What is the Breast?
It is a Cavity in which the Heart and the Lungs are principally enclos'd.
What is to be consider'd outwardly in the Breast?
Its extent, and the situation of the Parts therein contain'd.
What is its extent?
It is extended from theClaviclesto theXiphoides, or Sword-like Cartilage on the fore-part, and bounded on the hinder by the twelfthVertebraof the Back, having all the Ribs to form its Circumference, and the Diaphragm for its Bounds at bottom, separating it from theAbdomenor lower Belly.
What is the situation of the Parts contain'd in the Breast?
The Lungs take up the upper Region, and fill almost the whole Space, descending at the distance of two Fingers breadth from the Diaphragm; the Heart is situated in the middle, bearing its Point somewhat towards the Left side, under the Lobes of the Lungs, which are divided by theMediastinumthat distinguishes them into the Right and Left Parts.
How is the Breast Anatomiz'd or open'd?
After the dissection of the five Teguments, and the removal of the Muscles, as in the lower Belly, the Anatomist proceeds to lift up theSternumor Breast-Bone, by separating it from the Ribs; then it is laid upon the Face, or else entirely taken away, to the end that the internal Parts of the Breast may be more clearly discover'd; whereupon immediately appear, the Heart, the Lungs, the Diaphragm, and theMediastinum, which sticks to theSternumthroughout its whole length.
What is the Heart?
It is a most noble Part, being the Fountain of Life, and the first Original of the Motion of all the others; on which account it is call'dPrimus vivens, &ultimum moriens; that is to say, the first Member that begins to live, and the last that dies.
What Parts are to be consider'd in the Heart?
Its fleshy Substance, with all its Fibres turn'd round like the Skrews of a Vice; itsBasis, Point, Auricles, Ventricles, large Vessels,Pericardiumand Ligatures or Tyes: TheBasisis the uppermost and broadest part; the Point is the lowermost and narrowest part; the two Auricles or small Ears being as it were little Cisterns or Reservers, that pour the Blood by degrees into the Heart, are situated on each side above the Ventricles. The Ventricles, which are likewise two in Number, are certain Cavities in its Right and Left Sides. The large Vessels are theAortaor great Artery, and theVena Cavatogether with the Pulmonary Artery and Vein. ThePericardiumis a kind of Bag fill'd with Water, wherein the Heart is kept; which isfasten'd to theMediastinumby itsBasis, and to the large Vessels that enter and go out of its Ventricles.
What are the Terms appropriated to the continual beating of the Heart?
They areDiastoleandSystole, from whence proceed two several Motions, the first whereof is that of Dilatation, and the other of Contraction, communicated to all the Arteries which have the same Pulse.
To what use serves the Water contain'd in thePericardium?
It prevents the drying of the Heart by its perpetual Motion.
What are the Lungs?
They are an Organ serving for Respiration, of a soft Substance, and porous as a Sponge, being all over beset with Arteries, Veins, Nerves, and Lymphatick Vessels, and perforated with small Cartilaginous Tubes, that are imparted to it from the Wind-Pipe, and are call'dBronchia. Their Natural Colour is a pale Red, and marbl'd dark Brown; and their whole Body is wrapt up in a fine smooth Membrane, which they receive from thePleuron. They are suspended by the Wind-Pipe, by their proper Artery and Vein, and by the Ligatures that fasten them to theSternum,Mediastinum, and frequently to thePleuronit self: They are also divided into the Right and Left Parts by theMediastinum; having four or five Lobes, whereof those on the Left side cover the Heart. Their continual Motion consists inInspiration, to take in the Air, andExpiration, to drive it out. TheLarynxmakes the Entrance of the Wind-Pipeinto the Lungs, and thePharynxthat of theOesophagusor Gullet, at the bottom of the Mouth to pass into the Stomach.
What is the head?
It is a bony Part, that contains and encloseth the Brain within its Cavity.
What is most remarkable in the outward parts of the Head?
The Temporal Arteries, theCrotaphitæ, or Temporal Muscles, and the Sutures of the Skull.
Why are these things considerable?
The Temporal Arteries are of good Note, because they are expos'd on the outside, lying even with the Skin. TheCrotophiteMuscles are so likewise, in regard that they cannot be hurt without danger of Convulsions, by reason of thePericraniumwith which they are cover'd. And the Sutures, because theMeningesof the Brain proceed from thence to form thePericranium.
What is thePericranium?
It is a Membrane that lies under the thick hairy Skin of the Head, and immediately covers the Skull.
What are theMeninges?
They are two Membranes that enclose the Substance or Marrow of the Brain.
What is a Suture?
It is a kind of thick Seam or Stitch, that serves to unite the Bones of the Skull.
How many sorts of Sutures are there?
There are two sorts,viz.the true, and the false or Bastard.
What are the true Sutures?
They are three in number, namely theSagittal, theCoronal, and theLambdoidal.
What is the disposition or situation of the true Sutures?
TheSagittalis streight, beginning in the middle of the Fore-head, and sometimes at the root of the Nose, and being terminated behind, at the joining of the two Branches of theLambdoidal Suture.
The Coronal appears in form of a Crown, passing to the middle of the Head, and descending thro' the Temples, to finish its Circumference in the Root of the Nose.
TheLambdoidalSuture is made like an open Pair of Compasses, the Legs whereof are extended toward the Shoulders; and the Button is in the top of the Head backward.
What are the Bastard Sutures?
They are those that are call'dSquamousor scaly.
What is the disposition of natural situation of these false Sutures?
They are plac'd at the two sides of the Head, and make a Semi-Circle of the bigness of the Ears, round the same Ears.
What difference is there between the true and spurious Sutures.
The true Sutures are made in form of the Teeth of a Saw, which enter one into the other; and the false or Bastard ones are those that resemble the Scales of Fishes, whichare join'd together by passing one over the other.
What is the Use of the Sutures?
