CHAP. I.
Of the Qualifications of a Surgeon, and of the Art of Surgery.
Who is a Surgeon?
A Person skill'd in curing Diseases incident to Humane Bodies by a methodical Application of the Hand.
What are the Qualifications of a good Surgeon in general?
They are three in Number: viz. Skill in the Theory, Experience in the Practical part, and a gentle Application of the Hand.
Why ought a Surgeon to be skilful?
Because without a discerning Faculty he can have no certainty in what he doth.
Why must he be experienc'd?
Because Knowledge alone doth not endue him with a dexterity of Hand requisite in such a Person, which cannot be acquir'd but by Experience, and repeated Manual Operations.
Why must he be tender-handed?
To the End that by fit Applications he may asswage those Pains which he is oblig'd to cause his Patients to endure.
What is Chirurgery or Surgery?
It is an Art which shews how to cure the Diseases of Humane Bodies by a methodical Manual Application. The Term being derived from the Greek Word ?e??, signifying a Hand and ?????, a Work or Operation.
After how many manners are Chirurgical Operations usually perform'd?
Four several ways.
Which be they?
I. Synthesis, whereby the divided Parts are re-united; as in Wounds. II. DiÆresis, that divides and separates those Parts, which, by their Union, hinder the Cure of Diseases, such is the continuity of Abscesses or Impostumes which must be open'd to let out the purulent Matter. III. ExÆresis, which draws out of the Body whatsoever is noxious or hurtful, as Bullets, Arrows, &c. IV. Prosthesis adds some Instrument or Body to supply the defect of those that are wanting; such are Artificial Legs and Arms, when the Natural ones are lost. It also furnishes us with certain Instruments to help and strengthen weak Parts, such as Pessaries, which retain the Matrix in its proper place when it is fallen, Crutches to assist feeble Persons in going, &c.
What ought to be chiefly observed before the undertaking an Operation?
Four things; viz. 1. What the Operation to be perform'd is? 2. Why it is perform'd? 3. Whether it be necessary or possible? And 4. The manner of performing it.
How may we discern these?
The Operation to be perform'd may be known by its Definition; that is to say, by explaining what it is in it self: We may discover whether it ought to be done, by examining whether the Distemper cannot be cur'd otherwise: We may also judge whether it be possible or necessary, by a competent Knowledge of the Nature of the Disease, the Strength of the Patient, and the Part affected: Lastly, the manner of performing it may be found out, by being well vers'd in the Practice of Surgery.
What are the Fundamental Principles of Surgery?
They are Three in number: viz. 1. The knowledge of Man's Body. 2. That of the Diseases which require a Manual Operation. 3. That of proper Remedies and Helps upon every Occasion.
How may one attain to the Knowledge of Humane Bodies?
By the study of Anatomy.
How may one learn to know the Distempers relating to Surgery, and the Remedies appropriated for them?
Two several ways; viz. 1. By the reading of good Books, and Instructions receiv'd from able Masters of that Art. 2. By practice and the Observation of what is perform'd by others upon the Bodies of their Patients.
What are the Diseases in general that belong to Surgery?
They are Tumours, Impostumes, Wounds, Ulcers, Fractures, Dislocations, and generally all sorts of Distempers whereto Manual Operations may be applyed.
What are the Instruments in general which are commonly used in Surgery for the curing of Diseases?
They are Five; viz. the Hand, Bandages, Medicines, the Incision-Knife, and Fire.
What is the general Practice which ought to be observ'd in the Application of these different helps?
Hippocrates teacheth us, in saying, that when Medicines are not sufficient, recourse may be had to the Incision-Knife, and afterward to Fire; intimating that we must proceed by degrees.
Are there any Distempers that may be cured by the Surgeon's Hand alone?
Yes, as when a simple and small Dislocation is only to be reduced.
CHAP. II.
Of Chirurgical Instruments, portable and not portable.
What do you call portable and not portable Instruments?
Portable Instruments are those which the Surgeon carries in his Lancet-Case with his Plaister-Box; and not portable are those that he doth not carry about him, but is oblig'd to keep at home; the former being appointed for the ready help which he daily administers to his Patients, and the others for greater Operations.
What are the Instruments which a Surgeon ought to have in his Plaister-Box?
These Instruments are a good pair of Sizzers, a Razor, an Incision-Knife streight and crooked, a Spatula, a greater Lancet to open Impostumes, and lesser for letting Blood. They likewise carry separately in very neat Lancet-Cases, a hollow Probe made of Silver or fine Steel; as also many other Probes, streight, crooked, folding, and of different thickness; a Pipe of Silver or fine Steel, to convey the cauterizing Button to a remote Part, without running the hazard of burning those that are near it; another Pipe or Tube serving instead of a Case for Needles, which have Eyes at one end for sowing; a Carlet, or thick triangular Needle; a small File; a Steel Instrument to cleanse the Teeth; a Fleam; a pair of crooked Forceps to draw a Tooth; a Pelican; a Crow's Bill; several sorts of Raspatories; a Hook to hold up the Skin in cutting, &c.
What are the Instruments which a Surgeon ought to keep in his Repository to perform the greater Operations?
Some of them are peculiar to certain Operations, and others are common to all. The Instruments appropriated to particular Operations, are the Trepan for opening the Bones in the Head, or elsewhere: The Catheters or Probes for Men and Women afflicted with the Stone, or difficulty of making Water. Extractors, to lay hold on the Stone in Lithotomy, and to gather together the Gravel; large crooked Incision-Knives, and a Saw, to make Amputations of the Arms or Legs; great Needles with three Edges, to be used in making Setons; small Needles to couch Cataracts; other Needles; thin Plates and Buckles to close a Hair-Lip, &c.
May not the Salvatory be reckon'd among the portable Instruments?
Yes, because the Balsams, Ointments, and Plaisters contain'd therein, are means whereof the Surgeon makes use to restore Health.
CHAP. III.
Of Anatomy in general; and in particular of all the Parts whereof the Humane Body is compos'd.
What is Anatomy?
It is the Analysis or exact Division of all the Parts of a Body, to discover their Nature and Original.
What is requisite to be observ'd by a Surgeon before he goes about to dissect a Body?
Two things; viz. The external Structure of the Body, and the Proportion or Correspondence between the outward Parts, and those that are within.
Why so?
Because without this exterior and general Knowledge, the Surgeon wou'd be often mistaken in the Judgment he is to pass concerning a Dislocation or Wound, inasmuch as it is by the Deformity which he perceives in the Member, that he knows the Dislocation, as it is also by the means of the Correspondence which the outward Parts have with the inward, that he is enabled to draw any certain Consequences relating to a Wound, which penetrates into the Body.
What is a Part?
It is that whereof the whole Body is compos'd, and which partakes of a common Life or Sensation with it.
How many sorts of Parts are there in a Humane Body?
We may well reckon up Fifteen distinct Parts, which are the Bone, the Cartilage, the Ligament, the Tendon, the Membrane, the Fibre, the Nerve, the Vein, the Artery, the Flesh, the Fat, the Skin, the Scarf-Skin, the Hair, and the Nails.
What is a Bone?
It is the hardest and driest Part of the whole Body, and that which constitutes its principal Support.
What is a Cartilage or Gristle?
It is a yielding and supple Part, which partakes of the Nature of a Bone, and is always fasten'd to its Extremities, to mollifie and facilitate its Motion.
What is a Ligament?
It is a Membranous Contexture usually sticking to the Bones to contain them; as also sometimes to other Parts, to suspend, and retain them in their proper place.
What is a Tendon?
It is the Tail or Extremity of the Muscles, made by the re-union of all the Fibres of their Body, which serves to corroborate it in its Action, and to give Motion to the Part.
What is a Membrane?
It is a Nervous Part, the use whereof is to adorn and secure the Cavities of the Body on the inside, and to wrap up or cover the Parts.
What is a Fibre?
They are fleshy Lines of which the Body of a Muscle is compos'd.
What is a Nerve?
It is a long, white, and thin Body, consisting of many Fibres, enclos'd within a double Tunick, and design'd to carry the Animal Spirits into all the Parts, to give them Sense and Motion.
What is an Artery?
It is a Canal compos'd of Four Coats, that carreyth with a kind of Beating or Pulse even to the very Extremity of the Parts, the Blood full of Spirits, which proceeds from the Heart, to distribute to them at the same time both Life and Nourishment.
What is a Vein?
It is a Canal made likewise of Four Tunicles, which receives the Arterial Blood, to carry it back to the Heart.
What is Flesh?
It is a Part which is form'd of Blood thicken'd by the natural Heat; and that constitutes the Body of a Muscle.
What is Fat?
It is a soft Body made of the Unctuous and Sulphurous part of the Blood.
What is the Derma or Skin?
It is a Net compos'd of Fibres, Veins, Arteries, Lymphatick Vessels and Nerves, which covers the whole Body to defend it from the Injuries of the Air, and to serve as a universal Emunctory: It is very thin in the Face, sticking close to the Flesh, and is pierc'd with an infinite number of imperceptible Pores, affording a Passage to insensible Transpiration.
What is the Epiderma, or Scarf-Skin?
It is a small fine Skin, transparent and insensible, having also innumerable Pores for the discharging of Sweat, and other Humours by imperceptible Transpiration: It is extended over the whole inner Skin, to dull its too exquisite Sense, by covering the Extremities of the Nerves which are there terminated. It also renders the same Skin even and smooth, and so contributes very much to Beauty.
What is the Hair?
The Hairs are certain hollow Filaments planted in the Glandules of the Skin, from whence their Nourishment is deriv'd. They constitute the Ornament of some Parts, cover those which Modesty requires to be conceal'd, and defend others from the injury of the Weather.
What is a Nail?
The Nails are a Continuity of the Skin harden'd at the end of the Fingers, to strengthen and render them fit for Work.
CHAP. IV.
Of the general Division of a Humane Body.
How is the Humane Body divided before it is dissected, in order to Anatomical Demonstration?
Some Anatomists distinguish it into Similar and Dissimilar Parts, appropriating the former Denomination to all the simple Parts of the Body taken separately, as a Bone, a Vein, a Nerve, &c. but they attribute the Name of Dissimilar to all those Members that are compos'd of many Similar or Simple Parts together; such are the Arms, Legs, Eyes, &c. wherein are contain'd all at once, Bones, Veins, Nerves, and other parts.
Others divide it into containing and contained Parts, the former enclosing the others, as the Skull includes the Brain, and the Breast the Lungs; whereas the contained Parts are shut up within others; as the Entrails within the Belly, the Brain within the Skull, &c.
Others again divide the whole Body into Spermatick and Sanguineous Parts; the former being those which are made at the time of Formation; and the latter all those that are grown afterward by the Nourishment of the Blood.
Are there not also other Methods of dividing the Humane Body?
Yes: Many Persons consider it as a Contexture of Bones, Flesh, Vessels and Entrails, which they explain in four several Treatises, whereof the first is call'd Osteology, for the Bones; the second Myology, for the Muscles; the third Angiology, for the Veins, Arteries and Nerves, which are the Vessels; and the fourth Splanchnology, for the Entrails.
But lastly, the most clear and perspicuous of all the Divisions of the Body of Man, is that which compares it to a Tree, whereof the Trunk is the Body, and the Branches are the Arms and Legs. The Body is divided into three Venters, or great Cavities, viz. the Upper, the Middle, and the Lower, which are the Head, the Breast, and the lower Belly. The Arms are distributed into the Arms properly so called, the Elbow and Hands; and the Legs in like manner into Thighs, Shanks, and Feet: The Hands being also subdivided into the Carpus or Wrist, Metacarpium or Back of the Hand, and the Fingers; as the Feet into the Tarsus, Metatarsus, and Toes. This vision is at present follow'd in the Anatomical Schools.
CHAP. V.
Of the Skeleton.
Why is Anatomy usually begun with the Demonstration of the Skeleton, or Contexture of Bones?
Because the Bones serve for the Foundation Connexion, and Support of all other Parts of the Body.
What is the Skeleton?
It is a gathering together, or Conjunction of all the Bones of the Body almost in their Natural Situation.
From whence are the principal differences of the Bones derived?
They are taken from their Substance, Figure, Articulation, and Use.
How is all this to be understood?
First then, with respect to their Substance, there are some Bones harder than others; as those of the Legs compared with those of the Back-Bone. Again, in regard of their Figure, some are long, as those of the Arm; and others short, as those of the Metacarpium. Some are also broad, as those of the Skull and OmoplatÆ or Shoulder-Blades; and others narrow, as the Ribbs. But with respect to their Articulation, some are joined by thick Heads, which are received into large Cavities, as the Huckle-Bones with those of the Hips; and others are united by the means of a simple Line, as the Chin-Bones. Lastly, with relation to their Use; some serve to support and carry the whole Body, as the Leg-Bones, and others are appointed to grind the Meat, as the Teeth; or else to form some Cavity, as the Skull-Bone, and those of the Ribs.
What are the Parts to be distinguished in the Bones?
They are the Body, the Ends, the Heads, the Neck, the Apophyses, the Epiphyses, the Condyli or Productions, the Cavities, the Supercilia or Lips, and the Ridges.
The Body is the greatest Part, and the middle of the Bone; the Ends are the two Extremities; the Heads are the great Protuberances at the Extremities; the Neck is that Part which lies immediately under the Head; the Apophyses or Processes are certain Bunches or Knobs at the Ends of the Bones, which constitute a Part of them; the Epiphyses are Bones added to the Extremities of other Bones; the Condyli or Productions are the small Elevations or Extuberances of the Bones; the Cavities are certain Holes or hollow places; the Supercilia or Lips are the Extremities of the Sides of a Cavity, which is at the End of a Bone; the Ridges are the prominent and saliant Parts in the length of the Body of the Bone.
How are the Bones join'd together?
Two several ways, viz. by Articulation and Symphysis.
How many sorts of Articulations are there in the Bones?
There are generally two kinds, viz. Diarthrosis and Synarthrosis.
What is Diarthrosis?
Diarthrosis is a kind of Articulation which serves for sensible Motions.
How many kinds of Diarthroses, or great Motions are there?
There are Three, viz. Enarthrosis, Arthrodia, and Ginglymus.
Enarthrosis is a kind of Articulation which unites two Bones with a great Head on one side, and a large Cavity on the other; as the Head of the Thigh-Bone in the Cavity of the Ischion or Huckle-Bone.
Arthrodia is a sort of Articulation, by the means whereof two Bones are join'd together with a flat Head receiv'd into a Cavity of a small depth. Such is the Head of the Shoulder-Bone with the Cavity of the Omoplata or Shoulder-Blade; and that of the Twelfth Vertebra of the Back with the first of the Loins.
Ginglymus is a kind of Articulation which unites two Bones, each whereof hath at their Ends a Head and a Cavity, whereby they both receive and are received at the same time, such is the Articulation in the Bones of the Elbow and the VertebrÆ.
What is Synarthrosis?
Synarthrosis being opposite to Diarthrosis, is a close or compacted Articulation, destitute of any sensible Motion.
How many sorts of Synarthroses, or close Articulations are there?
There are Three. viz. Sutura, Harmonia, and Gomphosis.
A Suture is that which joins together two Bones by a kind of Seam or Stitch, or by a Connexion of their Extremities dispos'd in form of a Saw, the Teeth whereof are reciprocally let one into another: Such are the Sutures of the Skull-Bones.
Harmonia is the uniting of two Bones by a simple Line; as the Bone of the Cheek with that of the Jaw.
Gomphosis is a kind of close Articulation, which unites two Bones after the manner of Nails or Wooden Pins fixt in the Holes made to receive them: Such is that of the Teeth in their Sockets.
What is Symphysis?
Symphysis is the uniting of two Bones by the interposition of a Medium, which ties them very streight together, being also threefold: Such is the Connexion of the Knee-Pan or Whirl-Bone of the Knee, and the Omoplata or Shoulder-Blade.
Are not these three kinds of Articulations or Symphyses distinguish'd one from another?
Yes; for tho' they are all made by the means of a third Body intervening, which joins them together; nevertheless every one of these various Bodies gives a different Denomination to its respective Articulation: Thus the Articulation which is caus'd by a Glutinous and Cartilaginous Substance, is properly call'd Synchondrosis; as that of the Nose, Chin, Os Pubis, &c. But an Articulation which is made by a Ligament is termed Synncurosis, as that of the Knee-Pan. Lastly, that which is wrought by the means of Flesh, bears the Name of Syssarcosis; as the Jaw-Bones, the Os Hyoides, and the Omoplata or Shoulder-Blade.
Have the Bones any sense of Feeling or Motion?
They have neither; for their sense of Pain proceeds from nothing else but their Periostium, or the Membrane with which they are cover'd, and their Motion is perform'd only by the Muscles that draw them.
Doth the Marrow afford any Nutriment to the Bones?
No, all the Bones are nourish'd by the Blood, as the other Parts; but the Marrow is to the Bones what the Fat is to the Flesh; that is to say, it is a kind of Oil or Unctuous Substance, which moistens, and renders them less brittle.
Are all the Bones of the same Colour?
No, they follow the Temperament and Constitution of the Persons.
How many in number are the Bones of the Humane Skeleton?
There are two hundred and fifty usually reckon'd, viz. 61 in the Head, 67 in the Trunk or Chest, 62 in the Arms and Hands, and 60 in the Legs and Feet; but the true Number cannot be exactly determin'd, by reason that some Persons have more, and others fewer; for some have more Ossa Sesamoidea, Teeth and Breast-Bones than others: Again, some have many indentings in the Lambdoidal Suture, and others have none at all.
Can you rehearse the Number of the Bones of the Head?
There are Fifteen in the Skull, and Forty six in the Face.
The Fifteen of the Skull are the Coronal for the fore-part of the Head; the Occipital for the hinder-part; the two Parietals for the upper-part and each side; the two Temporals for the Temples; the Os Sphenoides or Cuneiforme, which closeth the Basis or bottom of the Skull; the Os Ethmoides, or Cribriforme, situated at the Root of the Nose; and the four little Bones of the Ear on each side, viz. the Incus or Anvil; the Stapes or Stirrup; the Malleolus or Hammer; and the Orbiculare or Orbicular Bone.
Of the Forty six of the Face, Twenty seven are counted in the Upper-Jaw, viz. the two Zygomatick, or the two Bones of the Cheek-Knots; the two Lachrymal in the great Corners of the Eyes toward the Nose; the two Maxillar, that receive the Upper-Teeth, and which form part of the Palate of the Mouth, and the Orbits of the Eyes; the two Bones of the Nose; the two Palate-Bones which are at its end, and behind the Nostrils; the last being single is the Vomer, which makes the Division of the lower part of the Nostrils; and there are generally Sixteen Upper-Teeth. The Lower-Jaw contains Nineteen Bones, viz. sixteen Teeth; two Bones that receive them; and the Os Hyoides, which is single, and fix'd at the Root of the Tongue.
How are the Teeth usually divided with respect to their Qualities?
Into Incisive or Cutters, Canine or Dog-Teeth, and Molar or Grinders: There are eight Incisive, and four Canine, which have only one single Root; as also twenty Molar, every one whereof hath one, two, or three Roots.
Can you recite the Number of the Bones of the Trunk or Chest?
There are generally thirty and three in the Spine or Chine-Bone of the Back, viz. seven Vertebra's in the Neck, twelve in the Back, five in the Legs, five, six, and sometimes seven in the Os Sacrum, three or four in the Coccyx, and two Cartilages at its end.
There are twenty nine in the Breast, viz. twenty four Ribs, two Clavicles or Channel-Bones and commonly three Bones in the Sternum. The Hip-Bones are likewise divided into three, viz. Ilion, Ischion and Os Pubis.
Do you know the Number of the Bones of the Arms?
There are thirty and one Bones in each Arm, that is to say, the Omoplata or Shoulder-Blade; the Humerus or Shoulder-Bone; the two Bones of the Elbow call'd Ulna, and Radius; eight little Bones in the Carpus or Wrist; five in the Metacarpium or Back of the Hand; and fourteen in the Fingers, three to every one except the Thumb, which hath only two.
Can you give us a List of the Bones of the Leg in their Order?
There are thirty Bones in each Leg, viz. the Femur or great Thigh-Bone, the Knee-Pan or Whirl-Bone on the top of the Knee; the Tibia, greater Focile, or Shin-Bone; and the Perone or Fibula, or lesser Focile, which are the two associated Bones of the Leg; seven little Bones in the Tarsus; five in the Metatarsus; and fourteen in the Toes; that is to say, three to every one, except the great Toe, which hath only two.
Thus the Number of Bones of the Humane Skeleton amounts to two hundred and Fifty, without reckoning the Sesamoides, the Indentings of the Skull, and some others which are not always to be found.
CHAP. VI.
Of Myology, or the Anatomy of the Muscles of a Humane Body.
What is a Muscle?
It is the principal Organ or Instrument of Motion; or it is a Portion of Flesh, wherein there are Veins, Arteries, Nerves, and Fibres, and which is cover'd with a Membrane.
How many parts are there in a Muscle?
Three, viz. the Head, the Belly, and the Tail: The Head is that part thro' which the Nerve enters; the Belly is the Body or Middle of the Muscle; and the Tail is the Extremity, where all the Fibres of the Muscle are terminated to make the Tendon or String which is fasten'd to the Part whereto it gives Motion.
Have all the Muscles their Fibres streight from the Head to the Tail?
No, some have them streight, others transverse, and others oblique or circular, according to the several Motions to which they are appropriated.
How many sorts of Muscles are there with respecting to their Action?
There are two different kinds, viz. the Antagonists and the Congenerate; the former are those that produce opposite Motions; as a Flexor and an Extensor, a Depressor and a Levator. The Congenerate are those that contribute to one and the same Action; as when there are two Flexors or two Extensors, and then one supplies the defect of the other; whereas when one of the Antagonist Muscles is cut, the other becomes useless, and void of Action.
How is the Action of a Muscle perform'd?
It is done by Contraction and Extension; the former causeth the Antagonist to swell, and the other compels it to stretch forth in length.
What is Aponeurosis?
It is the continuity of the Fibres of a Tendon which makes a Connexion that serves to strengthen the Muscle in its Motion.
CHAP VII.
Of the Myology, or Anatomy of the Muscles of the Head.
How many Muscles are there appointed to move the Head, and which be they?
The Head is mov'd by the means of fourteen Muscles, seven on each side; of these, two serve to depress it, eight to lift it up, and four to turn it round about.
The two Depressors are call'd Sternoclinomastoidei; they take their Rise in the Sternum, at the Clavicles, and proceed obliquely to join the Apophysis Mastoides.
Of the four Elevators on each side the first is the Splenius, which begins at the five VertebrÆ of the Back and the three lower ones of the Neck, and ascending obliquely, cleaves to the hinder part of the Head. The second, named Complexus or Trigeminus, having its beginning as the Splenius, sticks in like manner to the hinder part of the Head, and they form together a figure resembling that of S. Andrew's Cross. The third is the Rectus Major, which proceeding from the second Vertebra of the Neck, shoots forward to join the hinder part of the Head. The fourth is the Rectus Minor, which begins at the first Vertebra of the Neck, and ends likewise in the hinder part of the Head.
