The Compleat Surgeon Part 30

CHAP. III.

_Of the Operation of the _Cataract_._

This Operation is perform'd when there is a small Body before the Apple of the Eye, which hinders the Sight from entring into it; but it is undertaken only in Blew, Green, and Pearl-colour'd Cataracts, or in those that are of the Colour of polish'd Steel; and not in Yellow, Black, or Lead-colour'd.

To know whether the Cataract be fit to be couch'd, the Patient's Eye must be rubb'd; so that if the Cataract remains unmoveable, it is mature enough; but if it changeth its place, it is requisite to wait till it become more solid. The Spring and Autumn are the most proper Seasons for performing the Operation.

To this purpose the Patient being set down with his Eyes turn'd toward the Light, and having his sound Eye bound up, the Surgeon must likewise sit on a higher Seat, whilst the Patient's Head is held by a Servant; and his Eye being turn'd toward his Nose, is kept steady with a _Speculum Oculi_, which is a little Iron-Instrument made like a Spoon, pierc'd in the middle, so that the Ball of the Eye may be let thro' this Hole: Then the Surgeon taking a Steel-Needle either round or flat, accordingly as he shall judge convenient, perforates the Conjunctive at the end of the Corneous Tunicle, on the side of the little Corner of the {217} Eye, and boldly thrusts his Needle into the middle of the Cataract, which he at first pusheth upward, to loosen it with the Point of the Needle; and then downward, holding it for some time with his Needle below the Apple of the Eye. If it ascend again after it is let go, it must be depress'd a second time; but the Operation is finish'd when it remains in the same place whereto it was thrust; neither is the Needle to be remov'd till this be done, and the Cataract entirely couch'd. In taking out the Needle, the Eye-Lid must be pull'd down, and press'd a little over the Eye.

_The Dressing and Bandage,_

Is to cause both the Patient's Eyes to be clos'd and bound up; then he must be oblig'd to keep his Bed during seven or eight Days, and some Defensative is to be laid upon the sore Eye, to hinder the Inflammation.

M. _Dupre_, Surgeon to the Hospital of _Hotel-Dieu_ at _Paris_, a Person well vers'd in these kinds of Operations, hath observ'd, that after the same manner as Cataracts were form'd in a very little s.p.a.ce of time in perfect Maturity; it happen'd also very often, that the Cataracts which were suppos'd to have got up again, were not the very same with those that were couch'd, but rather a new _Pellicula_ or little Skin, which sometimes hath its Origine in the top of the _Uveous_ Tunicle, and is caus'd only by a very considerable Relaxation of the Excretory Vessels from the Sources of the Aqueous Humour which in filtrating permits the running {218} of many heterogeneous Parts, the Encrease of which produceth a new Cataract.

_Of other Operations in the Eyes._

Sometimes a sort of purulent Matter is gather'd together under the Corneous Tunicle; so that to draw it out, the Eye must be fixt in a Posture with the _Speculum Oculi_, and after a small Incision made therein with a fine Lancet, is to be press'd a little, to let out the Matter; but if it be too thick, it may be drawn forth by sucking gently with a small Tube or Pipe, having a little Vial in the middle, into which the Matter will fall as it is suck'd out.

Sometimes a small Tumour ariseth in the Eye, which being ty'd at its Root with a Slip-Knot, to streighten it from time to time, will at length be dissolv'd: But if the Tumour lie in the Hole of the Apple of the Eye, this Operation must not be admitted, lest the Scar shou'd hinder the Pa.s.sage of the Light. Sometimes also a somewhat hard Membrane, call'd _Unguis_, appears in the great corner of the eye, which when it sticks thereto, may be cut off by binding it; this is done with a Needle and Thread, which is pa.s.s'd thro' the Membrane, and afterward ty'd.

If the Eye-Lids are glu'd together, a crooked Needle without a Point may be threaded, and pa.s.s'd underneath 'em; then the ends of the Thread may be drawn, to lift up the Eye-Lids, and they may be separated with a Lancet.

