NEW Practical Observations IN SURGERY, Containing divers remarkable CASES AND CURES. By HUGH RYDER Surgeon in Ordinary to His Majesty. LONDON, Printed for James Partridge, Stationer to his Royal Highness Prince George of Denmark at the Posthouse between Charing-Cross, and Whtie-hall, 1685. Mr. Partridge, AT your request I have perused these Observations in Surgery, and Judge them very ingenious, elaborate and worthy of remark: Observations being the best Maps all Surgeons can Sail by to a safe and good Port. Moreover by the contents of this Treatise, it appears that the Practice of Surgery in England is parallel to that of France, Italy, or other Nations. Dec. 1st. 1684. GIDEON HARVEY. M.D. Med. Ord. Regis. SIR, I Have read over part of your Practical Observations in Surgery (as my time would permit) and find you have taken great pains and care in your own Collections, made good Observations, and expressed much Art; therefore I cannot but encourage you to make them public, by which you will oblige many, who are friends to Surgery, amongst whom give me leave to reckon, Decemb. 2. 1684. SIR, Your affectionate Friend to serve you James Molins, M.D. Regius Chirurgus Ordinarius. This 3. of Decemb. 1685. WE have perused this small Treatise Entitled Practical Observations in Surgery, in which we find nothing repugnant to the Doctrine of our best Authors; but do approve the same to be laudable Practice; and commend it as very useful, Witness our Hands, George Horsnell Wardens. Robt. Sanderson Wardens. Tho. Page Assistant of the Company of Surgeons. To the Right Worshipful Sir John Godwin Kt, One of the Principal Officers and Commissioners of His Majesty's Navy. SIR, I Make bold to present you with this little New-year's Gift; the Subject is Surgery. You being one of the Commissioners of His Majesty's Navy, Surgery a part of Naval furniture, falls off right into your Province for Protection; the matter is plain but useful. I am not a stranger to the ill usage good endeavours commonly meet with; however I presume the number of my Enemies will be less, when they shall perceive I have shelter under a shield so capable to defend me. If any little Zoile or Mome will be making Grimaces, and carping, my regard of them shall be less than of those small Infects, which let alone would spoil the best meat, if not corrected with a Fly-flap. Sir, I have had the honour to be known to you many years in the discharge of my employments by Sea and Land; where the multiplicity of Favours conferred on me, imposes the obligation on him, who subscribes eternally, Your most humble Servant HUGH RYDER. Some Books Printed for James Partridge, and sold at his Shop at the Posthouse, between Charing-cross and Whitehall. A New Discourse on the Smallpox and Malignant Fevers, with an exact discovery of the Scorvey; together with Observations and Discourses on Convulsions, Palsies, Apoplexies, Rheumatisms and Gouts, with their several Methods of Cure, and Remedies by Gideon Harvey, M. D. Physician in Ordinary to his Majesty, in 120. The French Pox with all its Kind's, Causes, Signs and Prognostics; also the Running of the Reins, Shankers, Buboes, Gleets, and their Cures, and what is the chief: An Appendix of New Observations never yet discovered by any, all comprised in this Fifth Edition of Little Venus Unmasked, by Gideon Harvey in 120. The Unsatisfied Lovers, a New English Novel in 120. INTRODUCTION. THE Head for its curiosity of frame, structure, situation and diversity of Organs, may not unfitly be styled the Citadel or watch Tower of the Microcosm, whence the Sentinels visive and auditory give, and receive information of amicable, or inimical objects, which being by the least accident disordered, deduces trouble to the whole Body. How careful then ought the Chirurgeon to be, into whose Hands shall happen Wounds, and Fractures of the same, sometimes attended with dreadful symptoms, as may appear in some of these following Cures, and Observations, to which I refer. CHAP. I. A Wound of the Brain Cured. IN an Engagement with the Hollanders, in which our Ship was boarded by four of their capital Men of War, we were reduced to our close Fight, our Forecastle and Steeridge doors being made fast, one of our Men was so unfortunate, as to be left out upon the Deck, who calling for quarter, one of the assailants, with a large Cutlace, struck him into the Head, from whence with two endeavours he could hardly pluck it forth; the wounded party lay on the Deck as dead, but the Fight being over, and our Ship taken, he crawled down into the hold, where several with large lacerated Wounds, others with compound Fractures, and some requiring amputation, seemed fit for speedy attendance, leaving him to be the last dressed, as supposing it only a simple Incision; but looking well upon the Wound, which was in length about five inches, and full of a white matter, which spewed out, I could not conceive digestion could be so soon procured, viz. in the space of two hours; I therefore concluded it to be the substance of the Brain, and so it proved; for with my Spatula I removed from the surface of the Wound about a spoonful of the Cerebrum, the hair being removed from the sides of the Wound: it was dressed with a Stegnotick Medicine, for it bled largely, taking care withal, to defend the edges of the Cranium with dry lint, for fear the access of such earthy Medicines that are Stegnotick, should fowl them, which I would have all Surgeons take notice of in all parts, where Bones lie bare, and is occasion to apply restringents, that they cover the boney parts with lint, as I said before, the better to secure them from the injury of the restringents, the not taking care of which is the cause, that many times the Patient is longer delayed in his Cure than reasonable, and to wait the Exfoliation of Bones, fouled by such Terrene Medicines. He had ill symptoms, as delirium and dotage, which latter hath not yet left him, if living; he lost eight ounces of Blood next day out of the right Arm, and cupping Glasses were applied to his Neck, and Shoulders; a fomentation always made use of at dress, and to the wound applied Thereb. lot. Tinct. Traumatic. cum Syr. de Ros. Siccis; so in six week's time the Wound was cured, convenient bandage being fitly applied, and greatly conducing to the Cure. I saw this person several times, and several years after in Southwark, and observed in him a very great depravation, and but little right use of his senses. I have the more freely set down this Cure, to