The Compleat Surgeon Part 34

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CHAP. XXVII.

_Of the Operation of opening stopt _Ductus_'s._

If there be only one Membrane that stops the Entrance of the _v.a.g.i.n.a_, an Incision may be made, and a Leaden Pipe put into it, having Rings to fasten it to the Waste, to hinder the re-uniting of the Wound.

If the Lips of the _Pudendum_ are conglutinated or clos'd up, the Patient must be laid upon her Back, and her Knees rais'd up, in order to make an Incision with a crooked Incision-Knife, beginning at the Top; and then a Leaden Pipe is to be put into the Opening.

If the _v.a.g.i.n.a_ be fill'd with a Fleshy Substance, an Incision is to be made therein, till it be entirely perforated, putting at the same time a Leaden Tube into the Orifice.

If the Urinary _Ductus_ as well in young Boys as in Virgins, be stopt up, an Incision is to be made therein with a very narrow Lancet; and if a small Leaden Pipe can be conveniently introduc'd, it may be done; but it is not very necessary, in regard that Children are almost always making Water, which wou'd of it self hinder the closing of the Orifice.

If the _Ductus_ of the Ear be stopt with a Membrane, it must be perforated, taking care not to go too far, for fear of piercing the Membrane of the _Tympanum_ or Drum, and {261} a small Leaden Pipe is to be put into the Opening.

If there be a carnous Excrescence on the outside of the Ear, a Ligature ought to be made therein, or else it may be cut with a pair of Sizzers, to cause it to fall off; and the rest of the Fleshy Substance that remains in the Ear must be consum'd with Causticks, convey'd to the Part by the means of a small Tube, care being had, nevertheless, to avoid cauterizing the _Tympanum_.

CHAP. XXVIII.

_Of the Operation of the _Phimosis_ and _Paraphimosis_._

When the _Praeputium_ is so streight that the _Glans_ can be no longer uncover'd, this Indisposition is call'd _Phimosis_; but if the _Praeputium_ be turn'd back above the _Glans_, after such a manner that it can no longer cover the same _Glans_, it is a _Paraphimosis_. If in the _Phimosis_ the _Praeputium_ cleaves very close round about the _Glans_, it is most expedient to let it alone; but if in handling the _Glans_ it be perceiv'd that it is moveable, or else that some parts of it only stick together, the Operation may be perform'd after this manner: The Patient being set in a Chair, a Servant is employ'd in pulling back the Skin to the Root of the _p.e.n.i.s_, to the end that the Incision may be {262} made directly at the bottom of the _Glans_: Then the Surgeon having drawn out the bottom of the _Praeputium_, introduceth a small Instrument with a very sharp Point on its flat side, at the end of which is fixt a b.u.t.ton of Wax, pierceth the _Praeputium_ at the bottom of the _Glans_ on the side of the Thread, and finisheth the Incision by drawing the Instrument toward himself.

The _Paraphimosis_ is cur'd by making Fomentations on the Part, to allay the Inflammation if there be any; and it is to be pull'd down with the Fingers. But if Medicinal Preparations prove ineffectual, Scarifications are to be made round about the _Praeputium_; and afterward convenient Remedies may be apply'd to remove the Inflammation, and prevent the Mortification of the Part; so that at length the _Praeputium_ may be drawn over the _Glans_.

CHAP. XXIX.

_Of the Operation of the _Varix_._

In order to cure this Tumour, the Surgeon having first cut the Skin to discover the dilated Vein, separates it from the Membranes, and pa.s.seth underneath a crooked Needle with a double wax'd Thread; then he makes a Ligature both above and below the dilatation of the Vein, opens the dilated Part with a Lancet, to let out the Blood, and applies a convenient Bandage: But without performing this {263} Operation, the Vein might be open'd with a Lancet, to draw out a sufficient quant.i.ty of Blood; and then the _Varix_ is to be press'd with a somewhat close Bandage.

CHAP. x.x.x.

_Of the Operation of the _Panaritium_._

The _Panaritium_ is an Abcess which ariseth at the end of the Fingers; some of these Tumours are only superficial, and others penetrate even under the _Periosteum_; nevertheless after whatsoever manner the _Panaritium_ may happen, it ought to be open'd on the side of the Finger, that the Tendons may not be hurt. If the Abcess be extended under the _Periosteum_, the opening must be made on the side, and the Lancet thrust forward to the Bone: Afterward the _Pus_ or corrupt Matter is to be discharg'd, which wou'd cause the Tendons to putrifie, if it shou'd remain too long upon 'em.

