Eyes, heaviness of the Head, and puffing up of the Face; as also afterward Drowsiness, Shivering of the whole Body, Fever, Deliriums, Convulsions, &c.

Must all these Signs appear before a Determination can be made of the necessity of using the Trepan?

No, it is sufficient to have the Univocal Signs to make a Crucial Incision in the place of the Wound, and to lay bare the Bone, in order to observe the Fracture, which sometimes is so fine, that the Operator is oblig'd to make use of Ink, which insinuates it self into the Cleft, and of a particular Instrument, with which the black Line that hath penetrated to the bottom, cannot be rubb'd out; whereas it may be easily defac'd when the Fracture is only superficial.

How long time is commonly spent before the appearing of the Accidents?

In the Summer Season they appear in three or four Days, and at the latest in seven; in Winter they are slower, and sometimes do not happen till the fourteenth Day: But at the end of this term, it may be affirm'd that the Trepan is often unprofitable.

What is requisite to be done in a doubtful Occasion; Must the Trepan be apply'd or omitted?

The Surgeon is to have recourse to his own conscientious Discretion, which ought to serve as a Guide, and requires that we should always act according to the known Rules of Art; insomuch that after having well consider'd the Accidents, with all the Circumstances of the Wound, if there be no good grounds for the undertaking of the Operation, it is expedient to desist, and in this case to have deference to the Advice of other able Surgeons of the same Society, rather than to rely too much upon his own Judgment, to the end that he may be always secure from all manner of Blame.

Is the Trepan apply'd upon the Fracture?

No; but on one side of it, and always in a firm place.

What Course is to be taken when a Fracture is found in a Suture?

A double Trepan is to be made, and apply'd on each side of the Suture, by reason of the overflowing of the Blood, which may happen therein.

What Method ought to be observ'd in the curing of the Wounds of the Head, and Fractures of the Skull?

In simple Wounds of the Head, it is necessary only to make use of Balsams, and to lay over 'em Emplastrum de Betonica. When there is a Contusion either in the Pericranium, or in the Skull, the Wound must be kept open till after the Suppuration or Exfoliation.

When there is only a Bunch without any Wound or Accident, it must speedily be dissolv'd with Plaister or Mortar, Chimney-Soot, Oil of Olives, and Wine, laid upon the Part between two Linnen-Rags; or else with Soot, Spirit of Wine, and Oil of St. John's-Wort, wherein the Bolsters are soakt, to be in like manner apply'd with a Band.

Wounds of the Head accompany'd with a Fracture, absolutely require the application of the Trepan, wherein it is requisite to make use of Oil of Turpentine to be dropt upon the Membrane of the Brain; or else Spirit of Wine mingled with Oil of Almonds, and not with the Oil or Syrrup of Roses; and to endeavour to cause a plentiful outward Suppuration.

Besides, it must not be neglected to enjoyn the wounded Person to be let Blood both before and after the Operation, if he hath a Fever or a Plethory; and more especially it is to be remember'd to cause his Body to be kept open at least every other Day, with Clysters, obliging him to keep a good Diet, and to avoid all violent Agitations both of Body and Mind, abstaining from eating Flesh till the Fourteenth Day. All manner of Venery and Conjugal Embraces, which prove fatal at this time, are to be prohibited during forty Days, to be counted from the Day of the Operation; as they are also in all other considerable Wounds.

Of the Caries or Ulcer of the Bones, Exostosis, and Nodus.
What is Caries?

It is the Putrifaction of the Substance of the Bone, or else its Ulcer or Gangrene.

Whence doth the Caries of the Bone derive its Original?

It proceeds from an internal and external Cause; the former being that which hath been produc'd at first in the Substance of the Bone; and the other that which takes its Rise from an inveterate Ulcer in the Flesh, which hath communicated its Malignity to the Substance of the Bone, and by that means corrupted it.

How is the Caries known which proceeds from an inward Cause?

By the continual and violent Pains which are felt before, and continue for a long time without diminution; as also afterward by the alteration of the Flesh that covers the Bone, and which becomes soft, spongy, and livid.

By what means is a Caries that derives its Origine from an outward Cause, discover'd?

By the quality of the purulent Matter that issueth out of the Ulcer in the Flesh, which is blackish, Unctuous, and extremely stinking; as also by the help of the Probe, that discovereth asperity or roughness in the Bone when it is laid bare.