encourage other Surgeons, that they should not despair of dressing any Man, though never so dangerously wounded, but use his best endeavour and means, leaving the success to God, who often gives a miraculous blessing, even when our greatest reasons fail us. If any one doubteth the possibilty of a Cure of this nature, let him consult the Learned Sir Charles Scarborow, who can inform him of a Captain in the King's Army, that received a wound on the occiput, carrying a large part away, and cerebellum with it, and yet was beyond expectation recovered. CHAP. II. A small wound of the Head by a blow with its symptoms. A Gentleman of the Guard, in the Night, received a terrible blow on the Head, depriving him of his Speech and Senses at the same minute; the next day coming to him, I found a very small wound on the left Bregma, he had bled but little at the wound; wherefore I took away nine ounces of Blood out of the left Arm, and applied cupping Glasses to the Scapula and Spine on each side. I should have told you, he had also lost the use of his right Arm, by the same Paralysis of his Head and Tongue: the second day I dilated the wound a finger's length, the fifth day I made a large triangular incision, leaving the Skull bore for the applying a Trefine, which I did on the seventh day, although nothing appeared on the Skull of fracture, or sedes; before the seventh day he fell into dangerous Convulsions, and frequent Lypothymies, for remedy whereof were administered Cardiac, and Antiepileptick Juleps, etc. too long to be here inserted, as also a Cephalick Plaster to the Head, after the application of the Trefine: through the perforated part of the Skull, came forth a large quantity of black grumous Blood, which by pressing upon the meanings and Brain, and sending forth putrid steams, had been the occasion of these ill symptoms, which said grumous clots came forth for several days together at dressing, and the Meninge black and discoloured, to which I applied Therebin. lot. cum Tinct. Trauma. & melle Ros. and always a hot Fireshovel held over the Head, to correct the coldness of the Air, and hot Stupes to the Head, dry lint to the Cranium, and to the edges of the wound a digestive of Thereb. vitell. ou. & mel. Ros. cum ol. Rosar. every day, or other day, was a clyster administered: So with these dress he every day grew better, and in a short time recovered the use of his Tongue and Arm, which before had been lost by his Palsy, and Convulsions mentioned. CHAP. III. A wound of the Head, with the Fracture of the Collar-bone, dislocation of the Shoulder, compound Fracture of the Leg, and general contusion of the Body. IN the Year 78. when I was Surgeon to the Honourable Sir Tho. Allen, than Admiral in the Royal James, one of our Men fell down from the Foreyard upon a piece of Ordnance on the Forecastle, a large piece of the Scalp from the hinder part of the Head being cut clearly off by the breech of the Gun; with a Fracture of the left Clavicle, Dislocation of the Shoulder, and a compound Fracture of the Leg on the same side, such as we call Fracture ascialis, the bones of the Leg coming through his stockings. I first dressed the wound of his Head, lest the Skull being bare the Air might prejudice it, than reduced the Dislocation of the Shoulder, next the Clavicle, and afterwards the Leg and placed it on a pillow in a box, or case with hinges, to turn down, to come at and dress the wounded places, which I had at convenient interstices left open for that purpose; I bled him largely, and kept him to a spare diet, giving him inwardly some Irish-slate in Spruce-beer, and Sperma-ceti in Balsam. Lutatelli (not of the commonpreparation) the wound of the Head from the edges incarned, and grew up in a short time, without any exfoliation of the Skull, by carefully preserving it from the Air, whereas perhaps some might with their Desquamatory powders, needlessly applied, made foul, and cast off some part of the Occiput. The chiefest concern and greatest trouble was the Leg; both fociles being by the height and vehemence of the fall shattered, and dashed in pieces, and accommodated with short rulers for convenience of losing to dress it, and afterwards bound up the fractured parts wounded; for there is no room for long rulers: in seven weeks he was so well as to go abroad with Crutches, as the Admiral himself can testify. CHAP. IU. A wound on the Head, etc. in a Venereal Person. A Person (whose name I willingly conceal) in a rencontre received a large wound on the Head, two on the Arm, and one on the Breast, who applied himself to me for Cure; he had at the same time an Ulcer on his right Leg, a little above the Malleolus externus of an ill Figure, to which Ulcer and Wounds, although I made use of the most fit (to my apprehension) and methodical Remedies, yet for many days I could procure no better from neither, than an ugly Ichor or Sanies, or sometimes a greenish sordid matter; considering with myself, that this could not be barely and solely the product of the parts affected, I asked him, if he had lately, or sometimes before received a misfortune by some one of the Virtuosa's of this Town? He told me, He had, and that he had been in an ill case, but had been under a Surgeon's Hands of good note, and that he believed himself to have been well. I told him, it seemed to me that his Scavenger had not taken away all his soil, but had left an Egg still in the nest, and that he could not be perfectly cured barely by Surgery, without referring to some internal Medicines, which might have regard to his former mishap, whereunto he consented; so putting him upon a course of antivenereal Pills, and diet Drink, in three days time there was laudable digestion, and in a short time his Ulcer and Wounds were perfectly healed, yet after they were well, I kept him to this course for three weeks longer, believing it more safe in such cases, rather to over than underdo. I was the more willing to express this case, because sometimes an ingenious Surgeon may lie under an Error, to the great detriment, and utter ruin perhaps of his Patient, if he direct his Eye no farther, than only to the superficies of the part affected. CHAP. V Mania. BEING Surgeon of the Naval Hospital, when His Majesty's Fleet was at Shotland, there was put on board us, by advice of the Surgeon General, from one of the Frigates, in order to his Cure (if possible) a distracted Person, most violently raving, and the maddest I ever yet beheld, breaking what ever cords he was tied with. I