The two Muscles on each side, which move the Head circularly, are the Obliquus Major and Minor; the greater Oblique taking its rise from the second Vertebra of the Neck, goes to meet the first; but the lesser Oblique hath its Origine in the hinder part of the Head, and proceeds to join the other obliquely in the first Vertebra.
How many Muscles are there in the Lower-Jaw, and which be they?
The Lower-Jaw hath twelve Muscles which cause it to move; that is to say, six on each side, whereof four serve to close and two to open it.
The first of the Openers is the Latus, which beginning at the top of the Sternum, Clavicle, and Acromion, cleaves on the outside to the bottom of the Lower-Jaw-Bone. The second of the Openers is the Digastricus, which takes its rise in a Fissure lying between the Occipital Bone and the Apophysis Mastoides, from whence it passeth to the bottom of the Chin on the inside.
The first of the Shutters is the Crotaphites or Temporal Muscle, which hath its Origine at the bottom, and on the side of the Os Coronale, the Os Parietale, and the Os Petrosum, from whence it is extended till it cleaves to the Apophysis Coronoides of the Lower-Jaw, after having passed above the Apophysis of the Zygoma: Its Fibres are spread from the Circumference to the Center, and it is covered again with the Pericranium, which renders its Wounds very dangerous; so that the least Incisions as can be, ought to be made therein.
The second is the Pterygoideus or Aliformis Externus, whose rise is in the Apophysis Pterygoides, from whence it sets forward till it stick between the Condylus and the Coronal of the Lower-Jaw.
The third is the Masseter, which hath two Sources or Beginnings, and as many Insertions; the first Source thereof is at the Cheek-Knot or Ball of the Cheek, and the second at the lower part of the Zygoma. The first Insertion is at the outer Corner of the Jaw, and the second in the middle part, by that means forming the Figure of the Letter X.
The fourth is the Pterygoideus or Aliformis Internus, which hath its beginning in the Apophysis Pterygoides, and is terminated in the inner Corner of the Jaw; so that Mastication or Chewing is perform'd by the means of these four Muscles.
How many Muscles are there in the Face, and which be they?
There are two for the Forehead, call'd Frontal, whose Origine is in the upper part of the Head, from whence they descend by streight Fibres, until they are fasten'd in the Skin of the Forehead near the Eye-Brows, where they are re-united: Their Action or Office is to draw the Skin of the Forehead upward, whereto they stick very close.
There are also two others call'd Occipital, which have their Beginning in the same place with the preceeding, but they descend backward, and cleave to the Skin of the hinder part of the Head, which they draw upward.
There are two Muscles to each Eye-Lid, one whereof is termed the Attollens or Elevator and the other the Depressor. The Elevator takes its rise in the bottom of the Orbit of the Eye, and is fastned by a large Aponeurosis to the edge of the upper Eye-Lid. The Shutter or Depressor, call'd also the Orbicular, hath its Origine in the great Canthus, or Corner of the Eye, passeth over the Eye-Lid upward, and is join'd to the lesser Corner of the same Eye, being extended along its whole Compass.
The Eyes have each six Muscles, viz. four Recti and two Obliqui; the Recti or streight Muscles are the Elevator, the Depressor, the Adductor, and the Abductor. The first of these call'd Elevator, or Superbus, draws the Eye upward, as it is pull'd downward by the Depressor or Humilis; the Adductor or Bibitorius draws it toward the Nose, and the Abductor or Indignarorius toward the Shoulder: All these small Muscles have their Originals and Insertions in the bottom of the Orbit through which the Optick Nerve passeth, and are terminated in the Corneous Tunicle, by a very large Tendon.
The first of the Oblique ones is term'd the Obliquus Major, and the other Obliquus Minor, because they draw the Eye obliquely. These Muscles cause Children to squint when they do not act together. The Obliquus Minor is fasten'd at the outward part of the Orbit near the great Corner, and draws the Eye obliquely toward the Nose: But the Obliquus Major is fixt in the inner part of the Orbit, and ascends along the Bone to the upper part of the great Corner, where its Tendon passeth thro' a small Cartilage nam'd Trochlea, and is inserted in the little Corner with the lesser Obliquus Minor, to draw the Eye obliquely toward the lesser Corner.
The Ear, altho' not usually endu'd with any sensible Motion, nevertheless hath four Muscles, viz. one above, and three behind; the first being situated over the Temporal, and fasten'd to the Ear to draw it upward: The three others have their beginning in the Mammillary Apophysis, and are terminated in the Root of the Ear, to draw it backward.
There are also three Muscles in the inner part of the Ear, whereof the external belonging to the Malleus or Hammer lies under the exterior part of the Bony Passage which reacheth from the Ear to the Palate of the Mouth, being fixt in a very oblique Sinuosity which is made immediately above the Bone that bears the Furrow, into which is let the Skin of the Tympanum or Drum. The internal Muscle lies hid in a Bony Semi-Canal, in the Os Petrosum; one part of which Semi-Canal is without the Drum, and clos'd on the top with a Passage that leads from the Ear into the Palate. But the other part within the Drum advanceth to the Fenestra Ovalis, and is inserted in the hinder part of the Handle of the Malleus. The Muscle of the Stapes or Stirrup is also hid in a Bony Tube, almost at the bottom of the Drum, and fixt in the Head of the Stapes.
The Nose hath seven Muscles, that is to say, one common and six proper; the common constitutes part of the orbicular Muscle of the Lips, and draws the Nose downward with the Lip. Of the six proper Muscles of the Nose, four serve to dilate it, being situated on the outside, and two to contract it, which are placed in the inside.
The two first Dilatators of a Pyramidal Figure, take their rise in the Suture of the Forehead, and are fasten'd by a large Filament to the AlÆ of the Nose. The two other Dilatators resembling a Myrtle-Leaf have their Source in the Bone of the Nose, and are inserted in the middle of the Ala.
The two Restrictors are Membranous, beginning in the internal part of the Bone of the Nose and adhering to the inner Ala of the Nostril.
The Lips have thirteen Muscles, viz. eight proper, and five common: Of the proper there are four for the Upper-Lip, and as many for the Lower: with two common for each, and the odd one.
The first of the proper of the Upper-Lip bears the Name of the Incisivus, its Origine being in the Jaw, in the place of the Incisive Teeth and its Insertion is in the Upper-Lip.
The second is the Triangulis, Antagonist to the former; its Rise is on the outside, at the bottom of the Lower-Jaw; and it is implanted in the Upper-Lip, near the Corner of the Mouth.
The third being the Quadratus, springs from the bottom of the Chin before, and cleaves to the edge of the Lower-Lip.
The fourth is the Caninus, Antagonist to the Quadratus, beginning in the Upper-Jaw-Bone and being terminated in the Lower-Lip near the Corner of the Mouth.
The first of the common is the Zygomaticus, the Origine whereof is in the Zygoma and its Insertion in the Corner of the Mouth, to draw it toward the Ears; so that it is the Muscle which acts when we laugh.
The second of the common is the Buccinator or Trumpeter, which is swell'd when one sounds a Trumpet. It hath its rise at the Root of the Molar Teeth of both the Jaws, and is extended quite round about the Lips.
The odd Muscle, or the thirteenth in number, is the Orbicular, which makes a Sphincter round about the Lips to close or shut them up.
The Uvula or Palate of the Mouth hath four Muscles, whereof the two first are the Peristaphylini Externi, taking their rise from the Upper-Jaw, above the Left Molar Tooth, and being ty'd to the Palate by a thin Tendon.
The two others are the Peristaphylini Interni, which have their beginning in the Apophysis Pterygoides on the inside, and likewise stick to the Palate.
The Tongue, altho' all over Musculous and Fibrous, yet doth not cease to have its peculiar Muscles, which are eight in Number.
The first of these is call'd Genioglossus, taking its rise in the lower part of the Chin, from whence it is extended till it cleave to the Root of the Tongue before, to cause it to go out of the Mouth.
The second is term'd Styloglossus, its Rise being in the Apophysis Styloides, from whence it passeth to the side above the Tongue, to lift it up.
The third bearing the Name of Basiglossus, commenceth in the Basis or Root of the Os Hyoides, and thence insinuates it self into the Root of the Tongue, to draw it back to the bottom of the Mouth.
The fourth is the Ceratoglossus, deriving its Original from the Horn of the Os Hyoides, and cleaving to the side of the Tongue to draw it on one side: The Action of these Muscles of both sides together, causeth an Orbicular Motion in the Tongue. To these some add a fifth Pair of Muscles, call'd Myloglossus, which serves to draw it obliquely upward.
What is the Action of the Os Hyoides in the Throat, and how many Muscles hath it?
The use of the Os Hyoides is to consolidate the Root of the Tongue; and it hath five Muscles on each side, which keep it as it were hung up.
The first of these, call'd the Geniohyoideus hath its beginning in the Chin on the inside, and adheres to the top of the Os Hyoides, which it draws upward.
The second is the Mylohyoideus, whose Origine is in the inner side of the Jaw, from whence it cleaves side-ways to the Root of the Os Hyoides, which it draws upward, and to one side.
The third is the Stylohyoideus, which after it hath taken its rise in the Apophysis Styloides, is fasten'd to the Horn of the Os Hyoides, to draw it toward the side.
The fourth is the Coracohyoideus, which springing up from the Apophysis Coracoides of the Omoplata, cleaves to the Root and side of the Os Hyoides, to draw it downward and to the side.
The fifth is the Sternomohyoideus, that hath its beginning in the Bone of the Sternum on the inside and is inserted in the Root of the Os Hyoides, which it draws downward.
How many Muscles hath the Larynx?
There are fourteen, viz. four Common, and ten Proper. The first Pair of the Common is the Sternothyroideus or Bronchycus, which proceeding from the inside, and the top of the Sternum, ascends along the Cartilages of the Wind-Pipe, and is terminated in the bottom of the Scutiformis or Buckler-like Cartilage, which it draws downward. The second is the Hyothyroideus, which ariseth from the Root of the Os Hyoides, and is inserted in that of the Scutiforme. This Muscle serves to lift up the Larynx, as also to dilate the bottom of the Scutiformis, and to close its top.
The first Pair of the Proper is the Cricothyroideus Anticus, which deriving its Original from the hinder and upper part of the Cricoides, or Ring-like Cartilage, is fixt in the upper and lateral part of the Scutiformis, to close or shut it up.
The second is the Thyroides.
The third is the Cricoarytenoideus Lateralis, which proceeds from the side of the Cricoides within, and is fasten'd to the bottom and side of the Arytenoides, which it removes to dilate the Mouth of the Larynx.
The fourth is the Thyroarytenoideus, which arising from the fore-part on the inside of the Scutiformis, is terminated on the side of the Arytenoides, to close the Orifice of the Larynx.
The fifth is the Arytenoideus, which having its Source in that place where the Cricoides is united to the Arytenoides is inserted in its upper and lateral part, to close the Larynx.
How many Muscles hath the Pharynx?
It hath seven, the first whereof is the Oesophagieus, which takes its rise from the side of the Scutiformis or Buckler-like Cartilage, and passing behind the Oesophagus or Gullet, is fasten'd to the other side of the Cartilage. It thrusts the Meat down by locking up the Pharynx as a Sphincter.
The second named StylopharingÆus, springs from within the Acute Apophysis of the Os Sphenoides, or Cuneiforme, and is inserted obliquely in the side of the Pharynx, which it dilates by drawing it upward.
The third, call'd SphenopharyngÆus, proceeds from the Apophysis Styliformis, and is terminated in the side of the Pharynx, which it dilates by drawing its sides.
The fourth Pair is the CephalopharyngÆus which ariseth from the articulation of the Head with the first Vertebra, and closeth the Larynx.
How many Muscles are there in the Neck, and which be they?
There are four Muscles in the Neck on each side, viz. two Flexors, and two Extensors. The Flexors are the Scalenus and the Rectus or Longus; and the Extenders are the Spinatus and the Transversalis.
The Scalenus or Triangularis hath two remote Sources, viz. one in the first Rib, and the other in the Clavicle, and is fasten'd to the third and fourth Vertebra of the Neck.
The Rectus or Longus begins in the side of the four upper Vertebra's of the Back, and is join'd to the upper Vertebra's of the Neck, and the hinder part of the Head.
The Spinatus hath its Origine in the fourth and fifth upper Vertebra's of the Back, and is fasten'd to all the six lower Vertebra's of the Neck.
The Transversalis springs forth out of the upper Vertebra's of the Back, and cleaves to the Extremity of the four Vertebra's of the Neck.
CHAP. VIII.
Of the Myology or Anatomy of the Muscles of the Chest; or of the Breast Belly, and Back.
How many Muscles are there in the Breast, and which be they?
The Breast hath fifty seven Muscles, that is to say, thirty that serve to dilate it, twenty six whose Office is to contract it, and the Diaphragm or Midriff, which partakes of both Actions.
The thirty which dilate the Breast are equally plac'd to the number of Fifteen, viz. the Subclavius, the Serratus Major Anticus, the two Serrati Postici, and the eleven external Intercostals.
The twenty six which contract the Breast are likewise equally rank'd to the Number of thirteen on each side, viz. the Triangularis, the Sacrolumbus, and eleven internal Intercostals.
The Subclavian takes up the whole space between the Clavicle and the first Rib: Its Original being in the internal and lower part of the Clavicula, and its insertion in the upper part of the first Rib.
The Serratus Major is a large Muscle having seven or eight Indentings or Jaggs. It takes its rise in the interior Basis of the Omoplata or Shoulder-Blade, and its Jaggings are inserted in the five lower true Ribs, as also in the two upper spurious Ribs.
The Serratus Posticus Superior, begins with a large Aponeurosis in the Apophyses of the three lower VertebrÆ of the Neck, and of the first of those of the Back; then passing under the Rhomboid, it is join'd obliquely by four Indentings to the four upper Ribs.
The Serratus Posticus Inferior, commences in like manner with a large Aponeurosis in the Apophyses of the three lower Vertebra's of the Back, and of the first of those of the Loins, and is afterwards fasten'd by four Digitations to the four lower Ribs.
The eleven External Intercostal Muscles are situated in the spaces between the twelve Ribs passing obliquely and on the outside from the back part to the fore part. They take their rise below the Upper Rib, and have their Insertion above the lower Rib.
The Triangularis is the first of those that contract the Breast, and possesseth the inward part of the Sternum: Its Original is in its lower part, and its Insertion in the top of the Cartilages of the two upper Ribs.
The Sacrolumbus hath its Source in the hinder part of the Os Sacrum, as also in the Vertebra's of the Loins, and ascending from thence, insinuates it self into the hinder part of the Ribs, to every one of which it imparts two Tendons, one whereof sticks on the outside, and the other on the inside. This Muscle is fleshy within, and fibrous without.
The Eleven Internal Intercostals, contrary to the External, derive their Original from the top of every lower Rib, and ascend obliquely from the back-part to the fore-part, till they are join'd to the lower Lip of every upper Rib: Thus these Internal Muscles, with the External, form, by the opposition of their Fibres, a Figure resembling a Burgundian Cross.
The Diaphragm or Midriff is esteem'd as the fifty seventh Muscle of the Breast, and serves as well for its dilatation as contraction. It separates the Thorax or Chest from the lower Belly, and is tied circularly to all the Extremities of the Bastard Ribs, immediately under the Xiphoides, or Sword-like Cartilage.
Modern Anatomists have discover'd that the Diaphragm is compos'd of two Muscles, viz. one Upper, and the other Lower; so that the Upper cleaves to the Extremities of the Spurious Ribs, and is terminated in a flat Tendon in the middle, which hath been always taken for its Nervous part. The Lower begins with two Productions, the longest whereof being on the right side, ariseth from the three upper Vertebra's of the Loins, and the other on the Left from the two Vertebra's of the Back, till it is lost in the Aponeurosis of the Upper Muscle.
How many Muscles are there in the Back and the Loins, and which be they?
There are three in each side, viz. one for Flection, and the other for Extension.
The Triangularis is the Flexor, taking its rise in the hinder part of the Rib of the Os Ilion, and the inner part of the Os Sacrum, in passing from whence it is joined to the last of the Bastard Ribs, and to the transverse Productions of the Vertebra's of the Loins.
The Extensors are the Sacer, and the Semi-spinatus, which make the Waste streight, and are so interwoven along the Back-Bone, that one would imagine that there were as many Pairs of Muscles as Vertebra's, affording Tendons to all.
The Sacer springs from behind the Os Sacrum, as also from the hinder and upper Extremity of the Os Ilium, and is inserted in the Spines of the Vertebra's of the Loins and Back.
The Semi-spinatus hath its Source in the Spines of the Os Sacrum, and is join'd to all the transverse Productions of the Vertebra's from the Back to the Neck, being exactly situated between the Sacer and the Sacrolumbus.
CHAP. IX.
Of the Myology, or Anatomy of the Muscles of the lower Belly.
How many Muscles are there in the lower Belly, and which be they?
There are generally ten, five on each side, that is to say, two Obliqui, one ascending, and the other descending; one Transversus, one Rectus, and two Pyramidal, of which last, nevertheless, there is sometimes only one, and sometimes none at all.
The Obliquus Descendens, which is the first, hath its Original by digitation in the sixth and seventh of the true Ribs, in all the spurious Ribs, and in the transverse Apophyses of the Vertebra's of the Loins, and comes near to the Serratus Major Anticus of the Breast; from whence it proceeds to the external Rib of the Os Ilion, and is terminated by a large Aponeurosis in the Linea Alba or White Line, which separates the Muscles that are on each side of the Abdomen or lower Belly.
The Obliquus Ascendens ariseth from its Source in the upper part of the Os Pubis, and in the Ridge of the Hip-Bone, till it cleaves to the Apophyses of the Vertebra's of the Loins in the Extremities of all the Ribs, and in the Xiphoides or Sword-like Cartilage, and is terminated in the White Line by a large Aponeurosis.
The Rectus being situated between the Aponeuroses of the Obliquus, takes its rise in the Cartilages of the Ribs, in the Xiphoides and the Sternum, and enters into the Os Pubis, having many nervous parts to corroborate it in its length.
The Transversus having its beginning in the transverse Apophyses of the Vertebra's of the Loins, is fasten'd to the internal Rib of the Os Ilium, and within the Cartilages of the lower Ribs, and is terminated by a large Aponeurosis in the Linea Alba, passing over the Rectus, and sticking to the PeritonÆum.
The Oblique Muscles, and the Transverse, have Holes toward the Groin, to give Passage to the Spermatick Vessels of Men, and to a round ligament of the Matrix in Women; so that Ruptures or Burstenness happen through these parts in both Sexes, although the Holes of these three Muscles are not situated one over-against another.
The Pyramidal, so named by reason of its Figure, is situated in the lower Tendon of the Rectus, its Origine being in the upper and external part of the Os Pubis; but it is terminated in the White Line, three Fingers breadth above the Pubes, and sometimes even in the Navel itself. These Muscles are not found in all Bodies for there are sometimes two, sometimes only one, and sometimes none.
The use of the Muscles of the lower Belly is to compress all the contain'd parts, in order to assist them in expelling the Excrements.
How many Muscles are there in the Testicles?
They have each of them one, call'd Cremaster; this Muscle takes its rise from the Ligaments of the Os Pubis, and by the dilatation of its Tendon covers the Testicle, which it draws upward.
How many Muscles hath the Penis?
It hath two Pair, viz. the Erectores or Directores, and the Dilatantes: The Erectores arise from the internal part of the Os Ischion, under the beginning of the Corpora Cavernosa, where they are inserted, and retake their Fibres in their Membranes. The Dilatantes or Acceleratores have their Source in the Sphincter of the Anus and slipping from thence obliquely under the Ureter, are join'd to the Membrane of the Nervous Bodies.
How many Muscles are there in the Clitoris?
It hath two Erectors which spring forth from the Protuberance of the Os Ischion, and are inserted in the Nervous Bodies of the Clitoris. There are also two others suppos'd to be its Elevators, which proceed from the Sphincter of the Anus, and are terminated in the Clitoris.
How many Muscles are there in the Anus?
There are three, viz. the Sphincter, and two Levatores. The Sphincter is two Fingers broad, to open and close the Rectum. This Muscle being double, is fasten'd in the fore-part to the Penis in Men, and to the Neck of the Matrix in Women, as also behind to the Coccyx, and laterally to the Ligaments of the Os Sacrum, and the Hips.
The two Levatores arise from the inner and lateral part of the Os Ischion, and are fasten'd to the Sphincter of the Anus, to lift it up after the expulsion of the Excrements.
The Bladder hath also a Sphincter Muscle to open and shut its Orifice.
How many ways doth the Omoplata or Shoulder-Blade move, and what are its Muscles?
The Omoplata moves upward, downward, forward, and backward, by the means of four proper Muscles, which are the Trapezius, the Rhomboides, the proper Levator, and the lesser Pectoral, or Serratus Minor Anticus.
The Trapezius or Cucullaris hath its beginning in the back part of the Occiput, or hinder part of the Head, in the Spines of the six lower Vertebra's of the Neck, and of the nine upper of the Back, in passing from whence it is implanted in the Spine of the Omoplata or Shoulder-Blade, and the external part of the Clavicula, as far as the Acromion. This Muscle produceth many Motions by reason of its different Fibres, drawing the Shoulder-Blade obliquely upward, downward, and forward.
The Rhomboides is situated over the Trapezius, its rise being in the Apophyses of the three lower Vertebra's of the Neck, and of the three upper of the Back, but it is afterward join'd to the whole Basis or Root of the Omoplata, which it draws backward.
The proper Levator commenceth in the Transverse Apophyses of the four first Vertebra's of the Neck, by different Progressions, but is afterward re-united, and inserted in the upper Corner of the Omoplata, which it draws upward.
The lesser Pectoral, or Serratus Minor Anticus, is situated under the great Pectoral, its rise being by Digitation or Indenting in the second, third, and fourth of the upper Ribs, and its Insertion in the Apophysis Coracoides of the Shoulder-Blade, which it draws forward.
How many Motions are there in the Humerus, or Arm; which be they, and what are its Muscles?
The Arm performs all sorts of Motions by the help of nine Muscles: For it is lifted up by the Deltoides and the Infra-Spinatus; it is depress'd by the Largissimus, and the Rotundus Major; it is drawn forward by the Pectoralis Major, and the Coracoideus; it is drawn backward by the Infra-Spinatus, and the Rotundus Minor. It is drawn near the Ribs by the Subscapularis, and its circular Motion is performed when all these Muscles act together successively.
The Deltoides or Triangular hath its beginning in the whole Spine of the Omoplata, the Acromion, and half the Clavicula, and by its point cleaves with a strong Tendon to the middle of the Arm.
The Infra-Spinatus takes its rise in the Cavity that lies above the Spine of the Omoplata, which it fills, passing over the Acromion, until it is join'd to the Neck of the Shoulder-Bone, which it surrounds with a large Tendon.
The Largissimus, otherwise call'd Ani-scalptor, covers almost the whole Back, proceeding from a large and Nervous Stock, in the third and fourth lower Vertebra of the Back, the five Vertebra's of the Loins, the Spine of the Os Sacrum, the hinder part of the Lip of the Hip-Bone, and the external part of the lower Bastard-Ribs, in passing from whence it insinuates it self into the lower Corner of the Omoplata, as also into the upper and inner part of the Humerus.
