Book 12: Contusions And Gangrenes
Table of Contents
1. Contusions
A contusion, according to Galen, is a solution of continuity in the flesh or bone, caused by the stroke of some heavy and obtuse thing, or a fall from an high. The symptom of this disease is by Hippocrates called Peliosis, and Melasina, that is to say, blackness and blueness; the Latins term it Sugillatum. There are many sorts of these sugillations or blacknesses, according as the blood is poured forth into the more inward or outward part of the body. The blood is poured forth into the body when any (for example) falls from an high, or has any heavy weight falls upon him, as it often happens to such as work in mines, or are extremely racked or tortured; and sometimes by too loud and forcible exclamation. Besides also by a bullet shot through the body, blood is poured forth into the bellies, and so often evacuated by the passages of the guts and bladder. The same may happen by the more violent and obtuse blows of a hard truncheon, club, stone, and all things which may bruise and press the blood out of the vessels either by extending or breaking them. For which causes also the exterior parts are contused, or bruised sometimes with a wound, sometimes without, so that the skin being whole, and as far as one can discern, untouched, the blood pours itself forth into the empty spaces of the muscles, and between the skin and muscles; which affect the ancients have termed ecchymosis; Hippocrates calls it by a peculiar name, Nausiosis, for that in this affect the swollen veins seem to vomit, and verily do vomit or cast forth the superfluous blood which is contained in them. From these differences of contusions are drawn the indications of curing, as shall appear by the ensuing discourse.
2. Of the general cure of great and enormous contusions.
The blood poured forth into the body must be evacuated by visible and not visible evacuation. The visible evacuation may be performed by bloodletting, cupping-glasses, horns, scarification, horseleeches, and fit purgative medicines; if the patient has not a strong and continual fever; the not visible evacuation is performed by resolving and sudorific potions, baths, and a slender diet. Concerning bloodletting Galen’s opinion is plain, where he bids, in a fall from a high place, and generally for bruises upon what part soever they be, to open a vein, though the parties affected are not of a full constitution; for that unless you draw blood by opening a vein, there may inflammations arise from the concrete blood, from whence without doubt evil accidents may ensue. After you have drawn blood, give him four ounces of oxycrate to drink, for that by the tenuity of its substance hinders the coagulation of the blood in the belly, or instead thereof you may use this following potion.
℞. rad. Gentianae ʒiij; bulliant in Oxycrato; in colatura dissolve rhci electi ʒj. fiat potio.
These medicines dissolve and cast forth, by spitting and vomiting, the congealed blood, if any thereof is contained in the ventricle or lungs. It is expedient to wrap the patient presently in a sheep’s skin, being hot and newly taken from the sheep, and sprinkled over with a little myrrh, cresses and falt, and put him presently in his bed, and then cover him so that he may sweat plentifully. The next day, take away the sheeps-skin and anoint the body with the following anodyne and resolving unguent:
℞. unguent. de althaea ℥vj. olei Lumbrie. chamaem. anethi. an ℥ij. terchinth. venetae ℥iiij. farinae foenugrae. rosar. rub. pulverisat. pul. myrtillorum, an ℥j. fiat litus ut dictum est.
Then give this potion which is sudorific and dissolves the congealed blood:
℞. Ligni guaiaci ℥viij. radicis enulae camp. consolid. majoris, ireos Florent. polypod. querni, seminis coriandri, anisi, an ℥ss. glycyrhiz. ℥ij. nepeta, centaurcae, caryophyl. cardui ben. verbena, an, m. s. aquae fortanae lib. xij.
Beat them all and infuse for the space of twelve hours, then boil them over a gentle fire until one half is consumed; let the patient drink some half pint of this drink in the morning, and then sweat some hour upon it in his bed, and do this for seven or eight days. If any poor man light upon such a mischance, who, for want of means, cannot be at such cost, it will be good, having wrapped him in a sheet, to bury him up to the chin in dung mixed with some hay or straw, and there to keep him until he has sweat sufficiently. I have done thus to many with very good success.
You shall also give the patient potions made with syrups which have power to hinder the coagulation and putrefaction of the blood; such as syrup of vinegar, or lemons, of the juice of citrons and such others to the quantity of an ounce dissolved in scabious, or Carduus water.
You may also presently after the fall give this drink, which has power to hinder the coagulation of the blood and strengthen the bowels:
℞. Rhei elect. in pul. redacti ʒj, aquae rubiae majoris, & plantagin. an. ℥j. theriacae ʒss. syrupi de rosis siccis, ℥ss, fiat potus.
Let him take it in the morning for four or five days. Instead hereof you may make a potion of one dram of Sperma ceti dissolved in bugloss or some other of the waters formerly mentioned, and half an ounce of syrup of Maiden-hair; if the disease yield not at all to these formerly prescribed medicines, it will be good to give the patient for nine days, three or four hours before meat some of the following powder.
℞. rhei torrefacti, rad. rub. majoris, centaurei, gentianae, aristolo. rotundae, an. ℥ss. give ʒj. hereof with syrup of vinegar and Carduus water.
They say that the water of green walnuts, distilled by an alembic, is good to dissolve congealed and knotted blood. Also you may use baths made of the decoction of the roots of orris, Elecampane, sorrel, fennel, marshmallows, water-fern, or Osmund the waterman, the greater Comfery; the seeds of fenugreek; the leaves of sage, Marjerome; the flours of Chamomile, Melilore and the like. For a warm bath has power to rarifie the skin, to dissolved the clotted blood, by cutting the tough & mitigating the acrid humors, by calling them forth into the surface of the body, and relaxing the passages thereof; so that the rebellious qualities being orecome, there ensues an easy evacuation of the matter by vomit, or expectoration, if it float in the stomach, or is contained in the chest; but by stool & urine, if it lie in the lower parts; by sweats and transpiration if it lie next under the skin. Wherefore baths are good for those who have a Peripneumonia or inflammation of their lungs, or a pleurisy, according to the mind of Hippocrates, if so be that they are used, when the fever begins to be assuaged; for so they mitigate pain, help forwards suppuration, and hasten the spitting up of the purulent matter. But we would not have the patient enter into the bath, unless he have first used general remedies, as blood-letting and purging; for otherwise there will be no small danger, lest the humors diffused by the heat of the bath, cause a new defluxion into the parts affected. Wherefore do not thou by any means attempt to use this or the like remedy, having not first had the advice of a physician.
3. How we must handle contusions when they are joined with a wound.
Every great contusion forthwith requires blood-letting, or purging, or both; and these either for evacuation, or revulsion. For thus Hippocrates, in a contusion of the heel, gives a vomitory potion, the same day, or else the next day after the heel is broken. And then if the contusion have a wound associating it, the defluxion must be stayed at the beginning, with an ointment made of Bole Armenic, the whites of eggs, and oil of roses, and myrtles, with the powders of red roses, allome and mastich. At the second dressing apply a digestive made of the yolk of an egg, oil of violets and turpentine. This following cataplasm shall be applied to the near parts to help forwards suppuration.