The Ancients were of Opinion, that they were made to hinder the Fracture of one Skull-Bone from passing thro' the whole Head; but there is more reason to believe that they have the three following Uses, that is to say, 1. To promote the transpiration of the Brain. 2. To give Passage to the Vessels that go to theDiploe. 3. To retain theMeninges, and to support the Mass of the Brain, which is cover'd by them.
What are the Names of the Bones that compose the Skull?
The Bone of the fore-part of the Head is call'dSinciput, or the Fore-head-Bone, as also theFrontalorCoronalBone. The Bone of the hinder-part, enclos'd within theLambdoidalSuture, is term'd theOccipital.The two Bones that form the upper-part, and are distinguish'd by the Sagittal Suture, bear the Name ofParietals, one being on the Right side, and the other on the Left. And those behind the Ears are call'dTemporal,Squamosa, orPetrosa. These also are distinguish'd into the Right and Left Temporals, and are join'd to the bottom of the Parietal by a bastard squamous Suture.
What is most remarkable in the thickness of the Skull-Bones?
TheDiploe, which is nothing else but aPlexusor Contexture of small Vessels, that nourish the Bones, and in the middle of their thickness make the distinction of the first and second Tablature of the Bones; whence it sometimeshappens that an exfoliative Trepan, or Semi-Trepan, is sufficient, when the first of these two Tables is only broken, the other remaining entire.
Is the Brain which is preserv'd in the Skull all of one Piece, or one equal Mass?
No, it is distinguish'd by the means of theMeningesinto the Brain it self, and theCerebellumor little Brain; the Brain, properly so called, takes up almost the whole Cavity of the Skull, and theCerebellumis lodg'd altogether in the hinder-part, where it constitutes only one entire Body; whereas the former is divided into the Right and Left Parts by theMeninges, which cut it even to the bottom; whence these Foldings are call'dFalx; i. e. aScytheorSickle.
What is chiefly remarkable in the Substance of the Brain?
The Ventricles or Cavities which are found therein, together with the great Number of Veins, Arteries, Lymphatic Vessels, and Nerves, that carry Sense to all the Parts of the Body, and Spirits for their Motion.
An exact Historical Account of all the Holes of the Skull, and the Vessels that pass thro' them.
To attain to an exact Knowledge of all the Holes with which the inside of theBasisof the Skull is perforated, they are to be consider'd either with respect to the Nerves, or to the Sanguinary Vessels.
There are nine Pairs of Nerves that arise from theMedulla Oblongata, and go forth out of the Skull through many Holes hereafter nam'd.
The first Pair is that of theOlfactoryNerves, appropriated to the Sense of Smelling, which are divided below theOs Cribiforme, or Sieve-like Bone, into divers Threads, that passing into the Nose through many Holes with which this Bone is pierc'd, are distributed to the inner Tunick of the Nose.
The second Pair is that of theOptickor Visual Nerves, that pass into the Orbits of the Eyes, thro' certain peculiar Holes made in theOs Sphenoides, or Wedge-like Bone, immediately above theAnterior Apophysis Clinoides.
In the Portion of theOs Sphenoides, that makes theBasisof the Orbit, lies a Fissure about seven or eight Hairs breadth long, which is to be observ'd chiefly at the bottom, that is to say, below the Hole, thro' which the Optick Nerve passeth; where it is almost round, and larger than at the top, where it is terminated in a very long and acute Angle.
There are many Pairs of Nerves that enter into the Orbit thro' this Fissure,viz.1. The third Pair, call'd theMotorii Oculorum. 2. The fourth Pair, nam'dPathetici, by Dr.Willis. And 3. The whole sixth Pair. Besides these three Pairs, which go entire thro' this Cleft, there is also a Passage for the upper Branch of the foremost Fibre of the fifth Pair, which the same renowned Physician calls theOphthalmickBranch. Beyond the lower-part of the said Fissure, toward the hinder-part of the Head, is to be seenin theOs Sphenoideson each side, a Hole that doth not penetrate theBasisof the Skull, but makes a kind ofDuctus, about an Hair's breadth long, which is open'd behind the Orbit on the top of the Space between theApophysis Pterygoides, and the third Bone of the Jaw; thro' thisDuctusruns the lower Branch of the foremost Fibre of the fifth Pair.
About the length of two Hairs breadth beyond theseDuctus's, we may also discover in theOs Sphenoides, or Wedge-like Bone, two Holes of an Oblong and almost Oval Figure, which are plac'd in the hindermost sides of that of theOs Sphenoides, and gives passage to the hindermost Fibre of the fifth Pair.
The Hole thro' which runs theAuditoryNerve, that makes the seventh Pair, is in the middle of the hinder-part of theOs Petrosum, that looks toward theCerebellum: This Hole being very large, is the Entrance of aDuctusthat is hollow'd in theOs Petrosum, and which sinking obliquely from the fore-part backward, for the depth of about two Hairs breadth, forms as it were the bottom of a Sack, the lowermost part whereof is terminated partly by theBasisof theCochlea, and partly by a Portion of the Mouth of theVestibulum. At the bottom of thisDuctusare many Holes, but the most considerable is that of the upper-part, thro' which passeth a Portion of the Auditory Nerve. This is also the Entrance of anotherDuctusmade in theOs Petrosum, which is open'd between theApophysis MastoidesandStyloides: These other Holes afford a Passage to the Branches of the soft Portion of the same Auditory Nerve.
Below thisDuctusthere is a remarkable Hole form'd by the meeting of two hollow Cuts the larger whereof is in the Occipital Bone and the other in the lower-part of theApophysis Petrosi: From the middle of the upper-part of this Hole issueth forth a small Prominence or bony Point, whereto is join'd an Appendix of theDura Mater, which divides the Hole into two parts; so that thro' the foremost Orifice passeth the Nerve of the eighth Pair, and that which is call'd theSpinalNerve. We shall have occasion hereafter to shew the Use of the hinder Orifice.
