M. le Clerc

“ 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. ”

“ 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. ”

“ When the Wound is so small that the Bone cannot be seen, and nothing appears but the Accidents.
What are the Accidents or Signs of the Fracture of the Skull?
They are a dimmness of the Sight, and loss of the Understanding, which happen at the very Moment when the Fall or Blow is receiv'd; with the Phlegmatick Vomittings that follow soon after: These Signs are call'd Univocal. And there are others that bear the Name of Equivocal, and which confirm the former; as a Flux of Blood thro' the Nose, Eyes, and Ears, redness of the Eyes, heaviness of the Head, and puffing up of the Face ”

“ 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. ”

“ To let out the Matter, the Patient must be oblig'd to lean on one side, stopping his Mouth and Nose, and puffing up his Cheeks, as if he were to blow vehemently; then if Blood appears, a greater quantity of it may be taken away than if it were Matter, in regard that a Flux of Matter weakens more than that of Blood. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ In the Luxation of the Vertebra's of the Neck, the Head stands to one side, and the Face is swell'd and livid, with a difficulty of Respiration.
To reduce this Dislocation, the Patient is to be set upon a low Seat, an Assistant leaning on his Shoulders, to keep his Body steady, whilst the Surgeon or Operator draws his Head upward, and turns it from one side to another: Then if the Accidents or Symptoms cease, the Cure is perform'd; so that Fomentations may be apply'd to the Part; and the Patient being laid in his Bed, must take care to avoid moving his Head. ”

“ 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. ”

“ 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? ”

“ The Luxation which most commonly happens in this Part, is the Internal; so that a Protuberance appears on the Hole of the Os Pubis; the indispos'd Leg is longer than the other, and the Knee and Foot turn outward; neither can the Thigh be any longer bended, nor drawn near the other.
If the Luxation be External, the Leg becomes shorter than the other, the Knee and Foot turning inward, and the Heel to the outside.
When the Luxation is on the fore-part, a Tumour ariseth in the Groin, so that the Patient cannot draw this Thigh toward the other, nor bend the Leg; his Body resting only upon the Heel. ”

“ But if the Entrails are fasten'd to the Caul, it is requisite to separate 'em by cutting a little of the Caul, rather than to touch the Intestine; which last being reduc'd, a Servant may press the Belly on the side of the Wound; so that if a Mass of Flesh be found in the Caul, which hath been form'd by the sticking of the Caul to the Muscles and Peritonæum, this Fleshy Mass must be entirely loosen'd, and then a Ligature may be made to take it away, with some part of the Caul, as we have already shewn in the Gastroraphy. ”

“ In the mean time the Surgeon is to lay hold on the upper-part of the Humerus, a Servant kneeling behind him, who is to hold the Patient's Arm above the Elbow, which is to pass between the Surgeon's Legs, and is to be drawn down by the Assistant as much as is possible, whilst the Surgeon in like manner draws the Arm, to remove the Head of the Bone out of the place where it was stopt; insomuch that the Bone sometimes makes a Noise in re-entring its Cavity. ”

“ 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? ”

“ 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. ”

“ In order to perform the Operation of Lithotomy, the Patient must be laid along upon a Table of a convenient height, so as that the Surgeon may go about his Work standing; the Patient's Back must also lean upon the Back of a Chair laid down, and trimm'd with Linnen-Cloth, lest it shou'd hurt his Body; his Legs must be kept asunder, and the Soles of his Feet on the sides of the Table, whilst a Man gets up behind him to hold his Shoulders: His Arms and Legs must be also bound with Straps or Bands. ”

“ 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. ”

“ If the Bone be put out of its place by a coagulated sort of Matter like Mortar or Plaister, Resolutives and Attenuants are to be us'd, such as the volatile Spirit of Tartar prepar'd with the Lees of Wine, volatile Spirit of Tartar destill'd with Nitre in a Retort with a long Neck, or Spirit of Tartar prepar'd by Fermentation with Tartar, and its proper Alkali: This last is the best of all, and the use thereof ought to be continu'd. The volatile Salt of Human Bones is also very efficacious ”

“ If the Artery stick too close to the Vein, the later is to be prickt higher or lower than it is ordinarily done; and if the Vein be superficial, and lie close upon a hard Muscle, the Lancet must not be thrust downright into the Vein, but it is requisite to carry it somewhat obliquely, and to take the Vessel above, lest the Muscle and its Membrane shou'd be prickt, which wou'd cause a great deal of Pain, and perhaps a vehement Inflammation. It is well known that the Veins of the Right Arm are usually open'd with the Right-hand, and those of the Left-Arm with the Left-hand. ”

“ 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 ”

“ The Patient being plac'd in a convenient Posture, and having his sound Eye bound up, to take away the sight of the Instruments; the Operator causeth the other Eye to be kept steady with a Bolster held with an Instrument, and makes an Incision with a Lancet in form of a Crescent upon the Tumour, taking care to avoid cutting the Eye-Lid and the little Cartilage which serves as a Pulley to the great Oblique Muscle. ”

“ If the Rib appear without, the Patient is to be set in a a Chair, and oblig'd to bend his Body on the side opposite to the Fracture, holding his Breath, with which he must puff strongly, without letting it forth, in order to dilate the Breast, whilst the Surgeon thrusts the Rib into its place. ”

“ If there be no Wound in the Nose, there will be no need of a Bandage; but if the Fracture be accompany'd with a Wound, after having apply'd the proper Medicines, it wou'd be requisite to lay upon each side of the Nose a Triangular Bolster, cover'd with a little piece of Paste-board of the same Figure. This small Dressing is to be supported with a kind of Sling that hath four Heads; being a piece of Linnen-Cloath, two Fingers broad, and half an Ell long; it is slit at both ends, and all along, only leaving in the middle a Plain of three Fingers, that is to say, a part which is not cut. ”

“ 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. ”

“ 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 ”

“ It is also necessary that another Ligature be made in the lower part of the Artery, by reason that the little lateral Arteries might otherwise let out Blood.
The Artery ought not to be cut between the two Ligatures, lest the first Ligature shou'd be forc'd by the Impulsion of the Blood; but the Thread must be let fall, that it may rot with the Suppuration. Then the Wound may be dress'd with Pledgets, Bolsters strew'd with Astringent Powders and a Plaister; a Bolster being also laid in the Fold of the Elbow. ”

“ Neither is it convenient to apply the Actual Cautery to stop the Hæmorrhage, because it is apt to break forth again anew, when the Escar is fall'n off,
When the Tumour is not as yet ulcerated, a Crucial Incision may be made in the Skin, without penetrating into the Glandulous Bodies; then the four Pieces of the Glandules being separated, the Cancerous Tumour may be held with the Forceps, and afterward cut off. If there be any Vessels swell'd, they may be bound before the Tumour is taken away; but if the Tumour sticks close to the Ribs, the Operation is not usually undertaken. ”