_The Dressing and Bandage_

Are made with a Plaister cut in form of a _Malta_ Cross, which is apply'd at the middle to the end of the Finger, the Heads being cross'd round about. The Bolsters must be also cut in the shape of the _Malta_ Cross, or of a plain Cross only; the Band being a Finger's breadth {264} wide, and long enough to be roll'd about the whole Dressing: It must be pierc'd at one of its ends, and cut the length of three Fingers at the other; so that the two Heads may pa.s.s thro' the Hole, to surround the Finger with small Rollers.

CHAP. x.x.xI.

_Of the Reduction of the falling of the _a.n.u.s_._

To reduce the _a.n.u.s_ to its proper place when it is fallen, the Patient being laid upon his Belly, with his b.u.t.tocks higher than his Head, the Operator gently thrusts back the Roll that forms the _a.n.u.s_ with his Fingers dipt in the Oil of Roses: Then he applies the Bolsters steept in some Astringent Liquor, and causeth 'em to be supported with a sort of Bandage, the Nature of which we shall shew in treating of the Fracture of the _Coccyx_, that is to say, the T. the double T. or else the Sling with four Heads.

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CHAP. x.x.xII.

_Of the Reduction of the falling of the _Matrix_._

In this Operation, the Patient being laid upon her Back, with her b.u.t.tocks rais'd up, Fomentations are to be apply'd to the Part; a Linnen Cloth is to be laid upon the Neck of the fallen _Matrix_; and it is to be thrust very gently with the Fingers, without using much force. If the _Matrix_ shou'd fall out again, it wou'd be requisite to convey a Pessary into it, after it hath been reduc'd; and to enjoyn the Patient to lie on her Back with her legs a-cross.

CHAP. x.x.xIII.

_Of the Application of the _Cautery_._

The Cautery is an Ulcer which is made in the Skin, by applying Causticks to it, after this manner:

The Surgeon having moisten'd the Skin for a while with Spittle, or else having caus'd a light Friction to be made with a warm Cloth, applies a perforated Plaister to the Part, and breaks the Cautery-Stone, to be laid in {266} the little Hole, leaving it for a longer or shorter time, accordingly as he knows its Efficacy, or as the Skin is more or less Fine.

Afterward he scarifieth the Burn with his Lancet, and puts a Suppurative, or piece of fresh b.u.t.ter into the Part, till the Escar be fallen off.

_The Dressing and Bandage._

After the Application of the _Lapis Infernalis_, or any other Cautery-Stone, it is necessary to lay over it a Plaister, a Bolster, and a Circular Bandage, which ought to be kept sufficiently close, to press the Stone, after a Pea or little Piece of Orrice-Root, hath been put into the Ulcer to keep it open. Then the Patient is to make use of this Bandage, with which he may dress it himself. Take a piece of very strong Cloth, large enough to roll up the Part without crossing above it: And let three or four Holes be made in one of its sides, as many small Ribbans or Pieces of Tape being sow'd to the other, which may be let into the Holes, as occasion serves, to close the Band.

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CHAP. x.x.xIV.

_Of the Application of Leeches._

It is requisite that the Leeches be taken in clear running Waters, and that they be long and slender, having a little Head, the Back green, with yellow Streaks, and the Belly somewhat reddish. Before they are apply'd, it is also expedient to let 'em purge during some Days in fair Water, fast half a Day in a Box without Water. Afterward the Part being rubb'd or chaf'd with warm Water, Milk, or the Blood of some Fowl, the Opening of the Box is to be set to the Part, or the Leeches themselves laid upon a Cloth; for they will not fasten when taken up with the Fingers. The end of their Tail may be cut with a Pair of Sizzers, to see the Blood run, and to determine its quant.i.ty, as also to facilitate their sucking. When you wou'd take 'em away, put Ashes, Salt, or any other sharp thing upon their Head, and they will suddenly desist from their Work; but they are not to be pull'd off by force, lest they shou'd leave their Head or Sting in the Wound, which wou'd be of very dangerous consequence. When they are remov'd, let a little Blood run out, and wash the Part with salt Water. {268}