℞. rad althae, & lilio. an. ℥iiij. sol. malv. violar. senecionis, an. M. ss. coquantur complete, & passentur per setaceum, addendo butyrirecentis & olei viol. an. ℥iij. farinae volatilis quant. sufficit; fiat cataplasma ad formam poultice liquidae.
Yet have a care in using of cataplasms, that you do not too much exceed, for too frequent and immoderate use of them makes wounds phlegmonous, sordid and putrid. Wherefore the wound after it is come to suppuration must be cleansed, filled with flesh and cicatrized, unless happily the contused flesh shall be very much torn, so that the native heat forsake it, for then it must be cut away. But if there is any hope to agglutinate it, let it be sewn, and other things performed according to art; but the stitches must not be made so close together, as when the wound is simple, and without contusion; for such wounds are easily inflamed and swell up, which would occasion either the breaking of the thread or flesh, or tearing of the skin.
4. Of these contusions which are without a wound
If the skin being whole and not hurt, as far as can be discerned, the flesh which lies under it is contused, and the blood poured forth under the skin make an Ecchymosis, then the patient must be governed according to art until the malign symptoms, which commonly happen, be no more to be feared. Wherefore in the beginning, draw blood on the opposite side, both for evacuation and revulsion. The contused part shall be scarified with equal scarifications; then apply cupping-glasses or horns, both for evacuation of the blood which causes the tumor and tension in the part; as also to ventilate and refrigerate the heat of the part, lest it turn into an abscess. Neither must we in the meanwhile omit gentle purging of the belly. The first topical medicines ought to be astrictives which must lie some short while upon the part, so that the veins and arteries may be straightened and closed up, and so the defluxion hindred; as also that the part it self may be strengthened. This may be the form of such a remedy,
℞. Albumina everum nu. iij. olei myrtini & rosacei, an. ℥j. boli armeni, & sanguin. dracon. an. ℥ss. nucum cupress. gallarum, pul. aluminis usti, an. ʒij. incorporentur omnia addendo aceti parum, fiat medicamentum.
Then you shall resolve it with a fomentation, cataplasm, and discussing emplaisters.
5. By what means the contused part may be freed from the fear and imminent danger of a gangrene
Great contusions are dangerous even for this cause, for that a gangrene and mortification sometimes follows them; which Hippocrates teaches to happen, when as the affected part is grown very hard and liquid. Wherefore when the part grows livid and black, and the native color thereof, due to the afflux of the concrete blood, is almost extinct; chiefly, to ease the part of that burden, cupping glasses and horns shall be applied to the part itself being first scarified with a lancet, or else the following instrument termed a scarificator, which has 18 little wheels sharp and cutting like a razor, which may be straightened and slacked by the pins noted by D. and P. This instrument is to be commended for that it performs the operation quickly and gently, for it makes 18 incisions in the space that you make one with a lancet or knife.
Then you shall foment the part with strong vinegar wherein the roots of radish or of Dragons, Cuckow-pint, Salomons Seal, Auripigmentum and the like have been boiled; for such acrid things do powerfully heat, resolve and draw the concrete blood from the inner part of the body unto the skin, which by its settling in the part affected, prohibits the entrance of the vital spirits, the preservers of its integrity; yea also extinguishes the native heat of the same part. Now we must not use these things but with great discretion, lest so we draw not only that blood which is poured forth of the vessels, but also the other which is contained in the vessels. Moreover also we must not use them unless when the defluxion is stayed.
For small contusions (which Galen judged by the softness of the contused part) it is sufficient to apply to discuss them, Virgins wax dissolved and mixed with cumin seeds, cloves, the root of black Briony, (which has a wonderful faculty to discuss all blacknesses and sugillations) for the same purpose, you may also apply wormwood bruised and so warmed in a dish and sprinkled over with a little white wine. Also fry wormwood with oil of chamomile, bran, the powder of cloves and nutmegs, adding thereto a little aqua vitae, then put it all in a linen cloth and apply it hot to the part. The following emplaster does powerfully discuss congealed blood:
℞. Picis nigrae ℥ij. Gum. Elemi. ℥ij. styracisliquidae & terebinth. com. an. ℥ss. pul. sulphuris vivi. ℥j. Liquefiant simul, fiat Emplastrum; and let be spread upon leather and so applied.
6. Of that strange kind of symptom which happens upon contusions of the ribs
7. A discourse of mumia, or mummy
Peradventure it may seem strange what may be the cause, why in this Treatise of curing contusions, or bruises, I have made no mention of giving mummy either in bole or potion to such as have fallen from high places, or have been otherwise bruised, especially seeing it is so common and usual, yea the very first and last medicine of almost all our practitioners at this day in such a case. But seeing I understood, and had learnt from learned physicians, that in using remedies, the indication must always be taken from that which is contrary to the disease, how could I? How can any other give mummy in this kind of disease, seeing we cannot as yet know what mummy is, or what is the nature and essence thereof? So that it cannot certainly be judged whether it has a certain property contrary to the nature and effects of contusions.
This how it may have, I have thought good to relate somewhat at large; neither do the physicians who prescribe mummy, nor the authors that have written of it, nor the apothecaries that sell it, know any certainty thereof. If you read the more ancient, Serapio and Avicenne, to the modern Matthiolus and Thevet, you shall find quite different opinions. Ask the merchants who bring it to us, ask the apothecaries who buy it from them, to tell it to us, and you shall hear them speak diversely hereof, that in such variety of opinions, there is nothing certain and manifest. Serapio and Avicenne have judged mummy to be nothing else but Pissasphalthum; now Pissasphaltum is a certain froth or foam rising from the sea, or seawaters; this same foam, as long as it swims upon the water, is soft and in some sort liquid: but being driven upon the shore by force of tempest, and working of the sea, and sticking in the cavities of the rocks, it concretes into a somewhat harder substance than dried pitch, as Dioscorides says. Belonius says that mummy is only known to Egypt and Greece. Others write that it is man’s flesh, taken from the carcasses of such as are dead, and covered over in the sands in the deserts of Arabia; in which country they say the sands are sometimes carried and raised up with such force and violence of the winds that they overthrow and suffocate such passengers as they meet withall; the flesh of these dried by the sand and wind they affirm to be mummy.
Mathiolus, following the more usual and common opinion, writes that mummy is nothing else than a liquor flowing from the aromatic embalming of dead bodies, which becomes dry and hard. For understanding whereof you must know from all manner of antiquity, that the Egyptians have been most studious in burying and embalming their dead; not for that end that they should become medicines for such as live, for they did not so much as respect or imagine so horrid a wickedness. But either for that they held an opinion of the general resurrection, or that in these monuments they might have something, whereby they might keep their dead friends in perpetual remembrance.