Near the great Hole of the Occipital Bone from whence proceeds theMedulla Oblongata, we may observe a Hole almost round and oblong thro' which passeth the Nerve of the ninth Pair. This Hole is entirely situated in the Occipital Bone, and making a little Way in the Bone passeth obliquely from the back-part forward. In the inside of the Skull this Hole is sometimes double, but its two Entrances are re-united in the outward-part of the Skull; and the two Branches that form the Origine of this Nerve and which pass thro' these two Holes, are likewise re-united at their Departure, These are the Passages of the nine Pairs of Nerves that proceed from theMedulla Oblongata, and it remains only to show that Paths thro' which the Intercostal Nerve goes forth, as also that of the tenth Pair. The Intercostal runs out of the Skull thro' theDuctusthat gives Entrance to the InternalCarotickArtery. As for the tenth Pair, in regard that it ariseth from the Marrow which is enclos'd between the OccipitalBone and the firstVertebra, it goes forth thro' the Hole of theDura Mater, where the Vertebral Artery enters.
To know well the Holes thro' which the Vessels that belong to the inner-part of the Head enter, and issue forth, it is requisite to distinguish them into those which are distributed to theDura Mater, and those that are appointed for the Brain. The Vessels of theDura Mater, are Branches of theCarotickor Vertebral Arteries.
In theOs Sphenoides, or Wedge-like Bone, behind the Hole thro' which passeth the hindermost Fibre of the fifth Pair of Nerves lies another small Hole, almost round, that gives Entrance to a Branch of theExternal CarotickArtery, which in entring, immediately adheres to theDura Mater, and forms many Ramifications to overspread the whole Portion of this Membrane, which covers the sides, and the upper-part of the Brain.
At the bottom and top of the lateral outward part of the Orbit of the Eye, above the acute Angle, for want of theOs Sphenoides, there is a Hole thro' which passeth an Artery, being a Twig of a Branch of theInternal Carotick, which is diffus'd in the Eye, and distributed to almost the whole Portion of theDura Mater, that covers the fore-part of the Brain.
The Vertebral Artery in entring into the Skull, furnisheth it on each side with a considerable Branch, which is dispers'd throughout the whole Portion of theDura Materthat covers theCerebellum.
As for the Veins that accompany these Arteries, they almost all go out of the Skull thro' the same Holes where the other enters.
There are four thick Arteries which convey to the Brain the Matter with which it is nourish'd, and that whereof the Spirits are form'd,viz.the twoInternal Caroticks, and the twoVertebrals.
TheInternal CarotickArteries enter into the Skull thro a particularDuctusmade in the Temporal Bone, the Mouth thereof being of an Oval Figure and situated in the outward part of theBasisof the Skull, before the Hole of theInternal Jugular.ThisDuctusextends it self obliquely from the back-side forward, and after having made about three Hairs breadth in length, is terminated in the hinder-part of theOs Sphenoides. The Artery traverseth the whole winding Compass of thisDuctus, which resembles the Figure of theRomanLetter S, and at the Mouth of the sameDuctusruns under theDura Materalong the sides of theOs Sphenoidesto theAnterior Apophyses Clinoides, where it riseth up again, to perforate theDura Mater, and to adhere to the Root of the Brain. These Vessels, in like manner, after their departure from the Bone of the Temples to the place where they pierce theDura Mater, make a second Circuit in form of theRomanCharacter S. At the place where theseCarotickArteries penetrate theDura Mater, they send forth a thick Branch, which enters into the Orbit of the Eye, by the lower-part of the Hole, thro' which theOptickNerve hath its Passage.
TheVertebralArteries proceeding from the Holes of the transverseApophysesof the firstVertebra, turn about in passing under the upper obliqueApophysesof the sevenVertebra's: Afterward they perforate theDura Mater, and running under the Marrow, enter into the Skull thro' the Occipital Hole; then inclining one toward another, they are re-united, and form only one single Trunk.
The Veins that bring back the Blood from the Substance of the Brain, are emptied into theSinus'sof theDura Mater, which are all discharg'd into those that are call'dLateral, which last go out of the Skull immediately under the Nerves of the eighth Pair, thro' the hinder-part of the Hole made by the meeting of theOccipitalBone, and theApophysis Petrosa. These LateralSinus'sfall into theInternal Jugulars, which are receiv'd into a considerable Sinking hollow'd on each side in the outward, part of theBasisof the Skull, which is nam'd the Pit or Hole of theInternal Jugular.
In the upper and hinder-part of the Hole, from whence the lateralSinus'sissue forth, is to be seen an opening in the Extremity of aDuctus, the Mouth whereof lies behind theCondyli, which are on the sides of the Occipital Trunk: ThisDuctusis extended about the length of two Hairs breadth in the Bone, and the Canal enclos'd therein is open'd immediately into theVertebral Sinus: So that one might affirm it to be as it were its Original Source. Whence it appears that the Blood contained in the lateralSinus'sis emptied thro' two places; the greater Portion thereof descending in theJugularsfrom the Neck, and the other in theVertebral Sinus's: Sometimes thoseDuctus'sare four only on one side, another while both are stopt up, and the Blood contain'd in the lateralSinus'sis discharg'd into theInternal Jugulars.
Behind theApophysis Mastoideson each side is a remarkable Hole, thro' which passeth a thick Vein, which brings back part of the Blood that hath been distributed to the Teguments and Muscles, which cover part of theOcciputor hinder-side of the Head: This Vein is open'd into the lateralSinus'sat the place where they begin to turn about. But in the Heads of some Persons, this Hole is found only on one side, and even sometimes not at all, in which case the Blood contain'd in the Vessels falls into theExternal Jugulars, with which the Branches of this Vein have a Communication.
In eachParietalBone on the side of theSagittalSuture, at a little distance from theLambdoidal, appears a Hole, thro' which passeth a Vein, that brings back the Blood of the Teguments of the Head, and dischargeth it self into the upperLongitudinal Sinus. These Holes are sometimes on both; and then the Blood contain'd in the Branches of this Vein runs into theExternal Jugulars.