The Rotundus Major, or Teres Major, having its Origin in the external Cavity of the lower Corner of the Omoplata, is confounded with the Largissimus, and adheres with it by the same Tendon to the upper and inner part of the Humerus, a little below the Head.
The greater Pectoral hath its Source in half the Clavicula, on the side of the Sternum; covers the fore-part of the Breast, and is fasten'd by a short, broad, and nervous Tendon, to the top of the Shoulder-Bone, on the inside, between the Biceps and the Deltoides.
The Coracoideus or CoracobrachyÆus, beginning in the Apophysis Coracoides of the Omoplata or Shoulder-Blade, adheres to the middle of the Arm on the inside, which with the Pectoral it draws forward.
The Infra-Spinatus fills the Cavity which lies below the Spine of the Omoplata, its Origine being in the lower Rib of the Omoplata, from whence it passeth between the Spine and the Rotundus Minor, to cleave to the Neck of the Shoulder-Bone, which it embraceth, and draws backward.
The Rotundus Minor, or Teres Minor, proceeds from the lower Rib of the Omoplata, and adheres to the Neck of the Shoulder-Bone with the Infra-Spinatus to draw it in like manner backward.
The Sub-scapularis or Immersus is situated entirely under the Omaplata, proceeding from the internal Lip of the Basis or Root of the same Omoplata, and being terminated in the Neck of the Arm-Bone, which it causeth to lie close to the Ribs.
How many Motions are there in the Cubitus or Elbow, and what are its Muscles?
The Cubitus or Ulna is endu'd with two sorts of Motions, viz. that of Flection and that of Extension, the former being perform'd by the help of two Muscles, that is to say, the Biceps, and the BrachiÆus Internus; and the later by eight others, which are the Longus, the Brevis, the BrachiÆus Externus, and the Anconeus.
The Biceps is a Muscle with two Heads, one whereof proceeds from the Apophysis Coracoides, and the other from the Cartilaginous edge of the Glenoid Cavity of the Omoplata or Shoulder-Blade: These two Heads descend along the fore-part of the Arm, and are united in one and the same Body, from whence springs forth a Ligament, which is inserted in a tuberosity situated in the upper and fore-part of the Radius.
The BrachiÆus Internus is a small fleshy Muscle, lying hid under the Biceps, which takes its rise in the upper and fore-part of the Humerus, and is implanted in the upper and inner-part of the Radius, to bend the Elbow with the Biceps.
The first of the four Extenders is the Longus having two Sources, viz. one situated in the lower Rib of the Omoplata, near its Neck, and the other descending to the hinder-part of the Arm, till it is tyed to the Olecranum or Ancon, by a strong Aponeurosis, which is common thereto, with the Brevis, and the BrachiÆus Externus.
The Brevis or short Muscle of the Elbow arising from the hinder and upper-part of the Humerus, is fasten'd to the Olecranum with the Longus.
The BrachiÆus Externus is a fleshy Muscle which proceeds from the hinder part of the Humerus, and adheres to the Olecranum with the Brevis and the Longus.
The Anconeus or Cubitalis being situated behind the Fold of the Cubitus, is the least Muscle of all; it springs from the Extremity of the Arm-Bone, at the end of the Brevis and the Longus, and in descending is inserted between the Radius and the Cubitus or Ulna, three or four Fingers breadth below the Olecranum.
How many Muscles hath the Radius, and which are its Motions?
The Radius is endu'd with a twofold Motion by the means of four Muscles: Of these the Rotundus and Quadratus cause that of Pronation, as the Longus and the Brevis that of Supination.
The Pronator Superior Rotundus, or round Muscle of the Radius, commenceth from the inner Apophysis of the Shoulder-Bone, in a very fleshy Stock, and is terminated obliquely by a Membranous Tendon in the middle and exterior part of the Radius.
The Pronator Inferior Quadratus, springing forth from the bottom and inside of the Cubitus, is fixt in the lower and outward part of the Radius by a Tail as large as its Head. This Muscle lying hid under the others near the Wrist, is that which jointly with the Rotundus, turns the Arm with the Palm of the Hand downward, which is the Motion of Pronation.
The Longus is the first of the Supinators, whose Origine is three or four Fingers breadth above the external Apophysis of the Arm-Bone; from whence it passeth along the Radius, and cleaves to the inner-part of its lower Apophysis.
The Brevis, or the second of the Spinators arising from the lower part of the Inferior Condylus, and the external of the Humerus, is twisted round about the Radius, going forward from the hinder-part till it is united to its upper and forepart. This Muscle, with the Longus, serves to turn the Arm and the Palm of the Hand upward, and produceth the Motion of Supination.
How many sorts of Motions belong to the Wrist, and what are its Muscles?
Two several Motions are perform'd by the Wrist, viz. one of Flection, and the other of Extension, three Muscles being appropriated to the former, and as many to the later: But it ought to be observed, that a strong Ligament, call'd the Annular, appears here, which, surrounding all the Tendons of the Muscles as it were a Bracelet, holds them together, and elsewhere serves to unite the two Bones of the Elbow. The three Flexors or Bending Muscles of the Wrist are the CubitÆus Internus, the RadiÆus Internus, and the Palmaris.
The CubitÆus Internus derives its Original from the part of the Arm-Bone, passeth under the Annular Ligament, and is ty'd by a thick Tendon to the small Bone of the Wrist, which is plac'd above the others.
The RadiÆus Internus proceeds from the same place with the CubitÆus, and is fasten'd to the first Wrist-Bone which supports the Thumb. It lies along the Radius, and passeth under the Annular Ligament.
The Palmaris is reckon'd among the Flexors of the Wrist, although situated in the Palm of the Hand. It ariseth from the inner Process or Knob of the Arm-Bone, and is united by a large Tendon to the first Phalanges of the Fingers, slipping under the Transverse or Annular Ligament and sticking under the Skin of the Palm of the Hand.
The three extending Muscles of the Wrist are the CubitÆus Externus, and the RadiÆus Externus or the Longus, and the Brevis.
The CubitÆus Externus taking its rise from the hinder-part of the Elbow, passeth under the Annular Ligament, and adheres to the upper and outward-part of the Bone of the Metacarpus that stayeth the little Finger.
The RadiÆus Externus, or the Longus, having its Origine in the edge of the lower part of the Arm-Bone, slides from thence along the Radius on the outside, extends it self under the Annular Ligament, and cleaves to the Wrist-Bone, which stayeth the Fore-Finger.
The Brevis or short Muscle of the Wrist springs from the lower part of the same Edge; afterwards it runs along the Radius, passeth under the Annular Ligament, and is terminated in the Bone of the Carpus or Wrist, which stayeth the Middle Finger. But we must take notice, that besides these six Muscles, there is also Caro quÆdam quadrata, or a square piece of Flesh under the Palmaris, which seems to arise from the Thenar, and sticks to the eighth Wrist-Bone. It is supposed that this Musculous piece of Flesh serves with the Hypothenar of the little Finger, to make that which is call'd Diogenes's Cup.
How many Motions are there in the Fingers, and what are their Muscles?
The Fingers are bent, extended, and turn'd from one side to the other by the means of twenty-three Muscles, whereof ten are proper, and thirteen common: The former are those that serve all the Fingers in general, and the other those that are particularly serviceable to some of them: The Common are the Sublimis, the Profundus, the common Extensor, the four Lumbricales, and the six Interossei.
The Sublimis or Perforatus, arising from the internal part of the lower Process of the Humerus or Shoulder-Bone is divided into four Tendons, which run below the Annular Ligament of the Wrist, and are inserted in the second Phalanx of the Bones of the four Fingers, after having stuck in passing to those of the first Phalanx, to help to bend it. It is also observed that every one of these Tendons hath a small cleft in its length, to let in the Tendons of the Profundus.
The Profundus or Perforans lies under the Sublimis, deriving its Original from the top of the Cubitus and Radius. It creeps along these two Bones, and is divided into four Tendons, which pass under the Annular Ligament, and slip into the Fissures of the Tendons of the Sublimis, to adhere to the third Phalanx of the Fingers, which they bend with the Sublimis: So that these two Muscles make together the bending of the Fingers.
The Extensor Magnus is that which extends the four Fingers. It springs from the external and lower Process of the Arm-Bone, and is divided into four flat Tendons, which pass under the Annular Ligament, and cleave to the second and third Phalanx of the Fingers.
The four Lumbricales or Vermiculares are in the Palm of the Hand, to draw the Fingers to the Thumb: They proceed from the Tendons of the Profundus, and the Annular Ligament, extend themselves along the sides of the Fingers and are inserted in their second Articulation, to cause the drawing toward the Thumb.
The three Interossei Interni, and the three Externi, are situated between the four Bones of the Metacarpium, as well on the inside of the Hand as without: They have their beginning in the Intervals or Spaces between the Bones of the Metacarpium, are united with the Lumbrical, and fixt in the last Articulation of the Bones of the Fingers, to produce the Motion of drawing back or removing from the Thumb.
The Thumb is mov'd by five particular Muscles; one whereof serves to bend it, two to extend it, one to remove it from the Fingers, and another to draw it to them.
The Flexor of the Thumb takes its rise from the upper and inner part of the Radius, passes under the Annular Ligament, as also under the Thenar, and adheres to the first and second Bones of the same Thumb to bend it.
The two Extensors of the Thumb are the Longior and the Brevior: The former proceeding from the upper and outward part of the Cubitus, ascends above the Radius, and is ty'd with a forked Tendon to the second Bone of the Thumb. The Brevior hath the same Origin with the Longior, keeps the same Track, passes under the Annular Ligament, and is terminated in the third Thumb-Bone.
The Thenar removes the Thumb from the Fingers, and forms that part which is call'd the Mount of Venus: It hath its Source in the first Bone of the Carpus or Wrist, and the Annular Ligament, and is inserted in its second Bone.
The Antithenar draws the Thumb to the other Fingers, having its Origine in the Bone of the Metacarpus, that stayeth the middle Finger, and its Insertion is in the first Bone of the Thumb.
The Muscle which serves to extend the Fore-Finger, is call'd Indicator: It proceeds from the middle and outer part of the Cubitus, and is fixt by a double Tendon in the second Articulation of the Fore-Finger, as also in the Tendon of the great Extensor of the Fingers.
That which draws the Fore-Finger to the Thumb is term'd Adductor: It commenceth in the fore-part of the first Thumb-Bone, and is terminated in the Bones of the Fore-Finger.
That which removes the Fore-Finger from the Thumb is known by the Name of Abductor, which arising out of the external and middle part of the Bone of the Elbow, and passing under the Annular Ligament, cleaves to the Lateral and outward part of the Bones of the Fore-Finger.
The Little-Finger hath two proper Muscles, viz. an Extensor and an Abductor.
The Extensor springs from the lower part of the Condylus of the Arm-Bone, and is fasten'd by a double Tendon in the second Articulation of the Little-Finger, and in the Tendon of the Extensor of all the others.
The Abductor, call'd also Hypothenar, hath its beginning in the small Bone of the Wrist, which is situated over the others, and is terminated in the first Bone of the Little-Finger on the outside.
CHAP. XI.
Of the Muscles of the Thighs, Legs, and Feet.
What are the Motions of the Thighs?
The Thigh performs five kinds of Motions; for it is bent, extended, drawn within side and without, and turn'd round: All these Motions are produc'd by the means of fourteen Muscles, viz. three Flexors, three Extensors, three Adductors, three Abductors, and two Obturators for the Circular Motion.
The Flexors of the Thigh are the Psoas, Iliacus, and Pectineus.
The Psoas or Lumbaris is situated inwardly in the Abdomen, on the side of the Vertebra's. It proceeds from the transverse Apophyses of the two lower Vertebra's of the Back, and of the upper of the Loins, and lying on the inner Face of the Os Ilion, sticks to the lesser Trochanter or Rotator.
The Iliacus Internus hath its Origine in all the Lips of the inner Cavity of the Os Ilion, and being joyn'd by a Tendon to the Lumbaris, is inserted with it in the lesser Trochanter.
The Pectineus takes its rise from the fore-part of the Os Pubis, and is united before to the Thigh-Bone a little below the lesser Trochanter.
The Extensors of the Thigh are the GlutÆus Major, Medius, and Minimus.
The GlutÆus Major springs forth out of the lateral part of the Os Sacrum, as also the hinder and outer part of the Os Ilion and Coccyx, and enters into the Thigh-Bone, four Fingers breadth below the great Trochanter or Rotator, being the thickest of all the Muscles of the Body.
The GlutÆus Medius, deducing its Original from the hinder and outward part of the Os Ilion, is inserted three Fingers breadth below the great Trochanter.
The GlutÆus Minimus ariseth from the bottom of the Cavity of the Os Ilion, and is fasten'd to a small Hole near the great Trochanter.
The Adductors of the Thigh are the Triceps Superior, Medius, and Inferior.
The Triceps Superior hath its beginning in the top of the Os Pubis, and is terminated in the top of a Line, which is on the inside of the Thigh.
The Triceps Medius proceeding from the middle of the Os Pubis, is inserted in the Thigh-Bone a little lower than the Triceps Superior.
The Triceps Inferior hath its Source in the bottom of the Os Pubis, and is implanted in the Thigh-Bone, a little lower than the Triceps Medius. Some Anatomists make only one Muscle of these three, attributing thereto three Originals and three Insertions. These Muscles serve to draw the Thighs one against another.
The Abductors of the Thigh are the Iliacus Externus, or Pyriformis, the Quadratus, and the Gemelli.
The Pyriformis arising from the upper and lateral part of the Os Sacrum, and the the Os Ilion cleaves to the Neck of the great Trochanter.
The Quadratus or square Muscle of the Thigh takes its Origine from the external Prominence of the Os Ischion, and adheres to the outward part of the great Trochanter.
The Gemelli or Twin Muscles arise from two small Knobs in the hinder-part of the Ischion and insinuate themselves into a small Cavity in the Neck of the great Trochanter.
The Circular Motion of the Thigh is performed by the means of two Muscles, named the Obturatores Externi and Interni.
The Obturator Internus springs from the inner Circumference of the Oval Hole of the Ischion and its Tendons passing between the two Gemelli are inserted in a small Cavity at the Root of the great Trochanter or Rotator.
The Obturator Externus ariseth from the outward Circumference of the same Hole of one Ischion, and is terminated in the side of the other near the great Trochanter.
What are the Motions of the Leg, and what are its Muscles?
The Leg is mov'd four several ways, that is to say, it is bent, extended, and drawn inward and outward, by the means of eleven Muscles viz. three Flexors, four Extensors, two Adductors and two Abductors.
The three Flexors of the Leg are the Biceps, the Semi-nervosus, and the Semi-membranosus.
The Biceps hath two Heads, the longer whereof cometh out of the bottom of the Prominence of the Ischion, and the other from the middle and exterior part of the Femur, and is terminated in the outward and upper part of the Epiphysis of the Perone or Fibula.
The Semi-nervosus hath its Origine in the Knob of the Ischion, and is join'd backward to the top of the Epiphysis of the Tibia. These three Muscles are plac'd in the back-part of the Thigh below the Buttocks.
The four Extensors of the Leg are the Rectus, the Vastus Internus, the Vastus Externus, and the Crureus.
The Rectus or streight Muscle of the Leg takes its rise from the fore-part and the bottom of the Ilion, and descends in a right Line: It covers with its Tendon, which is common to the three following, the whole Knee-Pan, and adheres to the top of the Tibia, on the fore-part.
The Vastus Internus, being situated on the inside of the Thigh, hath its beginning in the top of the Thigh inwardly, and a little below the lesser Trochanter or Rotator: Afterward it is ty'd to the Tibia by a large Tendon, common thereto with the preceeding.
The Vastus Externus is plac'd on the outside of the Thigh, springing from the top and the fore-part of the Femur, being united by the same Tendon with the two preceeding.
The Crureus proceeds from the top, and the fore-part of the Thigh-Bone, between the two Trochanters; then covering the whole Bone, it is also fasten'd to the Leg-Bone with the three preceeding Muscles, after having cover'd the Knee-Pan with their common Tendon, which serves likewise as a Ligament to the Knee.
The two Adductors of the Leg are the Sartorius and the Gracilis.
The Sartorius or the Longissimus draws the leg inward, deriving its Original from the upper Spine of the Ischion; from whence it descends obliquely thro' the inside of the Thigh, and cleaves to the top on the inside of the Tibia.
The Gracilis hath its Origine in the fore-part at the bottom of the Os Pubis, and its Insertion in the top of the Tibia on the inside.
The two Abductors of the Leg are the Fascia lata, and the PoplitÆus.
The Fascia lata, or the Membranosus, is as it were a kind of large Band, which covers all the Muscles of the Thigh. It proceeds from the outward Lip of the Os Ilion, is ty'd by a large Membrane to the top of the Perone or Fibula and sometimes descends to the end of the Foot.
The PoplitÆus, or Sub-poplitÆus, arises from the lower and external Condylus of the Thigh-Bone, passeth obliquely from the outside to the inside, till it is lost in the upper and inner part of the Leg-Bone under the Ham.
What are the Motions of the Foot, and what are its Muscles?
The Foot performs two Motions by the help of nine Muscles, as being bent by two, and extended by seven.
The two Flexors are the Crureus Anticus, and the PeronÆus Anticus.
The Crureus or TibiÆus Anticus, is plac'd along the Tibia, and takes its rise from its upper and fore-part: Afterward it is bound by two Tendons to the first Os Cuneiforme, or Wedge-like Bone, and to that of the Metatarsus or Instep, which stayeth the great Toe, after having pass'd under the annular Ligament.
The PeronÆus Anticus springs from the middle and outward-part of the Perone or Fibula, and insinuating it self thro' the Cleft which is under the external Malleolus before, sticks to the Bone of the Metatarsus that supports the little Toe.
The seven Extensors of the Foot are the two Gemelli, or the Soleus, the Plantaris, the Crureus Posticus, and the two PeronÆi Postici.
The Gemelli are the Interior and the Exterior; the former having its Source in the inner Condylus, and the other in the outward and lower of the Thigh-Bone; from whence they extend themselves till they are fasten'd to the Talus or Ankle-Bone by a Tendon common to them, with the two following.
The Soleus ariseth from the top on the back-part of the Leg-Bone and Perone, and confounding its Tendon with that of the Gemelli, sticks close to the Talus.
The Plantaris, which lies hid between the Gemelli and the Soleus, hath its Origine from the Exterior Condylus of the Thigh-Bone; then uniting its Tendon with the preceeding, it adheres to them; and this common Tendon is call'd Chorda Achillis.
The Crureus or TibiÆus Posticus, springs from the back-part of the Leg-Bone, from whence extending it self downward, it passeth thro' the Fissure in the Internal Malleolus, and cleaves to the inner-part of the Os Scaphoides.
The PeronÆi, or FibulÆi Postici, are otherwise call'd the Longus and the Brevis, whereof one proceeds from the upper and almost fore-part of the Perone, terminating in the upper-part of the Bone, that supports the great Toe in the Metatarsus, and the other from the lower part of the Perone, adhering in like manner to the Bone with which the little Toe is sustain'd.
With what Motions are the Toes endu'd, how many Muscles have they, and which be they?
The Toes are bent and extended, as also drawn inward and outward, by the means of twenty two Muscles, of which sixteen are Common, and six Proper. The former are two Flexors, two Extensors, four Lumbricales, and eight Interossei. The first Flexor is nam'd Sublimis, and the other Profundus.
The Sublimis or Perforatus derives its Original from the lower and inner-part of the Talus and is fixt in its proper place by four cleft Tendons, which are inserted in the upper-part of the Bones of the first Phalanx of the four Toes. It is situated under the Sole of the Feet.
The Profundus or Perforans hath its beginning in the top and back-part of the Leg-Bone and Perone, slips under the Malleolus Internus thro' the Sinus Calcaris, and makes four Tendons which pass thro' the Fissures of the Tendon of the Sublimis, and cleaves to the Bones of the last Phalanx of the Toes, to bow them.
The first Extensor is call'd the Common, and the other the PediÆus.
The Common Extensor, or the Longus, takes its rise from the top and fore-part of the Tibia in the place of its joyning with the Perone or Fibula, and divides it self into four Tendons, which after having pass'd under the Annular Ligament, are inserted in the Articulations of every Toe.
The PediÆus or the Brevis, being plac'd over the Foot, proceeds from the Annular Ligament, and the lower-part of the Perone, and sends forth four Tendons, which are fixt to the first Articulation of the four Toes on the outside, Thus this Muscle, together with the Longus, causeth their Extension.
The four Lumbrical Muscles of the Toes arise from the Tendons of the Profundus, and a Mass of Flesh at the Sole of the Feet. They are joyn'd by their Tendons with those of the Interossei Interni, and adhere inwardly to the side of the first Bones of the four Toes, to incline them toward the great Toe.
The Abductors, or those Muscles that remove the Toes from the great Toe, are the eight Interossei, whereof four are call'd Externi, and as many Interni. The former take their rise in the Spaces between the Bones of the Metatarsus, and are terminated outwardly in the side of the first Bones of the Toes. The Internal lie in the bottom of the Foot, and take up the Spaces between the five Bones of the Metatarsus. They arise from the Bones of the Tarsus, and the Intervals between those of the Metatarsus, and are implanted with the four Lumbricales inwardly, in the upper-part of the Bones of the first Phalanx of the four Toes.
Of the six Proper Muscles of the Toes, there are four appointed for the great Toe, which cause it to perform the Motions of Flexion, Extension, and drawing forward or backward. The two others are the Adductor of the second Toe to the great Toe, and the Abductor of the little Toe, call'd Hypothenar.
The Proper Flexor of the great Toe, arises from the top of the Perone or Fibula, on the back part, passeth thro' the Ancle-Bone on the inside to the sole of the Foot, and is fasten'd to the Bone of the last Phalanx.
The Proper Extensor of the great Toe springs from the middle of the fore-part of the Perone, passeth over the Foot, and hath its Insertion in the upper-part of the Bone of the great Toe.
The Proper Adductor of the great Toe, or the Thenar, taking its rise inwardly on the side of the Talus, the Ossa Schaphoidea and Innominata, extends it self over the outward-part of the Bone of the Metatarsus, which stayeth the great Toe, and adheres to the top of the second Bone of the great Toe, which it draws inward.
The proper Abductor of the great Toe, or the Antithenar, draws it toward the other Toes. It derives its Origine from the Bone of the Metatarsus, which supports the little Toe, slides obliquely over the other Bones, and cleaves to the first Bone of the great Toe on the inside.
The Adductor appropriated to the second Toe hath its Source in the first Bone of the great Toe, on the inside, and sticks close to the Bones of the second Toe, which it draws to the great Toe.