What Means are to be us'd in order to cure a Caries proceeding from an external Cause?

The Powder of Flower-de-luce may be us'd, and it is sufficient for that purpose, when the Caries is superficial; but it is necessary to take Oleum Guyaci, and to soak Bolsters therein, to be laid upon the Ulcer when it is deep; or else Aqua-Vitæ or Brandy, in which have been infus'd the Roots of Flower-de-luce, Cinnamon, and Cloves. Lastly, the actual Cautery, which is Fire, must be apply'd thereto.

What is to be done when the Caries proceeds from an internal Cause?

The Flesh must be open'd to give Passage to the Sanies that runs out of the ulcerated Bone, to the end that Exfoliation may be procur'd; and if the Ulcer hath not as yet laid open the Bone on the outside, the Trepan ought to be apply'd; but the Ulcer or Caries must be afterward handled, as we have even now declar'd.

What is Exostosis?

It is the Swelling of a Bone made by the settling of a corrupt Humour in its proper Substance.

What is Nodus?

It is a kind of gummy and wavering Tumour, which is form'd by the settling of a gross Humour between the Bone and the Periosteum.

Are Exostoses and Nodus's suppurable Tumours?

Yes, because they sometimes produce Ulcers and Gangrenes in the Bone, which are call'd Caries, proceeding from an internal Cause; nevertheless they are generally dissolv'd by Frictions with Unguentum Griseum, or by the application of Plaisters of Tobacco, or Emplastrum de Vigo quadruplicato Mercurio; taking also to the same purpose internal Diaphoretick and Sudorifick Medicines, with convenient Purgatives.

Of Cauteries, Vesicatories, Setons, Cupping-Glasses, and Leeches.
What is a Vesicatory?

The Name of Vesicatory may be attributed to every thing that is capable of raising Bladders or Blisters in the Skin; nevertheless in Surgery, by a Vesicatory is understood a Medicament prepar'd with Cantharides or Spanish Flies dried, which are beaten to Powder, and mingled with Turpentine, Plaisters, Leaven, and other Ingredients.

In what places, and after what manner are Vesicatories usually apply'd?

They are apply'd every where, accordingly as there is occasion to draw out or discharge some Humour from a Part: In Defluxions of Rheum upon the Eyes or Teeth, they are laid on the Neck and Temples; in Apoplexies, behind the Ears; and so of the rest, observing always to make Frictions on the places where the Application is to be made, to the end that the Vesicatory may sooner take effect.

How long time must the Vesicatory continue on the Part?

The Blisters are generally rais'd by 'em within the space of five or six Hours; yet this Operation depends more or less upon the fineness of the Skin; and when the Bladders or Blisters appear, it is requisite to deferr the openning of 'em for some time, to the end that Nature may have an Opportunity to introduce a new Scarf-Skin, by which means the Pain may be avoided that would be felt, if the Skin were too much expos'd to the Air.

What is a Cautery?

It is a Composition made of many Ingredients, which corrode, burn, and make an Escar on the Part to which they are apply'd.

How many sorts of Cauteries are there in general?

There are two kinds, viz. the Actual and the Potential; the former are those that have an immediate Operation; as Fire, or a red-hot Iron; and the others are those that produce the same Effect, but in a longer space of time; such are the ordinary Cauteries compos'd of Caustick Medicaments.

Which are the most safe, the Actual or the Potential Cauteries?

A distinction is to be made herein; for Actual Cauteries are safest in the Operation, because they may be apply'd wheresoever one shall think fit, as also for as long a time, or for any purpose: Whereas the Potential cannot be guided after the same manner. But in Hæmorrhages the Potential Cauteries are most eligible, by reason that the Escar produc'd by 'em not being so speedily form'd, the Vessels are better clos'd, and they are not so subject to open again when it falls off; as it often happens in the Fall of an Escar made by Fire.

In what places are Cauteries usually apply'd?

In all places where an Attraction is to be made, or an Intemperature to be corrected, or a Flux of Humours to be stopt, by inducing an Escar on the Part: However they are commonly laid upon the Nape of the Neck, between the first and second Vertebra; on the outward Part of the Arm in a small Hole between the Muscle Deltoides and the Biceps; above the Thigh, between the Muscle Sartor, and the Vastus Internus; and on the inside of the Knee, below the Flexors of the Leg; observing every where that the Cautery be plac'd near the great Vessels, to the end that it may draw out and cleanse more abundantly.