In the middle of theSellaof theOs Sphenoides, we may observe one or two small Holes thro' which (according to the Opinion of some Modern Anatomists) theLymphacontain'd in theGlandula Pituitariais throwninto theSinusof the edge of theOs Sphenoides; nevertheless it is certain, that these Holes are fill'd only with Sanguinary Vessels, which carry and bring back the Blood of the Bones and Membranes, whereof thoseSinus'sare compos'd; besides that, these Holes are rarely found in adult Persons.
Between the Spine of theCoronalSuture and theCrista Galli, is a Hole which serves as an Entrance for aDuctus, which sinks from the top to the bottom, the length of about two Hairs breadth in the thickness of the inner Table of theCoronal: The Root of the upperLongitudinal Sinusis strongly implanted in this Hole, which also affords a Passage to some Sanguinary Vessels appointed for the Nourishment of this inner Table.
Many other small Holes are found in divers places of theBasisof the Skull; the chief whereof are those that are observ'd in theApophysis Petrosa, and give Passage to a great number of Vessels that serve for the Nutriment of that part of the Temporal Bone which is call'd theTympanum, or Drum: The other Holes are principally design'd for the Vessels that are serviceable in the nourishing of divers parts of theBasisof the Skull.
After what manner is the opening of the Head or Skull perform'd?
It is done by sawing it asunder round about and above the Ears; then it is taken off, after having before cut off the Hair, and made a Crucial Incision in the Skin from the fore-part to the hinder, and from one Ear to the other; as also after havingpull'd off and laid down the four Corners to the bottom.
How is the Brain anatomiz'd?
It is done by cutting it Superficially, and by Leaves, in order to discover by little and little the Ventricles, Vessels, and Nerves, with their Original Sources, &c. Or else it is taken entire out of the Skull, (the Nerves having been before examin'd) and laid down; so that without cutting any thing, all the parts of the Brain may be set in their proper places, to find out those that are sought for.
What is a Strap?
It is a kind of Band commonly made use of for the Extension of the Members in the reducing of Fractures and Luxations; or else in binding Patients, when it is necessary to confine them, for the more secure performing of some painful Operation: These sorts of Ligatures have different Names,according to their several Uses, and often bear that of their Inventer.
What is the Matter whereof these Straps are compos'd?
They may be of divers sorts, but are usually made of Silk, Wooll, or Leather.
What is a Swathing-Band?
It is a long and broad Band, that serves to wrap up and contain the Parts with the Surgeons Dressings or Preparatives.
Of what Matter are these Swathing-Bands made?
They are made at present of Linnen-Cloth but in the time ofHippocrates, were made of Leather or Woollen-Stuff.
How many sorts of Swathing-Bands are there in general?
There are two sorts,viz.the Simple and Compound; the former are those that are smooth, having only two ends; and the other are those which are trimm'd with Wooll, Cotton, or Felt, or that have many Heads, that is to say, Ends, fasten'd or cut in divers places according as different Occasions require.
What are the Conditions requisite in the Linen-Cloth, whereof the Swathing-Bands are made?
It must be clean, and half worn out, not having any manner of Hem or Lift.
What are the Names of the different Swathing-Bands?
There are innumerable, but the greater part them take their Denominations from their Figure or Shape; as the Long, Streight, Triangular, and those which have many Heads, or are trimm'd.
What is A Bandage?
It is the Application of a Swathing-Band to any Part.
How many sorts of Bandages are there?
As many as there are different Parts to be bound; some of them being Simple, and others Compound: The former are those that are made with an uniform Band; as the Bandage call'd theTruss, and divers other sorts: The Compound are those that consist of many Bands set one upon another, or sew'd together; or else those that have many Heads. They have also particular Names taken from the Inventers of them, or from their Effect; asExpulsiveBandages to drive back,Attractiveto draw forward,Contentiveto contain,Retentiveto restrain,Divulsiveto remove,Agglutinativeto rejoin, &c.
There are others whereto certain peculiar Names are appropriated; asBridlesfor the lower Jaw,Slingsfor the Chin, the back part of the Head, Shoulder, andPerinæum;Scapulariesfor the Body, after the manner of the Scapularies of Monks;Trussesfor Ruptures;Stirrupsfor the Ankle-Bones of the Feet, in letting Blood, and upon other Occasions. Lastly, there are an infinite Number of Bandages, the Structure whereof is learnt by Practice, in observing the Methods of able Surgeons, who invent them daily, according to their several Manners; and the firstIdeasof these can only be taken in reading Authors that have treated of them.
What are the general Conditions to be observ'd in the Bandages?
There are many,viz.1. Care must be taken that the Bands be roll'd firm, and that they be not too streight nor too loose. 2. They are to be untied from time to time in Fractures, they must also be taken away every three or four Days, to be refitted. 3. They must be neatly and conveniently roll'd, that the Patient may not be uneasie or disquieted.
What ought to be observ'd in fitting the Bolsters?
Care must be taken to make them even, soft, and proportionable to the bigness of the Part affected; to trimm them most in the uneven places, that the Bands may be better roll'd over them, and to keep them continually moisten'd with some Liquor proper for the Disease as well as the Bands.
In treating of every Disease in particular, we shall shew the manner of making the particular Bandage that is convenient for it.
In treating of every Disease in particular, we shall shew the manner of making the particular Bandage that is convenient for it.
What is a Tumour?
A Tumour is a rising or bloated Swelling rais'd in some part of the Body by a Setling of Humours.
How is this setling of Humours produc'd?
Two several ways,viz.byFluxionandCongestion.
What is the Setling by Fluxion?
It is that which raiseth the Tumour all at once, or in a very little space of time, by the Fluidity of the Matter.
What is the Setling by Congestion?
It is that which produceth the Tumour by little and little, and almost insensibly, by reason of the slow Progress and thickness of the Matter.
Which are the most dangerous Tumours, those that arise from Fluxion, or those that derive their Original from Congestion?
They that proceed from Congestion, because their thick and gross Matter always renders 'em obstinate, and difficult to be cur'd.
Whence do the differences of Tumours proceed?
