A TREATISE OF Wounds. BY RICHARD WISEMAN, ONE OF His Majestie's Serjeant-Chirurgeons.  
LONDON, Printed by R. Norton, for Richard Royston, Bookseller to His most Sacred MAJESTY, MDCLXXII.   

Reader,  
HAving spent betwixt Thirty and Forty years in a plentiful exercise of my profession, and that in different Countries and Places, where I have been eye-witness of the variety of methods in Chirurgery, I think it is no great vanity for me by this time, to pretend to something of experience in the Faculty: Which how difficultly it is attained, I not only can testify by my own frequent misadventures in this employment, but also do appeal to all others that have undertaken the Art. Vita brevis, Ars longa, Experimentum fallax, Judicium difficile, said the great Father both of physic and Chirurgery, of which it is true, that the former hath more of uncertainty, because the diseases are hidden as well as their causes, and little of either lieth open to the Eye: Yet ours also meets with many great difficulties, and very dubious cases, such as will sometimes puzzle an old Chirurgeon, but a young one would be quiter lost in, without the assistance of an expert Guide. This is the Reason why I think all men, that have arrived to any thing of Knowledge or Experience, are obliged by the general debt they owe to mankind, to leave behind them such Monuments of it as may be useful to posterity. Thus our Art at first grew, when Apollo's Temple at Delphos received in Tables the Histories of particular cures consecrated by the Votaries, and when Fathers bread up their Children in their own profession, faithfully delivering to them such Rules and Maxims, as their frequent observations had both suggested and confirmed: Insomuch that the Art became Hereditary, and propagated in families. And it is the opinion of some learned men, that the so much admired Volume, that goes under the name of Hippocrates, was the product of such a succession of Communications, there being no less than seven of that Race that were in their several generations eminent that way: The world is since grown bigger, and the Art itself much enlarged, by the great accession both of Diseases and Remedies; insomuch that Medicine, which heretofore was the work of one man, is now split into three parts, the Physician, Chirurgeon, and Apothecary; each finding work enough for the whole man. Yet with all this increase of Knowledge we do but increase sorrow, and after whole Ages spent in Chirurgical and Medical Disquisitions, we find little advance towards the certainty of Cure, or the commanding of help in the necessities of nature: A great Reason of which I take to be the excess of employment, or( which is worse) disingenuity in great Practitioners, who have not often been free in communicating their Observations to the world, but have rather left that task to Sedentary men, who having Chairs in Universities, have more indulged themselves in the speculation of the Art, than in a diligent attendance to matter of fact; who having reduced the Art into method, have spoken rather pursuantly to their own Rules, than agreeably to our Experience: Hence it is thought, that from Galen's days, who first drew physic into a strict Body, we have found little Augmentation of Knowledge, till some bold adventurers in these latter Ages have made some fortunate Essays at farther discoveries.  
For my own part, I shall not pretend to new Inventions, only what I have, I do here bring as my Mite to the Treasury of other mens Learning; affecting more the praise of fidelity and easiness of being understood, than of having enriched my Faculty with any far-fetched or novel additions: Our Art is rich enough already in that kind, Nature having plentifully supplied us with a Materia Medica in every field; nor need we any other Instructions than in the use of that Store we find ready provided for us. In this such men as have spent their whole Time and Parts in a perpetual practise, are the best Instructors, of which, whether I deserve to be reckoned for one, the ensuing Treatise must tell you: It being an Essay to a further work, which if this succeeds, may hereafter be offered to the use of the world. Why I have begun with a Treatise of Wounds, will easily be guessed by those who know me to have spent so much of my Time in Armies and Navies, in both which it was my chief business during my abode in that employment. I have observed many great Errors committed in dressings, very much to the damage, and often to the destruction of the Patient; to which notwithstanding custom and frequency of example have given countenance. This very consideration did more excite me, when I once understood his Majesties design of a Navy Royal, where many young surgeons being employed, and my Sickness of Body and my present relation to his Majesty rendered me not so fit for attendance there, as both my Genius and my desire of serving his Majesty makes me inclinable; I thought it my duty to assist, at least with such directions as my Pen will afford, faithfully delivering those methods of Cures, which I myself have practised with success, and by giving early notice of such Errors as have been observed by me, either in my own, or other mens practise, arming them as well as I could against all misfortunes in the Faculty. I have therefore chosen the method that seemed to me the most easy and facile, and most accommodated to practise, still confirming Rules by Examples, and thereby illustrating what ever might else seem obscure. Not that I was ignorant how hard a task I have undertaken to speak of things of this nature, whilst so many both surgeons and Patients who are therein concerned, are yet alive; which is the reason why in some difficult cases, I have chosen to give so few Instances, as making use only of such as I was either concerned in myself alone, or such as might give least offence to others, which I have avoided as carefully as I could: For which cause I have made choice of such observations as may be rather for the Readers instruction than my own credit, mixing as well my unprosperous attempts as my successful administrations.  
The Lecture of Fractures was first written and red in the surgeons and Barbers-Hall, and had been pursued by the rest, had not the Fire prevented us, and that occasion given a stop to a laudable custom. The Treatise of Gun-shot was afterwards compiled, and that of simplo wounds last, one thing begetting another, but when they were done, I put them into that order which did seem most agreeable to the design I now have in publishing them. I mention this here, that if any thing happen to be preposterous in the several Treatises, your charity may be furnished with an excuse for it.  
It is true, that this discourse( the former part of that of simplo wounds excepted) were done long since for the use already mentioned, though since pollish't and filled up; Several other little things, as of tumours, fistulas, and Lues venerea( all which ly rough cast) and may come to light, if the success of this small Tract encourage me: I have taken pains in one part of tumours, which my relation to his Majesties service hath engaged me, viz. the Kings-Evil; of which I wonder so little hath been written by the surgeons of the English and French Courts, both which Kings do so publicly exercise themselves in the Cure of it: And though so many thousands of people pass through the hands of the surgeons to be judged of, and presented to their Princes, yet excepting that of Laurentius, and an imperfect piece or two of our countrymen, there is nothing appears in print concerning it. I therefore thought it worth my pains to writ what I have observed in that disease, hoping withal to give so much credit to our Society in this Nation, as to let the world know, we do not all spend our time in talking in Coffee-houses, and drolling over the Accidents that befall one another in our profession; but that some of us at least make it our business to Improve our Faculty and to give Strangers, pretenders to great things in Chirurgery, that come over to us( and are so welcome to our Gentry, only upon the account of their being Strangers) occasion of understanding, that they may whilst they are here, traffic for Skill as well as money, and carry that back with them, which may give the world some opinion of the Knowledge and Experience of our English Artists, as well as of the liberality of their Patients.   

Reader,  
I do pretend to have spent my time in Armies, Navies, and Cities, not in Universities; Nor to have been much conversant in Books, through my constant Employment in, and the little leisure I had from my Profession, till my want of health of late years enforced me to make them my diversion. Therefore thou must not expect a nice exactness in the disposition of the parts of this Book, which it may be from a perfect Logician thou wouldst; yet I hope I have done so much that way as will excuse me from being altogether rude, and what it wants in that kind, will possibly be made up by its accommodation to the surgeons hand in dressing, to which I have wholly applied myself; as thinking it more profitable for the persons, to whose use I design it. The whole is contracted into a little bulk, and yet I hope nothing is wanting that is necessary to thy Instructions; It becomes by this means cheaper and more portable, and if those conveniencies be accompanied with a sufficient perspicuity in delivering, and fullness in handling what I undertook, it is all that is desired by thy Friend to serve thee,  
R. W.   


The Contents of Part I.  
CHAP. I. OF Wounds in General. page. 1.  
CHAP. II. Of the Second Intention. p. 7.  
CHAP. III. Of the Fourth and Fifth Intention and of Compound Wounds. p. 17.  
CHAP. IV. Wounds of Veins and Arteries. p. 34. 

Observation 1. Wound of the Internal Jugular. p. 37.  
Observat. 2. An Artery wounded p. 38.  
Observat. 3. An Artery wounded. p. 39.  
observe. 4. Aneurisma p. 40.  
observe. 5. Wound of the Sural Artery. p. ibid.  
observe. 6. An Artery pricked by letting blood, with the manner of Deligation. p. 43.    
CHAP. V. Wounds of the Nerves, Tendons and Ligaments, with Observations. p. 47.  
CHAP. VI. Wounds of the Face, with Observations. p. 56.  
CHAP. VII. Wounds of the Limbs. p. 61. 

Observat. 1. Puncture of the Arm. p. ibid.  
Observat. 2. Wounds in the Thigh. p. 62.  
observe. 3. A wound in the Arm. p. 63.  
Observat. 4. Wound in the Leg. p. 64.    
CHAP. VIII. Wounds of the Breast. p. 66. 

Observation 1. p. 69.  
Observation 2. p. 70.  
Observation 3. p. 71.  
Observation 4. p. ibid.  
Observation 5. p. 73.    
CHAP. IX. Wounds of the Abdomen. p. 75. 

Observation 1. p. ibid.  
Observation 2. p. 78.    
CHAP. X. Of Wounds in the Head. p. 80. 

Observat. 1. Wound in the Temporal Muscle. p. 88.  
Observation 2. p. 98.    
Observations of the wounds of the Head. p. 107. 

Observat. 1. A large wound of the Calvaria. p. ibid.  
Observation 2. p. 108.  
Observat. 3. Of the Calvaria torn off. p. ibid.  
Observat. 4. A great contused wound. p. 110.  
observe. 5. A Concussion. p. 111.  
Observat. 6. Another Concussion. p. 113.  
observe. 7. A Fracture with a long fissure, and depression of the Cranium. p. 117.  
Observat. 8. A Contused wound by a blow on the Crown of the Head. p. 120.  
Observat. 9. A Concussion of the Brain. p. 123.  
observe. 10. A large fissure, the Dura matter putrefied. p. 126.  
Observat. 11. A carries through the Cranium, wherein the Pericranium and dura matter become one Body. p. 128.    
An additional Discourse of Wounds of the Brain, with Observations. p. 131.   

The Contents of Part II.  
CHAP. I. OF Gun-shot-wounds in General, with an Observation. page. 1.  
CHAP. II. Of the Cure of Gun-shot-wounds; and first of Extraction of Bullets, &c. with Observations. p. 4.  
CHAP. III. The first dressing after Extraction, with an Observation. p. 12.  
CHAP. IV. Of Accidents befalling Gun-shot-wounds, and of Sinuous Ulcers, with Observations. p. 19.  
CHAP. V. Of Gun-shot-wounds with Fracture, with Observations. p. 26.  
CHAP. VI. A Fracture made by a Splinter, with Observations. p. 41.  
CHAP. VII. Of Gun-shot-wounds in the joints with Fracture, with an Observation. p. 50.  
CHAP. VIII. Of Wounds of the Belly. p. 55.  
CHAP. IX. Of Gun-shot-wounds of the Thorax, with an Observation. p. 63.  
CHAP. X. Of Symptoms of Gun-shot, omitted in the fourth Chapter. page. 68.  
An Appendix to the Treatise of Gun-shot-wounds. p. 75. 

CHAP. I. De Ambustis, or Burning, with Observations. p. ibid.  
CHAP. II. De Gangraena & Sphacelo, with Observations. p. 81. 

What is to be considered by the Chirurgeon in the heat of Fight. p. 90.    
CHAP. III. Of Fistulae, with Observations. p. 103.  
CHAP. IV. Of Fractures in General, with several Observations. p. 110.      


CHAP. I. Of Wounds in General.  
A Wound is a solution of continuity in any part of the Body, 
A Wound defined.  suddenly made by any thing that Cuts or Tears, with a division of the Skin.  
THIS definition differs much from what is usually delivered by Authors, and it is fit it should, for they generally defining a Wound by a solution in parte molli, do thereby exclude a Cut made into a Bone; as that into the Cranium by a Pole-Axe, &c. which why it should not be called a Wound I know not? Secondly, I say it is made by any thing that Cuts or Tears; other Authors define it to be made by an external Instrument, &c. How then do they call that fracturam cum vulnere, a fracture with a Wound, where the Bone from within makes the Wound, and thrusts itself quiter through the flesh? Sennertus adds to his Definition, that it be done à re secante & acutâ; yet he reckons those for Wounds that are made by Bullets, although it be cannon-shot.  
I do therefore think it fit to make my definition more comprehensive, and to take in whatsoever makes a sudden solution of continuity, at least immediately and by itself, on what part soever it lighteth; so a Cut into a Bone is a Wound, tearing the Flesh, Nerve, Sinew, Tendon or cartilege, by Bullet, ston, Splinter, &c. is a Wound; only I add this restriction, that the Skin must be likewise divided: By which last words I exclude fractures that come not through the skin and contusions, if the exterior parts be continuous. But by the word Skin, I understand not only the external cutis, but also the Inward membranes of the Gullet, Ventricle, Guts, Bladder, Urethra, Womb, all which are capable of Wounds from sharp Instruments, whether swallowed or thrust into them.  
A Wound thus defined admits of many differences, 
Differences of Wounds.  of which I know none that can be properly called essential. Great and small, deep and shallow, wide and narrow, streight and crooked, round and Angular, are but Accidental differences. Distinctions taken from the Weapons whether sharp or blunt; Sword, Rapier or Bullet; Cut, prick or Tearing, the likewise Accidental: Those that look most like essential differences are they which are taken from the subject in which the Wound( which is itself but an Accident) inhereth, viz. from the Flesh, Skin, Brain, Nerve, Tendon, Artery, Vein, Gristle, Bone &c. All which being the several subjects of Wounds may well be allowed to specify them, and so much the rather, because from the nature of them we raise our greatest Indications of altering the method of Cure. To this head may also be referred the division of them into simplo or Compound.  
Wounds are in themselves so visible, 
Signs and prognostics.  that they need no general marks to be known by. But the peculiar affections of the particular parts hurt, and the methods of discovering what Inward part is Wounded, by observation made of the symptoms that happen, are fully handled in the Treatise of Gun-shot-wounds, to which I refer you: And not they only, but the prognostics also are there delivered, in which a Chirurgeon ought to be well versed, lest through ignorance of them he undertake the Cure of Wounds that are mortal. I therefore have translated them to that Treatise, because the difficulty of Knowing them in cases of Gun-shot, is much greater than in those of other Weapons. The greater symptoms likewise, 
Symptoms.  as Gangrena, Paralysis, Spasmus, are there distinctly treated of, as being more frequent and important in Gun-shot-wounds than elsewhere; Hemorrhagiae are spoken of in this present Treatise.  
As to Intentions of Cure, 
Intentions of Cure.  the Wound being a solution of continuity doth require to be made One again. Unity being the perfection of whatsoever hath a being. To effect this, is the work of Nature and Art: both must mutually join their helping hands, and unless both the vital faculties and nourishment of the part do assist the Art of the Chirurgeon, it will be lost labour, here must be a joint meeting and agreement of all in one.  
In simplo Wounds the Chirurgeon is to afford his assistance Five manner of ways, the omitting of any of which will render him negligent or ignorant in his Trade.  
The first is in careful and diligent taking away all such extraneous Bodies, as by their interposition may hinder the true Agglutination of the disjoined parts, whether they be concrete blood, Hair, Sand, Dust, pieces of Bones, Cartilages, or pieces of the Weapons, Rags, &c.  
The second is performed in bringing the Lips of the Wound even together which were separated.  
The third is in retaining the Lips so brought together, that they may be Consolidation be restored to their former Figure.  
The fourth is in conserving the Temperament and Natural Heat of the part in order to Unition.  
The fifth is to prevent ill Accidents, and to correct such as have already seized on the part.  
Thus much is required of us if the Wound be only simplo; 
What is required in Compound and Contused Wounds.  but if it be a Compound Wound with loss of substance, or Contusion, then he hath somewhat more to do: as where there is loss of substance there he must assist Nature with his sarcotics, for regaining what is lost: And where there is Contusion, there he must promove the turning what is Contused into pus or Matter, which must be performed before there can possibly be Re-union.  
As long as there is Alienum quid, 
The First Intention in taking out Extraneous Bodies.  some strange Body or different substance to keep off the Unition, you must not hope to make any Cure of a Wound; therefore if any such be to be drawn forth, before you attempt it, consider seriously; first whether it can be done or no; secondly, whether safely.  
For first, sometimes the Weapon sticketh so fast, that by no Art it can be extracted; then it is of necessity to be left to Nature, who this way sometimes worketh miracles: Mercatus in Lib. Institut. Chirurg. says, sometimes pieces of Weapons sticking so fast in the Inward parts have lain hide under the cicatrized Wound, and have a long time after upon the Apostemation of the part come forth of themselves.  
Secondly, You are to consider whether you may with safety pluck out the Weapon or no; some will live a day with the Weapon in their Bodies, which would expire upon the moment of extraction; but if your judgement suggest to you that the Patient is recoverable, make hast out with it before the part be inflamed, or else you must stay until digestion.  
If the Weapon have not pierced deep, 
Which way the Weapon is to be drawn out.  and through great Vessels and Nervous places: If the part opposite be full of Veins, Arteries and Nerves, or have a Bone in it over against the Wound; If there be no great fear of Laceration, pull it out the same way it went in; for the effecting of which, our Masters have left us variety of Instruments, the figure and usage whereof you may see in Scultetus. But if the point of the Weapon have pierced above the half way, and there be no Bones nor notable Vessels to hinder you,( here is use of your Anatomy, and exact Knowledge of the parts) either thrust the Weapon through, or make way for it by incision on the contrary side; but beware the Weapon be not too big, lest you do make two large Wounds for one.  
If the Weapon stick in the Bone, 
Weapon stuck in a Bone.  move it up and down to loosen its point, and then pluck it out; but in case it will not move, cut away the Bone before you extract it.  
If a Weapon be fastened betwixt two joints, 
Weapon stuck between the joints.  make an extension of the parts both ways, as it is the manner in Fractures and Dislocations, that so the Tendons and Ligaments being Elonged, the Weapon may with more ease come out; but do this with moderation, lest you break some notable Vessels, and a flux of blood or some ill Accident befall you as you extract it. It will be necessary in this work that you consider the Position the part was in when the Wound was Inflicted. Gesner hath a story in his observe. de Chirurgiae dignitate & praestantia, of a Chirurgeon, who when he could by no means get forth an Arrow, asked the wounded Patient in what Figure of his Body he received the Wound, understanding it was done on Horseback, he placed him in a riding posture, and immediately drew out the Weapon.  
The Weapon thus drawn out, cleanse it from Rags or ought else, and permit the Wound to bleed accordingly, as you in your judgement shall think fit, you having respect to the constitution and habit of Body, that what is in the small Veins cut asunder may flow out as well to hinder Inflammation, as the generation of much Matter. The Bleeding stayed, if there be Hair growing about the Wound, shave it off, then wipe away the clotted blood with a sponge dipped in Red-wine, Oxycrate or Water. But if it stick in the Wound deep, be not too busy with your armed Probe, for thereby you may stir up a new bleeding; whereas this concreted, keeps the Wound warm, and defends it from the outward Air, and by digestion Nature will thrust it forth.   

CHAP. II. THe Second Intention is performed by bringing the Lips of the Wound exactly together. 
The Second Intention.   
THIS Intention is delivered in a few words, but they are as a Law to be observed, 
Unition is to be made.  for without that reduction of the Lips a slow and deformed healing follows. Nature hath nothing to do here in bringing the Lips together, that is the sole work of the Chirurgeon, who must not lay a Pledgit, or crowd a Dossel of Lint or Tent into a little Wound. No, that is the way to keep the Wound open, and make it painful, whereby defluxions are stirred up, the Temperament of the part weakened, and the Cure prolonged; contrary to the Intention of all who have writ of them, and to the practise of our Knowing surgeons here: But amongst the pretenders to that Art, we often meet with such work; particularly in a young man Wounded near Highgate in the Back, 
Observation concerning Dossils in simplo Wounds.  slanting under the right Scapula, another wound on the Back, and another through the upper part of the other Shoulder, with a long Gash over the forehead, and with other wounds, some whereof not considerable: The next day I was carried thither to Dress these Wounds, I found them all distended with Tents and Dossils of Lint, disposed to inflame and swell; the Patient exceeding full of pain: after I had taken out these Extraneous Bodies, my endeavour was to Dress them so, as I might incline their up-heaved Lips to return to their Natural scite; to which purpose I fomented them with Milk, and dressed them with Pledgits spread with my digestive of Tereblnth. cum vitel. ovi, and Embrocated them with Ol. Ros. and by Empl. è Bolo, and Bandage with gentle compression I dressed him up, and afterwards here in Town Cured him by Sarcotics and Epulotics, as in Compound Wounds, a longer work which at first ought to have been by Agglutination: Parts separated and disjoined are to be brought together gently and equally, that they may touch one another, and so be prepared for Unition.  
This must be done first gently sensim & sensim, as Fallopius hath it, by little and little, not hastily at one pluck: If the parts be equally soft bring them equally together: 
First Gently.  if the one soft, the other hard, and not to be moved, but with difficulty, bring the soft part to the stubborn. If the part be grown stiff with could, as if they had been left in the fields all night, which after a battle hath often happened,( and particularly to a merry fellow, a common soldier, that used to wear an Iron Skull under a Cap, and from thence was called by a Nick-name; his wounds were large, and the Lips hardened with the could, and it was well for him his bleeding being thereby stayed) in this case you are with Milk or warm-Water, and oil to suppling them by Fomentation or Embrocation, till you perceive the Lips made soft enough for your purpose, before you endeavour Re-union.  
Secondly Equally, that the parts cut asunder may answer one another, as well in profundo, as in superficie, the Top as the Bottom, Brim to Brim; and, if possible, underneath Vessel to Vessel, 
Secondly, Equally.  that Nature may be in a capacity of doing itis own work, and by virtue of its Balsam, Reunite, Agglutinate, Consolidate, and Heal the Wounds: In all which Intentions she is the Agent, and the Chirurgeon only the Assistant, which assistance, that it may be more effectually given, we must go on to the Third.  

THe Third Intention is Deligation, 
The Third Intention retaining the parts United.  or Retaining the parts so joined together.  
For the effecting of this, our famous Masters have left us two principal means, fascias & suturas, rolling and Stitching; to which some, nay most of them added fibulas, or Clasps: But I will not put you upon that. If the Wound be small in parte molliore, in a fleshy part in the Limbs, and according to the length of the Fibres and Member; if the Wound be simplo, and in a sound Body, you may perform the whole Cure only by Bandage, 
Bandage.  for here Nature will truly act her part by application of blood and nourishment to both sides indifferently, and finish the Coalitus without your further assistance: this is that which gives such credit to the hermetic Powder. In the application of this, it becomes every Chirurgeon to be much experienced, in respect of the unspeakable commodities which the whole Art receiveth by them.  
By them not only are parts dexterously accommodated for Union, 
Their Use.  but such also as would unnaturally grow together kept asunder, in Burnings, Scaldings, &c. The Finger or Ham would many times grow together, the Chin would grow to the Breast, the Arms to the sides, were they not this way hindered. By them are fluxes averted, and the delapse of humors into the inferior parts forbidden, and being already lodged they are prest out. By these are good Juice wisely forced into parts Emaciated, as if the Right Arm pine away, roll up the Left from the hand to the arm-pit, that the blood being prest out into the Vena Cava, or rather hindered to flow in so fast by the Artery, may with more eagerness flow into the other side where it was wanting: By these we see great fluxes of blood, large Hemorrhages every day stayed: By them are ill shaped Ulcers brought into better figures, made more apt to be Cured: By them are the force of your application helped and furthered, they keeping them close to their proper places, where your care hath bestowed them: By them is the true natural form and beauty of the part commonly preserved.  
Three especial sorts of Fasciation or rolling pertaining to our present work have the Worthies of our Profession commended to posterity; 
Three sorts of Especial Use.  the first they term Incarnatrix or Agglutinatrix, the Incarnative or Agglutinative: The second Retentrix, or Retentive: The third Expultrix, or Expulsive.  
The Incarnative is that which brings the Lips of the Wound together, 
1. Incarnative.  and conserveth them in their right Figure; it must be more strict than the Retentive, and more loose than the Expulsive, and is the most useful in simplo, fresh, and yet bleeding wounds; The manner of performing it is thus,  
Have in readiness a Rouler of such matter, length and breadth as I shall anon show you, roll it up at both ends firmly to the middle; then lay the middle part of the Rouler on that part which is opposite, to prevent pain and Inflammation, and to cherish the heat of the part, you are, after you have made a turn upon the wound with both ends of the Roulers, to go up with the one and down with the other, and take so many turns about the part, according as may be requisite, for the restraining the flux of blood, or according to the season of the year, to defend from could, and yet not keep the wound too hot, for that may weaken the part; you must also be careful that your Bandage be not too hard so as to intercept the Spirits, your Bandage running downward will press out the matter from the affencted part, and by passing upward hinder the Influx of humours and Inflammation.  
The Fascia retentrix, 
2 Retentive.  is used to keep on close Applications about the wound, for cure of the Patient; and these are they that are only in use, in wounds of the Head: there must be a moderation of this Bandage.  
Fascia Expulsiva is performed by a Rouler of one head, 
3 Expulsive.  the special use of it is to expel matter out of fistulas, or the Sinuous Ulcers, and also to keep out and stay the descent of Humours, and to expel such as have already seated themselves upon the part wounded, or otherwise; I do it in the manner following.  
Begin in the sound part, beneath the seat of the Humours, and then roll hard at first, and by degrees, as you come nearer the mouth of the Wound gentler and gentler; if you will press out the Matter contained in the Cavity about the Ulcer, roll loosely a turn or two, then harder, and yet a little straighter, the higher you go to hinder the descent of Humours, but not too hard for fear of harm, Terminus sit bona laborantis tolerantia, Celsus: 
How hard to bind.  Let it be made with such moderation, as the Patient may well endure.  
Hippocrates de office. Medica; Vinculorum aliud per se( saith he) Remedio est, aliud iis quae Remedio sunt subservit, amongst Ligatures, some of themselves are Remedies, others are servants to Remedies; and true it is in this, for the Incarnative, and expulsive, are in themselves as you may perceive Remedies, and the Retentrix the common servant to them all.  
To this Fallopius in Tract. de vulneribus in Genere, adds Four more, 
4 Other Bandages added by Fallopius.  viz. Fasciam disjunctionis; Secondly, Fasciam directionis; Thirdly, Fasciam facientem Apostema; Fourthly, Fasciam prohibentem Apostema.  
Fascia disjunctionis. by rolling keepeth parts from joining together, as the fingers when they are bared of the Cutis.  
Fascia directionis, is that which assisteth in making a crooked part strait, or bendeth a part unnaturally strait to his proper figure.  
Fascia faciens Apostema, is that which will procure an Apostem, by summoning the matter up into one Body, which might perhaps dangerously flow into many parts, and those more principal.  
Fascia prohibens Apostema, is that which forbiddeth the collection of Matter, and by consequent hindereth the Generation of an apostume.  
For the matter of your gardeners, 
Of what Roulers are to be made.  they must be fine and even Cloath, white, clean and gentle, but of strong linen without Hem, Seam or Threads hanging by.  
Let the length be such as the Member affencted and the multitude of Circumvolutions require, 
Their Leng h.  longer in winter than in Summer: Hieme( saith Celsus,) saepius fascia circumire debet, Aestate quoties necesse est, roll on, on, and again in the winter, in the Summer no oftener than needs must; his ground I suppose he had from our great Master, Sect. 5. Aphor. 20. Frigidum ulceribus mordax, cutem obdurat, dolorem insuppurabilem facit; could nippeth a Wound, makes the Skin hard, and causeth pain, which cannot be digested for the breadth of the roller. 
Their Breadth.  Petr. Pigreus lib. de vulneribus, is most punctual; let them be for the Shoulder, saith he, of six Inches broad, for the Thighs of five Inches, for the Legs of four Inches, for the Arm of three Inches, for the Fingers and Toes of one Inch broad; but this your judgement will teach you to Alter according to the comformation, shape, and positure of parts.  
Fasten not your roller by tying a knot, 
How to be fastened.  nor yet sew it upon the wound, or where you cannot easily come at it again, lest you hurt your Patient; quickness and neatness distinguisheth the Workman from the ignorant and unskilful; as the subject is the more noble you work on, so strive to perform your office more excellently, intending not only your profit but decency in the dispatch, that you may please the eye both in the time of, and when you have done your work. Thus shall you gain credit to yourself, and endear your Patient to submit the more readily to your Rules, which is not the least part of the cure.  
The next thing that offers itself for keeping the Lips of the wound together are Sutures, 
Sutures 3 Sorts.  and they are of three Sorts; the Incarnative, the Restringent, and the third Conserver, 
Incarnative.  the first is that which is in most use amongst us, and is by making so many stitches at a distance.  
The Second is the Glovers stitch, 
Restringent or Glovers Stitch.  and much in use among the Spaniards, they stitch almost all wounds by it; in the Forehead and Face I have seen them bring the wound very close, and the third day they commonly cut the knot off, and draw the Thread out, then with dry stitches keep them so brought together, and so in two or three dayes more the wound is cured.  
The Third Stitch is in great wounds to hold them forcibly together; 
Conserver.  it is performed as in Hair-lips.  
There are Four sorts of Stitches, mentioned by the Ancients, for the wounds of the Belly, whereof I shall take notice only of one, which I have made use of myself, in the stitching of those wounds; the manner whereof is thus,  
You are to take up the Peritoneum on one side, and leave it on the other, and then take it up on the other side, and leave it on this; This is thus made, that the Peritoneum which is a dry Body may be united with the Musculous flesh, otherwise only the fleshy parts would unite, and the Peritoneum not, through which a Hernia succeeds, whereby you put the Patient to the wearing a Truss the rest of his Life, and to other trouble. The Thread, you ought to use for this purpose, is to be a white, strong and round Thread, proportionable to the Needle, and both according to the wound.  
You will remember to cleanse the wound of its clotted blood, if you can; but however go on with your work, that blood will find its passage out.  
In great fluxes of blood the Glovers stitch is best, be sure in your stitching, you bring the Artery and Vein to his wounded fellow, so shall you the likelier secure yourself, and make the work more shape-like.  
In the Incarnative you are to consider the wound. If the wound be but the length of a fingers breadth or a little more, 'tis not worth the stitching, your Medicaments and Bandage will keep the lips of the wound together, and quickly heal.  
If the wound be of two fingers breadth, 
The distance of Stitches.  make one stitch in the middle, if three fingers breadth two stitches, if four fingers breadth three stitches, and so go on making a stitch less than the wound is in number of the fingers, ut semper numerus digitorum uno superet numerum punctorum, so as the number of the fingers breadth always exceed by one the number of the Stitches; sometimes in declining parts we make our stitches at a little more distance.  
The time of taking out these Stitches is, 
Time of taking out these Stitches.  when parts are agglutinated, which is sooner or later according to the habit of Body or season of the year; commonly in great Transvers wounds eight days is required, in less wounds not so deep three or four days, in the Face the next dressing, lest the Stitches make so many Scars. But in this work you must use your judgement, for sometimes the wound seems to be agglutinated, while the Lips are held together by Suture, which after the Stitches are cut out is not so exactly Cicatrized, 
Caution.  but that you might have done better to have left the Stitches a day longer; 
Dry Stitches.  but thereto the dry Stitches will help you, which is the next way of keeping these wounds together; they are made with little bits of strong linen Cloath, Triangular or Quadrangular, or of such figure as may serve your purpose; these are most in use in the Face to avoid Stitching, and are of use in other parts to preserve the Stitches; These are commonly spread with Sang. dracon. Thuris, Aloes, farinae triticae, Gum-Tragacanth, a part. aeq. mixed with the white of an Egg, Gypsum will will do as much being so mixed; they are to be applied at such distance as they may be most strong to perform what they are designed for, they will dry presently if you apply any thing to warm them, then draw the lips together as you do in Sutures.    

CHAP. III. Of the Fourth and Fifth Intention, and of Compound Wounds, &c.  

THE Fourth Intention is in the Preserving the Natural Temperament of the Part, 
Fourth Intention.  so that thereby Agglutination may be obtained, and is divided into Universal and particular Regiment.  
THE Fourth Intention is in the preserving the natural Temperament, 
Fourth Intention preserving natural Temperament.  that thereby Agglutination may be obtained, which Agglutination indeed as I have already hinted, is the work of Nature alone, by whose only power all parts wounded, disjoined and broken are Knit and made one again; but in regard there is a certaim Medium which Answers in proportion to a glue, required in this work, Nature taketh what is next hand, even the nourishment of the Part which is hurt to make it of; 
Nature the agglutinator of wounds. Healing.  ubi morbus Ibi Remedium is here as an Oracle, where the disease is there is the Remedy; no sooner is the wound made but the balsam is discovered. blood( at lest the serous part of it) is the glue, which she useth both in curing by the First and Second Intention; the first being performed per Symphisin, 
1 per Symphysin.  i.e. a re-union of the part without any Medium, by which word I here mean any Callus or flesh, or other body interposed, for in another sense the Balsam of Nature is the Medium, the Instrument of Unity, and Knits the parts together. 
2 per Syssarcosin.  The Second per Syssarcosin, i.e. with a Medium or Interposition of some flesh or Callous substance, that fills up the space between the Lips of the wound; great care must therefore be taken that the blood offend neither neither in quantity or quality, too much bringeth on carnem luxuriantem ac supercrescentem, proud and loose flesh; too little doth defraud the part and affordeth not a competency of matter for the work.  
If the quality of the blood be ill, it cannot produce good flesh, qualis sanguis talis caro, as the blood is such is the flesh: the means whereby this Intention is performed is a regiment of the Patient, 
Regiment, 1 Universal.  and that is either Universal as to his diet, or particular as to the peculiar management of the part itself. As to the Universal we are to consider; first, an victus plenus vulneratis an tenuis, whether a full, or slender diet? This hath been a dispute in former Ages, but I think no man of common sense but knows, that as a full diet is hurtful for those of a full body, and in wounds where there is great Inflammation and like symptoms; so when a Body hath been exhausted through loss of blood or the like, 
Consideration from their manner of living.  it is reason that a greater liberty should be allowed, as broths, Cullices, Cordials, &c. Withal I conceive there should be consideration had of their manner of Living; some people have so accustomend themselves to drinking of strong drink, that without such a proportion they cannot live, I could instance it by many stories if it were necessary; but one for all, and from abroad, 
E. B. cured by allowing Wine.  Ed. Br. an old servant to a Person of Honour, was bit by a Monkey in the back of his hand: to prevent Inflammation I forbid him Wine; he next morning complained he had not slept that night, that he was faint and sick, and that his wound was the least of his ailment; that day he continued faint and ill, and the next morning complained again of his want of rest, and that afternoon he swooned, and complained he could not live without Wine, he had good broths, Caudles and such like, and I believe he did drink some Wine( but he was allowed by his Master a Bottle of a quart every morning for his draft, and was seldom sober) his wound was Crude, and Inflamed; I complied with his desire; he drank again as he pleased, his sickness went off, his wound digested and he cured. This I have seen often in some of our Dunkirkers at Sea, who drank extraordinarily, and were full of drink in our Sea-fights, I could scarce ever cure them without allowing them Wine, and thereby their Spirits were kept up, and I had the liberty to bleed them as I thought fit.  
It hath been a common saying, a hair of the same Dog, and that Brandy-wine is the common relief to such; what then must become of such a one after a hard drinking for many months together, if he chance in heat of drink to be wounded, and from that time his chirurgeon condemn him to Ptisan for a week together, nay two daies? will he not Faint and languish, his wounds become Indigested and Inflamed? you may laugh at my pleading for them, but I hope you will consider I am a water-drinker the while.  
In other things such diet is to be observed as their strength will permit, we do not use to purge in wounds with Cathartics lest by stirring matter it flow to the weak part, but allow Lenitives, as Cassia, Tamarinds, Manna, Sena, Rhubarb. with Sal. Prunel. also Electuaries as Lenitiv. diaprun. sir. Ros. sol. de cichor. cum Rhubarbaro, also broths wherein hath been boiled Lettuce, Succory, Endive, Sorrel, Purslane, Borage, Bugloss, &c. and bleed according to the strength of Body, and as symptoms Indicate in a direct line of the same side.  
Another part of the Regiment of wounded persons will consist in giving of Vulnerary drinks, 
Of Vulnerary drinks powders and Electuaries.  of which we find many mentioned by Authors, and the Materia Medica very large, witness that great tribe of Vulneraries in Perkinson's Herbal.  
The most common Simples with us in England are, Comfrey, Bugle, Ladies Mantle, Agrimony, Sanicle, Pauls betony, Fluellin, Periwinkle, Mugwort, Plantain, Horse-tail, Adders-tongue, Avens, Cinkefoil, Wild tansy, Vervain, Ground-Ivy, Golden-rod, Herb trinity, Centaury, St. Johnswort, Snakeweed, Knot-grass, Mouseare, Yarrow, Scordium, Strawberry leaves and roots, tormentil, Bistort, Valerian, read roses, &c.  
Some of these are made choice of to be boiled in water with white Wine and Honey, of which sort you have a sufficient example in the decoctum Traumaticum of the Dispensatory.  
Their principal use is in wounds of the Thorax and Abdomen, though they be of frequent use in all great wounds. Sometimes also if the disease run out to a length we add Guajacum, Sarsa, and Scorbutical Medicines.  
There are likewise Powders made of Crabbs-eyes, Coral, Nutmegg, &c. and Electuaries of the roots and herbs beaten up with those Powders.  
The particular Regiment is in preserving the natural heat and tone of parts, 
Second Particular.  without which we can hope for no union. For the better understanding hereof I must put you in mind that there is not any part of our Body admits of a solution of continuity without pain; every scratch in the skin and little cut in the finger is painful, much more wounds in the flesh; This pain stirs up a heat which ferments in the Serous part of the blood, which readily makes way to the wound, and if not timely prevented distends and raises the part into a tumour and Inflames. If this happens in a full Body, or one of an ill habit, where the blood is Serous and more apt to ferment, the mischief is greater; and if the wound be in a declining part, as the legs, the Influx of humours are more abounding, and the member through its weakness not able to assimilate, nor yet expel; whence crudities heap upon the lower parts and makes an oedematous Tumour there.  
To make this more plain, 
A Person pricked with a Thorn in his leg.  I shall give you one Instance of the many that happen daily; A young Gentleman of about 18 years of age, of a good habit of Body, one day sporting in the Country with his Gun and dogs, was pricked with a Thorn on the outside of the Calf of his leg, he takes little notice of it, returning in the evening to his home, he dressed his leg with a little Balsam, the next morning it was more painful, Inflames and Terminates in a Phlegmon; I am sent for after a few days, and find the Tumour large with great Inflammation, and suppurated; In the lower part, about the foot an oedematous Tumour: I opened the Tumour, and discharged a quantity of Matter, and cured the Patient as is usual in Phlegmons. If this Person had been treated according to the universal Regiment by bleeding and Lenient purgatives, &c Nay if only after this particular Regiment in the preserving the Temperament of the part, which ought in this case to have been by refrigerants and astringents to have prevented the Influx of humours, and applied some maturative to the festered Scratch or prick, 
Medicaments proper in the beginning of a Phlegmon.  as ung. Basilic. upon a Pledgit of Lint to give a Breathing to the part; this with any of our restrictive Emplasters a compress dipped in Oxycrate with convenient Bandage over all, had preserved the tone of the part, and cured the Patient without further trouble.  
To proceed rationally, by this Intention in wounds, you are to apply to the Lips of the wound such Medicaments as have an Agglutinative faculty, as Bolus Armen. Sang. Dracon. Thus, Aloes, Gum. Elemi. Colophon. Terebinth. And outwardly, to prevent influx of humours, such as are Cooling, Drying and Corroborative, as fol. plantag. Equiseti● Millefolii●●. vincae per vincae, ulmi●. flor. Ros. rub. ballast. nucum cupressi. Gallar. Baccar. Myrtillor. far Hordei. fabar. vinum rubr. posca. Aqua font. & oleum. These are the simplo Medicaments, which are to be proportioned to the habit of Body and wound, as it is greater or less, Parva & superficiaria vulnera natura sua sponte nullius Medicamenti indiga sanare solet: Labia solum à nobis contrahantur & Ligamento circumdentur, ne pilus aut arena aut tale quid illabatur, & ulcus penitus coalescet, Aetius de curatione vulnerum. In small and superficial wounds, as those which are made according to the length of the member, there Nature of her own accord is wont to effect the cure, without the help of any Medicament; from us only is required that the Lips of the wound be brought close together by bandage, that neither hair, nor dust, nor any other thing fall between them. But in greater wounds that will not so easily be cured by Suture, we keep the Lips together, sprinkling them with this, or some such like Powder, ℞ Bol. Armen. Thuris. Sang. Dracon. part. aquales, and spreading a cloath with some of the same Powder, apply it with a Compress dipped in Oxycrate, and a suitable Bandage over all; This is generally the way. But lest by the adhesion of this emplastic Medicament, 
The Authors way.  the Lips of the wound should be torn and disturbed in taking it off; I choose rather to apply over the sprinkled Powder, a pledgit of Lint spread with lineament. Arcei, or this following Unguent. ℞ Terebinth. Venet. ℥ iij. Gum. Elemi. ℥ ij. Sang. Dracon. Thuris. mastic. an. ʒ j. M. f. Unguent. s. a. or this, ℞ Terebinth. ʒ ij. rosin. Pin. Oliban. Colophon. an. ℥ jss. mastic. ℥ j. Croci ʒ j. Cerae. ℥ ij. Olei. Hyperic. q. s. ut ft. Unguent. Unguentum Aureum in the London Dispensatory is also good in this case; as likewise are the compound Emplasters, Diapalma, Diachalcit. de Lithargyr. de Bolo. de Betonicâ; or you may use this following ℞ Terebinth. lb ij. rosin. Pini ℥ iiij. Gum. Elemi ℥ iij. Aristoloch. Long. ℥ j. Sang. Dracon. ℥ iss. pulver. omn. subtilissimè, & f. Empla. s.a. igne lentissimo.  
In all Wounds where I propose to Cure by Agglutination, and would preserve my Stitches, I forbear the use of Fomentations and slabby Medicaments: nor will you have occasion for such applications, if you proceed rationally as you ought to do; I always accounting these simplo Wounds cured, when the Lips are well brought together, and dressed as above-said. Indeed in large and deep Wounds, where the Muscles and Tendons are cut through, there the Wound may require to have a space left open in a declining corner for discharge of Matter, lest it be healed outwardly, and some Matter shut in, whereby it becomes an hollow Ulcer. In this case you may use Fomentations and Embrocations. This is to be left to the judgement of the Chirurgeon, who is not to doubt but that Nature will do much towards the Agglutination of the wound; if influx of humors be kept off by his Art. But if the wound be so great and deep that you cannot bring the Lips close together, then in a declining part you may put in a Tent with a Digestive è Terebinth. & vitel. ovi, Turpentine being one of the most proper Medicaments in all Wounds, especially those of the Nervous parts; for it preserves Bruises from corrupting and putrefying, strengtheners the part, eases pain; and this it doth by its Digestive Faculty, and is thus commonly used. If you apprehended its acrimony, you may take that off by washing it in Plantain, or other water: where we fear Inflammation we add farin. hordei. Or you may use this Balsam of the Spanish Priests, known by the name of Oleum Aparici, 
Ol. Aparici.  which is thus made, ℞ Ol. olivar. unc. iij. Terebinth. venet. unc. viij. frumenti Integri, unc. j. sem. Hyperici, unc. ij. rad. Cardui Benedict, rad. Valerianae, an. unc. j. Thuris pulveriz. unc. ij. the Seeds and Roots are to be shred and beaten, put them into a pot, cover them over with White-wine, let them stand two days infusing, then add to them the oil and Wheat bruised, boil them to the consumption of the Wine, then strain it out hard, and add to it the Terebinth and Thus, then give it a walm or two, and keep it for your use as a very good Balsam, often used by me. This is to be dropped warm into large Wounds, and prest out again, and the wound brought as close together as you can, with a Compress dipped in Red-wine, wherein hath been infused flor. ros. rubr. ballast, and such like, over this Compress make your Bandage; these Wounds are to be dressed but every third day.  
Galen, speaking of Ulcers, says, In Ulcers, although Matter flowed much, he dressed them but every third day, and in Winter every fourth day, yet there may be occasion of opening sooner, for the straightening the Bandage, or putting on dry Stitches, or cutting out the true Stitches, lest upon any accident the Suture should relax and the Wound open again.  
Thus far I have proceeded in simplo wounds, 
Compound Wounds.  to the Agglutination of parts, we shall now consider, of Wounds, wherein there is loss of substance by Abcision, or through a redoubling of the blow cutting twice or thrice in one place, or where through the distance, or hardness of the Lips of the Wound, it could not be kept together, but that a Cavity hath remained in the bottom; and herein we are to regard the habit of body, that there happen no defluxion or inflammation upon the part. This is done by universal Regiment and Digestion, with Mundification, that a new flesh may be made to fill the Cavity, to which purpose this or such like may be used, ℞ Terebinth. unc. iij. farinae Hordei drach. sex. Thuris Drach. j. s. victual. ovi j. to these you may add after a day or two, mell. ros. aut mell. come. q. s. and if yet there be required more detersion, or flesh grow lax, you may use Mer. praecipitat. at your pleasure: In these cases I have long pieces of Vitriolum, 
Vitriol and Allom-stones.  Roman. & alumen. fitted to Quills, whereby I dry this supercrescency with less disturbance to the Patient. To this purpose you may use this Mundificativum Apii, ℞ Fol. Plantag. & Apii an. M. j. Ros. rubr. P. ij. Vini rubr. unc. viij. decoquant. ad medias in Colat. dissolve. sach. rubr. unc. ij. Terebinth. unc. j. Farin. Lupinor. & orobi an. drach. j. Aloes, Myrrhae an. drach. s. decoq. rursus & addendo Cerae q.s. reducant. ad formam ung. This is Quercetan's. In the use of detergents you must consider the habit of Body, and accordingly add or diminish, making them of a good consistence, and having so disposed the Wound to Incarnation, if what be prescribed do not Incarn, add pull. Ireos, Colophonia, mastic, Sang. dracon. sarcocol, to make a Sarcotick Ung. and afterwards cicatrise with Ung. Tutiae Vigon. or desiccativum, &c. or with Pledgits dipped in an Aq. Calcis, or Aq. Alumin. simple. factâ solutione in Aq. Rubi, and dried again. 
Contus'd Wound.  If a Contusion be joined with a Wound, then you are in the first place to endeavour, that the Contused flesh in the Wound may be suppurated and turned into Matter, and that cum vitello ovi & Terebinth. & ol. Ros. or Ung. Basilici malaxt in ol. lilior. warm the parts about to be Embrocated with lenients Ol. Lilior. Chameli, Lumbricor. and that the more circumjacent parts about be Embrocated with Albumine Ovor. Ol. Ros. Ol. myrtle. and a little Acet. and some of our restrictive Powders, as Bol. Armen. Sang. Dracon. Flor. Ros. Rub. ballast, mixed with the above-said to the consistence of a mell. or Emplast. è Bolo applied over all, to prevent the Influx of serous blood into the pained part, and a Compress dipped in Posca, with good Bandage to be made over all, to press out the humors already fallen into the part affencted, as also to prevent the access of more, which would be apt to flow thither by reason of the pain; to which purpose you are to let the Patient blood, and proceed as is said in preserving the temperament of the part: If that pain increase, you are to have recourse to Anodynes, as is proposed in the Fifth Intention; but if there be little pain, and the flux of humors restrained in some measure; then you are to apply Discutients to the parts about: The Wound digested, proceed as abovesaid with Detergents, Sarcotics, and Epulotics.  
These great Tranverse Wounds are not so often seen here in times of Peace, 
Transverse Wounds.  but in the Wars are frequent, especially when the Horse-men fall in among the Infantry; the Enemy cruelly hacking them, the poor soldier the while sheltering his head with his Arms, sometimes the one, then the other, until they be both most cruelly mangled, and yet the head fareth little the better for their defence; many of them not scaping with less than two or three Wounds, through the Skull to the Membrains, and often into the Brain, and if he fly and the Enemy pursue, his hinder parts meet with great Transverse wounds, over the Thighs, Back, Shoulders and Neck. Mr. Sanderson, now one of the surgeons of St. Bartholomews Hospital, was once a fellow-labourer with me in the Dressing such: At Sterling Mr. chase the Kings Apothecary assisted me in the Dressing many such, and one with such a Gash thwart the nape of the Neck, as it was our wonder that he lived: All these wounds inflicted behind were full of Maggots, they having been some days undressed: These Wounds I stuped with a decoct. Absinth. Centaur. scored. Lupinor. Myrrhae, Aloes, and softened the stubborn lips with fomentations of Rad. Althae. Consolid. Maj. Sumit. Malvar. Violar. Hyosciam. boiled in broth, or with decoct Hordei, or with Milk, or warm-water, we refreshed and disposed them to yield to Suture, or Bandage; we digested them with Terebinth. & victual. ovi, with Dossils, Pledgits, or small Tents dipped in a warm Ol. Hyperici, keeping some declining part open. 'Tis proper to pour oil or Balsam into these Wounds, but then it must run down, or be prest out of them again: the parts about we likewise Embrocated and applied over all Empl. de Lithargyro, with Compress and Bandage: digestion once made, we then deterg'd with Mund. Paracels. and cicatrized, as hath been said elsewhere. Thus I cured all these wounded people, or so disposed them, as with leave they retired to their own home to be cured with more convenience.  
Si vero vulnus profundius fuerit, & in superficie, Angustius, scalpello incidatur ut aequalis amplitudo fiat; Aetius, lest Matter corrupt and putrifie in the bottom, or if it happen that a wound is made so deep, and amongst the Vessels, or that the Unition is hindered by extravasated blood, lying in the bottom of the wound corrupting and disturbing the Unition of the part; and that the Matter cannot well discharge this way, you are then to consider, whether you may not pass the Matter by a Perforation In fundo, which if you may( as I have often done) then do it either by Knife, or a caustic, or both: First a caustic, then a Knife, or by a Seton-needle with a twisted Silk or Thread, or upon keeping this open a few days by a Tent or hollow Canula, you shall easily heal the upper part by leaving out that Tent only; it healing up, as it were, of itself, or by the help of Bandage, to compress the parts; and after a few days more, this lower opening will cure by common Applications, your very Roulers with a Compress dipped in Red-wine, or the like will effect it.  
Sometimes wounds are made deep, 
A Wound double in the bottom with Attrition.  as in the side glancing to the spin, and run between the Musculous flesh five or six Inches; and in some of these, before the Rapier is half out of the Wound, a second thrust is made, by which there is a double Wound, and an attrition of the lower part wounded: the Chirurgeon is to consider well the wound and part wounded, and if this be so made, and is not likely to be cured, by the first Intention,( as it is not if it be by Attrition in fundo) or that a tendinous body be wounded, then consider whether it may not presently have a way made out below; if it may, and that part kept open by digestion with a small Tent, then the upper part will Unite by Agglutination; but if it may not be opened, then he is to digest this upper Orifice, and keep it open; and if it be not large enough, he ought presently by Cutting, to enlarge it, while the wound is warm, and dress with your digestive warm, and let him Embrocate the part, the whole length as it is affencted, with Ol. Ros. cum Aceto, and apply a good restrictive Emplaster over all, to hinder influx of humors; to dispose parts to quiet, then bleed, and what else is necessary for conserving the the tone of the part. If after all these endeavours the wound do digest, yet will not Cure, however he ought not presently to open his wound a-thwart the Muscles, nor yet according to the Fibres of them, to such a length, not though it may be done without laming the Patient; but shall in such a wound, at the first while it is recent, make search with a Probe to the bottom of it, and with his finger without, feel what thickness the skin is from it, and keep this place as a mark in time of need, for to make the Apertion in; and if he do after digestion apply his caustic there, the Matter will thereby discharge, and the Patient be happily cured; whereas the cutting open such a Wound the whole length hazards his Patients life, and makes a long work for himself.   