What is the Composition of the Potential Cauteries?

They may be made with quick Lime, Soap, and Chimney-Soot; or else take an Ounce of Sal Ammoniack, two Ounces of burnt Roman Vitriol, three Ounces of quick Lime, and as many of calcin'd Tartar; mingle the whole Mass together in a Lixivium of Bean-Cod Ashes, and cause it to evaporate gently to a Consistence: Let this Paste be kept for use in a dry place, and in a well-stopt Vessel. Or else the Silver-Cautery, or Lapis Infernalis may be prepar'd after the following manner:

Take what quantity you please of Silver, let it be dissolv'd with thrice as much Spirit of Nitre in a Vial, and set the Vial upon the Sand-Fire, to the end that two third parts of its Moisture may evaporate: Then pour the rest scalding-hot into a good Crucible, plac'd over a gentle Fire, and the Ebullition being made, the heat of the Fire must be augmented, till the Matter sink to the bottom, which will become as it were an Oil: Afterward pour it into a somewhat thick and hot Mould, and it will coagulate, so as to be fit for Use, if it be kept in a well-stopt Vial. This Cautery is the best; and an Ounce of Silver will yield one Ounce and five Drams of Lapis Infernalis.

What is a Seton?

It is a String of Silk, Thread, or Cotton, threaded thro' a kind of Pack-Needle, with which the Skin of a Part is to be pierc'd thro', to make an Ulcer therein, that hath almost the same effect as a Cautery.

What is most remarkable in the Application of a Seton?

It ought to be observ'd, that the String must be dipt in Oil of Roses, and that one end of it must always be kept longer than the other, to facilitate the running of the Humours.

In what Parts is the Seton to be apply'd?

The Nape of the Neck is the usual place of its Application, altho' it may be made in any part of the Body where it is necessary. It sometimes happens that a Surgeon is oblig'd to use a kind of Seton in such Wounds made with a Sword, or by Gun-shot, as pass quite thro' from one side to the other; then the String or Skain must be dipt in convenient Ointments or Medicinal Compositions; and as often as the Dressings are taken away, it will be requisite to cut off the Part soakt in the Purulent Matter, which must be taken out of the Ulcer.

What is a Cupping-Glass?

It is a Vessel or kind of Vial, made with Glass, the bottom whereof is somewhat broader than the top, which is apply'd to the Skin to cause an Attraction. There are two sorts of these Cupping-Glasses, viz, the Dry, and the Wet; the former are those that are laid upon the Skin without opening it; and the latter those that are apply'd with Scarification.

In what Diseases are Cupping-Glasses us'd?

In all kinds where it is necessary to make any Attraction; but more especially in Apoplexies, Vapours in Women, Palsies, and other Distempers of the like Nature. But the Applications of Cupping-Glasses are altogether different; for in Apoplexes they are generally set upon the Shoulders or upon the Coccyx; in Vapours upon the inside of the Thighs; and in Palsies upon the Paralytick Part it self.

What is a Leech?

It is an Animal like a little Worm which sucks the Blood, and is commonly apply'd to Children and weak Persons, to serve instead of Phlebotomy: Leeches are also us'd for the discharging of a Defluxion of Humours in any Part; as also in the Hæmorrhoidal Veins when they are too full; in the Varices and in several parts of the Face.

What choice ought to be made of Leeches?

It is requisite to take those that have their Backs greenish, and their Bellies red; as also to seek for 'em in a clear running Stream, and to cast away those that are black and hairy.

Of Phlebotomy.
What is Phlebotomy?

It is an evacuation of Blood procur'd by the artificial Incision of a Vein or Artery, with a design to restore Health.

Which are the Vessels that are open'd in Phlebotomy or Blood-letting?

They are in general all the Veins and Arteries of the Body, nevertheless some of 'em are more especially appropriated to this Operation; as the Vena Præparata in the Forehead; the Ranulæ under the Tongue; the Jugular Veins and Arteries in the Neck; the Temporal Arteries in the Temples; the Cephalick, Median, and Basilick Veins in the inside of the Elbow; the Salvatella between the Ring-Finger and the Little-Finger; the Poplitæa in the Ham; the Saphena in the internal Malleolus or Ankle; and the Ischiatica in the external.