They are taken,first, from the Natural Humours,Simple,Mixt, andAlter'd:Simple, as thePhlegmon, which is made of Blood, and theErysipelasof Choler;Mixt, as theErysipelas Phlegmon, which consists of Blood mingl'd with a Portion of Choler; or thePhlegmonous Erysipelas, which proceeds from Choler intermixt with a Portion of Blood:Alter'd, as theMeliawhich is compos'd of many Humours, that can not be any longer distinguish'd by reason of their too great Alteration.Secondly, the difference of Tumours is taken from their likeness to some other thing, as the Carbuncle and theTalpa, the former resembling a burning Coal, and the other a Mole, according to the Etymology of theirLatinNames.Thirdly, From the Parts where they are situated; as the Ophthalmy in the Eye and the Quinsey in the Throat.Fourthly, from Disease that causeth 'em, as Venereal and Pestilential Buboes.Fifthly, from certain Qualities found in some, and not in others; as theEncystedTumours, which have their Matter clos'd within their properCystesor Membranes, and so of many others.
How many kinds of Tumours are there that comprehend at once all the particular Species?
They are four in Number,viz.the Natural Tumours, the Encysted, the Critical, and the Malignant.
What are natural Tumours?
They are those that are made of the four Humours contain'd in the Mass of the Blood, or else of many at once intermixt together.
What are the four Humours contain'd in the Mass of the Blood?
They are Blood, Choler, Phlegm, and Melancholy, every one whereof produceth its particular Tumour: Thus the Blood produces thePhlegmon, Choler theErysipelas, Phlegm theOedema, and Melancholy theScirrhus.The Mixture of these is in like manner the Cause of theErysipelatous Phlegmon, theOedomatous PhlegmonorPhlegmonous Erysipelas, and thePhlegmonous Oedema, according to the quality of the Humours which are predominant, from whence the several Tumours take their Names.
What are theEncystedTumours?
They are those the Matter whereof is contain'd in certainCystes, or Membranous Bags; as theMeliceris, and theStrumaor Kings-Evil.
What are Critical Tumours?
They are those that appear all at once in acute Diseases, and terminate them with good or bad Success.
What are Malignant Tumours?
They are those that are always accompany'd with extraordinary and dreadful Symptoms, and whose Consequences are also very dangerous; as the Carbuncle in the Plague.
What are Impostumes or Abcesses, Breakings out and Pustules?
Indeed, it may be affirm'd, that all these kinds of Tumours scarce differ one from another, except in their size or bigness; nevertheless, to speak properly, by the Names of Impostumes or Abcesses are understood gross Tumours that are suppurable, or may be dissolv'd, and by those of Breakings out and Pustules, only simple Pusteal Wheals, or small Tumours, that appear in great Numbers, and which frequently do not continue to Suppuration; some of them consisting of very few Humours, and others altogether of dry Matter.
What difference is there between a Tumour and an Impostume or Abcess?
They differ in this particular, that all Tumours are not Impostumes nor Abcesses; but there is no Impostume nor Abcess that is not a Tumour: As for Example, Wens andGanglionsare Tumours, yet are not Abcesses nor Impostumes; whereas these last are always Tumours in regard that they cause Bunches and Elevations.
What ought a Surgeon chiefly to observe in Tumours, before he undertake their Cure?
He ought to know three things,viz.1. The Nature or Quality of the Tumour. 2. Thetime of its formation and 3. Its situation: The Quality of the Tumour is to be known, because the Natural one is otherwise handl'd than that which is Encysted, Critical or Malignant. As for the time of its Formation, it is four-fold,viz.the Beginning, Increase, State, and Declination, wherein altogether different Remedies are to be apply'd. The Situation of the Tumour must be also observ'd, because the dressing and opening of it ought to be as exact as is possible, to avoid the meeting with an Artery or neighbouring Tendon.
How many ways are all the Tumours that are curable, terminated?
They are terminated after two manners,viz.either by dissolving 'em, or by Suppuration.
Are not theScirrhusand theEsthiomenusor Gangrene, two means that sometimes serve to terminate and cure Impostumes?
Yes, but it is done imperfectly, in regard that a Tumour or Impostume cannot be said to be absolutely cur'd, as long as there remains any thing of the Original Malady, as it happens in theScirrhus, where the Matter is harden'd by an imperfect dissolving of it, or when the Impostume degenerates into a greater and more dangerous Distemper, as it appears in theEsthiomenusor Gangrene that succeeds it.
Which is the most effectual means of curing Impostumes, that of dissolving, or that of bringing them to Suppuration?
That of dissolving 'em is without doubt the most successful, and that which ought to be us'd as much as is possible; nevertheless some Cases are to be excepted, wherein the Tumoursor Abcesses are Critical and Malignant; for then the way of Suppuration is not only preferable, but must also be procur'd by all sorts of means, even by opening; which may be done upon this occasion, without waiting for their perfect Maturity.
What are the Precautions whereto a Surgeon ought to have regard before he undertake the opening of Tumours?
He must take care to avoid cutting the Fibres of the Muscles, and in great Abcesses, to cause all the corrupt Matter to be discharg'd at once, to prevent the Patient's falling into a Swoon.
Ought the opening of Tumours always to be made longitudinally, and according to the direct Course of the Fibres?
No, it is sometimes necessary to open 'em with a Crucial Incision, when they are large, or when aCystisor Membranous Vehicle is to be extirpated.
How many sorts of Matter are there that issue forth in the Suppuration of Tumours?
There are four sorts,viz.thePus,Ichor,Sanies, andVirus.
What isPus?
It is a thick Matter, and white as Milk.
What isIchor?
It is a thick Matter like thePus, but of divers Colours.
What isSanies?
It is a watery Matter that riseth up in Ulcers, almost after the same manner as the Sap in Trees.
What isVirus?
It is a kind of watry Matter, being whitish, yellowish, and greenish at the same time; which issueth out of Ulcers, very much stinking, and is endu'd with corrosive and malignant Qualities.
