The Compleat Surgeon Part 22

_Is it necessary to put Tents into all Wounds, and to make use of Digestives and Suppuratives?_

No: It is sufficient to procure the Re-uniting of the Parts simply by the Means of Balsam in small Wounds; because they ought not to be brought to Suppuration: so that Digestives and Suppuratives are only necessary in great Wounds, and those that are accompanied with Contusion, avoiding the ill Custom of some Country-Surgeons, that stuff up their Wounds too much with Tents and Pledgets, whereas they might well be content with simple Bolsters or Dossels which shou'd be dipt in the ordinary Digestive composed of Turpentine and the Yolks of Eggs with a little Brandy, or else with the Tincture of Myrrh and Aloes.

Suppuration may also be promoted by mundifying and quickening the Wound, especially if the Bolsters be steep'd in the following Composition. {148}

Take half an Ounce of Aloes and Myrrh powder'd, two Drams of _Sal Saturni_, twenty Grains of _Sal Ammoniack_, the same quant.i.ty of beaten Cloves, a Dram of Queen of _Hungary_ Water and half an Ounce of _Unguentum Basilicon_, and let the whole Ma.s.s be mingled together.

In fine, the whole Mystery consists in well cleansing the Wounds with a Linnen Cloth, or with the Injections of the Tinctures of Myrrh and Aloes; or with simple Decoctions of Wormwood, _Scordium_ or Water-Germander, Bugle, Sanicle and h.o.r.e-Hound in White-Wine; as also by prescribing the Vulnerary Decoctions of Powder of Crab's-Eyes, and _Saccharum Saturni_, to be taken inwardly, to consume the acid Humours, which are a very great Obstacle that hinders the speedy cure of Wounds.

_What are the Vulnerary Plants, the Decoctions of which is to be taken inwardly?_

They are _Alchymilla_ or Lion's-Foot, Ground-Ivy, _Veronica_ or Fluellin, St. _John_'s-Wort, Wormwood, Centory, Bugle, Sanicle, Chervil, and others.

The Broth of Crabs may also be prescrib'd, which is an excellent Remedy, and may serve instead of a Vulnerary Potion.

Sometimes Sutures or St.i.tches contribute very much to the re-uniting of the Lips of Wounds, when they cannot be join'd by Bandage.

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CHAP. III.

_Of particular Wounds of the Head._

_What ought first to be consider'd in a Wound of the Head?_

Two things, that is to say, the Wound it self, and the Instrument with which it was made; for by the Consideration of the Wound, we may know whether it be Superficial or Deep; and by that of the Instrument, we are enabled to make a truer Judgment concerning the Nature of the same Wound.

_What is a Superficial, and what is a Deep Wound in the Head?_

That is call'd a Superficial Wound in the Head, which lies only in the Skin; and that a Deep one which reacheth to the _Pericranium_, Skull, or Substance of the Brain.

_What is to be apply'd to a Superficial Wound?_

It is cur'd with a little Queen of _Hungary_ Water; or else with a little Balsam, laying upon it the Surgeon's Plaister, or that of Betony. But if the Wound or Rent be somewhat large, it must be clos'd with a St.i.tch.

_What is to be done to a Deep Wound?_

If it be situated in the _Pericranium_, the Wound must be kept open, waiting for Suppuration; but if it enter the Skull, an Enquiry is to be made, whether there be a Simple Contusion, or a Fracture also. In the Contusion it is necessary to wait for the Suppuration, and the {150} fall of the Splint, and to keep the Wound open; as in the Fracture, to examine whether it be in the first Table only, or in both; it is known to be only in the first, by the Application of an Instrument, and of Ink, as also in regard that there are no ill Symptoms; but a Fracture in both Tables shews it self by the Signs; and it may be found out by making a Crucial Incision in the Flesh, to discover the Fissure.

_What are the Signs of the Fracture of the two Tables of the Skull, and of the overflowing of the Blood upon the Membranes of the Brain?_

They are the loss of the Understanding at the very Moment of receiving the Wound; an Haemorrhage or Flux of Blood thro' the Nose, Mouth, or Ears; drowsiness and heaviness of the Head, and more especially Vomitting of Phlegm; from whence may be inferr'd the necessity of making use of the Trepan.