Thevet, not much dissenting from his own opinion, writes that the true mummy is taken from the monuments and stony tombs of the anciently dead in Egypt, the chinks of which tombs were closed, and cemented with such diligence; but the enclosed bodies embalmed with precious spices with such art for eternity, that the linen vestures which were wrapped about them presently after their death, may be seen whole even to this day; but the bodies themselves, are so fresh that you would judge them scarce to have been three days buried. And yet in those sepulchers and vaults from whence these bodies are taken, there have been some corpses of two thousand years old. The same, or their broken members are brought to Venice from Syria and Egypt, and thence dispersed over all Christendom. But according to the different condition of men, the matter of their embalments were varied; for the bodies of the nobility or gentry are embalmed with myrrh, aloes, saffron, and other precious spices, and drugs; but the bodies of the common sort whose poverty and want of means could not undergo such cost, were embalmed with asphaltum or piss asphaltum.
Now Mathiolus says that all the mummy which is brought into these parts is of this last kind and condition. For the noble men and chief of the province so religiously addicted to the monuments of their ancestors, would never suffer the bodies of their friends, and kindred to be transported hither for filthy gain, and such detested use, as we shall show more at large at the end of this work.
Which thing sometimes moved certain of our French apothecaries, men wonderous audacious, and covetous, to steal by night the bodies of such as were hanged, and embalming them with salt and drugs they dried them in an oven, so to sell them thus adulterated instead of true mummy. Wherefore we are thus compelled, both foolishly and cruelly, to devour the mangied and putrid particles of the carcasses of the basest people of Egypt, or of such as are hanged, as though there were no other way to help or recover one bruised with a fall from a high place, than to bury man by an horrid insertion in their, that is, in man’s guts. Now if this drug were any way powerful for that they require, they might perhaps have some pretense, for this their more than barbarous inhumanity.
But the case stands thus, that this wicked kind of drug, does nothing help the diseased, in that case, wherefore and wherein it is administered, as I have tried a hundred times, and as Thevet witnesses, he tried in himself, when as he took some thereof by the advice of a certain Jewish physician in Egypt, from whence it is brought; but it also infers many troublesome symptoms, as the pain of the heart or stomach, vomiting and stink of the mouth.
Persuaded by these reasons, I do not only myself prescribe any hereof to my patients, but also in consultations, endeavor what I may, that it be not prescribed by others. It is far better according to Galen’s opinion in Method. med. to drink some oxycrate, which by its frigidity restrains the flowing blood, and by its tenuity of substance dissolves and discusses the congealed clots thereof. Many reasons of learned physicians (from whom I have learned this history of mummy) drawn from philosophy, whereby they make it apparent, that there can be no use of this or that mummy in contusions, or against flowing or congealed blood, I willingly omit, for that I think it not much beneficial to surgeons to insert them here. Wherefore I judge it better to begin to treat of combustions, or burns.
8. Of combustion and their differences
All combustions, whether occasioned by gunpowder, scalding oil, water, some metal or what things soever else, differ only in magnitude. These first cause pain in the part and imprint in it an unnatural heat. Which savoring of the fire, leaves that impression which the Greeks call Empyreuma. There are more or less signs of this impression, according to the efficacy of the thing burning, the condition of the part burned, and stay upon the same.
If the combustion is superficial, the skin rises into pustules and blisters, unless it is speedily prevented. If it below or deep in, it is covered with an eschar or crust, the burnt flesh by the force of the fire turning into that crusty hardness. The burning force of the fire, upon whatsoever part it falls, leaves a hot distemper therein, condensates, contracts, and thickens the skin, whence pain proceeds; from pain there comes an attraction of humors from the adjacent and remote parts.
These humors presently turn into watery or serous moisture, whilst they seek to pass forth, and are hindered thereof by the skin condensated by the action of the fire, they lift it up higher, and raise the blisters which we see. Hence several indications are drawn, whence proceeds the variety of medicines for burns. For some take away the Empyreuma, that is, the heat of the fire (as we term it) and assuage the pain; others hinder the rising of blisters; othersome are fit to cure the ulcer, first to procure the falling away of the eschar, then to cleanse, generate flesh and cicatrize it. Remedies fit to assuage pain and take away the fiery heat, are of two kinds; for some do it by a cooling faculty, by which they extinguish the preternatural heat, and repress or keep back the blood and humors, which flow into the parts due to heat & pain. Others endued with contrary faculties, are hot and attractive; as which by relaxing the skin, and opening the pores, resolve and dissipate the serous humors, which yield both beginning, and matter to the pustules, and so by accident assuage the pain and heat. Refrigerating things are cold water, the water of plantain, night-shade, henbane, hemlock; the juices of cooling herbs, as purslane, lettuce, plantain, houseleek, poppy, mandrake and the like. Of these some may be compounded, as some of the fore-named juices beaten with the white of an egg; clay beaten and dissolved in strong vinegar; roch Alome dissolved in water, with the whites of eggs beaten therein; writing ink mixed with vinegar and a little camphire; unguentum nutritum, and also populeon newly made. These and the like shall be now and then renewed chiefly at the first, until the heat and pain are gone. But these same remedies must be applied warm, for if they should be laid, or put to cold, they would cause pain, and consequently defluxion; besides also their strength could not pass, or enter into the part, or be brought into action; but so applied they assuage pain, hinder inflammation and the rising of blisters.
9. Of hot and attractive medicines to be applied to burns
Amongst the hot and attractive things which by rarifying, drawing out, and dissolving, assuage the pain and heat of combustions, the fire challenges the first place, especially when the burning is but small. For the very common people know and find by daily experience, that the heat of the lightly burnt part vanishes away, and the pain is assuaged if they hold the part which is burnt some pretty while to the heat of a lighted candle, or burning coals; for the similitude causes attraction. Thus the external fire, whilst it draws forth the fire which is internal and inust into the part, is a remedy against the disease it caused and bred. It is also an easily made and approved remedy, if they presently after the burn apply to the grieved part raw onions beaten with some salt.
Now you must note that this medicine has no place once it is gone into an ulcer, for it would increase the pain and inflammation; but if it is applied when the skin is yet whole and not excoriated, it does no such thing, but hinders the rising of pustules and blisters. Hippocrates, for this cause, also uses this kind of remedy in procuring the fall of the eschar. If any endeavor to gainsay the use of this remedy by that principle in medicine, which says, that contraries are cured by contraries, and therefore affirm that onions, according to the authority of Galen, being hot in the fourth degree, are not good for combustions; let him know that onions are indeed potentially hot, and actually moist, therefore they rarify by their hot quality, and soften the skin by their actual moisture, whereby it comes to pass that they attract, draw forth, and dissipate the imprinted heat, and so hinder the breaking forth of pustules.
To conclude, the fire is a remedy against the fire. But neither are diseases always healed by their contraries (says Galen) but sometimes by their like; although all healing proceeds from the contrary, this word contrary, being more largely and strictly taken; for so also a phlegmon is often cured by resolving medicines, which heals it by dissipating the matter thereof. Therefore onions are very profitable for the burnt parts, which are not yet exulcerated or excoriated.
But there are also many other medicines good to hinder the rising of blisters; such as new horse dung fried in oil of walnuts or roses and applied to the parts.
In like manner the leaves of Elder or Dane-wort boiled in oil of nuts and beaten with a little salt. Also quenched lime, powdered and mixed with unguentum Rosatum.