How many general Causes are there of Tumours?
There are three,viz.the Primitive, the Antecedent, and the Conjunct: The Primitive is that which gives occasion to the Tumours; as for Example, a Fall or a Blow receiv'd. The Antecedent is that which supplies it with Matter, such is the Mass of Blood that thickens and maintains thePhlegmon. Lastly, the Conjunct Cause is the overflowing Blood or Matter, which immediately forms the Tumor.
What regard ought to be had to these three sorts of Causes in the Cure?
The Primitive Cause may be prevented by avoiding the Falls, Blows, or other Hurts, and the Antecedent by diminishing the Plethory of the Blood, and cooling the whole Mass by Phlebotomy. The Conjunct Cause, which is the overflowing of the Blood, may be also remov'd in dispersing it by dissolving, or else in discharging it by Suppuration.
What is aCrisis?
It is a sudden setling of Humours, which happens in Diseases, whereby they are usually terminated.
How are these Critical Setlings effected?
By the Strength of Nature, which either expels the peccant Humours thro' the Belly, or carries them to the Habitude of the Body; for in the former she causeth Fluxes of Humours, Urine and Blood; as in the other she excites Sweatings, Tumours, and even a Gangrene it self.
In what Parts do the Critical Tumours usually arise?
In the Glandules, which the Ancients call'd theEmunctoriesof the Brain, Heart, and Liver; for they gave the Name of Emunctories of the Brain to the thick Glandules which lie under the Ears, that of the Emunctories of the Heart to those that are under the Arm-Pits; and that of the Emunctories of the Liver to those under the Groin. Now Malignant Tumours may arise in all these parts, but the Venereal happen only in the Groin.
What is aPhlegmon?
It is a red Tumour occasion'd by the Blood diffus'd in some part, wherein it causeth extension, pain, and heat with beating.
AreAneurismsandVarices,which are Tumours, made by the Blood, to be reckon'd among thePhlegmons?
No, because the Blood that forms theAneurismsandVaricesis not extravasated nor accompany'd with Inflammation, but only a Tumour of Blood proceeding from the Dilatation of the Arteries and Veins.
MayEchymosesor Contusions consisting of extravasated Blood, be esteem'd asPhlegmons?
By no means, in regard that it is not sufficient that the Blood be extravasated for the producing of aPhlegmon; it must also cause Pain, Heat, and a Beating, with Inflammation, which is not to be found in theEchymoses, except in great ones, after they have been neglected for a long time; where the corrupted Blood ought to be let out immediately, to prevent the Inflammation, overmuch Suppuration, and many other ill Consequences.
Is thePhlegmonalways compos'd of pure Blood?
No, it may happen sometimes to partake of Choler, Phlegm, or Melancholy; on which account it is nam'd anErysipelatous,Oedomatous, orScirrhous Phlegmon, always retaining the Name of the predominant Humour, which is the Blood; and so of the others.
What are the Remedies proper for aPhlegmon?
They are of two sorts,viz.General and Particular; the former having regard to the antecedent cause, and the other to the conjunct. ThePhlegmonis cur'd in its antecedent Cause, by Phlebotomy or letting Blood, by good Diet, and sometimes by Purgations, by which means the Plethory, Heat, and Alteration of the Blood is diminished; But Fomentations, Cataplasms and Plaisters facilitate the Cure in the conjunct cause, either by dissolving the Tumour, or bringing it to Suppuration.
At what time is the Opening of a Vein necessary?
In the Beginning and Increase.
What are the Remedies proper to be us'd immediately upon the first appearing of the Tumour?
They are Resolvents and Anodynes; such as those that are prepar'd with Chervil boil'd in Whey, adding a little Saffron to wash the Tumour, and soak the Linnen Cloaths apply'd thereto, which are often renew'd, and may be laid on with the Chervil.
Or else take the Urine of a healthful Person, wherein is boil'd an Ounce of Saffron for a Glass, and bath the Tumour with it.
The Sperm of Frogs is also made use of to very good purpose, either alone, or with Lime-Water and Soap mixt together; or Oak-Leaves and Plantane beaten small, and apply'd. But Care must be more especially taken to avoid cooling Medicines, Oils, and Grease, which are pernicious in great Inflammations.
What ought to be done in the increase of the Tumour and Pain?
They are to be asswag'd by mollifying and dissolving; to which end a Cataplasm or Pultis is to be made with the Leaves of Elder, Wall-wort or Dwarf-Elder, Mallows, Violet-Plants, Camomile, and Melilot; whereto is added beaten Line-seed; causing the whole Mass to be boil'd in Whey, and allowing to every Pint, or thereabout, a Yolk of an Egg, twenty Grains of Saffron, a quarter of a Pound of Honey, and the Crum of white Bread, till it comes to a necessary Consistence. Or else take Cow's Dung instead of the above-mention'dHerbs, and mix with it all the other Ingredients, to make a Cataplasm, which must be renew'd at least every twelve Hours.
What is to be done in the State?
If the Tumour cannot be dissolv'd (as was intended) it must be brought to Suppuration by Cataplasms, consisting of these Ingredients,viz.Garlick, White Lillies roasted under Embers, Milk, andUnguentum Basilicon.
Or else only take a Glass of Milk, in which an Ounce of Soap is dissolv'd, to wet the Linnen apply'd to the Tumour; and let it be often reiterated: Otherwise make use of Sorrel boil'd with fresh Butter, and a little Leaven or Yeast. The PlaisterDiasulphurisis also most excellent either alone, or, if you please, mixt withDiachylonandBasilicon.
What is to be done in the Declination after the Suppuration?
The Ulcer must be at first gently dry'd with a Plaister ofDiasulphurisorDiachylon, and afterward that ofDiapalmamay be us'd, and Ceruse or White Lead.
What Method is to be observ'd in case there be any Disposition toward a Gangrene?