The Abductor of the little Toe, or the Hypothenar, proceeds from the outward part of the Bone of the Metatarsus, that stayeth the little Toe, and is inserted in the top of the little Toe, on the outside, to remove it from the others.
| A List of all the Muscles in the Humane Body. |
| The Fore-head hath two Muscles | 2 |
| The hinder-part of the Head | 2 |
| The Eye-Lids | 4 |
| The Eyes | 12 |
| The Nose | 7 |
| The Ears on the outside | 8 |
| The Ears on the inside | 6 |
| The Lips | 13 |
| The Tongue | 8 |
| The Uvula, or Palate of the Mouth | 4 |
| The Larynx | 13 |
| The Pharynx | 7 |
| The Os Hyoides | 10 |
| The Lower Jaw | 12 |
| The Head | 14 |
| The Neck | 8 |
| The OmoplatÆ or Shoulder-Blades | 8 |
| The Arms | 18 |
| The Elbows | 12 |
| The Radii | 8 |
| The Wrists | 12 |
| The Fingers | 48 |
| The Breast, or the Parts of Respiration | 57 |
| The Loins | 6 |
| The Abdomen or lower Belly | 10 |
| The Testicles | 2 |
| The Bladder | 1 |
| The Penis | 4 |
| The Clitoris | 4 |
| The Anus | 3 |
| The Thighs | 30 |
| The Legs | 22 |
| The Feet | 18 |
| The Toes | 44 |
| Total 425 |
CHAP. XII.
Of the Anatomy of the Nerves, Arteries, and Veins in general.
What is the Structure of the Nerves?
The Nerves are round white Bodies enclos'd in a double Membrane, communicated to them from the two Meninges of the Brain: Their Office is to convey the Animal Spirits into all the Parts.
Where is the Root and first beginning of all the Nerves?
All the Nerves take their Original from the Medulla Oblongata, and that of the Spine.
How is the distribution of them made thro' the whole Body?
It is directly perform'd by Conjugations or Pairs, whereof one goes to the Right-hand, and the other to the Left: There are nine Pairs of them that proceed from the Medulla Oblongata and enter into the Skull; and a Tenth that comes from the Marrow which lies between the Occipital and the first Vertebra of the Neck. It passeth thro' the Hole of the Dura Mater, thro' which the Vertebral Artery enters, to distribute its Branches into several Parts.
To what Use are the nine Pairs of Nerves appropriated, which proceed from the Root of the Brain?
They are chiefly design'd for the Senses, and also for the Motion of their Organs, of which the Ancients discover'd only seven.
The first Pair of Nerves is call'd the Olfactory, and serves for the Smelling.
The second Pair is the Optici or Visorii Nervi, and bestows upon the Eyes the Faculty of seeing.
The third is term'd Motorii Oculorum, being serviceable for the Motion of the Eyes.
The fourth Pair is nam'd Oculorum Pathetici, which shews the Passion of the Mind in the Eyes, whereto it imparts a String as well as to the Lips.
The fifth is call'd the Gustative, and appropriated to the Taste, because it sends Twigs more especially to the Tongue, as also to the Fore-head, Temples, Face, Nostrils, Teeth, and Privy-Parts.
The Sixth is likewise for the Taste, and goes to the Palate.
The seventh is the Auditive Nerve, that enters into the Os Petrosum, where it divides it self into many Branches, which when gone forth, are distributed to the Muscles of the Tongue, Lips, Mouth, Face, Fore-head, Eye-Lids, &c.
The eighth is the Os Vagum, or wandering Pair, which is united to the Intercostal Nerve, as also to the Recurrent, Diaphragmatick, Mesenterick, &c.
The ninth Pair, after having form'd a Trunk with the eighth, disperseth its Twigs several ways, whereof one is join'd with the Twig to the tenth, to be distributed together into the Muscle Sternohyoideus, and into the Tongue.
The Intercostal and Spinal are not Pairs of Nerves, but only Branches or Twigs of other Pairs.
What is the Distribution and Use of the thirty Pairs of Nerves that proceed from the Spinal Marrow?
There are seven that go forth from the several Vertebra's of the Neck, twelve from those of the Back, five from the Loins, and six from the Os Sacrum, according to the following Progression.
The first of the seven Pairs of Nerves of the Neck proceeds from between the Occipital Bone and the first Vertebra, nam'd Atlas, its Fibres being lost in the Muscles of the hinder-part of the Head and Neck.
The second Pair springs from between the first and second Vertebra of the Neck; the Fibres whereof are lost in the Muscles of the Head, and in the Skin of the Face.
The third Pair issueth from between the second and third Vertebra of the Neck; and its Fibres are lost in the Flexor Muscles and Extensors of the Neck.
The fourth, fifth, sixth, and seventh Pairs proceed from between the Vertebra's, as before, but their Fibres are lost in the Neck of the Omoplata, in the Arm, and in the Diaphragme or Midriff. Here it ought to be observ'd by the way that the Arms receive Branches not only from the four last Pairs of the Nerves of the Neck, but also from the two first Pairs of the Back, which are extended even to the end of the Fingers: Whence it happens that in the Palsie of the Arms, Remedies are usually apply'd to the Vertebra's of the Neck; and that in Phlebotomy or letting Blood, care must be taken to avoid pricking the Nerve, which accompanies the Basilick Vein in the Elbow.
The twelve Pairs of Nerves that have their Beginning from between the Vertebra's of the Back, are each of them divided into two Branches, as the others; and their Branches are distributed in like manner to the Muscles of the Breast, and to those of the Back and Abdomen.
The five Pairs which take their Rise from between the Vertebra's of the Loins, have thicker Branches than the others, and the distribution of them is made to the Muscles of the Loins, Hypogastrium, and Thighs.
Of the six Pairs of Nerves that proceed from the Os Sacrum, the four Upper with the three Lower of the Loins, send forth Fibres of Nerves to the Thigh, Leg, and Foot; and the two last Pairs impart Nerves to the Anus, Bladder, and privy Parts.
What is the Structure of the Arteries?
The Arteries are long and round Canals, consisting of four sorts of Tunicks or Membranes, which have their Rise from the left Ventricle of the Heart, from whence they receive the Blood, and convey it to all the Parts of the Body for their Nourishment.
What is the Construction of these four Tunicks or Membranes of the Arteries?
The first being thin and Nervous in its outward Superficies, is in the Inside a Plexus or Interlacement of small Veins and Arteries, and Fibres of Nerves, which enter into the other following Tunicks, to nourish them.
The second sticking close to the former, is altogether full of whitish Glandules, that serve to separate the serous Particles of the Blood.
The third is intirely Musculous, and interwoven with Annular Fibres.
The fourth is very thin, and hath its Fibres all streight.
Whence proceeds the Pulse or beating of the Arteries?
It is deriv'd from the Heart, and exactly answers to its Motion of Diastole and Systole.
By what Name is the first Trunk of the Arteries call'd, and what is the Effect of the Distribution made thence to the whole Body?
The first Trunk of the Arteries is nam'd Aorta, or the thick Artery, which proceeds immediately from the left Ventricle of the Heart, whereto it communicates before its departure from the Pericardium, one or two small Branches call'd the Coronary: Afterward it is divided into two Branches, whereof one goes upward, and is term'd the Ascending Artery; and the other downward, under the Denomination of the Descending Artery.
The Ascending Artery ariseth upward along the Aspera Arteria or Wind-Pipe, to the Clavicles, and is there divided into two Branches, call'd the Subclavian Arteries, one whereof goes forward to the Right side, and the other to the Left; and they both send forth on each side divers Branches, which take their Names from the several Parts, whereto they are distributed; such are the Carotides or Soporales Interni & Externi, which pass to the Head; the Mediastina; the Intercostal; the Axillar, and others.
The Descending Artery, before its departure from the Breast, affords certain Branches to the Pericardium, Diaphragm, and lower Ribs; afterward it penetrates the Diaphragm, and constitutes seven double Branches. The first is of those that are call'd Coeliack, and which go to the Liver and Spleen. The second Branch contains the Upper Mesenterick. The third the Emulgent, which pass to the Reins. The fourth the Spermatick, which are extended to the Genitals. The fifth the Lower Mesenterick. The sixth the Lumbar. And the seventh the Muscular. But assoon as the great Trunk is come downward to the Os Sacrum, it divides it self into two thick Arteries nam'd the Iliack, which are distributed on both sides, each of them making two Internal and External Branches, which likewise impart Sprigs or lesser Arteries, to the Bladder, Anus, Matrix, and other adjacent Parts: Then the Master-Branch forms the Crural Arteries on the inside of the Thighs, which are communicated by multiplying their Number even to the ends of the Toes, in passing over the External Ancle-Bones of the Feet.
What is the Structure of the Veins?
The Veins are long and round Canals made of four kinds of Tunicks or Membranes, whose Office it is to receive the Blood that remains after the Nourishment is taken, and to carry it back to the Heart to be reviv'd.
What is the Form of the four Tunicks that make the Canals of the Veins?
The first is a Contexture of Nervous and streight Fibres. The second is a Plexus of small Vessels that carry the Nourishment. The third is all over beset with Glandules thro' which are filtrated the serous Particles of the Blood contain'd in the Vessels of the second Tunicle. The fourth is a Series of Annular and Musculous or Fleshy Fibres.
Which are the most numerous, the Arteries or the Veins?
The Number of the Veins exceeds that of the Arteries; and there are scarce any Arteries without Veins accompanying them.
Where is the Beginning and Original of all the Veins?
All the Veins have their Root in the Liver, and two of the three great Trunks that proceed from thence, are call'd Vena PortÆ, and Vena Cava; and the third is twofold, viz. the ascending and the descending.
The Vena PortÆ is distributed to all the Parts contain'd in the lower Belly, and terminated in the Fundament; where it makes the Internal HÆmorrhoidal Veins.
The Vena Cava is immediately divided into two thick Branches, one whereof ariseth upward to the Right Ventricle of the Heart, and forms the ascending Vena Cava; as the other goes downward to the Feet, and constitutes the descending.
What is the Distribution of the ascending Vena Cava?
It perforates the Diaphragm, goes to the Heart, and ascends from thence to the Clavicles, after having communicated to the Midriff in passing, a small Branch call'd the Phrenicus; as also one or two to the Heart, nam'd the Coronary; and some others to the upper Ribs, besides the single Branch, term'd Azygos, only on the right side. But the Trunk of the ascending Vena Cava, being once come up to the Clavicles, is divided into two Branches, well known by the Name of the Subclavian, one whereof Shoots forth toward the Right side, and the other toward the Left; and they both make various Ramifications like to those of the thick ascending Artery, by producing the Cervicalis or Soporalis, and the Internal and External Jugulars that go to the Head; as also the Axillars, which pass to the Arms and Shoulders, forming the Cephalick, the Median, and the Basilick on the inside of the Elbow.
The descending Vena Cava in like manner accompanieth the Ramifications of the Aorta, or thick descending Artery, to the fourth Vertebra of the Loins, where it sends forth two Branches, nam'd the Iliack, one whereof goes to the Right side, and the other to the Left, both inwardly and outwardly; imparting divers Twigs or lesser Branches to all the Parts contain'd in the Abdomen or lower Belly, even as far as the Fundament, where it makes the External HÆmorrhoidal Veins. Afterward the outward Branch of the Iliack descends in the Thigh, to form the Crural, and others, as far as the SaphÆna, together with those that are situated at the end of the Feet.
CHAP XII.
Of the Anatomy of the Abdomen, or lower Belly.
What is the clearest Division of the Human Body into various Parts, and that which is most followed in the Anatomical Schools?
It is that which constitutes three Venters, that is to say, the Upper, the Middle, and the Lower, which are the Head, the Thorax or Breast and the Abdomen or lower Belly, together with the Extremities, which are the Arms and Legs.
What is the lower Belly?
It is a Cavity of the Body that contains the nourishing parts, as the Reins, the Bladder, and all those that are appropriated to Generation in both Sexes.
What is to be consider'd outwardly in the lower Belly?
Its different Regions, and the several parts therein contain'd.
What are these Regions?
They are the Epigastrick, the Umbilical, and the Hypogastrick.
What is their Extent?
It is from the Xyphoides or Sword-like Cartilage to the Os Pubis, the division whereof into three equal Parts, constitutes the three different Regions; the Epigastrium being the first upward, the Umbilicus the second, and the Hypogastrium the third.
What Are the Parts contain'd in the Epigastrium, and what Place do they possess therein?
The Parts contain'd in the Epigastrium are the Liver, the Spleen, the Stomach, and the Pancreas or Sweet-bread, which lies underneath: The Stomach takes up the middle before, the Liver being plac'd on the Right side, and the Spleen on the Left; so that these two sides of the Epigastrick Region, are call'd the Right and Left Hypochondria.
What Parts are there contain'd in the Umbilical Region, and what is their situation?
They are the most part of the thin Intestines or small Guts, viz. the Duodenum, the Jejunum, and the Ileon, which have their Residence in the middle, where they are encircled with a Portion of the two great Guts, CÆcum and Colon, that take possession of the Sides, otherwise call'd the Flanks. The Reins or Kidneys are also in this Place, above, and somewhat backward.
What Parts are there contain'd in the Hypogastrium, and of what Place are they possest?
The greater part of the thick-Guts, Coecum, and Colon, are enclos'd therein, with the entire Rectum; there is also a Portion of the Ileon, which hides it self in the sides of the Ilia, or Hip-Bones: In the middle under the Os Pubis, the Bladder is situated on the Gut Rectum in Men, and the Matrix in Women lies between the Rectum and Bladder.
After what manner is the opening of a Corps or dead Body perform'd at a publick Dissection?
It is begun with a Crucial Incision in the Skin from underneath the Throat downward, traversing from one side to another in the Umbilical Region; then this Skin is pull'd off at the four Corners, and the Panicula Adiposa is immediately discover'd: Under this Fat lies a Fleshy Membrane, call'd Membrana Carnosa; and after that, the common Membrane of all the Muscles of the lower Belly. Thus we have taken a View of what Anatomists commonly term the five Teguments, that is to say, the Epiderma or Scarf-Skin, the Derma or true Skin, the Panicula Adiposa, the Panicula Carnosa or Membranus Carnosa, and the common Membrane of the Muscles.
The five Teguments being remov'd, we meet with as many Muscles on each side, viz. the descending Oblique, the ascending Oblique, the Transverse, the streight, and the Pyramidal, by the means whereof the Belly is extended and contracted. Afterwards appears a Membrane nam'd PeritonÆum, which contains all the Bowels, and covers the whole lower Belly, being strongly fasten'd to the first and third Vertebra's of the Back. The Fat skinny Net which lies immediately under the PeritonÆum, is call'd Epiploon and Omentum, or the Caul; it floats over the Bowels, keeping them in a continual Suppleness necessary for their Functions, maintains the Heat of the Stomach, and contributes to Digestion.
It remains to take an Account of the Bowels viz. the Stomach, Mesentery, Liver, Spleen, Kidneys, Bladder, and Guts, together with the Parts appointed for Generation, which in Men are the Spermatick Vessels, the Testicles, and the Penis; and in Women, the Spermatick Vessels, the Testicles or Ovaries, the Matrix, and its Vagina or Neck.
What is the Stomach?
It is the Receptacle of the Aliments or Food convey'd thither thro' the Oesophagus or Gullet, which is a Canal, or kind of streight Gut that reacheth from the Throat to the Mouth of the Stomach. The Stomach it self is situated immediately under the Diaphragm or Midriff, between the Liver and the Spleen, having two Orifices, whereof the Left is properly call'd Stomachus, or the Upper, and the Right (at its other Extremity) Pylorus, or the lower Orifice. Its Figure resembleth that of a Bag-Pipe, and the greater part of its Body lies toward the Left side. It is compos'd of three Membranes, viz. one Common, which it receives from the PeritonÆum; and two Proper; the two uppermost being smooth, and the innermost altogether wrinkled.
What is the Pancreas or Sweet-bread?
It is a Fat Body, consisting of many Glandules wrapt up in the same Tunicle, being situated under the Pylorus or lower Orifice of the Stomach: It helps Digestion, and hath divers other uses; but its principal Office is to separate the serous Particles of the Blood, to be convey'd afterward into the Gut Duodenum, by a Canal or Passage, nam'd the Pancreatick. This Juice serves to cause the Chyle to ferment with the Choler, in order to remove the grosser Particles from those that ought to enter into the Lacteal Vessels.
Into how many sorts are the Guts distinguish'd?
There are two sorts, viz. the thin and the thick.
How many thin or small Guts are there?
Three; that is to say, the Duodenum, the Jejunum, and the Ileon.
How many thick Guts are there?
Three likewise; viz. the Coecum, the Colon, and the Rectum.
Why are some of them call'd thin Guts, and others thick?
Because the thin are smaller, being appointed only to transport the Chyle out of the Stomach into the Reserver; whereas the thick are more large and stronger, serving to carry forth the gross Excrements out of the Belly.
Are the six Guts of an equal length?
No, the Duodenum, which is the first of the thin Guts, is only twelve Fingers breadth long. The Jejunum, being the second, so call'd because always empty, is five Foot long: The third is nam'd Ileon, by reason of its great Turnings which oblige it to pass to the Os Ilion, where it produceth a Rupture; it extends it self almost twenty Foot in length.
The first of the thick Guts, known by the Name of Coecum, is very short, and properly only an Appendix or Bag of a Finger's length. That which follows is the Colon, being the largest of all, and full of little Cells, which are fill'd sometimes with Wind and other Matters that excite the Pains of the Colick. It encompasseth the thin Guts, in passing from the top to the bottom of the Belly, by the means of its great Circumvolutions, and is from eight to nine Foot long. The last is the Rectum or streight Gut, so nam'd, because it goes directly to the Fundament: It is no longer than ones Hand, but it is fleshy, and situated upon the Os Sacrum, and the Coccyx or Rump-Bone.
What is the Peristaltick Motion of the Guts?
It is the successive Motion and Undulation, whereby the Guts insensibly push forward from the top to the bottom, the Matters contain'd in them; and that Motion which on the contrary is perform'd from the bottom to the top, is term'd the Antiperistaltick as it happens in the Iliack Passion, or twisting of the Guts, call'd Domine Miserere, by reason of its intolerable Pain.
What is the Mesentery?
It is a kind of Membrane somewhat fleshy, which is join'd to the Spine in the bottom and middle of the Belly, and by its folding, keeps all the Guts steady in their place; it is all over beset with red, white, and Lymphatick Vessels; that is to say, those that carry the Blood, Chyle, and Lympha, which serves to cause this last to run more freely, and to ferment. Three notable Glandules are also observ'd therein, the greatest whereof lies in the middle, and is nam'd Asellius's Pancreas; the two other lesser are call'd Lumbar Glandules, as being situated near the Left Kidney. From each of these Glandules proceeds a small Branch; and both are united together to make the great Lacteal Vein, or Thoracick Canal. This Tube conveys the Chyle along the Vertebra's of the Back to the Left Subclavian Vein; from whence it passeth into the ascending Vena Cava, and descends in the Right Ventricle of the Heart, where it assumes the form of Blood; from whence it passeth to the Lungs thro' the Pulmonary Artery; then it returns to the Heart thro' the Pulmonary Vein, and goes forth again thro' the Left Ventricle of the Heart, between the Aorta or great Artery, to be afterward distributed to all the Parts of the Body. This is the ordinary Passage for the Circulation of the Chyle, and the Sanguification of the Heart.
What is the Liver?
The Liver, being the thickest of all the Bowels, is plac'd in the Right Hypochondrium, at the distance only of a Fingers breadth from the Diaphragm; its Figure much resembling that of a thick piece of Beef: It is Convex on the outside, and Concave within; its Substance is soft and tender, its Colour and Consistence being like coagulated Blood: It is cleft at bottom, and divided into two Lobes, viz. one greater, and the other less: Its Office is to purifie the Mass of Blood by Filtration; and it is bound by two strong Ligaments, the first whereof adheres to the Diaphragm, and the second to the Xiphoides or Sword-like Cartilage. Two great Veins take their Rise from hence, viz. the Vena PortÆ, and the Vena Cava, which form innumerable Branches, as it were Roots in the Body of the Liver. The Gall-Bladder is fasten'd to the hollow part thereof, and dischargeth its Choler into the Gut Duodenum, thro' the Vessels that bear the Name of Meatus Choledochi, or Ductus Biliares. This Choler is not a meer Excrement, but on the contrary of singular Use in causing the Fermentation of the Chyle, and bringing it to perfection.
What is the Spleen?
The Spleen is a Bowel resembling a Hart's Tongue in shape, and situated in the Left Hypochondrium, over-against the Liver: Its length is about half a Foot, and its breadth equal to that of three Fingers; its Substance being soft, as that of the Liver, and its Colour like dark coagulated Blood: It is fasten'd to the PeritonÆum, Left Kidney, Diaphragm, and to the Caul on the inside; as also to the Stomach by certain Veins, call'd Vasa Brevia; nevertheless these Ligatures do not hinder it from wandering here and there in the lower Belly, where it often changeth its place, and causeth many dreadful symptoms by its irregular Motions. Its Office is to Subtilize the Blood by cleansing and refining it.
What are the Reins?
The Reins or Kidneys are Parts of a Fleshy Consistence, harder and more firm than that of the Liver and Spleen: They are both situated in the sides of the Umbilical Region, upon the Muscle Psoas, between the two Tunicks of the PeritonÆum; but the Right is lower than the Left: Their Shape resembleth that of a French Bean, and they receive Nerves from the Stomach, whence Vomitings are frequently occasion'd in the Nephritical Colicks: They are fasten'd to the Midriff, Loins, and Aorta, by the Emulgent Arteries; as also to the Bladder by the Ureters. The Right Kidney likewise adheres to the Gut CÆcum, and the Left to the Colon. Their Office is to filtrate or strain the Urine in the Pelves or Basons, which they have in the middle of their Body on the inside, and to cause it to run thro' the Vessels call'd Ureters into the Bladder.
Immediately above the Reins on each side, is a flat and soft Glandule, of the thickness of a Nut; they are nam'd Renal Glandules, or CapsulÆ AtribiliariÆ, because they contain a blackish Liquor, which (as they say) serves as it were Leaven for the Blood, to set it a fermenting.
What is the Bladder?
It is the Bason or Reserver of Urines, of a Membranous Substance as the Stomach, being plac'd in the middle of the Hypogastrick Region; so that it is guarded by the Os Sacrum behind, and by the Os Pubis before: Two Parts are to be distinguish'd therein, viz. its Bottom and Top; by its Membranous Bottom it is join'd to the Navel, and suspended by the means of the Urachus, and the two Umbilical Arteries which degenerate into Ligaments in adult Persons: As by its fleshy Neck, longer and crooked in Men, and shorter and streight in Women it cleaves to the Intestinum Rectum in the former, and to the Neck of the Womb in the latter. Lastly, its Office is to receive the Urines to keep them, and to discharge them from time to time.
What are the Genitals in Men?
They are the Spermatick Vessels, the Testicles, and the Penis. The Spermatick Vessels are a Vein and an Artery on each side; the former proceeding from the Aorta, or thick Artery of the Heart; and the other from the Branches of the Vena Cava of the Liver. These Arteries and Veins are terminated in the Body of the Testicles, which are two in Number, enclos'd within the Scrotum.
The Office of the Testicles is to filtrate the Seed, which is brought thither from all the parts of the Body, thro' the Spermatick Vessels, called PrÆparantia, and afterwards to cause it to pass thro' others nam'd Deferentia, to the VesiculÆ Seminales, from whence it is forc'd into the Ureter, thro' two small and very short Canals.