Or else the leaves of Cuckow-pint and sage beaten together with a little salt.
Also Carpenter’s Glue dissolved in water and anointed upon the part with a feather, is good for the same purpose.
Also thick varnish which polishers or sword cutlers use.
If the pain is more vehement, these medicines must be renewed 3 or 4 times a day and at night, so to mitigate the bitterness of this pain.
But if so be we cannot by these remedies hinder the rising of blisters, then we must presently cut them as soon as they rise, for that the humor contained in them, not having passage forth, acquires such acrimony that it eats the flesh which lies under it & so causes hollow ulcers: So by the multitude of causes & increase of matter, the inflammation grows greater, not only for nine days (as the common people prattle) but for far longer time; also some whiles for less time, if the body is neither replete with ill humors, nor plethoric, and you have speedily resisted the pain and heat by fit remedies. When the combustion is so great as to cause an eschar, the falling away must be procured by the use of emollient and humective medicines, as of greases, oils, butter, with a little basilicon, or the following ointment.
℞. Mucagin. psillij. & cydon. an. ℥iiij. gummi, trag. ℥ij. extrahantur cum aqua parietariae, olei lilliorum ℥iiss. cerae novae q. s. fiat unguentum molle.
For ulcers and excoriations you shall apply fit remedies, which are those that are without acrimony, such as unguentum album camphoratum, desiccativum rubrum, unguentum rosatum, made without vinegar, or nutritum composed after this manner.
℞. lithargyri auri ℥iiij. ol. rosat. ℥iij. ol. depapaver. ℥iiss. ung. populeon. ℥iiij. camphorae ʒj. fiat unguentum in mortario plumbeo secundum artem.
Or oil of eggs tempered in a lead mortar.
Also unquenched lime many times washed and mixed with unguentum rosatum, or fresh butter without salt, and some yolks of eggs hard roasted.
Or
℞. Butyri recent. fine sale, ustulati, & colati ℥vj. vitell. over. iiij. cerus. lotae in aqualplantag. vel rosar. ℥ss. tutkiae similiter lotae, ʒiij. plumbi usti, & loti, ʒij. Misceantur omnia simul, fiat linimentum ut decet.
Or else,
℞. cort. sambuc. viridis, & olei rosat. an. lib. j. bulliant simul lento igne, postea colentur, & add olei ovorum ℥iiij. pul. ceruss. & tuthiae praepar. an. ℥j. cerae albae quantum sufficit, fiat unguent. molle secundum artem.
But the quantity of drying medicines may always be increased or diminished according as the condition of the ulcer shall require. The following remedies are fit to assuage pain, as the mucilages of lineseeds, of the seeds of psyllium, or Flea-wort, and quinces extracted in rosewater, or fair water, with the addition of a little camphire; and lest that it dry too speedily, add thereto some oil of roses. Also five or six yolks of eggs mixed with the mucilages of Line seed, the seed of psyllium, and quinces often renewed, are very powerful to assuage pain. The women which attend upon the people in the Hospital in Paris, do happily use this medicine against burns:
℞. Lard. conscisilibram unam; let it be dissolved in rosewater then strained through a linen cloth, then wash it four times with the water of henbane or some other of that kind, then let it be incorporated with eight yolks of new laid egg, and so make an ointment.
If the smart is great, as usually it is in these kinds of wounds, the ulcer or sores shall be covered over with a piece of Tiffany, lest you hurt them, by wiping them with somewhat a course cloth, and so also the matter may easily come forth, and the medicines easily enter in. Also you must have a care when the eyelids, lips, sides of the fingers, neck, the armpits, hams, and bending of the elbow are burnt, that you suffer not the parts to touch one the other, without the interposition of some thing; otherwise in continuance of time they would grow and stick together. Therefore you shall provide for this, by fit placing the parts, and putting soft linen rags between them.
Note that deep combustions and such as cause a thicker eschar, are less painful than such as are but only superficial. The truth hereof you may perceive by the example of such as have their limbs cut off and seared or cauterized with a hot iron; for presently after the cauterizing is performed, they feel little pain. This great combustion takes away the sense, the vehemence of the sensory or thing affecting the sense, depriving the sensitive parts of their sense, as we have formerly noted when we treated of wounds and pains of the nerves.
The falling away of such eschars shall be procured by somewhat a deep scarification which may pierce even to the quick, so that the humors which lie under it may enjoy freer perspiration, and emollient medicines may the freelier enter in, so to soak, moisten and soften the eschar that it may at length fall away. The rest of the cure shall be performed by detergent and sarcotic medicines, adding to the former ointments metallic powders, when the present necessity shall seem so to require. But we cannot justly say in what proportion and quantity each of these may be mixed, due to that variety which is in the temper and consistence of bodies, and the stubbornness and gentleness of diseases. After a burn, the scar which remains is commonly rough, unequal, and ill favoured: therefore we will tell you in our treatise of the plague how it must be smoothed and made even.
I must not here omit to tell you, that gunpowder set on fire does often so penetrate into the flesh, not ulcerating nor taking off the skin, and so insinuate and thoroughly fasten itself into the flesh by its tenuity, that it cannot be taken or drawn out thence by any remedies, no not by Phoenigmes nor vesicatories, nor scarification, nor ventoses, nor horns, so that the prints thereof always remain, no otherwise than the marks which the Barbarians burn in their slaves which cannot afterwards be taken away or destroyed by any art.
10. Of a gangrene and mortification
11. Of the general and particular causes of a gangrene
12. Of the antecedent causes of a gangrene
The antecedent or internal and corporeal causes of a gangrene are plentiful and abundant defluxions of humors hot or cold, falling into any part. Seeing the faculty of the part is unapt and unable to sustain and govern such plenty of humors, it comes to pass that the native heat of the part is suffocated and extinct for want of transpiration. The arteries are hereby so shut or pent up in a straight, that they cannot perform their motions of contraction and dilatation, by which their native heat is preserved and tempered. But then the gangrene is chiefly incurable when the influx of humors first takes hold of the bones, and inflammation has its beginning from them.
In the opinion of Galen; all these kind of affects which may befall the flesh, are also incident to the bones. Neither only a phlegmon or inflammation, but also a rottenness and corruption does oft times first invade and begin at the bones; for thus you may see many who are troubled with the leprosy and French disease, to have their skin and flesh whole and fair to look on, whose bones notwithstanding are corrupt and rotten, and oft times are much decayed in their proper substance. This mischief is caused by a venomous matter, whose occult quality we can scarce express by any other name than poison inwardly generated. Oft times also there is a certain acrid and stinking filth generated in flesh with a malign and old ulcer, with which if the bones chance to be moistened, they become foul and at length mortified: of which this saying of Hippocrates is extant, ulcers of a years continuance or longer, must necessarily foul the bone, and make the scars hollow.