It is requisite during the great Inflammation to make use of good Vinegar, in an Ounce whereof is dissolv'd a Dram of White Vitriol, with as muchSal Ammoniack, to bath the Tumour: Or else take the Tincture of Myrrh and Aloes, with a littleUnguentum Ægyptiacum, and afterward make a Digestive of Turpentine, the Yolk of an Egg, and Honey, mingling it with a little Spirit of Wine, or Brandy, if there remains any Putrifaction or Rottenness.
Remedies forAneurismsandVarices.
What is to be done in order to cure anAneurism?
When it is little, as that which happens after an Operation of Phlebotomy or letting Blood ill perform'd, it may be sufficient to lay upon the affected Part a thin Plate of Lead, or else a Piece of Money or Counter wrapt up in a Bolster, and to bind it on very streight: But a Piece of Paper chew'd is much better for that purpose.
If theAnuerismbe considerable, an Astringent Plaister may be us'd, such as the following.
TakeBolus, Dragon's Blood, Frankincence, Aloes, andHypocystis, of each a Dram; mingle the whole with two beaten Eggs, and add Wax to give it the consistence of a Plaister, which may be apply'd alone, or mixt with an equal Portion ofEmplastrum contra Rupturam, always making a small Bandage to keep it on.Emplastrum de Cicutahath also a wonderful effect.
When theAneurismis excessive, it is absolutely necessary to proceed to a Manual Operation, the manner whereof shall be shewn hereafter in the Treatise of great Operations.
What is requisite to be done in theVarices?
Varicesare not generally dangerous, but even conduce to the preservation of Health; nevertheless, if they become troublesome by reason of their greatness, and the Pains that accompanie 'em, they may be mollify'd with the following Remedy.
Take the Mucilages of the Seeds ofPsylliumand Line, of each two Ounces; ofPopuleontwo Ounces;Oleum Lumbricorum&Hyperici, of each one Ounce; and of the Meal of Wheat one Ounce, adding Wax to make the Consistence of a Plaister; part of which spread upon Linnen or Leather, must be apply'd to theVarix, and ty'd thereto with a small Band.
If the Blood abound too much, it may be discharg'd by the Application of Leeches, or by a Puncture made with a Lancet: Afterward lay upon the Part a Piece of Lead sow'd up in a Cloth, and let it be kept close with a proper Bandage. Otherwise you may make use of an Astringent, such as this.
Take a Pomegranate, cut it in pieces, and boil it with as much Salt as may be taken up with the Tip of your Fingers, in a Gallon of strong Vinegar; then dip a Spunge in this Vinegar, apply it to theVarix, bind it on, and continue the use of it twice a Day for a Month together.
How areEchymosesto be treated?
All possible means must be us'd to dissolve 'em, by laying Slices of Beef upon the Part, renewing 'em very often, or applying Linnen Rags dipt in Spirit of Wine impregnated with Saffron.
They may be also dissolv'd with the Roots of Briony grated and apply'd thereto, or else with Plaister or Mortar, Soot, Oil of Olives andUnguentum Divinum, a Mixture whereof being made, is to be put between two Rags, and laid upon the Tumour or Swelling.
If theEchymosishappens in a Nervous Part, Balsam ofPerumay be us'd, or, for want thereof,Oleum Lumbricorum&Hyperici, with luke-warm Wine, with which the Bolsters must be soak'd, to be laid upon it.
When theEchymosisis great, and much Blood is diffus'd between the Skin and the Flesh, the safest way is to make an Opening to let it out, lest a too plentiful and dangerous Suppuration should ensue, or even a Gangrene it self. However, a Surgeon ought to proceed in the curing of anEchymosisin the Face with great Circumspection, which must be always prepar'd for Incision.
What are the Tumours or Impostumes that partake of aPhlegmon?
They are theBubo, Carbuncle,Anthrax,Furunculus,Phyma,Phygeton,PanaritiumorParonychia, Burn, Gangrene, and Kibe or Chilblain.
What is aBubo?
ABubois a Tumour which ariseth in the Groin, being accompany'd with Heat, Pain, Hardness, and sometimes a Feaver.
What is a Carbuncle?
A Carbuncle is a hard Swelling, red, burning, and inseparable from a Fever: It is cover'd with a black Crust or Scab, that afterward falls off at the Suppuration, leaving a deep and dangerous Ulcer, and which sometimes doth not suppurate at all.
What is anAnthrax?
TheAnthraxis very near the same thing as the Carbuncle, only with this difference, that the latter always appears in the Glandulous Parts, and theAnthraxevery where else.
What is aFurunculus?
It is a kind of Boil, or benign Carbuncle, which somewhat resembles the Head of a Nail, and is on that Account call'dClouby theFrench, causing Pains, as if a Nail were driven into the Flesh.
What is aPhygeton?
ThePhygetonis a small, red, and inflam'd Exuberance, situated in the Miliary Glandules of the Skin, where it causeth a pricking Pain, without Suppuration.
What is aPhyma?
ThePhymaappears after the same manner as thePhygeton, and suppurates.
What are the Remedies proper for all these sorts of phlegmonous Tumours and Impostumes?
They are Cataplasms and Plaisters Anodyn, Emollient, Resolvent, and Suppurative, which are us'd proportionably as in thePhlegmons.
What is aGangrene,Sphacelus, orEsthiomenus?
TheGangreneandSphacelussignifie the same thing, nevertheless are commonly distinguish'd; the former being a Mortification begun, and theSphacelusan entire or perfect Mortification; call'd alsoNecrosisandSideratio. AnEsthiomenusis a Disposition to Mortification, discover'd by the softness of the Part; and a Gangrene is defin'd to be a Mortification of a Part, occasion'd by theInterception of the Spirits, and the Privation of the Natural Heat.
What are the causes of a Gangrene in general?
Every thing that can hinder the Natural Heat from exerting it self in a Part; as strong Ligatures, astringent or resolvent Medicines, not conveniently us'd in great Inflammations; a violent Hæmorrhage; or Old Age, whereby the Spirits are exhausted; the bitings of Mad Dogs; excessive Cold,&c.
By what Signs is the Gangrene known?
