The Compleat Surgeon Part 28

_What is _Nodus_?_

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

_Are _Exostoses_ and _Nodus_'s suppurable Tumours?_

Yes, because they sometimes produce Ulcers and Gangrenes in the Bone, which are call'd {199} _Caries_, proceeding from an internal Cause; nevertheless they are generally dissolv'd by Frictions with _Unguentum Griseum_, or by the application of Plaisters of Tobacco, or _Emplastrum de Vigo quadruplicato Mercurio_; taking also to the same purpose internal Diaph.o.r.etick and Sudorifick Medicines, with convenient Purgatives.

CHAP. V.

_Of Cauteries, Vesicatories, Setons, Cupping-Gla.s.ses, and Leeches._

_What is a Vesicatory?_

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

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

They are apply'd every where, accordingly as there is occasion to draw out or discharge some Humour from a Part: In Defluxions of Rheum upon the Eyes or Teeth, they are laid on the Neck and Temples; in Apoplexies, behind the Ears; and so of the rest, observing always to make Frictions on the places where the {200} Application is to be made, to the end that the Vesicatory may sooner take effect.

_How long time must the Vesicatory continue on the Part?_

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

_What is a Cautery?_

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

_How many sorts of Cauteries are there in general?_

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

_Which are the most safe, the Actual or the Potential Cauteries?_

A distinction is to be made herein; for Actual Cauteries are safest in the Operation, because they may be apply'd wheresoever one shall think fit, as also for as long a time, or for any purpose: Whereas the Potential cannot be {201} guided after the same manner. But in Haemorrhages the Potential Cauteries are most eligible, by reason that the Escar produc'd by 'em not being so speedily form'd, the Vessels are better clos'd, and they are not so subject to open again when it falls off; as it often happens in the Fall of an Escar made by Fire.

_In what places are Cauteries usually apply'd?_

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

_What is the Composition of the Potential Cauteries?_

They may be made with quick Lime, Soap, and Chimney-Soot; or else take an Ounce of _Sal Ammoniack_, two Ounces of burnt _Roman_ Vitriol, three Ounces of quick Lime, and as many of calcin'd Tartar; mingle the whole Ma.s.s together in a _Lixivium_ of Bean-Cod Ashes, and cause it to evaporate gently to a Consistence: Let this Paste be kept for use in a dry place, and in a well-stopt Vessel. Or else the Silver-Cautery, or _Lapis Infernalis_ may be prepar'd after the following manner: {202}

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

_What is a Seton?_

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

_What is most remarkable in the Application of a Seton?_

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

_In what Parts is the Seton to be apply'd?_

The Nape of the Neck is the usual place of its Application, altho' it may be made in any part of the Body where it is necessary. It sometimes happens that a Surgeon is oblig'd to use a kind of Seton in such Wounds made with a Sword, or by Gun-shot, as pa.s.s quite {203} thro' from one side to the other; then the String or Skain must be dipt in convenient Ointments or Medicinal Compositions; and as often as the Dressings are taken away, it will be requisite to cut off the Part soakt in the Purulent Matter, which must be taken out of the Ulcer.

_What is a Cupping-Gla.s.s?_

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

_In what Diseases are Cupping-Gla.s.ses us'd?_

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

_What is a Leech?_

It is an Animal like a little Worm which sucks the Blood, and is commonly apply'd to Children and weak Persons, to serve instead of Phlebotomy: Leeches are also us'd for the discharging of a Defluxion of Humours in any Part; as also in the Haemorrhoidal Veins when they are too full; in the _Varices_ and in several parts of the Face. {204}

_What choice ought to be made of Leeches?_

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

CHAP. VI.

_Of Phlebotomy._

_What is Phlebotomy?_

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

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

They are in general all the Veins and Arteries of the Body, nevertheless some of 'em are more especially appropriated to this Operation; as the _Vena Praeparata_ in the Forehead; the _Ranulae_ under the Tongue; the Jugular Veins and Arteries in the Neck; the Temporal Arteries in the Temples; the _Cephalick_, _Median_, and _Basilick_ Veins in the inside of the Elbow; the _Salvatella_ between the Ring-Finger and the Little-Finger; the _Poplitaea_ in the Ham; the _Saphena_ in the internal _Malleolus_ or Ankle; and the _Ischiatica_ in the external.

_What are the Conditions requisite in the due performing of the Operation of Phlebotomy?_

They are these, _viz._ to make choice of a proper Vessel; not to open any at all Adventures; not to let Blood without necessity, nor {205} without the Advice of a Physician; whose Office it is to determine the Seasons or Times convenient for that purpose; as that of Intermission in an Intermitting Fever; that of Cooling in the Summer; and that of Noon-tide in the Winter; and lastly, to take away different quant.i.ties of Blood; for in the Heat of Summer they ought to be lesser, and greater in the Winter.

_What are the Accidents of Phlebotomy?_

They are an Impostume, a _Rhombus_, an _Echymosis_, an _Aneurism_, Lipothymy, Swooning, and a Convulsion.