Whither also belongs this saying of the same party; An Erysipelas is ill in the laying bare of a bone. But this flowing venenate and gangrenous matter is somewhiles hot, as in pestilent carbuncles, which in the space of four and twenty hours by causing an eschar, bring the part to mortification: otherwhiles cold, as we see it many times happens in parts which are possessed with a gangrene, no pain, tumor, blackness, nor any other precedent sign of a gangrene going before. John de Vigo says that happened to a certain gentlewoman of Genoa under his cure.
I remember the same happened to a certain man in Paris, who supping merrily and without any sense of pain, went to bed, and suddenly on the night time a gangrene seized on both his legs, caused a mortification without tumor, without inflammation; only his legs were in some places spread over with livid, black and green spots, the rest of the substance retaining his native color: yet the sense of these parts was quite dead, they felt cold to the touch, and if you thrust your lancet into the skin no blood came forth.
A counsel of physicians being called, they thought good to cut the skin, and flesh lying under it, with many deep scarifications; which when I had done, there came forth a little black, thick and congealed blood; wherefore this remedy as also several other, proved to no purpose, for in conclusion a blackish color coming into his face, and the rest of his body, he died frantic. I leave it to the reader’s judgment, whether so speedy, and suddenly cruel a mischief could proceed from any other than a venenate matter; yet the hurt of this venenate matter is not peculiar, or by itself.
For oft times the force of cold, whether of the encompassing air, or the too immoderate use of narcotic medicines, is so great, that in a few hours it takes away life from some of the members, and several times from the whole body, as we may learn by their example, who travel in great snows, and over mountains congealed, and horrd with frost & ice. Hence also is the extinction of the native heat and the spirits residing in the part, and the shutting forth of that which is sent by nature to aide or defend it. For when as the part is bound with rigid cold, and frozen, they cannot get nor enter therein. Neither if they should enter into the part, can they stay long there, because they can there find no fit habitation, the whole frame and government of nature being spoiled, and the harmony of the four prime qualities destroyed, by the offensive dominion of predominant cold their enemy. whereby it comes to pass, that flying back from whence they first came, they leave the part destitute and deprived of the benefit of nourishment, life, sense and motion.
A certain Briton an Hostler in Paris, having drunk soundly after supper, cast himself upon a bed; the cold air coming in at a window left open, so took hold upon one of his legs, that when he waked forth of his sleep, he could neither stand nor go. Wherefore thinking only that his leg was numb, they made him stand to the fire; but putting it very nigh, he burnt the sole of his foot without any sense of pain, some fingers thickness, for a mortification had already possessed more than half his leg. Wherefore after he was carried to the Hospital, the surgeon who belonged thereto, endeavored by cutting away the mortified leg to deliver the rest of the body from imminent death; but it proved in vain; for the mortification taking hold upon the upper parts, he died within three days, with troublesome belching and hiccuping, raving, cold sweat, and often swooning. Verily all that same winter, the cold was so vehement that many in the Hospital of Paris lost the wings or sides of their nostrils, seized upon by a mortification without any putrefaction.
But you must note, that the gangrene which is caused by cold, does first and principally seize upon the parts most distant from the heart, the fountain of heat, to wit, the feet and legs; as also such as are cold by nature, as gristly parts, such as the nose and ears.
XIII. Of the signs of a gangrene
The signs of a gangrene which inflammation or a phlegmon has caused, are pain and pulsation without manifest cause, the sudden changing of the fiery and red color into a livid or black, as Hippocrates shows where he speaks of the gangrene of a broken heel. I would have you here to understand the pulsific pain not only to be that which is caused by the quicker motion of the arteries, but that heavy and pricking which the contention of the unnatural heat does produce by raising a thick cloud of vapors from these humors which the gangrene sets upon. The signs of a gangrene caused by cold, are, if suddenly a sharp pricking and burning pain assails the part; for penetrabile frigus adurit (i) piercing cold does burn: if a shining redness as if you had handled snow, presently turn into a livid color; if instead of the accidental heat which was in the part, presently cold and numbness shall possess it, as if it were shook with a quartan fever. Such cold if it shall proceed so far as to extinguish the native heat, brings a mortification upon the gangrene; also oft times convulsions and violent shaking of the whole body, wondrous troublesome to the brain and the fountains of life. But you shall know gangrenes caused by too straight bandages, by fracture, luxation, and contusion, by the hardness which the attraction and flowing down of the humors has caused; little pimples or blisters spreading or rising upon the skin due to the great heat, as in a combustion; by the weight of the part occasioned through the defect of the spirits not now sustaining the burden of the member; and lastly from this, the pressing of your finger upon the part, it will leave the print thereof as in an edema; and also from this, that the skin comes from the flesh without any manifest cause.
Now you shall know gangrenes arising from a bite, puncture, aneurism, or wound in plethoric and ill bodies, and in a part indued with most exquisite sense, almost by the same signs as that which was caused by inflammation.
By these and the like causes, there is a far greater defluxion and attraction of the humors than is fit, when the perspiration being intercepted and the passages stopped, the native heat is oppressed and suffocated. But this I would admonish the young surgeon, that when by the forementioned signs he shall find the gangrene present, that he do not defer the amputation for that he finds some sense, or small motion yet residing in the part.
For oft times the affected parts are in this case moved not by the motion of the whole muscle, but only by means, that the head of the muscle is not yet taken with the gangrene: with moving itself by its own strength, also moves its proper and continued tendon and tail though dead already; wherefore it is ill to make any delay in such causes.
XIV. Of the prognostics in gangrenes
Having given you the signs and causes to know a gangrene; it is fit we also give you the prognostic. The fierceness and malignity thereof is so great, that unless it is most speedily withstood, the part itself will die, and also take hold of the neighboring parts by the contagion of its mortification: which has been the cause that a gangrene by many has been termed an Esthiomenos. For such corruption creeps out like poison, and like fire eats gnaws and destroys all the neighboring parts, until it has spread over the whole body. As Hippocrates writes, Lib. de vulner. capitis; Mortui & viventis nulla est proportio (i) There is no proportion between the dead and living. Wherefore it is fit presently to separate the dead from the living; for unless that is done, the living will die, by the contagion of the dead. In such as are at the point of death a cold sweat flows over all their bodies: they are troubled with ravings, and watchings, belchings, and hicketing molest them; and often swoonings invade them, due to the vapors abundantly and continually raised from the corruption of the humors and flesh, and so carried to the bowels and principal parts, by the veins, nerves, and arteries. Wherefore when you have foretold these things to the friends of the patient; then make haste to fall to your work.
XV. Of the general cure of a gangrene
The indications of curing gangrenes are to be drawn from their differences, for the cure must be diversely instituted according to the essence and magnitude. For some gangrenes possess the whole member; others only some portion thereof; some are deep; othersome superficial only. Also you must have regard to the temper of the body. For soft and delicate bodies, as of children, women, eunuchs, and idle persons, require much milder medicines, than those who by nature and custom, or vocation of life, are more strong and hardy, such as husbandmen, laborers, mariners, huntsmen, potters, and men of the like nature who live sparingly and hardly.