_What Consequence may be drawn from the Knowledge of the Instrument with which the Wound was made?_

It is according to the Quality of this Instrument; as it is proper to cut, p.r.i.c.k, or bruise; if it be cutting, the Wound is more Superficial, and not subject to a great Suppuration: If it be p.r.i.c.king, the Wound is deeper, but of small Moment: If it be a battering or bruising Instrument, the Wound is accompany'd with Contusion, producing a great Suppuration, besides the Concussion and Commotion of the Part, which are inseparable, and often cause very dangerous Symptoms. {151}

Inferences may be made also from the disposition of the wounded Person; for a strong robust Man may better bear the Stroke than a weak one; and even Anger causeth an Augmentation of Vehemency; so that all such Circ.u.mstances are not to be despis'd, in regard that they give occasion to profitable Conjectures.

_What particular Circ.u.mstance is there to be observ'd in undertaking the Cure of Wounds in the Face?_

It is, that a more nice Circ.u.mspection is requir'd here than elsewhere, in abstaining from Incisions, as well as in making choice of proper Medicines, which must be free from noisome Smells; and it is in this Part chiefly that Balsams are to be used, avoiding Suppuration, to prevent Scars and other Deformities.

CHAP. IV.

_Of the particular Wounds of the Breast._

_What is to be observ'd in Wounds of the Breast?_

Two things, _viz._ whether they penetrate into the Cavity of the _Thorax_ or not, which may be discover'd by the Probe, and by a Wax-Candle lighted, and apply'd to the Entrance of the Wound, obliging the Patient to return to the same Posture wherein he receiv'd the Hurt, as also to keep his Nose and Mouth shut: For then the Flame may be perceiv'd to be wavering, the Orifice of the Opening being full of {152} Bubbles; a Judgment may be also made from the running out of the Blood.

_What is to be done when it is certainly known that the Wound penetrates into the Cavity of the Breast?_

It is necessary to examine what Part may be hurt, by considering the situation of the Wound, and its Symptoms: If the Lungs are pierc'd, a spitting of froathy Vermilion-colour'd Blood ensues, with difficulty of Respiration, and a Cough. If any of the great Vessels are open'd, the wounded Person feels a Weight at the bottom of his Breast, is seiz'd with cold Sweats, being scarce able to fetch his Breath, and Vomits Blood, some Portion whereof issueth out of the Wound. If the _Diaphragm_ or Midriff be cut in its Tendinous Part, he is suddenly hurry'd into Convulsions: And if the Heart be wounded either in its _Basis_ or Ventricles, he falls into a Swoon, and dies incontinently.

But if the Probe doth not enter, and none of the above-mentiond Symptoms appear, it may be taken for granted that the Wound is of no great Consequence.

_What is to be done when the Wound penetrates into the Chest, yet none of the Parts are hurt, only there is an Effusion of Blood over the _Diaphragm_?_

It is necessary to make an _Empyema_, or otherwise the diffus'd Blood in corrupting, wou'd inevitably cause an Inflammation, Gangrene, and Death it self.

_What is an _Empyema_?_

It is an Operation whereby any sorts of Matter are discharg'd with which the Diaphragm is over-spread, by making a Puncture or Opening in the Breast.

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CHAP. V.

_Of the particular Wounds of the lower Belly._

_What is to be done to know the quality of a Wound made in the lower Belly?_

It is requisite to make use of the Probe, to observe the situation of the Wound, and to take notice of all the Symptoms: For by the help of the Probe, one may discover whether it hath penetrated into the Cavity or not, after having enjoyn'd the Patient to betake himself to the same Posture wherein he was when he first receiv'd the Wound: By its situation a Conjecture may be made that such a particular Part may be hurt; and by a due Examination of the Symptoms, one may attain to an exact Knowledge. As for Example; It is known that one of the thick Guts is open'd, when the Hurt is found in the _Hypogastrium_, and the Excrements are voided at the Wound; as it is certain that one of the thin Guts is pierc'd, when the Wound appears in the Navel, and the Chyle issueth forth from thence; and so of the others.

_What Method ought to be observ'd in curing Wounds in the lower Belly?_

It is expedient at first to prevent letting in the Air, and to dilate the Wound, in order to sow up the perforated Gut, and afterward to {154} restore it to its place; as also to bind the Caul, which is let out at the opening, and to cut it off, lest in putrifying it should corrupt the neighbouring Parts. Then these Parts may be bath'd with Lees of Wine, wherein have been boil'd the Flowers of Camomile and Roses with Wormwood: The Powders of Aloes, Myrrh, and Frankincense may be also thrown upon 'em; and the Wound must be sow'd up again to dress it on the outside, the Patient in the mean time being restrain'd to a regular Diet. But Clysters must be forborn on these Occasions, especially when one of the thick Guts is wounded, making use rather of a Suppository or laxative Diet-Drinks, to avoid dilation and straining.