The Penis or Yard is a Nervous and Membranous Part, well furnish'd with Veins and Arteries, containing in the middle the Canal of the Ureter: Its Extremity, which consists of a very delicate and spongy sort of Flesh, is call'd Balanus, or Glans, and the Nut, the Skin that covers it being nam'd the PrÆputium, or the Fore-Skin. Thus by the means of this swell'd Part, and stiff thro' the affluence of the Spirits, the Male injects his Seed into the Matrix of the Female, to propagate his Kind.
What are the Parts appropriated to Generation in Women?
They are the Spermatick Vessels, the Ovaries or Testicles, and the Matrix. The Spermatick Vessels are a Vein and an Artery on each side, as in Men: The Ovaries or Testicles, situated on the side of the bottom of the Matrix, are almost of the same bigness with those of Men, but of a round and flat Figure. The VesiculÆ, or little Bladders which they contain, are usually term'd Ova or Eggs by Modern Anatomists; and the Vessels that pass from these Testicles or Ovaries to the Cornua of the Uterus, are call'd Deferentia or Ejaculatoria.
The Matrix, Uterus or Womb, is the principal Organ of Generation, and the place where it is perform'd, resembling the Figure of a Pear with its Head upward, and being situated between the Gut Rectum and the Bladder: It is of a fleshy and membranous Substance, retain'd in its place by four Ligaments, fasten'd to the bottom; whereof the two upper are large ones, proceeding from the Loins, and the two lower round, taking their Rise from the Groin, where they form a kind of Goose-Foot, which is extended to the Os Pubis, and the flat part of the Thighs; which is the cause that Women are in danger of Miscarrying when they fall upon their Knees.
The Exterior Neck of the Womb, call'd Vagina, is made almost in form of a Throat or Gullet, extending it self outwardly to the sides of the Lips of the Pudendum, and being terminated inwardly at the internal Orifice of the Matrix, the shape whereof resembleth that of the Muzzle or Nose of a little Dog. The outward Neck of the womb is fasten'd to the Bladder and the Os Pubis before, and in the hinder part to the Os Sacrum: Between the Lips of the Pudendum lie the NymphÆ, which are plac'd at the Extremity of the Canal of the Bladder, to convey the Urines; and somewhat farther appear four Caruncles, or small pieces of Flesh, at the Entrance of the Vagina, which when join'd together make the thin Membrane call'd Hymen.
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 the Clavicles to the Xiphoides, or Sword-like Cartilage on the fore-part, and bounded on the hinder by the twelfth Vertebra of the Back, having all the Ribs to form its Circumference, and the Diaphragm for its Bounds at bottom, separating it from the Abdomen or 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 the Mediastinum that 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 the Sternum or 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 the Mediastinum, which sticks to the Sternum throughout 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'd Primus 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; its Basis, Point, Auricles, Ventricles, large Vessels, Pericardium and Ligatures or Tyes: The Basis is 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 the Aorta or great Artery, and the Vena Cava together with the Pulmonary Artery and Vein. The Pericardium is a kind of Bag fill'd with Water, wherein the Heart is kept; which is fasten'd to the Mediastinum by its Basis, 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 are Diastole and Systole, 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 the Pericardium?
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'd Bronchia. 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 the Pleuron. They are suspended by the Wind-Pipe, by their proper Artery and Vein, and by the Ligatures that fasten them to the Sternum, Mediastinum, and frequently to the Pleuron it self: They are also divided into the Right and Left Parts by the Mediastinum; having four or five Lobes, whereof those on the Left side cover the Heart. Their continual Motion consists in Inspiration, to take in the Air, and Expiration, to drive it out. The Larynx makes the Entrance of the Wind-Pipe into the Lungs, and the Pharynx that of the Oesophagus or Gullet, at the bottom of the Mouth to pass into the Stomach.
CHAP. XV.
Of the Anatomy of the Head, or upper Venter.
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, the CrotaphitÆ, 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. The Crotophite Muscles are so likewise, in regard that they cannot be hurt without danger of Convulsions, by reason of the Pericranium with which they are cover'd. And the Sutures, because the Meninges of the Brain proceed from thence to form the Pericranium.
What is the Pericranium?
It is a Membrane that lies under the thick hairy Skin of the Head, and immediately covers the Skull.
What are the Meninges?
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 the Sagittal, the Coronal, and the Lambdoidal.
What is the disposition or situation of the true Sutures?
The Sagittal is 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 the Lambdoidal 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.
The Lambdoidal Suture 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'd Squamous or 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, which are 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 the Diploe. 3. To retain the Meninges, 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'd Sinciput, or the Fore-head-Bone, as also the Frontal or Coronal Bone. The Bone of the hinder-part, enclos'd within the Lambdoidal Suture, is term'd the Occipital. The two Bones that form the upper-part, and are distinguish'd by the Sagittal Suture, bear the Name of Parietals, one being on the Right side, and the other on the Left. And those behind the Ears are call'd Temporal, Squamosa, or Petrosa. 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?
The Diploe, which is nothing else but a Plexus or 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 sometimes happens 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 the Meninges into the Brain it self, and the Cerebellum or little Brain; the Brain, properly so called, takes up almost the whole Cavity of the Skull, and the Cerebellum is 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 the Meninges, which cut it even to the bottom; whence these Foldings are call'd Falx; i. e. a Scythe or Sickle.
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 the Basis of 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 the Medulla Oblongata, and go forth out of the Skull through many Holes hereafter nam'd.
The first Pair is that of the Olfactory Nerves, appropriated to the Sense of Smelling, which are divided below the Os 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 the Optick or Visual Nerves, that pass into the Orbits of the Eyes, thro' certain peculiar Holes made in the Os Sphenoides, or Wedge-like Bone, immediately above the Anterior Apophysis Clinoides.
In the Portion of the Os Sphenoides, that makes the Basis of 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 the Motorii Oculorum. 2. The fourth Pair, nam'd Pathetici, 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 the Ophthalmick Branch. Beyond the lower-part of the said Fissure, toward the hinder-part of the Head, is to be seen in the Os Sphenoides on each side, a Hole that doth not penetrate the Basis of the Skull, but makes a kind of Ductus, about an Hair's breadth long, which is open'd behind the Orbit on the top of the Space between the Apophysis Pterygoides, and the third Bone of the Jaw; thro' this Ductus runs the lower Branch of the foremost Fibre of the fifth Pair.
About the length of two Hairs breadth beyond these Ductus's, we may also discover in the Os 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 the Os Sphenoides, and gives passage to the hindermost Fibre of the fifth Pair.
The Hole thro' which runs the Auditory Nerve, that makes the seventh Pair, is in the middle of the hinder-part of the Os Petrosum, that looks toward the Cerebellum: This Hole being very large, is the Entrance of a Ductus that is hollow'd in the Os 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 the Basis of the Cochlea, and partly by a Portion of the Mouth of the Vestibulum. At the bottom of this Ductus are 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 another Ductus made in the Os Petrosum, which is open'd between the Apophysis Mastoides and Styloides: These other Holes afford a Passage to the Branches of the soft Portion of the same Auditory Nerve.
Below this Ductus there 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 the Apophysis 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 the Dura 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 the Spinal Nerve. We shall have occasion hereafter to shew the Use of the hinder Orifice.
Near the great Hole of the Occipital Bone from whence proceeds the Medulla 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 the Medulla 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' the Ductus that gives Entrance to the Internal Carotick Artery. As for the tenth Pair, in regard that it ariseth from the Marrow which is enclos'd between the Occipital Bone and the first Vertebra, it goes forth thro' the Hole of the Dura 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 the Dura Mater, and those that are appointed for the Brain. The Vessels of the Dura Mater, are Branches of the Carotick or Vertebral Arteries.
In the Os 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 the External Carotick Artery, which in entring, immediately adheres to the Dura 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 the Os Sphenoides, there is a Hole thro' which passeth an Artery, being a Twig of a Branch of the Internal Carotick, which is diffus'd in the Eye, and distributed to almost the whole Portion of the Dura 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 the Dura Mater that covers the Cerebellum.
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 two Internal Caroticks, and the two Vertebrals.
The Internal Carotick Arteries enter into the Skull thro a particular Ductus made in the Temporal Bone, the Mouth thereof being of an Oval Figure and situated in the outward part of the Basis of the Skull, before the Hole of the Internal Jugular. This Ductus extends 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 the Os Sphenoides. The Artery traverseth the whole winding Compass of this Ductus, which resembles the Figure of the Roman Letter S, and at the Mouth of the same Ductus runs under the Dura Mater along the sides of the Os Sphenoides to the Anterior Apophyses Clinoides, where it riseth up again, to perforate the Dura 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 the Dura Mater, make a second Circuit in form of the Roman Character S. At the place where these Carotick Arteries penetrate the Dura Mater, they send forth a thick Branch, which enters into the Orbit of the Eye, by the lower-part of the Hole, thro' which the Optick Nerve hath its Passage.
The Vertebral Arteries proceeding from the Holes of the transverse Apophyses of the first Vertebra, turn about in passing under the upper oblique Apophyses of the seven Vertebra's: Afterward they perforate the Dura 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 the Sinus's of the Dura Mater, which are all discharg'd into those that are call'd Lateral, 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 the Occipital Bone, and the Apophysis Petrosa. These Lateral Sinus's fall into the Internal Jugulars, which are receiv'd into a considerable Sinking hollow'd on each side in the outward, part of the Basis of the Skull, which is nam'd the Pit or Hole of the Internal Jugular.
In the upper and hinder-part of the Hole, from whence the lateral Sinus's issue forth, is to be seen an opening in the Extremity of a Ductus, the Mouth whereof lies behind the Condyli, which are on the sides of the Occipital Trunk: This Ductus is extended about the length of two Hairs breadth in the Bone, and the Canal enclos'd therein is open'd immediately into the Vertebral Sinus: So that one might affirm it to be as it were its Original Source. Whence it appears that the Blood contained in the lateral Sinus's is emptied thro' two places; the greater Portion thereof descending in the Jugulars from the Neck, and the other in the Vertebral Sinus's: Sometimes those Ductus's are four only on one side, another while both are stopt up, and the Blood contain'd in the lateral Sinus's is discharg'd into the Internal Jugulars.
Behind the Apophysis Mastoides on 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 the Occiput or hinder-side of the Head: This Vein is open'd into the lateral Sinus's at 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 the External Jugulars, with which the Branches of this Vein have a Communication.
In each Parietal Bone on the side of the Sagittal Suture, at a little distance from the Lambdoidal, 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 upper Longitudinal Sinus. These Holes are sometimes on both; and then the Blood contain'd in the Branches of this Vein runs into the External Jugulars.
In the middle of the Sella of the Os Sphenoides, we may observe one or two small Holes thro' which (according to the Opinion of some Modern Anatomists) the Lympha contain'd in the Glandula Pituitaria is thrown into the Sinus of the edge of the Os 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 those Sinus's are compos'd; besides that, these Holes are rarely found in adult Persons.
Between the Spine of the Coronal Suture and the Crista Galli, is a Hole which serves as an Entrance for a Ductus, which sinks from the top to the bottom, the length of about two Hairs breadth in the thickness of the inner Table of the Coronal: The Root of the upper Longitudinal Sinus is 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 the Basis of the Skull; the chief whereof are those that are observ'd in the Apophysis 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 the Tympanum, or Drum: The other Holes are principally design'd for the Vessels that are serviceable in the nourishing of divers parts of the Basis of 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 having pull'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.
A
TREATISE
OF
Straps, Swathing-Bands, Bandages, Bolsters, Splints, Tents, Vesicatories,
Setons, Cauteries, Leeches, Cupping-Glasses, and Phlebotomy.
CHAP. XVI.
Of Straps, Swathing-Bands, Bandages, and Bolsters.
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 of Hippocrates, 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 the Truss, 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; as Expulsive Bandages to drive back, Attractive to draw forward, Contentive to contain, Retentive to restrain, Divulsive to remove, Agglutinative to rejoin, &c.
There are others whereto certain peculiar Names are appropriated; as Bridles for the lower Jaw, Slings for the Chin, the back part of the Head, Shoulder, and PerinÆum; Scapularies for the Body, after the manner of the Scapularies of Monks; Trusses for Ruptures; Stirrups for 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 first Ideas of 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.
A
TREATISE
OF
Chirurgical Diseases.
CHAP. I.
Of Tumours in general, Abcesses or Impostumes, Breakings out, Pustules, and Tubercles.
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. by Fluxion and Congestion.
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, and Alter'd: Simple, as the Phlegmon, which is made of Blood, and the Erysipelas of Choler; Mixt, as the Erysipelas Phlegmon, which consists of Blood mingl'd with a Portion of Choler; or the Phlegmonous Erysipelas, which proceeds from Choler intermixt with a Portion of Blood: Alter'd, as the Melia which 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 the Talpa, the former resembling a burning Coal, and the other a Mole, according to the Etymology of their Latin Names. 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 the Encysted Tumours, which have their Matter clos'd within their proper Cystes or 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 the Phlegmon, Choler the Erysipelas, Phlegm the Oedema, and Melancholy the Scirrhus. The Mixture of these is in like manner the Cause of the Erysipelatous Phlegmon, the Oedomatous Phlegmon or Phlegmonous Erysipelas, and the Phlegmonous Oedema, according to the quality of the Humours which are predominant, from whence the several Tumours take their Names.
What are the Encysted Tumours?
They are those the Matter whereof is contain'd in certain Cystes, or Membranous Bags; as the Meliceris, and the Struma or 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 and Ganglions are Tumours, yet are not Abcesses nor Impostumes; whereas these last are always Tumours in regard that they cause Bunches and Elevations.
CHAP. II.
Of the general Method to be observ'd in the curing of Tumours.
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. The time 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 the Scirrhus and the Esthiomenus or 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 the Scirrhus, 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 the Esthiomenus or 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 Tumours or 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 a Cystis or 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. the Pus, Ichor, Sanies, and Virus.
What isPus?
It is a thick Matter, and white as Milk.
What is Ichor?
It is a thick Matter like the Pus, but of divers Colours.
What is Sanies?
It is a watery Matter that riseth up in Ulcers, almost after the same manner as the Sap in Trees.
What is Virus?
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 the Phlegmon. 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 a Crisis?
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 the Emunctories of 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.
CHAP. III.
Of Natural Tumours.
ARTICLE I.
Of the Phlegmon and its Dependancies.
What is a Phlegmon?
It is a red Tumour occasion'd by the Blood diffus'd in some part, wherein it causeth extension, pain, and heat with beating.
Are Aneurisms and Varices, which are Tumours, made by the Blood, to be reckon'd among the Phlegmons?
No, because the Blood that forms the Aneurisms and Varices is not extravasated nor accompany'd with Inflammation, but only a Tumour of Blood proceeding from the Dilatation of the Arteries and Veins.
May Echymoses or Contusions consisting of extravasated Blood, be esteem'd as Phlegmons?
By no means, in regard that it is not sufficient that the Blood be extravasated for the producing of a Phlegmon; it must also cause Pain, Heat, and a Beating, with Inflammation, which is not to be found in the Echymoses, 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 the Phlegmon always compos'd of pure Blood?
No, it may happen sometimes to partake of Choler, Phlegm, or Melancholy; on which account it is nam'd an Erysipelatous, Oedomatous, or Scirrhous Phlegmon, always retaining the Name of the predominant Humour, which is the Blood; and so of the others.
REMEDIES.
What are the Remedies proper for a Phlegmon?
They are of two sorts, viz. General and Particular; the former having regard to the antecedent cause, and the other to the conjunct. The Phlegmon is 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'd Herbs, 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, and Unguentum 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 Plaister Diasulphuris is also most excellent either alone, or, if you please, mixt with Diachylon and Basilicon.
What is to be done in the Declination after the Suppuration?
The Ulcer must be at first gently dry'd with a Plaister of Diasulphuris or Diachylon, and afterward that of Diapalma may 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 much Sal Ammoniack, to bath the Tumour: Or else take the Tincture of Myrrh and Aloes, with a little Unguentum 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 for Aneurisms and Varices.
What is to be done in order to cure an Aneurism?
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 the Anuerism be considerable, an Astringent Plaister may be us'd, such as the following.
Take Bolus, Dragon's Blood, Frankincence, Aloes, and Hypocystis, 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 of Emplastrum contra Rupturam, always making a small Bandage to keep it on. Emplastrum de Cicuta hath also a wonderful effect.
When the Aneurism is 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 the Varices?
Varices are 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 of Psyllium and Line, of each two Ounces; of Populeon two 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 the Varix, 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 the Varix, bind it on, and continue the use of it twice a Day for a Month together.
Remedies for Echymoses, Contusions, or Bruises.
How are Echymoses to 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 and Unguentum Divinum, a Mixture whereof being made, is to be put between two Rags, and laid upon the Tumour or Swelling.
If the Echymosis happens in a Nervous Part, Balsam of Peru may 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 the Echymosis is 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 an Echymosis in the Face with great Circumspection, which must be always prepar'd for Incision.
Of phlegmonous Tumors or Impostumes, and of Remedies proper for 'em.
What are the Tumours or Impostumes that partake of a Phlegmon?
They are the Bubo, Carbuncle, Anthrax, Furunculus, Phyma, Phygeton, Panaritium or Paronychia, Burn, Gangrene, and Kibe or Chilblain.
What is a Bubo?
A Bubo is 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 an Anthrax?
The Anthrax is very near the same thing as the Carbuncle, only with this difference, that the latter always appears in the Glandulous Parts, and the Anthrax every where else.
What is a Furunculus?
It is a kind of Boil, or benign Carbuncle, which somewhat resembles the Head of a Nail, and is on that Account call'd Clou by the French, causing Pains, as if a Nail were driven into the Flesh.
What is a Phygeton?
The Phygeton is 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 a Phyma?
The Phyma appears after the same manner as the Phygeton, 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 the Phlegmons.
What is a Gangrene, Sphacelus, or Esthiomenus?
The Gangrene and Sphacelus signifie the same thing, nevertheless are commonly distinguish'd; the former being a Mortification begun, and the Sphacelus an entire or perfect Mortification; call'd also Necrosis and Sideratio. An Esthiomenus is 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 the Interception 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, with Sanies issuing forth after Punctures or Scarifications made therein. Lastly, a Gangrene is perceiv'd by the cold Sweats, Swoonings, Syncope's, and Delirium's that 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'd Caries.
How is this Caries or 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 the Sanies that 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.
REMEDIES.
What are the Remedies proper for a Gangrene?
They are those that take away the mortify'd and 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 much Sal 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, wherein Unguentum Ægyptiacum is 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 of Mercurius Dulcis; adding four Ounces of Spirit of Wine, to make an excellent PhegedÆnick Water, 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, and Euphorbium afterward put into it, laying also some upon the Bolsters, and abstaining 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 with Unguentum Rosatum, is also very good, or Petroleum alone.
What is a Panaritium?
Panaritium or Paronychia, 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 the Periosteum, or that little Membrane with which it is immediately invested.
What Remedies are convenient for the curing of Panaritium?
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 and Oleum 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, and Populeon, 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 and Psyllium, and Frog's-Sperm, of each an equal quantity, adding to every four Ounces twenty Grains of Saccharum 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 the Pus or 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.
ARTICLE II.
Of the Erysipelas and its Dependances.
What is an Erysipelas?
An Erysipelas, commonly call'd St. 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.
REMEDIES.
What are the Remedies proper for an Erysipelas?
An Erysipelas that ariseth in the Head and Breast is not without danger, and the Cure of it ought to be undertaken with great Care in the Application as well of internal as external Remedies: For it is requisite to take inwardly a Dose of the Diaphoretick Mineral, Crabs-Eyes, Egg-shels, Powder of Vipers, and other Medicines; as also Potions that have the like Virtues, such as the following. Take four Ounces of Elder-Flower-Water, adding thereto a Scruple of the volatile Salt of Vipers or Hart's-Horn with an Ounce of Syrrup of red Poppies.
Phlebotomy or Blood-letting hath no place here, unless there be a great Plethory, but frequent Clysters are not to be rejected, viz. such as are made of Whay, Chervil, Succory, and Violet-Plants, adding a Dram of Mineral Crystal dissolv'd with two Ounce of Honey of Violets.
As for outward Applications, Linnen-Rags dipt in the Spirit of Wine impregnated with Camphire and Saffron, are to be laid upon the Tumour, and renew'd as fast as they are dry'd. An equal quantity of Chalk and Myrrh beaten to Powder, may also be strew'd upon a Sheet of Cap-Paper over-spread with Honey, and apply'd to the Part.
If the Heat and Pain grow excessive, take half a Dram of Saccharum Saturni, twenty Grains of Camphire, as much Opium, with two Drams of red Myrrh, to be infus'd in a Gallon of White-Wine: Let this Liquor be kept to soak the Cloaths that are laid upon the Erysipelas, and often renew'd. But to dress the Face, a Canvass Cloth may be us'd, which hath been dipt in a Medicine prepar'd with a Gallon of Whey, two Yolks of Eggs, and a Dram of Saffron.
Moreover amidst all these Remedies, it is necessary to oblige the Patient to keep to a good Diet, and to prescribe for his ordinary Drink a Diet-Drink made of Hart's-Horn, the Tops of the lesser Centory, Pippins cut in Slices with their Skins, and Liquorish; a little good Wine may be also allow'd, with the Advice of the Physician.
What are the Tumours or Impostumes that partake of the Nature of an Erysipelas?
They are the dry and moist Herpes, the former being that which is call'd the Tetter or Ring-Worm; and the other a kind of yellow-Bladders, Pustules, or Wheals, that cause itching, and raise small corroding Ulcers in the Skin: To these may be added divers sorts of Scabs and Itch.
The Remedies prescrib'd for the Erysipelas may be us'd for both these kinds of Herpes; as also Lotions or Bathing-Liquors made of Lime-Water, and a Decoction of Wormwood and Sal Ammoniack, allowing half a Dram to four Ounces of Liquor. Or else take half a Dram of Sal Saturni, and put it into a Glass of the Decoction of Fumitory or Chervil. You may also make use of the Oil of Tartar per deliquium, to make a Liniment either alone, or mingl'd with the above-mention'd Decoctions.
ARTICLE III.
Of the Oedema.
What is the Oedema?
It is a white soft Tumour, with very little sense of Pain, which ariseth from the Settling of a pituitous Humour.
What are the Remedies proper for an Oedema?
They are Fomentations, Cataplasms, Liniments, and Plaisters.
The Fomentations are made with Bundles of Wall-Wort or Dwarf-Elder, thrown into a hot Oven after the Bread is bak'd, and sprinkled with Wine: Afterward being taken out smoaking, they are unty'd, open'd, and wrapt about the Part, putting a warm Linnen Cloth over 'em. This Operation is to be re-iterated; and by this means the Humour is dissolv'd thro' Transpiration by Sweat.
The Cataplasms are compos'd of Camomile, Melilot, St. John's-Wort, Sage, Wall-Wort, Pellitory of the Wall, Roots of Briony and Onions, all boil'd together in White Wine with Honey, adding, if you please, a few Cummin or Fennel Seeds beaten. Cataplasms are also made of Horse-Dung and the Seeds of Cummin beaten, which are boil'd in strong Vinegar, and mixt with Barly-Meal to the Consistence of Pap.