What are the Conditions requisite in the due performing of the Operation of Phlebotomy?

They are these, viz. to make choice of a proper Vessel; not to open any at all Adventures; not to let Blood without necessity, nor without the Advice of a Physician; whose Office it is to determine the Seasons or Times convenient for that purpose; as that of Intermission in an Intermitting Fever; that of Cooling in the Summer; and that of Noon-tide in the Winter; and lastly, to take away different quantities of Blood; for in the Heat of Summer they ought to be lesser, and greater in the Winter.

What are the Accidents of Phlebotomy?

They are an Impostume, a Rhombus, an Echymosis, an Aneurism, Lipothymy, Swooning, and a Convulsion.

What is a Rhombus?

It is a small Tumour of the Blood which happens in the place where the Operation is perform'd either by making the Orifice too small, or larger than the Capaciousness of the Vessel will admit. The Rhombus is cur'd by laying upon it a Bolster dipt in fair Water, between the Folds of which must be put a little Salt, to dissolve and prevent the Suppuration.

How may it be perceiv'd that an Artery hath been prickt or open'd in letting Blood?

The Puncture of an Artery produceth an Aneurism; and the Opening of it causeth a Flux of Vermilion Colour'd Blood, which issueth forth in abundance, and by Leaps.

Are the Leaps which the Blood makes in running, a certain Sign that it comes from an Artery?

No, because it may so happen, that the Basilick Vein lies directly upon an Artery, the beating of which may cause the Blood of the Basilica to run out leaping: Therefore these three Circumstances ought to be consider'd jointly, that is to say, the Vermilion Colour, the great quantity and the Leaps, in order to be assur'd that the Blood proceeds from an Artery.

How may it be discover'd that a Tendon hath been hurt in letting Blood?

It is known when in opening the Median Vein, the end of the Lancet hath met with some Resistance; when the Patient hath felt great Pain, and afterward when the Tendon apparently begins to be puff'd up, and the Arm to swell. A Remedy may be apply'd to this Accident thus; after having finish'd the Operation, a Bolster steep'd in Oxycratum is to be laid upon the Vessel, a proper Bandage is to be made, and the Arm must be wrapt up in a Scarf: If the Inflammation that ariseth in the Part be follow'd with Suppuration, it must be dress'd with a small Tent; and if the Suppuration be considerable, it is necessary to dilate the Wound, and to make use of Oil of Eggs and Brandy, or Arcæus's Liniment, with a good Digestive; as also to apply Emplastrum Ceratum; to make an Embrocation on the Arm with Oil of Roses; and to dip the Bolsters in Oxycratum to cover the whole Part.

Is it not to be fear'd that some Nerve may be wounded in letting Blood?

No, they lie so deep that they cannot be touch'd.

Under what Vein is the Artery of the Arm?

It is usually situated under the Basilica.

What Course is proper to be taken to avoid the Puncture of an Artery in letting Blood?

It must be felt with the Hand before the Ligature is made, observing well whether it be deep or superficial; for when it lies deep, there is nothing to be fear'd; and when it is superficial, it may be easily avoided by pricking the Vein either higher or lower.

What is to be done when an Artery is open'd?

If it be well open'd, it is requisite to let the Blood run out till the Person falls into a Syncope or Swoon, by which means the Aneurism is prevented; and afterward the Blood will be more easily stopt: It remains only to make a good Bandage with many Bolsters, in the first of which is simply put a Counter or a Piece of Money; but a bit of Paper chew'd will serve much better, with Bolsters laid upon it in several Folds.

If the Arteries cause so much trouble when open'd accidentally, why are those of the Temples sometimes open'd on purpose, to asswage violent Pains in the Head?

By reason that in this place the Arteries are situated upon the Bones that press 'em behind; which very much facilitates their re-union.

Are not the Arteries of Persons advanc'd in Years more difficult to be clos'd than those of Children?

Yes.

Are there not Accidents to be fear'd in letting Blood in the Foot?

Much less than in the Arm; because the Veins of the Malleoli or Ankles are not accompany'd either with Arteries or Tendons; which gave occasion to the Saying, That the Arm must be given to be let Blood only to an able Surgeon, but the Foot may be afforded to a young Practitioner.