Neither must you have respect to the body in general, but also to the parts affected; for the fleshy and musculous parts, are different from the solid, as the nerves and joints, or more solid, as the vertebrae. Now the hot and moist parts, as the privities, mouth, womb, and fundament, are easilyer and sooner taken hold of by putrefaction; wherefore we must use more speedy means to help them. Wherefore if the gangrene is chiefly occasioned from an internal cause, he must have a diet prescribed for the decent and fitting use of the six things not natural. If the body is plethoric, or full of ill humors; you must purge, or let blood by the advice of a physician.
Against the ascending up of vapors to the noble parts, the heart must chiefly be strengthened with treacle dissolved in sorrel, or Carduus water; with a bole of Mithridate, the conserves of roses & Buglosse; and with Opiates made for the present purpose according to art; this following Apozeme shall be outwardly applied to the region of the heart.
℞. aquae rosar. & nenuphar. an. ℥iiij. aceti scillitici ℥j. corallorum, santalorum alborum & rubrorum, rosar. rub. inpulver. radactarum, & spodij, an. ℥j. mithrid. & theriacae, an. ʒijss. trochiscorum de Caphura, ʒij. flor. cordial. in pollin. redactarum. p. ij. croci ʒj. ex omnibus in pollinem redactis, fiat epithema.
Which may be applied upon the region of the heart with a scarlet clot or sponge. These are usually such as happen in the cure of every gangrene.
XVI. Of the particular cure of a gangrene
The cure of a gangrene caused by the too plentiful and violent defluxion of humors suffocating the native heat due to great phlegmons, is performed by evacuating and drying up the humors which putrify by delay and collection in the part. For this purpose, scarifications and incisions, great, indifferent, small, deep and superficial according to the condition of the gangrene, are much commended so that the burdened part may enjoy the benefit of perspiration, and the contained humors, of difflation, or evacuation of their sooty excrements.
Make incisions when the effect is great, deep in, and near to mortification. But scarifications may be used when the part first begins to putrefy, for the greatness of the remedy must answer in proportion to that of the disease.
Wherefore if it penetrate to the bones, it will be fit to cut the skin and flesh with many deep incisions with an incision knife made for that purpose. Take heed not to cut the larger nerves and vessels unless they are wholly putrified, for if they are not yet putrified, you shall make your incisions in the spaces between them. If the gangrene is smaller, we must rest satisfied with only scarifying it.
When the scarifications and incisions are made, we must suffer much blood to flow forth so that the conjunct matter may be evacuated. Then we must apply and put upon it such medicines as may by heating, drying, resolving, cleansing and opening, amend and correct the putrefaction, and by piercing to the bottom may have power to overcome the virulence already impacted in the part.
For this purpose, lotions made of the lye of the ashes of fig trees, or oak, wherein lupines have been thoroughly boiled are good. Or you may with less trouble, make a medicine with salt water, wherein you may dissolve aloes and Aegyptiacum, adding in the conclusion a little Aqua vitae; for aqua vitae and calcined vitriol are singular medicines for a gangrene.
Or
℞. acet. opimi lb. j. mel. ros. ℥iiij. syrup. acetosi ℥iij. salis com. ℥v. bulliant simul, add aq. vitae. lb. s.
Prescription: Take 1 pound of opium acetate, 3 ounces of rose honey, 3 ounces of vinegar syrup, and 5 ounces of common salt. Boil them together, then add 6 pounds of aqua vitae (brandy or distilled water).
Wash the area frequently with this medicine, for it has much force to repress gangrenes. After your lotion, lay Aegyptiacum for a liniment and put it into the incisions; for there is no medicine more powerful against putrefaction, for by causing an eschar, it separates the putrid flesh from the sound. But we must not in this kind of affect expect that the putrid flesh may of itself fall from the sound; but rather cut off with your incision knife or scissors, whatsoever thereof you can, & then put to it Egyptiacum as oft as need shall require. The knowledge hereof may be acquired from the color, smell, and sensibleness of the flesh itself. The description of the Aegyptiacum, whose wondrous effects I have often tried in these causes, is this:
℞. floris aris, aluminis roch. mellis com. an. ℥iij. aceti acerrimi ℥v. salis com. ℥j. vitrioli rom. ℥ss. sublimatipul. ʒij bulliant omnia simul ad ignem, fiat unguent.
If the force of the putrefaction in the part is not so great, a weaker Aegyptiacum may serve. When you have put in the Aegyptiacum, then presently lay the following cataplasm thereupon. It hinders putrefaction, resolves, cleanses and dries up the virulent sanies, and by the dry subtlety of the parts penetrates into the member, strengthens it, and assuages the pain:
℞. farin. fabar. hor dei orobi, lent. lupin. an. lb. s. sal. com. mellis rosat. an. ℥iiij. succi absinth. marrub. an. ℥iiss. aloes, mastiches, myrrhae, & aquavit. an. ℥ij, oxymelitis simpl. quantum sufficit; fiat Cataplasma molle secundum artem;
Somewhat higher than the part affected, apply this following astringent, or defensive, to hinder the flowing down of the humors into the part, and the rising up of the vapors from the putrid part into the whole body.
℞. oleirosati, & myrtill. an ℥4. succi plantag. solani, sempervivi, an. ℥ij. album ovorum 5. boli armeni, terrae sigillata subtiliter pulverisatorum, an. ℥j. oxycrati quantum sufficit, misce ad usum dictum.
But these medicines must be often renewed. If the grief is so stubborn that it will not yield to the described remedies, we must come to stronger, to wit, cauteries, after whose application, Galen bids to put upon it the juice of a leek with salt beaten and dissolved therewith, for that this medicine has a piercing and drying faculty, and consequently to hinder putrefaction.
But if you prevail nothing with cauteries, then you must come to the last remedy and refuge, that is, the amputation of the part. According to Hippocrates, to extreme diseases exquisitely extreme remedies are best to be applied. Yet first be certain of the mortification of the part; for it is no little or small matter to cut off a member without a cause.
Therefore I have thought it fit to set down the signs whereby you may know a perfect and absolute mortification.
XVII. The Signs Of A Perfect Necrosis Or Mortification
You shall certainly know that a gangrene is turned into a sphacel, or mortification, and that the part is wholly and thoroughly dead if it’s a black color and colder than stone to your touch, the cause of which coldness is not occasioned by the frigidity of the air; if there is a great softness of the part, so that if you press it with your finger it rises not again, but retains the print of the impression. If the skin come from the flesh lying under it; if so great and strong a smell exhale (especially in an ulcerated sphacel) that the standers by cannot endure or suffer it; if a sanious moisture, viscid, green or blackish flows from thence; if it is quite destitute of sense and motion, whether it is pulled, beaten, crushed, pricked, burnt, or cut off. Here I must admonish the young surgeon, that he is not deceived concerning the loss or privation of the sense of the part.
I know very many deceived as thus; the patients pricked on that part would say they felt much pain there. But that feeling is oft deceitful, as that which proceeds rather from the strong apprehension of great pain which formerly reigned in the part, than from any faculty of feeling as yet remaining. A most clear and manifest argument of this false and deceitful sense appears after the amputation of the member; for a long while after they will complain of the part which is cut away.