THE Fifth Intention is in preventing of Evil Accidents, and correcting such as are already fallen upon the part; and these are, Hemorrhagia, Pain, Fever, Intemperies, Convulsions, Syncope, Delirium and palsy.  
We shall begin with Hemorrhagia, 
Of Hemorrhage, or Bleeding.  as being incident to all Wounds more or less, and sometimes the cause of all the other Accidents: wherefore I have treated purposely of the Wounds of Veins and Arteries in a Chapter by itself, so propose here only to speak of it as the stoping of it is made by some Authors the second Intention. The way to stop the flux of blood, as it is common in wounds, is by retaining the Lips of the wound together by Suture or Bandage, and by applying such Medicaments to them as have a drying and Agglutinative faculty; as Galen's Powder, Aloes p. j. Thuris p. ij. with Hares fur cut, some of these mixed with a white of an Egg, and applied upon a Pledgit on the Lips of the wound, and over that some little Bole and Sang. Draconis, with a little Resina added to the former mixture, and spread upon a double cloath, and laid over the wound and parts about with Compress and Bandage, and the member placed in such a position as is for the ease of the Patient. This is our first and common way of Dressing wounds, to stop the bleeding and prevent Inflammation, and is not taken off until the third day, by which time the bleeding is stopped, and the wound near Agglutinated; but if the wound be great and deep, so as you cannot bring the Lips of the wound together, then apply those Powders of Galen's upon Dossils upon the bleeding Vessels, and your astringent next, and a Compress wet in oxycrate, with good Bandage over all, and by the next dressing you may hope that bleeding is stopped by incarnation, if by your Probing you cause not a new flux of blood.  
You ought to be speedy in the mitigating pain, 
Of Pain.  for that nothing dispiriteth your Patient more, nor makes more disturbance in Wounds, the humors flowing abundantly to the pained part offending in quality or quantity, according as the habit of Body is affencted, whence vehement pain ensues, with great Inflammation and tumour, wherefore you must hasten to succour it; and in the first place Phlebotomia is proposed as the best Anodyne, for that it takes away the cause of pain. Unguent. Nututum, Refrigerans Galeni, Ung. Alb. Camphurat. populeon. cataplasms of Far. Hordei, Fabar. Flor. Ros. Rubr. Sambuci pull. decocted in Red-wine; Oxycrate or Oxymel, or Fol. Hyosciami m. ij. boiled in milk and with white-bread crumbs, a new-laid-Egg, and a little Saffron, and Ol. Ros. applied as a cataplasm; Fomentations of the Roots of Althaea Fol. Malvar. Viol. Flor. Chamel. Meliloti boiled in broth of a Sheeps-head and feet. If after this it tend to suppuration, then you may proceed that way as in a Phlegmon, but if it yield to none of these, then you may truly conjecture some Nerve is offended, and proceed as is said in the Wounds of the Nerves. But if pain be caused by Matter that wants a passage out, give it one by Knife or caustic.  
If some hot distemper from Choler offend the part, which may be perceived by the pain and vesication, then those Unguents Nutritum, Alb. Camphorat. Refrigerans Galeni, Populeon. are proper, or this following, ℞ Succi Plantag. Solani, Sempervivi an. ℥ j. Boli Armen. ℥ ss. Litharg. loti aq. Plantag. & Tutiae praeparatae an. ℥ j. Ol. Ros. Omphac. & Nymph. an. ℥ ij. Aceti Rosacei & Cerae Tantillum. Ft. Unguentum.  
If the distemper be oedematous, as will appear by the laxness; then Fomentations wherein Flor. Cham. Aneth. Meliloti Sem. Faenug. &c. such like boiled in Wine with good Bandage will serve your purpose.  
Fever accompanies great Wounds, 
Of Fever.  especially where there is Inflammation, it is almost inseparable: therefore you are the less to trouble yourself thereat: but if in small Wounds it happen or continues after the pain and Inflammation is removed, and hath Delirium or Syncope with it, then there is great cause to doubt the welfare of your Patient: You are to order in all these distempers a slender and cooling diet, and humecting, and with lenients gently to loosen the Body, and by bleeding and repeating as you see cause, Apozems, Juleps, Emulsions, Epithemes, which by refrigerating and contemperating the heat, are here proper.  
For Gangrena, Convulsions and Palsies; I refer you to their proper places, as more accompanying gun-shot than these Wounds.    

CHAP. IV. Wounds of Veins and Arteries.  
THE next thing that offers itself to our consideration, is the Wounds of particular parts, and first of the Veins and Arteries, which are subject to great effusion of blood, whereon the life of your Patient depends. Est enim sanguis Thesaurus vitae: and therefore requires your speedy help. 
signs of the Artery wounded.  You may distinguish whether the blood be from an Artery or a Vein, by the flowing of it, and by its colour. From the Artery the blood rushes impetuously & per saltum, by reason of the dilatation and constriction of the heart, and is of a florid colour. 
Of the Vein wounded.  The Venal blood flows with a more smooth and even stream, of a gross consistence, and of a darkish colour. Of these Wounds there is no great danger, 
prognostic of Vein and cure.  Galen's Powder with the white of Egg, with the Suture and the formerly proposed way of dressing and Bandage, will certainly stay the bleeding of Wounds in the greater Veins, and cure the Wound at the same time, or in few days: 
prognostic of Artery.  But those of the Arteries are most difficultly stopped, for that the blood is in a most vigorous and strong motion.  
If these wounds be not with loss of substance, 
And cure.  and lips bruised, 
Suture.  you are then by Suture to bring the Lips & Artery both together, passing your Needle, with a good strong thread seared through both Artery and Lips, making Guido's suture, which he calls suppressoria or Glovers-stitch. And having thus secured the Vessels for the present, you are then to apply such as this over all. 
Applicatives.  ℞ Boli Armen. ℥ iij. Sang. Drac. Thuris, Aloes, Glutinis sic. an. ℥ j. Gypsi, Farin. Volatilis an. ℥ ss. Hipocystidis, Acatiae Sumach. an. ʒ iij. with the white of Eggs make it to the consistence of Honey, apply this upon a double cloath over the wound and parts about, with a compress squeazed out of oxycrate or Acetum, and roll up the Member, with the Agglutinative Rouler, beginning on the opposite part, 
Roulers.  bringing both the heads over the wound, and having taken a turn or two there, roll upwards and downward, so as to press the blood from below upward, and to hinder the Influx from above. Your Bandage must so be made, as may be to the ease of the Patient, and the position such as may prevent as much as may be all pain, keeping him cool and quiet, 
Ordering the part and diet.  and to a slender diet, and his drink cooling and Incrassating, as Fountain water, with Sal Prunella, or Acetum, or with Gads of Steel quenched in it, sweetened with sir. of Coral, or Pomegranates, or some of these of Quercitan's, ℞. Croci Martis, Essentiae Corallor. an. ℈ j. sir. de Ros. Sic. & Mirtill. an. ℥ j. aq. Papaver. Rhead. ℥ iiij. m. or a Decoct, Hordei cum Sem. Papaver. Alb. & Hiosciami, with Rose-water and a little Sugar, as a draft at night, or at present in any great extremity in bleeding; also a grain or two of Laudanum, if the Patient bears it well, in these case is commendable. 
Bleeding, where,  You are to let blood from the contrary part as the strength of the Patient will permit; only a little at a time for revulsion, as also Cupping, Friction, Binding the remote parts, & the like for derivation.  
In such great effusions dress not the Patient again in five or six days; 
Qu. if the Stitches break.  then if all be well, dress him again after the same manner; but if you find the blood hath made its passage through all, and the Stitches broken, then if you can come to the artery, you shall do well to take hold of it by a little hook, 
Deligation and Abcision.  and separate the Vessel from its teguments, and with a twisted thread make a deligation upon the upper and lower-most part of the Artery, and divide it in the middle, so the ends will contract; and as the Artery Incarns, the Ligature will cast off: Then proceed by digestion and Sarcoticks, and cicatrise the wound. But if the Artery lies so deep that you cannot possibly come to make deligation upon it, 
Escaroticks, &c.  proceed by Escaroticks applied to the Vessel, or by an actual Cautery. If by Escaroticks, then you are to cleanse the wound of the clotted blood, and dip it in some such like Powder, ℞ Thur. pull. ℥ ij. Aloes, Glutinis Sic. an. ℥ j. Chalcant. Ust. ℥ ijss. Arsenici ʒ vj. Gypsi ℥ ijss. apply this upon the Artery thick, and fill up the rest of the wound with Galen's Powder, with Hares fur cut into it, and over all your digestive è Terebinth. & ovo integro, and dress up the wound as before; and at your next dressing, leave the Escarotick sticking, and Incarn as fast as you can, or instead of them, Vitriol powdered and tied in a fine rag, and thrust to the bottom of the wound, and dressings applied over as before.  
But if after these former dressings that Artery bleed, 
Cautery.  and you cannot come to divide the Artery, then you must use the actual Cautery. By it the Vessel shrinks up at both ends, the flux is immediately stopped, and the part marvelously strengthened. You are to convey it down by a Canula, and that it may not heat, cover it over with an Emplaster, and wet the outside with the white of an Egg, or mucilage of Quince-seeds. But before you use your Cautery, you should remove the grumeous blood, or whatsoever else lies in your way, lest it cool your Cautery, and frustrate your endeavours, and pain your Patient to no purpose: 
Cautim.  Once or twice pressing with your actual Cautery to divide and contract the Artery will be sufficient. oftener may burn it to a coal, which may cause the falling off of the Eschar before it is Incarned, and a new flux of blood follow; that done, dress the part with a little of the mucilage of Quince, mixed with the white of an Egg, and Embrocate them about with Ol. Rosar. and apply your Emplaster Diacalcith. malaxt with some of the same oil over all; and after you have allayed the heat of the part, then digest the Wound, and with Sarcoticks Incarn, and by Epuloticks cicatrise the Wound.  
A person of a good habit of body, about 35. years of Age, wounded in a Duel on the right side the Aspera Arteria; 
observe. 1. Wound of the internal Jugalar.  being run through his neck below the last Vertebra of that side behind: The Wound was small, yet he bled with a full stream, but it stopped by holding a finger upon it while I made dressings ready, which was with a few of our common astringent Powders, with the white of an Egg, and a little Acet. upon a thick Pledgit of Lint, with an Emplaster after of the same, with Compress and such Bandage as it would bear: The Wound behind bled, when that before was dressed. I applied the said Medicaments to that, and we held them on with our hands, until they were dried on, then we put him to bed in the same house, and kept him cool and quiet. I used all my endeavours for the contemperating his blood, as is usual in such cases, and dressed him but once in four or five days, unless I were necessitated by the bursting out of the blood from his wound; he bled at times about 16. or 17. days; his wound by the Vertebrae of the neck was cured in few days: and this near the Aspera Arteria was cured by this way of Agglutination the nineteenth or twentieth day.  
A man wounded in the Artery under the right Eye, 
observe. 2. An Artery wounded.  was at that instant dressed by Mr. faucet Chirurgeon, the next day in the afternoon it burst out impetuously; I was sent for, and found it bleeding with a strong impulse, the wound very small, not so big as a silver penny, made by a blow with the corner of a Trencher; I dressed the Wound with Pulv. Galeni, and applied an Emplaster over it made up with my common restrictive Powders, cum Albumin. Ovor. and a little Acetum, with good Compress and Bandage bound it up: The next day his Wound bled again, and upon stoping of that little wound with my finger, the blood was seen to beat all along the Artery under the Eye to the Temporal Muscle, with a greater force than is commonly seen in an Aneurisma; I then with a crooked Needle pierced through both the Lips and Artery, and by Deligation restrained the bleeding, and with Emplastricks dressed it up as before, concluding I should have very little more trouble from this wound; but within two or three days after, it burst out bleeding again; then I being absent, some other Chirurgeon was called in, and after at another bleeding Mr. faucet dressed him, and at another time Mr. Aris dressed him, the wound was now grown large, with the crowding of Dossils, and being in a very inconvenient place for bandage, it bled often, and was dressed by such chirurgeons as they could meet with in their necessity; Escaroticks being thus frequently applied to stop the flux of blood, his Eye was very much inflamed, so as it was verily believed by us, that if he did recover of his wound, yet his Eye would be lost, his continual bleeding thus for many dayes had so exhausted his Spirits, that there was small hopes of his surviving.  
At the last bursting out of this Vessel, Mr. E. Molins deceased, Mr. faucet and myself met together at his Chamber, we found him lying as dead, with his hand out of his bed upon his breast, we felt for his pulse but it did not beat, we concluded him dead, and took the dressings hastily off the wound, it did not bleed though it was open, we supposed the blood exhausted, the Artery lay in the wound torn by the Escaroticks, we took up the Ends and tied them, and dressed the wound with lineament Arcei and an Empl. over it, not believing that the man would ever recover, but from this time, the bleeding of the wound ceased, and the wound by very common remedies daily Incarned to my admiration, and he was in less than a month perfectly cured, both of his wound and eye. This Patient was subject to the like bleeding upon every Scratch.  
A Butcher was wounded in the Artery between the Thumb and Fore-finger, with a large wound, 
observe. 3. Artery wounded.  after he had been dressed three or four days by some body, the wound continuing still to bleed, he came to me late one night from Westminster bleeding, with dossils crowded in the wound, I threw them out, and with a needle and a thread stitch't up the wound and the Artery with it, sprinkling my agglutinative Powders upon the Suture with my Empl. and Bandage, as in the former wounds is said; in three or four dressings I cured him, but after there remained some pulsation extraordinary under the Cicatrix, which proceeded from the too lax Incarnation of the wound, wherefore with a pledgit dipped in a dulcified Tincture of Vitriol prest out, and Applied with a good Compress, and rolled over the affencted part, it was dried and shriveled so as from that Application there was seen no more pulsation in the skin from the Artery.  
One in the New Exchange had an Aneurisma in the palm of his hand, 
observe. 4. Aneurisma broken open.  lying a-long to the third and and fourth fingers, which at last broken out, and bled at times the space of eight or ten daies, and being at a loss he sent for me, with this Tincture of Vitriol as above-said, I cured him not only by stoping the blood, but by making a firm Cicatrix, I dressed these Eruptions, but seldom once in four or five days.  
A Sedentary young Gentleman of an ill habit of Body, 
observe. 5. Wound of the Surall Artery.  wounded by a puncture in the Inside of the calf of his leg into the Surall Artery, bled much, a chirurgeon is called for; he fills up the wound with his Dossils dipped in albumine ovi, and astringent powders, wherein was Escarotics calchantum ustum, &c. Applying over this his Emplaster and Bandage, by which he stopped the flux of blood, and left the Patient to rest: The next day I am called in to dress the Patient. Upon a relation of the wound and this manner of dressing, I propose not to open the wound in four or five daies, unless some Accident happen I visit him daily, he keeps his bed, complains of a disturbance in the wound, as burning, throbbing, and pain at times, not constantly, and is very apprehensive of its bleeding; looks himself often upon the Bandage, and alarms me by messages as often. The third morning his chirurgeon and myself meet, we find the Bandage all bloody; we propose to dress, The Apparatus being made we take off the dressings, and find the blood fresh in the Roulers, but upon taking off the Emplaster see the Dossils come out, and with such a foul bloody sanies, as is usual in such wounds after the filling them with such Powders. I consider with my Brother chirurgeon, whether the putting in a Tent with Escarotics may not stir up flux of Humours, and be attended with Inflammation, &c. and whether that way we may be sure of meeting with the Artery; and if we do whether our Medicaments will restrain its bleeding; and if not, then whether by pressing upon that Artery we may not raise a flux of blood anew? To avoid all such I resolve to dress the wound with our common digestive, with Tereb. victual & ovi with pulvere Galeni, and so we apply it upon a thick pledgit of Lint, and Embrocate the parts about with ol. Ros. & Aceto, & Empl. è Bolo over all with good Compress and Bandage; by this I supposed the parts would be at ease, the wound at liberty to discharge the sloughs and sanies which was made and choked in by the last dressings; and the Unition of parts within furthered, and the blood in the Artery restrained. If it did not thus answer expectation, yet I concluded we had done what became good chirurgeons, and that at the next dressing it would be in our power more easily to lay open the wound, and divide the Artery without hurting the nervous or tendinous bodies near it. For a wound so dressed up would either unite or dilate its lips, there being a pledgit proportionable to receive a small quantity of matter, such as might be expected from such a wound, well-condition'd, but a greater quantity, or a new flux of blood that could not get out so, must necessary distend the lips, we resolving not to dress the wound again in less than 3 or 4 daies: Thus we left the Patient easy; but the next day I found him unsatisfied how this wound could cure so dress without a Tent, and oft murmuring that it would rancle; yet he continued pretty easy, and did not bleed all these three dayes. The Fourth day at the opening, we found no blood but what was mixed with matter, and the wound looked well; but by his importunity I complied with him, and put in a short Tent spread with digestive and dipped in precipitate, and dressed him up again; and the third day opened, and upon the dressings there was a fresh blood again, which was followed by a thick white Matter, as from a Phlegmon, more than might reasonably be expected from a small puncture, not above half an Inch deep; wherefore fearing a cavous Ulcer, I resolved to dress without a Tent, and by good compress and bandage to press out thit Matter from within, and defend the part from Influx of Humours from above: to which purpose I dressed with pledgits as before with my digestive, &c. and opened the wound once in three dayes, and altered not this method, though I changed the ung. upon the pledgit as I thought fit: Thus I kept the part without tumour or Inflammation, and the matter lessened each dressing, but was not well digested nor free from blood, but his feet swelled, and himself ill-disposed; Scorbutic and such like affections, with loss of Appetite, fainting, &c. To relieve him in these Dr. W. was consulted, and after a while I caused a strait stocking to be laced on both legs, and got him out of Bed at least for some little while every day, and when he was able he retired into the Country, but hath not yet got off of the disease he heightened, by keeping within doors with this little wound. Doubtless this cure had been shorter, if immediately in the first dressing he had been bound up with an Agglutinative bandage, and the whole committed to nature.  
A Cooper living near Maidenhead in the County of Bucks, 
observe. 6. Artery wounded in a Coopers arm at Windsor.  accidentally in letting blood was pricked in an Artery, the Arm swells and is pained, he puts himself into another Barber chirurgeons hands dwelling in Windsor, who by unfit applications, Relaxes the part, then supposing the soft tumour he had made was a Suppuration of Matter,( though indeed it was the Arterial blood) he with his Incision knife or Lancet cuts into it, at which an impetuous flux of blond rushes out, to the quantity of four flagons, he fills up the opening with Lint, and makes a hard bandage round it, which somewhat restrains the flux of blood, but the Arm swells, and threatens a gangrene: While this poor man lay thus afflicted, We his Majesties and Royal Highness surgeons attending the Court, did visit him, and proposed to make an apparatus for the taking up this Artery, or in case of failing to take off his Arm by Amputation; We met the next morning, the Patient is taken out of bed and placed in a Chair towards the Light, one of his friends held him in the Chair: Mr. Whittle stood behind his Arm, and held his Elbow with his left hand; and with the other hand was ready to help me in the operation; Mr. L. holds the lame hand: In the first place I viewed the Arm, where finding no gangrene according to the report of the Chirurgeon, but rather( as I thought) an Aneurisma, I made a bandage above the wound, to hinder the Influx of blood into it: Upon this bandage Mr. pierce made the gripe; I then untied the Ligature from about the wound, and found that also free from Mortification; I put my finger into it, and finding the skin made thin by distension from the blood, I called for a Knife, which while I was searching in the wound, Mr. Whittle took into his hand: I prayed him to cut through the length of the hallowness. It being done, I with my finger thrust out the Grumous blood and an Abscess from the lower part of the Arm. When I had cleared the parts more distant, which would have fallen in and blinded my Work, I then made way to the Artery, removing from about it the clotted blood; upon which it immediately burst out, I prayed Mr. Whittle to hold his finger upon it, he did so; then I separated it from the parts about it, and passed a crooked Needle under it; and being ready to tie it, I desired Mr. Whittle to hold off his finger, that I might be the more sure it was the Artery, upon the doing of which it spurted out: I tied it; but in tying the Thread broken: This caused a murmuring in some of the by-standers, as that the Patient would die under our hands while I was endeavouring deligation, which by a new wounding of the parts would hasten Mortification and Death; I desired they would continue their places, and Mr. Whittle his finger upon the Artery, that it bled not; he did so; in the while I made a strong Ligature of some twisted Threads, seared it, and put it into the eye of one of our common silver searching Probes. Gentlemen, said I, you shall see me pass this probe under the Artery, and thereby you may be assured I shall wound no parts; I immediately did so and tied the Artery, Mr. Whittle took off his finger, it bled not; then Mr. pierce took off his hands, I then loosened the Bandage, which was all the time before under his hands, It bled no more; I  told them there was more to be done in order to the binding that Artery; but in continuation of the continual Fainting of the Patient, we would defer it to the next dressing: then calling for dressings, they brought me what was designed for Amputation, which I refused; and ordered the common digestive è Terebinth. cum victual. ovi, which they fetched.  
I cut off the ends of the Ligature, and dipped some of the pledgits spread with the lineament in Galen's powder, and applied them next the Artery, and the rest of the pledgits dipped in ol. Ros. warm, and lightly filled up the wound, then Embrocated the Arm with the same oil, and laid a Diacalcitheos Emplaster over the wound and that part of the Arm, and over the hand and Arm below which was Oedematous, a mixture of Diacalcith. & Paracels. Then with bandage began at the hand and rolled up the wound, and taking a turn or two there, I rolled up to the Axilla. This was the Ligatura Expulsiva, by which I proposed the thrusting back the Influx of humors, and to give strength to the inseebled Member; He being now again in his Bed, I placed his hand upon his breast in much ease to the great joy of the Patient. At the next dressing, only Mr. Whittle and the country surgeons were present with me, we opened the Member, found the tumour allayed, the wound fresh and tolerably digested, we now passed another Ligature upon the Artery above the first, and in pulling the first to cut it off between the Ligatures, it broken, which was as well: We dressed it up with the same digestive, only leaving out the Powders; Embrocated and applied our Emplaster, rolled up parts as before; The next time Mr. Whittle and I undressed the member, and found the wound in a very good condition, with assured hopes of curing it in a few weeks, the Lips of the wound being more digested and contracted, we dressed it up with Mund. Paracels. And now being Impatiently expected at London, with my diseased Patients, I return, leaving it to Mr. Whittle, who dressed it for the space of 10. dayes, it healing up without any return of blood; In his absence Mr. L. dresses the Patient; but whether in wiping off the knot or what else, it burst out again; sergeant Knight came in, dresses it with Calcanth. ust. and from that time it bled no more.  
The Ancient way of tying this Artery is as I have already said by tying it in two distinct places, and cutting it off between, but here the Patient often fainting interrupted us in that work, and the breaking between saved us the labour.  
The cutting in pieces the Arteries hath often been performed by me in Strumous ulcers, where they ride over the Carious bones; in doing which I never see the Artery break out in bleeding after the day I cut it.   

CHAP. V. Wounds of the Nerves, Tendons and Ligaments.  
NErves may be many ways wounded, viz. Caesim or Punctim, 
Wounds of Nerves and Tendons.  the former way they are usually cut through, and then occasion no new consideration in Chirurgery, because they wholly cease from action and are irrecoverable; but when pricked by a sharp pointed weapon, which is called a puncture, they are much to be regarded; so also Tendons, not the small Fibres of them( which are in every wound of the fleshy parts, when they are largely cut, whence they become painful) but the main body of them, which usually make up the tail or head of a Muscle, if you would know whether these are wounded or not, consider the place wounded, viz. whether near the Joint, in the inside the Arm, or Leg, or the end of the Muscle, or if in the Tendinous parts of the hand or foot, whence immediately arise great pains and Inflammation, also a contraction and hardness in the Nerve or Tendon follows. But if the Nerve be quiter divided, the pain is little, a kind of Stupor or profaneness, and the particular part is Lame.  
The most frequent wounds of Nerves, 
Ill consequences of bleeding not alway from a prick of Nerve or Tendon.  and most to be taken care of in Chirurgery being Punctures; I shall instance in them, and choose the most common, viz. those which are made accidentally by letting blood: and here by the way you must take notice, that in letting blood, sometimes the Apertion happens to be made when the skin, by the Bandage or position of the Arm, lies equal with the Vein, yet afterwards is not so, or the Apertion is made too small in the skin; so as part of the blood is choked, and lies there extravased, whence a Phlegmon is made, or it happens in those that are well Let blood, yet through the Indisposition and ill habit of Body, the part pricked festers( as they usually say) and is a day or two after sore, and if neglected makes a Phlegmon: all these Phlegmons do Inflame and swell the part, and contract the Arm; if a boil in a fleshy part be painful, then much more these in the joints, amongst the Nerves and Tendons, and this accident hath happened to all that do use to Let blood, whether Physicians or surgeons.  
This was the reason that some of our old Master surgeons did after Letting blood, always apply a pledgit of Basilicon upon the Apertion with an Emplaster over it, this breathed the part, and secured it from corrupting. But we by a contrary way, as by a little Compress dipped in water, endeavour to restrain the blood, and should be laughed at if we should continue the old way of Basilicon.  
At the time we Let people blood, they are commonly labouring under some great fermentation, or apprehended it so; no wonder if it sometimes fall upon the part where it was invited by bandage.  
I have been sent for into the country to a Person, that after a Letting blood, was seized with a great Inflammation the whole length of the Arm, this was an Erysipelas, the Apertion in the Vein might possibly be the cause, but that place was not affencted at all; Dr. R. complained once of a Chirurgeon, who was so unconscionable as he said, to ask five pounds for curing an Arm he had made sore by his Letting blood; but I hope no person is so ignorant or malicious, to impute these accidents to a Puncture of the Nerve and Tendon.  
But when they are really pricked, their symptoms, 
Signs of a Nerve pricked.  as you may red in all those that have writ of them, are sudden with vehement pain, faintings, convulsions, and are attended by great defluxions; they do not terminate presently in a Suppuration with good Matter, until great Endeavours have been used, these yield not to the simplo anodyne cataplasm of white bread and milk.  
Here are other considerations; and in the first place whether they lye open, or the Apertion in the skin over them be small, or that the Nerve or Tendon lye covered under the Membrane Adiposa; 
Cure.  if it be so, then you are to open the skin that the Medicaments may penetrate to the wounded Nerve or Tendon, and hereto those Medicaments are proper, which are of hot dry and subtle parts to consume that Ichorous water, which first affects the Nerve or Tendon, and will cause putrefaction: ol. Ros. with a little bay-salt dissolved in it and dropped into the part scalding hot, dressing it with a pledget spread with Basilicon dipped in the same oil, and the part Embrocated about with ol. Lumbric. with an Empl. diasulp. over, and this cataplasma over that, ℞ farinae Hordei, & fabar. an. ℥ iiij. sem. lini & foenugraeci pull. an. ℥ j. flor. ros. rub. flor. cham. Sambuci, & sumit. Absinth. an. ℥ iij. boil this in read Wine, or the come. lixivium, adding oxymellis ℥ iij. ol. Ros. ℥ j. M. So roll up the part gently; if there be much pain dress it twice a day, and if the part requires Medicaments of more drying and subtle parts dress with Balsam sulphuris Terebinthinati, or ol. Sabinae & Terebinth. an. ʒij. Misce or ol. Costinum, Ruthae, Sabinae, Aneth. scorpion. &c. These are all proper Medicines to dress the affencted part, they having the quality required to dry and consume that matter which lies corrupting in them, if applied actually hot, the Application of the former oil of Roses and Salt hath alway served my purpose.  
In your Application of your Medicaments, you are to consider what degree of heat and Siccity is proper for the offended Nerve or Tendon; if in your use of these Medicaments your Patient feels not the heat of them, 
Caution.  or feels it vehemently, it is then not rightly fitted; For in the former case it doth not enough dry up that sanies, or in the latter it doth withal inflame the part; 
prognostics.  if the Patient feel the heat moderately, the medicine is good, but if from the use of the Medicine the part Itch and Smart, and the Apertion made by the Puncture gape as at first, then the Medicament is stronger than it should be; if the hardness go off and the contraction, and the orifice not too open, 'tis a good sign: if the Nerve be cut according to its length it is the least dangerous, but if transverse most dangerous, all these wounds are accompanied with gleet and great pain which stirs up fluxion; if they yield not in their cure to such Medicaments as have been proposed, then you are to divide them, to prevent convulsions, spasma's, and gangrene, after which they cure as other wounds, but do require more care in their position to keep the member steady, if it be in such a Joint where there are Nerves and Tendons, that move contrariwise; otherwise the member will not yield to that contraction, and become more difficult in their cure, and of less use when cured.  
The Ligaments require much one method with the Tendons, 
Cure of ligaments wounded, the same with Tendons.  only your Medicaments are here to be more drying, as Euphorbium, Sulphur vivum, calx lota Tutia, &c. without acrimony.  
A Youth about ten years of Age, 
Wound in the inside of the wrist  one day in the Sessions yard leaning over the spiked pails to see the Malefactors, was suddenly frighted down by the Marshals men; in his falling was catched by one of these spikes in the inside of his wrist; it passing between the bone and Tendons, he hung thereby until he was taken down, they carried him home, I was sent for, I found the Tendons stretched out to a great length, and some of them broken; others torn, and one of the bones of the carpus lying loose in the wound. In the dressing this wound there was trouble how to place these Tendons; I began in taking out the loose bone, and cleansing the wound, and placing these shattered and overstretcht Tendons within the lips of the wound, and made my first Stitch in the middle of the wound, bringing the lips as close together as I could, then I made two stitches more, one of each side the middle stitch, dressing him up with my digestive è Terebinthina, &c. dipped in this following Balsam, ℞ Terebinth. lb ij olei olivar. lbiij. ol. Laurini ℥ iiij. Cinnam. ℥ iij. Euphorbii Garyophil. Baccar. Juniperi an. ℥ j. Gum hederae, sagapeni, Ammoniac. opoponac. Galbani an. ℥ j ss. Myrrhae, mastic. Colophoniae pull. an. ʒ iij. distillentur pro usu. Over this I applied my Empl. è Bolo, with a compress dipped in Oxycrate, and so rolled up the member, and some hours after let him blood, and gave him that night a draft of Aq. Paralyseos with sir. de meconio. & aq. cardiac. C. iij. that night he restend ill, and in the morning was full of pain. I took off the Bandage, and bathed the affencted part with a decoct. radic. Althae, Malvar, violar. cham. verbasci hioscyami, and applied a Cataplasma with farina Hordei, fabar. flor. Ros. rub. ballast, decocted in Oxymel, with the addition of ol. Lumbric. & rosar. over the former dressing; the next day his pain was much mitigated, the Tendons all drawn up, and the stitches lax: I thought to have drawn the Lips close, but found them too painful to admit of it, therefore I cut the stitches out, and brought them as close as they easily would, and dressed up the wound as before. After some few days, the wound being tolerably digested, I dressed it with this unguent. dipped in the former Balsam, and applied over the wound the Empl. Diasulphuris Rulandiae, with bandage and compress as before, ℞ Terebinth. Resinae, pini, ol. Hyperici, an. ℥ iiij. sarcocollae, myrrhae, Thuris, an. ʒ iij. Cerae q. sufficit; dissolve them, and bring it to the form of an unguent: Thus I happily deterg'd and incarn'd, and by ung. Tutiae and my ordinary Epulotics cicatrized the wound, and he some while after was restored to the use of his hand.  
A Coach man wounded transverse over the backside of the wrist, deep into the joint, 
Wound on the inside of the wrist into the Joint.  so that his hand doubled inward, was carried into the next Inn: I caused a ferula to be placed under his hand the better to support it, and placing the fingers crooked over the ferula, I searched the wound and pulled out many fragments of Bones, and after cleansing the wound brought the lips together by three stitches, leaving a discharge for Matter in the ends of the wounds which were both depending, dressing those ends with a digestive è Terebinthina cum vitel. ovi & far. Hordei with a little crocus. Upon the Suture I sprinkled the powders of myrrhae, Aloes, Thuris, & sang. dracon. and applied the unguent mentioned in the former Chapter: then taking Bolus Armen. with some of the former Powders, made up with Alb. ovor. Acet. & ol. Ros. mixed to the consistence of a mell. applied it as a restrictive over the wound and parts about, and placed his hand again upon the ferula, with a soft folded cloath under it, bringing his fingers over the end of the ferula, that they might be in some capacity for future use: Thus having placed his hand I rolled it upon a good compress dipped in Oxycrate, and afterward Let him blood, and gave him ʒ vj. sir. de meconio in a draft of Mace-Ale for his Supper, and settled him to rest, but he slept little that night. The next day I ordered him a Clyster and a slender diet; the day after I opened his hand again, and fomented the wound and parts about with an Anodyne decoction, as in the former Chapter, and dressed up his wound as before, Embrocating patts well about with ol. Lumbric, and applied my Emplast. è Bolo, over the wound and adjacent parts; it digested in the declining ends a little, but continued painful, yet much more pained in the fingers: the next days dressing I cut out the stitches, and dressed the wound with my digestive è Tereb. dipped in my former mentioned Balsam, and applied a cataplasm warm over all the wound and hand, as in the former Chapter, and rolled up the member again: This wound did not digest kindly, nor was it easy during the whole cure, but the Inflammation went off with the tumour about the wounded Lips; but in the fingers and back of the hand remained an oedematous tumour. The day following I took off the dressings, and finding the Lips which I had stitched lie open, and a white flesh within them, I dropped in some of my Balsam warm into the wound, and filled the crude Lips with mer. praecipit. and laid pledgits spread with the above-mentioned unguent, with some succ. Centaur. & Chelidonii, with mell Ros. boiled it gently to a good consistence, and laid the Cataplasma as before over all: Thus I deterg'd and cured this wound, sprinkling the Lips with calx lota, which cicatrized it. After this I put on a Catagmatick Emplaster, and kept the maimd hand still upon the ferula, and afterwards caused a Glove to be made to lace upon his hand and fingers, to take off that pituitous tumour, which did accordingly answer my expectation. But his pain continued, and so weak, as he kept it upon the ferula a good while after; since the writing of this I am informed he continues in the same service, his wrist is stiff, but he drives his Coach.  
A Person of a good Age and ill habit of Body walking in the street, 
A finger bit off by a Horse.  passing by a Coach one of the Horses snapped off the end of his finger the Glove with it: I dressed the stump with the common digestive dipped in a little ol. Ros. warm, and with Emplast. diacalcitheos, malaxt with a little of the same oil, rolled up the stump. This Patient kept not his house with this little hurt, but came to me to be dressed once in a day or two, and sometimes dressed himself, he not thinking it worth the observation of diet, bleeding, or the like: one day when neither of us suspected ill he came to me, the Ulcer was crude, an Ichor dropped from it, and the part about it was blistered, I scarified the part blistered, and dabbled the wound and about with ol. Terebinth. warm, and strewed mer. precipitate over all, and with pledgits dipped in Basilicon with a little ol. Terebinth. and with Empl. diacalcith. over it, rolled it up; and that night came to his Lodging with a fomentation, and other Medicaments prepared for a mortification, but found it better disposed; so continued the dressing, and afteward Let him blood, and the next day purged him with an infusion of Senn, &c. the wound digesting well from that time, I Incarned and Cicatrized the stump. Thus sometimes great mischiefs attend little wounds, through the contempt some of our Patients have of them.   

CHAP. VI. Wounds of the Face.  
A Lady was wounded down the whole length of the forehead to the Nose, and then transverse under the left Supercilium towards the Temporal Muscle, her Eye and Face much bruised. This happened to her traveling in a Hackney Coach, upon the Jetting whereof she was thrown out of the hind-seat, against the forepart of the Coach.  
At the first sight of the wound in her forehead, seeing the bone bare and her self so disturbed, I doubted whether I should stitch it, or keep it open with dossils; but seeing no fissure or Inequality in that part of the bone that was bare, and considering the deformity in that place would be great, being the whole length and middle of the forehead, I resolved to make one stitch in the middle of the forehead to bring the lips close together; so as if any symptom prognosticated ill, I might at pleasure by the cutting off the stitches lay it open again, but if there was no cause, then the next dressing, I proposed by dry stitches to bring the Lips of the wound close together; the upper Eye-lid hung down upon the Eye, reaching from the Inner Canthus of the Eye more than half an Inch beyond the outward, it was bruised, excoriated, and much swelled, not capable of the dry stitch, nor in that place of Bandage, it being all along under the Brow, wherefore I made four stitches at such distance as they might be able to keep the Lips close together, and the last stitch towards the Temporal Muscle, I took in the piece of skin that was divided by a wound above it, as in a double Hair-lip; and over these Sutures and Wounds I sprinkled a little of these powders, Terra. sigil. Sang. Dracon. Aloes & Thus, and my Pledgits spread with Arceus his ointment, and over these my Empl. è Bolo, and with Compress dipped in Oxycrate, and made my Bandage over from the wound, the two heads of the Roulers meeting behind; this I did to keep the wound in the forehead from uniting too close, I still fearing some Fissure or mischief there, she complaining much of her head; I having thus dressed her wounds, I caused some Aq. Ros. Rubr. cum Alb. ovi to be beaten together, and dropped in her Eye, and little folded clothes doubled and wet in the same to be laid over that part, and over the Cheek my Empl. è Bolo, and forbore the bleeding her that night, in consideration that nunc fluebant catamenia, and she bled the space of five miles coming back.  
The second day after I dressed her again, and finding less suspicion in the wound of her forehead, of fracture or fissure, I brought the Lips of that wound together with dry stitches, with a little of the powder forementioned, with the white of an Egg, and strengthened those sutures of the Supercilia by the same Medicament, lest the continual motion of the Lid should relax them, and then dressed it up, and brought the Bandage now from behind, with both the heads forward, passing one by another to bring the Lips of the wound in the forehead close together, and dressed her Eye with Aq. Pomor. Matur. with a few grains of Vitrioll. Alb. this warm to remove the suffusion upon the Cornea; and upon her bruised cheek I applied a cataplasm of the roots of Orpen beaten in a Mortar, with the white of an Egg.  
Two days after I dressed her again, and finding that the dry stitches kept those Lips of the wound close together, I cut off the other stitches from out the Lips of the wound, and dressed her with my Sarcoticks composed of some of those powders forementioned, which supplied the place of Epuloticks, and that morning I let her blood, taking away about 10. ounces with a rotten Serum upon it.  
The next day she was purged, this was done for the carrying off the flux of humour from her Eye and Face; thus was she Cured and disposed to go out of Town, the same day seven-night she was wounded, she was hurt upon the monday, and the Saturday afterward she was cured.  
A Servant of the L. B. was wounded on the right Cheek, from under the Eye over the as Zygoma down the Muscles of the Cheeks; In cleansing of the wound, I felt a piece of the same Bone which was cut off by a slanting blow, and hung only by some fleshy fibres in the wound; it was cut over the whole breadth of the Bone; I took it out, & for that the part would not well admit of Bandage, I made two stitches in the wound, bringing the Lips even and close together; I dressed this Patient as the former, and the third day after dressed him again, and found his wound agglutinated; I cut out the stitches, and dressed him with the same agglutinatives as before, and the second day after I opened his wound again, and found it perfectly cured.  
And so I have cured all the wounds of the Face as happily; in a Hair-Lip of the Nether-Lip, I cut a little Boy( who lay in London, and lived at Greenwich) of about seven or eight years of Age, and cured him in ten or twelve days, though this Lip by reason of slavering, and a childish trick he had of sucking his Lips in his sleep, was the more troublesone to me; yet he is so well cured, as I believe 'tis scarce discernible.  
whilst I served amongst the Dunkirkers, 
A Dutch Hamburger marked with a across on the Right Cheek.  where Snick and Snee was, as it were, a fashion, I had much of this kind of work, and for your diversion shall set you down one of them.  
whilst our Squadron road at Anchor in the groin, there came in some Hollanders, under the notion of Hamburgers, with three Ships new trimmed up for the King of Spain's service; a Boatswain of one of these Ships happened in company a-shore with some of our men, after a little drink the Hollander began to speak of Religion, upbraiding our men for their wearing a across, and after a little more drink became quarrelsome; and that Sacramenta he would not wear a across, no the devil take him, repeating this often, one of our men beat him down and fell with him, kneeling upon his breast, holding his head down, he draws out a knife sticking in his Sash, and cuts him from the Ear down towards the Mouth, then from under the Eye from that Cheek-bone to the nether-Jaw, now said he you shall wear a across that the Devil do not carry you away. I was sent for from the next house as a friend to the Cause, and dressed him; I brought the corners of the Wound close together and even by stitches, then a stitch in each of the slits brought the Lips of the wound together, then dressed him, sprinkling a little pull. Galeni finely powdered, which we always had in our Pockets, over this a Pledgit with some emplastic Unguent, so with a Compress spread with a mixture of the same powders, cum Albumine ovi over the wound, bound him up, he keeping temperate the first three days, feeding only upon Bread and Bear boiled together, with a piece of Butter and a little Sugar in it: The next morning he was let blood, and the third day after I took off the dressings, and finding the wound as it were agglutinated in the slits, I cut out the stitches, and sprinkled the wound as at first, dressed him up with Pledgits and my Empl. è Bolo, with Compress and Bandage; and the second day after dressed him again, and cut out all the stitches, and in a dressing or two more he was cured, the stitches brought close together, any thing of a drying quality without acrimony cicatrizes; these, your Suture does all itself, if the part be defended from influx of humors: The Patient was well pleased with his cure, though there remained some marks of a across.  
Some of these kind of people wearing them with much pride in their Faces, as marks of their courage.   