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If the Hairs of the Eye-Lids or Eye-Brows offend the Eye, they must be pull'd out with a Pair of Tweezers or Nippers; and when any small, hard, and transparent Tumours arise in the Eye-Lids, they are to be open'd, to let out the corrupt Matter.

CHAP. IV.

_Of the Operation of the _Polypus_._

This Operation is necessary, when there are any Excrescences of Flesh in the Nostrils, which, nevertheless, when they are livid, stinking, hard, painful, and sticking very close, must not be tamper'd with, because they are Cancers. But if they are whitish, red, hanging, and free from Pain, the Cure may be undertaken after this manner: Take hold of the _Polypus_ with a Pair of _Forceps_, as near its Root as is possible, and turn 'em first on one side, and then on another, till it be pull'd off. If the _Polypus_ descends into the Throat, it may be drawn thro' the Mouth with crooked _Forceps_; and if an Haemorrhage shou'd happen after the Operation, it may be stopt by thrusting up into the Nostrils certain Tents soakt in some Styptick Liquor; or else by Syringing with the same Liquor.

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CHAP. V.

_Of the Operation of the _Hare-Lip_._

This Operation is perform'd when the Upper-Lip is cleft; but if there be a great loss of Substance, it must not be undertaken; neither ought it to be practis'd upon old nor s...o...b..tick Persons, nor upon young Children, by reason that their continual Crying wou'd hinder the re-union. But if any are desirous that it shou'd be done to these last, they are to be kept from taking any rest for a long time, to the end that they may fall a-sleep after the Operation, which is thus effected:

If the Lip sticks to the Gums, it is to be separated with an Incision-Knife, without hurting 'em; then the Hare-Lip must be cut a little about the edges with Sizzers, that it may more easily re-unite, the edges being held for that purpose with a Pair of Pincers, whilst the Servant who supports the Patient's Head, presseth his Cheeks before, to draw together the sides of the Hare-Lip: Whereupon the Operator pa.s.seth a Needle with wax'd Thread, into the two sides of the Wound, from the outside to the inside at a Thread's distance from each. But care must be had that the two Lips of the Hare-Lip be well adjusted, and very even; the Thread being twisted round the Needle by crossing it above.

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_The Dressing and Bandage._

After the Lips are wash'd with warm Wine, the Points of the Needles must be cut off, small Bolsters being laid under their ends; then the Wound is to be dress'd with a little Pledget cover'd with some proper Balsam, putting at the same time under the Gum a Linnen Rag steep'd in some desiccative Liquor, lest the Lip shou'd stick to the Gum, if it be necessary to keep 'em a-part. Lastly, upon the whole is to be laid an agglutinative Plaister, supported with the uniting Bandage, which is a small Band perforated in the middle; it is laid behind the Head, and afterward drawn forward, one of its ends being let into the Hole which lies upon the Sore: Then the two ends of the Band are turn'd behind the Head upon the same Folds where they are fasten'd, sticking therein a certain Number of Pins, proportionably to the length of the Wound.

The Patient must be dress'd three Days after; and it is requisite at the first time only to untwist half the Needle, loosening the middle Thread if there be three; to which purpose a Servant is to thrust the Cheeks somewhat forward. On the eighth Day the middle Needle may be taken off, if it be a young Infant; nevertheless the Needles must not be remov'd till it appears that the sides are well join'd; neither must they be left too long, because the Holes wou'd scarce be brought to close.

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CHAP. VI.

_Of the Operation of _Bronchotomy_._

This Operation becomes necessary, when the Inflammation that happens in the _Larynx_ hinders Respiration, and is perform'd after this manner:

The Wind-Pipe is open'd between the third and fourth Ring, above the Muscle _Cricoides_, or else in the middle of the Wind-Pipe; but in separating the Muscles call'd _Sternohyodei_, care must be had to avoid cutting the recurrent Nerves, lest the Voice shou'd be lost; as also the Glandules nam'd _Thyroides_. The s.p.a.ce between the Rings is to be open'd with a streight Lancet, kept steady with a little Band, and a transverse Incision is to be made between 'em: Before the Lancet is taken out, a Stilet is put into the Opening, thro' which pa.s.seth a little Pipe, short, flat, and somewhat crooked at the end, which must not be thrust in too far, for fear of exciting a Cough. This Pipe hath two small Rings for the fastening of Ribbans, which are ty'd round about the Neck; and it must be left in the Wound till the Symptoms cease. Afterward it is taken away, and the Wound is dress'd, the Lips of it being drawn together again with the uniting Bandage, which hath been already describ'd.