that Afternoon had him by force of Men held down, and gave him a clyster, which wrought well; the next Morning I bled him in the Arm, kept him to a cooling spared yet, bled him next day in the forehead, and imposed cupping Glasses with Scarifications to the Neck and Shoulders; but all to no purpose, for he remained as mad still as before; wherefore I applied a Caustick on the Crown of his Head, and made a large Eschar, that being done, and for three days time there being no amendment, I was not willing to tarry for the casting off the Eschar by digestion, which would have protracted time, but with my incision Knife I cut out the whole Eschar round to the Cranium, leaving it bare, and about midnight it was told me, the Madman had recovered his senses, and desired to speak with me; when I came to him, I so found it; for he gave me thanks, and expressed himself very joyfully, saying, he was perfectly well, and so remained from that time forward. I was unwilling to send him aboard again over-soon, but let the edges fill up, and kept it as a Fontinel with a large Pea in it for a month, afterwards took out the Pea and healed it, and sent him to his own Ship again; who near a twelvemonth after found me out in London, and returned me a thousand thanks for my great care of him. CHAP. VI Wounds of the Head with ill symptoms. A Young Carpenter being at work upon Bow-Church, before the structure of the Steeple, fell from the top thereof, and was taken up dead; but after a small time perceiving life in him, I bled him, so he was carried home, and remained speechless for seven days, having also by the same accident lost the use of his right Arm: I applied cupping Glasses to his Neck, Scapulaes' and Spine, he had three or four wounds on his Head (for he fell amongst ragged Stones) which to sight seemed inconsiderable, he took every other day a clyster, and a very sparing diet (as in such cases requisite) I dressed his wounds with a Cephalick Balsam; he took often of an Antiepileptick Julep. But observing he often laid his left Hand on his right Temple, for there was also a small wound, I dilated the same largely toward the Eyebrow, observing the rectitude of Fibres (which always is to be. heeded, where incisions are to be made, unless an extraordinary occasion hinder) from thence I took several small pieces of the Cranium, which were divided from the whole, and some of them pricking against the edge of the temporal Muscle, upon the taking out of which, he recovered both the use of his Speech and Arm. I should have told you likewise, that he sometimes was troubled with a Spasmus Cynicus on the right side, by reason I suppose of those pungent Ossicles; the dilated wound I dressed with a Digestive at first, cramming in dorsils of dry lint on the bare Skull, afterwards with a Traumatick tincture, and Syr. de Ros. siccis; so in five weeks or thereabout, he perfectly recovered. CHAP. VII. A wound in the Liver. A Person raging with Wine, as well as with love of his dear Mistress, of whose enjoyment he despaired, leaving his company, went forth of the room, and with a Knife stabbed himself in the upper part of the right Hypochondrium, wounding also the Liver, from whence flowed a large and violent stream of Blood; to divert which I took a good quantity of Blood from the left Arm; I gave also some aq. Styptica Vitrioli in aq. Plantaginis; I kept him to refrigerating Juleps, wherein was a competent quantity of Sal. prunellae, also to laxative Glisters; and although he complained much of a very great pain in his right Hypogastrium, which I feared might arise from extravasated Blood, falling from the wound, and there subsiding, yet by the use of fomentations and Glisters, he became well, and was in fourteen days recovered. CHAP. VIII. A wound in the Belly. A Soldier, being returned from Flanders, upon some disgust he had received from his Mother, with a large Flemish knife stabbed himself about two inches above, and on one side of the Navel, through the right Muscle and Peritonaeum into the Abdomen; from out the wound hung forth a large piece of the Omentum, which had so done for four hours, for so long after it was that I saw him: it being Winter time, the Air having seized it, and being discoloured, I made ligature upon it, and cut off the discoloured part near the the tying, and having fomented it with warm Brandy, I put in the Omentum again, leaving the thread hanging forth to the wound; I used a Digestive for three or four days, afterwards a Balsam, whose basis was Turpentine; so without any supervening symptom he became well in less than a fortnight. CHAP. IX. Two penetrating Fistulaes' in ano, etc. cured. AN Apothecary of this Town had for many months tried practice upon a Gentleman for the cure of a Fistula, not at all knowing what he was about, having used, as the Patient afterwards informed me, at least forty different sorts of Medicines, as Waters, Ointments, etc. a sufficient argument of his unsteady ignorance. Once or twice, by Mercurial means (against his will as he professed) raised a Salivation on him, had sometimes with his Knife made incisions, and sufficiently teaz'd him, at length told him, he had done with him, for he was cured and well; but the Gentleman being alarmed by some pain he felt there, was advised by a friend of his to show it to me; upon sight whereof I put my Probe into the Orifice, being about two Inches from the Anus, and past it in length five Inches, viz. two from the Orifice to the Anus, and three Inches from the edge of the Sphincter up into the Sinus, it had made in the intestinum rectum; so having satisfied the Gentleman of the ill condition he was in, and bestowed on this Amphibious Apothecary his malediction, he became my Patient from that time, till he recovered. But by the way, it is a common thing for Apothecaries to practise Surgery, but with what success, let them and their Patients boast, as in the case above, and these two following may appear. A Neighbour of mine in the Old-Baily, consulting with a learned Apothecary, he advised her to an Issue, which he would make, and accordingly did; and having made it upon the Gasterocnemius, it caused such a Phagedaenic Ulcer, as eat away above half the calf of her Leg, whom I afterwards cured, not without much trouble. The ill Medicines he had applied, having left a stain upon the part, not suddenly to be washed off, according to that of the Poet, Quo semel est imbuta recens servabit odorem, Testa diu— The other case is, a Phlebotomist Apothecary much