CHAP. VII. Wounds of the Limbs.  
ONe of our Mariners abroad in Spain fighting a-shore, 
observe. 1. Puncture of the arm.  was thrust into the outside of the Arm, through the Biceps with a Rapier: A Chirurgeon in the Town seeing him bleed much, stitched the wound with the Glovers-stitch close, and applied over all his restrictives, and rolled up the part well: After three or four days, the Patient belonging to our Ship, came a-board, and being in pain desired me to dress him, the Arm was swelled and inflamed a little, but did not bleed. I cut the stitches open, their issued out a bloody Sanies in some quantity, and after followed a digested Matter; by search with my Probe I found the wound wanted little of passing through; I Embrocated the wound, and dressed it up with a short Tent with my common digestives, to see whether it would by good Bandage and the help of Sarcoticks Incarn, but it would not; whereupon I passed a Seton-needle through, and that way discharged the Matter, and after that Apertion was digested, I dilated it, and kept a Tent there a few days: In the while, the upper part of the wound healed up, and the wound below digested well with little Matter. I also healed it up. This I insert, not that I approve of stitching Punctures, but this way without stitching wounds, in a good habit of body, by good applications and Bandage, does sometimes agglutinate them in a few days, when dressed by Tents they are of longer and difficult cure.  
While I was in the King's service in the time of the War in the West-country, 
observe. 2. Wound in the Thigh.  I was fetched to Captain M. who in fighting a Duell was run through the Thigh, with a broad sword; I was also fetched at the same time to the other, I hastily dressed this Officers Thigh, with Pledgits spread with my Agglutinative, and some Astringent powders mixed with the whites of Eggs, applied it over both the orifices, bringing the Lips of them close, and with Compress and Bandage rolled it up, and left him to go to bed; from whence I went to dress the other, who had many little wounds, as his fingers, hands, and head cut. At my return I visited my Patient, whom I found in his bed with little pain: the second day after I dressed him again, and finding all in good temper without pain or swelling, I dressed the wounds as before; well satisfied that his wounds would heal up by agglutination, there being little or no Matter, pain or swelling: If it had appeared inflamed with tumour or pain, I ought then to have kept the Orifice most distempered open; and if they had both suffered, to have kept them both open with small short Tents, dressed with the common digestives, and have let him blood, and have proceeded as in a body ill-disposed; but there was no need, there was only required a quiet position of the part which he submitted to. He was happily cured in seven or eight days. This was truly performed by the Balsam of his blood, I neither bleeding nor purging him in the time of his Cure or after.  
A person wounded in the in-side of the Arm, 
observe. 3. A Wound in the arm.  the sword passing over the joint, and through the out-side of the Arm, he was first dressed by a Chirurgeon near the place where he was hurt; he bled much. The next day I opened the wound in the presence of Dr. T.C. one of the Kings Physicians, I found the wound Tented at both Orifices, the Arm swelled, and a little disturbed, as wounds in that place are subject to be, when the blood is shut in by Tents, and not dressed rationally by refrigerants and astringents, and good Bandage. The swelling most between the two orifices, and was from blood choked in the part, which was now more straitned from the influx of humors, so not likely to yield to other than suppuration; yet we foment the wounded parts with discutients and dissolvents, and keep both the orifices open with small Tents dipped in the common digestive, and Embrocated about the wound with Ol. Ros. & gut. aliquot Aceti, and over all my Empl. è Bolo, rolled it up: the third dressing there appeared blood from that orifice in the in-side of the arm, which I filled with Precipitate and a dossil upon it, then dressed the parts up as before. This time I acquainted the Patient with my thoughts of opening the swelled part, between the two apertions; there being no likelihood the Matter there could discharge itself by either of these openings, yet it was not safe to heal them up, wherefore I proposed the opening of that tumour by a little caustic, after a day or two D. C. was acquainted with it, and it was opened as was afore proposed, and a corrupt Serum was discharged: from that time I threw my Tents out of the wound, and healed them up in four or five days after, and as the Escar separated and the Ulcer digested, I cured that in few days. That the bone was bare under the tumour, may I suppose yet be felt from the Adhesion of the musculous flesh to that bone.  
A person was wounded in the out-side of the Right Leg, 
observe. 4. Wound in the Leg.  below the Gartering-place, the wound running upward; after six weeks dressing by the neighbouring surgeons, the part being much disturbed by a flux of humors, I am called in; I find the wound sinuous( some two inches) undigested, and inflamed with a tumour about it upward; the small of the leg and foot Oedematous, the whole member so weakened by the influx of humors, that it was neither able to assimilate its aliment, nor yet to resist the crudities that fell upon it, so would be difficult to cure; as all such wounds are where the Patient is ill ordered, as to his diet and dressings in the beginning of the disease: I propose in order to the cure to dissipate this flux about the wound, and to digest the wound by Lenients, to mitigate inflammation, and to discuss and breath out that pituitous tumour on the foot and parts about, and with the help of good Bandage to restore the tone of the parts, and then if this sinuous Ulcer yielded not to agglutination, to lay it open: To which end I proposed a fomentation of Summit. Absinth. Scordii. Flor. Ros. Rubr. Chamom. Sambuci, Bacc. Myrtillor. ballast. Nuc. Cypress. these boiled in Aq. Font. adding Vini Rubr. lb ij. and some Spir. Vini; with this I foment the parts, and dress the wound with Ung. Basil. madge. adding Precipitate to it, and Embrocate the parts about with Ol. Ros. cum Aceto, over this I applied Cerat. Galeni, and over the Oedematous tumour below, Empl. Diacalcith. p. ij. Empl. Stict. Paracels. p. j. and over all these a good Bandage, not opening the Oedematous tumour more than once a week, and then to give a breathing to the part, The wound I continued to dress daily as I had begun, and happily freed the part from inflammation and influx of humors: But the wound would not digest as I desired, wherefore I laid it open a little more than an inch, and dressed it up with dossils spread with the same medicament as before, and incarned and cicatrized it in three weeks or a month after, but not without some difficulty, and the help of a straight Stocking. This person had been long kept in his chamber by this wound, and now supposing himself well, he rides to his Country house, unknown to me, seventeen miles off, but that night his Leg swells much, the Cicatrix scarce confirmed breaks out again, with great excoriation and inflamed redness. Thus this Gentleman returns again to his house, and sends for me. To alloy this pain and inflammation, I foment the part cum decoct. Malvar. Violar. Plantag. Solan. & Flor. Ros. Rubr. and laying a fine Lawn wet in a solution of Troch. Alb. Rhasis made in some of the same decoction. I also dressed it with Ung. Alb. Camph. over this Lawn, and spread some of it upon the edges, lest the Matter should be shut in by the Lawns adhesion to the Lips, and the fretted Cuticula raised more up. Thus I dress twice a-day, and keep the Leg upon the bed; after some few dressings, that the heat and acrimony were allayed, then in the place of the former Unguent, I apply Ung. Tutiae Mag. Vigon. and dipped the Lawn in a decoction of Fol. Plantag. Summit. Rubi, Equiseti, & Flor. Ros. Rubr. to which I added some Lapis Calaminaris, Tutiae come. Cervi ust. & Calx lota pull. ostrear. combust. this was set in Balneo, and afterwards strained out, and applied upon Pledgits over the Lawn: Thus with much difficulty I cicatrized this wound and Ulceration, which at first possibly might have been cured by the way of our ancient Masters in few days.   

CHAP. VIII. Wounds of the Breast.  
WOunds of the Breast are penetrating or not, if they do penetrate, then we are to consider the depth, whether it be only between the Mediastinum in the hollow cavity of that in the lower part of the Breast, or if it pierce into the cavities of the Thorax, or what the parts are that be hurt. How the Breast is circumscribed, with the symptoms of each part when hurt, you may find in the Treatise of Gun-shot.  
The signs of the wounds penetration are discovered by the proportion of the searching Candle or Probe, which enters into the Cavity; 
Signs of penetrating wounds.  you may also when it penetrates the cavities of the Thorax perceive it by laying a Down-feather upon the wound, or by holding a lighted Candle near the wound, the Patient holding his breath the whilst, in this case it will move the feather or flamme, if it do not blow away the one, and extinguish the other; as also the Air makes a noise in its issuing forth; sometimes it's discovered by the quantity of blood discharged by the wound or mouth, or both with difficulty of breathing.  
Wounds in the hinder part of the Thorax are reckoned dangerous by reason of the Nerves and Tendons, and if they penetrate that way, 
prognostic.  there is another danger from the great vessels of blood which are nearer to the weapon in this case, than in those wounds which are made forward. Yet all wounds in the Breast are dangerous, by reason of the blood that falls down to the Diaphragma and corrupts.  
If the Lungs be wounded deep amongst the great vessels, though they escape the first nine days, yet they commonly terminate in a Pthisis or Fistula.  
A Wound in the outer part of the Breast is cured as a simplo wound; if it penetrate, 
Cure.  you are to endeavour first the restraining the blood, then that the extravased blood be discharged, and that either by the mouth by expectoration, or by the Wound, or by Urine.  
The way by Urine Fab. Aq. penned. says, is by a branch of the Azygos, which, saith he, passes near the Diaphragma, by the spin to the Emulgents. Those that own the circulation will hardly allow of his Hypothesis; however if the matter of fact be true, that there is sometimes a discharge by Urine, which I confess I have not yet observed in my own practise, it will be reasonable to propose as he doth: In this case diuretics, as the Decoct. Capill. Veneris, Polytrichi, Rad. Petroselini, Beton. Apii, Faenicul. Asparag. To prevent inflammation, Ptisans with Ol. Sulphuris, Vitrioli, Barly-creams, Emulsions, &c. The Ancients gave Acetum with warm water for dissolving the concrete blood, and restraining the present flux.  
The second way is by Expectoration, & thereto our Decoctum pectorale, Lohocs, sir. capel. Ven. Jujub. Glycirrhiza, Oxymel. &c. whereof our Pharmacopeia land. is full. This I have mentioned for their sakes who cannot have a Physician; but here I leave this work to them, these cures consisting much in their well ordering and prescribing internal Remedies, and content myself in the dressing of the Wound, 
Whether the wound is to be kept open or not?  as it appertains to Chirurgery. In the treating these Wounds there is a question, whether the Wound shall be kept open, or agglutinated; they that are for a speedy agglutination do urge it, lest the external Air corrupt parts within, and the heat expire: they that propose the keeping them open, do design thereby a readier discharge of Matter; for, says Aq. Pendens, if the Matter be to be discharged by Urine, it must first pass into the substance of the Pleura, then into the Vein Azygos, so into the Emulgents, then to the Kidneys, and through the Ureters and Bladder. If by Expectoration; then it must also first pass into the substance of the Lungs, then into the Aspera Arteria or Weazond, from thence cought up by the Mouth.  
In my practise in these Wounds of the Breast, 
The Authors judgement.  I consider the wound how it is capable of discharging the extravased blood and Matter, if it was inflicted so as that the blood or Matter may be there discharged, then it is to be kept open, the welfare of the Patient depending mainly upon the well-dressing and governing it; but if it do not lie well for evacuation of that extravased blood, then it may do hurt, so ought to be healed up.  
A person of about 23. years of Age, 
observe. 1.  of a good habit of Body, wounded into the Breast, upon which followed immediately great effusion of blood, almost to the exhausting of his Spirits. Mr. R. Chirurgeon, and myself, were presently sent for, we find him lodged in an inn near Fox-Hall, we viewed his wound, it was four fingers above the Cartilago ensi-formis a little to the left side; he laboured under a small pulse, fainting often: Dr. W. & Dr. Wed. came in while we were providing dressings, 
How to order Tents in penetrating wounds of the Breast.  the wound was large and penetrating, we made a foft Tent with a thread fastened to it; which in these wounds you must be sure to do, lest you lose it in the body: This Tent we dipped in a mixture of a powder composed of Bol. Armen. Sang. Dracon. Thuris, mastic, &c. with a new-laid Egg and a Pledget spread with the same over all, with Empl. è Bolo, and Compress with convenient Bandage. The Phycisians prescribed such things as restrained the bleeding, and were proper to resolve the concrete blood, and withall to relieve his fainting spirits: that night he restend ill, the next day when we met, seeing him labour under great difficulty of breathing, with pain above the Diaphragma, his Pulse quick, little Urine, and that high, we agreed he should be let blood presently, which was done accordingly in the left Arm, the blood flowed with a quick stream, we took about six or seven ounces, a mere Serum, but the Patient was relieved by it; we took off our dressings to look upon the wound, whereon we found some blood and Sanies discharged: we then dressed him with Terebinth. Lot. in Succo Lamii adding some of the former powders with victual. ovi, this upon a Tent as before, with an Emplaster and Bandage over: Thus we continued to dress him, until we see the bleeding cease. In wounds within the body, I have always endeavoured to preserve the native heat of the part, and further the discharge of Matter from within, by keeping the wound open, until it lessened, and the ill symptoms went off; but shun the casting in of liquid Medicaments which are not easily to be gotten out again, they commonly proving very destructive. Here the Physician is to act by Internals, we only to assist by keeping a way open, if it may be, for the discharge of what is extravased and corrupted within the cavity, and commit the cure to Nature. In this Person here was a great effusion of blood upon the receipt of the wound, and the orifice large to discharge the extravased blood and Matter; the Physicians careful in restraining accidents, and removing what he laboured under; through all which our work succeeded prosperously, so as parts within united; we threw out our Tent, and by Sarcoticks cured this wound without, and the Patient was restored in few weeks to perfect health, and continues so.  
Another person was wounded into the Breast below the fourth Rib on the right side, 
observe. 2.  coughed up much blood at times; Sir Fr. Pr. was his Physician, he prescribed him Ptisans, Pectoral decoctions, &c. by which, and by often Phlebotomy the symptoms went off, the wound digested, the Patient rambled abroad, and was cured by such dressings as I left for him at his Chamber, I seeing him no more until he was wounded again.  
Another wounded in the right Breast, 
observe. 3.  coughing up much blood, with great pain and difficulty of breathing, I took away ten ounces of blood presently, and ordered him( it being then night) some Syrup de Meconio & Jujub. in a draft of Aq. Papaver. with a few drops Sp. Sulphuris, he slept well that night; against the morning he had the Decoct. Pectorale( the hotter herbs left out) and it I sweetened with sir. de Ros. Sic. & Jujub. with Sp. Sulph. this he drank in the morning, and at other times as he listed; by his disorder, he cought up blood at times, and I let him blood as oft, in the while I kept his wound open and digested: Upon another relapse I began to be sick of him, and persuaded him to sand for a Physician, Sir Ed. Graves was called in, who see his wound almost cured, we agreed and let him blood: and from that time he continued well.  
A person run through the Body the breadth of three fingers under the right Clavicle, 
observe. 4.  and out below the Scapula, was first dressed by the Chirurgeon near the place where he was wounded: I found him in his bed faint and weak, but without pain or difficulty of breathing, Dr. Bacon his Physician: The next day I met him and Mr. Sh. Chirurgeon to his Highness Pr. Rupert. The patient had restend very ill the preceding night, had bled from his wound in his back through the bed, and fowled many Napkins that night in coughing up blood, we took off the dressings from the wound in his Breast, from whence there was blood discharged, and more came out in the dressing: I dressed up the wound with a short Tent dipped in a little Terebinth. with Farina Volatilis, a few of our Agglutinative powders cum Vitello ovi, with an Empl. Diacalcith. over it; the other wound under the Scapula was painful, but so small as it was not reasonable in our judgments to keep it open; we laid a Pledgit of the same mixture with an Emplaster upon that, and dressed it no more; this method of dressing I continued, and let the Patient blood: The third day he coughs up blood, and some little issued from his wound for a few days; after four or five days I waited upon him to his lodgings in London, by the way he cought some blood, and so more or less day and night; but by the care of his Physicians it lessened, his wound digested, and I now kept in it a hollow Tent made of a Sparadrap, which was composed of Resina, pini, Gum. Amoniac. Bdelli. Galb. Terebinth. & Cora, with pull. Ireos, dipped in a little mell. Ros. Rubr. This way of dressing I continued until the coughing of blood diminished from twelve Napkins in a day and night, to ten, eight, seven, four, two, one, and but one Napkin in a week, and after that in a weeks space I see no blood one way or other, nor any symptom of ill. I then called in his Physicians together, and severally, and had all their positive judgments for throwing out the Tent, and healing up the wound: I did so, and in a week more cured him; five days after, or thereabouts, he sent me his thanks by his servant; and within few days after I made him a visit, and there met Dr. Willis, who inquiring of me whether his wounds were cured, I desired that person that he would show the Doctor whether they were or not, he presently stripped himself of his shirt, and shewed the Doctor, who both see and felt their scars, and replied they are well.  
A young man wounded in the Breast, 
observe. 5.  labouring under very great pain and difficulty of breathing, with a cough, sent for me late one night, he shewed me some little blood he had then cought up: he had been wounded the night before by a man standing at a door some steps higher than himself, as it were over him, thrusting his Rapier from within the breadth of two fingers of the right Clavicle downward into the Lungs, the Patient run into that house bleeding much, and was seized with such difficulty of breathing, as he was forced to stretch his arms at length over his head, without which doing he could not breath; he had been let blood twice, and prescribed Ptisans, &c. But for all this he was little relieved, I presently let him blood about ten ounces, and ordered the Apothecary to give him a draft of Aq. Papaver. with sir. de Meconio & de Ros. Siccis, with a little Aq. Cordial. frig. Sax. and against the next morning to sand for a Physician to meet me, they did so; when I came in the morning, I found the Patient marvelously relieved, and resolved to remove his lodging, which was now by Scotland-yard to his own in Wildstreet: in the presence of his Physician Dr. St. I took off the dressings, found his wound small and shut up from within, but not skinned, and if it had not, yet the wound within was so much below this without, as it was not capable of discharging the Matter: So this was not worth my attendance, the wound within was the work of the Physician, however he continued me with his Physician, and we agreed to bleed him again; we did so, taking away about ℥ viij. of blood, and the Physician proceeded by Clysters and Internals proper in his case: That afternoon the Patient, unknown to me, pursued his intention of removing to his old lodging in Wild-street, where going up three pair of stairs to his chamber, he relapsed into the former difficulties of breathing with pain and coughing blood, and in the morning after where I met his Physician, the Patient seemed to me quiter tired, labouring under great oppression; and by his pains about the Diaphragma and Back there was suspicion of extravased blood; to relieve him there was a necessity of taking away a little blood; we took away some four or five ounces, and proceeded with Embrocations, Lohocs, Pectoral Decoctions, &c. and got off this difficulty in five or six days, then I left him: But after that, by disorder he relapsed again, and was freed again the same way by his Physician, and since holds well, but I never see him since.  
Of all these wounded Patients, and many more I have helped to cure, 
The Authors observation concerning the discharge of the Sanies of the Breast by Urine.  I never see one that I could say passed their disease by Urine, nor many of them that passed their Urine well during the time of their lying under these wounds; nor have I often seen them who recover, expectorate any such quantity of Matter, as might be thought to proceed from the great quantity of blood extravasated: They cough fresh blood most of them, like to what they discharge from their wounds, but more florid.  
Those who do cough great quantity of Matter from these wounds made by a sharp Weapon, or avoid it by their wounds, do seldom well: They usually terminate in a Tabes, with or without a Fistula: Yet by the ninth day one may truly predict their present recovery, if all things have been rightly administered.   

CHAP. IX. Wounds of the Abdomen.  
A Man wounded with a Rapier into the belly, 
observe. 1.  through the Right Hypocondrium out to the side of the Back, is brought to my house one night to be dressed, he had bled much; I considered the wound, see it had past through, the orifices were small, little advantages to be made by keeping them open, yet I put in two small Tents dipped in a little Digestive è Terebinth. & victual. Ovor. and dressed up with Empl. è Bolo, and a Bandage over, and advised him to go to his bed and keep quiet. I gave his friend ʒ vj. sir. de Meconio, mixed with a draft of Aq. Papaver. with a little Cordial-water for the Patient to take in bed: The next morning I found him hot, and his Pulse a little disturbed, but without symptoms of any part of the Viscera wounded within: 
Signs of the inward Viscera hurt by a wound of the Abdomen.  neither Tension of the Belly, colic, Vomiting, or ought by Urine or Stool. However I Let him blood about 10 ounces, and ordered him to keep his bed, and a Clyster of Milk in the afternoon with Sugar, and at night his haust us again. The next day I opened his wounds, and considering here was no symptom of hurt within by Urine or Stool, nor Tension nor Swelling, only the wound a little heated by the Tents, I threw them out, and dressed both the wounds with pledgits spread with the same digestive, Embrocating the parts with ol. Ros. dressed him up as before, and desired him to keep his bed six or seven dayes. Two daies after I dressed him again and found all well, with Inclination to cure; from that time I dressed him no more, but ordered him to keep a spare diet, and to lye quiet in bed, and if there were occasion I would see him again: my servant dressed him afterward, and before the seven days were expired he was well and walked abroad not complaining more of that wound. So I have happily sometimes cured such wounds through the body; in this wound here was no considerable part touched, yet if the wound had been kept tented with long tents, 
Digression concerning the ill use of Tents.  they might have stirred up inflammation, or so the Air might have altered the parts within, or the Matter offended them, whereby putrefaction, colic and Ill accidents would have followed: But what could the Chirurgeon have advantaged the Cure of his Patient, if blood had extravasated within, by keeping such little wounds open? Yet if it be not done, he is usually condemned by the common Vogue; therefore it is, that against their own Judgments they keep them tented often to the ruin of their Patient. If in these wounds of the Belly the small Intestines be wounded, there follows a continual vomiting of choler with gripping, and death within few daies; 
Signs of the guts wounded.  if in the first dressing these wounds a Chirurgeon should propose a cutting open the wound, to seek the wounded Intestine to stitch it, 
Of opening the belly in wounds of the Intestines. Cure of wounds of great Intestines.  the friends would not permit it, nor in truth have we Authority or Example for it, so we have nothing to do but stitch up the wound, and refer the Cure to Internal remedies, yet at last when he is dying, they will wish we had attempted it. In the great Intestines where they are fleshy, if the wound be not great enough, you are to enlarge it and seek the Intestine, and stitch it up with the Glovers stitch, and cleanse the Bowels from the Excrements, and sprinkle the Sutures with some of your Incarnative powders, and reduce them to their places, and stitch up the belly, as you shall see presently: you are in these cases to give your Patient Clysters made with Chicken or Veal-broath, wherein barley flor. Ros. rubr. Chamom. hath been boiled, adding the yolks of Eggs to it, with mell. Ros. & sacchar. Ros. an. ℥ j. and Internals such as are glutinative, as decoct. plantag. Equesiti, pimpinellae, pilosellae, Rad. Consolid. ma. these sweetened with Sugar of Roses, spec. diatragacan, cons. Cydon. Cons. Ros. rubr. boli. Terrae, sigil: their diet must be sparing, drying and agglutinative: they must be Let blood, and after some days their Clysters must be agglutinative and often repeated. After this manner the wounds of the Viscera are to be treated, only in them you are to keep the wound open in some declining part, whereby they may be dressed if occasion be, and discharge their Matter. If a flux of blood happen as in wounds of the Liver and Spleen, the Ancients commonly commend succ. pilosellae, pimpinell. plantag. Pologoni; with pull. Bol. Terr. sigil. sang. Dracon. Thuris, and such like mixed, and put in by Tents, and after the like mixed with sir. Ros. suc. and parts about Embrocated with ol. Ros. Mirtyl. & Empl. Diacalcith. over all, or a cataplasm ex farin. hoard. fabar. flor. Ros. Rubr. coct. cum hydromelite and treat them by Internals as I have said, such as are agglutinative, exsiccant and detergent, I refer you to the treatise of wounds made by Gun-shot, where you shall see their various symptoms and way of Curing.  
A Man wounded and brought to Lambeth sent for me one morning early, 
A wound in the Abdomen. observe. 2.  he was wounded transverse the belly a little below the Navel, on the left side the Omentum, and Intestines thrust out, and kept close with a handkerchief in his hand, I see parts fresh; the Omentum or Call much out, but not altered. I caused warm clothes presently to be held upon them very close, and the Patient to be laid low with his head, his Hips raised up, and by the help of his friends raising them up and shaking his body, I reduced them. Then they leaving his Hips high, and he declining with his body on the Right side, by the help of one pressing with his hand a little above the wound( by which the Lips of the wound were a little turned upward, and the viscera kept down;) I with a strong Needle a little crooked at the point with a strong Thread seared take hold of that lower lip, 
Manner of sewing the Peritoneum in this case.  and near the end past my Needle first through the Peritonaeum, and then on the opposite side through the flesh and skin, leaving the Peritonaeum, and so go along passing the Needle from without Inward, till I sewed up the wound, which cannot be very close, then I pulled the stitches as close together as I could, 
What to have been done in case the Omentum had changed Colour.  and fastened my Thread. If any part of the Omentum had been altered in its Colour, I should have tied it hard and cut it off, and placed it with the Thread hanging out, and so I would have served a great part of it, if I could not have reduced it, I having done so heretofore often; but if the Intestines had been so swelled, 
What if the Intestines were swelled.  as by no way of fomenting or position I could have reduced them, I ought then to have cut the wound more open, but these were easier reduced, and the wound stitched, I then sprinkled them with pull. Aloes, Colophoniae, sang. Dracon. Mastic, sarcocolla, Bol. &c. and over them pledgits of my Incarnative, and with some of these powders mixed cum Albo ovor. to strengthen my stitches, I applied them upon a cloath over all, and with compress and a strong Towel bound all fast, then after a while let him blood, and ordered him to ly quiet upon the well side, and to a spare diet, and to keep his body soluble by Clysters; every other day I dressed him after the same manner, and after the wound seemed to be Cicatrized, and that my stitches began to fret, I cut them out the Eighth or Ninth day, and after with the continuance of my sarcoticks, I cured him very well. These wounds are not subject to great Inflammation or defluxion, but by reason of the fatness and thickness of the Lips, and manner of sewing, 'tis a troublesome work; and yet if they be not so stitched as the Peritonaeum and fleshy parts may unite together, a rapture follows to the great trouble of the Patient, and shane of our profession: the Peritonaeum bears a great stress, therefore you must be sure to take good hold with your stitches, and if you doubt their holding, make dry stitches over them and good Bandage.   

CHAP. X. Of Wounds in the Head.  
WOunds in the Head according to Hippocrates and our daily experienced are full of danger, how slight soever they may appear to a common eye.  
In this discourse I propose to writ of them, not only as they are made by cut, stab, or bruise, but also of those made by Gun-shot, and so by Anticipating part of the discourse next ensuing, to give you the full doctrine of wounds of the Head made by what Instrument soever without the necessity of future repetitions, and that you may understand the Basis whereon these cures are wrought, I shall represent the head to you as it is framed.  
The Head according to Galen. de usu part. is the noblest Member of our Body, 
Parts of the head considered.  the principal faculties being there seated, for the use of which it was ordained: and is so contrived as to be the fountain of the Animal spirits, and also to contain the principal Organs both of the Internal and External senses.  
In the first part, 
The Hairy Scalp.  the hairy scalp presents itself to our eye, and therein is to be considered its Thickness, Sense and Vessels, with the Muscles that lye under it. The Hairy Scalp is thinnest on the top of the Head, nor is there any Muscle between it and the Skull in that part, unless you will call the membrana carnosa a Muscle,( which some men of late do, and possibly not improperly;) and here the rather, because by it many men move the whole Scalp. If you doubt of a fracture there, you may boldly cut into the Hairy Scalp, it is of an obtuse sense and easily healed up again. 
Forehead.  But be cautious how you make your Incision in the forehead, where a transverse Incision may cause the Eye-brows to fall over the Eyes; therefore if you are forced to make Incision, let it be according to the length of the Fibres, and avoid the vena frontis, lest its bleeding disturb your work. And be careful that you make no Incision upon the Temporal Muscles, 
Temporal Muscle.  for thereby Convulsions and other ill Accidents may happen.  
Under the Hairy Scalp lies the Pericranium, 
Pericranium.  which we are to cut through, in making way to the Cranium; you are to raise them both together when you lay bare the Cranium for the use of the Terebra; for if in perforating you tear this Membrane, Inflammation and Fever may follow, the Pericranium arising from the dura matter through the Sutures; by which continuity that may also partake of the Inflammation.  
The Cranium follows, 
Cranium and Sutures.  which is a Bone composed of many joined together by Sutures, of which there are five concern us Coronalis, Lambdoides, Sagittalis, &c. two false ones. In perforating the Cranium, you are to shun these,( if you may) for through them the dura matter passes, being continued unto the Pericranium. The Sutures divide the Bones of the Cranium, by which one part of the Cranium may be preserved entire while the other is broken, which otherwise would be in hazard; These Sutures are weak in resisting Blows, and upon them also Matter may be easily contracted and make a carries the sooner, and sooner work through to the brain than in either parts of the Skull. It is necessary to know them well, lest as Hippocrates well cautions, you take them for Fissures. 
The way to find the Sutures.  The way of finding them is, by passing one string from ear to ear, and another from the Nose to the Crown of the head; the former of these shows you the Coronal Suture, the second the Sagittal, which usually begins at that point where these lines intersect, being the part where we make Fontanels, and reacheth to the Crown of the head where the Lambdoides begins; sometimes it beginneth quiter at the Nose. The Lambdoides begins at the end of the Sagittal, and goeth forked down the two sides of the occiput: of the Suturae nothae: the two chiefly to be regarded are the Squamosae, which run under the temporal Muscle of each side, round about the outermost verge of the ear.  
You are also to take notice that the Cranium is thinnest in the middle part of the head, 
Thickness of the Cranium.  and thickest in the hinder part, and of a middle thickness in the fore part: Hence it is that wounds are most dangerous in the Crown of the head, where the Skull by reason of its Tenuity easily communicates its hurt to the brain, and also for that the upper part of the brain lies there high, one of the largest Sinus being immediately under the Skull, and many Capillary veins running so close with it, as to make themselves Trenches in the Internal part of the Cranium: Wherefore upon a blow or concussion in this place, the veins may easily be broken, and the blood extravased between the Cranium and dura matter, and ill Accidents follow.  
The dura matter, a strong Membrane, 
Dura matter.  is placed under the Cranium, which being wounded is attended frequently by Palsies, and in progress of the distemper by Convulsions and other ill Symptoms; and the greater if wounded in the middle part of the head according to its length, there being many Vessels, which if they chance to be cut, will fill the vacant space between the Cranium and dura matter with blood.  
The Pia matter lies upon the body of the Brain so close, 
Pia matter.  that a wound cannot be made into the Pia matter and the Brain escape; and from its many veins a flux of blood must follow.  
The Brain lies under the Pia matter, 
Brain.  in whose ventricles is lodged the Plexus choroides, and under whose Basis ly large numerous branches of Arteries and Veins, which by great blows of the head may be broken.  
From the Description of the head we shall proceed to the Description of its wounds, 
Wounds of Brain.  which are strictly so called, when any part of the skin, flesh, bones, membranes or brain is either cut or torn, or when more of these are hurt together.  
Contusions and Concussions do not truly belong 
Contusions  to this place, yet for the better Information of the young Chirurgeon, I shall say something of those also, and shall treat of all these things by the sollowing degrees.  
First, there may happen Contusions, or great and violent Concussions of the Brain from a blow, fall, &c. when there is no visible wound either inward or outward.  
Sometimes this Concussion is accompanied by a ruption of the Vessels of the meanings. Sometimes a fissure of the Skull, or a spill broken off from the inside of it, &c. the skin all this while remaining whole.  
Other while the wound begins on the outside being made by Sword, Bill, or Bullet, &c. and either goeth no further, or else penetrates sometimes to the Skull, sometimes into the first Table, sometimes through both, or yet further through the dura or pia matter, or into the brain itself.  
Some are mere cuts, others contused wounds, and in gun-shot, the very outward parts of the head, as hair, skin, flesh, bones, &c. are often driven by the violence of the Bullet into the Brain itself.  
Of Fissures some are directly under or near the place of the Blow; some on the quiter contrary side, and are called contra fissurae.  
Celsus in his 8 lib. & 4 ch. gives you the signs; 
Signs.  when you are called to such a Patient, presently says he, you shall inquire num vomuerit, &c. whether he vomited, or was stupefied at the first receipt of the Blow or Fall, or a Resolution of the Nerves followed, or torpor, or delirium, or raving; these show the Membrane of the brain affencted, and the Patient in great danger. But if none of these were, you may then dubitare an as fractum, doubt whether the Bone be broken: then it is to be considered, whether it was ston, Iron, or led, that he was hurt withal, and with what force the Blow was given. But if there be a wound, nothing is more sure than the finger or Probe; if it feel smooth or slippery, the Cranium is safe: But if you feel any Asperity or roughness, if it be not the Suture, then you may be assured of a Fissure or Fracture, the holding a Tread between the Patients Teeth, or biting of a Crust, is mentioned as a sign of a Fracture, but this way is very uncertain: To find hair cut in a wound may be a sign, if you consider, no small force will cut a hair there.  
If by your Probe you make no discovery of the fissure, and yet the symptoms be grievous, then lay it open, and if the Fissure do not then appear, rub the bared Cranium with Ink, and wiping it off again, you will see the Ink remaining only in the Fissure or crack, then Rugine it.  
If no breach of skin appear, you must consider the outer side, numquis locus mollior sit, & tument, eumque aperire; whether any part be softer and swell, which you must open and see whether there be any Fissure, non tam magno negotio, cutis sanescit etiansi frustra dissecta est, it being no great matter to heal it again, though it should be laid open in vain.  
In the prognostic, 
prognostics.  wounds by much how nearer the Brain, are so much the more dangerous; the solution made by Incision is of less danger than those made by puncture, this of less than those made by Contusion; and those of Gun-shot worst of all wounds. In the middle of the head most dangerous, the hinder part least dangerous, the fore part of a mediocrity between both, it having passages near for discharge of its blood and matter: Wounds of the Sutures are dangerous, but those are more or less as they fall into good or bad surgeons hands, and as the Patient submits to the method of cure. A simplo wound by a Blow hath been through ill surgeons, &c. the cause of much danger, that in skilful hands would easily have been cured: All wounds save those of the Brain are curable, if the Chirurgeon be timely called in, and that it be discovered in such place where he may lay open safely.  
We begin with the cure of Contusions of the Calvaria, 
Contusions of the head.  where the outer skin is whole, yet with great attrition of the Musculous flesh and membrane underneath; which often happens from blows or Falls, and are subject to great pain, tumour, Inflammation, and Apostemation, &c. caused through the Ill habit of body, or untimely applications, therefore it requires your special care in the first place to prevent the afflux of humors and pain, which is performed presently in the beginning by repellents and astringents, which are to be often renewed, lest they heat the part affencted. You are in the first place to shave the hair, if there be any, then Embrocate with ol. Ros. & myrtle. cum aceto, and apply this or such like over the contused parts; ℞ farin. hordei, fabar. an. ℥ vj. pulv. Nucis, Cupressi, ballast, Alum Rochae, Ros. rubr. an. ʒ j. ol. Ros. ℥ iij. Alb. ovor. nu. ij Aceti q. s. ft. Cataplasma. You are to make your Bandage over this, to further the expulsion of the serous humors from the grieved part, therefore your Bandage begins there, and terminates where it may resist the Influx; then bleed, &c.  
The second day you are to foment with read wine, wherein hath been boiled flor. ros. rubr. Bacc. myrtill. fol. beton. & flor. Chammol. and if much pain Embrocate with ol. Ros. & Chamom, or decoct. beton. ros. rubr. Rad. Althe. sem. Lini, fenugraeci: If after these your endeavours the part affencted do tend to Apostemation, you must then use suppuratores, and open it in the declining part, and digest it as in a Pphlegmon; but if the pain do mitigate, then it will be proper to discuss and breath out the Serosity by such like, ℞ farinae hordei fabar. an. ℥ iij. flor. ros. rubr. Bacc. Mirtill. pulv. an. ℥ j. sumit. Absinthii, fol. beton. slor. sambuci & chamom. pulv. an. ʒ iij. sem. Cumini, pulv. ʒ j. mell. ℥ ij. coq. in vino Austero, ft. Cataplasma, addendo ol. Cham. Ros. an. ℥ j. apply it; then in the next place comes in the use of Emplastr. Vigonis.  
If there happen a Concussion from some great Fall or blow without a wound, 
Concussions.  we cause the head to be shaved, Embrocate with ol. Ros. & myrtill. cum Aceto, all the head, neck and behind the ears, and apply a Cataplasm with farin. hordei. fabar. bacc. Mirtill. flor. ros. rubr. decocted in read wine or Oxycrate, adding mell. ros. to it or Empl. vigonis, or such as this which is his, and hath been often used by me in such cases, ℞ furfuris Tritici ℥ iiij. far. lentium ℥ ij. flor. ros. rub. Bacc. Myrtillor. ballast. an. ʒ j. Calami Aromatici ℥ j ss. flor. camomile. Melilot. pulv. an. ℥ ss. nuc. Cypress. no. 6. pulver. omnia coq. in vino Austero q. s. ad consistent. Cataplasmatis addendo olei Rosati Chamom. an. ℥ iij. or add wax to it, and make it into the form of a Cerott; you may make fomentations of the like; you must remember in these Concussions to bleed largely, even to defailancy of spirits, according as the symptoms do show to you the greatness of the Malady, and as strength of body will permit, and keep the body soluble by Clysters, also fops, Emulsions, and what else may alloy fermentation of the blood,  
In the cure of wounds of the head, 
Cure.  if it be a simplo wound only to the Pericranium, the lips are to be brought close together; the stitching these wounds is objected against by some, lest thereby Matter should be penned in, 
simplo incised wounds.  and Inflammation and carries of the Skull follow, but done judiciously; it is safe, if you can satisfy yourself that the wound ought speedily to be healed. Abroad I have seen them as commonly stitched as other incised wounds, and do myself in great wounds of the Scalp make a few stitches to keep it close; however you are not to crowd those wounds with dossils, but having shaved the hair bring the lips close together, and cure it by the first Intention, vid. Agglutination; as in simplo wounds, by Arceus's lineament or some incarnative, and keeping the lips close by Empl. è Bolo, or with some of your Astringent powders mixed with album. ovor. Thus in a few days all these simplo incised wounds may be cured.  
In a wound in the right Temporal Muscle, 
observe. 1. Wound in the Temporal Muscle.  where the Artery was wounded, I have often stitched them up without any ill Accident. Smith a Tanner sometimes in Chester, Captain of a Company of Dragoons picked up in hast to disturb us in our flight from the battle at Worcester, was bleeding almost to death, by a wound he received from some of our routed Forces; when I was brought a prisoner to his Quarters, I stitched up his wound, taking the Artery up with the lips and with a little wheat-meal, and the white of an Egg, laid over all upon a Compress dipped in aceto, bound his head up; this was upon a necessity, but this served to keep my stitches close; after two or three days, I dressed him again, and found all quiet, I now sprinkled the lips with pulver. Thuris, sang. dracon. an. p. aeq. and applied a pledget with Linim. Arcei & Empl. diacalcit. all which I was now supplied with from Warrington; and the next dressing cut out the stitches, and dressed him up again with the same as before, and from that time he was cured: which was before he had recruited his spirits from his loss of blood.  
In wounds of the head where you cannot cure by the first Intention, 
Contused wounds.  as where the wound is contused or some part of the Hairy Scalp torn off, there you are to digest with Terebinth. and the yolk of an Egg, I commonly boil the Turpentine a little to make it thick, otherwise it is too slabby; add a little farin. Hordei, After Digestion I add a little Sarcacoll. Myrrhae, Aloes, pull. Ireos, with mell. Ros. by which it serves to deterg, I commonly Incarn with this of vigoes, ℞ ol. Rosat. ℥ vj. ol. mastic, ℥ ij. pinguedinis vitulin. porcin. an. ℥ iiij. fol. plantag. matrisylvae, Beton, pimpinellae, pilosellae, flor. Anthos. an. Mss. vini odorif. cochl. iiij. coq. ad Consumpt. vini in colat. add mastic. Gum. Elemi, rosin. pini, an. ℥ j. litharg. Auri & argent. an. ℥ ij. Minii ʒ x. Terebinth. venet. ℥ iiij. cerae q. s. ft. vng. S. A. or with Lin. Arcei; touching the lax flesh, as I think fit with either of the stones, and by the help of ung. Tutiae madge. Lint dry or dipped in sp. vini. Aq. calc. Alum, and prest out, I cicatrise these and all such like wounds.  
If in a wound of the head by Incision the Pericranium be bared, 
Pericranium laid bare or cut.  if there be no fissure, you are to keep the Air from it by bringing the lips of the wound close together, that the bone may Incarn: But in these wounds Fabr. ab Aq. penned. says, and by the authority of Galen, that you ought to Exfoliate the bone; for says he, it is not likely so thin a membrane as the Pericranium, adhering to the bone, can be cut, and the bone not hurt; and if the Cranium be but a little hurt, there is a necessity of Exfoliation: In my practise I have often met with wounds in the head, where the Pericranium hath been cut, and the bone only bare; sometimes also the bone is cut: But if I came into the first dressing, it hath for the most part Incarned without any difficulty, and the better for the little cut made into it. But where the bone hath been bared by a Contusion, the bone is commonly altered by the Air, or Gleet from the contused flesh, and doth for the most part require Exfoliation; yet in this case I have cured without Exfoliation, but with great difficulty.  
If a Contusion be made by a blow or musket-shot, 
Cranium laid bare by contused wounds.  when the force is spent, or when the head is armed, if there be no wound or symptom of fracture, or the like, you are to shave the hair off, and Embrocate the part well, and apply over all a Cataplasm, è Farin. Hordei, Flor. Ros. ballast. decocted in Oximell, adding some Ol. Ros. and let your Patient blood, and if there be a wound joined with it, and made by shot or blow, you are to digest that wound as in contused or Gun-shot wounds: If there be not a way for discharge of Matter, you are to make one, that it be not shut in, and cause inflammation in Pericranio, and Fever follow. After digestion and separation, you are to proceed to Exfoliation of the bone; for in such wounds the bone is Altered, both by Air and Matter. In order to Exfoliation you are to consider, that if the bone were not hurt, it is smooth and slippery, as it were polished, and flesh difficultly grows upon it; wherefore by the Authority of Galen and your own reason, you are with Rugines to make it rough and thin, that you may make way for the Callus to sweat out of it: In this case if you rasp it here and there thin, till you see the blood ready to come out of it, the bone will thereby be sooner supplied with materials for generation of flesh; but if your Patient will not admit of Rugines, as in children it will not be allowed, then you are to keep your dossils with Sarcoticks close to the lips of the wound, and make your Exfoliation from the edges, that the sound part may thrust off the rotten bone; for neither Crabs-eyes, nor any Medicine inwardly prescribed, or wine outwardly with Lint or other medicament applied to the middle of a bone, will signify any thing to the Exfoliation; nay the while you are so trifling, the matter from the edges will rot the bone underneath, and in continuance pierce through the first table, and run underneath betwixt the two tables, and do much mischief, and put you upon the use of the Terebra, in the curing of your Patient. If therefore you propose Exfoliation, then according to the Ancients you are to use Rugines to scrape the bone, and after the use of them, the bone requires its proper medicaments, Sarcoticks most drying in potestate & actu, as ℞ Rad. Ireos, Aristoloch. Rot. Thur. an. prt. aeq. in moister bodies Thus alone; I suppose that bones raspt require digestion, and therefore dress it with lineament Arcei, and such like spread upon Pledgits of Lint, and so commonly Incarn them, then proceed with Ung. Tutiae, &c. to cicatrise.  
Hitherto we have written of wounds and contusions of the hairy scalp and Pericranium, 
Cranium wounded, or fracture.  and of the Cranium laid bare, as also of concussion: now follow those wounds of the Cranium itself, whether by cutting or puncture, by sharp or pointed weapons, which cannot be without solution of Continuity of the hairy scalp, but by a musquet-bullet shot at a distance, by a fall or blow the skull may be fissured or fractured, and the hairy scalp whole, and this fracture or fissure under the Contusion, or in some other part: If the symptoms do demonstrate that there is a fracture or fissure, you are then without delay to open the hairy scalp, according as the part will admit, Angular, or in the manner of a across, or of the letter T, that the fracture may be discovered by the raising up of the hairy scalp with its Pericranium: For if you shall in doubtful fissures or fractures make a round Incision, 
Against round incisions upon surmise.  and take out the whole piece, then if there chance to be no fissure, you have made yourself a long work to little purpose; and if your fissure run farther than your Incision under the Calvaria, not discovered sufficiently, you are to cut it open that length, by which it will appear you have through mistake laid it open more than was necessary in one place, and too little in another, doing that which neither Hippocrates nor any of the Judicious would ever allow: Whereas if you made it without cutting off a piece, but only raising the scalp, you might, I say, if reasonably judged, have laid it open, so as you might have discovered the fissure or fracture; and if yet part of the fissure or fracture had lain undiscovered, you might have stretched your Incision to it; and in case after all, there had been no fracture or fissure which often happens, as in counter-fissure, then you might have laid the hairy scalp down again, and easily cured it, which by an excision of part of the scalp you have made, you cannot do.  
Objection. As to what may be objected, that the raised up Lips may be troublesone to the Chirurgeon in his work, and are painful to the Patient; there is no such thing; for if the Incision be made the way proposed by the Ancients, and that the fracture or fissure be all in your view, you may order the lips of the wound as you please.  
The Cranium laid bare, you are to fill up the place opened with dossills, pressed out of read Wine or Oxycrate, or a sponge prest out of either of the same liquours, and apply an Emplaster over all of Diacalcith. malaxt with Ol. Ros. cum Aceto, and bind it up.  
The next day you are to consider the fissure, 
Trial of Fissures.  if it be so small, as you doubt whether it be one or not, then wet it with Ink, and wipe it off again, and where the fissure is, the Ink will discover; but if it do not, then this Emplaster is proposed; ℞ Cerae novae flavae, Thuris, Laudani, an. unc. ij. Farinae Fabar. Terebinth. Aceti an. ℥ j. Misce ad Ignem: you are to apply it on the suspected part, and the next day where it is found moist, that there you are to Rugine.  
Fallopius tell us, that where the Cranium is contused, certain spots will appear read, not unlike those white ones which are seen in the nails of the fingers; but after the third day the blood exhales, and that redness ceaseth: If by the former you discover the fissure, or that the bone be contused, you are to Rugine the contused bone, and the whole length of the fissure; To which purpose and for that use to supply yourself with various forms of Rugines: whilst you are working with them, the lips of the wound are to be covered, that neither you hurt them, nor the Air offend them; sometimes these very small fissures, how inconsiderable soever they may seem, are the cause of the Patients death, there being often found extravased blood upon the Dura matter, the Veins being broken either by the concussion from the blow, or by the rough edges of the inner table next the Membrane: Therefore you are to consider the symptoms, and accordingly lay open either by Rugines or cutting into it, so as the Sanies may be discharged, and the Asperity taken away: But if there be a fracture of the Cranium in one or both tables with a depression of the bone and a fissure also, 
Depression.  which often happens, you are presently to make a way to relieve the Membranes underneath, for they cannot be without great disturbance and inflammation, and a putrefaction will follow, whence those symptoms of Fever, Delirium, Coma, Convulsions, Palsies, and Death ensue, if neglected. In this case you are to consider, whether the fissure do discharge the serous blood or Sanies, and whether by cutting that fissure open, the depressed and fractured bone may not be raised up; if it may, then you are to proceed by enlarging that fissure, and there with your Levatory raise up the depressed bone, and remove the fragments, and cleanse the membrane from the Raspings or ought else hath soiled it: But if the fracture doth not penetrate so far into the bone, nor there be any such depression or fear that Sanies is detained underneath, then you ought not to perforate the bone, nor expose the membrane to the Air, or more than is necessary; in this your eye and symptoms will guide you.  
In order to perforation of the Cranium, 
Perforation.  the bone is to be cleared of its Pericranium, least in setting on the Terebra( or Modiolus, which are two several names for a Trepan) you tear the membrane, then the lips of the wound to be covered, and the Terebra set on the breadth of a finger distant from the edge of the fissure, on the side which is most depending; if it may be with convenience, when you have set it on, press upon it with your left hand, and turn it round with your right, you must use a little Ol. Ros. or Milk, to cause it move the easier, and as it fouls brush it, in the doing of which it will cool, or you may dip it in water to cool; when you come to the second table, which you will know by the blood that appears, it will be required that you take out the pin & proceed more warily, not listening to the prattling of the standards by, but often lifting up your hand, lest by your compression or hast you unawares fall upon the Dura matter and wound it. All this while it is fit his ears were stopped, lest the noise disturb him, and the room close. The perforation made in Cranio, and the bones taken out, you are to smooth away the Asperity, which remains in the lower part of the main bone, and this is to be done by the Lenticular instrument made for that purpose.  
If after this the membrane be fouled by the saw-dust, from the bone you are to wipe it off with a little Lint upon your Probe; the part cleansed, you are to dress the membrane: 
First dressing after perforation.  About this first Application Authors differ, Avicen dressed the Patient with Lenients, as Ol. Ros. Celsus he dressed the part with Siccantia, as with Aceto acerrimo, you may find him positively for it in these words, His factis, the perforation made, ea Membrana acri aceto, respergenda est, ut sieve aliquid sanguinis ex ea profluit cohibeatur, sieve intus concretus Cruor remanet discurtiatur; The Membrane is to be sprinkled with sharp Vinegar, to prevent the flowing of blood from the part, and that if there should remain any clotted blood, it may be discussed. But the most part of the Ancients and many of the Moderns do propose Lenients, as Ol. Ros. that the crude Sanies descending upon the Dura matter, in pus convertatur, may be digested into Matter: In this you are to be guided by your eye: If there be Sanies or putrefaction, mell. Ros. Spir. Vini, and higher detergents are to be used, as the putrefaction is more or less. If there be much blood extravased, or that you fear bleeding, that of Celsus may be proper; but if the blood exceed not in quantity as it seldom doth, and if it be recent, it possibly happened from some scratch of your Terebra or little asperity of the inner bone or Table, or if there be neither of these, but the membrane fresh, and of its natural colour, then you are not to grieve that membrane, new exposed to the Air with detergents, nor by the Acrimony of the Vinegar; for if you shall by scratching of the membrane make it bloody, and then dress it with either Acetum or mell. Ros. & Spir. Vini, you shall then proceed contrary to the common Indications in Chirurgery, which teacheth to digest recent wounds before you deterge: And indeed what would you deterge?  
Therefore I do propose to you Lenients, not only by the Authority of those Ancients and Moderns, but by my own practise. Galen proposed Sang. Columb. and the blood of Turtles dropped warm from their wings, Fallop. and Fabric. Aq. penned. propose, as I said, Ol. Ros. with rosin. Abietis, and afterward they increase the Resina and lessen the Oil; but if there be putrefaction through the long lying of concrete blood, then mell. Ros. & Spir. Vini are proper; 
The thinner part.  yea mell. Egyptiac. and higher as occasion shall offer; otherwise in common cases of recent Terebrations by the emplastic quality from the Resina; the concoction is better made, and the part secured from inflammation, &c. It is to be proportioned to the habit of body; dry bodies require more of the Resina and less of the Oil, and by this simplo Medicament, I never failed of good digestion, and afterwards by the tempering this,( as I have said) have deterged and incarned, continuing it until the membrane was well incarned, not finding the least prejudice the bare bone had received from it; but you must take care, you do not too much relax parts; therefore after digestion, mell. Ros. with the Resina instead of the Oil will be answerable to your intentions, both to deterge and incarn; or you may use this to both purposes, its composition will commend itself, ℞ Terebinth. Venet. ℥ j. Ol. Ros. ʒ iiij. mell. Ros. Colat. ʒ iij. Croci ℈ j. Granor. Kermes ʒ ss. Sem. Hyperici ℈ ij. Vini Hispanici ℥ iij. Coq. ad consumpt. Vini Colat. add Aloes ʒ j. m. In the use of Medicaments, you are to consider the part and habit of body, and add or diminish your simples accordingly, and so they will perform all intentions; if the wound be made by Gun-shot, then you are to dress the wounds as is said in simplo Gun-shot wounds, and take out the Eschar, and afterwards deterge, as I have said, or with this, ℞ Terebinth. Opt. ℥ iij. mell. Ros. ℥ ij. Succ. Plantag. & Apii an. ℥ ss. Coq. simul ad succour. consumption. add Farin. Hordei ℥ j. Sarcocollae ʒ jss. afterwards add Aloes ℥ ss. Myrrhae ʒ iij. Thuris ʒ ij. and so it will incarn; and apply this Cataplasma, ℞ Farin. Hordei, Flor. Ros. Rubr. Fol. Beton. cum Ol. Myrtill. decoct it in Red-wine, and apply it over all. The Ancients used to the bone after digestion, pull. Aristoloch. Rot. Rad. Iridis Pucedani, Myrrhae, as their Sarcoticks to sprinkle on the bone, which are very good, but Pledgits of Lint dipped in Spir. Vini, and prest out hard, will at such a time serve your purpose well; and an Empl. de Beton. over all, or de minio madge. or the like; and where the flesh is luxuriant, touch it with either of the stones, or this Pulv. ballast. Ros. Rubr. & Alumin. an. prt. aeq. Thus at Worcester, 
observe.  a day or two before the battle, a Gentleman attended the Earl of Derby thither, with a large wound cut with a sword to the Dura matter, he had no other dressings on but a linen cap, the membrane covered with the shivers of the bone, it had not been dressed, and may be the better for him, for if dossils in hast had been prest in the wound, he would have laboured under some severe symptoms; but the shivers lay loose upon the membrane, and he felt not his danger. I took these lightly out, cleansed the wound, and dressed him up with lenients, the short time we were together. Authors have set us a limited time to dress with this or that Medicament, as to the fourth day so, and from that to the seventh to deterge, and so the fourteenth day Sarcoticks, but herein you must make use of your own judgments, persisting to cherish the native heat of the part.  
If the wounds penetrate to the Dura matter, you must consider the source of the Weapon, and make hast to relieve the parts under the Cranium. 
Gun-shot.  But where they are made with Bullets or heavy blunt things, there they are often pasht into one another; there you are presently to lay open the hairy scalp, & raise it up from the Cranium, and relieve the oppressed membrane; but if the flux of blood should be so great as it will not permit, fill up the part with dossils dipped in Wine or Vinegar; accordingly open it again as soon as you may, and in the while dress it up as hath been already said. These bones are to be hastened out with as much speed as may be, and the part afterwards dressed with Lenients, as hath been said: If the opening in the fractured Cranium be not sufficient, make one in the most declining part, and raise up the bones, and free the membranes of whatever may offend it, but do not take out more bones than needs must, like some of those surgeons I have met carrying them about, boasting in that which was their shane; for these bones in recent fractures do unite as those in other parts, therefore having raised them up, dress them lightly with the Catagmatick powders, and they will happily agglutinate and make your cure more facile. In these wounds of the Dura matter, the lenients of Ol. Ros. or warm Pigeons-bloud are proper, they are Anodyne and digest; Ol. Hyper. and mastic are also good mixed with Resina, for the curing these wounds, Fabric. Aq. penned. cites Galen, and he Archigenes using the Succus Calamenthae dropped into the wound, and sprinkling pull. Milii over for incarnating them, the Milium moderating the heat of the other, he delivers them to us as siccantia, detergentia, & incarnantia. The unition and incarning of the Lips of the Dura matter is performed by a fleshy substance that ariseth upon the membrane, which afterwards as it increaseth, doth unite over it, and becomes one body, and grows firm; mean-while the bones within Exfoliating thrust from the side a Callus, which uniting with the forementioned flesh becomes one body with it, & filling up the place that was perforated, is in time more firm than the bone itself was; but in the while, you must be careful that your Lenients make not the part too lax by their greasiness, for so a Fungus will thrust out thence which may be vexatious to you; This in the beginning by desiccants, as pull. court. Granat. ballast. Ros. Rubr. Alum. ust. with a soft dossil and compression by Bandage, will be taken down, or if it grow very big by ligature it is taken off: But to tell you truly, I never met with any such like disturbance as is represented to us by Authors, nor shall you, if you use your desiccants timely: The Vitriol or Allom-stone insensibly takes this off, and disposes the part to cicatrise if daily used.  
The Pia matter is a most delicate fine membrane, and adheres so close to the brain, that it can scarce be wounded without a wound in the Brain; and these are most commonly mortal, for that it is full of Veins, and subject to great effusion of blood; the Brain wounded and exposed to the Air corrupts by reason of the external could which soon extinguishes the little heat of this part. And by reason of the fluidity of the Brain, and contraction of the meanings( or membranes) caused by the constant pain and irritation, the brain perpetually ouseth out upon you, till the whole wounded Lobe be spent. You must make way to these wounds by removing the shattered flesh and extraneous bodies and bones: but if they will not come easy away, leave it to nature, lest he die under your hands, and you be thought to hasten his death. Your dressings must be with Galen's powder, with Hares fur, with the white of an Egg to restrain the bleeding, and retain the brain within its bounds, and over them your dressings, as in the wounds of the Dura matter, and over the wound digestives; remembering in all these Gun-shot wounds to cut off the shattered lips of the Calvariae, 
Note.  lest a Gleet drop from them upon the meanings and brain, and heighten the inflammation: If the brain be retained within its membranes Pia & Dura matter, and they digest and incarn, then you are to proceed in the rest of the cure as in fractures of the Cranium, as hath already been said.  
In all hurts of the head what sort soever they be of, the Body is to be emptied, and the rather, 
Internal medicines.  if there be Plethora or Cacochymia; for in such habits of body humors are apt to stir up ill symptoms, especially if the wound be great; therefore you are the first day to open a Vein in the Neck or Arm on the same side, and bleed according to the exigency and strength of body; also cupping with scarification of the Neck and Shoulders, with Fontanels under the Ears is necessary: Then Lenient medicaments, such as may evacuate the serous blood, which by reason of its tenuity and heat readily flies to the affencted part. These are such as have been proposed in the Fourth Intention of Wounds in General, to which I refer you. In these cases cordial Species and Electuaries, with Juleps and Emulsions may be proper, if they be proportioned to their temperature, hotter or colder, as there are Fever or other Accidents joined with the malady. Vulnerary drinks are sometimes in use here, if they be fitted according to the nature of the part, and the ingredients, for these are Beton. Artemis. Caryophilat. primula veris, Lillium convallium, Salvia: Hypericon. Sanicula, Veronica. Plantag. Flor. Ros. Rubr. Nux Moschat. &c. as in the Chapter forementioned: Of these you may make drinks with Wine and Water or small-Ale, as ℞. Sanic. Beton. Veronic. Artemis. an. ℥ j. Cons. Ros. Rubr. Caryophillat. an. ℥ ss. Torment. ʒ ij. Coquantur in Aq. pure. & Vini Rhenani an. lb ij. Vase clauso in B. M. colentur per manicam Hippocratis; give ℥ iiij. of this morning and evening, or take ℥ j. of all these Plants well dried and cut, boil these as you do Thè, sweeten it with mell. or Saccharum to the palate of your Patient, and give them a dish of it to drink twice or thrice a day, you may Aromatize it with Saunder. Cassia Lig. or Sassafras, &c.  
In the External Applications to the part affencted, 
External.  you are in the first place to prevent flux of humors, which is performed by refrigerants & exsiccants, which also dries up what is already extravased in the part; to which purpose Hippocrates proposes Far. Hordei ℥ viij. Ol. Ros. ℥ iiij. Coct. in Acet. or Oxycrat. and made into a Cataplasma; In Winter he added Flor. Ros. Rubr. Pulv. ℥ ij. and decocted it in Vino, others have since added Bac. Mirt. ballast. to corroborated the relaxt parts, then they Embrocated the head and about the Jugulars, with Albumin. Ovor. Acet. & Ol. Ros. &c. sometimes only with the latter, but without the Acet. the Ol. Ros. seems to me not to penetrate enough. The want of these Embrocations is sometimes the cause that tumours arise behind the Ears. To contused and great wounds speedy digestion is required, not only in the Calvaria, but meanings of the brain, and these ought to be humectantia & emollientia; and herein, as I have elsewhere said, Terebinthina is the most proper medicament, and in these Nervous parts you may use it washed or not; in dry bodies they add Thus, in humid bodies and recent wounds Vitel. Ovor. & Ol. Ros. also Farin. hoard. Cribrat. others Terebinth. Venet. ℥ jss. Ol. Hyperic. ʒ vj. Thuris ʒ ij. Vitel. Ovi j m. or R. Resinae Abiet. ʒ vj. Vitel. Ovi; or R. Terebinth. Lot. in aq. Salviae ℥ j. Ol. Ros. ℥ jss. Gum Elemi cum olco supper Ignem dissoluti & colat. ℥ ss. Vitel. ovi ʒ j. Croci ℈ j. m. and if there be much pain a Cataplasma ex Radic. Althae, Flor. Meliloti, Farinae hoard. Ol. Ros. Vitel. Ovor. and a little Crocus, but you must have a care by your slabby medicaments you cause not putrefaction; wherefore Matter thus made, which happens in three or four days, you are then to deterge by adding mell. Ros. or mell. come. or this, R. Terebinth. ℥ ij. mell. Ros. ℥ j. pull. Myrrhae, Aloe, mastic, an. ʒ ss. m. Discutients are now required outwardly by cataplasms, Cerots, and Emplasters, as Empl. Vigonis de Beton. Gum Elemi de Matrisilva, Cerat. Isidis, or R. Succi Beton. ℥ ij. Ol. Ros. ℥ iiij. mastic, Myrtillor. an. ℥ j. Pingued. Hirci ℥ jss. Coq. ad Succ. consumption. Colat. add Gum Elemi, Tacamahaca an. ʒ x. Terebinth. ℥ ijss. Cerae Alb. qs. Iterum Buliiant ad consistent. Cerat. or ℞ Gum Elemi ℥ iij. Opoponac. ℥ ij. Bdellii ℥ ss. Resinae pin. ℥ j. Cerae qs. Ft. Ceratum. In all wounds of the head Gum Elemi is much commended, it mitigates pain, and corrects the evil temper of the part, by a peculiar virtue it hath thereunto. Fab. ab Aq. penned. commends this Empl. R. Beton. Virid. m. viij. Contund. Contus. addantur Ol. lb iiij. Cerae, Terebinth. an. lb j. coquantur, & exprimantur suc. add Beton. virid. Contus. m. viij. Iterum coquantur & exprimantur pro usu.  
The use of Spir. Vin. is much commended in these wounds of the meanings, 
Spir. Vini of what use in these cases.  as having such a siccant quality, as is requisite for them; but in recent wounds where there is fear of pain and inflammation, it is not to be admitted, but amongst detersives is of great use and proper for the Bones: Vigo commends this, ℞ Spir. Vini ℥ vj. Myrrhae ℥ ss. Aloes ℥ j. Sarcocol. Thuris an. ʒ ij. or this Balsam. ℞ Spir. Vini lb jss. Vin. Malvatici ℥ xuj. Myrrhae, Thuris an. ʒ x. pull. Rad. Consolid. ℥ j. pull. Centaur, Min. ℥ jss. Flor. Hyperici pull. ℥ ss. Tereb. lb ss. set this in Balneo a month, then reserve it for your use, drop of it warm upon the meanings, or mix it with your other medicaments for your use. If the Dura matter have changed his colour, and do not deterge with what is proposed, then this is commended to you, ℞ Tereb. Lot. in Vin. Alb. ℥ iij. mell. Ros. Spir. Vin. an. ℥ j. Myrrhae, Aloe, Sacchar. Alb. an ʒ ij. m. If there be yet such ill quality in these wounds that they tend to putrefaction, scarify the Lips of the wound, and apply this or such like, ℞ Mithridatii ʒ vj. Theriac. venet. ʒ ij. mell aegyptiac. ʒ j. pull. scored. myrrhae, an. ℈ j. sp. vin. qs. The putrefaction got off, and the Membrane recovered in its colour, you may then dress with the above mentioned, or you may dress it with this of Johan. Andr. à cruce, ℞ ol. Terebinth. venet. mell Rosar. p. aeq. apply it warm, all these Medicaments are to be applied upon a Sindon to the Membranes. A Sindon is a piece of Silk, or fine Lining cut round proportionable to the perforation made in the Cranium, and is to be placed in under the edges of the Cranium by the Lenticular Instrument, that the edges of the fractured or perforated Cranium hurt not the Dura matter: A Thread or Silk is to be fastened to it to pull it out at pleasure; over this you are lightly to place soft dossils of Lint dipped in some convenient Medicament, to fill up the voided space in the Bone, this serves to cherish the native heat of the part, and to keep the dura matter from rising above the Bone, whereby your Patients life would be in great hazard: the Tincture of Myrrhae forementioned is proper to dip the dossils in after digestion.  
In wounds of the membranes of the Brain, 
Medicine in wounds of the meanings.  and Brain itself, this is good, ℞ succ. Beton. ℥ iiij. succ. calamenth. ℥ ij. flor. Centaur. min. p. j ss. hyperici, contus. ʒ ij. vini odoriferi lb j. Infuse these three days, then boil them to the consumption of the Juices, then strain it, and add to it Terebinth. clarae ℥ iij. Gum. Elemi ℥ j. dissol. in sp. vini ℥ ij. ol. Hyperi. ℥ j ss. mell. Ros. ℥ iiij. boil these a little, then add pull. myrrhae, Aloes, Sang. dracon. Thuris an. ʒ j. and reserve it for your use; oleum Aparici prescribed in wounds in general is an excellent good Medicament in recent wounds of the meanings and Brain.  
Fabr. ab Aq. penned. proposes this in wounds of the Brain, 
Qu. whether the dose of ol. chalcanth. be not mistaken, at least if by it he mean ol. vitriol.  ℞ farinae milii ℥ ss. olei aparici ℥ j. Mithridati ʒ vj. balls. pervan. ex Aegypto ℥ iij. sp. vini ʒ v. and if more desiccant be required, he adds olei de chalcanto ʒ j ss. drop this( says he) warm and your digestives over the wound, and to Embrocate the head and parts about with ol. Ros. and lay this Emplaster over all, far. Hordei ℥ viij. pull. chamel. ℥ iiij. pull. spicae Scenanthi an. ʒ iij. pulv. Beton. staechad. an. ʒ ij. ol. mastic. lb ss. ol. Ros. ℥ iiij. oxy mell. simple. ℥ v. vini albi medioc. potentis. qs, ft.  
If the bones be carious and do not readily exfoliate, you are to Rugine them and dress them with ung. Arcei, and if they do not incarn by that, then ℞ sp. vini ℥ x. Myrrhae ℥ j. Aloes ℥ j ss. rad. pucedan. Aristoloch, court. Thuris, an. ℥ ss. pulveriz. & misceantur pro usu. It is to be used with Lint; In dry Bodies this ℞ pull. Aloe pumic. ust. pomphol. an. ʒ ij. Myrrhae. ʒ j. pull. ostre. combust. ℈ ij. this to be mixed with mell. Ros. & sp. vini. And this Emplaster over it, ℞ cerae, Resinae pini, amoniaci, Elemi, an. ʒ vj. Terebinth. ℥ iij. pulv. Myrrhae, mastic, Aristoloch. rot. Ireos, Aloes, opoponac. Euphorb. an. ʒ j. ol. Ros. q. s. ft. Emplastrum, after parts are incarned you may cicatrise with one of these or such like, ℞ plumbi usti cum sulphur & loti Litharg. aur. an. ℥ ij. Antimonii usti & loti cerussae, an. ℥ j. ol. Ros. q. s. ft. ung. or thus, ℞ pulv. Aristoloch. ust. flor. Ros. rub. ballast. cupress. ustor. ostrearum. an. p. aeq. ft. pull. or thus, ℞ calcis testarum ovor. calcinat. ℥ ss. Alum. usti ʒ j. croci martis ℥ j. ft. pull. Thus I have set you down variety of Medicaments, whereof you may fit yourselves according to the exigency, and shall now show you some of my work, wherein I used but a few.  