The Plaisters are prepar'd with an Ounce of Diapalma, half on Ounce of Martiatum, a Pint of Oil of Lillies, half an Ounce of Cummin-Seeds powder'd, half a Dram of Sal Ammoniack, and an Ounce of yellow Wax to make a Consistence.
If any hardness remains, the Plaister of Mucilages may be apply'd, or that which is made of the Gums Bdellium, Ammoniack, and Galbanum, dissolv'd in Vinegar. But Care must be taken not to omit the Purgatives of Jalap to the quantity of a Dram in a Glass of White-Wine; or of half an Ounce of Lozenges of Diacarthamum, which are effectual in drawing out the bottom of pituitous and serous Humours that nourish the Oedema's.
Of Oedomatous Tumours and Impostumes.
What are the kinds of Tumours that partake of the Nature of an Oedema?
They are the PhlyctÆna, the Emphysema, the Batrachos or Ranunculus, the Wen, the Talpa, the Bronchocele, the Ganglion, the Fungus, the Scurf, the Scrophula or King's-Evil, and all sorts of Dropsies both general and particular.
What are PhlyctÆna's?
They are Pustules or Blisters fill'd with a white and somewhat yellowish Humour.
What is an Emphysema?
It is a kind of flatuous Tumour, wherein Wind is contain'd, with a little slimy Phlegm.
What is a Batrachos or Ranunculus?
It is a Blister fill'd with slimy Water, that ariseth under the Tongue near the String, and in French is call'd Grenouillette, or the little Frog; which is the same with its Greek and Latin Names.
What is a Wen?
It is a Tumour consisting of thick plaistry Phlegm, which is reckon'd among the Encysted.
What is a Talpa?
It is a soft and very broad Tumour, which usually appears in the Head and Face, containing a white, thick and pituitous Matter.
What is a Bronchocele?
It is a bunch'd Tumour which ariseth in the Throat, and causeth it to swell extremely; being compos'd of thick Phlegm mix'd with a little Blood, and ranked among the Encysted Tumours.
What is a Ganglion?
It is a very hard Tumour, void of Pain and wavering, produc'd by thick Phlegm: But it is always found upon some Nerve or Tendon.
What is a Fungus?
It is a spungy Tumour that grows upon Tendons bruis'd or weaken'd by some Hurt.
What is the Scurf?
It is a whitish and scaly Tumour rais'd in the Skin of the Head by a viscous and mixt Phlegm, having its Root in the bottom of the Skin.
What is the Scrophula or King's-Evil?
ScrophulÆ or StrumÆ, commonly call'd the King's-Evil, are Tumours that generally shew themselves in the Glandules of the Neck, and in all those Parts where there are any. They consist of a viscous, serous, and malignant Phlegm, The Source or Root whereof is suppos'd to be in the Glandules of the Mesentery. They are also of the number of the Encysted Tumours.
What is the Dropsie?
It is a soft Tumour occasion'd by the setling of abundance of serous Matter in the Parts where it appears.
How many sorts of Dropsies are there?
There are three general Species, viz. the Ascites, Tympanites, and Leucophlegmatia.
What is an Ascites?
It is a kind of Dropsy that forms the Tumour or Swelling of the Abdomen or lower Belly, by a Mass of Water.
What is a Tympanites?
It is a kind of Dropsy, which in like manner causeth a Tumour or Swelling in the lower Belly, with this difference, that a great deal of Wind is mixt with the Water, which renders the Tumour transparent, and sounding, as it were a Drum; whence this Disease hath taken its Name.
What is the Dropsy call'd Leucophlegmatia?
It is a Tumour, or, to speak more properly; a general Swelling or Bloating of all the other Parts of the Body, as well as of the lower Belly. It is produc'd by a viscous and mucilaginous sort of Phlegm; whence it happens that the Print of the Fingers remains in those places that have been press'd.
What are the particular kinds of Dropsies?
They are those that are incident to different Parts, of which they bear the Names; as the Hydrocephalus, which is the Dropsy of the Head; the Exomphalus, of the Navel, and the Hydrocele of the Scrotum. There is also a Dropsy of the Breast, and that of the Matrix.
What are the Remedies proper for all these sorts of Tumours or Dropsies?
They are in general all those that are agreeable to the Oedema, which are variously us'd, as Liniments, Fomentations, Cataplasms, and Plaisters: Internal Medicines ought also to be much consider'd, as Diaphoreticks, Sudorificks, and Purgatives, when they are assisted by a regular Diet.
A Decoction of the Roots of Briony with Cinnamon and Liquorish, provokes Urine very much; as well as a Decoction of Turneps and Carrets, and an Infusion of Sage in White-Wine.
ARTICLE IV.
Of a Scirrhus, and its peculiar Remedies.
What is a Scirrhus?
It is a hard unmoveable Tumour, almost altogether void of Pain, and of a livid dark Colour; which is form'd of a Melancholick Humour, frequently succeeding Phlegmons and Oedema's that have not been well dress'd with convenient Remedies.
How is a Scirrhus cur'd?
By mollifying or dissolving it, and seldom by bringing it to Suppuration.
It may be mollify'd by the application of a Cataplasm or Pultis, compos'd of the Leaves of Violet-Plants, Mallows, Beets, Elder, Rue, and Wormwood, with Camomile-Flowers, Horse-Dung, Cow-Dung, and White Lillies. The whole Mass is to be boil'd together in Wine, afterward adding Honey and Hogs-Lard, to make a Cataplasm thereof with the Crum of White Bread.
It is dissolv'd with Plaisters compos'd of those of Diachylon, Melilot, and Mucilages, to which is added Oleum Lumbricorum, and Flower of Brimstone. To render the Remedy more effectual, Oil of Tobacco may be also mixt with it, and Gum Ammoniack dissolv'd in Vinegar.
Furthermore, these Topical or outward Medicines are to be accompany'd with others taken inwardly, which serve to prepare the Humours for convenient Evacuations; Such are Crab's-Eyes, the Decoctions of Sarsaparilla, the use of good Wine, and light Meats of easie Digestion.
Of Scirrhous Tumours, and their Remedies.
What are the Tumours that partake of the Nature of a Scirrhus?
They are the Polypus, Carcinoma, Sarcoma, Natta, and Cancer.
What is a Polypus?
It is an Excrescence of fungous Flesh arising in the Nostrils: But Hippocrates confounds the Carcinoma and Sarcoma with the Polypus, of which he says they are only a Species.
What is the Natta?
It is a Tumour or Excrescence of Flesh that appears in the Buttocks, Shoulders, Thighs, Face, and every where else, the various Figures of which cause it to be call'd by different Names. For one while it resembleth a Gooseberry, at another time a Mulberry, and at another time a Melon or Cherry. Sometimes also these Swellings are like Trees, Fishes, Birds, or other sorts of Animals, according to the ardent desire that Women with Child have had for things that they cou'd not obtain when they longed for 'em.
What are the Remedies proper for the Polypus, and other kinds of Excrescences of the like Nature?
The Polypus may be cur'd in the beginning, but it is to be fear'd lest it degenerate into an incurable Cancer, when it hath been neglected or ill dress'd.
Besides the general Remedies, which are letting Blood a little, and reiterated Purgations, with an exact Regulation of Diet, there are also particular Medicaments which dry up and insensibly consume the Excrescence; as a Decoction of Bistort, Plantain, and Pomegranate-Rinds in Claret-Wine, which is to be snuff'd up the Nose many times in a Day, and serves to soak the small Tents that are put up therein, as also often to cool the Part, adding a little Allum and Honey.
The Patient must sometimes likewise keep in his Mouth a Sage-Leaf, sometimes a piece of the Root of Pellitory of Spain; and at another time Tobacco or some other thing of this Nature, which causeth Salivation. If the Tumour continues too long, and doth not yield to the above-mention'd Remedies, it is necessary to proceed to a Manual Operation, which is very often perform'd with good Success.
As for the Natta's, it is most expedient not to meddle with 'em at all; nevertheless these Marks which Infants bring along with 'em into the World, are frequently defac'd by an Application of the After-Burdens, whilst they are as yet warm, as soon as their Mothers are deliver'd.
What is a Cancer?
It is a hard, painful, and ulcerous Tumour, produc'd by an adult Humour, the Malignity whereof can scarce be suppress'd by any Remedies.
How many sorts of Cancers are there?
There are two kinds, viz. The Primitive and the Degenerate; the Primitive Cancer is that which comes of it self, and appears at first about the bigness of a Pea or Bean, which nevertheless doth not cease to cause an inward Pain, continual, and pricking by intervals; during this time it is call'd an Occult Cancer; but when grown bigger, and open'd, it bears the Name of an Ulcerated Cancer; which is so much the less capable of being cur'd or asswag'd, as it makes it self more conspicuous by its dreadful Symptoms, or concomitant Circumstances.
The Degenerate Cancer is that which succeeds an obstinate and ill-dress'd Tumour or Impostume, and which becomes an Ulcerated Cancer, without assuming the Nature of a blind or occult one.
What Remedies are requisite to be apply'd to a blind Cancer?
In regard that it cannot be known in this Condition without difficulty, it is often neglected; nevertheless it is a Matter of great Moment to prevent its Consequences, more especially by a good Diet, and by general Remedies, which may gently rectifie the intemperature of the Bowels: Afterwards Baths may be prescrib'd, together with the use of Whey Asses-Milk, and Specificks in general, as Powders of Crab's Eyes, Vipers, Adders, and others. As for Topical Remedies, none are to be administer'd, except it be judg'd convenient to apply to the Tumour a Piece of Lead rubb'd with Quick-silver; all others serving only to make the Skin tender, and apt to break. The Patient may also take for his Drink Water of Scorzonera and Hart's-Horn, with the Flowers of Bugloss or Borage, and Liquorice: Or else Quick-silver-Water alone, boiling an Ounce of it in a Quart of Water every time, the Quick-silver always remaining at the bottom of the Vessel.
What are the Remedies for an ulcerated Cancer?
Besides the general ones, that are the same with those of the blind Cancer, there are also Topical, which may take place here. The Powders of Toads, Moles, Frogs, and Crabs calcin'd, cleanse the Ulcers perfectly well. A Decoction of Vipers and Crabs may serve to bath 'em, and some of it may be taken inwardly. Detersives made of Lime-Water, or Whey clarify'd, and boil'd with Chervil are very good; and (if you please) you may add Camphire or Saccharum Saturni.
If the Pains grow violent, recourse is to be had to Laudanum, one or two Grains whereof may be given in a little Conserve of Roses. When the Cancer is situated in the Glandules or Flesh, the Extirpation of it may also be undertaken with good Success.
As for the manner of handling Degenerate Cancers, respect must be always had to the kind of Tumour, from whence it deriv'd its Original.
CHAP. IV.
Of Bastard or Encysted Tumours.
What is an Encysted or Bastard Tumour or Impostume?
It is that which is made of a Setling of mixt and corrupt Humours, the Matter whereof is contain'd in certain proper Cystes or Membranous Bags.
What are the kinds of these Tumours?
They are the Steatoma, the Atheroma, the Meliceris, the Wen, the Bronchocele, and the Scrophula or King's-Evil.
How is the difference between these Tumours discern'd?
The Steatoma is known by its Matter resembling Suet; as that of the Atheroma resembleth Pap; and that of the Meliceris is like Honey: These three Tumours cannot be well distinguish'd on the outside, in regard that they do not change the natural Colour of the Skin, which equally retains in all three the print of the Fingers that press it. But the Bronchocele is discover'd by the Place and Part which it possesseth; that is to say, the Throat; as also by its somewhat hard consistence without the Alteration of the Skin. The ScrophulÆ or King's-Evil Swellings are known by their unequal Hardness, and their situation in the Glandules, either in the Neck, Arm-pits or elsewhere, without alteration likewise of the Skin.
REMEDIES.
Want is the Method to be observ'd in curing these sorts of Tumours?
An Attempt is to be made to dissolve 'em, as in all the others; nevertheless the safest way is to bring 'em to Suppuration, and to extirpate the Cystes, which are apt to be fill'd again after the Dissipation of the Humour.
What are the Medicines proper to dissolve these Tumours?
They are all such as may be us'd for the Oedema and Scirrhus; but the Specificks or particular Remedies are these:
Take Rosemary, Sage, Wormwood, Elder, great Celandine, Camomile, Melilot, St. John's-Wort, and Tobacco; boil 'em in White-Wine with Soot and Mercurial Honey, adding, thereto Cummin-seeds beaten, and Oleum Lumbricorum, to make a Cataplasm, which is to be renew'd twice a Day. Afterward if the Tumour be not dispers'd, you may apply the following Plaister, which hath an admirable Effect.
Take an equal Portion of the Plaister of Diachylon, Devigo, and four times as much Mercury, and Emplastrum Divinum; let 'em be dissolv'd together; then intermix Saffron, and Oil of Tobacco, to make a Plaister with the whole Mass, which may be spread upon thin Leather, and apply'd to the Tumour, without taking it off only once every eighth Day, to cool it; so that it must be laid on again after having wash'd and bath'd the Part with warm Urine or Brine.
But it is to be always remember'd that external Remedies take effect only imperfectly, unless they are assisted by internal, such as in this case are reiterated Purgations, join'd with a regular Diet.
What are the Remedies proper to excite Suppuration?
To this purpose those may be us'd that serve in other kinds of Tumours: But as for the extirpation of the Cystis, it is done by dividing the Tumour into four Parts, by procuring Suppuration, and by consuming the Bag by little and little. The Bronchocele alone will not admit this Extirpation, by reason of the great Number of Nerves, Veins, and neighbouring Arteries amidst which the Tumour is settl'd. However Bronchotomy, or opening the Throat, may be perform'd; which is an Operation peculiar to this Tumour.
CHAP. V.
Of Critical, Malignant, Pestilential, and Venereal Tumours and Impostumes.
What difference is there between Critical, Malignant, Pestilential, and Venereal Tumours?
It consists in these particular circumstances, viz. that Critical Tumours or Impostumes are indifferently all such as are form'd at the End or Termination of Diseases, in whatsoever Place or Part they appear.
Malignant Impostumes or Tumours are those that are obstinate, and do not easily yield to the most efficacious Remedies.
Pestilential Impostumes or Tumours are those that are accompany'd with a Fever, Swooning, Head-ach, and Faintness: They usually arise in the time of a Plague or Pestilence, and are contagious.
Venereal Tumours or Impostumes are those that appear only at the bottom of the Groin, and are the product of an impure Coitus.
However, the Critical Impostume may be Malignant, Pestilential, and Venereal; the Malignant Impostume may be neither Critical, nor Pestilential, nor Venereal: But the Pestilential and Venereal Tumours are always Malignant.
What are the ordinary kinds of Critical Tumours or Impostumes?
They are the Anthrax, the Boil, the Phlegmon, and the Parotides or Swellings in the Almonds of the Ears.
What are the kinds of Malignant Tumours or Impostumes?
They are the Cancer, the Scrophula or King's-Evil; and others of the like Nature.
What are the kinds of Pestilential Tumours or Impostumes?
They are Carbuncles that break out every where; a sort of Anthrax which appears under the Arm-pits, and Bubo's in the Groin.
What are the kinds of Venereal Tumours or Impostumes?
They are Botches or Bubo's and Cancers that arise in the Yard; as also Wens and Condyloma's in the Fundament.
What is the difference between a Pestilential and a Venereal Buboe?
They may be distinguish'd by their Situation, and respective Accidents; the Pestilential lying higher, and the Venereal lower: Besides, a Fever, Sickness at the Heart, and an universal Faintness or Weakness, are the ordinary concomitant Circumstances of the former; whereas the Venereal Buboe is always the consequence of an impure Coitus, and is attended with no other Symptoms than those of common Tumours, viz. Pain, Heat, Shootings or Prickings, &c.
As for the Remedies, they may be sought for among those that have been already prescrib'd for Tumours.
CHAP. VI.
Of the Scurvy.
This Disease is known by the Ulcers of the Mouth, which are very stinking; as also by excessive Salivation, great Pains in the Head, Dizziness, frequent Epilepsies, Apoplexies, and Palsies. The Face, being of a pale red, and dark Colour, is sometimes puff'd up or bloated, inflam'd, and beset with Pustules: The Teeth are loose and ake, the Gums are swell'd, itch, putrifie, exulcerate, and are eaten with the Canker; and the Jaw is almost unmoveable: The Members are bow'd, and cannot be extended: The Patients become stupid and drowsie, so that they fetch their Breath with difficulty, are obnoxious to Palpitations of the Heart and Coughs, and fall into Swoons: The Ulcers sometimes are so malignant, that their Cheeks are entirely eaten up, and their Teeth seen: They are also much inclin'd to Vomitting, Looseness, and Gripes; and their Entrails are swell'd: They have red and livid Pustules on their Belly and Privy-parts, which sometimes break out into Ulcers; their whole Body being dry'd, &c.
This Disease may be easily cur'd in the beginning; but when it is grown inveterate, and invades the Bowels, it becomes incurable; as well as when it is the Epidemical Disease of the Country, or the Persons afflicted with it, are old, or well advanc'd in Years.
In undertaking the Cure, it is requisite to begin with a good Diet, and to sweeten the Blood, let the Patient take the Broth of boil'd Fowl; eating Pullets and Eggs; in the Broth may also be put divers sorts of Antiscorbutick Herbs; viz. Cresses, Spinage, Parsly-Roots, Sparagus, Smallage, Scorzonera, Scurvy-Grass, &c. Let him eat nothing that is high season'd, nor acid or sharp; let him drink pure Claret, without any adulterate Mixture; let him use moderate Exercise and Rest; Lastly, let him keep his Mind sedate, and free from all manner of violent Passion.
The following Remedies taken inwardly are very good for the Scurvy, viz. the Tincture of Flints from ten Grains to thirty; Diaphoretick Antimony, from six Grains to thirty; sweet Sublimate, from six Grains to thirty; Mars Diaphoreteus, from ten Grains to twenty; Crocus Martis Aperitivus, from ten Grains to two Scruples; prepar'd Coral, from ten Grains to one Dram; Volatile Spirit of Sal Ammoniack, from six Drops to twenty; Water of Cresses, from fifteen Drops to one Dram; Spirit of Scurvy-grass, from ten Drops to one Dram; Tincture of Antimony, from four Drops to twenty; Oily Volatile Sal Ammoniack, from four Grains to fifteen; Spirit of Guyacum, from half a Dram to a Dram and a half; Vitrioliz'd Tartar, from ten Grains to thirty; the Volatile Salt of Tartar, Urine, Vipers, and Hart's-Horn, of each from six Grains to fifteen; the Spirit of Gum Ammoniack, from eight Drops to sixteen; White Mercury Precipitate, from four to ten Grains; Mercurial PanacÆa, from six Grains to two Scruples. We shall shew the manner of compounding 'em in our Treatise of Venereal Diseases.
It is also expedient to give Emollient and Detersive Clysters to the Patient at Night going to bed, his Body being always kept open with convenient Diet-drinks: Afterward let him take gentle Sudorificks, such as are made of the Decoctions of Fumitory, wild Cicory, Dandelion, Hart's-Tongue, Scabious, the lesser House-Leek, Germander, Borage, Scorzonera-Root, and Polypody, with Flowers of Broom, Elder, and Marygold.
These are stronger for cold Constitutions, viz. Decoctions of Scurvy-Grass, Lepidium, Arse-smart, the lesser Celandine, Wormwood, little House-Leek, Trifolium Febrinum, Angelico, Juniper-Berries, &c.
Convenient Decoctions to wash the Mouth may be made with Sage, Rosemary, Hyssop, Oak-Leaves, Scurvy-Grass, Cresses, Tobacco, Roots of Bistort, Aristolochy or Birth-Wort, Tormentil, Flower-de-Luce, Balaustia or Pomegranate-Flowers, Red Roses, &c.
To corroborate the Gums, Gargarisms are made of Anti-Scorbutick Plants; as of Spirit of Scurvy-Grass two Drams, one Scruple of Spirit of Vitriol, one Scruple of common Salt, four Ounces of Rose-Water and Plantane-Water. But if the Gums are putrefy'd, they are to be rubb'd with Honey of Roses, and some Drops of Spirit of Salt.
To asswage the Pains of the Members, Bathings and Fomentations are to be us'd; and a Decoction of Saxifrage taken inwardly, with some Grains of Laudanum is good for that Purpose.
To allay the Gripes, Clysters may be given with Whey, Sugar, Yolks of Eggs, Syrrop of Poppies, and Oils of Earth-Worms, Scurvy-Grass, Camomile, &c.
Against the Scorbutick Dropsy, take the Essence of Trifolium Febrinum and Elicampane, from twenty four Drops to thirty, and continue the use thereof.
Milk taken inwardly hinders Vomitting; and a Broth or Gelly of Crabs sweetens the Blood. The Looseness may be stopt with the Essence of Wormwood, and Spirit of Mastick; as also the Fever with Febrifuges and Anti-scorbuticks.
The Spots may be fomented with Decoctions of Aromatick and Anti-Scorbutick Herbs and Nitre. For the Ulcers of the Legs, pulverize an equal quantity of Saccharum Saturni, Crocus Martis, Myrrh, and Mercurius Dulcis, and lay it upon the Bolsters that are to be apply'd to the Sores.
To mollifie the sharpness of Acid Humours, this is a good Remedy: Prepare half an Ounce of Spirit of Scurvy-Grass, two Drams of tartariz'd Spirit Ammoniack, a Dram of the Tincture of Worms. Take thrice a Day fifteen or twenty Drops of this Liquor, in a Decoction of the Tops of Firr.
Against the Tubercles, take two Handfuls of the Flowers of Camomile and Elder, three Drams of Briony-Root, and an Handful of White-Bread Crum; Boil the whole Composition in Milk, and make Cataplasms thereof.
To mitigate the Pains in the Head, take twenty or thirty five Drops of the Tincture of Amber, in Anti-scorbutick Spirits or Waters.
The difficulty of Respiration may be remov'd by a Medicinal Composition made of two Drams of an Anti-scorbutick Water, two Drams of the Essence of Elicampane, and half a Dram of the Spirit of Gum Ammoniack; take three or four Spoonfuls thereof several times in a Day.
To prevent the putrefaction of the Gums, take one Dram of the Tincture of Gum Lacca, three Drams of the Spirit of Scurvy-Grass, with fifteen or twenty Drops of Oil of Tartar made per Deliquium, and rub the Gums with this Composition many times in a Day. Brandy in which Camphire is infus'd, or Spirit of Wine, is likewise a most excellent Remedy; as also all Lotions or Washes made with the Waters or Decoctions of Anti-scorbutick Plants.
For Leanness, Goat's-Milk with the Spirit of Scurvy-Grass may be us'd, and other Waters drawn from Anti-scorbutick Plants. The Apozemes or Decoctions of Endive, Cicory, Sorrel, Becabunga, and Snail-Water, are in like manner very good for the same purpose.
Ointment of Styrax is frequently us'd in the Hospital call'd HÔtel-Dieu at Paris, and apply'd to Spots and callous Swellings that arise in the Legs.