exercised in bleeding, (not for want of ignorance in them who permit him, any more than in himself) let Blood one of his Neighbours Daughters, and in the career of his Lancet, made a large wound in the Tendon of the Biceps; being called to take care of it, I saw the Arm very much tumefyed, full of pain, and a large quantity of Gleet from the wounded Tendon; the tumour of the Arm I appeased, with Anodyne Cataplasms, and dressed the Tendon with a There been thinate Medicine, which after some time became well. I could add many more of these, and other like cases, wherein Apothecaries, by interfering in our Profession, have gotten to themselves no great reputation; for if a young Apothecary (for the old ones have more prudence) get acquainted with some Surgeon's Apprentice, who is but an Embryo in his Profession, he shall from him be furnished with such pretty knacks in that Practice, that he need not doubt to proclaim himself a Chiron, as in Physic he doth an Aesculapius; but I hope these brief Memoires will dehort them from it in the future. But to return to my Patient, whose Postern calls out for help; for upon a second inspection, I found two Sinus' from within the outward Orifice, which ran one to the right, the other to the left hand; these having laid open, I yet found another small outlet, within an inch of the anus, that in three or four days, being made wider, by the use of Sponge tents, I incided: in the mean time I confined him to a diet of Sarsa and China, with some vulnerary Herbs, sometimes gently purging him with an Infusion of Senna and Salt of Tartar, with Syr. Ros. Soiut. or Manna, and twice a Week fifteen or twenty grains of Calomel. with res Gialap. or as much of another Mercurial preparation of my own, excellent in Ulcers or Fistulaes', by which means this almost incredible quantity of Gleet was exhausted and dried up: it being most true, that Siccum est sano proximum. the dress for the Fistulous parts incised, was a Balsam of Sulphur, joined sometimes with a Traumatick tincture: what incisions soever I made, I always let them bleed freely, to discharge the great hardness round the Anus; to discuss which, did not a little help a fomentation applied Night and Morning before dressing. The Incisions intra anum I made with my Cannula Scissor upon the Scoop. Thus in the space of ten Weeks he became absolutely well, and so remaineth. CHAP. X. A Fistula in Ano. ANother being a very fat Man, having ridden some hundreds of miles, from a tumour of an external Hemorroid Apostemating, incurred into a Fistula, which searching with my Probe I felt it come through its upper Orifice into the intestinum rectum, about two inches above the Anus. Having an ill habit of Body I durst not presently attempt the Chirurgical part of his cure, till I had given him a preparatory Apozeme, and with an Hydrotick Medicine purged four or five times, the better to empty and carry off that load of humours, I might otherwise expect to fall upon the part; then with my leaden Probe Idrew a waxed silk through, daily tying it straighter, till at length it cut its way through; which being done, and the part so incised, by use of a drying Balsam, in a short time was perfectly cured; a drying diet-drink, which he at that time took, helping very much to effect it. CHAP. XI. An Abscess on the Os Sacrum. ANother Gentleman having lain ill of a Fever for a long time, the Disease at length terminated into an Abscess near the lower part of the Os Sacrum; being sent for, which was two or three months after the breaking thereof, I perceived a small Orifice, out of which issued a thin matter daily in a large quantity, and extremely fetid; after three or four days time I passed my Probe in at the Orifice (which at first I could not by reason of its smallness) down toward the Anus, above four inches in depth, and after some time, with my large Probe Scissors, I dilated as far as their length would permit, and so filling it with Dorsils of dry lint (for it bled not much) I so left it till next dressing, which was with a digestive, being for some week's time continued. From the part affected a great quantity of matter daily flowed, with an excessive stercorary odour, which gave me occasion for a while to fear, there might be some small perforation into the Intestinum rectum, which might be the reason of this ill smell: However by the use of Fomentations and Injections, in which were some Vulneraries in a Decoction of Aqua calcis, adding some Traumatick tincture and honey of Roses, the stench daily diminished. I continued still to dress twice a day; the Medicine with which I dressed the part, was a Balsam of Sulphur with Traumatick tincture, by the use of which Medicine and Injection, and using now and then a little lift with a Mercurial Bolus, the parts were corroborated, the matter lost its ill smell, became well digested, and in quantity daily decreased, till at length having shortened my Dress, the Party became well. Note. He still continued his Diet-drink, which reduced his Cachochymick Body to a better habit, I advised him to make use of little pieces of Sponge dipped in an Emplastic matter, which I prepared for him, for purpose to keep it open as a Fontanel, which he did for many Months; but not long after his Cure, by some disorder, he fell into a most violent Fever, from whence he was recovered by a large torrent of humours, finding vent at the Orifice so kept open; which extremely running, in about a Fortnight's time made a total discharge of the Morbific matter, and he became well, and about half a year after, unwilling for the troubles sake to wear it open as a Fontanel, closed it up, and hath remained well for above a year. CHAP. XII. A penetrating Wound in the Thorax. AVintner bringing in a Reckoning, and giving some unpleasing Language to his Guests, one of them with his Rapier ran him into the right side, about an Inch below the Axilla or Armpit; he bled not much at the Wound; wherefore I took away about fourteen Ounces of Blood; two days after the Wound received, the Party wounding sent three eminent Surgeons to take a view of him, believing him not so wounded as reported; I desired one of them that he would please to take the Candle in his hand, and hold it near the Wound, which he did: Whereupon I advised the Patient to shut his Mouth, and hold his Breath, and immediately the included Air being forcibly expelled, blew the Candle out. I made use of short Tents dipped in Balsamum Lucatelli; kept him to a thin Diet, refrigerating Juleps