Observations of the Wounds of the Head.  
A Poor woman near Ludgate, coming out of Chamber one Night, 
A large wound of the Calvaria.  pulling the door to her by the Key, it slipped out, and she tumbling down stairs, cut and raised up the Hairy Scalp; from the beginning of the Lambdoides downward; I was sent for, and having caused the hair to be clipped and shaved away from about the wound, I cleansed it from the blood, and brought the lips close together by three or four stitches, and held them so, then sprinkling them with some of my agglutinative powders, I applied a pledget over the Suture, and Embrocated the parts about cum Alb. ovi, Aceto with ol. Rosar. and adding some of my agglutinative powders with the foresaid mixture, I applied it over all and rolled up her head. I gave her afterwards ℥ iiij. Aq. Papaveris with Syrup. de miconio and a little Aq. Cinamom. hordeat. and left her to rest. The next morning I took off my Bandage and restrictive Emplaster, and Embrocated with ol. Ros. & Aceto. and applied a Cataplasm of farin. Hordei & fabar, dedocted in Oxycrate, adding ol. Ros. and took away a little blood by the opening a Vein in her Arm, and prescribed her a Clyster of Milk and Sugar that afternoon: Thus, I continued the Cataplasma and renewed it morn, and night; but dressed not the Sutures till the third day, and by that time the tumour diminished, and the wound inclined to agglutination. I Embrocated the parts about, and dressed up the wound again as before, the next dressing I cut out the stitches, and dressed up with my Agglutimative and Sarcotic, with my Empl. Beton. over all instead of the Cataplasma, and in a few days cured her of that wound by Agglutination.  
Some while after I had a young man my Patient, who by a such like Accident was so wounded on the right Sinciput, whom I cured the same manner as abovesaid. It hath often happened abroad, that upon a fall from their horse, or blow by a Pole Axe or the like, the Patient hath been stunned and did vomit, by which symptoms I have suspected a Fracture or Fissure, so have presently laid open the calvaria, very large by across or the like Incision, and after the raising up the hairy Scalp, seeing all well, I have laid it presently down again, and by Agglutinatives, and sometimes by Suture with two or three Stitches at a distance to keep the lips of the wound close, have by agglutination cured it in few days, applying refrigerants and exsiccants with bleeding, Clysters, &c. and have happily gotten them off in a little while.  
A Young fellow a servant to a Horse-courser, was cast off his Horse against some of the Bars in Smithfield, 
Of the Calvaria torn off.  whereby the calvaria or hairy Scalp was torn up from the Coronal Suture to the Temporal Muscle on the left side, the Skull was bared between two and three Inches broad, he was lead to the next Barber-Chirurgeons, who cut the piece off, and hanged it up in his Shop; the next day the poor fellow was brought to me, I caused the hair to be shaved off from about the wound, and dressed the Bone and Lips with Linim. Arcei warm, Embrocated parts about cum ol. Ros. & Chamamel. and applied Empl●● Rolo over the wound, and with compress and bandage rolled up his head. He had been Let blood the day before without consideration of the great quantity which he had lost from his wound. I continued the former dressing to the Lips of the wound and Bone, until they were digested well, in which time the edges of the Bone Incarned round, the middle of the Bone I Rugined. whereby I disposed a callus to put forth. After digestion I deterged with mund. Paracell. and after the callus grew up from the Bone, I dressed the part with pledgets dipped in sp. vin. prest them out dry and applied them over the Bone. After detersion I dressed the wound with one of my Sarcotics mentioned in the fourth Chapter of wounds in General, and afterwards by Epuloticks as ung. Tutie, &c. cicatrized the Lips of the wound even with the callus, as it rose from the Bone, and as the Bone shel'd off here and there in thin seals I Cicatrized the wound, and about that time to dispose it the better to do so, he was purged sometimes, Thus he was cured as a wound with loss of Substance, a troublesone and vexations work to the Patient and Chirurgeon, which might at first have been cured by agglutination or with a less Cicatrix and have enjoyed its natural treatment with the hair, whereas now it remained Bald & very unseemly.  
A Cook-maid, by the fall of a great Jack-weight from its full height without doors upon her head, 
A great contused wound.  was beaten down, and stunned for some while by the blow, she vomited and was carried in doors with great pain, there were three wounds to the Cranium, the flesh pasht, with a great tumour, the bone seemed to me to be depressed all under and to have a fissure, I presently made a Circular Incision, and raised up that part of the hairy Scalp in Order to Terebration, and filled up the wound, and the bone with dostils of dry Lint, shaving the hair from about the wound. I applied pledgets spread with my digestive upon the Lips of the wound, Embrocated parts about with ol. Ros. & Aceto, & Empl. è Bolo over, then with compresses dipped in oxycrate rolled up her head. Some hours after I caused her to be Let blood about eight ounces, and that night gave her ʒ vj. sir. de meconio, in a draft of Aq. Papaver. with a little Aq. Cardid●a. The next day I took off dressings, and viewing well the bared bone, I found neither depression or fissure, I was deceived by the shape of her head, viz. double crwoned, the tumour great, and the saggittal Suture running underneath, I fomented the parts affencted with vin. Rubr. wherein was decocted flor. ros. rubr. Chamom. fol. Beton. scabiosae, sumit. Absinthii, Bacc. myrtle. &c. dressed the bone and Lips, the former with my Unguent è succis, and the latter with my digestive è Terebinth. dipped in ol. Hyperici warm, and having Embrocated her head well with ol. Ros. & chamom. I applied a Cataplasma, sarir, hordei, pulv. ballast. & ros. rub. decocted in Oxycrate with ol. Ros. over all with convenient Bandage, this method I continued till the wound was digested, and pain mitigated, and the tumour discussed, then I deterged the wound, and continued the former ung. to the Bone, as also to the Lips as a sure Sarcotick, and dressed over all with one of Vigo's Cerots instead of the Cataplasma; by this method the bone Incarned, she returning with Medicaments to be dressed by some of her fellow servants at her Masters house a few miles off, sometimes coming to me, the Bone and Lips Incarned, I Cicatrized them as in the former Laceration of the Calvariae, I did not believe so great a blow could be without a Fracture and great Accidents, otherwise I should not so presently have raised off the hairy Scalp.  
A Tradesman returning from visiting some of his friends in the country, near Knights-bridge, 
A Concussion.  fell off his horse to the ground bruised and wounded his Forehead and Face, was taken up as dead. After he was a little revived, they put him into a Coach and brought him to his house, they sent for me, I found him in his bed labouring under a Concussion, a Stupor upon his Spirits, not capable of giving any account of his ailment, his Face & Nose much bruised with a wound to the Bone upon the as ●ribrosormis, reaching from the upper part of his Nose, to the as frontis: I caused the blood and gravel to be washed out of his wound, and with my Knife laid open the wound a little higher up the forehead, viewed the bone and see it without Fissure, I then brought the lips close together, and dressed the wound with my agglutinative, with an Empl. è Bolo over it and his Face; I then caused the hair to be shaved from the forepart of the head, from the Coronal Suture down to his Ears forward, and Embrocated the parts shaved with ol. Ros. cum Aceto, and applied a cataplasm of farinae Hordei with pulv. flor. Ros. rubr. ballast. & Bacc. myrtle. boiled in oxymel, and by Bandage retained dressings close, then I let him blood, between Ten and Twelve ounces, a Neighbouring Physician visited him that night, and prescribed him what he thought necessary; he lay dozing all that night, groaning and troubled, and was not better in the morning; he spake not willingly to any of us, nor so as we could understand what he said, that day I took off dressings, viewed and felt the parts about, the left eye was Inflamed, the lid swelled, and the forehead bruised, I was not able to make out any thing, whereby I might take new Indications, I dressed him up again as before, ordering a little breast milk to be dropped warm into his eye, and renewed the Embrocation and cataplasm, that day he was Let blood again, and a Clyster given him, and what else his Physician thought necessary, the next day he was not better, old Mr. Boune a Chirurgeon was consulted, we took off dressings and considered parts, opened the Lips of the wound again, and viewed the Bone, it was fair without the least Impression, Mr. B. did conclude that the wound should be cured without farther enquiry therein, which accordingly was done in few daies after without exfoliation. Blistering of his Neck and Shoulders, and Cupping with Scarification was resolved by us, and accordingly performed with Fontinells behind his ears, Fomentations and Emplasters were applied as in Concussions; but the relief was small yet by these, purging, fomentation and Emplasters with otherlike applications, he after a month or six weeks was so well as a little to follow his occasions abroad, but was not well: his eye was cured, but after he had followed his affairs some while, of a sudden that eye-lid fell down, and recovered not its strength again, but in some moneths after he lost the sight of that eye, without any outward soreness, which I imputed to the obstruction from within, it being the effect of his Concussion: He was a live at the time of the Fire, and may be so still for ought I know; if ought was omitted it was further bleeding.  
A Gentleman of about 30 years of Age, coming out of Hartfordshire in passing through tottenham, 
Another Concussion  road upon the Causey near an Inn. One emptying a Chamber-pot out at a window, just as he was passing by, his horse started, and rushed violently between a Sign-post and a three which supported it. The poor Gentleman was beaten off his horse by that three, and lay stunned on the ground: The people sent Immediately for Mr. Torner, a Chirurgeon from London; Sir T. B. upon notice of his friends mishap sent me thither also, where I found the Gentleman lying stunned upon the ground, the people and Chirurgeon gazing upon him. I felt his Pulse much oppressed, the right Brow bruised, I enquired whether they had Let him blood, the Chirurgeon replied he had opened a Vein in his Arm, but it would not bleed; I replied we must make him bleed though it be by slitting his Veins. I turned his head on one side, proposing to open the Jugular Vein on the bruised side. I did so, and he bled freely; after I had taken about twelve Ounces of blood, the blood run down from his Arm, which was opened before; we bled him till he came to life. Then he raved, beat us from him; we stayed the bleeding by Emplaster and Bandage, and caused the people to carry him into the Inn, and put him into a Bed. All the while they carried him and were making him unready, he roared and was very unruly, especially whilst they were pulling off his Stockings from his right Leg, which enquiring more particularly into, we found broken short in the middle of the Thigh-bone, 
A great Bony when.  close by a Bony when of the bigness of a Tennis-ball; they put him into Bed, and we prepared dressings for setting and reducing the fracture, he opposed us mainly in the Setting and dressing it up, but some of the people holding him down in his Bed, we set and dressed his Leg as is said in the Lecture of simplo Fractures; but he was no sooner at liberty, than he endeavoured to loose the Bandage which we had put on for keeping the Fractured bones together, and would not be quiet until he had done it. We contented ourselves in what we had endeavoured, and from that time left his Leg to lie unset or dressed, not so much as an Emplaster over it, and prepared the application for his head, shaving the hair from that side of the Temporal Muscle, and Embrocated the part which seemed to us affencted, cum oleo & Aceto, and applied a Cataplasma of Bean-meal which was speediest to be had, and with aceto & mell. & oleo, and four whole Eggs, which he permitted patiently. That bound on, I left my Brother Chirurgeon to stay with him and returned to London: The next day, Sir T. B. sent for Sir Ch. Scarborough, and carried us with him to tottenham where we found the Patient raving as by their report, he had done all night. We understood not one word he spake, his pulse was now intermitting, no Indication for bleeding, what was necessary for him to take the Physician then prescribed, and concluded that there was no Indication to do more at present; his bruise was upon the Temporal Muscle, a part not to be laid open, upon a bare surmise, nor shall I ever allow the laying it open though a Fissure were under it, but content myself, as Ambr. Par. did in such like cases, to open above it, and make discharge that way, wherefore we renewed our Embrocations and cataplasms, and continued to dress his head daily as hath been said in Concussions: Then we left the Chirurgeon to wait upon the Patient; Sir Ch. Scarborough was going a journey farther into the country, I to London, but with promise to return daily to this Patient while he lived. I did so, and the next day finding the Patient raving as I left him, his pulse troubled and intermitting, I resolved to attempt a doubtful remedy rather than suffer him so to languish, and that was bleeding him: his distemper proceeding from Inflammation of the Membrains of the Brain, the oppression was certainly there; to which purpose I let him blood from the same Jugular about Ten ounces, and so proceeded every day or second day at least. The Patient bare it well, and seemed to be relieved, his pulse rising upon it, and he slumbering sometimes, and taking his nourishment which before he did not; about the 17 day I coming to him near tottenham met his Chirurgeon going to London, he  told me that if he had met me at the Patients Lodging, we might have set his Leg, he being now more sensible of the Fracture. I persuaded him back, much rejoicing to hear that the Patient was so well; but when I came near his Chamber I heard him hollowing. It troubled me what to do, I knew his bleeding had much relieved him, but the People as also the Chirurgeon disliked my so often Letting him blood, and did abusively say, Now you shall see this Chirurgeon Let him blood again, and that I would be the death of the Gentleman; however I resolved to Let him blood once more, and no more. This I declared with the necessity of doing it, and accordingly opened the same Vein again, and held a white ston Porringer to receive the blood, which flowed with a sprightly stream, the Patient lying as quietly the while upon his back, I put the Porringer into Mr. Turners hand, and seeing the blood flow with much vigour, I catched up hastily a pewter Porringer, proposing to take a little in that. In bleeding these Veins in the Neck, we usually holding the Poringer close to their Neck it serves us as a Bandage to intercept the descent of the blood. I put this Porringer into my brother surgeons hands, with pretence to make a dressing to lay upon the Vein, but stood at a little distance, looking my Patient in his Face, with a resolution to bleed him until I saw his Countenance change; which I did, and then stepped to the Patient to stop the Vein: The while the Porringer was taking away, the blood run out of the Porringer, it having been melted in the side, and the hole so covered by the Sawder as I did not see it before; in the while he was bleeding I thought him long in bleeding, and wondered to see so little quantity gathered from so full a Stream, and now seeing the bed so bloody, it was evident that when the melted hole prest not against his Neck, the blood ran into the bed which deceived me. But the Patient upon the taking a little of his Cordial over, refreshed his Spirits, I sat a while by him, and left him pretty hearty. The next day I returned sooner than I used to do, being doubtful how I should find him, but to my wonder, he was perfectly well in his Sences, and discoursed soberly of what passages he remembered in the time of his delirium.  
We presently prepared now to set this fractured thigh bone, after it had lain 17 daies unset, it was without Inflammation tumour or pain. The Callus I suppose was thrust out at the ends of the bones, and that had covered the Asperity of the fractured ends of them; as the large bleeding and disease had made revulsion and evacuation. We by an easy extension brought the ends of the bone together, and dressed it up as I usually do in simplo fractures, and in less than twenty daies the Callus was dried, and his Leg so strong as to bear him again, and some weeks after he went abroad about his Affairs.  
A Youth about Ten years of Age, was struck down by a blow upon the forehead, 
A Fracture with a long fissure and depression of the Cranium.  his Father fetched me to him, I found him lying upon a bed deprived of his speech with a loss of the use of his legs: I took off the Emplaster which was upon his forehead, there was no wound, nor considerable swelling, but searching with my fingers I felt a depression of the bone, upon which having advertised the Parents of the danger of the child, and the way of my proceedings, I sent for the Chirurgeon at next door, who had applied the first Emplaster, I desiring to retain him for more constant attendance, shewed him the way of making dressings ready in order to dilatation: Then causing the hair to be shaved, I made an Incision so large as to set on the Terebra, if an occasion should be, for the raising up the depressed bone. Upon the raising this Calvaria upwards toward the Coronal Suture, I espied a fissure running up from the fractured Bone beyond my first Incision; wherefore I followed the fissure laying it open the whole length near to the Coronal Suture, out of which I see a serous blood flow in a good quantity, by which I promised myself a sudden remission of these symptoms which the child laboured under. The depression was a piece of bone as broad as a three pence sunk in below the first Table: I filled up the opening with dossils of dry Lint, and applied over all my digestive, è Terebinth. vitel. ovi upon pledgets with Empl. è Bolo, and made a Bandage to keep my dressings on, after I had Embrocated parts about with ol. Myrtill. & Ros. cum Aceto; The next day in the presence of Dr. Barwick and some country Physicians with Mr. Arris Chirurgeon, I took off the dressings, and set the Terebra above the fractured bone for to avoid the great Scar which must have been, had I made it below the fracture, besides that poriness of the bone below. Here in this wound, I also cut that Vein, which in the former discourse I gave you caution to avoid, which could not be here, the fracture being just under it, and in such cases even the Artery itself is not to be spared. The Terebra set on, the bone taken out, and the inner edges smoothed by the Lenticular Instrument I put in a Levator, and raised up the depressed bone even with the rest: That done I placed in a Syndon with a bit of Thread or Silk fastened to it, first dipped in ol. Ros. with a third part Resinae warmed, then with a round dossil dipped in a little Lin. Arcei, which filled up the opening, out of which the bone was Terebrated. Then I opened the fissure with my Rugines, scraping away its edges that no sanies or matter might be detained there to hurt the bone. Then I dressed up the bone with Linement Arcei warm, in that long wound which I made to give a breathing to the fissure, keeping it open by a single dossil giving way to the lips to fall in, and digested them with the same Linement: I desiring no more opening than was necessary for discharge of matter from within the Cranium, taking care that the fractured bone should not be entangled with lax flesh, lest it become carious. Over these dressings I applied Empl. Diacalcith. malaxt with ol. Ros. cum Aceto, and with compress Bandage concluded that second dressing; and from this time, all our threatening symptoms vanished: Indeed the first opening and Letting blood that same night recovered his Speech, and after this second dressing his Legs became well again, yet we kept him in the dark, and to a slender diet allowing no flesh. What concerned Internals Dr. Barwick took care of, the other Physicians and surgeons coming no more; I continued the same method in my dressing until digestion, which was made in 4 or 5 days, then I added mell. Ros. instead of the oil, and afterwards incarned by increasing the Resina and lessening the mell. Ros. The flesh rising in little grains presently after the digestion was completed, after a few days did more cover up the Dura matter; Then I hastened the exfoliation of bones, deterging the wounded lips with Mund. Paracels. from this time the work being rather to keep down the lax flesh, than to seek how to make it grow; to which purpose I dressed the Cranium with pledgets dipped in sp. vini, and the Lips of the wound with ung. Tutiae, sometimes touching them with my Vitr. and Allom-stone, which were of great use, and do hasten the cicatrise with much safety: In less than six weeks the bones were Exfoliated, and the wound ready to cicatrise, at which time I left it to the neighbouring-Chirurgeon; the Patient was cured, and is now a man.  
A person wounded near the Vertex by a blow, sent for a Chirurgeon, 
A contused wound by a blow on the crown of the head.  who dressed his wound, the Patient going daily abroad kept ill hours, without any Consideration had of his wound, whether it was dressed or not. After seventeen days towards the full moon, coming from abroad home one morning, he felt his legs falter, and before he was got up stairs into his chamber his tongue failed him, his friends and servants put him into a bed and sent for me. They declared to me how he was wounded so many days since, and how he was seized with a Paralisis of his legs and tongue. I saw a necessity of laying open the hairy scalp, for the setting on a Terebra, I offered to go away that I might sand for some of my servants to help me: He apprehending that I was leaving him as deplorable, catched hold of me, would have spoken but could not: he made signs for pen, ink and paper, he endeavoured to writ but could not form one letter, he threw himself down in his bed, breathing out Jes. I prayed his patience, telling him I would return suddenly: but before I went I let him blood ten ounces, then hastened away, and returned again within an hour, and found that he had lost the use of his Arms. I considered the wound, and concluding a necessity of setting on a Terebra, and thereto having caused his head to be shaved, I made a circular Incision about the wound, and raised up the Calvaria with my Spatula, bringing the Pericranium smooth off. I both saw and felt the bone, but could discover no fault in it, with sponges dipped in Aceto I dried up the blood, and raised up with my Spatula the edges round from the bone, and with a fresh sponge dried up the blood, and looked again under them, but could discover nothing ill in the bared Cranium. I filled up the wound with dossils of dry Lint with my digestive over the lips, and Embrocated the parts about with Ol. Ros. and an Emplaster over the wound, and a cataplasm è Farin. Hordei, Flor. Ros. Rubr. ballast. in Vino Rubro, with Syrup. de Ros. Sic. & Ol. Chamomell. and bound it up. That day Sir Fr. Pr. gave him a Visit, and prescribed him a Clyster, with Cordials, Juleps, and what else he thought necessary. The next day was full Moon, at which time the brain is thought to rise high, and the Vessels turgid; wherefore I deferred the setting on the Terebra, contenting myself with the letting him blood again. All this while he was in a Fever, and deprived of speech and limbs; the next morning about ten or eleven of the clock in the presence of Sir Fr. Pr. Serj. pile, Mr. Arris and Mr. R. who thought himself concerned for his servant who had first dressed him, I took off dressings and looked into the wound: we found no fissure, however there was a necessity of the Terebra. Wherefore without delay I proceeded, and in order to it covered the lips of the wound with a fine Lawn dipped in Oil of Roses, & began to work with that Instrument commonly called a Trepan, which I much prefer, it being an Instrument that suffers you to turn lightly, and cut equally or how you please, without shaking or pressing so hard on the head: In the performing this or any operation amongst our brethren the standers-by are very apt to be teaching, one cries not so fast, the other thinks you move too slow, but of these I took no notice but proceeded, and brought out the bone, taking out the pin, when I came to the first table. You shall perceive yourself to be entering it, when you see the raspings change, or begin to be bloudish, from that time proceed very gently, and take out the head of the Trepan often, and cleanse it by a brush: The Bone out, I looked into the part, and see the Dura matter of its natural colour without Matter or blood, I dressed it up with a Sindon dipped in Ol. Ros. with a little Resina dissolved and warm; this way of dressing was objected against by Mr. R. as I expected. I smiled and dressed it up with it, and assured the Person that I would cure this Patient without applying any other remedy to the Dura matter than these two simplo medicaments: But withal was much unsatisfied in myself, that such grievous symptoms as loss of speech and limbs with a Fever should afflict the Patient, and yet no depressed bone or fissure, nor ought of Matter or Sanies appear upon the Dura Matter; this troubled me much, fearing some other place, or that the blood lay putrefied under the Dura matter. But I dressed up with a soft round dossil dipped in the same medicament, and placed it in next the Sindon lightly, and dressed the bone with linement Arcei, and continued the digestion to the lips of the wound, and my Empl. de Beton. madge. over all, I placed him down in his bed. Going presently out of this close room, where I was crowded up with great lights burning near me, into the fresh Air, I burst out with a violent coughing of blood, but the next day dressed the Patient again, and found his speech and limbs restored, but he was hot, and his pulse quick: I opened his wound and found all well, as I could expect: I dressed him up again as before with the same, and after I had bound him up, as is usual in these cases, I let him blood ten ounces, and gave order to repeat his Clysters, &c. From the first opening there came no more any of the surgeons; I retained the Chirurgeon that had first dressed him in his little wound, he dwelling near the Patient. After three or four days dressings these wounds digested, and all symptoms went off well: I then lessened the quantity of the Ol. Ros. and increased the Resina, and made good my word in curing him with these simplo medicaments. I deterg'd and incarned as firm and speedily by this, as any Sarcotick I ever used, and as the bones cast off proceeded to cicatrise, as in the former Patient, dressing the lips of the wound with my Basil. Vigon. adding a little Merc. Precipit. to it; coming one day after the Exfoliation of the bone my Patient was abroad, so from that time I left him to his neighbour-Chirurgeon to dress, but see him twice or thrice after at times, and dressed him then again; he was well cured, and remained well, and is yet so.  
I was called to consult with Dr. T. C. one of the Kings Physicians, 
A Concussion of the Brain.  in a Gentlewoman who laboured under a great pain between the Coronal and Sagittal suture, from a blow she had many months before received riding under a Penthouse. The blow stunded her, she was brought to London, was viewed by some surgeons of the City, who cured her wound, it being small, but from that time her pain was excessive, and now we were to consider what to do: Her pain seemed to arise from that blow, and we suppose the extravased and putrefied blood caused this pain, with a Vertigo; we considered the pained part, as she touched it with her fingers( the scalp was swelled thick) and proposed the laying open that part, which we thought necessary, but she would not consent to it: Other things were then proposed as Fomentations and cataplasms discutient, blistering, cupping, bleeding, purging, and such like, all which she submitted to, but without success. She then at last yielded to the making a Fontanel in this part affencted by a caustic, which I did, and by Dr. C. consent I made it to the bone, and so large as that I might afterward set on a Terebra; upon the cutting out the Escar there was neither fracture nor fissure; we rubbed the part with Ink, and rubbed it out again, no mark remained; I Rugined the bone, but all was smooth, I put some pull. Aloes, Myrrhae, and mastic upon the bone, and dressed the Escar with Basilicon. simple. cum Ol. Terebinth. to hasten digestion and separation of the Escar, and in few days it separated, but her pain still increased, with other indispositions which threatened her life, if something more were not done. Much unwillingly she heard of the opening this bone, but at last it was referred to old Mr. Arris, he is called in and approves of it, the thing is resolved upon, we met, I opened it with a Terebra, and find the Dura matter of its natural colour, but a scent from within, as in corrupt wounds of the brain; I dressed it up with Lenients as the former, viz. Ol. Ros. and a little Resina: Her pains still increased, she kept her bed, her pulse was all a-long weak and troubled; I dressed her again: Next day I find her wound digest which I wondered at, considering what ill symptoms she laboured under.  
The third day I dressed her again, and in the opening I find good digestion a beginning to incarn, a little read flesh sprouting up out of the Dura matter.  
The next day it was increased, and so the next: but then when I opened the next dressing after, I find the Calvaria sunk, the lips flat and little Matter, but it was of good colour, the Dura matter did seem no better, the little ruddy flesh was not increased, began to change the colour and look palish, I then left off the Ol. Ros. and added mell. Ros. to the Resina, with a little Pulv. Myrrhae, and a little Ol. Terebinth. and dressed the lips with my Basilicon. Mag. Vig. with precipitate and Ol. Terebinth. warm, laying over the bared Cranium lint dipped in a tincture of Myrrhae, Aloes, Rad. Aristoloch. Rot. Ireos, mixed with a little Extract. Scordii & Empl. Melilot. with a good compress out of a Lixivium, wherein was boiled some of the greater Cephalicks, as Flor. Anth. Beton. Magoranae, Origani, &c. But that night she was seized with Convulsions and a Sopor, and the day after the lips of the wound were without heat, & the flesh upon the Dura matter altered, and no hopes left. She dying within a day or two after, we would fain have opened her head, but she had forbid it in her life: I turned her head downward the next day, there did run from her nose a purilent Matter of a brown colour, with the same scent that was when I opened her skull: I do believe this putrefaction was from the corrupt blood extravased between the Pia and Dura matter, and at first by large bleeding and proper applications might have been relieved, and if here we had timely opened the Dura matter, this Matter would have there discharged itself; But this tender sex does not admit of that part of Chirurgery which consists in opening the skull or cutting their flesh, unless it be too late.  
A little girl was brought to me with a swelling upon the left Sinciput, 
A large Fissure, the Dura matter putrefied.  the breadth of about two fingers off the Temporal Muscle, about the bigness and shape of half a great French Walnut, and behind the Ear a little swelling: This greater swelling happened from a fall down a pair of Stairs some weeks before, but whether through ignorance or negligence the fracture was not suspected by them, though there was visible symptoms of a fracture or fissure, as vomiting oft, and great indispositions, with pains, &c. The Child even languished with it: I acquainted the Mother with the deplorable condition of her Child, and that the only way to relieve her was by opening that tumour wide, and afterward I believed there must be as much done to the Skull, that I feared through the not timely doing this, her child would now die. She prayed my help, and submitted to what I should propose; this tumour was soft, and without doubt replete with a Sanies, and the bones underneath fractured or fissured: The way had been in a stronger body to have cut this tumour round, and raised it off from the Skull, and so have made present way to the bone; but the Child was so weak, as I feared it might die under my hands, or if it did live, yet if after such a bloody work, if the Child should not be cured, the Mother would never forget my cruelty,( as she would call it) Wherefore in such cases I use to work in a more calm manner with that sex, and do that by an Emplaster, which in others we do with a Knife: To which purpose I applied my Ung. Catheraet. and with an Emplaster over it, the Mother bound up her Childs head, and carried it home: And about two hours after I called to see the Child, and found it had been very easy, these parts being of an obtuse sense, and the less sensible for that the skin was distended by the Matter; I took off the Empl. and found it had worked well, I opened it, and discharged about three or four spoonful of a filthy Sanies; I took off this caustic the sooner here, suspecting lest it should by longer lying penetrate through, and by its salts offend the parts within: Upon dividing this Escar the bone was seen bare, and by a Probe I felt it to the whole length; upon which I cut it open, and afterward a-thwart over, and then by turning the Escar aside, I see a long fissure the whole length of the tumour, running transverse over from the Temporal Muscle backward, the Skull very thin, yielding to the least pressure of my finger, as a piece of velum, so as I might have enlarged it with my Knife if I had thought it necessary. I laid the Childs head upon one side and dropped in a little mell. Ros. with a little of my Tincture of myrrh, Aloes, &c. as prescribed in this Treatise, and with Pledgits dipped in the same, lightly covered up the same bone, and with Pledgits dipped in Basilicon. with a little Ol. Lilior. and a little Ol. Terebinth. dressed up the Escar, and laid a cephalic Emplaster over all, and bound up her head, and thus dressed her daily, sprinkling my cephalic powder upon the bone for the space of many days. I see pieces of the Dura matter purge out, and hang in the fissure, and for some while a thin Ichor came out of the fissure; the Escar separated, I dressed the lips with Mund. Paracels. and the bone with my linement Arcei, dropping into the fissure the Balsam prescribed for these wounds by Vigo, pag. 105. Thus I proceeded, and happily cured this Child: The tumour behind the Ear and part about I Embrocated with Ol. Ros. warm daily, by which that tumour went off, it arising from this of the fissure; but about a year after this Child grew lame of her left Leg, and was strumeous: How I proceeded in this you may red in the Treatise of that disease, she being the product of a diseased Mother.  
A Gentlewoman falls with her little Daughter, a Child of half a year old in her Arms, 
A carries through the Cranium, wherein the Pericranium and Dura matter become one body.  the Mother is hurt, and the Child a little scratched on the left side of her head; it's viewed by a pretender to skill in such things, and slighted as inconsiderable; but from that time the Child grew indisposed and vomited often, especially after the receiving its sustenance, & as it grew able to speak complained of a pain in her head, and through her often vomiting she languished: After Ten years a small tumour appeared in that part of the head where it had been hurt by the fall so many years before: They now again consult and bring the Child to me, a very starveling; I viewed the tumour and felt in it a pulsation, which at first I thought an Aneurisma, but pressing my finger more into it, I felt the brain without any skull, the breadth of an old English shilling: This at first a little amused me, but upon consideration of the fall and symptoms succeeding, it was evident to me, that by the fall the skull was fissured; and being of a thin Cartilaginous substance at that time of her infancy, had been by length of time mouldered away, and from that Erosion the Dura matter inflamed, and thrust out from within; and by adhesion to the Pericranium had become one body; It is usual for parts inflamed to adhere to the next adjacent part: This I supposed the case: The presage here was a sudden death if the cure was not attempted, and in the attempting it she was in great danger: To begin this by a Circular Incision from the compass of the skull, was not difficult; but then to separate these two membranes, the Dura matter from the Pericranium, or this from that( they being become one body) was a difficult work even in a dead body, here in a weak Child much more, where the blood would be apt to blind me, and the impatiency of the Child would make it hazardous; this work requiring a steadiness: Then I considered of a caustic, and having predicted the danger either in leaving it to die by its malady after a few weeks, which was certain, or in attempting the cure doubtfully; I referred it to them: They had consulted before, and were not ignorant of the danger the Child was in by its disease; Therefore they readily put the care of managing this great work to me, and lodged it near me, in Suffolk-buildings: I presently caused the hair to be shaved off from about the grieved part, applied the most gentle caustic I could propose; and at such time as I thought it might have made its way in the Superficies of the Calvaria, I took it off, and with a Caustick-stone rubbed into the Musculous part of it; then I washed out the salts well with Wine first, then Milk, after that with warm Oil, then with a Knife I cut into the Eschar, and Embrocated the part warm, and dressed it up with Ung. Basilic. with Ol. Ros. and applied my Emplaster over all, and rolled up the part with good Compress and Bandage: that night she was seized with a fit of Convulsions, Vomited, and was very ill; Dr. Fisher was sent for, he prescribed her a Cordial-Julep, proper in that her case, and relieved her: The next morning I took off dressings to look upon the part, and raised up the hairy scalp round from the skull through my Eschar, which gave the wound a breathing, and discharged a little Ichor; from this time her vomiting ceased, she had no more Convulsive fits, she began to be more lively than in Ten years before: We kept her in bed warm and close, with a slender diet, allowing her only Spoon-meats: Her Physician took care in what concerned her health by Internals: I proceeded to hasten digestion, and by Fomentation and the like to cherish the native heat of the part, and as the Calvaria separated, so I endeavoured digestion sometime, otherwhile detersion interchangeably; as the one medicine corrupted, so the other deterg'd: It was a nice work to separate the Pericranium from the Dura matter, but I happily effected it, while the latter slough was separating, the Callus rising up in the mean time: The Patient being free of all the former ill symptoms, and brisk, and in a sure way of recovery. I invited Sir Charles Scarborough and Dr. Walter Needham, who did me the honour to see her. It was a rare case, not mentioned by any Author, nor scarce to be seen again: Since that time the bone Exfoliated, the Dura matter incarned, and the wound cicatrized and contracted to a very narrow compass. The Child returned to her friends perfectly in health, is a witty girl, but it's doubted she will be but a dwarf.   