A
TREATISE
OF
Wounds, Ulcers, and Sutures.
CHAP. I.
Of Sutures.
Sutures or Stitches are made only in recent, and as yet bleeding Wounds, when they cannot be re-united by Bandage, as are the transverse; provided there be no Contusion, nor loss of Substance, nor great HÆmorrhages, as also that the Wounds were not made by the biting of venomous Beasts, that there be no violent Inflammations, and that the Bones are not laid open; because generally 'tis necessary to cause 'em to be exfoliated; neither is this Operation to be perform'd in the Breast, by reason of its Motion.
The Instruments proper for the making of Stitches, are streight and crooked Needles, with waxed Thread; and these Sutures are of four sorts, viz. first the Intermittent Stitch for transverse Wounds; the second for the Hare-Lip; the third, commonly call'd the Dry Stitch, for superficial Wounds; and the fourth, term'd the Glover's Stitch.
The Intermittent Stitch is that which is made at certain separated Points, according to the following manner: After having taken away all extraneous Bodies out of the Wound, let a Servant draw together its Sides or Lips; and let a Needle with waxed Thread be pass'd thro' the middle from the outside to the inside, several Points being made proportionably to its length. It is requisite to pierce a good way beyond the Edge of the Wound, and to penetrate to the bottom, lest any Blood shou'd remain in the Space, that might hinder the reuniting.
If the Wound hath Corners, the Surgeon begins to sow there; and before the Knot is made, causeth the Lips of the Wound to be drawn exactly close one to another: The Knots must be begun with that in the middle, and a single one is first made on the side opposite to the running of the Matter; laying upon this Knot (if it be thought convenient) a small Bolster of waxed Linnen, on which is tied a Slip-Knot, to the end that it may be untied if any bad Accident should happen. If a Plaister be apply'd to the Wound after the Stitching, a small Bolster is to be laid over the Knots, to prevent their sticking to the Plaister. In case any Inflammation happens in the Wound, the Knots may be loosen'd and ty'd again when the Symptoms cease: But if the Inflammation continue, the Threads are to be cut by passing a Probe underneath: When the Wound is clos'd, the Threads are cut in like manner with a Probe; and in drawing 'em out, a Finger must be laid near the Knot, lest the Wound should open again.
To make the second sort of Stitch for the Hare-Lip, a small streight Needle is pass'd into the sides of the Wound, and the Thread is twisted round the Needle, by crossing it above at every Stitch.
To form the Dry Stitch in very superficial Wounds, a piece of new Linnen-Cloth is to be taken, wherein are made Digitations, or many Corners; the Selvedge or Hem ought to be on the side of these Corners or Digitations; and a small Thread-Lace is ty'd to every one of 'em. Afterward this Cloth is dipt in strong Glue, and apply'd about a Finger's breadth from the Edges of the Wound; so that a piece thereof being stuck on each side, the Laces may be ty'd together, to cause the Lips of the Wound to meet.
To make the Glover's Stitch, the Operator having drawn together the Lips of the Wound, holds 'em between two Fingers, passeth a Needle underneath 'em, and soweth 'em upward all along, after the manner of Glovers.
CHAP II.
Of Wounds in general.
What is a Wound?
A Wound is a recent, violent, and bloody Rupture or Solution of the Natural Union of the soft Parts, made by a pricking, cutting, or bruising Instrument.
What ought to be observ'd before all things in the curing of Wounds?
It is requisite to take notice of their differences, as well as of the Instruments with which they were made; to the end that Consequences may be drawn from thence for the Application of proper Remedies.
From whence arise the differences of Wounds, and which be they?
They are taken either from their Figure or Situation: With regard to their Figure, they are call'd Long, Broad or Wide, Triangular Great, Little, Superficial, or Deep; and with respect to their Situation, they are term'd Simple, Complicated, Dangerous, or Mortal.
What is a Simple and a Complicated Wound?
A Simple Wound is that which only opens the Flesh, and hath no other concomitant Circumstances; but a Complicated Wound, on the contrary, is that which is attended with grievous Symptoms, as HÆmorrhages, Fractures of Bones, Dislocation, Lameness, and others of the like Nature.
What is a dangerous and mortal Wound?
A dangerous Wound is that which is complicated the Accidents whereof are dreadful: As when an Artery is open'd or prick'd, when a Nerve or Tendon is cut, or when the Wound is near a Joynt and accompanied with a Dislocation or Fracture. A mortal Wound is that which must be inevitably follow'd by Death; as is that which is situated deep in a principal Part necessary for the Preservation of Life.
What are the Parts wherein Wounds are mortal?
They are the Brain, the Heart, the Lungs, the Oesophagus or Gullet, the Diaphragm, the Liver, the Stomach, the Spleen, the small Guts, the Bladder, the Womb, and generally all the great Vessels.
Wherein doth the Cure of Wounds consist?
In helping Nature readily to procure the reuniting of the Parts that have been divided, after having taken away or asswag'd every thing that might cause an Obstacle.
What are the things that hinder the speedy reunion of the Parts?
They are extraneous Bodies found therein, as Bullets, Flocks, and Pieces of Wood or Stone, &c. As also sometimes the Accidents which attend 'em; as an HÆmorrhage or Flux of Blood, Inflammation, Esthiomenus or Mortification, Hypersarcosis, or an Excrescence of Flesh, Dislocation, the Fracture of a Bone, the Splinter of a Bone, & sometimes a contrary Air.
REMEDIES.
What are the Remedies proper for stopping an HÆmorrhage or Flux of Blood?
The common Remedy is a kind of Cataplasm, made up with the Powders of Aloes, Dragons-Blood, Bole Armenick and Whites of Eggs, which are mix'd together and laid upon the Wound. But the following is an excellent one.
Take two Ounces of Vinegar, a Dram of Colcothar, two Drams of Crocus Martis Astringens; beat the whole together, steeping Muscus Quercinus therein; then throw upon it the Powder of Mushrooms, or of Crepitus Lupi: Apply this Remedy, and you'll soon stop the HÆmorrhage, taking Care nevertheless to bind the Part well, otherwise the Astringents do not readily take Effect.
To this Purpose you may also make use of Cobwebs, Mill-Dust, and the Powder of Worm-eaten Oak; or else take Oven-Soot mixt with the Juice of the Dung of an Ass or Ox, adding only thereto the White of an Egg.
Besides these Remedies there are also actual and potential Cauteries, or simple Ligatures, which are infallible. Indeed the actual Cautery is not always sure; because when the Escar made by the Fire, falls off the HÆmorrhage breaks out again as before: but the potential Cautery is almost always successful; such as the following.
Take about an equal Quantity of Vitriol and Powder of Mushrooms; apply 'em upon a little Lint to the Place where the Blood issueth forth, and you'll see it stop immediately: But Care must be taken to avoid touching a Nerve or Tendon; by reason that the Vitriol is apt to excite Convulsions.
How is the Inflammation and Mortification of a Wound Suppress'd?
If the Inflammation proceeds from the Presence of an Extraneous Body, it must be taken away as soon as possible with a Pair of Forceps, and if from the Quantity of Pus or corrupt Matter, it must be let out. But in case the Inflammation ariseth from extreme Pains, they are to be asswaged with Cataplasms or Pultises and anodyn Liniments, such as those that have been already prescribed in the Cure of the Phlegmon: or else the Part may be bath'd with Camphirated Spirit of Wine, mixt with as much Water: Saccharum Saturni infus'd in Lime-water, performs the same Effect, and the Water of Crabs alone is admirable in its Operation.
Against the Esthiomenus or Mortification, make use of Wine boil'd with Wormwood, St. John's Wort, Rosemary and Aloes; or else take the Tincture of Aloes and Myrrh, or Spirit of Wine alone impregnated with Camphire and Saffron.
What is to be done in Case a Convulsion happens by reason of a wounded Nerve or Tendon?
If the Convulsion be caus'd by the Presence of an Extraneous Body that bruiseth the Part it must be taken away; and if from the wounding of a Nerve, pour into the Wound some Drops of the Oil of Lavender distill'd, which in that Case is of singular Use; this Oyl may be also taken inwardly in an appropriated Liquour, such as a Decoction of Wormwood and the Tops of the lesser Centory. Balsam of Peru us'd in the same Manner, is an excellent Remedy, and the Oyls of Worms, Snails, St. John's-Wort and Turpentine are frequently apply'd with good Success.
If the Convulsion proceeds from the Biting of some venomous Creature, Cupping-Glasses or Leeches are to be immediately applied, putting into the Wound Treacle with the Spirit of Wine or even Fire it self, and leaving to the Physician's Care the Prescription of other vulnerary Remedies proper to be taken inwardly.
What is to be done to draw the Extraneous Bodies out of a Wound?
When they cannot be taken away with the Fingers or Forceps, the Patient must be set in the same Station or Posture wherein he was when he receiv'd the Wound, in order to get some farther Light to discover 'em; or else such Plaisters may be us'd as are endu'd with an Attractive Quality: Particularly this:
Take an Ounce of Treacle, half a Dram of Gum Ammoniack, one Dram of Bdellium, and two Drams of Bore's Grease, adding a Quarter of a Pound of Wax to make 'em up into the Form of a Plaister. It is reported that Hare's Grease alone hath the same Effect, and that it goes for a Secret among the Surgeons but you may (if you please) mix it with Ointment of Betony. However it hath been observed that Leaden Bullets may sometimes remain in a Man's Body, during his whole Life-time without doing any Harm.
How are Excrescences to be taken away?
They may be consum'd with Powder of Allom, Unguentum Ægyptiacum, or Lapis infernalis.
After having remov'd every thing that hinders the reuniting of the Lips of a Wound, what is to be done to attain thereto?
The Re-Union in Wounds is properly the Work of Nature; but it may be promoted by putting into 'em a little Balsam of Peru, and drawing together their Lips with the Fingers. Afterwards the Lips must be kept closed with a Bandage, a Glutinous Plaister or a dry Stitch, provided the Wound be only superficial, hindring the Air from penetrating into it. For Want of Balsam of Peru, an excellent one may be made with the Flowers here specified.
Take the Flowers of Henbane, St. John's-Wort, and Comfry and let 'em be digested in the Sun during the whole Summer-Season in the Oyl of Hemp-seed, which Oyl, the longer it is kept, proves so much the better, if it be set forth in the Sun every Summer, the Vessel that contains it being well stop'd. There is also the Balsam of Balsams, or the Balsam of Paracelsus call'd Samech.
To avoid the exposing of Wounds to the Air, it is requisite to cover 'em over the Dressings with some sort of Plaister, which is usually termed the Surgeon's Plaister, such is that which is effectual in Dissolving, corroborating and allaying Pain or Inflammation.
Take the Mucilages of the Roots of great Comfrey and Fenegreek, half a Pound of Ceruse or white Lead, two Drams of Crude Opium, one Dram of Camphire, as much of Saffron, two Drams of Sandarack, one of the Oyl of Bays, one half Pound of Rosin, and as much Turpentine and Wax. Boil all these Ingredients together in a sufficient Quantity of Lin-seed-Oyl, and make a Plaister according to Art.
In great Wounds it is expedient to lay over the Dressings a Cataplasm or Pultiss, such as this:
Take the Leaves and Flowers of Camomile, and Melilot, the Tops of Wormwood, common Mallows and Marsh-Mallows, with the Seeds of Line and Cummin powder'd: Then boyl the whole Composition in Wine, and add thereto Barly-Meal, to give it a due Consistence. If there be any Cause to fear a Gangrene, you may also intermix Saffron, Myrrh and Aloes with Spirit of Wine.
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.
Take half an Ounce of Aloes and Myrrh powder'd, two Drams of Sal Saturni, twenty Grains of Sal Ammoniack, the same quantity of beaten Cloves, a Dram of Queen of Hungary Water and half an Ounce of Unguentum Basilicon, and let the whole Mass 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 Hore-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 Stitches contribute very much to the re-uniting of the Lips of Wounds, when they cannot be join'd by Bandage.
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 Stitch.
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 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 HÆmorrhage 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, prick, or bruise; if it be cutting, the Wound is more Superficial, and not subject to a great Suppuration: If it be pricking, 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.
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 Circumstances are not to be despis'd, in regard that they give occasion to profitable Conjectures.
What particular Circumstance is there to be observ'd in undertaking the Cure of Wounds in the Face?
It is, that a more nice Circumspection 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 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.
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 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.
CHAP VI.
Of Wounds made by Guns or Fire-Arms.
These Wounds are always bruis'd and torn, with the loss of Substance, and commonly with the splitting and breaking of a Bone: They are red, black, livid, and inflam'd, not being usually accompany'd with an HÆmorrhage: They are generally round, and streighter at their Entrance than at their End; at least if they were not made with Cross-Bar-Shot, or Quarter-Pieces.
Of the Prognostick of Wounds by Gun-shot.
When these Wounds penetrate into the Substance of the Brain, or Marrow of the Back-Bone, or into the Heart, Pericardium, great Vessels, and other noble Parts, Death always inevitably follows, and often happens at the very Instant. But one may undertake the Cure of those that are superficial, and which are made in the Neck, Shoulders, Arms, and all other parts of the Body.
Of the Cure of Wounds by Gun-shot.
For the better curing of these sorts of Wounds, it is requisite to be inform'd of the Quality of the Fire-Arms by which the Wounds were made, in regard that a Musquet is more dangerous than a Pistol, and a Cannon much more than a Musquet; as also to examine their situation and concomitant Accidents; for by how much the more complicated they are, so much the greater is the danger. Then the Patient must be set (as near as can be) in the very same Situation and Posture wherein he remain'd when the Wound was receiv'd, in order to discover the direct Passage of the Wound by the help of the Probe, with which a search is to be made, whether a Bullet, or any other extraneous Bodies, as Wood, Flocks, Linnen, or Stuff as yet stick in the Wound; so that Endeavours may be us'd to take 'em out thro' the same Hole where they enter'd, care being more especially had to avoid making Dilacerations in drawing 'em out: But if the Operator hath endeavour'd to no purpose to remove these extraneous Bodies, let him make a Counter-Opening in the opposite Part, where he shall perceive any hardness, nevertheless without touching the Vessels; thus the Incision being made, he may readily draw 'em out with his Fingers, or some other Instrument.
If the Bullet sticks so far in a Bone that it cannot be taken away without breaking the same Bone, it is more expedient to let it lie therein; but if the Leg or Arm-Bones are very much split or shattered, then the Amputation of 'em becomes absolutely necessary. The Pain and Inflammation of the Part may be asswag'd by letting Blood, topical Anodyns, cooling Clysters and Purgations; but in case much Blood hath been already lost, Phlebotomy must be omitted. The Clysters may be made with Decoctions of Mercury, Mallows, Beets, a Handful of Barley and Honey of Roses.
Some Surgeons are of Opinion that the Patient ought to be purg'd every other Day, and even on the very same Day that he receiv'd the Wound, if his Strength will permit; however very gentle Purges are to be us'd upon this occasion, such as Cassia, Manna, Tamarins, Syrrup of Violets, and that of White Roses.
In the mean while Anodyns may be compounded to mitigate the Pain; as Cataplasms or Pultisses made with the Crum of white Bread, Milk, Saffron, the Yolk of an Egg, and Oil of Roses us'd hot; which last Ingredient is of it self a very good Anodyn. But to asswage great Inflammations, Oil of Roses, the White of an Egg and Vinegar beaten all together, may be laid on the neighbouring Parts.
At first it is necessary to apply spirituous Medicines to the Wound, and Pledgets steep'd in camphirated Brandy, are admirable for that purpose; but if there be a Flux of Blood, styptick Waters, or other astringent Remedies may be us'd, still remembring that all these Medicaments must be apply'd hot.
To promote the Suppuration of these contused Wounds, a Digestive may be made of Oleum Rosatum, the Yolk of an Egg, and Venice Turpentine.
If the Wound be in the Nerves, Tendons, or other Nervous Parts, it is requisite to use spirituous and drying Medicines, never applying any Ointments, which will not fail to cause Purtrefaction in those Parts: But a Cataplasm may be made with Barley-Meal, Orobus, Lupins and Lentils boil'd in Claret, adding some Oil of St. John's-Wort.
The Balsam of Peru, Oil of Turpentine destill'd, Oil of Wax, destill'd Oil of Lavender, Oleum Philosophorum, Oil of Bays destill'd, Balsam of St. John's-Wort, Spirit of Wine, and Gum Elemi, are excellent Medicaments for the Nerves: Or else,
Take four Ounces of Unguentum AlthÆÆ with a Dram and a half of destill'd Bays; mingle the whole Composition, and apply it: Or else,
Take an Ounce of destill'd Oil of Turpentine, a Dram of Spirit of Wine, and half an Ounce of Camphire; let all be intermixt, and dropt into the Wound: Or else,
Take a Scruple of Euphorbium, half an Ounce of Colophonia, and a little Wax; let 'em be mingl'd together, and apply'd very hot to the Nervous Parts.
If the Wounds are deep, Injections may be made with this Vulnerary Water, which is very good for all sorts of Contusions, as also for the Gangrene and Ulcers.
Take the lesser Sage, the greater Comfrey, and Mugwort, of each four Handfuls; Plantane, Tobacco, Meadowsweet, Betony, Agrimony, Vervein, St. John's-Wort, and Wormwood, of each three Handfuls; Fennel, Pilewort Bugle, Sanicle, Mouse-Ear, the lesser Dazy, the lesser Centory, and All-heal, of each three Handfuls; three Ounces of round Birth-Wort, and two Ounces of long: Let the whole Composition be digested during thirty Hours, in two Gallons of good White-Wine, and afterward destill'd in Balneo MariÆ, till one third part be consumed.
If a Gangrene happens in the Part, Spirit of Mother-Wort may be put into it, which is compounded with two Drams of Mastick, Myrrh, Olibanum, and Amber, and a Quart of rectify'd Wine, the whole being destill'd.
This Fomentation may be apply'd very hot to very good purpose, viz. an equal quantity of Camphirated Wine and Lime-Water, with three Drams of Camphire.
This is also an excellent Cataplasm: Take a Pint of Lye, and as much Spirit of Wine, half an Handful of Rue, Sage, Scordium, and Wormwood, a Dram of each of the Roots of both sorts of Birth-Wort, and two Drams of Sal Ammoniack. Let the whole Composition be boil'd till a third Part be consum'd; adding half a Dram of Myrrh and Aloes, and a little Brandy.
Of a Burn made by Gun-Powder.
If the Burn be recent, and the Skin not exulcerated, Spirit of Wine or Brandy is to be immediately apply'd; or else an Ointment may be made with Oil of Olives, or bitter Almonds, Salt, the Juice of Onions, and Verjuice.
If the Skin be ulcerated, and little Bladders or Pustules arise, an Ointment may be compounded with the second Bark of Elder boil'd in Oil of Olives. After it hath been strain'd, add two parts of Ceruse or White-Lead, and one of Burnt Lead, with as much Litharge, stirr'd about in a Leaden-Mortar, to make a Liniment. But it is not convenient to take out the Grains of Powder that remain in the Skin, because they are apt to break, and to be more confounded or spread abroad; so that they must be left to come forth in the Suppuration.
When the Wound is superficial, and the Skin as yet whole, peel'd Onions with common Honey are an excellent Remedy; but if the Skin be torn, it is not to be us'd, by reason that the Pain wou'd be too great; in which case Oil of Tartar per diliquium hath a very good effect.
If the Burn be accompany'd with a Fever, it may be allay'd with fixt Nitre, Nitre prepar'd with Antimony, and Gun-Powder taken inwardly, which are very effectual in their Operation. Crab's-Eyes prepar'd, and even some of 'em unprepar'd, are in like manner admirable Remedies.
As for external Medicaments, when the Burn is only superficial, take Onions and unslack'd Lime, quench'd in a Decoction of Rapes, and apply this Liquor very hot, with double Bolsters dipt therein. Or else take what quantity you please of quick Lime well wash'd, and pound it thoroughly in a Leaden-Mortar, with May-Butter without Salt, to make an Ointment, which may be laid altogether liquid upon the affected Part: Or else,
Take as much quick Lime as you can get up between your Fingers at two several times; Milk-Cream and clarify'd Honey, of each about half the like quantity; let the whole be intermix'd to the Consistence of an Ointment, and apply'd: It is an approv'd Remedy; as also is the following;
Take unslack'd Lime, and put it into common Water, so as the Water may appear four or five Finger's breadth above it. After the Effervescence, pour in Oil of Roses; whereupon the whole Mass will be coagulated in form of Butter, and may be apply'd.
A good Lotion or Washing-Liquor may be prepar'd with the Juice of Garlick and Onions, in recent Burns; otherwise make use of this Ointment. Take an Ounce and an half of raw Onions, Salt, and Venice Soap, of each half an Ounce; mingle the whole Composition in a Mortar, pouring upon it a sufficient quantity of Oil of Roses, to make a very good Ointment: Or else,
Dissolve Minium or Litharge in Vinegar, filtrate this Liquor, and add thereto a quantity of Rape-Oil newly drawn off, sufficient to give it the Consistence of a liquid Liniment; then stir it about in a Leaden-Mortar till it become of a grey Colour, and keep it for Use as an excellent Liniment: Or else,
Pound Crey-Fishes or Crabs alive in a Mortar to get their Blood, and foment the Part with it hot; it is a good Remedy: Otherwise intermix the pounded Crabs with May-Butter without Salt, and let 'em be boil'd up together, and scumm'd, till a red Ointment be made, which may be drawn off, or strain'd for Use. And indeed, all manner of Ointments, and other Medicinal Compositions wherein Crabs are an Ingredient, are true specificks against Burns made by Gun-Powder.
The Mucilages of the Seeds of Psyllium, or rather those of Quince-Seeds prepar'd with Frog's Sperm, and a little Saccharum Saturni, spread with a Feather upon the affected Part, have a wonderful Operation in Burns.
A Medicament compounded with one third part of the Oil of Olives, and two of the Whites of Eggs well beaten and mixt together, is a very simple and singular Remedy. Otherwise take half an Ounce of Line-seed-Oil infus'd in Rose-Water, with four Yolks of Eggs; beat 'em together, and let the whole be apply'd to the burnt Part.
If the Burn be very violent, and hath many Pustules, Etmullerus is of Opinion that they ought to be open'd, and that an Ointment shou'd be apply'd, which is made of Hen's-Dung boil'd in fresh Butter: Otherwise,
Take a handful of fresh Sage-Leaves, two handfuls of Plantane, six Ounces of fresh Butter without Salt, three Ounces of Pullet's-Dung newly voided, and the whitest that can be found; then fry the whole Composition for a quarter of an Hour; squeeze it out, and keep it for use: Otherwise,
Take two Ounces of sweet Apples roasted under Embers, Barly-Meal, and Fenugreek, of each half an Ounce, and half a Scruple of Saffron; let the whole Mass be mingled to make a Liniment or soft Cataplasm, which may serve to asswage Pain, and mollifie the Skin.