and Glisters every day, or at least every other day; and if he slept not well, in his composing draught, I gave him sometimes fifteen or more drops of Liquid Laudanum; so his Fever going off, and finding no occasion to keep it longer open, I took out my Tent, and in ten days he recovered, not leaving behind me that ill accident, which I remember a Surgeon once did, who by keeping open a penetrating Wound of the breast too long with Tents, procured a Callosity round the edges of the Wound, leaving behind him a Fistula uncured. CHAP. XIII. A Wound in the Breast. Acountries Gentleman being in London, and going in the dusk of the Evening home to his Lodging, was met by a Bully of the Town; who because he immediately gave him not the Wall, drew upon him, and ran him through the Pectoral Muscle into the Thorax; there was a considerable flux of Blood at the Wound, as also out of the Mouth, as often as he spit or coughed; from whence we may believe the Lungs to have received prejudice; I nevertheless took away ten or twelve Ounces of Blood, used to the Wound for four or five days after the first dressing, Tents armed with a digestive, keeping him to a Pectoral and Traumatick Decoction, and a very low Diet; but finding that little matter proceeded from the Wound, and that his Cough (which at first was troublefome) went off, I left out my Tent, and only applied a Pledget on the part spread with Lucatellus' Balsam; so in three days more it was healed, and he went down to his Affairs into the Country. CHAP. XIV. A Mortification on the Arm. AYoung Woman upon a disorder in Diet, fell into a most desperate Fever, she having an Issue in her Arm, was over hard bound, the slackening and dressing of which, being for three or four days neglected, there happened a large tumour of the Arm and Hand; when I came I found the Arm discoloured, and a large Mortification upon it, from the Shoulder to the Elbow quite round, part of the Mortification reaching to the Clavicle and Breast: with my head Razor I made many and deep Incisions, which she felt not, unless upon the edges of the sound parts, which I spared not to cut to cause the sooner separation. I dressed her twice a day with Stupps wrung out of a strong Lixivium, and applied scalding hot. The application to the incised parts, was Egyptiacum and Spirit of Wine, as hot as with Dorsils, and pledgets dipped, could be applied, and over all a Cataplasm of Mithridate, or sometimes Venice Treacle round the Arm. In the mean while there was no neglect of fit Alexipharmacaes, and cordial Juleps; so a stop being put to the progress of the Mortification, and the Fever abated, I began to make use of Digestives, by which means, and by cutting off daily large quantities of the mortified cadaverous and stinking sloughs, the subjacent parts daily appeared more florid: after gently mundifying, for a long time I made use of the best Incarnatives, by which means there was a gradual reparation almost of that vast loss of substance she sustained. In the mean time I laid open by incision several Fistulous Sinus', the virulent and corrosive matter had made upon the Breast, Shoulder and Scapula, which I afterwards cured, and she in the space of ten weeks recovered, and hath the use of her Arm almost as well as ever. CHAP. XV. A Leg Amputated. A Neighbour's Son about nine years of age, by reason of a wrench, had a painful tumour of the Ankle, and afterwards of the whole Foot, without alteration of colour. For remedy of which, use had been made for many Months of several Surgeons one after another, and some pretending Bone-setters, in hopes to have a Cure; but all in vain, the tumour and pain daily increasing, and becoming almost insufferable: at length his Parents desired me to visit him, which I did; they asked my opinion concerning his Cure. When I had considered the violence of his pain, the tumour of the lower part of his Leg and Foot, his lost appetite, want of rest, and his being emaciated, I informed them that I did believe, that his Cure was impossible, and that there was but one way left to save his life, which was, to take off his Leg without much further delay; for that it had been kept on too long already, which news was unwelcome to them, they telling me, that such eminent Surgeons as they had applied themselves to, and had had the management of it all along, could not be so ignorant or deceitful, as thus to abuse them, and leave them in the lurch, and they hoped I was much mistaken in my Prognostics. But I still persisting, in what I had asserted, left them to their future consideration, and further advice; whereupon they applied themselves to the Surgeons of the Hospital, the result of whose advice was, that my opinion was to be agreed with; whereupon two days after by their consent and desire, I amputated him below the Knee, Mr. Pierce and Mr. Johnson being Wardens, then present. So soon as I had dressed his stump, rolled him up, and placed him in Bed, I took the Leg, and made incision according to the length of the Tibia, laying it bare, where I shown them a hole quite through both sides of it, as if made by an Augre, and through which I could put my little Finger; so powerfully penetrating and corrosive are acid humours, that they can with their pungent Particles thus terebrate the Bony parts. There being a very great Atrophy of the Thigh and Knee (which yet remains, though nine years since taken off) the adjacent parts having received an ill taint from the subjacent putrid humours, it was a long time, before I could raise flesh enough to cover the ends of the Bones; but what is most remarkable, such was the industry of Nature, who is never idle, but always endeavouring to progender, though impeded by imperfect and defective principles, that some time after there grew out of the end of the stump from the remaining part of the Tibia (as it were) another little Tibia, near an Inch in length, and about the bigness of a Tobacco-pipe, hollow, and covered round about with a Cartilaginous substance, which I cut off with a pair of cutting Nippers close to the stump end, and which several times since hath flown out the breadth of a Twopences, for as I said above, the Leg was kept on too long. The Excoriation was easily Cicatrized with aq. calcis. This caution therefore may be of use to Surgeons, that although it is not good to be overhasty to dismember, without sound and urgent reasons; yet on the other hand, it is as dangerous to be dilatory, in keeping on a defective Member, until it hath made a vicious