An Additional discourse of Wounds of the Brain.  
THE greater symptoms that are usually said to attend the Wounds of the Brain, 
Uncertainty of symptoms in Wounds of the Brain.  do show themselves more uncertainly than a speculative Chirurgeon would imagine. And in Cuts or Wounds made by sharp weapons, or sudden strong force more uncertainly than in Contusions, Concussions, & Depressions of the Skull. The highest of them, viz. Vomiting, Stupor, loss of speech, with a Paralysis of Legs and Arms arising more suddenly in these latter cases, than in the former. These symptoms have appeared in one of the forementioned Observations, where there was nothing of fissure or extravased blood seen upon the Dura matter, after the Terebration or Perforation of the Cranium. Nay, we see many die suddenly from a box of the Ear, and from small blows or wounds: In some upon opening the Cranium there is much blood extravased, in others none at all, or ought else that may be thought to have killed the Patient.  
A Young man from a blow with a Cudgil upon the forehead, presently takes his bed, becomes delirous, a Sopor follows, and after some days he death. I am sent for to see his head opened; in laying open the forehead, I see a small hair-like fissure, running from the great Canthus of the eye upward: we took off the skull and Dura matter, and found but little blood extravased, the Pia matter as little altered. Others I have been called to see opened, where there had preceded only a contusion of the Calvaria, without fissure or extravased blood, more than is usually seen in every opening, or taking off the Cranium: yet the Patient lay, as I am informed, under all those symptoms of Delirium, Coma, &c.  
Then again I have dressed many that have been cut through the skull, the shivers of bones and pasht flesh, and hair lying upon the Dura matter, yet the Patient without any symptom of such a wound; some whereof you have red of in this preceding Discourse, 
Observation.  some other I shall instance. At Sterling Mr. John chase was present, when a poor Servant-maid came to me to be dressed of a wound she had received on her head by a musket-shot, in the taking of Calander-house by the enemy; there was a fracture with a depression of the Skull: I set on a Trepan for the elevation of the depressed bone, and for discharge of the Sanies: She had laboured under this fracture at least a week before she came to me; yet had none of those symptoms afore-mentioned, but after perforation, and raising up this depressed bone, and dressing the wound, she went her way, and came daily thither to be dressed, as if it were only a simplo Gun-shot wound of the hairy scalp: Mr. Penycuke an eminent Chirurgeon of that Nation did assist me in this work; I think the Brain itself was wounded: I left it in his hands, who I suppose finished the cure.  
At the beating up of some of our out-guards near Truro, the enemy pursuing them, a Trooper wounded between the Right Brow and Ear, on the Sinciput; espying me amongst the flying crowd, importuned me earnestly to dress him; he would admit of no excuse, we stopped at an Apothecaries house on the right hand, going out of the Town towards Perin. I called to the Apothecaries servant to bring somewhat to dress him, 
Observation.  in the while hastily I lifted up the bloody hair, and see a quantity of the Brain lie among it, I took it up with my fingers, and shewed it him, the sight whereof calmed his passion, whereby I had liberty to fly from the Enemy who was entred the Town. Here the prognostic was certain, yet none of those cruel Symptoms which accompany Concussions or lesser fissures.  
From battles and Sieges of Towns and garrisons, we meet with many such wounds; 
Manner of dressing the Brain.  in them we hasten our way to the Extraction of the Extraneous bodies, by cutting off the shattered calvaria first, then pulling out what ever was carried within the Cranium; if this be well performed, we then dress up the Brain and Membranes with a Sindon of Silk or soft linen, of a bigness proportionable to the wound; this is dipped in a warm digestive, such as is proper for the wounded Membranes, for however surgeons have proposed to dress the Brain with one kind of Medicaments, and the Membranes with another, that is not possible to be so done, but that the Membranes or meanings will be washed with the same Medicaments, and if they be offended by that Acrimony, Inflammation, Fever, Delirium and death will the speedier follow: In the Cure of these wounds of the Brain, I do consider the Brain as an Insensible body, and that their cure consists in keeping it within its Membranes, and dressing them as wounds of the Membranes with Lenients, &c. if this can be done, as in small wounds of the Brain it doth sometimes happen,( and the better if the fracture of the Skull hath not been very large,) then the Patient may recover.  
But if the fracture in the Skull be large, and the wound in the Brain proportionable, that the Brain cannot be contained within, then it corrupts by the external could, and gets between the meanings, and offends them by its putrid Acrimony, whence Convulsions, Palsies, and other ill accidents follow, and death. They sometimes live until that Lobe be consumed, or hath wrought itself forth; as for Instance,  
At the Siege of Mellcome Regis, a foot-souldier of Lieut. 
Observation.  Coll. Ballards by the grazing of a Canonshot, had the fore-part of his head carried off, and the Skull fractured into many pieces, driving some of it with the hairy Scalp into the Brain: The man fell down as dead, but after a while moved, and an hour or two after his fellow Souldiers seeing him endeavour to rise, fetched me to him. I pulled out the pieces of bones, and lacerated flesh from amongst the brain, in which they were entangled, and dressed him up with soft folded linen dipped in a cephalic Balsam, with Empl. and Bandage bound him up, supposing I should never dress him any more. Yet he lived 17. days; and the 15. day walked from that great corner Fort over against Portland to the bridge, which separates Waymouth from Mellcome Regis, only lead by the hand of some one of his fellow Souldiers; the second day after he fell into a Spasmus and dyed, 
N. B.  howling like a dog, as most of those do who have been so wounded.  
About the same time a maid servant was shot into the right side of the Sinciput by a Musket bullet deep into the Brain, she lived as long, viz. until the Lobe of the Brain was wrought out or corrupted.  
At the siege of Taunton one of Coll. John Arundell's men in Storming the Work was shot in the face by Caseshot, he fell down as dead, and in their retreat was carried off amongst the dead, and laid into an empty house by the way until the next day, when in the Morning early the Coll. marching by that house, heard a knocking within against the door, some of the Officers desiring to know who it was, looked in, and saw this man standing by the door without Eye, Face, Nose or Mouth: The Coll sent to me,( my quarters being nearest) to dress the man, I went, but was somewhat troubled where to begin; The door consisted of two hatches, the uppermost was open, and the man stood leaning upon the other part of the door which was shut, his Face with the Eyes, Nose, Mouth, and forepart of the Jaws, with the Chin was shot away, and the remaining parts of them driven in: one part of the Jaw hung down by his Throat, and the other part pasht into his Throat; I see the Brain working out from under the lacerated Scalp from both brows, I could not see any advantage he could have by dressing, to have cut away the lacerated parts here, had been to expose the Brain to the Air; But I helped him to clear his throat, where was remaining the root of his tongue: he seemed to approve of my Endeavours, and implored my Art by the signs he made with his hands. I asked him if he would drink, and proposed a sign by the holding up a finger, which he presently held up and immediately both his hands expressing his thirst, a Soldier fetched some milk, & brought a little wooden dish to pour some of it down his throat, but part of it run down on both sides; he made signs to have the dish in both his hands, they gave it him full of milk, he held the root of his tongue down with the one hand, and with the other poured it down his throat,( carrying his head backward) better than I had done, and so poured down more than a quart; After that I bound his wounds up, the dead were removed from thence to their graves, and fresh straw fetched for him to lye upon, with an old Blanket to cover him, it was in the Summer; there we left that deplorable Creature to lodge, and while we continued there which was about 6 or 7 dayes, all that while he was dressed by some of the surgeons with a fomentation made with our Vulnerary decoctions, with a little Brandy-wine in it, then with Stupes dipped in our common Suppurative we bound him up.  
I could tell you of many wounded into the Brain, but do think these may serve to prove what I would declare of them, viz. that the Brain is of itself insensible, that those symptoms which accompany these wounds proceed from the pain which the meanings, Dura and Pia matter suffer: which if oppressed by extravasated blood, or a depression of the Skull, do quickly suffer the greatest symptoms, as Vomiting, Stupor, Paralysis, &c. much more if they be pricked by any spill of a Bone, or other Extraneous sharp body. When the Brain itself ouzeth out between them in the manner already mentioned, it is a mildred soft substance and lenient to them, so that the accidents appear not till that begins to corrupt between them, and with it the Membranes themselves putrifie, upon which their follows Convulsions, Howlings, and a sudden dispatch of the Patient. From which very Observation, may be seen the folly of dressing these wounds with powerful desiccatives, which so far as I could observe, did hurt the Membranes, but never either digest or Incarn the Brain. According to Hip. non Coalescet, but as it gets liberty, works itself forth like unto Barme, and as I have said corrupts, and the meanings suffering from that putrefaction, Spasmus follows, and the Patitient dies; At Sea these Patients wounded in the Brain died presently, we having no conveniency of lodging them, or dressing them so warm as they require. In the wars my employment did not permit me to see the finishing of their Cures, and here in my practise in and about the City, I never was called unto any such wounds, therefore must leave that to others to treat off: But by what I have seen from them heretofore, their Cure consists in dressing them, as in wounds of the Dura matter, and in keeping the Brain within its membranes, without which no Incarnation can be made on the Membranes.     

OF Gun-shot-wounds. PART II.  

CHAP. I. Of Gun-shot in General.  
GReat hath been the Contention amongst the Learned about fire and venom in Gun-shot-wounds; 
Gun-shot wounds, whether fiery or venomous.  some maintaining the one, some the other to be in them; and others defending, that there is neither. That which I suppose might be the occasion of their suspecting Empyreuma, and a Venefick quality, was the deadly colour of these Wounds; which in those early dayes, when the Invention of Guns was novel, surprised them; they being not unlike poisoned and burnt Wounds. Where the Bullet pierceth, it extinguisheth the natural heat, and the lips of the Wound are livid, or blackish, and if not dressed rationally, it inflames round about, from the afflux of humours, and hath ulcuscula, with a fetid smell.  
In this condition the Wound is the first day, and so to the seventh, and( if not succoured) it gangrenes, and so the Patient commonly dyes. If in those dayes the Learned thus deceived by their aspect, dressed them as venomous Wounds, it will be no marvel that they should writ so of them: I verily believing, that in their way of treating them, they were directly as poisoned Wounds, difficult to digest and cure.  
In these our times, although they do not call them venomous, 
Errors in dressing Gun-shot-wounds.  yet it is the hardest thing in the world to dissuade many of our chirurgeons from dressing these Wounds with Tinctures of myrrh, and Honey of Roses, and thrusting in of great Tents, by which way of dressing, I have seen these Wounds, undigested the tenth day, one whereof was in the Cheek, with dry and flaggy lips. These lesser fleshy wounds, being undigested, at last gangrene; and in truth it is not to be wondered at. I will undertake to show you the Experiment every day; and that in a Fontanel or Issue, made by a caustic.  
Cut you through this livid or black Escar, and put a Pea in the middle of it, with Tincture of myrrh and Honey of Roses, as I have seen some of them dress Gun-shot-wounds, and the next day, or two dayes after, when you dress it again, it will be to your sight not unlike a Gun-shot-wound; continue your dressing it with a Pea, and with your Tincture of myrrh, and if it do not gangrene, yet it will be Inflamed, and slow in digestion. And this is from the improper application in the dressing it. For if you dress this Escar in the Fontanel, with Emollients and Digestives, as you ought to do the Escars in Fontanels, the Escar will separate with digestion, in the worst habit of Body. And so it will in Gun-shot-wounds, with little distemper or difficulty, if you have timely extracted the extraneous Bodies. But a discontinuance in this kind of Chirurgery, makes us apt to forget ourselves.  
Thus at our entering into Worcester, 
Observation.  when the King came out of Scotland with an Army of that vallant People, a Townsman was shot. A Pistol fired by the Cheek, shot him through his lower Jaw and Tongue, and out by the contrary Cheek, the chirurgeon of the Town a good chirurgeon, upon sight of it, concluded it Gangreened from the black colour; and declined the dressing it the way he rationally ought; upon which the part grows exceedingly painful, and inflames and Gleets with great tumefaction. After two dayes, I am called in, and by lenient Medicaments and good Bandage, keeping up the fractured Jaw, allayed the pain and digested the Wound, leaving it in the same surgeons hands, who cured it. In this person, the Wound was burnt by the flamme, the very powder sticking in some parts of the Cheek. This, with the putrefaction from the hot weather, contributed to our Brother surgeons apprehension. It is this ugly aspect that puts the inconsiderate Chirurgeon out of his Method, and so makes Gun-shot more difficult of cure, which otherwise would digest, and heal as easily, as any complicated Wound, as I shall make appear in this following Discourse.   

CHAP. II. Cure of Gun-shot-wounds; and First of Extraction of Bullets, &c.  
WOunds made by Gun-shot are, Implicatissimum morbi Genus; The most complicate sort of Wounds that can be inflicted. For they are not onely a solution of continuity, but have joined to that contusion, Attrition and Dilaceration in a high and vehement kind. To this we may add all sorts of Fractures and Accidents, as Hemorrhage, inflammation, Erysipelas, gangrene and Sphacelus; besides the extraneous Bodies, which are violently carried into the Wound. And multiply Indications ex compositis, affectibus, non unica elicitur Indicatio, said plures pro diversitate morborum. The number of the Indications in compound, 
Compound intentions.  affections, must answer to the variety of disturbances, were it a simplo Wound, the cure of it would presently be performed( as you have red in the preceding Treatise of simplo Wounds) per Astringentia & exsiccantia, by such Medicaments as are of an astringent and drying quality: The cure of a Wound is the exsiccation of it; but here is always joined with these that which Indicateth the use of Emollentia, digerentia, & suppurantia, according to that of Hippocrates, Omne quod contusum est, necesse est ut putrescat, & in pus vertatur; What is contused must necessary putrifie, and be turned into matter.  
That which is fretted and torn must also be reduced to the whole, or cut off, 
What is torn is to be reduced to the part, or cut off.  before your ordinary intentions of Incarning. Moreover, in these Wounds, not onely the Bullet itself is ordinarily lodged; but many times other strange Bodies are carried along with it. For extraction of which, judicious care and industry are required in you; Here in these recent Wounds, we very rarely have a flux of blood, though the Veins and Arteries be wounded; they commonly lye quashed in the contused flesh, until separation of the Escar, and about that time when you least think on it, they may burst out violently. I have seen it thus often break forth; 
Haemorrhagy.  but if such Vessels do bleed upon the receipt of the Wound, and interrupt you in drawing out the Extraneous Bodies, you must endeavour to suppress the blood, for thereupon depends the Life of your Patient. But withall so proceed, that you may extract the Bullet first, and then be careful that in the restraining the bleeding, by your crowding in Dossils, and strict Bandage, you bring not on a Mortification. 
Observation.  Such a Hemorrhage happened to a soldier at the surprise of Weymouth, by the Garrison of Portland; he was shot through the Heel; for the restraining of bleeding, I applied my endeavours. But after all, I was put to the use of the actual Cautery, which I did successfully, and have since seen Botallus authority for it: Tutius enim est( saith he) eam Ignito ferro constringere. 
Anodynes  Pains are here to be appeased by Anodynes, but you must well consider the application, least you extinguish that small remainder of heat that is left. How you shall deal with all these Inconveniencies, and not add one evil to another, I shall plainly deliver to you. And first, what must be first put in execution, which is the extracting of Bullets and other Extraneous Bodies.  
The Part is at first dressing, 
Dress presently, during the heat of Battle.  with what diligence you can, to be cleared of all such foreign Bodies, as have made violent Intrusion into it, while the Patient is warm with the heat of Battle, and the Wound fresh, and very little altered, by either Air or Accidents, so that less pain must necessary follow upon the Extraction.  
In the Armada Naval de Dunquerquo, where we surgeons were oft employed in this Service, we after every fight went together, visiting one anothers wounded men: Amongst us it was thought a great shane if any thing of this work of Extraction were then to be done. For after the first and second day the Wound proveth tumefied, 
Necessity of it.  all the neighbouring parts are inflamed and changed so in their temper, that they conceal from your sight both the Bullet and his Companions, that the place they are couched in can hardly be known; or being discovered, you cannot without hazard of your Patient, or great trouble of the Part, make extraction of them.  
And yet if the Wound be near a joint, or the Shot lodged amongst the Tendons, it is much to be feared the pain will not off, until those strange Bodies be drawn out; consequently the omission of that extraction, will bring Mortification, which hath been the cause of the death of many a brave soldier. And is the cause of all the mischief these Wounds are subject to, as Pain, Inflammation, Spasmes, Convulsions, gangrenes, Sphacelus, what not? Every battle produces Instances of it to the discredit of our Profession.  
But if the Bullet be lodged in a less noble Part, as in Musculous Flesh, you may with more ease content yourself, unto the seventh day, or until the fierceness of the Accidents be over, and the Wound digested. But withal, it will require more care, for the Wound will be more painful, and slow in digestion then otherwise it would be; yet by the confession of those that allow fire and poison in it, the Bullet may ly long there, and do little harm; nay, I suppose there are not many, but have heard or seen of Bullets that without grievance to the Patient have continued, lying long in fleshly parts of wounded men. Conceive this spoken of Leaden Bullets, for Iron or Brass cannot( by reason of their aptness to rust) remain without doing harm; however let nothing of this encourage you; for the Bullet pierceth not any part, without carrying rags along with it, which corrupts in the Wound, and makes Apostemations and prolongs the Cure, as must needs be observed by all men in their practise.  
The Servant of a Noble man, 
Observation.  was wounded and shot in the thigh by High-way men, the Bullet not having been drawn out by his Country Chirurgeon at the first dressing, could not be drawn out by me at the second, but occasioned great pain with inflammation, great heat and watchings: Although he had many other considerable Wounds upon him, to make a derivation; yet was his Gun-shot more vexatious then all the rest, until I extracted the Bullet and rags carried in with it, yet this was but a Pistol Bullet. But after I drew out this Bullet, my digestion became good; and by equal Bandage, with gentle compression of parts, I united and healed it in ten or twelve dayes, which I doubt would not have otherwise been cured in three moneths.  
Nay, while any of the rags remain in the Wound, it will never cure, but the Extraneous Bodies drawn out, there is little difficulty in the curing these simplo Wounds; if dressed, as I shall here following show, but if handled, as some have lately taught, they are as so many poisoned Gun-shot-wounds.  
Now for the taking out of the Bullets, 
Two methods of extracting Bullets.  and other Extraneous Bodies, there are two Methods; 1. One to extract them by the way they went in; The other to open them a way, by which they would, if their force had not failed them, have passed themselves through.  
For to take them out the way they were forced in, you must place the Patient, 
1. The way the Bullet went in. Methods of search.  as near as he can guess in the posture he was in when shot. And, if by reason of his weakness or other Infirmity, he cannot without prejudice, be so situated; let him be laid in a position which may as nearly answer it, as may be; Least some part of a Muscle, Tendon, or Ligament, obscure what you desire to make manifest. Then make search for it with your finger or probe. The Figure of these Wounds is always round; the Bullet forces the Flesh in with it, and its entrance presently contracts closer; but itis going out is more lax; you may guess by view of the Wound, the largeness of the Bullet, and comparing the Figure with that, make choice of a fit Instrument for extraction, whereof you ought to be always well furnished. Your main care in this work is to find out the Bullet, which if you fail of by searching into the Wound with your Probe: Then you are to feel the parts about, it being wonderful to consider how these Shots do twirle about, at least seem to do so, when the posture is changed in which the Wound was received.  
As for Example; A man hath been shot in the Cheek, and I have cut out the Bullet behind in the Neck: A man shot in the outside of the small of the legs, the whole Member unmeasurably swelled and inflamed, no possibility of finding it out either way; at last by chance, I felt it in the inner side of the Thigh above the Knee. And so another being wounded in the outside of the arm, I have cut out the Bullet below the Scapula; If the Bullet have not been in so long( as in some of these cases) that the parts are extremely pained with inflammation and tumour, the pain where the Bullet lodges discovers it.  
A common soldier shot in the Breast through the Sternon, 
Observation.  lay roaring very grievously, complaining of the pain of his Back. I was fetched to him; and turning him on his side, I saw the Bullet lie like a small when or Scrophul, thrusting out under the Skin, not far from the spin. I made Incision over it, according to the length of the part, and thrust out the Bullet as easily as I could desire. I dressed it, and the soldier ceased his crying, and acknowledged before us, his pain was from the Bullet in the Skin. For indeed the Lungs and other internal parts, are seldom sensible of pain, when wounded through; they discover their hurt by other symptoms. The common soldier dyed, as most do that are shot through the Lungs.  
If in your searching for the Bullet, you light on the part, though there be no Extuberance, or ought to be felt, yet his pain there, will be a good sign for it; if no accident occasioned that pain. Make your way there by Incision, avoiding the Vessels, and take out the Shot, and what else offers itself; by this you do both quit the part of its troublesone Lodger, and withal make way commodiously for discharge of matter, which in regard most of these Wounds are Sinuous;( the Bullet turning aside, when it is hindered in its journey forward) for want of discharge might in those places occasion fistulas and hollow Ulcers, not without ill quality.  
In the work of Extraction, 
Caution.  take great care you lay not hold of some Nerve or Tendon, and so pluck them along with the Bullet; for by so doing you may cause intolerable pain and grievous accidents; you must therefore neither open nor dilate your Instrument, until you may take hold of the Bullet, without any of the circumjacent parts.   

CHAP. III. The first dressing after Extraction.  
AS soon as you have made a separation of these Extraneous Bodies, if you judge the Wound to be so well conditioned, that there is neither sear of Putrefaction, nor Mortification,( as in recent Wounds there is not;) 
First dressing after Extraction. ) Be not discouraged at whatsoever evil aspect it hath at present; but consider itis Livid colour to be natural in the Wounds, when the Contusion is not simplo in the Skin, but through Flesh and all, as far as the Bullet hath entred, depriving parts of their sense, to the very bottom, and hath the colour of a gangreened or poisoned Wound. Therefore I pray disturb not your thoughts; but having taken out the Bullet, dress it up as a contused Wound, with Ol. Catulor. as hot as the part will bear, not giving credit to any that shall persuade you to the contrary; And it is thus made.  
℞. Ol. lilior. alb. lb vj. boil in this two new whelped Puppies, until the flesh fall from the bones, then add Lumbric. terrest. in vino lotor. lb j. boil these a while, then strain it by a gentle compression; to the strained liquour add Terebinth. ℥ iij. sp. vini ℥ j. reserve this for your use. Or this;  
℞. Ol. lini, Canab. an. ℥ iiij. Ol. lilior. chammeli an. ℥ iij. Terebinth. ℥ j. m. s. A. Or this;  
℞. Terebinth. opt. ℥ iiij. Thuris Mastish. an. 
See of Apanci in simplo Wounds.  ʒ iij. Myrrhae ʒ j. Ol. Aparici ℥ ij. Ol. lumbric. & sambuc. an. ℥ iij. m. ℞. Ol. olivar. lb j. Terebinth. lb. ss. Gum. Elemi ℥ ij. aeruginis pull. ʒ ij. Or this;  
℞. sp. vini lb ss. Terebinth. lb j. Ol. Hiperici & lini an. lb ss. sang. dracon. subt. pulveris ℥ j. m. s. A.  
With this I cured a servant of A. D. shot into his hand, this digested the Wound, 
Observation.  after separation began, I felt part of a bone bare, which I dressed with Extrac. scored. dissolved in Mell. Ros. with which I deterg'd, and feeling no more of the Bone, I incarn'd and cicatrized with ung. Tut. &c. in few dayes without any difficulty, Linement Arcei with any of the above mentioned oils is very good, adding a few drops Ol. Terebinth. which by its subtlety penetrates, and by its heat rouseth parts, and putteth them upon digestion and hastens separation.  
Quercitanus proposes this. ℞. succi herbar. Tussilag. oxalidis an. ℥ iij. Caricas ping. Nxx. Thur. ℥ ij. rosin. laric. ℥ ij. ss. Axungiae Gallin. Anscrin. an. ℥ ij. Butyri recentis lb ss. Olci visis pomorum compost. lb j. put this altogether in a Vessel close stopped, boil them by a gentle heat the space of six hours, then strain them out hot, and evaporate them to a good consistence: Or this;  
℞. Cerae novae, Resiuae, picis naval. an. ℥ iiij. seu Hircini, medullae, cruris, vitulini an. ℥ ij. aesypi, ℥ j. Ol. olivar. aut lini, lb j. liquefactis omnibus transcollatis, F. ung. quod reservetur ad usum. He adds a ʒ j. of praecipit. to every ℥ of this. But this in recent Wounds will not be necessary; for you will find by Experience, that these Wounds will digest and suppurate( and that frees them from putrefaction.) Nor will it be always for your Credit, if you consider the quantity of Balsomes we use in such Wounds, and the prejudice some people have to the use of Mercury; yet precipitate & Axungiae with a few drops of the Terebinth, was a common Medicament among us. But I refer that to you, it being a good Medicament to hasten separation of the Escars; you are to dress up these Wounds lightly with a proportionable soft Tent, and Plegdits dipped in some of these digestives very warm, not to scald parts. After that Embrocate the parts about with such like.  
℞. Ol. Lumbricor. Ros. Myrtill. an. ℥ iij. Aceti cochl. ij. mix them; in the first dressing, your Applications over the Wound and parts circumjacent, should be such as have Vim Astringendi & Intercipiendi, to hinder the flux of humours, and strengthen the part, take farinae hordei & fabar. an. ℥ vj. Ros. rubr. Bacc. myrtill. an ℥ j. s. sem. Cydon. ʒ vj. boil these in Posca, to the consistence of a Cataplasm, adding at last two new laid Eggs, with oxymel ℥ ij. ss. Apply this over the Wound and part; if you apprehended this too heavy, you may add Ol. Myrtill. & Ros. and Wax as much as is necessary, and make it into the form of a cerate; and above the Wound lay one of the defensatives, of which, or the like, you may have always ready by you.  
℞. Bol. Armen. ℥ iiij. Terr. sigil. ℥ iij. sang. dracon. ℥ ij. Corn. Cervi. Ust. or burnt bones ℥ ij. ss. our Juice of Sloes dried, an. ℥ iij, Cerae ℥ iiij. Ol. Ros. & Myrtill. an. ℥. vj. Acetis ℥ xij. boil these to the consistence of a cerate, add four whites of Eggs. Or this;  
℞. Pulv. Ros. rubr. Bacc. myrtill. an. ℥ j. Bol. Armen. Terr. sigil. an. ℥ vi. succ. plantagin. solan. an. ℥ ij. Aceti opt. ℥ iiij. Ol. Ros. & myrtill. an. ℥ iiij. cerae q. s. m. Apply your Compress, dipped in Aceto or oxycrate, let your Bandage be put on equally and gently, to retain your dressings, and hinder the Influx of humours.  
Having thus dressed the Patient, 
Bleeding.  presently consider of letting of him Blood, to prevent ill accidents, and especially if he lost little or no Blood from the Wound, and that there be a Cachochymia, Revulsio enim quae è directo sit, celerrimam utilitatem adfert. Galen. de sang. Missione.  
A glister should preceded Phlebotomy, 
glisters.  made of the decoctions of mallows, Violets, Beets, Mercury, Bays and Juniper-berries, with Ol. of Linseeds, honey of Roses, Hyera Picra, or Elect. lenetive. But if you have not this in readiness, make your glister with the broth of Flesh, Ol. Chamom. Sugar, and the Yolk of an Egg, and a little Salt, if your broth be not salt, or salt-water, or broth out of the Kettle, with a few flowers of Chamom. boiled in it and strained; adding a little Butter or oil, and read Sugar, is a good glister in time of need.  
Then you are to prepare some Cordials to resist the putrid vapours, 
Epithema  you may also fortify the spirits if there be need, by some Epithema of your distilled Waters; as Balm, Bugloss, Acetum, Ros, with the Powder of the roots of tormentil, Scordium, Scorzonera, Contrayerva, Treacle, Mithridate, &c.  
And with these you may make Cordials also, 
Cordials.  adding syrup of Citron, Gilliflowers, confect. Alkermes, and for your Common people, an. ʒ j. of Treatle or Mithridate in white-wine dissolved; for the better sort, take Aq. Bugloss. Cinamom. an. ℥ ij. conf. Alkermes ℈ j lapis Bezoad. occid. gr. xxij. sir. Citri cochl. ij. m. for an Epithema.  
℞. Aq. Melessae borage Bugloss. an. ℥ ij. Aceti Rosat. ℥ j. species Diarhodon. ʒ j. Croci ℈ j. As to their manner of diet hear Celsus, Lib. 2. Cap. 26. 
diet.  Ubi aliquis grave vulnus accipit à cibo tantum abstinere debet, quantum vires patiuntur, adco tenuis esse debet dycta, ut vix sustineatur; In great Wounds it is necessary to observe a spare diet, as barley Gruels, Panadoes, thin broth, or a poached Egg, this much availing to the preventing of Inflammation. But in this the Patients custom must be considered, also the Air must be temperate, and dress not in the Air, frigidum enim inimicum vulneribus, could is an Enemy to Wounds: rest is also required as well to the mind as the body. Therefore having thus dressed him, and laid him to rest, with ʒ vj. sir. de Miconio, with cochl. ij. aq. Cardiacae, in ℥ iiij. aq. papaveris.  
We are now to proceed to the second days work, 
The 2d days dressing.  and we are here to consider the habit of body, and more particularly what concerns the Wound. And in these Gun-shot-wounds it may be convenient the Body be gently purged by Lenitives only, as is formerly said; Purgatio enim per alvum plerisque vulneribus prodest, you thereby carrying off the bilous and serous humour, which from their heat and tenuity, are most apt to ferment and slow into these wounds, and cause Pain and inflammation, and other ill symptoms. In which cases use Cassia, Manna, Tamarinds, sir. de Cichor. cum rhubarb. Ros. solut. These are lenitive, and may be taken in Whey or Ptisan, and are fit to prepare the humour.  
But as for stronger Purgatives, 
Purging  hip. saith well, Cocl a sunt purganda non cruda, which is more especially true when you speak of Scammoniate Medicines.  
Having this proposed a general way of purging, you must consider the necessity of your particular case; we shall now again prepare our dressings, and look into the wound, and apply such Medicaments as may be fit for the quality thereof: And now it is necessary your Fomentation be ready, where-out may be wrung a hot stupe; to which end,  
℞. sumitat. Hiperici, Contauri, Scordii, 
Fomentation.  Absinth. an. m. j. Flor. Ros. Rubr. Chamom. Mililot. Sambuci, an. m. ss. Furfuris p. j. coq. in Aq. Fontan. ad lb ij. ss. colat. add vini Austeri lb j. sp. vini ℥ vj. st. Fotus: These will give a breathing to the parts, and defend the Wound from the Air while you consider it. If all be well, proceed with the same, but if it be accompanied with pain, foment with this ♃ decocti Rad. Althae, malvar. fol. verbas. Chamom. Melilot. sem. lini. faenugraeci. boiled in Sheeps-head-broath, 
If pain.  or other; and of the faeces of this Fomentation you may make a Cataplasma, adding farinae hordei lb ss. sem. lini. Cydonior. pulv. an. ℥ j. ung. Basilic. & ung. Dialthae. an. ℥ j. aux. porc. yet. qs. Croci ℈ ij. four whole Eggs, and apply it over all, or the former Cataplasma. It cherishes the heat of the part, furthers suppuration and is Anodyne. You are to make the Bandage as before, and continue this way of dressing to the seventh or ninth day, until you have digested the Wound, and the Escar is separated, and that you have laudable pus( as you are wont to call it) which is Album, aequale, leave & minimè foetidum, Equal, white, light Matter not soetid or ill scented; then we must seek for other kind of succour, which may restore the wounded part to its former sanity.  
If after separation of the Escar parts be not well digested, or want detersion; ♃ succ. Agrimon. Centaur. min. plantag. Apii an. ℥ j. Mucilagin. hordei ℥ iiij. boil these together; adding Terebinth. venet. ℥ iij. mell. come. ℥ ij. farinae hoard. cribratae ʒ iij. Croci pull. ℈ j. ft. mundificativum: To this you may add Aloes, Myrrhae, Sarcocol. Rad. Aristoloch. Gentian Ireos, for the Incarning these Wounds: If you desire rather Injection, the same Ingredients may serve. But in the use of Injections do not stop the Orifice to keep the liquour in, for you so distend the Ulcer and make it more sinuous.   

CHAP. IV. Of Accidents befalling Gun-shot-wounds, and of Sinuous Ulcers.  
BUt from the first to the eleventh day, many Accidents are wont to happen to these Wounds, which not onely impede the Cure, but often, without timely help, destroy the Patient. And these are vehement Pain, inflammation, Erysipelas, and other deadly Accidents, as gangrene and Sphacelus, all which take their beginning from inflammation. Therefore I have elsewhere particularly treated of inflammation and Erysipelas, that you seeing what it is may in its beginning prevent its increase: It commonly proceedeth from a very ill habit of Body, or from the ill handling of these Wounds in the beginning.  
The remedy is to prevent the Influx of more humours, & evacuate that which is already fallen into the part. The first way is by bleeding largely and purging, both which are directed you in the first dayes work, if you omitted that then, you must perform it now.  
The second way is by Externals; and that is by Anodynes, which may mitigate and repress the heat of the part; as also by Discutients and Concoction of the matter in the part affencted; which is performed by those Medicaments which were proposed in the Cure of the Wound, with observation of diet, &c.  
The Prevention and Cure of these, with the manner of handling them, you may see more particularly in the Treatise of Phlegm and Erysipelas, how in the beginning it is to be done with Refrigerants and Repellents; and in their state by moderate Calefaction and Discutients: and afterwards by Dissipants and higher Discutients, to which Treatise I refer you.  
The next and most cruel symptom, 
gangrene  is Mortification of the part, which so often attends great inflammations; and is shrewdly to be suspected, when they yield not readily to Discutients or Suppuratives. In their Wounds it happens most commonly through a Suffocation of the natural heats of the part; or through the great concourse of humours, or too refrigerating and repellent applications, in the time of great inflammations and Erysipelas, which have enfeebled and hindered the transitus of Spirits into the part. It is perceived by the change of colour, it begins to look Livid, the lips grow flaggy, the tumour sinks, and it gleets and is blistered, and blew spots after a while appear.  
When you see such a change begin, you must presently prepare to withstand a Mortification by Scarification, until the blood come, not onely about the lips of the Wound, but deep into it through the Escar to the quick, and suffer it to bleed freely, and make the party sensibly feel, that by such means you may disburden it of part of what would have choked it, and make way for the entrance of the force of the Medicine.  
Then foment the part with a good Lixivium made of Ashes and Salt, with acet. vin. in which you may boil scored. Absinth. centaur. and such like; and after Fomentation wash the scarified parts, and dress the Wound with Aegyptiacum, theriac. venet. dissolved in sp. vini, adding Calcin. vitriol. &c. and a Cataplasm of farine, hoard. fabar. orobj. lupinor. decocted in some of the same Lixivium, adding oxginel to it, applied over all. But for this I refer you to a particular Chapter of gangrenes and Sphacel. for further directions therein; as the gangrene, Separates, you are to deterge; to which end use mundificat, ex Apio or Paracelsi, to which by adding praecipitat. you may happily effect your Cure.  
But in the separating of contused parts, 
Haemorrhage.  as I have often  told you, great Fluxes of blood usually burst out upon us. 
Observation.  Thus in a Patient of mine wounded by Shot, through the inside of the Radius, upon separation of the Escar, a great deal of blood broken out with impetuosity. I stopped the Orifice which was nearest the Artery, with some mildred aglutinative Powder; suppose Galens Powder ex thuris part. ij. Aloes p. j. cum pilis, leporinis, &c. The blood then bursting out at the other Orifice, I applied over that also the same Powder, and rolled up the parts with a good Compress dipped in a styptic Decoction, laying my common Defensative over all, and not opening it till three or four days after. 
See Treatise of Wounds.  How such Fluxes of Blood from the Arteries are to be restrained, you may see in its proper place.  
Gun-shot-wounds, 
Sinuous Ulcers.  the Escar being once fallen out, become Sinuous Ulcers; especially after great mischievous Accidents, and where Bandage cannot be used to preserve the tone of the parts, as in the upper part of the Thigh and hip, &c. these Cavities causing much pain to the Patient, and difficulty and trouble to the Chirurgeon, we shall consider their Cure. Our indication therein, is from the parts affencted, the largeness of the Wound, Contusion and Laceration of parts: for contused Wounds, must of course corrupt, and turn into matter.  
And if the Bullet or any Extraneous Body be yet remaining in, the parts become more lax, and are accompanied with pain and influx of humours, and the included Body is straightened in its passage out, through generation of flesh, which causeth much difficulty in the Cure; especially if a Cacochymia, or Lues ven. be joined with it, you will scarce cure your Patient, without exhibiting Antivenerial and Scorbutick remedies.  
To prevent Sinuosities, you are to enlarge the Orifice at first, or keep it so wide open, that the matter that is daily there engendered, may have free passage out, which if it may not by the way the shot came in; then you must consider, how in another place the Sinus may discharge itself, this being prudently effected, and the matter thereby discharged, you shall speedily perfect your Cure, and with ease.  
But before you make this Apertion, you must consider, whether by altering the Position of the part, or by Compression by Bandage, or by hollow Tents, the matter may not be brought out. And to make the Cure of these Cavities more facile, you must endeavour to place the member in such a figure, as the Wound may be depending, and you must have Stupes, sponges, Compresses, and the expulsive Bandage; these prest out of read Wine, wherein is infused Flor. Ros. rubr. myrtillor. court. grand. ballast. nuc. Cypress. sumach. acacia, and dress it twice a day, and Injections of the same Decoction, with Myrrhae, Aloes, sarcocol. Rad. Irid. Aristoloch. sp. vini. mell. Ros. Aq. Calcis, Aluminosa, and such like.  
Sometimes in a Wound by the upper part of the Biceps deep, the matter not being likely to discharge itself, I have by a Seton Needle preforated it through, and retaining the twisted Silk, until the parts have been digested, then drawn out the Silk, and by a Tent kept that open a few daies, until the upper part by good Bandage Aglutinated. Then the discharged matter below being little and good, I have left of the use of the Tent, and healed it up.  
So I have often in Wounds of the Thigh, where by no Position or Bandage I could otherwise effect it. 
Observation.  And here in the Covent Garden, in an old Sinnous Ulcer, which discharged itself from the right Ilion through under the Inguen, viz. by the inside of the Thigh four fingers breadth below that place. I had great difficulty to make out whither the Sinus tended; at last I found by my searching Candle, that it wanted a little more then an Inch to pass throughout by the Glutens, and that without any opening that way; the matter would continue to make its Cavities, upon which I applied a caustic there, wither I supposed the end of my Probe tended. Then having taken out that Escar by Incision, I prest with my Probe against my finger which was within the Escar, I there felt the end of my Probe, though at a distance, upon which I passed a long Canula instead of my Probe, and feeling the end of that, I passed then a Needle through this Canula, and so through the Escar, which I take hold of, and the while pull back my Canula, and the Needle being free from encumbrance, I pulled it forward, with a twisted Silk at the end of it, and cutting off the end of the Silk from the Needle, I continue the Silk as a Seton there: the Needle, Canula and Silk were first anointed with Unguent. Dialihae. or Ol. lilior. or the like.  
One shot in the Face betwixt the Nose and Eye on the right side into the Ethmoides by a Pistol Bullet, 
Observation.  after some years that this Wound was cured, was troubled with a freting Ichor, which discharged by that Nostril, and at his first arising up in a morning out of bed, would discharge half a spoonful of a yellowish colour, and had made a chop or gutter at the lower end of this Nostrel, by its acrimony. After some while, he could feel upon bending of his head backwards or forwards, the Bullet to roll to and fro.  
He complained to me of his grievance at the Hague in Holland, a little before His Majesties going into Scotland. I proposed to him, as the onely way to free him from this grievance, speedily to cut through the oss. Palati. he assents to it. I placed him in a clear light, one holding his head steadily, I cut into the roof. The flesh was so close tied as it would not yield to my Spatula, as I expected; upon which, by a quick working Escarolick held to the place upon Lint a few minutes, I consumed the soft part to the bone. Then I cut into the bone such a hole, as I, by the moving of his Head, could see the Bullet lodged in the hole, but this was not done at once sitting. Yet by degrees the Bullet was taken out, and he eased of that discharge of matter, which threatened a filthy, carious, fistulous Ulcer. My attendance upon His Majesty into Scotland hindered my prosecution of that Cure. I left him in the hands of a Chirurgeon there; and since have often seen him at Court: but the Ulcer did not shut up with a Callus as it might, had it been closely attended.  
This way by making Incision, 
Method of cure in Sinuous Ulcers.  is the speedy way of curing all these Sinuous Ulcers, if it may be safely done without wounding great Vessels, Nerves, or Tendons. Your Incision is to be made according to the length of the Fibres, and a Probe or Canula must be your guide. Having once made your Apertion, you may enlarge it as you see cause by Incision, Gentian, or sponge, to discharge the impurities of the Ulcer, then digest it with the come. digestive ex Terebinth, vittell. ovi, and if there be occasion, you may add a little Mell. to it and Myrrhae Thuris rad. Irios, to make it more exiccant, but commonly the depending part oppened, the Wound is cured by Bandage, and keeping open this last Apertion a few days. If these grow Fistulous, you shall find the Cure of them in another place.   