Verily it is a thing wondrous strange and prodigious, and which will scarce be credited, unless by such as have seen with their eyes, and heard with their ears the patients who have many months after the cutting away of the leg, grievously complained that they yet felt exceeding great pain of that leg so cut of. Wherefore have a special care lest this hinder your intended amputation; a thing pitifull, yet absolutely necessary to preserve the life of the patient and all the rest of his body, by cutting away of that member which has all the signs of a sphacel and perfect mortification; for otherwise the neglected fire will in a moment spread over all the body, and take away all hope of remedy; for thus Hippocrates wishes: that sections, ustions, and terebrations must be performed as soon as need requires.
XVIII. Where amputation must be made
It is not sufficient to know that amputation is necessary; but also you must learn in what place of the dead part it must be done, and herein the wisdom and judgment of the surgeon is most apparent. Art bids to take hold of the quick, and to cut off the member in the sound flesh; but the same art wishes us to preserve whole that which is sound, as much as in us lies. I will show you by a familiar example how you may carry yourself in these difficulties.
Let us suppose that the foot is mortified even to the ankle. Here you must attentively mark in what place you must cut it off. For unless you take hold of the quick flesh in the amputation, or if you leave any putrefaction, you profit nothing by amputation, for it will creep and spread over the rest of the body. It befits medicine ordained for the preservation of mankind, to defend from the iron or instrument and all manner of injury, that which enjoys life and health. Wherefore you shall cut off as little of that which is sound as you possibly can; yet so that you rather cut away that which is quick, than leave behind anything that is perished, according to the advice of Celsus.
Yet oft times the commodity of the action of the rest of the part, and a certain ornament thereof, changes this counsel. If you take these two things into your consideration, they will induce you in this propounded case and example, to cut off the leg some five fingers’ breadth under the knee. For so the patient may more fitly use the rest of his leg and with less trouble, that is, he may the better go on a wooden leg; for otherwise, if according to the common rules of art, you cut it off close to that which is perished, the patient will be forced with trouble to use three legs instead or two.
I so knew Captain Francis Clerke, when as his foot was struck off with an iron bullet shot forth of a man of war, and afterwards recovered and healed up, he was much troubled and wearied with the heavy and unprofitable burden of the rest of his leg. Wherefore, though whole and sound, he caused the rest thereof to be cut off some five fingers’ breadth below his knee; and verily he uses it with much more ease and facility than before in performance of any motion. We must do otherwise if any such thing happen in the arm; that is, you must cut off a little of the sound part as you can. For the actions of the legs much differ from those of the arms, and chiefly in this that the body rests not, neither is carried upon the arms, as it is upon the feet and legs.
XIX. How the section or amputation must be performed
XX. How to stanch the bleeding when the member is taken off
XXI. How after the blood is stanched, you may dress the wounded member
XXII. How You Must Stop The Bleeding, If Any Of The Bound Up Vessels Chance To Get Loose.
XXIII. How To Perform The Residue Of The Cure Of The Amputated Member.
Now we must show what medicines are fitting to be applied after the amputation of a member; which are emplastics, as these which exceedingly conduce to green wounds.
As
℞. boli arm. ℥iiij. farin. vol. ℥iij. picis, resinae, an. ℥ij. pulverisentur omnia subtiliss. & simul mixtis fiat pulvis;
herewith let the wound be strewed, and lay thereupon dry lint; but let the following repercussive or defensitive be applied to the member.
℞. Album ovorum vj. boli arm. sang. drac. gypsi, terrae sigill. aloës, mastiches, gallar. combust.an. ℥ij. in pollinem redigantur omnia, & bene agitentur, addendo olei rosarum & myrtil. an. ℥j. fiat defensitivum ad formam mellis.
This ointment must be applied upon stoups dipped in oxycrate, and so that that it may not only cover the cut member, but also be spread further and cover the neighboring parts; as when the leg is cut off, it must be laid upon the joint, and spread higher than the knee, some four fingers upon the thigh; for it has not only a repercussive faculty, but it also strengthens the part, hinders defluxion by tempering the blood, assuaging pain, and hindering inflammation. It will also be good to moisten your double clothes and bandages in oxycrate; then you must place the member in an indifferent posture upon a pillow stuffed with oaten husks or chaff, stag’s hair, or wheat bran. It must not be stirred after the first dressing (unless great necessity urges) for four days in winter, but somewhat sooner in summer. For the ligatures with which the vessels are bound, they must not be loosed, or otherwise taken away, before the mouths of the vessels are covered with their glue or flesh, lest by too much haste you cause a new flux of blood. This agglutination will be performed by applying refrigerating, astringent, and emplastic medicines, such as this following powder.
℞. boli arm. farin. hord. picis. res. gypsi, an. ℥iiij. aloes, nucum cup. cort. granat. an. ℥j. incorporentur omnia simul, fiat pulvis subtilis
herewith let the whole ulcer be strewn over for three or four days’ space; which being ended, let only the seats of the vessels be powdered therewith, and that for eight or ten days, so that we need no further doubt of the agglutination of the vessels. In the meantime let the digestive be applied to the rest of the ulcer until it has come to suppuration; for then you shall give over your digestive, and betake you to detersive and mundificative medicines: As
℞. terebinth. ven. lotae in aqua vitae ℥vj. mellis ros. colati ℥iiij. succi plan•ag. Apij,centaur, minoris, an. ℥ij. bulliant omnia simul usque ad consumptionem succorum auferantur abigne, addendo farinae fab. & hord. an. ℥j. theriac. Gal. ℥ss. aloes, myrrhae, aristoloch. an. ℥iij. croci ℈j. fiat mundificativum.
But seeing the case stands so that the patients imagine they have their members yet entire, and yet do complain thereof (which I imagine to come to pass, for that, the cut nerves retire themselves towards their origin, and thereby cause a pain similar to convulsions; for as Galen writes in his book, De motu musculorum, that contraction is the true and proper action of a nerve and muscle: and again, extension is not so much an action as a motion) now we must endeavor to give remedy to this symptom. This may be done by anointing the spine of the back and all the affected parts with the following liniment, which is very powerful against convulsions, the palsy, numbness, and all cold affects of the nervous bodies.
℞ salviae, chamaepytheos, majoranae, rorismar. menth. rutae, lavendulae, an. m. j. flor. cham•mel.melilot. summit. aneth. & hyperici, an. p. ij. baccarum lauri & juniperi an. ℥ij. radicis pyrethri ʒij. mastic. assae odorat. an. ℥iss. terebinth. venet lb. j. olei lumbr. aneth. catell, an. ℥vj. olei terebinth.℥iij. axung. hum. ℥ij. croci ʒj. vini albi •doriferi lib. j. cerae quantum sufficit, contundenda contundantur pulverisanda pulverisentur, deinde macerentur omnia in vino per noctem, postea coquantur cum oleis & axungia praedictis in vase duplici, fiat linimentum secundum artem, in fine add aquae vitae ℥iiij.