communication to the other parts, to the depraving their Natural tone and temper. For the advice is good, — immedicabile vulnus Ense recidendum, ne pars sincera trahatur. So I shall conclude this, beginning with another not much unlike. CHAP. XVI. A Thigh Amputated. A Lawyer's Son in Fetter-lane, about the age of the preceding, and much about the same time, having eleven Fistulaes' in his Leg, and Thigh; for about a Twelvemonth, had been under the hands of several Surgeons; who at length despairing of his cure, left him off. The Boy calling to mind, that some four years before, I had cured him of two Ulcers in his Leg (for this accident was since, and happened by a Contusion from a Cartwheel, hurting his Thigh and Leg, from whence afterwards Apostemations, and Fistulaes' were produced) desired his Father to send to me, telling him withal, he was confident I could cure him. At his request to go along with him to see his Son, I accordingly went; but found him so discarned, that he was almost a Skeleton, having for twelve weeks been detained by a Diarrhaea. From his Ulcers, and Fistulaes' flowed a silthy matter, stinking beyond all comparison, his Heel stuck to his Buttock, and his Knee disjointed; for the head of the Tibia met not with the Os Femoris (which over-hung it) by above an Inch, the Ligaments being all eaten asunder, by the matter there contained. I told his Father, I had considered, the circumstances he lay under, were so severe, that I thought, there was no likelihood of his recovery, nor possibility of Cure; to which the Boy very hearty replied, he knew he should be well, if I would cut off his Thigh; and that if I would lend him a Knife, he would cut it off himself; whereat his Father weeping, he bid him not be troubled, telling him, that if he died, there would be an end of his charges, but if he outlived it, he would make him amends. I proposed to his Father, to bring the Wardens with me next day, to take a view of him; who when they came, and saw the miserable condition he was in, knew not what to think of it: But taking notice of the Boys undaunted confidence in me, by their persuasions, I was encouraged to dismember him, leaving the success to God, thinking it better rather to try a doubtful remedy, than to leave him (as others had done before) to perish without any. It being concluded, on the next day after his Mother should be brought to bed (for she was almost ready to lie down, and feared to have it done, till that was over) it should be attempted; so on the Morning after she was delivered, I came, and Amputated him near the upper part of his Thigh, above his uppermost Fistula; he not so much at the use of Knife or Saw, as once crying, or making any complaint, until the application of hot Cauteries, which I was forced to make use of, by reason of the largeness of the Vessels, from whence otherwise I might have expected in a few minutes his whole Mass of Blood, and Life to have been exhausted. It was on a Monday morning I took it off; and on the Thursday following, when I came to dress him, I found him very lively, his stump very fair, being indifferently well digested, and in six Weeks time perfectly healed; afterward he grew very plump and carnous, and so remaineth. Next I will set down another case of an Arm ill handled, and too long kept on, which is as followeth. CHAP. XVII. An Arm Amputated. AN Hostler belonging to an Inn in Holbourn, received a blow on his Elbow from a Horse's head, which for several Months gave him some pain, tho' not so much, but that he could follow his occasions; at length the tumour and pain increasing, he applied himself to a Surgeon of his acquaintance, one G.R. who kept him so long in hand, that for want of timely laying it open, the matter discharged its self, through several perforations it had made; into which perforations he daily injected such large quantities of Vitriolate, and sometimes Mercurial Waters, that fouled both the Ancon or Olecranon, and lower head of the Adjutory, there being a large tumour of the lower part of the Arm, the upper part being quite extenuated. Having sent for me (for he had discharged his other Surgeon) and taking notice of the extreme tumour, fetid smell, and colour of the Arm (for it was Livid) I told him I did believe the Bones were so foul, and the Arm so putrid, that he must of necessity lose his Arm, to save his life; and that if he would permit me, to make Incision, which should not hurt him, he should find my words to be true; so with my head Razor, I laid it open about four Inches in length (the parts being insensible) and with my Finger pulled out a great piece of the Adjutory, being lose and carious, like a rotten Cork. When he perceived the danger he was in, he told me he was very willing to submit to the loss of his Arm, rather than of his Life. I applied a Stupe wrung out of hot Brandy round about the Arm, and so left him till the next day. In the mean while I informed the Wardens of his condition, and of the necessity of taking off his Arm; on the next Morning they there met me, where having all things in readiness, I Amputated him; and afterwards laying the Arm open, I found the lower part of the Adjutory, for about three Inches in length foul quite through, so were also the upper parts of the Ulna, and Radius carious about the same length. About three days after his Surgeon hearing, that he had been dismembered, came to see him; I understanding that it was he, bid the Nurse let him in, whilst I stepped behind the Bed (unseen) so coming to the Patient, he told him, he had done villainously by him, and that he desired not to see him; Tother replied, he wondered any one should be so base and foolish to take off his Arm, when he would take his Oath, he could have cured it, in a week or ten days at farthest. Whereupon I came from behind the Bed, and told him he was as impudent as ignorant, to affirm such impossibilities, and that I had the Wardens to justify me in what I had done; ask him withal, what Medicines he had made use of, to occasion this mischief? he replied, he knew what he did, as well as any Man in England, and needed not be taught by any one; for he had used Injections with Vitriol and Plantain Water, and sometimes ☿ Sublimate and Plantain Water, as good as ever was used. I told him, those good Medicines were the cause of the loss of this poor Man's Arm, whereupon he went down Stairs railing at me, and very much displeased. He being so emaciated, it was somewhat long I could procure flesh enough, to cover