CHAP. V. Gun-shot-wounds with Fracture.  
HAving declared unto you the way of curing Gun-shot-wounds in the soft and fleshy part; I purpose now to proceed to the curing them, as they are complicated with the fracture of the Bones; whose firmness, dryness, stability and solidity cannot defend them from these Inconveniencies. Nay, in the case I am to speak of, they are rather Discomodities. For when the Bullet striketh like lightning, were they softer 'twere the better, that the Bullet might pass and not shatter them.  
Not any of the five sorts of Fractures mentioned by the Ancients, which these blows will not occasion. Sometimes they will cleave the Bone, assulatim secundum longitudinem, according to the length; and other times they will per transversum frangere, break the bones athwart. Other times they will divide it ad unguem, like the Scales of a Fish. Nay, if the Bones be drier then ordinary( as in elderly men, and in such a Nature or Diseases have made them so) they will grinned the Bone like Meal. Yet I have seen, and dressed a soldier that was shot through the joint of the ankle, without ever breaking the least cartilege.  
The ways to know when there is a Fracture in the Bone are many; hip. bids us compare the sound part with the parts affencted, and observe the Inequality.  
Secondly, You shall perceive a Cavity if you touch the parts above and under the Fracture.  
Thirdly, If you handle the fractured member, you shall perceive a crashing of Bones, by reason of the mutual attrition of the hard Bodies.  
Fourthly, There will be commonly extraordinary pain, in regard of the divulsion of the Nerves, and distortion of the Tendinous Bodies; or the pricking some sensible part, by the shivers of some Bone.  
Fifthly, There will be an Impotency of the broken Member, so that the Patient cannot lean upon it.  
Sixthly, The antecedent cause will teach much in this case ( gun-shot) then which there never was( or ever will be, I believe) invented a more powerful one.  
Seventhly and lastly, The Asperity and Inequality, or roughness of the Bone manifested to you, but the search will give you no small assurance.  
In Fractures made secundum longitudinem, all Authors agree that the Member which is hurt must needs show thicker then the other. Concerning prognostics, 
prognostics.  you shall understand,  
First, That Fractures are more easily cured in young people then in old, for the greater distance there is à pueritia, the more the humidum primo-genium is exhausted. Wherefore in Youth, Bones will be again Consolidated by the first Intention, in others only by the second, Interveniente materia( aliena) quae non est ejusdem naturae cum osse.  
Secondly, Bones receive a quicker Agglutination in Sanguine, then in choleric Bodies, by reason of the benignity of the Serum which sendeth out better matter for a Callus.  
Thirdly, Bones are broken with less danger in the middle, then near to the joint; they are both more hard to be restored, and to be kept so restored. And because of the multitude of symptoms( which in such Wounds cannot but Supervene) are not without great difficulties to be cured.  
Fourthly, Those Fractures are dangerous which are made so deep in the fleshy parts, as our hands cannot well come at them, to place them right.  
Fifthly, A great Fracture is of more danger then a small. I term that a great Fracture where the solution of continuety is large, the accidents sudden, many and terrible.  
Sixthly, Fractures made by Gun-shot, are of far more danger then any other, in regard of their multiplicity of Complicacie.  
Seventhly, Among all Fractures the most tolerable is the Transverse, if it be obliqne 'tis worse; still worse if the Bone be much shivered; but worst of all if the Shivers be sharp and pungent. Amongst the Cruisers in particular frigates from Dunkirk, it was complained that their surgeons were too active in Amputating those fractured Members, as in truth there are such silly Brothers, who will brag of the many they have dismembered, and think that way to ly themselves into credit: but they that truly understand Amputations and their Trade well, know how villainous a thing it is to glory in such a work.  
In the Roman History you will find it was not allowed at all. Livy tells you their reward among them. But later Experience judgeth it commendable, if it be necessary, and done in its proper time, that is to say, suddenly; whereas Amputations the next day are worse then death to them.  
Not so in proper time; 
Observation.  for in the heat of Fight I cut of a mans Arm, and after he was laid down, the Fight growing hotter and hotter, he ran up and helped to traverse a Gun, and a Walloon, while I was cutting of his leg, cried; Depechae vous con nous vendrone a terre nous bivron, hast ye, hast ye, when we come a shore we will so drink: But amongst us aboard in that Service, it were a great shane to the Chirurgeon, if that the Operation were to be done the next day, when symptoms were upon the Patient, and he spent with watchings, &c. Therefore you are to consider well the Member, and if you have no probable hope of Sanation, cut it off quickly while the soldier is heated and in mettle. But if there be hopes of Cure, proceed rationally to a right and methodical Cure of such Wounds. This following Method is best.  
Cleanse the Wound first from all strange Bodies, 
Cure.  as Bullet, armor, Apparel, Shivers of Bones. If the Fracture be near a joint, the violence of the blow will many times add a Dislocation also to it. If that happen, restore the joint first to its place, before you meddle with the Fracture; these dislocations are made by great Shot, or pieces of great Wood, whose force shatters the Limbs in pieces, or carrying it quiter away: but this later I never see so done, but that when the Member is shattered it hangs by the side, by some little part of the Musculous Flesh and Skin.  
Here your work is with a good Razor or Knife presently to plain the Stump, 
Smooth the stump.  and pull up the Flesh, that you may saw off the end of the Bone as even as may be.  
In one of these, 
Observation.  whose Arm was shot off above the Elbow, in hast we dressed him up, his shoulder proved out of joint: The next day we could not set it by reason of the Anguish of the stump, it was a greater pain then his Wound, and pained him for some months after, but it happens often and in short stumps is remediless. One of our Captains Reformadoes had been served so formerly with his stump.  
If you will endeavour the remedying it, you must do it by help of a Bandage, made above the stump, but if it be above the Elbow, how will you fasten it? yet in some Bodies they will be restored easily, therefore attempt it before you dress the member.  
In another that had his Leg shot off in the place of Amputation below the Knee; 
Observation.  some two months after, when I wondered the Bone would not scale, I put my Forceps to feel whether any part of the Bone was loose, and feeling it very loose, I took hold of it gently, and found it willing to come away, it was the Apophisis, or head of the great Bone which makes the Knee. I was surprised at it, but considering what is loose must away, I pulled it out to the amazement of the lookers on, this was relaxt from its ligament, by the force of the blow.  
In these fractured Wounds made by Gun-shot, the Chirurgeon ought to propose two things to himself, first the Fracture, and then the Wound. To proceed orderly you begin with the Fracture, viz. by Extension and Coaptation, that thereby the Fracture may be reduced to its proper seat; which in all these cases must be performed with much steadiness and discretion, not with such force as in them without a wound, lest the Musculous or Nervous parts being torn, bruised or crushed, should cause extreme Pain, Convulsions, and Mortification( and that which in special we seek to prevent) death may unaware ensue.  
And therefore this Operation would, 
Dislocations when to be reduced.  if it possibly might, be dispatched presently after the receipt of the Wound, before inflammation come on; but if the part be accompanied with a Flux of Humour and inflammation, before the Patient be brought unto you, then you must forbear the Extension until the third, seventh, or eleventh day, according to hip.  
And if it should so happen, that through such inflammation the Operation be delayed longer; it is then to be feared, Putrefaction, and other ill Accidents will happen, and your Patient run great hazards of his life, or a continual lameness of that Member.  
The Extension made moderately; fit the Bones into their former place, with what gentle dexterity and lenity you can possibly. If the Wound be narrow, dilate it by Incision at the first, for these Wounds require more dilatation than any other, that not only the bruised and vitiated blood and other excrements; may have a free passage; but that also by this means the shivers of Bones, of which these Wounds use to be very full, may with less trouble be discharged by nature, or extracted by yourselves.  
If you make not this dilatation in the beginning, 
Dressing.  you may afterwards perhaps be forced to do it, when the part is accompanied with great defluxion and pain, and the bones altered by the retention of matter, and not only to cut and open the Wound to the vexation of your Patient, but to keep it so dilated.  
Now consider whether the Bone be bare or not; which you may satisfy yourself in by your Eye, or your Finger, and the slipping of your Probe. If it be, you must apply next to the Bone some dry or exsiccant Medicine, sicca, siccis Gaudent, dry to dry. Of this sort are dry Lint, 
Dressing of Gun-shot with Fractures,  Powders of the roots of Iris, Myrrh, Aloes, Thus, Spirit of Wine; take heed of oil, for it makes the Bones apt to foul, and hindereth Callus. This done, proceed to the Wound, which is always with loss of substance, and commonly with lacerated Flesh, what of it cannot be restored to good purpose cut away, and dress up the Wound with your Suppuratives warm, as hath been proposed in simplo Gun-shot, with an Emplaister of two parts Diachalchith, and a third Paracels. with Ol. Ros. or Empl. de minio malaxt. with Ol. lumbric. over the Wound, and over the whole fractured Member, this Empl. Diachalcit. with the addition of Colophoniae, pull. Rad. consolide. may. Bol. Armen. court. Granator. Succo plantag. Ol. myrtill. Lumbricor. & cerae, qs. as a cerate over all, or double clothes dipped in a read Wine warm, wherein hath been infused flow. rosar. Rubr. ballast. sumach. Baccar. Myrtill. sumit. Absinthii, &c. Ol. Ros. &c.  
The third Intention which is required in these fractured Wounds, is Deligation; 
Deligation.  for unless they be rightly fitted, none of these Fractures, of what sort soever, can hope for perfect Unition and Cure. In simplo Fractures without a Wound, all kind of Bandage may be admitted, 
Bandage to be daily loosened in Gun-shot-wounds with Fracture.  whereof you may see in my Lecture of those Fractures various sorts, with many circumvolutions about the Member. And once in seven dayes opening will serve your turn. But in these another method of binding is required, for here the Bandage is to be loosened daily, the Wounds looked into and dressed: They being here to be long kept open, for discharge of Excrementitious and Purulent matter made in them, which otherwise wound corrupt the Bones.  
Therefore in these like Wounds, you must use such a Bandage as may least shake the fractured Member, 
Manner of Bandage in Gun-shot with Fractures.  for these Wounds being every day to be dressed, the so often rolling up the Member would cause grievous pains, and hinder union. Therefore it is that Authors have invented so many kinds of Bandage, to answer the intentions of dressing the Wound, and yet keep the Member immovable. And your Bandage in this case, is to be made of softer and broader linen clothes, then that we use in simplo Fractures, that it may comprehend both the Fracture and the Wounds, keeping the lips down, yet not hurt them, by its too hard compression, Minus astringendae sunt fasciae quam si vulnus non adesset, saith Celsus.  
Therefore we make choice of a piece of Cloath soulded three or four times double, to give them the more strength, and of such breadth to harass the lips of the Wound and fractured parts; and of that length as to come once about the Fracture. It is to be cut into three pieces from the ends to the middle, which middle lies undivided underneath, to bear more equally the fractured Member; and these ends to come over one another, with a Compress between, over the Wound, to press the lips of the Wound equally down, which would otherwise become crude, and put out great lips. The Compress also serves to receive the matter, and fills up the inequality: These are so to be fastened, as that you may dress and undress the Wound without disturbing the Member.  
But for that it happens, that in these Gun-shot-wounds the Bones are shrewdly shattered, and the Wound lacerated; and by reason of the largeness, the Wound is most painful, and the part so weakened by its Fracture, as it cannot be kept steady by this Bandage: therefore we make use of Ferulae or Splints; 
Splints.  whereof I have made mention in my Lecture of Fractures in General, with the judgement of the Ancients, who have been very Industrious in contriving ways to make equal compression, and leave a way for the dressing of these compound Fractures.  
Their use is not to be until the inflammation and flux of Humours be off, 
When to be used.  which is not until after the seventh day; Mean while I propose Splenia, which are linen clothes folded four times double, and cut in length and breadth like the Ferulae, so as it may encompass the whole Fracture: these are to be spread with Galen's cerate, or any ointment, so thin as they may adhere to the part only until you have put that Bandage over it; and this is that I propose where there is pain and fear of inflammation.  
These will handsomely strengthen the part, and make such equal compression, as the Bones; may be kept in their place, the serous humours prest out of the Cavernulae, and the fractured Member lie soft, which is a great help in these Wounds; the whole welfare of the Patient depending upon the easy Bandage and Position of the Member. The Pain and inflammation gone off, and the Wound digested,( or if you think the Member not so subject to inflammation, and that it require a greater strength to support it) you may use pasteboard cut into pieces proportionable to lay over those Splenia, 
pasteboard.  or having fastened those Splenia by the broad Bandage with three heads, cut a piece of pasteboard fit to receive the lower part of the Member, wet it to make it more pliant, cutting a place commodiously to dress the Wound at. Under this pasteboard three Ligatures are to come, which, after you have placed another pasteboard above to answer that underneath, you are then to firm close by these Ligatures in the most convenient place, for the ease of the Patient: or if the Splenia be wet in whites of Eggs and applied, they will strengthen the Member, and keep it steady, without those of Past-bord. To this purpose we also use Laminae, 
Laminae or Plates.  Copper or Tin Plates with soft linings to receive the fractured Member, with cuts in the out-side to receive three Ligatures answerable to the first underneath. These are to fasten and loose at pleasure, without disturbance to the daily dressing of the Wound. These Laminae, or what ever else you use, must have a large cut in them, for the Wound to be dressed through.  
But I have always observed inconvenience in these Plates, that there being not so good Compression made upon the lips of the Wound through those holes, as to hinder the lips from thrusting. There arises a laxity and indigesture in the Wound; and besides the matter that so discharges; heats the parts, and in hot weather corrupts and breeds Maggots.  
Therefore I make the pasteboard or Laminae over my first to harass so much of the lower parts as may support the Fracture, and come within an Inch of the Wound. And over the Wound itself I fasten a Splenium of Cloath, folded four times double, or a Ferula of Tin, Copper or pasteboard lined, and this according as I judge, the part can bear.  
The first Bandage next to my cerate, makes an equal Compression by its three heads meeting over one another; the lowermost presseth the Influx from below, and with the help of its next fellow keeps the Bones together, and presseth the matter out of the Wound; and( by the help this middle hath of the uppermost) the matter is also prest out of the upper part of the Fracture and Wound to the Orifice, which also hinders the Influx from above, strengthened by a defensative lying under it. In the dressing these Wounds, you are onely to undo the middle hinder to come to the Wound, having a special care that this Bandage be neither too hard or slacken, but indifferent, to the ease of the Patient.  
Having thus proposed to you the way of deligation, I shall now proceed to the last Operation performed in these Fractures of a Wound, 
Position of the part.  which is a commodious Position or placing of the Member; which as I have  told you in the Lecture of simplo Fractures, ought to have three Conditions.  
1. Soft, least the Compression offend the hurt parts, and cause Pain and inflammation.  
2. Equal, for if the Member be placed otherwise, it becomes distorted, and the Operation succeeds ill.  
3. Lastly, It must ly higher then the parts next the Body, especially the first three or four dayes, for if it incline downward, the humours by their own weight, will easily flow to the part afflicted. How this Position is performed, I have set down in the Lecture of simplo Fractures, to which I refer you.  
The fractured Bones of the wounded part thus restored to their natural places, and the Wound digested, and inflammation and other Accidents gone off; you shall now unloose the Bandages, and take of your restrictive Medicaments, and apply the Emplaster Cattagmat. in our London Dispensatory, or of these underwritten over the fractured Member, which may add strength to the part, and further the Generation of Callus.  
℞ Resinae, abietis, cerae an. lb j. pulv. court. Tiliae ℥ iij. succ. Geran. ℥ iiij. coq. ad Cerot. consist. Or this;  
℞ Mucilag. radic. consolid. ma. visci pomor. & populi an. ℥ iiij. succ. Geranii ℥ vj. lap. osteocollae ℥ iij. pull. cortic. Tiliae ℥ ij. Vittel. ovor. No xx. Terebinth. lb j. s. ol. Lumbricor. ℥ iij. coq. omnia been permixta ad ceroti consistentiam, pro usu. But if you conserve the temper of the part, you need not doubt of Callus. I commonly in these cases make use of Emp. stict. Paracels. p. ij. Empl. Diacalcith. p. j. over these a double Cloath dipped in read Wine, wherein hath been boiled some of the above mentioned Plants.  
And now place the former Bandage again, and over those Laminae of Copper, or Tin lined; or in the place of these, you may add those Splenia of double Clothes dipped in whites of Eggs, and wrung out hard, they will sit close to the part, and after they are dry, will support the fractured Member well.  
But if it be in the Thighs, the Plates are best, that part requiring such as are of great strength and length, and such compass, as may take in half the Member, you are now to forbear the use of Suppuratives, and use such Medicines as are detergent, as the Mundif. Paracels. Or if you please  
℞ Vincae pervincae, Paeti, persicariae Beton. an. m. j. slor. Hyperici verbasci, an. P. j. rad. Aristoloch. utriusque an. ℥ ss. Thuris; myrrh, sarcocol. Iridis an. ʒ ij. coq. in vino Albo addendo colaturae mellis rosacei, q. s. This may be cast in with a Syringe, it will deterge and incarn; or by the addition of Terebinth. Wax and oil of Hypericon, you may form it to an Unguent.  
If there be carries you may make a Decoction of Scordium, vinca pervinca, pucedanum gentian. cortic. Guaci Rad. Ireos myrrhae in Wine, and adding sp. Vini or the Extract. scordii. If the carries yield not to this, touch it now and then with some of the following Medicines by a Probe armed with Lint.  
℞ Ol. myrrhae distillat. per discentum & purisicat. cum sp. Vini ℥ ss. olei cariophil. ʒ ij. ol. sulphuris ʒ j. ss. m. This will in a short time remove the Cariosity, afterward proceed by Epuloticks.  
Vulnerary Potions are here of great use: as this, ℞ Aristoloch. rot. ℥ ij. fol. serpentariae, consolidae utriusque Geranii Columb. saniculae an. m. j. make them into gross Powder, & boil them in Wine in a Vessel close stopped to a Gallon, give the Patient this, morning and evening ℥ iiij. at a time: you may give in this of Osteocollae ʒ j. powdered, or in a draft of the Decoction of vinca pervinca made with Wine, for confirming and hastening the Callus; in the rest proceed as in the latter end of simplo Fractures.  
A soldier being shot by a Musket Bullet into the forepart of the Arm, near the Biceps, and out behind, the Bone fractured: I endeavoured by Extension to place the fractured Bone even together, but could not; upon which I dilated the lower Orifice by a large Incision, according to the rectitude of the Member, to pull out those fragments of Bones which hindered their right Coaptation; and putting my finger into the Wound to that purpose, I pulled out a ragged piece of a Bullet, whether it was part of that which had passed through was the question; some of the By-standers thought he was shot with a brace of Bullets; but I rather think the Bullet was torn by the Bone, and that the other part was it which had made its way thorough: however by this extraction the main Bone was rightly placed, and the Shivers, with the Extraneous Bodies removed, and the matter happily discharged by this depending Orifice, and the Patient as happily cured by the common intentions of curing these fractured Gun-shot-wounds.  
Whereas if I had taken it for granted, that the Bullet was passed through, and contented myself in having endeavoured the reducing of the fractured Bones, and so dressed him up, it had certainly Inflamed and gangrened: This confirms that doctrine in setting of Bones, that if any Bone will not be placed equally amongst his fellows, you ought to cut upon him, and take him out.   

CHAP. VI. A Fracture made by a Splinter.  
IN heat of fight at Sea, amongst the many wounded men that were put down into the Hold to me; 
Observation.  one of them had his Arm extremely shattered, it was about two fingers breadth on the out-side above the Elbow, by a great Splinter.  
This mans Arm I ought to have cut off presently, but a sudden cry that our ship was on fire, put me in such disorder, that I rather thought of saving myself, than dressing my Patients. I hastily clapped a dressing upon his Wound, and rolled it up, leaving his Arm in his other hand to support it, and endeavoured to get up out of the Hold, as the others did; I verily believing I should never dress him, or any of them more.  
But our men bravely quitted themselves of the friendship, by cutting the Sprizil Tackle off with their short Hatchets( which they wore during fight sticking in their Shashes) we were freed of the Fire, and by our hoisting up the top Sails got free of our Enemy.  
Now I was at a loss what to do with this man, who lay not far off complaining of his Arm. I would have cut off his Arm presently with a Razor( the Bone being shattered there needed no Saw) but the man would not suffer me to dress his Arm; he cried, it was already dressed.  
The Fight over, we got into the next Port; I caused presently the Mariners Bed to be set up( which was four pieces of Wood nailed together and corded, and a Bears skin laid upon it, this was fastened between two Guns to the Carriages:) Upon this I see him placed, he was a lean man, above thirty years of age, of a good habit of Body; it was the right Arm, which I caused to be laid outermost, that I might the better come to dress it.  
I having my dressings ready, I laid them orderly upon a small Pillow well stuffed, and quilted in the middle. Upon this Pillow I first laid a soft double linen cloath, then next I laid three Ligatures, then a pasteboard wet in Vinegar, to make it more soft and pliant; upon that I laid a double cloath of such length and breadth, as might serve to encompass the fractured Member, this cut from each end to the middle into three Binders. Over the middle of this I placed a Splenium of cloath four double, four fingers breadth, and of such length as to give strength to the Fracture: Over this lay my Defensative, spread upon a thick Cloath of such breadth and length as to take in the whole Arm. Dressings thus laid upon the Pillow, I cut off the dressings from his fractured Arm, and placed the Pillow with these dressings close by his side, so as I see his Arm laid as I designed upon my Restrictive, and his hand upon his Breast. Then I put my fingers into his Wound, and pulled out a piece of a Splinter an Inch thick, or thereabouts, more or less, then Rags and Bones great and small; I left not the least shiver.  
When I had so cleared the Wound of all the extraneous Bodies and loose Bones; I was amazed to feel what a distance or voided space there was between the two ends of the Bones: But I proceeded and cut off the lacerated lips, which were of no use, and dressed up the ends of the Bones with a couple of Dossils dipped in sp. vin. & mell. Ros. warm, and the rest of the Wound I dressed as warm with Axung. porcin. Mir. praecepitat. with some little Ol. Terebinth. mixed upon Dossils lightly within the Wound, and upon Pledgits without, and an Emplaster Diacalcit. malanc. with Ol. myrtle. over all the Wound.  
Then I embrocated the fractured Arm with Ol. myrt. & olivar. Immatur, and a little Acet. and brought my Emplaster Defensative, which lay under the Arm, over the whole Arm, from the Axilla to the Elbow, and round the Arm close, only leaving a space to dress the Wound.  
This gave a strength to the weak Member, and hindered the Influx from above. Just under this Emplaster there lay a Splenium, to answer that I applied three more, one on each side, and another above, which four were of such a size, as they lying a little off from one another, encompassed the Arm; they were spread lightly with a little cerate, Axungiae and Wax, to make them adhere where I placed them.  
Then I brought the Bandage which lay under the Splenium, with three heads at each end, the lowermost of these took in the lower part of the Arm from the Elbow upward, with part of the Fracture, and was fastened on the outer part of the Arm; this prest the Sanies from below to the Wound, and hindered the lapse of matter that way. The middlemost was made to press the matter out of the Wound, and keep parts close for unition. The uppermost served for restraining the Influx, and press that out which was already in the part: this Bandage was made with great moderation, and so fastened, as they might be loosened without trouble to the Patient.  
Then I brought the wet pasteboard close to the sides, and cut another piece to answer it, which I wet in Acet. and by the three Ligatures under, made them fast, but without disturbance to the Patient. If it could not have been so put on, I should have forbore the use of them: the Cure of these consists in the easy dressing and quiet position, without that you will not cure one of these compound Fractures; the pasteboard as it dried, received a shape fit for preserving the Fracture in the position I left it, and that with a very slacken Bandage.  
Thus I finished the first dressing, leaving my Patient in much case, he slept pretty well that night, and was the next day as well as I could expect; he was let blood the second day, and kept to a spare Diet, but we allowed a little Wine as a Cordial to all our Patients.  
The third day I dressed again, took off the upper paste-board, and loosened the Heads of the main Bandage, took off that Splenium which was over the Wound; raised up the emplaister from the wound, took out many dossils, found it warm and well-disposed; dressed it up quick with my Suppuratives hot, and an emplaster as before, not stirring the restrictive; made now a compress more particularly for the wound, purposing not to remove the two outer heads of the main Bandage, unless it were sometime to give a little breathing to the member; but the middle I opened as often as I thought fit to dress the wound, the other two had short Splenia to make the Bandage equal, but I was not then satisfied how this Arm would be supplied with Bone, yet my Patient was easier then any of my Patients with fractured wounds.  
When it came to my turn to be visited by my Brother surgeons of our Squadron, they did not dislike the wound nor my way of dressing,( for we being used to see one anothers Patients, had all much one way of dressing) but they laughed at the excuse I made for not cutting off his Arm, and doubted I should yet be forced to do it. But I kept my Patient flat on his back, and that after a while was his greatest pain, for the Wound digested and the tumour was never considerable.  
After the wound digested and a separation made of the contused flesh; I then renewed the dressings, taking all off and fomented the member with warm water, to give a breathing to it, and applied a catagmatic Emplaster, and dressed the Wound with a mundificative Parac. or such like, and bound up the Member as at first, and so continued my way of dressing as I see cause, putting into the Wound only a Dossil or Tent made upon a skewer soft and hollow to give way to the Wound to incarn, I scar ever using Injections, but by gentle compression assisting Nature, who seldom fails in supplying the lost substance in Wounds, if we disturb her not by improper applications.  
The next opening and dressing of this fractured Member was occasioned some sixteen or seventeen days after, by a troublesone Itching of the patt; which was I suppose partly from his liberty in diet, the heat of the weather, and want of perspiration: I then took off the Dressings, and bathed with Sea-water, and dressed him up with Emplaster de lithargiro; the Wound was about this time well incarned within, and the Lips beginning to cicatrise from their edges, I dressing them with Epuloticks, as ung. Tutiae, &c. yet I kept my Patient still upon his back, and renewed not the whole dressing until I was necessitated, which was about the fift or sixth week.  
One day coming from the Shore( where those of our wounded had liberty to lodge if they desired it, and were dressed by us there) I found this Patient with a heat all over his body like an Erysipilas, he was much frighted at it, he had it seemed drank Wine a little too liberally with his mates,( as they would most of them do if they were any thing well) unless it rather proceeded from a generation of Callus, 
Erysipelas upon the generation of Callus.  in which case it usually happens. I let him blood, and at next dressing finding his Arm pretty strong, and his Wound healed within, and in a fair way of cicatrizing. I raised him up, after he had lain about eight monarchs. All which while I believe he never stirred his Arm from the time I placed it, but in the time of renewing the dressing, he being the most patient man in that respect I ever attended; and in truth without that submission, he could scarce have been cured.  
There was in this Patient a strong Callus, filling up the voided place of the lost Bone at least two Inches, with little or no shortening of the Arm; but the joint of the Elbow was so stiff from the position it lay so long in, that he could not stretch that joint whilst I knew him, which was until that Ship was cast away.  
My memory will be much cried up for remembering so many particulars in a Patient, so many years since cured by me: But if you consider how remarkable a case it was, and in my Trade, there will be the less wondering at the possibility of it. You may inquire what was done by me in the Cure of Capt. read, where the loss of his Jaw was supplied by a strong Callus, and that Cheek uniform with the other, and will be long remembered by the then standards by, though not of the Profession.  
In our Sea Fights often times a Buttock, the Brawn of the Thigh, the Calf of the Leg are torn off by Chain shot and Splinters; all these are contused Wounds and look black, and do too often deceive the unexperienced Chirurgeon, he taking them by their aspect to be gangrened, and by dressing them as Gangrena, with Aegyptiacum and Spirit of Wine, hath either gangrened them, or drawn the other symptoms upon them of Pain, Fever, Delirium, Convulsions and Death.  
Whereas if they be considered rightly, though they look as flesh long hanged in the air, of a dry blackish colour, yet they have warmth, and will by Lenients, as is prescribed in simplo Gun-shot-wounds, digest, and as Separation is made they will deterge and incarn, but they are slow in digestion, and require good Fomentations and Embrocations to cherish the native heat, which is much weakned by so great a loss of substance.  
These require Oleum Terebinth. to be mixed with your digestives, but you must have a care you do not inflame and cause Pain, by adding too much of it. A spoonful to six Ounces of your Suppurative is enough in the driest habits; your judgement will best direct you, and your Patients complaint: it being unreasonable to hope that Wounds can digest, while they are accompanied with much Pain.  
In the former Sea-fights with the Dutch, Capt. H. had his Hand shattered, and his Fingers torn off; Mr. L. was his Chirurgeon; who entreats me, being called into counsel, not to think of cutting of his Hand; I  told him it will be of small use to him, and the Shivers of the Bone within hurting the Nervous parts, occasioned those convulsive twitches and pain he was subject to and often felt; notwithstanding I promised to comply with him, if he would follow such Methods as I would propose, which he agrees to, but does not perform accordingly.  
I came two dayes one after another, but finding nothing of it done, at the next meeting he pretends an Excuse, not to dress the Patient. I then discover his craft, and that he had used me onely to defend his Credit, which was questioned for the not taking off the Hand at first, as he ought to have done, of which he now saith I was the cause, having craftily drawn me in to be of his Opinion, though conditionally only; viz. that he should have laid open the Hand, and taken out the Shivers, which if he had done, he might have cured it, as I have done some others, as appears by this Treatise. Of the truth of this Mr. H. is Witness, who also was over-witted by him. The Chirurgeon of the Ship committed the first error, he ought at the first dressing, while the Wound was recent, to have pulled out the Shivers of Bones, or to have extirpated the hand, that being the proper time.   

CHAP. VII. Gun-shot-wounds in the joints with Fracture.  
THE Wounds of the joints are subject to more grievous Accidents, then those I have heretofore mentioned, therefore they require your more particular care. The Tendons and Ligaments being inserted near the joints for the motion thereof; as also the Membrains, and consequently the parts of a most exquisite sense. The trunk of Nerves also in every great joint passeth through for the use of the Member that is beyond it. To which I add, that the part being exanguious, the natural balsam of the Body is here more sparing supplied for the help of the Cure.  
What the pains are may be judged by the Wounds in the lesser joints. Capt. F. in Musselbrough fight, was shot in one of his Fingers, and the next day so grievously tormented, as he walked up and down like a mad-man, could take no rest until his wounded finger was digested, yet his pain was not so great in his Wound, as in his well fingers. The greater Wounds are attended with much more vehement Pain, inflammation, Dilirium, Convulsions, gangrene, and are commonly deadly. Therefore the shot is presently to be extracted, and dressed with such Medicaments as may defend them from putrefaction, and these are to be moderately hot and dry of subtle parts and Anodyne; as Ol. Terebinth. de Castoreo scorpion. vulpin. lumbricor. ovor. & pull. scored. Thyris myrrhae, Ter. leminae pull. euphorbi.  
And in these Gun-shot-wounds the Orifices of the Wound must be kept open, that your Medicaments may penetrate to the bottom: But if the Wound be on the inside of the joints, they are commonly attended with great Haemorrhage: For prevention of which, I refer you to its proper Chapter: And in the first place propose this digestive.  
℞. Tereb. lot. in sp. vini ℥ iiij Thuris, myrrhae mastic. an. ʒ j. olei Hyperici ℥ iij. victual. ovor. N ij. croci ℈ ij. Or,  
℞ Terebinth. ℥ ij. myrrhae, Thuris, corn. cervi usti. à ℈ iiij. Ol. scorp. de Castorco lumbricor. sambuci an. ℥ ss. victual. ovor. N ij. Apply either of these warm. If stronger be required,  
℞. Ol. Terebinth. ℥ j Ol. hyper. cum gumum. ℥ ij. euphorb. pull. ʒ j. drop this very hot, and apply the first mentioned Digestive over all Embrocate parts about well with Ol. lumbricor. & hyperici, and apply this following Cataplasma.  
℞ Farinae, Hordei & fabar. an. lb j. flor. cham. Meliloti ros. rub. scordii Absinthii pulver. an. ʒ vj. Decoct it in the broth of Offal or in Oxymel. adding Ol. Ros. & chamelaemel. Or this,  
℞. Mucilag. Radic. Althaeae consolid. ma. an. ℥ iiij. flor. Ros. rub. beton. cham. subtle. pull. an. ℥ ss. farinae lini. fenug. an. ℥ iij. farinae, hoard. & fabar. an. ℥ vj coq. in vino, add Ol. Ros. & Lumbric. an. ℥ j. ss. mell. ℥ ij. vitel. ovor. N iij. The Wound digested, you may deterge with this:  
℞. Farinae Orobi ℥ j s. Thuris rad. Ireos. an. ʒ vj. succi Apii ℥ iij. mell. come. & Terebinth. an. ℥ ij. m. F. ungu. The Wound deterged, you may dress with this Sarcotic.  
℞. Sumitat. Hyperici equiseti plant. Beton. an. p. j. rad. consolid. ma. Tormentillae an. ʒ iij. sevi Hircini ℥ iiij. lambric. terrest. lot. ℥ ij. Ol. mastichinae ℥ ij. vini odonf. qs. coquantur ad consumptionem vini postea colentur, cum forti expressione, dein. add Resinae pini ℥ j. Thuris, Myrrhae, mastic. Aloes, an. ℥ ss. cerae ℥ iiij. m. F. s. A. Ol. Aparici is excellent in these Wounds alone, or heightened by any of the former Prescriptions; so is the balsam in the Chapter of the wounded Nerves.  
If the Bone be bare, you must be careful that you do not foul it by your greasy or slabby Medicaments; you must here also consider of Phlebotomy and Universal Regiment. If Pain be violent, and yield not to Anodynes, cut off the affencted Tendon, and whatsoever corrupts, least it taint the rest.  
But in these great Wounds, you are at first to consider how curable they are, and endeavour to preserve the life of your Patient, by a timely extirpation, before his Spirits be too much exhausted: Of which this following story will give you warning.  
A page. of Lieutenant Gen. D. L. was shot through the Knee, 
A shot through the Knee  the Bullet entering in by the lower and outer side of the Rotula, passing through the joint out in the hollow of the Ham, tearing the Ligaments and Nervous parts, fracturing the joint as it passed, and rending the Artery in going out. This Wound was mortal the very minute it was inflicted, and ought then to have been dismembered: But such Proposals will not usually be admitted of in the first Dressings, whilst there is hopes: Yet the Accidents in these great joints thus made are sudden, from the vehement pain. And while Fever, Delirium, &c. are upon the Patient, then to make such an Amputation, most commonly hastens his death.  
Wherefore I proposed my first dressing by digestion upon a Pledgit, applied warm to the Wound upon the Rotula, there being no place for a Tent; and to enlarge the Wound amongst the Tendons and Ligaments, were to add one mischief to another. I also embrocated the parts about with Ol. Ros. cum Aceto, applying my Restrictive over all.  
In the depending Orifice, there was a throbing of the Arterial blood, as in an Aneurisma, the blood being choked in by the contused flesh, it therefore was not there to be tented, for fear of making a Flux of blood, nor yet could we endeavour to stop the bleeding by Cautery, Actual or Potential, least thereby new pains should be stirred up, that part being full of Ligaments and Tendons.  
Wherefore I dressed that Wound with the same Digestive mixed with pull. Galeni upon a thick Plegdit, and some of the same Restrictive over that, with such Bandage as that joint was capable of, hoping this way to hinder the Influx of humour, and that by such dressings the Wound would digest, but the pain continued vehement, and yielded to no Application, nor was there any possibility of conveying any Instrument into it whereby I might pull out the shivers of Bone.  
Mr. Penicuke formerly General Chirurgeon to the Scottish Army, was with me at the dressing this Patient, but proposed no alteration of what I had done, the pains increasing, a Fever was made and attended by Dilirium and Spasme, Death followed, as commonly it doth in all such Wounds of the great joints. I could instance it in many, but the late case of Sir J. L. may serve for all; his Wound, as I have heard, was of the Rotula, he had many of our most ancient surgeons, with the most eminent Physicians to help them, Persons who were well experienced in Chirurgery, yet they had no better success. Therefore at Sea while they are warm with heat of Fight, we dismember them, and by actual Cautery stop the Flux of blood.   

CHAP. VIII. Wounds of the Belly.  
I Have now briefly run through the Parts not principal; and purpose to say somewhat of the principal Parts, as the Belly and Breast. And that you may more certainly know the part wounded, I shall give you a short Description of them; and then show how they are to be handled in order to their Cure.  
The Belly is called Abdomen, or Inferior venture, it begins from the bastard Ribs, and extends itself to the Groins, and is divided into three regions by our Anatomists: The upper, middle, and lowermost. The uppermost is called Epigastrum; the middle Regio Umbilicalis; 
Abdomen described.  the Inferior Hypogastrium: The sides of the uppermost are the Hypochondria; the right Hypochondrium possesseth all the Liver; in the left is the Spleen, between these is placed the Ventriculus or Stomach. In the middle part of the Abdomen is the Navel, round about which ly the Guts, and behind those, on each side the Kidneys. In the sides of the Inferior part are the Ilia, the Pecten or Pubis in the middle, under which lies the Bladder. Thus much to the Internal Delineation.  
The Abdomen consists moreover of parts containing and contained.  
Parts containing or teguments of the Abdomen, are either the common, which reach all over the Body, as the Cuticula, Cutis, Pinguedo, Membrana Carnosa, or the particular and proper to this place, which are the Muscles of the Belly the Peritoneum, and in respect of the Guts, the Omentum. The parts contained are some of them designed for the nutrition of the whole Body: others for Expurgation; and others for Generation.  
The stomach, small Intestines, Mesenterium, vena porta, Cava, Arteria magna, & Celiaca, magna, the Liver and Spleen serve for Nutrition: The Bladder, gull, all the Intestines, but especially the great ones, Kidneys, Ureters for Expurgation; and for Procreation Vasa praeparantia & differentia prostatae & uterus in Women. Which parts containing and contained are subject to this Gun-shot, whence various Species arise of these Wounds, sometimes the containing parts; as Cutis, Pinguedo, Caro musculosa onely are wounded, so as neither the Peritoneum, nor the other Internal parts suffer any hurt.  
And this happened to many in Service, 
Wounds not penetrating.  who have been brought to me as mortally wounded; whereas I upon search have found the Impression only upon a greasy Leather Jerkin, or their Bellies black or a little scratched by the Bullet: In others the skin and flesh wounded and no further, these latter are called Wounds of the Belly, not penetrating, and are cured as Gun-shot-wounds in fleshy parts; in which cases all those things are approved of, which have been delivered in simplo Gun-shot-wounds.  
But this I must take notice of to you, as having often observed, not onely in Gun-shot-wounds, but in abscesses of the Belly, that from the laxity of the parts, they are subject to great defluxion, especially in the circumjacent Muscles: to my late vexation, whilst I was writing a rude draft of this Chapter, the matter flowed out upon us, Dr. S. Physician, Mr. Gin. and myself Chir. from various Sinuses raising up the Muscles, insomuch that the more we laid them open, the less hopes we had to effect our Cure. The particular whereof I shall give you in another place, with more of that kind, enough to show you the laxness of these parts, which is the greater, because we cannot make such Bandage here as elsewhere, by reason of their figure, scite, and perpetual motion.  
These thus briefly considered, we pass to the other Species, for the Bullet is for the most part carried with such force, as it not onely wounds the fleshy parts, but also pierces the Peritonaeum, hurting most an end the Internals. 
Wounds penetrating.  It being indeed impossible that the Bullet piercing the parts containing, should miss the contained which are soft and tender.  
I have seen sometimes in the Wars, a soldier shot scarce to the Peritonaeum, yet the contusion hath been so great that the Peritonaeum hath come of upon digestion, and the Bowels in these commonly labour under Cholicks, and the Patient is troubled with difficulty of breathing.  
If the Bullet penetrates through though no further, yet the Contusion makes foul work and requires speedy relief. But if it hath wounded the Internal Viscera, then you are to consider what the parts are that are wounded, whither the Liver, Stomach, or which of the Intestines, which you may apprehended from the scite of the part, and the accidents accompanying such Wounds, and by the proper symptoms of each part.  
According to Celsus, Lib. 5. Cap. 26. The Liver being hurt, 
Signs of the Wounds of Internal parts of the Abdomen.  there follows an Effusion of a gross blood; if the Porta or Vena Cava be hurt, the right Hypochondrium is oppressed: If the Artery be wounded, the blood is florid, and with Impetuosity leaps forth, and death follows. But if the stomach, Singultus or Hiccup, with Vomiting and Nausea, and his sustenance comes out of his Wound, with the Chyle, could Sweats, and the extreme parts could: Of the Intestines, if the lesser be wounded, poraceous Vomiting, what he eats or drinks, will pass out of his Wound in less then half an hour.  
If the great Intestines be wounded, the Excrements and filthy smell will demonstrate it: If the Wound be of the lest Hipochondrium under the short Ribs, you may conclude the Spleen wounded, and the blood floweth forth with great Tension of the Hypocondrium. If the Kidneys, the Wound is in the region of the Loins, near the Vertibra, under the Diaphragma, and the more certain sign is, if the pains reach to the Groins and Testicle, with difficulty of Urine mixed with blood, or pure blood voided by the bladder: If the Uriters be wounded, the Urine comes out of the Wound: If the Bladder be wounded, that part of the Belly is tense, pains are stirred up in the Groins, and the Urine is discharged by the Wound, and the Stomach suffers by consent, and the part wounded demonstrates it: If the Womb be wounded, vehement pains reaches to the Groins, and the Coxa and the Blood not only flows by the Wound, but per Vulvam they are troubled in mind, with other shrewd symptoms of death,  
For what concerns the Presage of these Gun-shot-wounds, 
prognostics.  if they be only in the region of the Belly, they are not without peril, and much loss in the middle, where the Linea Alba is; but if they penetrate,( as you may know by the signs forementioned) there is great hazard, seldom parts so shattered recover. What I have here seen from a man discharging his Excrements from the Colon on the left side, and heard of other like of the Stomach, are rather Miracles, then the work of the surgeons; but he was happy that had the managing that Cure.  
If Celsus in his time determined these Wounds mortal by cutting Weapons, how much more must they be such that are made in our age by Gun-shot; Yet Nature, as one saith, in his Vulneribus, Saepe miracula facere solet, is often as merciful and miraculous in the Cure, as the blow was cruel.  
In order to the Cure, 
Cure.  we must begin with the Extraction of the Bullet, least it sink into the most inward parts, and by its hardness offend the Bowels, as also the rags carried in with it, least it beget Putrefaction. Then we are to reduce the Omentum and Intestines least they be Inflated and altered by the outward Air: but in these Wounds they do not often fall out, unless it be by Splinter, or great Shot. Then Hemorrhagia is to be stayed, and inflammation allayed, and we are to resist Putrefaction, by bringing these contused and lacerated Wounds to digestion.  
The Intestines and Omentum are disposed to reduction by warm discutient Fomentations; but if there be not an opening large enough, you must enlarge the Wound. If the Omentum be corrupted, make a Ligature below that corrupt part to cut it off, leaving the Ligature upon the rest to fall of by digestion.  
If there be Haemorrhagia, you must inject such Medicaments as have a Refrigerant and Astringent quality, and those may be Aq. urtic. plant. spermatis Ranar. with sir. de Ros. sicc. with pull. Bol. Armen. ter. sigil. sang. dracon. Aloes, Thure, making a mixture of some of the same powders, with a new laid Egg, with Ol. mastic. & Lumbricor, and apply it upon a Tent fastened to a thread, 
Wounds of the Stomach and Guts.  as is before described, and apply the rest upon a Stupe over all. But if there be no Flux of Blood, digest as fast as you can.  
Fallopius hath recommended to our use this, by the use whereof he cured a Wound in the Stomach and Intestines.  
℞. Fol. Pilosellae plantag. rad. Tormentillae consolid. maj. flor. hypericii, these were decocted in read Wine; in the latter end of the dressing add a little Manna, Thuris, ol. mastic. rosin. Abiet. Terebinth. Cypriae, croci & verm. terrest. the Wound within to be dressed with this.  
If there be Putrefaction, you may use such Medicaments as are fit in that case, but those die in great pain: In all these Wounds of the Belly, to stop fluxes of Blood, I use such like Medicaments as I have proposed, and apply to the Wound itself Digestives, as in simplo gun-shot, and by good Fomentations, Embrocations and Cataplasma's, cherish the native warmth of parts.  
In Wounds of the Kidneys, 
Wounds of the Kidneys.  you are to inject such Medicaments as have an Abstersive and drying quality as Radices, consolidae, Iridis, Aristoloch. rot. and maj. myrtle. caudae equin. plantag. ballast these decocted in aq. chalybeat. adding after some Wine, and mell. Ros. digestivum Terebinth. & Integ. ovum with a little Terra sigil. Thus & mastic. & ol. Hyperici, with Emp. diacalcith. malaxt. with ol. Ros. and a Cataplas. of far. Hordei. fabar. & orobi decocted in oxymel. adding a new laid Egg to it, with Ol. Ros. to be applied over all.  
If the Liver or Spleen be wounded, 
Wounds of the Liver, Spleen, &c.  there will be great Flux of Blood, in which case I offer this to you.  
℞. Plantag. pentaphyl. polygoni Mille-follii, myrtle. Ros. rub. to these you may add Thuris, sang. dracon. Bol. Armen. Acaciae, boiled in water chalibeated, adding a little read Wine, and sir. de Ros. succ. This may serve for an Injection: if the extravasated blood fall down into the Cavity of the Belly, you must leave it to Nature.  
Thus you are to dress all the Wounds in particular parts of the Belly.  
The Wounds of the Womb are accounted deadly, the very least of them: and so are all these made by Gun-shot, yet you are to proceed in the universal regiment with glisters and Bleeding, and by good Vulneraries: there Diet here is to be medicated, and all endeavours to dispose parts to sanity, if it were possible.   

CHAP. IX. Gun-shot-wounds of the Thorax.  
AMongst the principal parts which are subject to this devilish Invention gun-shot, the middle venture or Thorax is numbered with the parts contained in it, viz. the Heart, Lungs, great Artery and Vessels, with the Mediastinum. The difference of these Wounds is as in those of the Inferior venture; sometimes it doth not penetrate into the Cavity, so as the plura is not hurt: Other times it doth penetrate through the Membranae and Costae, in which case the principal Viscera are wounded or not wounded.  
If the Wound do not penetrate into the Cavity of the Breast, 
Not penetrating.  but be only in the musculous flesh, it shall be cured as Wounds in the fleshy parts.  
But if the Bullet hath penetrated into the Cavity, 
Penetrating.  it may be easily discerned by the Laceration of the musculous flesh, and commonly by the Fracture or Perforation amongst the Ribs, 
Signs.  whereby the Wound is left open, and the Spirits and Air pass out with noise; and if the contained parts be wounded, there will follow a Flux of blood by the Wound or Mouth, or by both, unless the blood fall down upon the Diaphragma, and then the symptoms of the difficulty of breathing and such like Accidents, will more demonstrate its Penetration. And if the Lungs be wounded, a Cough, with difficulty of breathing, and flux of blood, and sighing often, and a rattling in the Aspera Arteria, the Patient inclining to ly much upon the Wound. If the Heart be hurt, the blood flows with impetuosity and reeking hot, their Pulse languishes, could sweats follow, and they die.  
The Diaphragma hurt, draws upwards, the spin is grieved, very difficult breathing, and unequal and painful, with a hoarse Cough, and great pains about the false Ribs.  
If the great Vein or Artery be hurt, a terrible Flux of blood follows; if it flow from the right side, it is the Cava is hurt; but if from the left side, we suppose it the Artery, you will discover it by its saltation and florid colour. The Aorta wounded, that Patient dies at the instant.  
If the Spinalis medulla be wounded, the Nerves are resolved, and a palsy follows, more immediately in the part under the Wound. Almost all these Wounds are mortal, they generally die. But it is not consisting with Religion or Humanity, to leave them without help. And for that I have happily prolonged the life of some, and have known others that have recovered of some of these wounds, in the Lungs and less noble parts thereabouts. I shall therefore proceed to deliver you what concerns their Cure, 
Cure.  both as to the Internal concerning the wound itself, and to that which relates to the Contusion and inflammation Externally, to prevent flux of humors, and facilitate the discharge of blood and Matter contained in the Cavity of the Thorax. You are in the first place to draw out the Bullets and Extraneous bodies, amongst which sometimes a part of the Ribs are carried in: All these are to be removed, and the place cleared of shivers, lest they prick the membranes, and thereby hasten ill accidents which attend these wounds. You are then to dress the wound with a Tent dipped in this or such like, ℞. Bol. Armen. Corn. Cerv. ust. Ol. Ros. & Sambuci, Farinae, Volatilis, and with ovo Integ. Misce; spread a compress with some of the same, and apply it over the wound: If the blood stop not by this dressing, then it may be proper for you to Inject some astringent decoction, which is otherwise than was advised in wounds made by puncture: For in Gun-shot-wounds the orifice is wide enough for the Injection to return out again; insomuch that not only the Astrictive intentions ought to be pursued, but also the Detersive; here being loss of substance and putrefaction. Therefore boil in Aq. Ger. querc. Fol. Plantag. Ulmi, Urticae, Vincae, Pervincae, Ros. Rubr. fol. myrtle. & ballast. adding a little Bol. Armen. & mastic. sir. de Symphyto qs. and if more astringent be required, boil it in Aq. Fabr. Having thus quieted the bleeding, you are to dress with this digestive, ℞. Terebinth. Lot. in decoct. Hordei ℥ ij. pull. Thuris, Myrrhae, an. ℈ ij. Sem. Faenug. p. ʒ j. Ol. Hyperic. qs. dress with a Tent dipped in this, then apply over it a Pledgit, with some of the same, or with some of your Suppuratives, as in simplo Gun-shot-wounds is prescribed, and Embrocate the breast and parts about with Ol. Amygdul. & Lumbric. with Ung. Dialth. m. and an Empl. Diach. simple. cum. ol. Lumbric. dissol. and after digestion you are to Inject such medicaments as have power to deterge, and are more resolvent, whereby the Matter is disposed to be discharged by the wound; and to this purpose extract. Scordii dissolved in Wine, with the addition of mell. Ros. is proper, or decoct. Pilosellae, Caude Equinae, Plantag. Tormentillae, Consolidae, Aristoloch. Rot. Rad. Iridis, & Sarcocollae, these boiled in Aq. Font. adding Wine to it, with mell. Ros. qs. and then you may dress the wound with this Mund. ℞. Terebinth. ℥ ij. Farin. hoard. Cribrat. ʒ j. Thuris, Sarcocol. Rad. Iridis, an. ʒ iij. Mellis Ros. ℥ iiij. Misce S. A. You may dip your Canula or Tent in this, and dress the wound in the fleshy parts with the same. The wound deterg'd incarn and cicatrise, as is said in other wounds, but keep a Canula in it, until it cease to run. Celsus proposes, that in all these Internal wounds the outer parts be vesicated, to draw off humors more powerfully from within, and the medicament he proposes thereto is, Sal been contritus cum cerato mixtus, quia leviter cutim erodit, eoque impetum materiae quo pulmo vexatur evocat. This his proposal may be proper in wounds made by sharp weapons, as by Arrows, &c. But here in these wounds there is vexation enough outwardly to make a revulsion, if that signified any thing. In the dressing these wounds you must be careful to cut off the sloughs without, lest from them a stinking Gleet distill upon the Viscera within: And in order to the cure there is required Phlebotomy according as the Patient lost blood by his wound: Here are also Clysters required to keep the body open, and the more temperate: Pectoral decoctions are here proper; such as is in the London dispensatory, omitting the hotter Plants; to them may be added sir. violar. de cichor. de liqueritia, Jujub. Capil. Ven. de symphyto, & Lohochs, and such as may take off the harshness which the Aspera Arteria, and Bronchia are subject to. Their diet is to be slender, and medicated. Hydromel is a proper drink in all these wounds, and may be medicacated with agglutinatives and pectorals added to it, and after Fever and such like accidents are diminished, Asses and Goats milk is necessary, yea a diet of Cows milk alone, or mixed with distilled milks, and sweetened with conserve of Roses; but this will be a work for the Physician a-shore.  
From the defeat of the Scotch-army near Dunbar, 
Observation.  there came many of the wounded to St. Johnstons, and amongst them there was several wounded into the Breast; they who were so shot as to have the Ribs broken, were in extreme pain from the shivers, whereas those whose Bones were not hurt had scarce any pain at all, but what proceeded from difficulty of breathing and coughing: A stinking Sanies issuing out both before and after the separation of the sloughs in great quantity; in one a very great proportion daily, of a brown thin Matter, of a rank smell; none but this died under my hands; they after some while retiring to their homes, where( as I have often heard them say) their Leeches performed great Cures, by virtue of their Plants which they gave Internally, and with Fats they made Balsams of; yet I believe most of these died Tabid.   