If the Wound be yet larger, and hath a Scab, open all the Pustules, and endeavour the two first Days to cause the Escar to fall off by the Application of a Liniment made of the Mucilages of Quince-Seeds steept in Frog's-Sperm, with fresh Butter, the Oil of White Lillies, and the Yolk of an Egg: Otherwise,
Make a Liniment with fresh Butter well beaten in a Leaden-Mortar, with a Decoction of Mallows, which being spread upon hot Colewort-Leaves, and apply'd to the Escar, it will fall off.
But if the Escar be too hard and obstinate, it is requisite to proceed to Incisions to make way for the Sanies, lest a deep and putrid Ulcer shou'd be engender'd Underneath. As soon as the Humour is evacuated, the above-mention'd Emollient Medicines may be us'd, till the separation of the Escar; then the Ulcer may be consolidated with Digestives and Mundificatives; such as the Ointment of quick Lime with Oil of Roses, and the Yolks of Eggs. The white camphirated Ointments, and that of Alabaster, are also good for the same Purpose.
If a Gangrene ensueth, Sudorificks must be taken inwardly; such are camphirated Spirit of Treacle, the Essence and Spirit of Elder-Berries, the Spirit of Hart's-Horn with its own proper Salt, Treacle impregnated with the Spirit of camphirated Wine, Scorpion-Water, Hart's-Horn, Citron with Camphire, &c.
As for external Remedies in the beginning of the Gangrene, the Spirit of Wine apply'd hot is excellent; and yet better if Aloes, Frankincense, and Myrrh be intermixt therein. It ought also to be observ'd, that Camphire must always be mingled in the topical Medicines for the Cure of the Gangrene.
A Decoction of unslack'd lime, in which Brimstone hath been boil'd, with Mercurius Dulcis, and the Spirit of Wine, is a very efficacious Remedy.
In a considerable Gangrene, after having made deep Scarifications, let Horse-Dung be boil'd in Wine, and laid upon the Part in form of a Cataplasm. This is an approved Remedy.
If a Sphacelus be begun, scarifie the Part, and apply thereto abundance of Unguentum Ægyptiacum over and above the Ointments and Cataplasms already describ'd; remembring always, that when the Gangrene degenerates into a Sphacelus, all the mortify'd Parts must be incontinently separated or cut off from the sound.
CHAP. VII.
Of Ulcers in general.
What is an Ulcer?
An Ulcer is a Rupture of the Natural Union of the Parts made a long while ago, which is maintain'd by the Sanies that runs out of its Cavity; or an Ulcer takes its Rise from a Wound that cou'd not be well cur'd in its proper time, by reason of the ill quality of its Pus or corrupt Matter.
What difference is there between a Wound and an Ulcer?
It is this, that a Wound always proceeds from an external Cause, and an Ulcer from an internal, such as Humours that fall upon a Part; or else a Wound in growing inveterate degenerates into an Ulcer.
Whence is the difference of Ulcers deriv'd?
It is taken from the Causes that produce 'em, and the Symptoms or Accidents with which they are accompany'd. Thus upon Account of their Causes they are call'd Benign or Malignant, Great, Little, Dangerous, or Mortal; and by reason of their Accidents, they are term'd Putrid, Corrosive, Cavernous, Fistulous, Cancerous, &c.
Do Ulcers always proceed from external Causes, or from an outward Wound degenerated?
No they sometimes also derive their Origine from internal Causes, as the Acrimony of Humours, or their Malignant Quality; the Retention of a Splint of a Bone, and other things of the like Nature. These Ulcers are commonly call'd Primitive, and the others Degenerate.
What are Putrid, Corrosive, Cavernous, Fistulous and Cancerous Ulcers?
The Putrid Ulcer is that wherein the Flesh is soft and scabby, the Pus and Ichor being viscous, stinking, and of a cadaverous smell.
The Corrosive Ulcer is that which by the Acrimony and Malignity of its Sanies, corrodes, makes hollow, corrupts and mortifies the Flesh.
The Cavernous Ulcer is that the Entrance of which is streight and the bottom broad wherein there are many Holes fill'd with malignant Sanies, without any callosity or hardness in its sides.
The Fistulous Ulcer is that which hath long, streight, and deep Holes, with much hardness in its sides; the Sanies whereof is sometimes virulent, and sometimes not.
The Cancerous Ulcer is large, having its Lips bloated, hard, and knotty, of a brown Colour, with thick Veins round about, full of a livid and blackish sort of Blood. In the bottom are divers round Cavities, which stink extremely, by reason of the ill Quality of the Sanies that runs out from thence.
Are there no other kinds of Ulcers?
Yes, there are also Verminous, Chironian, Telephian, Pocky, Scorbutick, and others, which have much affinity with, and may well be reckon'd among the five Kinds already specify'd.
What are the means to be us'd in the curing of Ulcers?
Ulcers ought to be well mundify'd, dry'd and cicatriz'd; but with respect to the several Causes and Accidents that render 'em obstinate, and difficult to be cur'd, it is also requisite to make use of internal Medicines, which may restrain and consume 'em. If their sides grow callous, they are to be scarify'd, in order to bring 'em to Suppuration; and if there be any Excrescences, they must be eaten away with corroding Powders, such as that of Allom; or by the Infernal Cautery.
What are the Remedies proper to cleanse and dry up Ulcers?
To this Purpose divers sorts of Liquors may be us'd, as also Powders and Plaisters: The Liquors are usually made of Briony-Roots, the greater Celandine, Lime, and Yellow Water; a Tincture of Myrrh, Aloes and Saffron, and Whey, whereto is added Saccharum Saturni; so that the Ulcers may be wash'd or bath'd with these Liquors; and very good Injections may be compounded of 'em.
The Powders are those of Worm-eaten-Oak, Allom, and Cinoper, the last of these being us'd by burning it, to cause the Fume to be convey'd to the Ulcer thro' a Funnel. The Country People often make use of Potter's-Earth to dry up their Ulcers, with good Success; but then they must must be of a Malignant Nature.
The Plaisters are Emplastrum de Betonica, Diasulphuris, Dessiccativum Rubrum, and others; and the Ointments are such as these;
Take three Yolks of Egg, half an Ounce of Honey, and a Glass of Wine, and make thereof a mundifying Ointment, according to Art: Otherwise,
Take Lime well wash'd and dry'd several times, let it be mingled with the Oil of Line and Bolus, and it will make an excellent Ointment to mundifie and dry; a little Mercury Precipitate may be intermixt (if you please) to augment the drying Quality; and Mercurius Dulcis may be added in the Injections.
For Ulcers in the Legs, and Cancerous Ulcers, take Plantain-Water and Allom-Water, or else Spirit of Wine, Unguentum Ægyptiacum, and Treacle; or else an Extract of the Roots of round Birth-Wort made in the Spirit of Wine. Gun-Powder alone dissolv'd in Wine, is of singular Use to wash the Ulcers, and afterwards to wet the Pledgers which are to be apply'd to 'em. But here are two particular and specifick Medicines to mollifie a Cancer.
Take Saccharum Saturni, Camphire, and Soot; let 'em be incorporated with the Juice of House-Leek and Plantain, in a Leaden-Mortar; then make a Liniment thereof, and cover the Part affected as lightly as is possible to be done, as with a simple Canvass-Cloth, or a Sheet of Cap-Paper: Or else,
Take the destill'd Water of rotten Apples, and mingle it with the Extract of the Roots of round Birth-Wort made in Spirit of Wine; reserving this Liquor to wash the Part, and to make Injections.
CHAP. VIII.
Of Venereal Diseases.
Of the Chaude-pisse or GonorrhÆa.
The Signs of this Disease are a painful Distention of the Penis or Yard, and a scalding Pain in making Water, the Urine being pale, whitish, and full of Filaments or little Threads: Sometimes the Testicles are swell'd as well as the Glans and PrÆputium; and sometimes there is a Flux of a kind of Matter yellowish, Greenish, &c.
If there be a great Inflammation in the Yard, endeavours must be us'd to allay it by letting Blood; and afterward the Patient may take a cooling and diuretick Diet-Drink, as also Emulsions made with cold Seeds in Whey. A very good Decoction may be prepar'd in all places, and without any trouble, by putting a Dram of Sal Prunella into every Quart of Water, whereof the Patient is to drink as often as he can: This Decoction is very cooling and diuretick; and the use of it ought to be continu'd till the Inflammation be asswag'd. Then some gentle Purges are to be prescrib'd in the beginning; such as an Ounce of Cassia, and as much Manna, infus'd in two Glasses of Whey, which are to be taken one or two Hours one after another.
Afterward the Patient must be often purg'd with twelve Grains of Scammony, and fifteen Grains of Mercurius Dulcis; and these Purgations must be continu'd, till it appears that the Fluxes are neither yellowish nor greenish, nor of any other bad Colour. When they are become White, and grown Thready, they may be stopt with Astringents: Amber and dry'd Bones beaten to Powder, eighteen Grains of each, with one Grain of Laudanum, the Composition being taken in Conserve of Roses, are very good for this Purpose. Crocus Martis Astringens, or else its Extract, taken from half a Dram to a whole Dram, in like manner performs the same Operation. As soon as the GonorrhÆa is stopt, to be certain of a perfect Cure, a Dram of the Mercurial PanacÆa is to be taken, from fifteen to twenty Grains at a time, in Conserve of Roses. In the mean while, if a small Salivation shou'd happen, it must be let alone for the present, since it may be stopt at pleasure by the Purgations. When it is requisite to restrain the GonorrhÆa, Mercury must not be given any longer, in regard that it is a Dissolvent, which is only good when the Glandules of the Groin or Testicles are swell'd, or else when it is expedient to set the Chaude-pisse a running, after it hath been too suddenly stopt. At the same time that the Astringents are taken with the Mouth, Injections also are to be made into the Yard; such as are prepar'd with Lapis Medicamentosus, of which one Dram is put into eight Ounces of Plantane-Water. All Astringents that are not Causticks, are proper for the Syringe.
Of Shankers.
They are round Ulcers, and hollow in the middle, which appear upon the Glans and the PrÆputium. To cure 'em, they must be touch'd with the Lapis Infernalis, and brought to Suppuration by the means of red Precipitate mixt with the Ointment of Andreas Crucius. Oleum Mercurii laid on a Pledget or Bolster, is very efficacious to open Skankers, and consume their Flesh. The Patient must be well purg'd with Mercurius Dulcis and Scammony, taking twelve or fifteen Grains of each in Conserve of Roses; and after these Purgations are sufficiently reiterated, he may take the Mercurial PanacÆa's. It is an excellent Remedy for all sorts of Pocky Distempers not yet consummated, or arriv'd at the greatest height of Malignity.
Of Bubo's.
Bubo's are gross Tumours or Abcesses that arise in the Groin, the perfect Maturity of which is not to be waited for in order to open 'em; because it is to be fear'd lest the corrupt Matter remaining therein too long, might be convey'd into the Blood by the Circulation, and so produce the grand Pox: Therefore it is necessary to open 'em betimes with a Lancet, or else with a Train of potential Cauteries, if they are too hard. They ought to be Suppurated for a considerable time: The Patient must be well purg'd with Scammony and Mercurius Dulcis: He must also take the Mercurial PanacÆa's.
Of the Pox.
This loathsome Disease begins sometimes with a virulent GonorrhÆa, and a weariness or faintness at the same time seizeth on all the Members of the Body: It is usually accompany'd with Salivation and the Head-ach, which grows more violent at Night: Pricking Pains are also felt in the Arms and Legs, the Palate of the Mouth being sometimes ulcerated. If it be an inveterate Pox, the Bones are corrupted, and Exostoses happen therein; divers Spots with dry, round and red Pustules appear in the Skin; and the Cartilages or Gristles of the Nose are sometimes eaten up. But when this Disease is come to its greatest height of Malignity, the Hair falls off; the Gums are ulcerated; the Teeth are loose, and drop out; the whole Body is dry'd up; the Eyes are livid; the Ears tingle; the Nose become stinking; the Almonds of the Ears swell; the Uvula or Palate is down; Ulcers break out in the Privy-Parts; Bubo's arise in the Groin; as also Warts in the Glans and PrÆputium; and Condyloma's in the Anus.
Indeed the Pox may be easily cur'd in the beginning; but when it hath taken deep Root by a long Continuance, it is not extirpated without much difficulty, more especially if it be accompany'd with Ulcers, Caries, and Exostoses; the Person afflicted with it being of an ill Constitution, and his Voice grown hoarse.
The Spring and Summer are the proper Seasons of the Year for undertaking the Cure of this Disease: In order to which, it is necessary that the Patient begin with a regular Diet, lodging in a warm place, and taking such Aliments as yield a good Juice; as Jelly-broath made with boil'd Fowl: Let him drink Sudorifick Decoctions, prepar'd with the Wood of Guayacum, China-Root, and Sarsaparella, and let him abstain from eating any thing that is high season'd: Let him take Clysters to keep his Body open; sometimes also he may be let Blood, and purg'd with half a Dram of Jalap, and fifteen Grains of Mercurius Dulcis. The Purgations may be re-iterated as often as it shall be judg'd convenient; and then the Patient may be bath'd for nine or ten Days, every Morning and Evening; during which time he may take volatile Salt of Vipers, the Dose being from six to sixteen Grains; or else Viper's-Grease from half a Dram to a whole Dram in Conserve of Roses.
Afterward it will be necessary to proceed to Fluxing, which is caus'd by the means of Frictions with Vuguentum Mercurii, which is made of crude Mercury stirr'd about in a Mortar with Turpentine, and then the whole mingled with Hog's-Grease, one part of Mercury being usually put into two parts of Hog's-Grease. The Rubbing is begun at the Sole of the Feet, by a long Continuance, it is not extirpated without ascending to the Legs, and the inside of the Thighs; but the Back-Bone must not be rubb'd at all; When the Persons are tender, or of a weak Constitution, a single Friction may be sometimes sufficient. Thus the Patient must be rubb'd at the Fire, after he hath taken a good Mess of Broath; but I would not advise it to be done with more than one or two Drams of Mercury at a time, without reckoning the Grease. Then the Patient must be dress'd with a Pair of Linnen-Drawers or Pantaloons, and laid in his Bed, where his Mouth may be lookt into from time to time, to see whether the Mercury hath taken effect; which may be easily known, by reason that his Tongue, Gums, and Palate swell and grow thick, his Head akes, his Breath is strong, his Face red, and he can scarce swallow his Spittle; or else he begins to Salivate.
If none of these Signs appear, the Rubbing must be begun again in the Morning and Evening; then if no Salivation be perceiv'd, for sometimes four or five Frictions are made successively, a little Mercurial PanacÆa may be taken inwardly, to promote it. During the Frictions, the Patient is to be nourish'd with Eggs, Broaths, and Gellies; he must also keep his Bed in a warm Room, and never rise till it shall be thought fit to stop the Salivation, which continues twenty or twenty five Days; or rather till it becomes Laudable; that is to say, till it be no longer stinking, nor colour'd, but clear and fluid.
If a Looseness shou'd happen during the Salivation, it wou'd cease, so that to renew it, the Looseness may be stay'd with Clysters made of Milk and the Yolks of Eggs; and in case the Salivation shou'd not begin afresh, it must be excited with a slight Friction: But if it shoul'd be too violent, it may be diminish'd by some gentle Purge, or with four or five Grains of Aurum Fulminans, taken in Conserve of Roses.
Three or four Pints of Rheum are commonly salivated every Day in a Bason made for that purpose, which the Patient holds in his Bed near his Mouth, so as the Spittle may run into it. But if the Fluxing shou'd not cease of it self at the time when it ought, he must be purg'd to put a stop thereto. If any Ulcers remain in his Mouth, to dry 'em up, Gargarisms are to be often us'd, which are made of Barley-Water, Honey of Roses, or luke-warm Wine.
The Warts are cur'd by binding 'em, if a Ligature be possible, or else they may be consum'd with Causticks, such as the Powder of Savine, or Aqua-fortis, by corroding the neighbouring Parts; sometimes they are cut, left to bleed for a while, and bath'd with warm Wine.
When the Patient begins to rise, he must be purg'd, his Linnen, Bed, and Chamber being chang'd; and afterward his Strength is to be recruited with good Victuals, and generous Wine. If he were too much weaken'd, let him take Cow's-Milk with Saccharum Rosatum.
If the Pox were not inveterate, the Fluxing might be excited by the PanacÆa alone, without any Frictions: For after the Phlebotomy, Purgations, and Bathings duly administer'd; the Patient might take ten Grains of the Mercurial PanacÆa in the Morning, and as many at Night; on the next Day fifteen Grains might be given, and the like quantity at Night; on the third Day twenty Grains might be given both Morning and Evening; on the fourth Day twenty five Grains in the Morning, and as many at Night; and on the fifth Day thirty Grains in the Morning, and the very same quantity in the Evening; continuing thus to augment the Dose, till the Fluxing comes in abundance; and it may be maintain'd by giving every two or every three Days twelve Grains of the PanacÆa. This Course must be continually follow'd till the Salivation becomes Laudable, and the Symptoms cease.
The manner of making the Mercurial PanacÆa.
To prepare this PanacÆa, it is requisite to take Mercury reviv'd from Cinnabar, because it is more pure than Mercury which is immediately dug out of the Mine. The Mercury is reviv'd with Cinnabar, after this manner: Take a Pound of artificial Cinnabar pulveriz'd, and mingled exactly with three Pounds of unslack'd Lime, in like manner beaten to Powder: Let this Mixture be put into a Retort of Stone, or Glass luted, the third part of which at least remains empty; Let it be plac'd in a reverberating Furnace; and after having fitted a Recipient fill'd with Water, let the whole be left during twenty four Hours at least; then let the Fire be put under it by degrees, and at length let the Heat be very much augmented, whereupon the Mercury will run Drop by Drop into the Recipient: Let the Fire be continu'd till nothing comes forth, and the Operation will be perform'd generally in six or seven Hours: Then pour the Water out of the Recipient, and having wash'd the Mercury, to cleanse it from some small quantity of Earth that may stick thereto, let it be dry'd with Cloaths, or else with the Crum of Bread: Thus thirteen Ounces of Mercury may be drawn off from every Pound of artificial Cinnabar.
The PanacÆa is made of sweet Sublimate, and the later of corrosive Sublimate: To make the corrosive Sublimate, put sixteen Ounces of Mercury reviv'd from Cinnabar, into a Matrass, pour upon it eighteen Ounces of Spirit of Nitre; place the Matras upon the Sand, which must be somewhat hot, and leave it there till the Dissolution be effected: Then pour off this dissolved Liquor, which will be as clear as Water, into a Glass Vial, or into a Stone-Jug, and let its Moisture evaporate gently over the Sand-Fire, till a white Mass remains; which you may pulverize in a Glass Mortar, mingling it with sixteen Ounces of Vitriol calcin'd, and as much decrepited Salt: Put this Mixture into a Matras, two third parts of which remain empty, and the Neck of which hath been cut in the middle of its height; then fix the Matras in the Sand, and begin to kindle a gentle Fire underneath, which may be continu'd for three Hours; afterwards let Coals be thrown upon it till the Fire burn very vehemently, and a Sublimate will arise on the top of the Matras; so that the Operation may be perform'd within the space of six or seven Hours. Let the Matras be cool'd, and afterward broken; avoiding a kind of Flower or light Powder, which flyes up into the Air as soon as this Matter is remov'd; whereupon you'll find nineteen Ounces of very good corrosive Sublimate; but the red Scoria or Dross which settleth at the bottom must be cast away as unprofitable. This Sublimate being a powerful Escarotick, eats away proud Flesh, and is of singular use in cleansing old Ulcers. If half a Dram thereof be dissolv'd in a Pint of Lime-Water, it gives a yellow Tincture; and this is that which is call'd the Phagedonick-Water.
The sweet Sublimate, of which the PanacÆa is immediately compos'd, is made with sixteen Ounces of corrosive Sublimate, pulveriz'd in a Marble or Glass-Mortar, intermixing with it by little and little, twelve Ounces of Mercury reviv'd from Cinnabar: Let this Mixture be stirr'd about with a Wooden Pestle, till the Quick-silver become imperceptible; then put the Powder, which will be of a grey Colour, into divers Glass-Vials, or into a Matras, of which two third parts remain empty; place your Vessel on the Sand, and kindle a small Fire in the beginning, the Heat of which may be afterward encreas'd to the third Degree: Let it continue in this Condition till the Sublimate be made; and the Operation will be generally consummated in four or five Hours: whereupon you may break your Vial, and throw away as useless, a little light Earth that lies at the bottom. You must also separate that which sticks to the Neck of the Vials, or of the Matras, and keep it for Ointments against the Itch; but carefully gather together the white Matter which lies in the middle, and having pulveriz'd it, cause it to be sublimated in the Vials or Matras, as before. This Matter must also be separated again (as we have already shown) and put into other Vials to be sublimated a third time. Lastly, the terrestrial parts in the bottom, and the fuliginous in the Neck of the Vials, must be, in like manner, separated, still preserving the Sublimate in the middle, which will then be very well dulcify'd, and amount to the quantity of twenty five Ounces and an half: It is an Efficacious Remedy for all sorts of Venereal Diseases; removes Obstructions, kills Worms, and purgeth gently by stool, being taken in Pills from six Grains to thirty.
Of the proper Composition of the Mercurial PanacÆa.
Take what quantity you please of sweet Sublimate, reduce it to Powder in a Marble or Glass-Mortar, and put it into a Matras, three quarters whereof remain empty, and of which you have cut off the Neck in the middle of its Height: Then place this Matras in a Furnace or Balneum of Sand, and make a little Fire underneath for an Hour, to give a gentle Heat to the Matter, which may be augmented by little and little to the third degree: Let it continue in this state about five Hours, and the Matter will be sublimated within that space of time. Then let the Vessel cool, and break it, throwing away as unprofitable a little light sort of Earth, of a reddish Colour, which is found at the bottom, and separating all the Sublimate from the Glass. Afterward pulverize it a second time, and let it be sublimated in a Matras, as before: Thus the Sublimations must be reiterated seven several times, changing the Matrasses every time, and casting away the light Earth. Then having reduc'd your Sublimate to a very fine impalpable Powder, by grinding it upon a Porphyry or Marble Stone, put it into a Glass Cucurbite or Gourd, pour into it alkaliz'd Spirit of Wine to the height of four Fingers; cover the Cucurbite with its Head, and leave the Matter in Infusion during fifteen Days, stirring it about from time to time with an Ivory Spatula. Afterward set your Cucurbite in Balneo MariÆ, or in a Vaporous Bath, make fit a Recipient to the Mouth of the Alembick; lute the Joints exactly with a moistened Bladder, and cause all the Spirit of Wine to be destill'd with a moderate Fire: Let the Vessels be cool'd, and unluted, and the PanacÆa will appear at the bottom of the Cucurbite. If it be not already dry enough, you may dry it up with a gentle Fire in the Sand, stirring it with an Ivory or Wooden Spatula in the Cucurbite it self till it be reduc'd to Powder. It may be kept for use in a Glass-Vessel, as a Remedy of very great Efficacy for all sorts of Venereal Diseases, as also for Obstructions, the Scurvy, Scrophula or Kings-Evil, Tettar, Scab, Scurf, Worms, Ascarides, inveterate Ulcers, &c. The Dose is from six Grains to two Scruples, in Conserve of Roses.
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