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CHAP. VII.

_Of the Operation of the _Uvula_._

When the _Uvula_ or Palate of the Mouth is swell'd so as to hinder Respiration or Swallowing, or else is fallen into a Gangrene, it may be extirpated thus: The Tongue being first depress'd with an Instrument call'd _Speculum Oris_, the Palate is held with a _Forceps_, or cut with a Pair of Sizzers; or else a Ligature may be made before it is cut; and the Mouth may be afterward gargl'd with Astringent Liquors.

CHAP. VIII.

_Of the Operation of a Cancer in the Breast._

The Cancer at first is not so big as a Pea, being a small, hard, blackish Swelling, sometimes livid, and very troublesome by reason of its p.r.i.c.kings; but when it is encreas'd, the Tumour appears hard, Lead-colour'd, and livid, causing in the beginning a Pain that may be pretty well endur'd, but in the increase it grows intolerable, and the Stink is extremely noisome.

When it is ready to Ulcerate, the Heat is vehement, with a p.r.i.c.king Pulsation; and the Veins round about are turgid, being {224} fill'd with black Blood, and extended as it were the Feet of a Crab or Crey-Fish, till Death happen. When this Tumour is not ulcerated, it is call'd an _Occult Cancer_; and an _Apparent_ one when it breaks forth into an open Ulcer.

To palliate an Occult Cancer, and prevent its Ulceration, a Cataplasm or Pultis of Hemlock very fresh may be apply'd to the Part. All the kinds of Succory, the Decoction of _Solanum_ or Night-shade; the Juices of these Plants, as also those of Scabious, _Geranium_ or Stork-Bill, _Herniaria_ or Rupture-Wort, Plantain, _&c._ are very good in the beginning. River-Crabs pounded in a Leaden-Mortar, and their Juice beaten in a like Mortar, are an excellent Remedy; as also are Humane Excrements or Urine destill'd, and laid upon the Occult Cancer: Or else,

Take an Ounce of calcin'd Lead, two Ounces of Oil of Roses, and six Drams of Saffron; let the whole Composition be beaten in a Mortar with a Leaden Pestle, and apply'd. The Amalgama of _Mercury_ with _Saturn_ is likewise a very efficacious Remedy.

In the mean while the Patient may be purg'd with black h.e.l.lebore and _Mercurius Dulcis_, taking also inwardly from one Scruple to half a Dram of the Powder of Adders, given to drink, with half the quant.i.ty of Crab's-Eyes: But very great care must be taken to avoid the Application of Maturatives or Emollients, which wou'd certainly bring the Tumour to Ulceration. {225}

When the Cancer is already ulcerated, the Spirit of Chimney-Soot may be us'd with good Success; and the Oil of Sea-Crabs pour'd scalding hot into the Ulcer, is an excellent Remedy. But if it be judg'd expedient entirely to extirpate the Cancer, it may be done thus:

The sick Patient being laid in Bed, the Surgeon takes the Arm on the side of the Cancer, and lifts it upward and backward, to give more room to the Tumour; then having pa.s.s'd a Needle with a very strong Thread thro' the bottom of the Breast, he cuts the Thread to take away the Needle, and pa.s.seth the Needle again into the Breast, to cause the Threads to cross one another. Afterward these four ends of the Threads are ty'd together, to make a kind of Handle to take off the Tumour, which is cut quite round to the Ribs with a very sharp Rasor. The Cutting is usually begun in the lower Part to end in the Vessels near the Arm-Pit, where a small Piece of Flesh is left, to stop the Blood with greater Facility: Then having laid a Piece of Vitriol upon the Vessels, or Bolsters soakt in styptick Water; the sides of the Breast are to be press'd with the Hand, to let out the Blood and Humours; and an Actual Cautery is to be lightly apply'd thereto.