It is discover'd by the livid Colour of the Skin, which departs from the Flesh, the softness, coldness, and insensibility of the Part; and sometimes by its dryness and blackness, from whence exhales a cadaverous Stench, withSaniesissuing forth after Punctures or Scarifications made therein. Lastly, a Gangrene is perceiv'd by the cold Sweats, Swoonings,Syncope's, andDelirium'sthat invade the Patient, and which are all the Fore-runners of approaching Death.
Is a Gangrene only found in the Flesh, and soft Parts of the Body?
It happens also in the Bones; and is then call'dCaries.
How is thisCariesor Gangrene of the Bone discover'd, when it lies hid under the Flesh?
It is known by the black Colour of the Neighbouring Flesh, the Stink of theSaniesthat comes forth, the intolerable Pains felt thereabouts, which are fix'd and continual before the Impostume and Ulcer appear; but when the Ulcer is made, a kind of roughness may be perceiv'd in the Bone.
What are the Remedies proper for a Gangrene?
They are those that take away themortify'dand corrupt Parts, and recall the Natural Heat; both which Indications are exactly answer'd in the Extirpation of what is already corrupted, with the Incision-Knife; and the Restauration of the Natural Heat by the following Remedies.
Take an Ounce of good Vinegar, steeping therein a Dram of White Vitriol, with as muchSal Ammoniack: Let it be us'd in bathing the Part; and apply thereto Bolsters well soak'd in the same Liquor. This Remedy is convenient in the first Disposition toward a Gangrene: Or, if you please, you may make use of the Yellow Water, which is made with Corrosive Sublimate and Lime-Water; taking, for Example, half a Dram of Corrosive Sublimate to be infus'd in a Pint of Lime-Water.
But a Tincture of Myrrh and Aloes is more efficacious, whereinUnguentum Ægyptiacumis steep'd; or else Lime-Water kept for that purpose, in which have been boil'd two Ounces of Sulphur or Brimstone, with two Drams ofMercurius Dulcis; adding four Ounces of Spirit of Wine, to make an excellentPhegedænickWater, with which the Part may be bathed, and the Bolsters soak'd.
If the Gangrene passeth to the Bone, the Ulcer must be immediately cleans'd with Brandy, andEuphorbiumafterward put into it, laying also some upon the Bolsters, andabstaining from all sorts of Oils and Greases. But if these Remedies prove unprofitable, recourse is then to be had to the Incision-Knife, Fire, or Amputation; the manner of performing which several Operations, is explain'd hereafter.
What are Kibes or Chilblains?
They are painful Tumours, which are often accompany'd with Inflammation; they happen more especially in the nervous and outward Parts, as the Heel, and are so much the more sensibly felt, as the Air and Cold are more sharp and Vehement.
What is to be done in order to cure these Kibes or Chilblains?
The Heel or affected Part must be wash'd and dipt in Wine boil'd with Allum and Salt, whereof a Cataplasm may be afterward made, by adding Meal of Rye, Honey, and Brimstone. The Juice of a hot Turnep apply'd withUnguentum Rosatum, is also very good, orPetroleumalone.
What is aPanaritium?
PanaritiumorParonychia, is a Tumour which generally ariseth in the Extremity of the Fingers, at the Root of the Nails: It is red, and accompany'd with very great Pain, even so exquisite, that the whole Arm is sensible thereof, insomuch that a Fever sometimes ensues, and a Gangrene; the Humour being contain'd between the Bone and thePeriosteum, or that little Membrane with which it is immediately invested.
What Remedies are convenient for the curing ofPanaritium?
Anodyn Cataplasms are to be first apply'd, that is to say, such as serve to asswage excessive Pain, as that which is compos'd of Millk, Line-seeds beaten, large Figs, the Yolk of an Egg, Saffron, Honey andOleum Lumbricorum, with the Crum of white Bread. Afterward you may endeavour to dissolve it, by applying Oil of Almonds,Saccharum Saturni, and Ear-Wax, or else Balsam of Sulphur. The Plaister of Mucilages, and that of Sulphur or Brimstone, dissolv'd in Wine, is also a most excellent Resolvent and Anodyn.
If it be requisite to bring this Tumour to Suppuration, white Lillies roasted under Embers may be added to the preceeding Cataplasm; or else a new Cataplasm may be made with Sorrel boil'd, fresh Butter, and a little Leaven.
What is a Burn?
A burn is an Impression of Fire made upon a Part, wherein remains a great deal of Heat, with Blisters full of serous Particles, or Scabs, accordingly as the Fire hath taken more or less effect.
What are the Remedies proper for a Burn?
A Burn is cur'd by the speedy Application of fresh Mud re-iterated many times successively; by that of peel'd Onions,Unguentum Rosatum, andPopuleon, mixt with the Yolk of an Egg and unslack'd-Lime: Cray-Fishes or Crabs pounded alive in a Leaden-Mortar; and a great Number of other things.
If the Burn be in the Face, you may more especially take the Mucilages of the Seeds of Quinces andPsyllium, and Frog's-Sperm, ofeach an equal quantity, adding to every four Ounces twenty Grains ofSaccharum Saturni. This Composition may be spread on the Part with a Feather, and cover'd with fine Brown Paper. It is an admirable and approved Receipt.
If the Burn hath made an Escar or Crust, it may be remov'd with fresh Butter spread upon a Colewort or Cabbage Leaf, and apply'd hot. But in Case the Scab is too hard, and doth not fall off, it must be open'd, to give passage to thePusor corrupt Matter, the stay of which would occasion a deep Ulcer underneath. The same Method is to be observ'd in the Pustules or Blisters, two Days after they are rais'd, applying also the Ointment of quick Lime, Oil of Roses, and Yolks of Eggs.
What is anErysipelas?
AnErysipelas, commonly call'dSt. Anthony's Fire, is a small Elevation produc'd by a Flux of Choler dispers'd and running between the Skin and the Flesh. It is known by its yellowish Colour, great Heat and Prickings.