the end of the stump. the keeping the Arm on so long had rendered him Hectic; for not long after the stump was Cicatrized, he took leave of this World. CHAP. XVIII. A Woman's Throat cut. A Young Woman who had been at a Meetinghouse, where the Bonerges had shut Heaven Gates, and threatened Hell to all, who were not on his side of the way; in a great discontent went home, and fell into such despair, that being melancholy by herself in her Chamber, with a Knife cut her Throat; the Wound was near six Inches in length and uneven. When the thing was done, being sent for, I was not in the way, but came about an hour or more after, where I found another Surgeon had been before me; I was very unwilling to meddle with it, but the Party herself making signs to me, that she would have me look on it, her friends and neighbours persuading me to it; I went about it, and perceived a large quantity of Tow sprinkled with some Astringent Powder crammed into the Wound, which I took out. The Wound looked very dreadful, having cleansed it, I saw the Larynx was notched in two or three places; for as she afterwards told me, she had made two or three cuts at it: Having brought the Lips of the Wound together with five stitches, and dressed it with an Agglutinative Balsam; she spoke not for three days, but on the fourth, asked me if I thought she could live; I told her there was no fear of her death, if she would be but governed, for she was in a Fever; wherefore I at first bled her, and kept her low, taking care she had every other day a clyster; the Wound healed as well as one could wish, and in less than three Weeks she recovered. CHAP. XIX. A Wound in the Belly. A Shoemaker's Wife, her Husband not presently granting her unreasonable demand, took one of his sharpest Knives wherewith he used to work, and stabbed herself obliquely into the Epigastrium: the Wound was small, (and so was the Knife, which I saw was Bloody about two Inches or more) and it bled but little; wherefore I took Blood from her to prevent inward bleeding which I feared; I dressed the Wound with a short Tent with a Digestive. There happened after 2. days a large tumour round about the wounded place, of which she complained very much, and proved to be only from wind; for upon the use of warm Fomentations, it was wholly discussed, and she in seven or eight days became well. CHAP. XX. A mortification of both Feet. A Master of a Ship (bound for the West-Indies, whereof a young Man belonging to me was Surgeon) had a Servant, who by extremity of cold Wether, got a Mortification of both his Feet; being desired I went down to Limehouse to see him, and feeling on his Feet, several of his Toes came off in my hand. I made divers deep Incisions on both Feet, till I came to the parts sensible; then with a broad Carpenters Chissel and Mallet, I cut off both Feet near the upper part of the Metatarsus; the ends of the Bones I covered with dry Lint, & to the Mouths of the Vessels I applied Chalcanthum; over all Bowl, Whites of Eggs and Oxycrate, and so rolled him up; I came every other day to see him for three Weeks, in which time the Bones were covered with flesh; so the Ship being bound to Sea, and he to go in her, I left him to the care of my Man, who gave me account by Letter, that before the Ship went out of the Downs, both his Feet were Cicatrized and well. I have often aboard made use of the Carpenters broad Chissel in Mortifications of the Hands and Feet, occasioned by Gun-shot Wounds, and therefore borrow room for it in the Armamentarium Chirurgicum. CHAP. XXI. A Dislocation of the Inner Ankle, with a Lacerated Wound. ONe belonging to an Inn on Snow-Hill, Aged about threescore and ten, being very corpulent and weighty, by a fall suffered a Dislocation of the Foot, the inner and lower head of the Tibia (the Ligaments being by the violence of the fall broken asunder) coming through at the Wound, which was above four Inches in length: I bled him largely, and kept him to an extraordinary spare Diet, to take off his too great Plenitude, (having also an ill habit of Body) and much ado I had to keep off a Mortification, which twice or thrice had like to have happened, but that he was rescued from it by Scarifications, a strong Lixivium and Theriacal Applications. The Medicine with which I dressed the wounded part was, of Ol. Therebinth. Tinctura Traumat. and Syr. de Ros. Sicc. and in two months' time I healed up the wound; but because the dislocation remained (which could not be remedied, the Ligaments which should have kept the head of the Bone in its place, being torn asunder) I made use of an Instrument of Steel, riveted to the Shoe below, and coming up the outside of the Leg, with a Leather Brace at the gartering place, and another below, to Lace on the outside of the outer Ankle, by which means the head of the Bone was firmly kept in his place, and he went indifferently well, till some years after growing still fat and unwieldy, and wanting exercise, he fell into a Dropsy, whereof he died; this being the only cure I ever heard of this nature, I thought good here to insert it. CHAP. XXII. A large Wound on the Head. ONe going down a pair of stone steps, it being Winter time, and very slippery, had the ill fortune to fall down with his Head upon the edge of one of the steps, whereby he received a Wound from a little above the Eyebrow, fetching a circumference round the side of the Head, to the hindmost part thereof, insomuch that the Scalp hung down upon the Neck, the Wound in length being eight Inches. Having taken off the Hair, and cleansed the Wound, I joined the Lips by six Equi-distant stitches, and left both ends of the Wound open with two short Tents, the better to make discharge of the great quantity of Sanies, and matter which continually slid down. The application after the two first days being Pledgets dipped in Balsam Lucatell. with Tincture. Traumat. making use always of a warm Fomentation before dressing, by which means in five Weeks time he was made well. CHAP. XXIII. Two Wounds of the Head. ANother being a little Boy, lately received such a Wound by a Cartwheel going over the side of his Head, tearing away the Scalp, and leaving the Cranium bare in some places; the Wound was about six Inches long, there being another Wound likewise on the other side of the Head about three Inches in length; the Head was very much tumefied, & from the greater Wound came such an excessive quantity of Sanies, that I was compelled to dress it twice a day. This Wound was handled much