Besides, in dressing these wounds, the surgeon must use diligence to procure the falling away of the ends or scales of the bones, which the saw and the appulse of the air never before coming hereto, have tainted; which may be done by applying to their ends actual cauteries, that is, hot irons, in using of which you must have a special care that you do not touch the sensible parts with fire; neither must the bones themselves be forcibly plucked off, but gently moved little by little, so that you shall think you and the patient have exceedingly well performed your parts if they fall away at the thirtieth day after the amputation. All these things being performed, you shall hinder the growth of proud flesh with the cathaeretics, such as are burnt vitriol, the powder of Mercury, and other things, amongst which is Alome burnt and powdered, which is excellent in these kind of wounds whether by itself or mixed with others. You shall use these and such, even unto the perfect agglutination and cicatrization of the wound, and you may of yourself devise other things, such as these, as occasion shall offer itself.
XXIV. What Just Occasion Moved The author To Devise This New Form Of Remedy, To Staunch The blood After The amputation Of A Member, And To Forsake The Common Way Used Almost By All Surgeons, Which Is, By Application Of Actual Arteries
Verily I confess, I formerly have used to stanch the bleeding of members after amputation, after another manner than that I have a little before mentioned. Whereof I am ashamed, and aggrieved; But what should I do? I had observed my masters whose method I intended to follow, always to do the like; who thought themselves singularly well appointed to stanch a flux of blood, when they were furnished with various store of hot irons and caustic medicines, which they would use to the dismembered part, now one, then another, as they themselves thought meet. Which thing cannot be spoken, or but thought upon without great horror, much less acted. This kind of remedy could not but bring great and tormenting pain to the patient, seeing such fresh wounds made in the quick and sound flesh are endewed with exquisite sense. Neither can any caustic be applied to nervous bodies, but that this horrid impression of the fire will be presently communicated to the inward parts, whence horrid symptoms ensue, and oft times death it self. And verily of such as were burnt, the third part scarce ever recovered, and that with much ado, for that combust wounds difficultly come to cicatrization; for by this burning are caused cruel pains, whence a fever, convulsion, and oft times other accidents worse than these. Add hereunto, that when the eschar fell away, oft times a new haemorrhagye ensued, for stanching whereof they were forced to use other caustic and burning instruments. Neither did these good men know any other course; so by this repetition there was great loss and waste made of the fleshy and nervous substance of the part. Through which occasion the bones were laid bare, whence many were out of hope of cicatrization, being forced for the remainder of their wretched life to carry about an ulcer upon that part which was dismembered; which also took away the oportunitie of fitting or putting too of an artificiall leg or arm in stead of that which was taken off.
Wherefore I must earnestly entreat all surgeons, that leaving this old, and too too cruel way of healing, they would embrace this new, which I think was taught me by the special favour of the sacred Deitie; for I learnt it not of my masters, nor of any other, neither have I at any time found it used by any. Onely I have read in Galen, that there was no speedier remedy for stanching of blood, than to bind the vessels through which it flowed towards their roots, to wit, the liver and heart.
This precept of Galen, of binding and sewing the veins and arteries in the new wounds, when as I thought it might be drawn to these which are made by the amputation of members, I attempted it in many; yet so that at first in my budding practise thereof, I always had my cauteries and hot irons in a readinesse, that if any thing happened otherwise then I expected in this my new work, I might fetch succour from the ancient practice, until at length confirmed by the happy experience of almost an infinite number of particulars, I bid eternally adieu, to all hot irons and cauteries which were commonly used in this work. And I think it fit that surgeons do the like. For antiquity and custom in such things as are performed by art, ought not to have any sway, authority or place contrary to reason, as they oft times have in civill affairs; wherefore let no man say unto us, that the ancients have alway done thus.
XXV. The Practice Of The Former Precepts Is Declared, Together With A Memorable History Of A Certain Soldier, Whose Arm Was Taken Off At The Elbow
I think it fit to confirme by an example the prescribed method of curing a gangrene and Mortification. Whilst I was surgeon to the Marshall of Montejan at Turin, a certain common soldier received a wound on his wrest with a musket bullet, by which the bones and tendons being much broken, and the nervous bodies cruelly torue, there followed a gangrene, and at length a mortification even to the Elbow; besides also an inflammation seized upon the middle part of his Chest, and there was a certain disposition to a gangrene, whereby it followed that he was painfully and dangerously troubled with belchings, hickettings, watchings, unquietnesse and frequent swoonings, which occasioned many surgeons to leave him as desperate. But it so it fell out, that I orecome by his friends intreaty, undertook the cure of this wretched person, destitute of all humane helpe. Wherefore knowing the mortification by its signs, I cut off the arm by the elbow as speedily as I could, making first the ligature, where of I made mention; I say I took it off not with a saw, but only with an incision knife, cutting in sunder the ligaments which held the bones together, because the sphacell was not passed the joint of the Elbow. Neither ought this section to be accounted strange, which is made in a joint; for Hippocrates much commends it, and says that it is easily healed, and that there is nothing to be feared therein besides swooning, due to the pain caused by cutting the common tendons and ligaments. But such incision being made, the former ligature could not hinder, but much blood must flow from thence, due to the large vessels that run that way. Wherefore I let the blood to flow plentifully so to disburden the part, and so afterwards to free it from the danger and fear of inflammation and a gangrene; then presently I stanched the blood with an hot iron, for as yet I knew no other course. Then gently loosing the ligature I scarify that part of the brawn of the arm which was gangreneated, with many and deep incisions, shunning and not touching the inner part, due to the multitude of the large vessels and nerves which run that way; then I presently applied a cautery to some of the incisions, both to stanch the bleeding, and draw forth the virulent sanies which remained in the part. And then I assailed and overcame the spreading putrefaction by putting and applying the formerly prescribed medicines; I used all sorts of restrictive medicines, to stay the inflammation of the Chest; I also applied Epithema’s to the region of the heart, and gave him cordiall potions and boles, neither did I desist from using them until such time as his belching, hicketting and swoonings had left him. Whilest I more attentively intended these things, another mischief assailes my patient, to wit, convulsions, and that not through any fault of him or me, but by the naughtinesse of the place wherein he lay, which was in a Barne every where full of chinkes and open on every side, and then also it was in the midst of winter raging with frost and snow and all sorts of cold; neither had he any fire or other thing necessary for preservation of life, to lessen these injuries of the air and place; Now his joints were contracted, his teeth set, and his mouth and face were drawn awry, when as I pittying his case made him to be carried into the neighboring Stable which smoked withmuch horse dung, and bringing in fire in two chafendishes, I presently anointed his neck and all the spine of his backe, shunning the parts of the Chest, with liniments formerly described for convulsions; then straight way I wrapped him in a warm linen cloth, and buried him even to the neck in hot dung, putting a little fresh straw about him; when he had stayed there some three days, having at length a gentle scowring or flux of his belly, and plentiful sweat, he begun little by little to open his mouth and teeth which before were set and close shut. Having got by these means some opportunitie better to do my business, I opened his mouth as much as I pleased, by putting this following instrument between his Teeth.