CHAP. X. Of symptoms of Gun-shot, omitted in the Fourth Chapter.  
THe symptoms attending Gun-shot, as you have red already elsewhere, are Pain, Fever, Delirium, Syncope, Phlegmon, Erisipilas, Gangrene, Convulsion & palsy. The Pain proceeds from inflammation or Phlegmon or Erisipilas, which I have elsewhere purposely treated off, as also of Gangrene; The Fever is Symptomatical, so is the Delirium, & will go off with the Pain, but may with the forementioned be relieved, by bleeding and Lenient purgatives, such as I have mentioned, and to fortify the Spirits against fainting, which proceeds from putrid Vapours and Pain which may affect the part, there are Cordials and Epithemata already taught, so that there remains only Convulsion and palsy.  
Convulsion is an involuntary contraction of the Nerves to their Original, 
Convulsion.  by which contraction the Member is also drawn up, and is said to be caused of Repletion and Inanition; In this our case it ariseth from putrid Vapours or Acrid matter offending the Nerves, which is often found in these wounds; The part affencted is the Brain, which being thus provoked causeth an involuntary contraction and rigidity of the Members. In parts dismembered, as near the Knee or Shoulder, there the Contraction cannot be discerned but by a trembling, which trembling is usually attended by a Convulsion of the Jaws: It likewise follows great inflammations, especially in the Nervous parts; The prognostic here is always Fatal, they being the forerunners of death. 
Observation.  In the Wars I was called to see a poor soldier who had his Arm shot off, near the Shoulder, his Chirurgeon dressed him with Egyptiac. as for a Gangrene, from which sharp dressings great Pain followed, with shivering of the Stump, inflammations and Gleets, but no change of Colour in the skin, he had roared some days, through the vehement pain; I dressed him up with Anodynes, as Linement Arcei cum vitel. ovi, fomented the part with fol. malvar. violar. caps. barbat. decocted in lact, and with Lenients Embrocated, as with ol. Lumbricor. & exped. Bovinis, and applied Empl. Diapalma cum succis over all, and anointed parts about, as Neck and spin with ung. Nervin. and blistered the Legs and Thighs, but it was too late; he died howling.  
Paralysis or resolutio Nervorum is generally defined a privation of sense or motion or both, 
palsy.  in some part or parts, and affects the Brain & spinalis medulla; But in Palsies which arise from wounds, the parts immediately affencted are the Nerves of that part only, this doth not take away the life of the Patient, though it may sometimes threaten a Mortification through the resolution of the part. In a Sea-fight an Irish master having discharged his Gun which was hony-combed, 
Observation.  and loaded it suddenly again, whilst he was ramming in a Carthage, the powder took fire, and shot the Rammer out of his hand, it did tear the Palm of his hand, and some of his Thumb and Fingers: The wound was not considerable, but it extinguished both sense and Motion of the Member. I dressed him up with our common digestive, of which at such a time we had great quantity ready, and over all a common Restrictive, so rolled him up, there being then no time for bleeding; But after the fight I let him blood, and the next day or two purged him, and Fomented and Embrocated him, with ol. Lumbricor. Cham. Aneth. lilior. ung. Nervinum, and such like I suppose, and did all that we surgeons of the Squadron thought fitting, but without success; one night lying a-sleep in his Hamock, he was awakened by the wet he felt, and got up to a Candle, and found the dressing upon his hand all bloody, as also his belly whereon it lay: I was called, taking off his dressings, found the palm of his hand and fingers gnawed by rats, they had eaten through his oiled clothes, and had knaw'd his hand more if he had not wakened from the trickling of his blood. I dressed his wound with my digestive, purposing not to hasten its cure. I supposing it might be a help to his recovery. I after the cure of this made him a Fontanell in that Arm, and bathed the Member, Cupt and Scarified it, and afterwards used Emplasters of Pitch, to stir up a heat in the part; but he was a young man and otherwise of a strong Constitution, and out of hopes of reward for his lost Arm, he hastened away to Madrid, and at his return had more use of it: These Paralyses do often happen in great Contusions, and after dislocations in the Shoulders, I could instance it in several. Dr. T. C. and Dr. T. W. did both see it in a Lady who had dislocated her Shoulder. I was sent for, and by the help of her Servants set it presently, and she so well the next morning, as Sir W. G. then present scarce believed it had been out; I was dismissed, but within a month after she was so Lame, as it was doubted, whether the Bone was Set or not. A Bone Setter was sent for, who at a time in another person pretended he had set so many Bones, where none were dislocated or broken. This man, I being present, acknowledged that the Bone was well Set; but had I been absent, he would have delivered otherwise, and by new Extension have rendered the part Incurable.    

AN APPENDIX TO The Treatise of GUN-SHOT-WOUNDS.   

To the Reader.  
HAving thus finished the Discourse of Wounds, I considered with myself that my design was to help the Sea-Chirurgeons, who seldom trouble their Cabins with many Books. I therefore thought it convenient to make this little Treatise as comprehensive for their use as I could, by making it contain all those things which may easily be foreseen to be of use to them. Now besides Wounds, we know by our experience that Burnings by Gun-powder and other materials do too frequently happen at Sea: and also by Ill dressing of Wounds Gangrenes and Fistulae arise, and withal much the sooner, if broken Bones, especially those with Wounds, be not well brought together and so held: The ease and life of the Patient consisting in the well handling and ordering of them. All which matter we occasionally handled in the foregoing work, yet not so much, but that for their fuller Instruction I thought it requisite to anticipate something of other Discourses, I intend for the Press, by the following Appendix, which if well perused may perfect the Chirurgeon in what remains to be known concerning Wounds, and save him the labour of reading many Authors.   

AN APPENDIX TO The Treatise of GUN-SHOT WOUNDS.  

CHAP. I. De Ambustis, or Burning.  
FOrasmuch as it often happens, that in close fights at Sea men are sometimes burnt by Gun-powder by their Enemies, and by various accidents amongst themselves: I shall therefore deliver to you the most plain way of curing them. For however people cry 'tis nothing to cure a Burn, yet by what I have seen of these Cures from Country or City, they are often very ill performed. Whether they are Burnt by Gun-powder, or any other way, their Cure is much alike; they only differing, secundùm magis & minus, only if they be burnt with Gun-powder, they must pick out the powder first, else they will carry the same blew mark in their faces, which some of our people use to do in their hands and arms, which I have often been employed to take out, when done wantonly in their youth; but could never remove this mark, otherwise than by taking off the skin.  
If the Burn be superficial, it raises the Cuticula up in Blisters. If it go deeper into the skin, it causes an Eschar: If it burn deeper into the flesh, the force of the fire makes a hard crust with a contraction: In all these the pain is excessive. Once dressing a Gangrened Leg with warm Spirits of Terebinth. &c. Mr. Arris and Mr. Hollyer surgeons, and others being close about me, and I upon my knees; the candle being too near the hot Spirits, catched the flamme, burnt my thumb and fingers, with that part of my hand before I could get free from those behind me to throw it into the chimney, which was some distance off. I felt much more pain for the while in the superficial scalding, than where it was burnt to an Eschar. The pain is vehement, & makes great fluxion. 
Cure of a Burn.  The Indications of Cure are of two kinds, either by refrigerants and Emollients to bath or anoint the part, until the heat be off, and the Eschar removed, and then to deterge and cicatrise; or by hot medicaments to relax the skin and open, to resolve and dissipate; and so by accident alloy the heat and burning. 
By Refrigerants.  The Refrigerants are Aq. Solani, Plantag. Hyosciami, lac Ebutyratum, and all the cooling Juices and Unguents; as Album. Nutritum, Populeon. Rosat. &c. These must be used warm, until the heat and pain cease, or the fire be taken out,( as the common expression is) else they will rather cause pain. The other is by Rarefaction to ally the fiery heat and pain, which in the first place is done, 
By Rarefaction.  by the holding a burning-hot Iron or fire to the part; so whilst the fire calls forth that fire it made, it becomes its Alexiterium. But the common remedy is to apply salt and an onion beaten together upon the Burn. But this is not to be done after the Blisters be out; for so you exasperate the pain and increase the inflammation. There are many other things do the like, Fimus Equinus doth the like fried in Ol. Nucum, uvae immaturae, Sambucus & Ebulus, in oleo Coct. Calx viva extinct. & cum Ung. Rosaceo mixta, ad consist. Ung. These are to be renewed often, until the pain and heat be off, which they in few days effect; if there be Cacochymia, it is another kind of work: If these applications do not prevent the arising of Pustulae, you must cut them as they arise, lest by their Erosion they make hollow Ulcers, and inflame with sharp pains, Fever, &c. But where they are burnt to a crust or Eschar, you must hasten its fall with Emollients; deterge, then incarn and cicatrise.  
Here is required bleeding and evacuation by lenients and spare diet, 
Regiment in Burns.  with all other regulation proportionable, as the Burn is greater or less. I could present you many cases of this, but shall give you one for all.  
A Scholar of about ten years of age, 
Observation.  at a School a few miles off, the evening before the Fifth of November, having filled his right pocket full of Squibs and Crackers, would before he went to bed, throw one of them in the Embers, it took fire: Whether it scattered the fire, or some spark, or that it was the Cracker, but those in his pocket took fire also, and his clothes were on fire; his little chamber-fellow ran for help, a little boy from some other Apartment takes the alarum, first comes in, sees his School-fellow in fire, catches up a basin of water, throws it upon him, runs out, cries help, they come in and help him out of his burnt clothes: A neighbour-Chirurgeon is sent for, who dresses him, and the next day the burnt child is brought to Town, and lodged by me. I find him burnt into the flesh, from a hands-breadth below the Axilla, down the side, and part of the belly, within two inches of the knee; in breadth from the belly, over the as Ileon to the Gluteus, and scorched about the edges; and by endeavouring to free his pockets of the Crackers, which was burning there, he burnt his hands from the fingers end, all the in-side of his arm to his elbow joint; where the parts were burnt to a crust, these I anointed with mell cum Succo Caepar. & pull. Iridis mixed; and all the parts about I fomented with a decoction of Hyosciam. Malvar. Solan. Violar. & Sem. Cydon. & Psillii, adding to it a third part of lac Ebutyratum; and then Embrocate the parts with Ung. Stramon. Then he should have been let blood, but would not: Clysters were admitted, and pearl Juleps, his Fever was very great with the pains; as any Blisters arose we snipped them. As they became raw, I finding that Cerots or ought else of Pledgits were apt to shut in Matter, and bring off the skin with it; dipped a fine Lawn in the decoction, and laid it over the parts, and with a feather dipped in Ung. de Stramon. mixed with Ol. Amygdul. anointed the Lawns, through which the Matter passed, and the parts lightly burnt healed; The parts deeper burnt, as they threw off their Eschars, I digested, with the yolk of an Egg, a little Tereb. lot. in aq. Solani, adding a little Farina Hordei finely searsed cum. Ol. Amygdalar. with a little Saffron. Upon the sides I laid of this Ung. Stramonii, with a little Calx Lot. and on other parts Ung. Album, adding a new-laid Egg to it. Thus each part is to be considered, and especial care that Matter be no where penned in.  
In these large Burnings there are variety of intentions at the same time: Some require anodynes, 
Several Indications in a large Burn.  Others detergents; digestion some, and others desiccants: Some the parts dressed twice a-day, Others but once: Some I dressed with this Ung. ℞ Ol. Sambuci. lb j. Cerae ℥ iij. These I melt, then taking it off the fire, I add Lithargar. Cerussae, Calcis lot. Thuris & Sarcocol. Upon some of these Lawns I laid Pledgits dipped in a solution of Troch. Alb. Rhaz. made in a decoct. of Equiset. Ros. Rubr. and Summit. Rubi to cicatrise the part: And as the part bears, I make it more drying. Thus I happily cicatrized this young Gentleman, even and smooth, without the least unequal Cicatrix; nothing but the read colour to make it discernible; and that was gone off his hand when I see him last: And I must tell you, in these great Ulcers it will require your care, that an Hypersarcosis be kept from growing upon you; for so your Cicatrizes will be deformed. I have had some persons of good quality come to me, so deformed with these, as they have suspected them to be wenny; and where they have happened upon womens Breasts, they have suspected them Cancerous: These were much to the credit of the Female-Chirurgery. In others from ill Chirurgery the lax flesh hath grown so high and callous, as when one of them came into my hands, he required to be burnt again in order to his Cure; but I performed it easier. In the face there is a special care to be had, as also in the neck and breasts of the Female sex. 
Medicines for Eyes burned.  A great care must be had likewise of the Eyes, that they be dressed with no greasy medicines, and that the Lids be not dressed with too drying, lest they contract and make a Lippitudo; in the cure of the Eyes you have Pigeons blood, Breast milk, Aq. Solani, Plantag. Ros. Pomor. Sem. Cydon. Faenug. Troch. Alb. Rhas. Tutiae, Lap. Calam. Thus, Sarcocol. washed or nor washed. The Ears, for want of care, I have seen adhering to the scalp, and the fingers one to another; and in others close contracted, with hard Callus; one of which I cut: It was a Boy from Cheshire the Lady B. commended to me. 
Observation.  I cut the cicatrix of each finger, and caused a roll to be placed under his crooked fingers, which carried with bars to the inward part of his wrist, which had by screw there fastened gently, thrust forward the bar, till it had born all the fingers before it, and by a complete extension restored them to their former liberty. The wrists and other joints are subject to the same inconveniences, which are prevented by the knowing Artist, by the well ordering them, without which the best Medicaments signify little.   

CHAP. II. De Gangraena & Sphacelo.  
THE most cruel symptoms that attend great wounds, and especially Gun-shot, with broken bones, are Gangraena & Sphacelus; Gangrene is the beginning of a Sphacelus; It is the disposition of fleshy, and spermatic parts to a mortification: Sphacelus is a perfect Mortification, with the extinction of the native heat, and privation of Sense and motion of the part. They differ only as the Mortification is more or less.  
The Signs of Gangrene, and Sphacelus are much alike, the last more intense; 
Signs.  it is of a deadly Livid Colour, Fetid, the lips Flaccid, without heat or sense of Knife or Fire; if there be yet sense in it, 'tis there Gangrena; If no sense then Sphacelus.  
That Brother was grossly ignorant, that  told me aloud, there was no need of enlarging the wound, he could turn his finger in it, and pull out the rags, &c. As I came out I met Dr. W. who asked me how the Patient did; I replied the Chirurgeon within hath given me unwittingly the certain sign of his death, which I had some two or three days before prognosticated, and advised his wound to be laid open for perspiration, and the taking out of Extraneous Bodies: The Chirurgeon tells me there is no need, he hath easily put his fingers into the wound and pulled out some rags, by which I conclude the Patient will die in few hours: The Doctor replied, yea, without doubt, and the Patient did die the next day. In magnis vulneribus & pravis si tumores non appareant, ingens malum. This was a great wound, and not being digested, it should have been accompanied with flux of humour, and Inflammation. The lips of the wound full, and rather with a narrow contracted Orifice, but the heat was decayed, the tumour sunk, and the lips flaccid.  
The causes of gangrene are various in Gun-shot wounds, 
Causes of Gangrene.  it commonly happens from error in the first applications, and not making timely extraction of the Extraneous Bodies, and shivers of bones; which prick the nervous and fleshy parts, by which great flux of humors falls into them, which debilitates and chokes their natural heat; could hard winters, by intercepting the spirits, cause mortification; hard Bandage is a caused deficiency of heat in old age; And the Scorbute is often a cause.  
The prognostics of these are sad: 
prognostics.  The Sphacelus incurable; The gangrene is curable, if the habit of the body be good and timely succoured; otherwise it terminates in Sphacelus, and the Patient dies miserable; whensoever you see the Inflammation will not discuss nor suppurate, or that you perceive the bottom of the wound doth not matter, but feels deeper, soft and more foul, you may suspect; but if the matter be changed to worse, you may assure yourself the heat is decaying, and the outer symptoms in the change of Colour and sinking of the tumour will follow. Therefore hast to prevent it, there being great danger in delay; 
Cure.  If it change colour, and Blisters arise with certain Livid spots, and they but in the superficies of the skin, scarify them to the Quick, and let them bleed freely, by your Patient's sensible feeling them, and by the fresh trickling down of blood, you may judge of the mortification: But if the gangrene have crept deeper, or arise from the bottom of the wound, then scarify deeper into the fleshy parts to the Quick; and if there be any abscess deep under the muscles or lips of the wound, let it out; So shall you give a breathing to the parts: If in making your deep Scarifications, you chance to cut some Vessel, whereby a flux of blood happens, have a care of choking the part with your Astringents and Dossils; for so the gangrene will be increased: In this Case, I propose the Actual cautery, which will not only secure you from a flux of blood, but dry up the putrefaction: Then you are to apply such things, as may remove the Escar; as honey, powder of Ireos and juice of an onion: And afterward deterge, Incarn and cicatrise as in other wounds. If in your Scarifications you wound a Nerve or Tendon, you add to the gangrene; So you do if you burn but in part, or apply sharp Medicaments upon them newly hurt; or it may be it was at first, as I said, some Nerve oppressed by hard bodies, or pricked by shivers. Consider well, and if such lye in your way,( as in Nervous parts they may) you had better cut them off, or burn them through, than Scorch them: The hurting and burning of these is often a cause that the pain and fluxion is kept up. I see it daily in my practise in Sinewy parts, and while I was a writing of this, I cut off some of them to quiet the part, which otherwise upon every touch was grievously pained and inflamed; that so I might with more ease come at the carious bone that lay under it: But if you meet with none of these accidents, then after Scarification, consider how far the Gangrene hath proceeded, and accordingly cleanse the wound, by washing out the clotted blood, either with a Tincture of Myrrhae and Aloes; with extract Scordii or Theriac. Aristoloch. Gentian, or( if you will) add Calcantum; or that common Medicine of the Ancients, Salt in water, or a good Lixivium, or dissolving some Aegyptiacum, and afterwards it is in your choice whether you will dress it warm, with these or some chemical oils, as Terebinth. Caryophyl, &c. In a Gangrene coming in a Phlegmon elsewhere mentioned, I Scarified the parts, and washed out the blood, with a little ung. Aegyptiac. dissolved in sp. of wine, and filled the Scarification round, between the gangrened lips and sound parts, by Sir Alex. Frasier's, 
Observation.  chief phies. to the King, order with a precipitate; And applied over such a like Cataplas. ℞ farinae fabar. Lupinor. pisor. an. lib. coq. in Aceto optimo & mill, with the addition of Succ. Apii & Absinthii: The part where we sprinkled the precipitate separated with a perfect good matter, as much as was of it, and I have since often used it with good success. 
Observation.  I have sometimes when the Gangrene hath been coming on, washed and dressed the Patient, with a little ol. Tereb. hot with an armed Probe, and dipped a Dossil, first in the same oil, and then in precipitate, and put into the wound; And a Pledget of Basilicon dipped in the same oil of Terebinth. hot over that; and in hast mixed the crumbs of a wheaten Loaf, with good Brandy; and stirring it over the fire, with the yoalk of an Egg, and some Safron to the form of a Cataplasma, and applied it over the part afflicted, and rolled it gently on: The first time I ever used it, was upon a contused wound, on a person of a full body, his pain was great, his wound gleeting, and the parts changed in their colour: Against the next morning I was better provided, but there was no need, his pain was mitigated, the colour of the lips was returned, and the wound dry: I suppose my precipitate with the oil had made some little Escar, therefore let it alone to fall off of itself, and applied a fresh pledget as before, over the Dossils, and after I had a while fomented the part affencted, I laid over it the remainder of the former Cataplasma: The next dayes dressing the Dossils came out with good digestion, and the wound afterward was Cured. But in these according to the increase, you must fit your Applications, farinae, hordei, fabar. orobi, Lupini, lentium, pisorum, sumit. Centauri, Min. Absinth. Scordii, Cardui Benedicti: Rutae, rad. Ireos Aristoloch. Gentian, vincetox. Sal. come. Lixivium. oxymel. Myrrhae & Aloes sp. vini; These are the common remedies, of which Fomentations and cataplasms are to be made, to corroborated and resist putrefaction.  
Then you have the common Aegyptiac. which you may heighten by the addition of Sal. come. Armoniac. nitri, Theriacae, Mithridati, Camphorae, &c. and a good defensative above the part, of Bole Terrae sigil. sang. dracon. Acetum succ. solani, ol. Ros. Myrr. Cerae, Alb. ovor. &c.  
In these dressings you are to cut away the mortified parts; and each time cleanse it of its putrefaction, 
Note,  otherwise it may be feared, it may be corrupted again under the Escar.  
If after all these Endeavours, the Gangrene penetrate more inwardly, 
Actual Cautery.  you must then attempt it, by the actual Cautery according to Hypp. Illi affectus qui Medicamentis non sanantur ferro sanantur, qui ferro non sanantur Igne sanantur, qui Igne non Curantur hos existimare oportet insanabiles; Those diseases which will not cure with Medicaments, are cured by a Knife, and those which yield not to that, are cured by Fire, and those which will not by either, are counted incurable.  
By the actual Cautery you shall resist all the degrees of putrefaction, except a confirmed Sphacelus, it not only corrects putrefaction, but corroberates the part.  
But if after all our vigilancy and industry in contriving remedies to resist the Gangrene, it does yet delude us, and terminate in Sphacelo, there is then no more need of taking Indication from antecedent causes or changing of Medicines, according to the variety of the Causes that introduced it: whether a Gangrene arise from an hot Intemperies or could, moist or dry; Sphacelus is alway the same extinction of the native heat and destruction of the Member: The mortification creepeth on, and not only encompasseth the Member, but infecteth the Spirit to the very heart with its corrupt vapours, mortifying the Vessels all along the sound parts, leaving the Member immovable without sense or heat, rotten, black and cadaverous; wherefore there is nothing now to be thought of in this case, but Amputation or cutting off, quia curatio syderationis non consistet in medio, the cure of this disease not consisting, as I said, in outward applications, but manual operation; and what success may be therefrom expected is much to be doubted. 
Extirpation.  At satius erit, with Celsus, Anceps auxilium experiri quam nullum. It is a miserable kind of help, yet it is the determination of all Authors, that in Sphacelus, Membrum corruptum abscindendum est, In this case it becomes the Chirurgeon to acquaint the friends with this last woeful kind of remedy, and withal to make his prognostic accordingly, and then provide all things in readiness: But before we undertake this last Remedy, we must consider how to proceed in the operation; In those places where Amputation cannot be made, as in the Buttock, Shoulder, Back, &c. Fab. held. proposeth the use of potential Cauteries applied to the mortified part, and often renewed, till the last Escar reached to the live flesh; yet he condemneth arsenic as being venomous, and producing many dangerous symptoms: It is true, that I myself have often used that method of Cure in Sarcomata with good success, but in a mortification there appears to me many greater Inconveniences that attend it; first from the caustic itself, as he proposeth it of Salts, it will melt in the working, and is more disposed to spread in the skin than penetrate deep into the flesh: This every young Chirurgeon knows in his making of Fontinels, that he cannot apply a bit so little with all his Art in defending it, but that it will have spread much farther than he designed it; then the separation of such Escars is too slow to effect your purpose, and in an ill habit of body, such medicaments are apt of themselves to procure a mortification rather than Cure: Whereas on the contrary, an actual Cautery answers all Intentions; it not only consumeth the mortification, but drieth up the venomous humour, thereby preventing its farther progress, and also communicateth warmth to the languishing parts; by virtue of which the separation is much farthered, and by working upon the gangrened sloughs performed more easy, as I shall show you in my practise elsewhere. But where Amputation itself is feisable, nay altogether necessary, as in the Limbs, there ariseth a new question; Whether it ought to be done in the sound part or in the dead: Fabr. ab Aq. penned. adviseth the dead part within a fingers breadth of the live,( as also do many others) then with a Cautery burns up all the remaining mortification. Others do perform the Operation with a hot Knife, the figure of which you may see in Hildanus. Aq. penned. speaks so confidently of his success in the practise of this way, that utterly to deny the thing were to give him the lye. I shall only make this objection, that the Sphacelus doth seldom affect the Member so equally round, as that an operation in the dead part is feisable; nay which is worse when once the mortification seizeth on the great Vessels, it runneth up so fast under the skin, that before any considerable part of the Member is outwardly gangrened, on the one side beyond the Knee or Elbow; The other side will have reached to the Inguen or Axilla. This I confess frustrates all manner of Amputating, whether in the sound or mortified part: yet generally speaking the Gangrene doth not grow so fast, but that if you make Amputation two fingers breadth more or less, within the live flesh, you may prevent it, and that far better than it is possible to be done by the other way of operating; for if you work there by actual Cautery with an hot Knife, your Knife will stick fast in the flesh till the moisture be wholly dried up, and then you must repeat many Knives and Cauteries, in every one of which you will meet with the same inconvenience; Yea before you can cut through with your hot Knife, it is very probable that you will near the Bone meet with some parts that are alive and sensible, especially when you come to the Periostium; for the Bone doth not usually corrupt at the same rate of swiftness with the other flesh, and then all your pains and trouble will be as great or greater than if you did it in the sound part. As to other Inconveniences, I shall refer you to Hildanus, who hath taken pains in confuting this opinion.  
The greatest motives to the Ancients for the use of this and that other way of Amputating in the joints, I presume was the easiness of preventing fluxes of blood this way, which they found more difficult than the other.  
But modern surgeons have answered this objection by good Bandages and deligation of the Vessels, and when we cut above the Knee by clapping Cauteries to the Vessels only, which sufficiently answers that Intention: Thus have I seen in my first Sea voyages, Amputations made above Knee, and afterwards practised them with great ease and safety:  
Now since not only in this Chapter of Gangrene, but frequently in this Book, we have mentioned Amputation, I think it necessary to take this occasion of showing the manner of performing it, the rather because the operation is much the same, whether it be done upon the account of Gangrene, or for other reasons. I shall therefore in general terms insert the whole doctrine of Amputation though briefly, not mattering whether the examples instanced be Sphacell or not; all instances being alike instructive, viz. If in heat of fight at Sea, a Leg or Arm be shattered by Splinter or Great Shot, 
What is to be considered in heat of Fight.  you are to consider the loss of Substance, whether the principal Muscles and Vessels are torn off; or if the wound was inflicted by Musket-shot in the bending of the Arm, in the inside of the Elbow, or in any of the Joints of the Leg or Arm; if you cannot extract it, or if the Bullet did pass through, yet if the fracture be great, or the shivers of Bones so lodged within the Joint, as you cannot pull them out, and if the Artery be wounded by the same shot, and that you cannot come to dress or stop it otherwise than by crowding dossils into the wound; you shall then presently make extirpation of them, cutting the Arm in the place where it is so shattered, and saw off the end of the Bone even; your assistant the while pulling up the musculous skin and flesh. If it were the Ankle thus maimed, you shall then cut off the Leg within three or four fingers breadth under the Knee, for that so long a stump would be troublesone: But if it were shattered in the calf of the Leg, do not put your Patient to the pain of Amputation, for the gaining a hands breadth or higher: If the Toes with part of the foot was shot off, cut off the lacerated parts smooth, but with care to save as much of the foot with the heel as you can; it being much better than a wooden Leg: But if the Arm or Leg be not so shattered, though the wound be large on one side, and hang gaping down with great fracture of Bones, yet be not discouraged, the largeness of the wound will make for your better pulling out those extraneous bodies, shivers, splinters, rags, or ought else; and for the easier discharge of matter, dress it as a wound by a splinter.  
If the great joint be so shot by Musquet-bullet, that you think it not reasonable to cut off the member, be sure you make extraction of the Bullet, and free it of all extraneous bodies; leaving not the least shiver to prick the Nerves or Tendons, and make such way presently, that you may be able to dress the wounded Nerves, Tendons, &c. without after-openings, when the part is inflamed and unfit for it.  
If after some days the wound do not digest but inflame and Gangrene, and the Gangrene do not yield to your Applications, as hath been proposed in Gangrene, then as in Sphacelus you are to proceed with the extirpation of that rotten member, while the Patient is free from Delirium, and hath strength to bear the operation.  
Seat him so as it may be for your conveniency. At Sea they sit or lie; I never took much notice, nor do I remember I had ever any body to hold them; with the help of my Mates, and some one or two that belonged to the Hold, I went on with my work. At Sterling I made an Amputation above the knee, and had as little help; besides my servants, there was only a Sea-Chirurgeons assisting me, we stopped the flux of blood by actual Cautery, the wound digested and cured without any ill accident; but where we have convenience to proceed more formally, there we place the Patient in a Chair, where he may be held firm, and in a clear light, and your assistance come better about you; the member is to be supported by some one of the servants, then one of your assistants should draw up the skin and musculous flesh above the part you propose to extirpate, then make a Ligature two fingers-breadth or there-about in the sound part; so as if you Amputate in case of Gangrene, you may be sure to quit yourself of the mortification. This Ligature is omitted by many of our surgeons here in the City, they only making a turn with a Tape, pinning it on as a mark to circumcise by; and instead of the Ligature I. propose they make a Gripe, which Gripe is commonly made by some Assistant who is strong in gripping: Indeed this is good where a shattered member is to be cut off to smooth the stump, where there is no great fear of bleeding; but in Amputation it seems to me to be very inconvenient, for I never see any man so gripe, but that the Artery bled with a greater force than was allowable; yea when Mr. Wodall gripped, who was so applauded, and in truth made for the work; it being so, in what a huddle is the stump then dressed: But suppose the uneasy posture, and the long gripping tires him, or that his hand be cramped the while, what is then the condition of the Patient? Whereas by this ancient way of Ligature which I propose, the Vessels are secured from bleeding, the member benumbed, and the flesh held steady, ready to receive the impression of your crooked Knife,( or Razor which I have often Amputated with) the Amputation made, the drawn-up skin and musculous flesh falls down to cover the stump, and the Chirurgeon hath time to take up the Artery or cauterize the mouths of the Vessels, and afterward to bring the lips over the stump by a across stitch. This Ligature made, the Assistant strengtheners it, whilst he draws up the musculous flesh; the mean time the Operator with a sharp crooked Knife by a turn cuts round to the bone, then with the back of his knife he scrapes the Periostium from the bone; if there be two bones, he with the Divider separates the fleshy membrane there, while the Assistant pulls up the divided parts more powerfully; during which the Operator with a few motions saws off the bones or bone: If there remain any Asperity on the end of the bone, it must be smoothed. There is to be a boul with Bran or sifted Ashes to be under the member, while this work is doing, to receive the blood: When you make this circumcision, begin in the upper part on the out-side of the Leg or Arm, cut down close to the bone, bringing your Knife round to the inside, where the great Vessels are; so shall you have the less effusion of blood: That done, and the bones freed of the Periostium, Guido proposes a linning, and Hildanus a kind of a purse to be brought over the upper-divided flesh, to pull it upward, to make more way for the Saw; but I think that needless. The flesh divided, the parts separate enough of themselves, besides the Assistants pulling up the musculous flesh and skin is sufficient, the bone is to be sawed off close by the flesh above: that done, you are at liberty, whether you will cauterize the Vessels by a Button-Cautery, or by Ligature stop the bleeding, or by agglutination. The use of Calcanthum I do not approve, to apply Escaroticks to the ends of the Nerves and Tendons, new incised, causes great pain, weakens the part, and makes way for Gangrene: It not being likely you can so apply them to the Artery, but that you must burn the parts about, which are, as I said, the Nerves, &c. The way Hildanus proposes by drawing the Vessels out by a pair of Forceps, is not a work to be done in heat of fight, nor without a clear day-light; if you attempt it on Land his Arm would be bowed, and his Leg stretched out, that the Vessels may be elonged after extirpation, that you may the better take hold of them. Ambr. Par. proposes a more easy and sure way of deligation, that is, by passing the Needle with a good strong Thread through the skin, about half an inch above from the lips, your Needle to come out just by the side of the great Vessels, then pass your Needle from the other side over the Vessels within, through the Raw-flesh out through the skin; there putting a fold of a rag or of Emplaster spread, and tie the two ends of the thread over this strait; thus you bind the Artery and Vein with inconsiderable pain: But at Sea, I suppose, your actual Cauteries are always at such times in readiness by you: Therefore in such cases use them, they will secure your Patient from the present danger, and fortify the part against future putrefaction, they requiring no such strict Bandage, as that thereby you shall fear interception of Spirits; when we Cauterize the Artery, we do then touch the end of the bone, it hastening the Exfoliation: The next thing is the loosening the Ligature, and bringing the lips close over the stump, then whether you should with a across stitch hold them so, or content yourself by Bandage as well as you can, is by some controverted; they that object against it say, it causes pain and inflammation, so doth Bandage, if it be made too strait; Therefore they should object against that also. The most that I have seen without across stitch have the next dressing been broad stumps, some of them with lips turned outward by the Bandage: In the least of them the whole stump hath been bare, whereas those where I have brought the lips over the stump, have been the next dressing close, covering the great Vessels, and a third or half part of the stump hath been well digested, and by the second dressing hath been near agglutinated, so far as it lay under that skin, & without inflammation happily cured: Whereas the broad stump is a certain sign of a long Cure, and commonly death. The exposing those incised parts too much to the Air, causes pain, and the want of native heat makes them gleet; or if they do digest, the discharge of so great a quantity of Matter commonly exhausts the Spirits of the Patient.  
If the musculous flesh and skin was well pulled up in time of Amputation, and brought over by a moderate extension, as far as they will easily admit, you will find it not painful; you are to pass the Needle with a strong brown-thread seared, you are to pass it about half an inch from the edges of the lips, having made them across from side to side equally, tie them with a moderate astriction, then apply a Pledgit on the Cauterized Vessels with pull. Irid. Suc. Cepar. & mell. But if no Cautery was used, then Buttons of Tow spread with your Restrictive, and dipped in Pulv. Galeni are to be applied to the mouths of the Vessels; afterward sprinkle the stump thick with this powder, ℞. Bol. Armen. Farin. volatile. Picis, Naval. an ℥ iiij. Aloe, Thuris, mastic, Sang, Dracon, an. ℥ j. Gypsi ℥ jss. pill. Lepor. Corii raspat. an. ʒ ij. pull. Subt. m. Mix some of the same cum Albumine ovor. and apply it upon a round thick Stupa, which hath first been wet in Oxycrate, and dried; over that another Stupa spread with the same so broad as to come over the first, & up a pretty height above the stump this is to be snipped deep in the edges, that it may lie smooth about the member; an Oxe-bladder ready cut & wet is to be turned over this, & a across cloth next the bladder to hold the dressings steady; then with a Rouler with two heads, begin upon the stump, & roll up to the next joint, and so again about the member to retain your dressings firm; then fasten it, so as that it may not be capable of falling off. But before you make this Bandage, you ought to apply your defensative over the parts above the stump: Some apply it before they begin the Amputation, but then it is found full of wrinkles, and sits uneasy. In the dressing of these stumps, you are to apply your medicaments, as you may without much bungle roll up the member, and place it to the ease of the Patient, one holding his hand somewhile upon the stump: Your defensative may be of the same which is proposed in Gun-shot-wounds, or this; ℞. Far. hoard. Bol. Armen. an. ℥ iij. Sang. Dracon. ℥ jss. Flor. Ros. Rubr. ballast. Nuc. Cupressi, pull. an. ʒ vj. Acet. ℥ x. Album. Ovor. n. viij. Ol. Ros. & myrtle. an. ℥ j. Cerae qs. Boil the powders in the Acet. then add the rest to it, to make it of the consistence of a Cerot. The third day take off the dressings, and then you may cut the across stitches, and sprinkle the wound with pull. Galeni, and dress with this Digestive; ℞. Terebinth. Lot. in decoct. Hordei ℥ iij. Ol. Lumbric. ℥ j. Gum Elemi dissolute. in predict. Oleo ℥ ss. Far. Hordei Cribrat. ʒ ij. Vitel. unius Ovi, Croci pull. ℈ j. m. Apply to the bone a Pledgit of Lint wet in Spir. Vin. and dried; after the wound is digested, you are to deterge with Mundificat. Paracels. or Apii, or this, ℞. Terebinth. Venet. Lot. in Spir. Vin. ℥ iij. pull. Rad. Iridis, Aristoloch. Rot. sarcocol. Thuris, an. ʒ j. mell. Ros. ℥ j. Then incarn and cicatrise, as hath been said in Compound Wounds.  
whilst I was a prisoner at Chester, after the battle of Worcester, I was carried by Coll. Duckenfield's order to a substantial man, that out of too much zeal to the cause pursuing our scattered forces, 
Observation, the ill consequences of wounds in the joints.  was shot through the joint of the Elbow, from the lower and outer-part of the as Humeri, out below, between the Ulna and Radius; he had laboured six weeks under great pain, the wound was crude, the lips turgid, with lax white flesh, the Bones not likely to unite, many shivers lying within the wound and joint, without hopes of getting out, the bones within carious, and the member oedematous from the wound down-wards to the fingers-ends, full as it could hold; and the more, for that the Patient could not suffer his Elbow to be bowed as to bring his hand to his breast, the upper part of the wound from above the joint to the Axilla above the shoulder inflamed, a perfect Phlegmon formed. The Patient thus tired with pain desired to be cured, or have his Arm cut off: To which purpose he had procured the Governors leave for my staying with him. But while that Phlegmon was upon the upper parts, there was no hopes of a prosperous Amputation, nor of cure while those shivers of bones lay pricking the Nervous parts within the joint: The Phlegmon was too forward for repercussion, and yet not likely to suppurate in less than a weeks time; therefore I endeavoured by Emollients and somewhat discutients, to succour the grieved shoulder and parts thereabout, by hindering the increase of the Phlegmon, and give some perspiration to the part, then with good fomentations to corroborated the weak and oedematous member below, and by detergents, fomentation, and bandage to dispose the wound and fractured part to a better condition, and made way for discharge of Matter, and the shivers of bones, also to remove the carries; to which end I had brought his hand nearer his breast: A few days after I opened the Abscess above, and below under the Axilla; A while after, the Matter discharged from above, the tumour flatted and agglutinated within, and the Ulcer cured: But the continual pains stirred up in the fractured joint, kept that opening in the Axilla from healing: The Patient growing weaker, and without hopes of cure, I was necessitated to proceed to the Amputation: To which purpose I sent to Chester for Mr. Morrey a knowing Chirurgeon, 
Amputation. ( since Mayor of that City) to come with Instruments and other necessaries whereby I might the better do the work. Mr. M. came, we prepared dressings ready, which were Stupa or Pledgits of fine short Tow well worked, some like the Splenia, others round bigger or less, these wet in Oxycrate and dried; also some buttons of Tow, then compresses of wisheth dipped in Oxycrate, three or four Roulers with one or two heads, Needles threaded and seared for making the across stitch, and lesser Needles threaded for common use, with Filletting for Ligature, and Bladders ready cut and wet in Oxycrate. A defensative of the above-mentioned prescription, spread upon a soft saith, to apply upon the parts above more distant, and a mixture of the Astringent powders with whites of Eggs to spread upon the Splenia and buttons, which buttons were also dipped in some of the same powder: Then for the round Pledgits which were designed to be applied next to the stump; Mr. M. proposed that they might be spread with a mixture of Umber and Calx viva, with whites of Eggs, according to Dr. red in his observation upon an Amputation he performed upon a servant of the Lord Gerrards at Gerrards-Bromley, whose famed yet lives in that Country, and amongst us surgeons, while his painful Lectures have a being.  
The Apparatus thus made, and the Patient some while before refreshed with a draft of a good Caudle, his friends take him out of his bed, and place him in a Chair towards the light, one of his servants held his Arm, another of his friends his other hand, then Mr. Morrey drew up the skin and musculous flesh of the Arm towards his shoulder, whilst I made a strong Bandage some three or four fingers breadth above the affencted part: Then with a good Knife I cut off the flesh by a quick turn of my hand, Mr. Morrey pulling up the flesh, whilst I bared the bone; then with a few motions of my Saw, I separated the bone, the Patient not whimpering the while. After this Mr. Morrey thrusting his hands down-wards, with the musculous flesh and skin which he had drawn upwards, I with a strong Needle and Thread passed through the middle of the fleshy skin on both sides, within half an inch of the edges, and brought the skin close within a narrow compass, and having tied that fast, and cut off the string, I passed the Needle again through the two contrary sides, and this I tied as close; this is called the Cross-stitch, and is of so great use, as without the performance of this, the Patient is long in Curing; and sometimes through the great discharge of Matter the Spirits are wasted, Spasmaes and the like follow: Or if he do recover, 'tis a long work and much pains; whereas by this across stitch the stump is covered to the breadth of a five shillings or half-crown piece, the flux of blood in a good measure choked, the heat of the part kept up, and the wound soon cured, and the Patient grows fat and strong: The while, having made this across stitch, I untied the Ligature, and applied little round Stupes of Tow, which had been first dipped in Oxycrate, then dried, and spread with a Restrictive, wherein was a quantity of Galens powder, mixed with Alb. Ovi. From these round ones I laid long Pledgits, spread with the powder of Umber, &c. mentioned by Dr. read in his Lectures; this and the long Pledgits were Mr. M's. proposal, and sat very close from the middle of the stump each way upwards along the Arm; then I put on a Bladder, a cross-cloath, and rolled up the stump, and made a Bandage from under his other Arm, and over his Neck to this Bandage,( which prevented an accident which hath since happened to a Patient here in London, where many of the best surgeons were concerned.) Then I put him into his bed, and three days after opening him, the wound was well digested, but the binding occasioned a new eruption of the Ulcer, which formerly came from the Phlegmon in the Axilla: Our stitches brought the skin so close to the stump, as here was no place for buttons with Escaroticks, which are so constantly used in these Operations, which lying commonly upon the new incised flesh, Nerves, and Tendons, do much disturb the quiet of the part.  
The second dressing was made by a digestive of a little Terebinth. washed in decoct. Malvar. with the yolk of an Egg, and Ol. Rosar. and with a large Stupe of Tow, with some of the same digestive, and a proportion of Galens powder upon it, and having Embrocated the parts with Ol. Rosar. and a little Acet. I applied my Empl. de Bol. over all, and rolled up as formerly, but very easy; and afterwards mundified with that of Paracels. and with Sarcoticks and Epuloticks incarned and cicatrized, and the bone Exfoliated: Then having procured a pass to come to London, I hastened away, leaving his stump cured.  
At the Siege of Weymouth I was called at break of day to an Irish-man of Lieutenant Coll. Ballard's Regiment, who in shooting off his musket, broke and tore his hand to pieces after a strange manner: I purposed to cut off his hand; 
Observat.  I sent presently to my quarters to one of my Servants to bring a Saw, and Knife, and dressings, of which at those times we had always store, which being brought, I took a read ribbon from off my Case of Lancets, and bound about his Arm some four fingers above the Carpus, and cutting the flesh, bared the bones of their membrane; I divided the flesh between the bones, and setting the Saw close to the flesh above, I sawed it off, and untied my Ligature above, and bringing down the musculous flesh and skin over the end of the bone, not making any cross-stitch, here dressed up that stump with my Restrictives, and rolled him up, and returned again to my quarters: I had not been one hour gone, but I was sent for again to this Irish-souldier, he being as the messenger said grievously full of pain; I wondered at it, and hastened away, before I came to his but, I heard him crying, I asked him what he ailed to roar so, it was a while before he would answer me, at last he  told me he was not able to endure that read Ribbon that I tied his Arm with; I was at first herein surprised, to think I should leave the Ligature upon his Arm, that being a sure way to bring a mortification upon the part: I put my hand in my pocket, and shewed him the read Ribbon on the Case of Lancets, he seemed at first to doubt it, but after he see it was so, he laughed; and was from that time in ease: Two days after our men were surprised, and chased out of the Town and Chappel-fort; I was at the same time, it being about twelve a clock, dressing the wounded in a house for that purpose in the Town, almost under the chapel and Fort, I heard a woman cry, fly, fly, the Fort is taken: I turned aside a little amazed, towards the Line, not knowing what had been done; when I got upon the Line, I see our people running away, and those of the Fort shooting at them, I slipped down this Work into the ditch, and got out of the Trench; and as I began to run, I heard one call Chirurgeon, I turned back, and seeing a man hold up his stump and his hand, I thought it was the Irish-man, whom I had so lately dismembered; I returned, and helped him up, and we ran together, it was within half musket-shot of the enemies Fort, he out-ran me quiter.   

CHAP. III. Of Fistulae.  
A Fistula according to the Vulgar denomination is every sinuous Ulcer, if it have been but of two months continuance; but strictly saying those only are Fistulae which are narrow, sinuous, and have contracted a hard Callus, they are usually some years in making: The worst sort of these, at least that ever I see, was from Gun-shot-wounds with fracture; especially where there hath been loss of bones, or through long continuance the carries hath chambered the bone, the lips of the wound and wound become Callus by keeping long open in order to Exfoliation, and sometimes through former sinuosities which have prolonged the cure, there the lips grow hard, and do become inverted thick, and are more or fewer in number as the Abscess or wound was more or less sinuous: This Callus of the Fistula is hastened by the perspiration and resolution of the thin and subtle humors, and Incrassation of the more pituitous, by the congestion of which a long pipe of skin is made, which brancheth itself inwards from the orifice quiter through all the Cavities of the Ulcers, from whence it hath its name.  
The differences of these Fistulae are made not only from the parts affencted, 
Difference.  as some in fleshy, others in Tendonous, or in the bones, or joints, or the breast, belly, &c. But also from the figure, magnitude and number of the Sinus, as sometimes only one, then again two or three crooked or winding, till they enter the bones themselves.  
They are known by the view, and by the touching of the parts, 
Signs.  or by searching with a Probe, and from the discharge of a thin serous fetid Matter, and have an Arched hollowness: If by your searching the parts are pained, or a drop of blood follows your Probe, the Fistula is not confirmed, but if neither succeed, the Fistula is confirmed.  
All Fistulaes are hard to cure, 
prognostic.  and those of long continuance with great discharge of depraved humors in sinuous parts amongst the bones and joints are worst, because their Sinus are narrow, and have contracted a hard Callus, and without that be removed they can admit of no cure.  
The way of Cure is performed by manual operation or by Medicaments; But before you proceed in either, you are to consider that these fistulas are subject to pain and defluxion; wherefore you are in the first place to proceed by evacuating of those humors which may disturb you in your work, and that is done by purging and bleeding, good Traumatic decoction and observation of diet, as is said in universal regiment.  
To proceed to the Cure by manual operation, 
Cure.  you are to consider the part affencted, whether the Callus be only in the lips, or in some part of the Fistula, or that the Callus be throughout the whole length of the Sinus, and this is discovered as I have aforesaid by the Probe, &c.  
If there be neither pain nor matter, the Fistula tending only down directly to the bone, then do you let it alone accounting it an imperfect cicatrix, and if undisturbed will in time grow more close; But if it be the former, then you must remove the Callus if you propose to cure it.  
If the Sinus may conveniently be laid open, divide it with Knife or scissors the whole length; if after the laying it open, the Sinus be not Callus, or not a confirmed Fistula, then deterge the Ulcer and Incarn and cicatrise it: But if the orifice of the Fistula be streight and narrow, that you cannot lay it open, you must then dilate it with Tents of sponge, gentian, Aristolochia, Elder-pith, &c. until the Sinus be large enough for your purpose; and to further this work it may be proper, that you outwardly apply such Medicaments, as may by their Emollient and digestive quality resolve and dissipate the matter, impacted in the parts about, and these are Rad. Altheae. lilior. Enulae campan. sigil. Solomonis, cucumeris agrest. sem. lini, fenugraec. Medullae ossium, Axung. Porcinae, Axungiae Humanae, Anseris, Gallinae, dialthae. Gum. Galban. Amoniac. &c. Of these you may make fomentations, Cataplasma's or Cerots: You have also to this purpose Empl. de ranis cum aut sine Mercurio, Empl. de Musilag. diacal. cum Gum. The Fistula thus disposed for laying open, you are to consider whether you may not remove the Callus by Catheretics: to which purpose Celsus proposes, lachrama papaver, cadmia, attramentum, sutoneam, Erugo, sandarach Alum, we commonly use our Lap. Caustic. Vigo's Troch. de minio Arsenicum ol. calcanth. or thus, ℞ Cerae resinae an. ℥ j. sublimati ℈ ij. mix this upon the fire, and dip a sponge in it, but not to hot, lest you burn your sponge; then press it out, and cut it into what length and thickness may serve your purpose; Guido commends Aq. fortis as the most Excellent for destroying the Callus of all these fistulas: But if you had rather have an Injection, you may make this or such like, ℞ ung. Aegyptiac. ℥ ss. sublimat. ʒ ss. Arsenic. ℈ j. Lixiv. ℥ j. Aq. ros. ℥ ij. aq. plantaginis ℥ iiij. boil this ad tertiae parts consumptionem, casting a little of this in with a Syringe three days together, shutting the orifice up with Cerae or some Emplaster; so shall you consume all the Callus: But you must consider the parts underneath that Fistula, that by its too far penetrating it hurt not the bone, or parts underneath. If these answer not your Expectation, then having dilated the Sinus, lay it open by Knife or Actual Cautery; after the application of these stronger Medicaments, or Actual Cauteries, you must by Lenients mitigate the pain, and defend the part from defluxion which will follow such appliplications, and these are by decoctions to Syringe, as fol. Malvae, bismalvae, violar. verbasci, Hyosciami sem. Cydonior. hordei, or ol. vittel. Byturum. Axungiae, ung. Basilic. cum ol. lileor. dealthae, &c. and over the parts refrigerants; as Empl. è Bolo Oxelium, Diapalma cum succis, or some of the defensatives mentioned in this Treatise: When inflammation is off, deterge with this, ℞ Terebinth. in aq. vitae lot. ℥ iij. succ. Apii Cinaglossi an. ʒ vj. mell. Ros. Colat. ℥ j ss. decoq. ad succ. consumptionem, dein add Aristoloch. rot. pull. ʒ ij. farin. lupinor. ℥ ss. you may add to it pulv. Ireos, myrrhae, sarcocol. Thuris, and thereby Incarn, and afterwards cicatrise: If the Bone be carries, you are to consider how far the carries hath entred into it, and proceed in the removal of it, either by Actual Cautery or Rugines scraping the rottenness off, then by cattagmatics hasten Exfoliation, and proceed in the rest with Sarcoticks and Epuloticks.  
But if these fistulas be near, or over some noble part, or that there be Nerve, Tendon, Artery, or in such bones where it reaches to the Medulla, or Joints where you may not safely proceed by Actual Cautery, or potential, and that it will not yield to milder Medicaments; you shall do better to palliate by some Emplasters and Unguents, as may dispose the part to quiet, purging the Patient sometimes, and observing the Universal Regiment in diet, &c.  
And old Officer of our Army labouring long under an Ulcer on the outside his Thigh, 
A Fistula in the fleshy parts  by the vastus externus from an old Gun-shot-wound, implored my help; the Ulcer appeared with a small contracted orifice, scarce admitting my least Probe, it ran towards the Bone about an Inch deep, then running downward with a Sinus more lax, discharging a thin Sanies it was outwardly accompanied with a pituitous tumour, but nearer about the Ulcer was hard, and of a darkish read colour, not unlike an Imperfect Schirrus: In order to his cure, I proposed to him temperance and quiet, purging and bleeding to carry off the Plethora; to the part affencted I proposed discutients and resolvents, Fomentations, Embrocations and Emplasters, as is abovesaid in the general Chapter, with Bandage to resist the Influx of humour: That done I applied a Caustic upon the orifice of the Fistula, and after separation of the Eschar, I dilate the Sinus by Tents made of Gentian, dipped in ung. Dealthae. This Sinus enlarged, I make way to the other by the same means, and having dilated that Sinus, I cut it open the whole length, and fill that with dossils spread with Basilicon and Turbith mineral filling the said Sinus, by which I proposed the Eradicating the Callus; To the recent parts cut I applied dossils with my digestive, and over all a Cerot composed of ung. pupuleon & cerae, and with a compress dipped in Oxycrate make my Bandage over all: The next day I take off my Bandage and Emplaster, Embrocate the part with ung. Pupuleon, and apply my Cerot and Bandage over all again. This I did to alloy the heat of the part, and prevent Influx of humour, nor meddling with the Escarotick till it came off of itself with the slough; then where I found any part of the Callus remaining, I rubbed it off with my Lapis Caustic. The Callus thus removed, I deterged with the Mundificative above proposed, and hastily Incarned, lest parts should again contract a cicatrise, as they are apt quickly to do, whereby my former Endeavours would have been rendered vain.  
An old Officer had long laboured under a Fistula, 
A Fistula with carries in the as Tibia.  from Gun-shot in the upper part of the as Tibia, near the Knee upon the Shin bone, where that Bone had been grievously Fractured, and from thence had been long Carous; he was my Patient in France, but here I finished what I there attempted and had not time to do. I here after general Evacuation applied a caustic the whole length of the Sinus, whereby I took off that Callus, and gave way to the discharge of that Faetid Ichor made in the Bone, and took out several pieces of the rotten bone which was shut in there: This done, I Rugin'd away that rottenness, and dressed the Bone with my Cattagmatick powders, &c. By which means after some time a Callus thrust forth, and United with the Musculous flesh, and after which by Sarcoticks Incarned, and was afterward cicatrized by Epiloticks, as is said in Ulcers of the Legs.  
It often happeneth, that in the time of Exfoliation of carries in the bones, where there hath been loss of bones, as in Gun-shot-wounds is too often seen, there while we are attending Exfoliation, the lips grow Callus, so as the Cicatrix is deep, and the lips at some distance.  
In this case heretofore I have taken much pains to better the cicatrise, but since by often experience have found, that in time the Lips flat, and the Callus rises up to them of itself, and the cicatrise becomes firm and seemly.   

CHAP. IV. Of Fractures in General.  
A Bone is a Similar part of the Body, and the hardest, and driest of all, the General use of which is Stabilimentum ac fundamentum reliquis omnibus partibus largiri, to be a firm prop and foundation upon the strength whereof all the rest of the parts are built: The whole Skeliton considered jointly may be looked upon, as performing that office to the little world, that Atlas hath been fabulously reported to do to the great one; it bears the whole bulk of it, and sustains it in all its motions, none of which could be performed, if either the bones were not, or not so articulated and jointed, as upon desection they appear to be, Nam si ossa abessent non flecteremus manus non nervos & fibras; nay if the least bone be but a little maimed, the use of the part is hindered, but they are not only fulcimenta, as Galen says de usu partium, said etiam defensio but also a defence. The Cranium quoddle Galea, as a helmet defends the Brain from external Injuries; So Pectus ossibus clauditur, the Heart, Lungs, and great vessel of the Thorax are guarded by a wall of Ribs; the Spina is a bulwark to the Marrow included in it, and such a defence is the as pubis and the as coxa & Ilion to the Womb and bladder; others otherwise serve the uses of Nature, as the three little Bones in meatu Auditorio by firming the Timpanum, are a great help to the hearing; the as hyodes assisteth the swallowing, by managing the root of the Tongue and the Epiglottis. The Rotula serves the motions of the Knee, and the Teeth prepare the meat by Mastication, not a Bone but hath its particular end set out: There was a reason of the Temper, of the Magnitude, of the number, of the Substance, of the situation, of the Connection of them, the wise Creator as much shunning Superfluity as deficiency. Indeed the whole fabric is so full of Excellency that it would take up much time to express them; But that is not my business: The subject I have undertaken to treat of is their misfortune, and that is twofold, to be Fractured and Dislocated; that of Fractures I have proposed for my present Discourse, and that only in General, it being sufficient for my design.  
To proceed Methodically, I shall begin with their definition, which according to Galen, de methodo medendi, Is unitionis sine continuitatis solutio quaecunque in osse, but this being too general, and taking in all cariosity and Ulcers of the Bones, which hardly belong to this head of Chirurgery: The moderns have more closely defined it to be Ossis divisio seu rupturia à causa violenter irruente: But this likewise seems to me to be liable to many exceptions, I shall name only this, viz. That a cut made into a Bone by a sword or a sharp Instrument, seems to be rather a wound than a Fracture: And for this Reason Guido de Cautiaco makes it to be continuitatis solutio in osse non à re qualibet facta, said ab ea qua contundit; yet I must still beg pardon if I be not yet satisfied with this description, because it leaves out all such Fractures as are made by any accidental bowing of a Bone, either in a wrench, or any other case where without any blow or contusion of parts, the bone snaps in sunder, and then wounds the neighbouring Muscles, even to the thrusting of itself very often quiter through the skin: These are( cases of battle excepted) the most frequent of all Fractures, yet not without some violence to be reduced to any of these later definitions. I shall therefore choose to define a Fracture in the following words, 
The Authors definition of Fractures.  It is a solution of continuity in a Bone suddenly made, either by contusion or flexure: By contusion, I mean either a Blow by a blunt Instrument, or a pressure by a great weight, either of which usually bruiseth the flesh about the Bone, as well as the Bone itself: In contrafissures indeed the bruise is not immediately upon the Fracture, but in the places where the blow is given: In Flexure there is seldom any bruise but what is made by the edges of the Bone itself, after it is snapped in sunder; all other Fractures are reducible to these.  
Amongst the Greeks it was commonly known by the name of Catagma: I purpose not to trouble you with the nice distinctions in Fractures, nor yet with their various names. Galen in his Book de method. medendi complains, that in his time non desunt ex Medicis Junioribus qui ambitiosè omnes fracturarum differentias propriis nominibus interpretantur, there wanted not( saith he) young Physicians who affencted to give proper names to all the several kinds of Fractures; At non Hippocrates hujus fuit sententiae; nor shall I spend my time so; But according to Galen do take the difference in Fractures to arise, 
Differences.  1. à figura. 2. à magnitudine. 3. ab ossium fractorum varietate: First from their Figure, it is either Right quae fit per longitudinem, or transverse per latitudinem, or obliqne which is as it were compounded out of the two former. Secondly, à magnitudine according as the Fracture is greater or lesser. The Third difference is ab ossibus ipsis, that is from the Bones themselves that are broken, whether it be the Arm, Leg, Ribs, &c.  
Causes of Fractures internal there are none, 
Causes.  unless it be ab humoribus corporis erodentibus, and of that sort you may red many in Skenkius, Fabr. Hildanus, and others: I myself have seen some, and lately, but these being from Erosion are rather to be called Ulcers with carries, and therefore more fit to be discoursed of amongst Ulcers of that kind, to which I refer you.  
Of Causes external there are many, as the too violent assaults or stroke of all external things, which may bruise, break, shatter or bend. In this number of causes may also be reckoned falls from on high, &c.  
The Signs of a Fracture without a wound are for the most part very evident; 
Signs.  the first and most certain is, when in our handling it we feel the pieces of Bones severed a sunder, and hear them crackle: Secondly, the Impotency of the Member: Thirdly, vehement pain: Fourthly, a distortion of the part; also by comparing the one with the other, the Fractured Member being shorter. But if there be a wound joined to the Fracture, then if the Bones thrust themselves not forth, yet you may easily know it to be Fractured, if you search with your finger or Probe. There is also a curvedness which may be reduced to Fracture; I have seen it in children often, as in D. C's. little daughter in the Old-Baily, and Mr. N's. Son in blackfriars, and others: It is as it were when you break a green stick, it breaks but separates not, so is cured by a due extension with little trouble to the Chirurgeon, or pain to the Patient after the Extension is made.  
If the Fractures be secundùm longitudinem, it will appear first by the unnatural thickness of the Member, then by the pain and inequality of the part.  
In prognostic or presage, 
prognostics.  a Fracture of the Bones cannot be without danger, for of necessity the Solution of continuity must be great. If a wound be made in a fleshy part, the wound is proportionable to the weapon that made it, & non ultra: But if the Bone be broken propter Rigiditatem & continuitatem non potest frangi nisi totum frangatur. The Fracture is more dangerous in a great bone than in a small, and the greater if the bones be broken, as the two Focills in the Leg or in the Arm, where the radius and ulna are; yet if in the middle of the bones, it is the less dangerous: Those in or near the Joint are more painful and difficultly cured, and if any shivers press upon the Nervous parts, ill accidents commonly follow. A Fracture with a wound is the most dangerous of all. As to the time of Cure, the lesser bones are perfected in 14, 18, or 25 daies; the bigger in 40, or 50, according to Guido: yet let me advice you not to be too hasty in taking them out of their Beds, for in some Bodies the generation of Callus is very slow, and a new distortion may happen, and ill accidents follow. I have been called in to consultation upon such an Accident, the Patient did recover, but by lying so long within doors contracted such an ill habit of body, as was not got off in a long while after.  
In the cure of Fractures, Unition is required; but that cannot be made, unless pain and inflammation be prevented; For a Fracture of the Bones is not made without an Internal wounding of the Periostium and parts next to it, whence grievous pain arises, which stirs up defluxion, and is attended often with great inflammation, and from the weakness of the Member many Excrements are made and received, which it is neither capable to assimilate, nor yet expel; and the mischief is the greater, by how much the Bones lie deeper within the Muscles, where they cannot be set by reason of the great quantity of flesh, interposing between them and the hand of the Artist: The Intention pursued in this case is the union of Bones, as I have already said, which is not performed by the first Intention, unless it be in little children, but by the second, viz. an intervening of Callus.  
The Method I thereto propose, 
Intentions of Cure.  is first to join the fractured parts together; Secondly, to keep them so joined; Thirdly, to preserve the Tone of the part; Fourthly, to generate Callus; Fifthly, to correct Accidents.  
That parts may be rightly joined together, 
1 Intention.  there is need of Extension and Coaptation; for in fractures, especially transverse ones, the bones are commonly distorted, the rectitude of the Member lost, some parts are prominent, and others hollow, the Fractured bones lying one upon another, and so the Member made short, quia musculi perpetuo membrum trahunt versus suum principium: for which cause extension is necessary, 
Extension.  that the parts which are indirect may be brought right, and the parts that stick out be reduced to their Cavities. And although sometimes, the Member seemeth not to be short, as if it consists of two bones and one broken, or that the Fractured bones do not lie one over another, nevertheless you ought to make due extension in all Fractures, because they never lie exactly equal, and most frequently they ride one over another; The want of which Extension is one reason, why the Fractured Thigh bones hap to be so often shorter than they should be, as Celsus hath it in these words, Si femur perfractum fuerit brevius erit; his reason is, Quia nunquam in antiquum statum revertitur: And I find in Galen, that Hipocrates says the same of the Leg and Arm, and withal tells us it is nisi ante confirmationem extensio debita adhibeatur & comodâ deligatione ossium coaptatio servetur; by which you may observe the fault is want of good Extension, and keeping the part in its right seat, else you shall hazard the starting again of the Bones, and thereby their Fractured ends may hap to be broken off, by mutual Attrition in the Act of joining together; and if they do chance to fall in again, between the Fractured bones, they will then hinder their uniting, and if those shivers slide outwardly towards the Membranes, they will cause extreme pain; This Inconvenience is therefore to be shunned by the help of Extension, but again in Extension, there must be observed a mean, as Vigo notes to us, ad magnam quidem Extensionem futurus spasmus valde suspectus est. Yea sometime the very Muscles are torn a sunder, as Galen tells us, and Albucasius cries out cave extensionem vehementem & compressionem fortem sicut faciunt multi stolidorum, multoties enim faciunt Apostema calidum & contractionem in membro; by which it seems in his time there was such a people, who thereby drew sad accidents, as Convulsions and inflammations upon their Patients: But yet if the Extension be less than it should, then as I said before the ends of the bones rub one against another, and are broken or not seated in their proper place; Therefore the bigger bones having large Muscles, which draw the Member forcibly to their original, do require the stronger Extension, and such are the Thighs, Legs and Arms; and if both the Focills be broken, the more Extension the Radius requires, lest because it hath no Muscles to draw it upwards, its motion being only secundum pronum & supinum: In Extension it behoves us to observe debitam figunationem, that the Member be extended in ea figura quae minimum facit dolorem saith Galen, which is done if the Fibres of the Muscles be stretched, according to their rectitude; children and such as are of a soft habit of body do best suffer Extension, elderly and dry bodies the contrary.  
In the next place is to be considered the most reasonable time to reduce the Fractures, 
When to be made.  and herein we all agree, the sooner the better, and that to avoid the inflammation according to Celsus, Si in primis diebus non restauratur, Inflamatio oritur, sub qua difficile & periculosa vis Nervis adhibetur: If at the first or second day the Fracture be not reduced, it is in danger of inflammation and Mortification, for indeed after the second day itis supposed, the Fracture is accompanied with great defluxion, so yields not to Extension, without hazard of drawing such ill accidents upon itself.  
Therefore Fallop. in his exposition upon Hipocrates de Capitis vulneribus, and by his Authority tells us what we shall do in such a case, Si as non fuerit in suo loco, says he, Ideo ad septimam, qui est primus Terminus Inflamationis, vel usque ad nonam, qui est secundus, debemus been advertere, & oportet Impedire Inflamationem, if the bone was not restored before the time of inflammation, then we ought to attend till the seventh day, which is the first period of the inflammation, or until the ninth day, which is the second period, and all this time we ought to restrain the defluxion, vel per lenitionem doloris vel expressionem & deligationem loci, lenimus autem Medicamentis, oleosis quae habent vim refrigerandi, per deligationem pluribus fasciis, either by lenient Medicines, or by deligation: We lenifie with soft cooling oils, we make our deligation or Bandage by many turns of the roulers, these are to be done until the Seventh or Ninth day; inflammation abating there is opportunity for reducing the Fracture: The Instruments for Extension are threefold. First, the surgeons hand for gentle Extension; 
Instruments of Extension.  and let him place his hand near the Fracture, otherwise he shall hurt the sound part, by too much compression, and not avail himself much in his Extension; Secondly, for the middle Extension are funes and habenae, a sort of Bandage fit to pluck at in order to Extension. Thirdly; are organa & machinamenta engines used often by us, but invented by the Ancients, and they are for the most strong Extension; but before you make your Extension, consider whether the Member be not Fractured in more places than one. An old Gentleman came out of the country, by a fall going down Ludgate-hill, breaks his Right Arm a little above the wrist transverse, and near the bending of the Arm a second Fracture obliqne, this double Fracture hath happened to others in the Leg, it requires your circumspection, lest the one escape your sight, and the Member left deformed and weakened in its Action.  
The Extension made; 
2 Coaptation.  the Extenders are to be loosed gently, and the Operator shall with his hand endeavour as gently to press down the ends of the Bones, and join them smooth and even together; and if there be any little Shiver, that will not be placed even with his fellows, cut upon it, and take it out, you shall know the perfect Coaptation of parts by these Signs; First, 
Signs of good Coaptation.  if the fractured Member answer to the sound; Secondly, if by your handling of it you feel no inequality; and Thirdly, if pain be abated.  
The Second Intention in Curing of Fractures is, 
2 Intention  that the parts brought together may so be preserved, and that is performed by Bandage, which ought to be so made, as not only to keep the parts so joined together, but to defend them from inflammation; and to this purpose I commend to you that of Hip. and from my own practise. It consists of 3 Roulers made of linen Cloath, not too coarse, lest by its hardness it offend the part affencted, nor yet too soft and fine, lest it break; 
1 Rouler.  with the first Rouler you are to begin upon the fracture, and take three turns, then roll upward to the sound part, and so at the upper-part end this Rouler; it will steady the fracture a little, until the other Bandage be made, and restrain the influx of humors which might cause inflammation.  
And the second Rouler as long again as the first, must be rolled contrary to the first; 
Second Rouler.  so as if the first was made to the right hand, then this must be turned to the left: So that if the Muscles by the first Bandage were wreathed too much on one side, they now may be restored again to the other. This second Rouler begins upon the fracture, and after a turn there is carried downward, that so you may press the influx of humour from the fractured part, and so having made three or four turns downward upon the sound part, you may roll upward again by the fracture, and making a circumvolution upon the fracture itself, pass upwards, until you come to the end of the first Rouler. And there Hippocrates terminates this second Bandage, because there is fear of the descent of humours à parte superiori, and these two Bandages do more defend the part from inflammation, than strengthen the fracture; but they being made. Hippocrates puts over them( about the fracture) compresses of wisheth three or four times doubled, of such length as to reach over the fracture, 
Splenia.  but so narrow, as that five or six might be placed over about the fracture, the distance of a finger one from another, and are to spread with a little Cerot, only to make them stick; these are called Plagulae and Splenia from their figure, and do supply the absence of agglutinative Medicaments, and lessen pain by hindering the compression of the Bandage.  
The third Rouler of Hippocrates fastens the said Compresses; 
Third Rouler.  and its first turn is made upon the fracture, the one head is carried upwards, and the other downward: And you are to take notice, that the Bandages are to be drawn more strait upon the fractured parts than elsewhere, that the fractured part being more weak may be kept from defluxions.  
Celsus in his Eighth Book and Tenth Chapter, 
Celsus's way of rolling.  proposes another way of Bandage, first he dips a cloath in read Wine and oil, and applied it over and about the fracture, and after he brings six Roulers, his two first are those of Hippocrates, and so rolled, over them, he brings a broad wisheth, spread with Cerot, to keep them close down, and because the fractured bone hath always a propensity that way, whither it tended when fractured; therefore saith he, You are always to put a Compress of wisheth dipped in Wine and oil, Ei parti quae contraria est parti in quam membrum inclinat, and over this he brings the four remaining roulers; so as the following rouler be rolled contrary to the former, and the third end in inferiori parte, in the lower part, reliquae omnes in superiori terminum habeant, all the rest end above.  
These are the Bandages of Hippocrates and Celsus, men of the greatest authority in Chirurgery, and are followed almost by all that have writ since, and are of excellent use in fractures, in and near the joints, where there is fear of inflammation: But then in your Binding you must observe such a mean, as consists with the ease of the member bound. 
Sign of good Bandage.  A small and lax tumour appearing at the extremity of the member a day after, is a sign of good Bandage; but if there appear no tumour, or if the swelling be great and hard, then the Bandage is nought; the first showing the Bandage not to be strait enough, and the last too strait, therefore you should often visit your Patient, to inform yourself how the Bandage is.  
But if no accident happen, you shall not unbind the fracture until the seventh day; 
Bandage, when to loosen.  and then if all be well, the Bandage will begin to slacken of itself, and that is one reason, why fractures should be opened about that time; another cause may be, for that often in fractures there is an intolerable itching through the detension of humors, which are made sharp by deligation, perspiration being thereby hindered, and is wont to terminate in a most painful excoriation and inflamed redness: And in this case you are to bath the affencted part with warm water, that the Matter may be evaporated, and then the member is to be bound up again; but now at this time you are to put Ferulae or Splints instead of the Splenia or Compresses, but in fractures with great contusion, or in and near the joints, there I have continued the use of Compresses wet in white of Eggs; during the whole cure, with good success: And lately a youth about ten years of Age, labouring under a Carious Ulcer in his foot, the last great frost broke his Thigh-bone, according to the length of the member: This fracture was dressed by my Emplast, è Bolo with Splenia, moistened with Albumin. ovor. this with Bandage, &c. as is proposed in this Treatise, confirmed the Callus; Mr. Yowell, sometimes a servant of mine, set his Thigh-bone for me, I being at that present otherwise employed. But all the Ancients, after the seventh day did use Splints, and so have I where they might safely be used; for they not only keep the member steady, but strait, and of these some are made of Tin, others of Scabboard, pasteboard, and of wood sowed up in Linnen-cloaths; those of Tin do very well by reason of their lightness; those of Scabboards are apt to bow, and so is the thickest pasteboard, especially if they chance to be wet; and those of Wood are heavy and apt to inflame the member, yet through the Artists care they may be all used with good success, yea from the first day of the fracture: As in the case of a Reverend Divine, who broke both the Focils of his left Leg, within a few fingers breadth of the Ankle: This person laboured under an Astma, which grievously shaked the fractured member, wherefore I was necessitated to put on Ferulae the very first dressing, and continued the use of them during the whole time of his cure; he lately  told me that he never felt the least pain in that Leg, since I took off the last Emplaster, which is more than ten years since. But Hippocrates used them not until the seventh day, for before that day there was more need of hindering the inflammation, than of strengthening the fracture, post septimam contra, but afterward the contrary is required.  
The third Intention in curing of fractures is in preserving the tone of the part; 
Third Intention.  Natura enim as unire nequit nisi pars sit sana, Nature cannot knit the bones while the parts are distempered, and that cannot presently be removed; for though fractured parts be very well set, yet there will remain some Cavernulae, which will be apt to fill with Sanies, and the part through its weakness can neither well assimilate nor expel, so is like to be burdened with Excrementitious humors: Therefore Phlebotomy may be here of especial use, and the keeping of the belly soluble by Clysters, or otherwise, and a slender diet prescribed; but this is the work of a Physician. Yet they not being alway at hand, I thought fit to mention it, and so to proceed to our own work, in keeping up the tone of the part, and hereto we have need of such medicines. Quae materiam influxam desiccant & inflammationem repellunt, which dry up serosities and repel inflammation: And these in a word are Astringentia, of which we have choice. Hippocrates he used Cerot, then read Wine; Celsus, you have heard, he used Wine and oil; others used oil of Mirtils, Roses, read Wine, and whites of Eggs together; others again used whites of Eggs alone; and others added oils of Myrtill. ballast. Ros. Rubr. Sang. Dracon. Bol. Armen. with a little Oil and Wine made up to the consistence of a linement, and applied upon clothes over the fracture. By the use of this latter medicament, I cured a man whose Arm was sore bruised and fractured in many pieces, by the fall of a piece of Cannon, which broke loose in a storm, while we were preparing to lay aboard our enemy; over this Restrictive I applied the Splenia of double soft Lining with Bandage, as in Compound Fractures, and happily cured him. If the inflammation be not great, I then take off the Empl. Diapalma, and some of the forementioned powders, with a little oil of Myrtles and Vinegar, made up to the consistence of an Emplaster. This I call my Empl. de Bolo, 
Empl. de Bolo.  which I spread upon cloath pretty thick, and apply over the fracture, and this not only restrains the defluxions, but strengtheners the fracture: They are all very good, if they be proportioned to the malady, and excellently preserve the tone of the part.  
There is yet farther requisite to the performance of this Intention, 
Position of the member.  position of the member, and that according to galen, debet esse mollis, the hurt part ought to lie soft, for that hard lying presses and causes pain and inflammation, debet esse aequalis ne distorqueat, it must lie smooth or equal, because an uneven scite distorts or draws a-wry the part; Sursum versus ne humores descendant, it should lie somewhat high, lest a painful defluxion fall upon it; Oportet congruam membri sigurationem considerare, It behoves, saith Hildanus, to consider the convenient figure of the member, that the Muscles be kept in their right scite, which is most free from pain, haec autem est figura media, which if it be not observed, Exiguo post tempore membrum dolere solet; What those pains are you possibly may guess, but no tongue can express, therefore you ought to handle the member very tenderly, and if the fracture be made in cubito, place it in a Case made of pasteboard, with a soft pillow under it, and bring it up to the breast with a fine Towel, or the like: But if it be the Leg that is fractured, we then place it in a bed, and in a Cradle, or upon a Pillow quilted in the midst with Juncks to support it, having a special care, that the hollow of the Ham and Heel be filled up, lest the weight of the Foot hurt the Heel, from whence grievous pain doth ensue, and sad accidents may, as some of us have seen, or at large may red in Fabr. Hildanus.  
The fourth Intention is Callum Generare, 
Fourth Intention.  to make Callus, which is to be endeavoured after the fear of inflammation is over, Quia natura parts laesa non potest Callum Generare, and that ceaseth circa diem septimam, about the seventh day sooner or later, and if after that time the fracture is to be set, possunt diversa & mala accidentia generari, saith Vigo, yet after the seventeenth day of the fracture, I have set the Thigh-bone, and cured the Patient, who is living without any ill accidents.  
How the Callus is made, you may red at large in Fallopius, in his exposition on Hippocrates; and though it be not bone it is so hard, saith he, that if the member hap again to be broken, potius in alia parte frangitur quam ubi Callus est Genitus, it breaks any where rather than in the Callus.  
Two things are therefore required: First, that it's to be supplied with fit matter. Secondly, That that matter be not wasted from the edges of the fractured bones, aut foras evocetur, saith Galen; as for the matter to make Callus, most Authors do agree, 
Diet for the engendering of Callus.  that there be a greater liberty in diet; At quo tempore( saith Galen) Callus gignitur, nutriendum corpus est cibis boni succi, & qui multum nutriant, and that viscuous, his reason is, Quia ossis alimentum crassum, and thenceforth they commend at this time offal of flesh, and broths of Kid and Veal, and the like which are boiled with Rice or Wheat; they also allow sweet Wines: But this liberty in diet I think is better forborn, for thereby we often see great obstructions arise, especially here, where our Patients are inclinable to feed plentifully; therefore in such fractures, where the Patient is constrained to keep his bed, I propose a slender diet, and of such things as are of easy digestion, for without that liberty surely we cannot fail to complete our cure; the bones having naturally a poriness in them, in which is always contained a matter fit for their nourishment, and ex illo ipso nutrimento in fracturis Generatur Callus, of that nourishment Callus is made: So if you be careful to prevent inflammation, and the like mischiefs, which disturb nature in her actions, and apply such remedies as may dry the proper nourishment into Callus, we shall not fail then of our desire, and they according to Galen ought to be emplastic and moderately hot; for saith he, Ea Callos tum promovent, tum augent; quae digerendi vim obtinent, ea magnos jam Callos diminuunt: Therefore it behoves us with care to fit our Medicines to the age and constitution of our Patients: For those which are proper for men of ripe age, if applied to children and tender bodies, would so dry the Callus, as it would quiter diminish it, and frustrate our cure: In children Albucasius commends to us whites of Eggs alone, or with a little Farina Volatilis; In those of more years, pull. Myrrhae, Aloes, Acatiae, Gum Tragacant Thuris, Labdani, &c. the Emplasters of Paracels. Diapalmae, Oxycroceum, severally or mixed: But this latter Vigo is very angry with, and says 'tis a Diabolical Emplaster, too hot for the Summer, and not very proper for Winter; Vigoes Emplaster, ad ossium fracturas is excellent, and so is our Catagmaticum in the London-Dispensatory. As to Internal medicines there are many, but I shall only recommend to you Ostrecolla, and that by the authority of Fabr. Hildanus, who often experienced it, itis Dose ʒ j. in Aq. Rad. Simplyti, and with this so given, he cured a Compound Fracture in one above sixty years of age, at in juvenibus & succulentis non putat convenire osteocollam.  
Thus I have proposed fit materials for the generation of Callus; now lest that the matter of which it is to be generated should be hindered from thrusting forth, it behoveth you to alter the Bandage, the member not to be rolled now so strait; by which means the nutritious juices will have liberty to flow in, and there by gradual digestion to thicken into a Callus: In the opening it, you are to consider whether the Callus generated be such as is required, how the fault of the Callus is to be remedied, if it be less or greater than it should be, you shall hear presently.  
Thus I have done with Fractures in General, which if they be simplo, whether transverse, or secundum longitudinem, are cured by the same methods, only those which are secundum longitudinem require a more strict Bandage, otherwise the bones will be apt to gape: I hasten to the fifth Intention:  
Which is correcting of those accidents, which happening in Fractures retard their cure, 
Fifth Intention.  and they are many; as Pain, inflammation, Aposthumation, Gangrene, Itching, Excoriaton, Callus more or less than should be, weakness of the member and depraved figure: If Pain invade the place, then Lenients are proper, and such as restrain defluxion, and hinder inflammation, and of which sort I have mentioned some, and for more variety, refer you to those who have written of a Phlegonon. If Gangrene appear, slacken your Bandage, and foment the part with a Lixivium, in which hath been boiled Scordium Absinth. Centaur. and the like, and you may apply over all a Cataplasma with Barley-meal, Lupines, with the tops of the forementioned Herbs, and the like powdered, adding oxymel to it: But if Itching affect the part, then foment the part with warm water, which will give a breathing to it by the pores, or with salt-water, Quae propter salem expurgat & poros aperit; the Itching neglected, is wont to terminate in excoriationem dolorosam, a very painful excoriation, cvi occurrendum est exsiccantibus & refrigerantibus, such are Ung. Album, Camph. Nutritum, Populeon, &c.  
As to the Callus, it is sometime just, sometimes greater or lesser than just; if it be too great, 
Callus to lessen.  you will perceive it by its bunching out; as also it will be painful to the touch or pressure, and besides it renders the part unapt for motion; in this case abate his diet, and make your Bandage more strict, and foment with discutients, and apply Emp. de Cicutâ, de Ranis cum Mercurio, &c.  
But if the Callus be less, the signs are quod ad motum redditur debilis, the bone is weak, and if the part be touched you scarce feel the Callus; and this was thought by the Ancients to proceed from slenderness of diet, or that it was not enough incrassating: 
Callus to increase.  But I think it rather proceeded from improper applications, or too strait Bandage; yet if the Patient be in years, and of a spare body, you may both increase and incrassate his diet, but withal slacken your Bandage, and invite forth the humors by warm water, not too hot; donec pars rubescat & in tumorem attollitur, until the parts a little swell tunc enim desistendum: But if the member be extenuated, it's either from the too strait Bandage, or over-much bathing with warm water; therefore you must now bath with fresh broths, and good Embrocations, also a Pitch-plaster applied, and presently pulled off again, will by its adhesion to the hair and skin cause pain, and also an attraction of aliment to the part, and so the member is nourished.  
Also after the fracture is cured, the member is too oft found to be of a depraved figure, by reason the bones were not well set, or through ill Bandage, or some inordinate motion, aut propter inscitiam Chirurgi. To help this, if the Patient be young and lusty, and the Callus but six months old; There is, saith Celsus, yet one refuge, that is, fracturam de novo rumpere; and in order thereunto, you are to foment the part with decoctions, ex Althaeâ, Cicuta, and then rursus as frangitur manibus vel digitis, impellendo seu comprimendo.  
But if the Callus be yet so hard, as it yields not, then says Fab. ab Aq. penned. Frango eum instrumento attrahente in diversas partes: But this Albucasius a Chirurgeon, as bold as any, and one that had seen the effects of such rash undertakings, utterly condemns; says it is operatio valde vituperabilis perducens ad mortem: So advices the Patient, not to give ear to such vain people, but content themselves with such help as Emollients, Decoctions, Linements, and Emplasters may effect, which in truth is safer, if you consider that after the Callus is so confirmed, as it yields not to extension, than I say if you should break it anew, or any other way separate it; yet it would no more yield to a right coaptation, than a Hare-lip or my two fingers will to agglutination, without separating their dry body, which is not possible to be done in Bones.  
I could here insert many of my Cures in Fractures of particular parts, 
Observation.  but it would signify little more than I have already written, their cure consisting in the very same extension and coaptation, and are subject to no other Accidents: all which I have writ as plainly and feelingly, as if I had been performing the work in your presence. Yet as a rarity I shall tell you, that in Bridewell some years before the Fire, I was sent for to a poor Widow inhabiting there, whose little Son, of about eight years of age, playing about the Wharf, was struck by one of those great Cart-horses full in the face, striking the Ethmoides quiter in from the as Cribriforme, without any great wound: The Boy lay for dead a while, and dozed longer; it appeared a strange sight at first to me, his face beaten in, and the lower Jaw sticking out, nor did I presently know how to help him; by what Art to make my extension; But after a while, he a little recovering his senses, was persuaded to open his mouth. There I see the as Palati and Uvula carried so close back, that it was not possible for me to get my finger behind, and other way of extension there was none: Upon which I presently formed an Instrument bended up at one end, by which I got up behind the Uvula, then raising it a little upward, pulled it forward with the Ethmoides into its former place very easily; but I no sooner let go my extender, than the Body returned back again: Upon which I contented myself in dressing up the face with a restrictive Cerot to prevent influx of humors, and let him blood, and within few hours after caused an Instrument to be made, whereby the great fractured Body was more easily brought into its natural place, and also kept there by the hand of the Child, his Mother and my Servants helping him some while, other way there was none. Thus by their and our care, the Tone of the part was preserved, and a Callus thrust forth, which as it hardened, the part grew stronger, and the face restored to a good shape, better than could have been hoped from such a distortion in that place. The Patient is yet alive and well.  
Thus have I done with that which concerns simplo Fractures. 
Compound Fractures.  In a fracture with a wound, if neither the bone be bare, nor yet prominent through the skin, then you are by extension to bring the fractured ends of the bone together, as was proposed in the first and second Intention of simplo Fractures; and the lips of the wound are likewise to be brought together by Suture, if it be any-whit large, and not too much contused; which manner of dressing is contrary to what is taught in Gun-shot-wounds with fracture; the methods being to be altered upon that occasion, for the reasons there alleged. Then endeavour as in our third Intention, to keep the fractured and wounded parts together by dressings, which may as well mitigate the pain, as keep off apostemation, by repelling the matter flowing to the part, and denying that already flown, Qualia sunt Astringentia, Glutinantia, of which sort I have sufficiently offered unto you, in the Discourse of simplo Fracture. Galen, by the authority of Hippocrates, recommends Cerot of Roses, but if their be no pain, you are to endeavour the strengthening of the fracture, and preventing defluxions by clothes spread, with that composition of Astringent powders mixed with the whites of Eggs and read Wine, which is already proposed: Then follows deligation of the part, and in this case Bandages are to be made of softer and broader linen than we use in fractures without a wound, that it may comprehend both the lips of the wound, and keep them down, yet not hurt them by its too hard compression, Minus Astringendae sunt fasciae quam si vulnus non adesset, says Celsus, and therefore it is that Hippocrates and Celsus make so many Circumvolutions: cum melius sit saepe circumire quam astringere,( saith Celsus again) The third day they loose the Bandage, then ferulae vel non apponendae ne vulnus comprimant, saith Albucasis; or if they be put on, supper vulnus apponi non debent; rather in these fractures do we use deligation, pluribus fasciis with many Roulers, saith Albucasis; and so all along he goes in his Sermons of Fractures, as if he had been rather bread under Hippocrates or Celsus in Greece or Italy, than where he was; But in truth this way of deligation is not only very troublesone to the Chirurgeon, to put on and off, but so very painful to the Patient, that it is almost impossible that he should ever be without a Fever, if his wound be every day to be so rolled and unroul'd: Therefore in these Compound Fractures we choose rather to follow the method of some of the Moderns, who instead of these many long Roulers, make choice of two or three short clothes, folded three or four times to give them the more strength, and of such breadth as to encompass the lips of the wound and fractured parts, and of that length as to come once about the fracture, and so stitch together on the most convenient side; and under these may be placed Compresses of fine Tow or double clothes, which will not only keep the lips of the wound down, but fill up the inequality, and further the expulsion of Matter: And so the wound may be dressed, and the fractured member relieved at your pleasure, without giving the Patient the pain to have the fractured member removed, or yourself the trouble in rolling and unrouling so many long Roulers as the Ancients proposed; and with this method I have cured Arms and Legs, so shattered by Splinters from Cannon shot, and with such loss of substance, as I even despaired of their Cure. But in some of these I have made use of Hippocrate's Plagulae, and often for the more strengthening the shattered member, have been glad to make use of some Splints, from the first day, but so as their compression was gentle and equal, and so placed, that the lips of the wound might be kept even, and that the discharge of Matter was by them furthered: But if the wound be transverse, it then requires more caution, lest the Matter should at any time be prest back into the wound, and so not only dilate it, but foul the bones: Thus much for a Fracture with a wound, where the bones are not exposed to the Air, but if the bone be bare, and thrust itself out of the wound, and yet is again restored to its place, then let the wound be stitched and dressed, as I proposed to you even now in the Compound Fracture.  
A Commander at Sea valiantly fighting in the midst of the enemies Fleet, 
Observation.  his Leg was fractured by the fall of his Mizon-Top-Mast, it breaking his Leg transverse near the Ankle, the edge of the bone thrusting out through the skin. He not suffering the bone then presently to be set while it was warm, afterwards being swelled and stiff, it did not yield to extension, but became painful and inflamed: After some few days he was brought to London, I was sent to him, he was of an ill habit of Body, subject to the Gout and dysenteries, and the Fracture accompanied with great defluxion, not in a condition to admit of Extension; therefore according to Falopius upon Hippocrates cited by me in this Treatise, I proposed to his Chirurgeon to proceed by Lenients, to mitigate pain, inflammation, and by Bandage to hinder defluxion, which we did, and his Chirurgeon continued that method a few days: The Accidents gone off, Mr. Arris, Mr. Hollyer, and myself, met Mr. pierce his Royal Highness's Chirurgeon at the Patients Lodging, with the Chirurgeon of the Ship, we find the Patient in ease, taking off the dressings we see the Member in good temper, we agree to make Extension and reduce the Fracture, the Patient was of a dry tough Body, the Member yielding difficultly to Extension, we satisfied ourselves with what we had done, doubting that upon a more forcible Extension, ill Accidents might follow( as an inflammation presently did) we dressed it up as a Compound Fracture, so as the wound was daily dressed, and after some while a Callus thrust forth and united the Bones. That Callus confirmed and dried, we hastened the Exfoliation of the bare Bone, by a little Aegyptiacum & pull myrrhae dissolved in sp. vini applied hot upon an Armed Probe: Thus the Bone was Exfoliated and the Ulcer cured by the ordinary Intentions required in them. Yet that inward leaning of the Bone, continued a weakness a long-time, as is usual where the Fracture hath not been timely reduced. To supply this, I cause a Bar to be fixed in his shoe with Joints, this by a Bandage strengthened his Leg, whether he hath yet left it off I know not: But if the end of the bared Bone have thrust itself so our, as that without great force it cannot be restored to its place, Tunc è duobus malis minus est eligengendum, then that end of the Bone which hath thrust itself so far out is to be Sawed off, and if this be done timely before a Gangrene hath seized upon the parte it may be performed with good success.  
In St. Clements parish behind the Church, some years since one Evening while I was preparing my dressings for the Setting a Fractured Thigh bone in a little Child, I was presently fetched to assist one Mr. P. a Barber-Chirurgeon in the Setting a Fracture of both the Focils of the Leg in a man of about Sixty years of Age, of a Tough dry body. 
Observation.  There I met Mr. Tatham an endustrious knowing Chirurgeon, the Fracture was obliqne almost secundum longitudinem, and the as Tibiae or greater Focil had shot itself out by the inside of the Ankle a great length; we endeavoured by a strong Extension to Reduce this Fractured Bone into its place, but the bone yielded very difficultly to our Extension: Yet we reduced it, then cleansed the wound of what we met of the Shivers or pieces of Bones, and brought the Lips of the wound together by Suture, hoping thus to keep the Fractued Bone the closer. Then we dressed the wound with our digestive warm, and with an Emplaster of diacalc. malaxt with ol. Ros. over it a mixture of flor. Ros. rub. ballast. Baccar. myrt. Bol. Armen. sang. drac. pulverizat. cum albumine ovor. ol. Ros. & acet. m. ad consist. mellis: This spread upon a double cloath, and applied over the Fractured Member and fastened by Bandage as hath been proposed in compound Fractures; but for the more strengthening the Fractured Member, we put on Ferulae with soft compresses between them and the first Bandage, and having fastened them by three Ligatures, we placed the Member as much to the ease of the Patient as we could contrive, upon a Pillow quilted in the the middle with Juncks to keep it steady; but these great Fractures with large wounds and near the Joint, are always subject to grievous pain; and this much more, for that the Tendons and Musculous flesh was sore bruised, and stretched by the great Extension, so was not likely to be attended with less mischief than afterward befell it: We Let him blood that night and gave him an Anodyne draft to dispose him to Rest, but he slept little his pains continuing with much disturbance; a fever followed, and within two or three daies he became delirous, and in the absence of his attendance got out of Bed, the great Focil flew out as at first, and the poor man fell down on the floor as half dead; We were both presently fetched, we took off the dressings and see the Bone distorted, the lower Stitches broken, and the wound of an ill Aspect, it tending to mortification without hopes of being any more reduced by a new Extension. Upon which consideration we resolved to Saw the end of it off, and to that purpose having prepared all things ready, we cut out the remaining Stitches, and turned the foot on one side towards the small of the Leg, thrusting the Bone more out; the one Sawing the end off whilst the other with a Spatula defended the Tendinous flesh underneath from being wounded by the Saw: That done we cleansed the wound from the Saw-dust and Shivers of little Bones, which we had not discovered in our first dressing, they lying under between the distorted Bone and Membranes, by which those sad Accidents had been hastened: The wound thus cleansed we turned the foot right in to its natural place, there being no need of Extension: The great work was now, how to support the foot and keep it even with the Leg, there being so great a distance between them without any whole Bone, we scarified the Lips of the wound and washed them with Spi. vin. with a little aegyptiac. dissolved in it, and dressing the ends of the Bones with Pledgets dipped in it, and prest out, we dressed the rest of the Bone with ung. Basilic. with a little ol. Terebinth. warm, with an Empl. of Paracels. & diacalcith mixed, and applied it over the wound and parts about with a Compress and Bandage over that, as in compound Fractures, and placing the Leg as before upon a Pillow, he was again put in to his Bed, we committing him now to the care of his friends to keep him still, and ordered him Cordial fops, &c. and after some hours Let him blood again. From that time his pains lessened, and his Fever and other ill symptoms went off as the wound digested. But after some daies, the heel became very painful and was discovered to us Inflamed with an Ulceration to the very Bone. The Patient not permitting to have his foot stirred, it had not been raised up, as for perspiration it ought to have been, whence this Ulcer became very troublesone to us. For a present relief we laid him upon his side, and dressed the Ulcer with Lenients to hasten separation of that Escar, and because the Patient grew soon weary of this position, which also was inconvenient for our dressing the great wound, we therefore designed an Instrument of Tin to receive his foot and leg, his heel to lie hollow in a place cut for the purpose, whereby we could daily dress it without disturbing the Patient, only placing him down lower toward the Beds feet, as the heel might lie over it; the side of this Instrument that came up by the wound, was to be taken off at time of dressing his wound, and afterward placed close again, whereby he was dressed without disturbing the weak Member. It lay also soft by the folds of linen we placed under, and between the Leg and Instrument, and was kept strait in hopes it might be supplied with Callus, but the wound became Sinuous, the Matter fowling the Bones, hindered the growth of Callus, and while we waited for Exfoliation, the Lips of the Ulcer became callous, which prolonged the Cure: The Ulcer in the heel we digested, and after we found the Bone would not Incarn, we dressed it with aegyptiac. with a little Merc. Subl. dissolved in it, by which dressing we hastened the Exfoliation of the Bones, and cured the Ulcer: The wound above was after the generation of Callus cured, as a Fistula with a carious Bone. The Patient lived many years after, but through the ill disposition of the Ulcer, the Callus was hindered in its growth, whereby the Leg remained the shorter almost as much as had been Sawed off of the Bone; yet this was better I suppose than to leave the Bone distorted until digestion, as in a such like case I have seen it.  
But if the Bone be not so much distorted, as that you may come to Saw off the end of it, nor yet cannot reduce the Bone after the ordinary way, then you may with a Chizil-like Instrument, thrust between the Fractured ends of the Bone, and use it after the manner of a leaver for the reduction of the prominencies; But then it's supposed these fractured ends of them are within the wound, and not much overshoot one another, and the Fracture is transverse or obliqne, otherwise this way will do little good; Nay possibly Rive up the piece of bone, and make another kind of Fracture, and grievously pain your Patient; and that you may do if the ends break off upon your hard and embody Extension: Therefore it becomes us to be very wary in making this extension, else I say, we may grievously pain our Patient, and do him little good.  
But to conclude, after your extension is made, and the Bone reduced, you are to feel if there be any Shivers of bones loose, and pull them out; and if you perform this operation in a fracture newly made, then you are to prevent inflammation and all other accidents, by dressing up the Patient with such Medicines as hath been proposed in compound Fractures, and make your Bandage so as you may come to dress the wound, as occasion shall offer, with as little molestation to the Fractured Member as is possible, having a care you grieve not the tender parts with Splints, until the inflammation be over, and the wound well digested.  
Then afterwards 'tis to be endeavoured, that the bones robbed of their periostium may again be Incarnated or Exfoliated, which is the work of Nature, yet ought to be helped by Medicines, which have a manifest hot quality and a peculiar faculty thereto, of which there are are enough in the Treatise of Gun-shot-wounds.  
The Bones Exfoliated, the rest will do itself, or may be performed by Epuloticks, of which you may have choice in this Book.    

erratas of Wounds in General.  
page. 106. line 5. for pervan. red peruvian. p. 36. l. 21. r. dip a pledgit: p. 55. l. 12. r. dabbled about: p. 82. l. 12. for either r. other: p. 126. l. 15. r. until: p. 43. l. 4. r. indisposed.  

erratas of Gun-shot-wounds.  
page. 59. line 8. red Ureters: l. 23. for loss r. less: p. 61. l. 24. for digestium r. digest cum: p. 106. l. 8. for sub. ℥ ij. r. ʒ ij. p. 14. l. 2. for the Terebinth. r. Ol. Terebinth. p. 16. l. 31. for and laid r. lay: p. 20. l. 19. for their r. these wounds.  
There are other Literal faults occasioned by the hasty Printing this Treatise.    

Imprimatur,  
Guliel. Wigan. Ap. 4. 1672.  
THE END.