after the same manner, as that above mentioned, and in near the same space of time was perfectly cured. CHAP. XXIV. A Compound Fracture of the Leg. ONe by a fall from a Scaffold, being about eighteen Foot high, received a Compound Fracture of the Leg with 2 Wounds, at the Wound above, came forth a part of the Tibia, at the lower Wound on the outside a part of the Fibula. I bled him, kept him low, and wrapped the whole Leg in a Cerecloth, cutting out two pieces, one above, and the other below: for convenience in dressing, I also contrived a Case of Tin to contain the Leg, in which were two little doors to open and shut, for the opportunity of making applications to the wounded parts. The Medicine to the ends of the Bones was of Tincture. Traumatica, Mel Rosar. and Pulu. Irid. Florentiae; for they had received prejudice from the dirt he fell into. Wherefore it was somewhat long before they cast off; however within the space of three Months he became well. CHAP. XXV. Divers Wounds by small Shot Cured. BEing in a Merchantman, we were attact by two Turksmen of War of good force, and by them at length taken; they did so gall us with their small Shot, that a Man could scarce appear upon the Deck, where several of our Company received very untoward Wounds, viz. one of our Men haling at a Tackle to run out a Gun, was shot with a Musket Bullet through both Arms, near the middle and hinder parts of the Brachia, about the beginning of the Brachiaeus externus; I at first drew Flammulaes' of Tow through, armed with a digestive, and afterward I used a short Tent to each of the four Orifices, suffering the Wounds to incarn in the middle: The flesh being pretty well filled up, I at length took out my Tents, using only Pledgets spread with the same Medicine; and lastly with dry Lint Cicatrized them. CHAP. XXVI. A Wound by a Musket Ball. A Seaman received a Wound by a Musquet-ball, entering in about the upper Angle of the Scapula, which passing through the Trapezius, and under the Levator humeri lodged upon the Cartilago Thyroeides. Running to me almost strangled, and not able to speak, he made sign of being choked with his Finger, whereupon feeling the Bullet, I made incision, and taking it out gave it him, scarce willing to stay to be dressed, only I clapped into the Wound above the Scapula, a short thick Tent of dry Tow; he went to his quarters again, and behaved himself with a great deal of courage, till the fight was over; the wound made by Incision proved but little troublesome, for that easily healed; and that on the Shoulder after it came to be well digested (the quantity of matter daily decreasing) short Tents being still applied, in about three Weeks was perfectly Cured. CHAP. XXVII. A Wound in the Thigh by small Shot. ANother of our Men at the same time received a small shot in the Thigh, between the Rectus and the Vastus Externus; I could by no means (although I made diligent enquiry) trace or find out the Bullet, wherefore leaving it behind me, in eighteen days time I cured the wound, and never heard he had the least trouble or inconvenience from it afterward. CHAP. XXVIII. Several Wounds by small shot. ANother time a great many of our Men were wounded by an Ambuscado of the Turks ashore, who unawares surprised them. One received a Wound on the side of the Thorax, the Bullet coming out near the Spine; I could not find it had penetrated the cavity of the Breast, either before or behind; wherefore bending my Probe, I found the shot had glanced upon the Rib, and had gone round it. I kept both wounds open by two short Tents dipped in Digestive, and with good Bandage (being a great cause of Unition) in a short time healed him. CHAP. XXIX. A Wound by a Musket shot. A Second was wounded in the Face with two slugs; one came in at his lower Jaw, beating in three of his Teeth, and a piece of the Mandible: the other having fractured the Os Jugale, came through the Orbit of the Eye, not wounding it, but with the violence of the contusion leaving behind an incurable Amaurosis, or Gutta Serena. CHAP. XXX. A fracture of the Leg by a Musquet-ball. A Mariner at the same time was shot through the Leg with several shot, fracturing both Fociles with great laceration of the Muscles & Tendons; divers pieces of Bones also being driven through some that were lose, I took out; the tumour of the Leg increasing, he fell into a Mortification, which proved of difficult cure; however at length by Incisions, the use of hot Lixivial Stupes, & Medicines formerly expressed, he got off from it; but it was long he recovered, the Unition of some, and exfoliation of other Bones, also the Confirmation of the parts debilitated, requiring much time. CHAP. XXXI. Remarks on some Errors in Surgery. BEing in the Hospital Ship in the year 65. after that great Engagement with the Dutch on the third of June (where his Royal Highness was so signally Victorious) from each Man of War were put aboard us their wounded Men; where I observed very great errors committed by some Surgeons, whose fame was greater than their merit; many of the wounded persons being brought in so ill a dress, that it is almost a shame to mention, viz. from aboard where J. F. was a Surgeon, among others one having a Compound Fracture of the Arm by a great shot, and shattered all in pieces from the Elbow to the Wrist, there was only a sheet of brown Paper (without any other application) wrapped round it, which I shown the Surgeon General, who looked upon it with admiration: This Person was a Scotchman, and so timorous that I could by no means persuade him to the taking off his Arm, nor yet to be dressed; at length it sending forth such a cadaverous smell, as was noisome to himself as well as his Neighbours (we having at that time above five hundred wounded Men aboard, near two hundred of them with amputations, the rest with Compound Fractures, and other Wounds by Gun-shot) I at length overcame him by persuasive arguments to save his Life, which by no other means could be effected, but by taking off his Arm, to which he consented; accordingly I did it, and he recovered. CHAP. XXXII. A Leg Amputated. ANother from aboard a Third Rate Frigate (where T. M. was Surgeon) upon the Recoil of a Gun the Truck ran over his Foot, breaking in pieces all the Bones of the Metatarsus; perceiving his Foot very much tumefied and discoloured above the Ankle, I made deep Incisions on the Tarsus, and Metatarsus, which he felt not; I told him there was a necessity to take off his Leg, to which he readily agreed; so he hopped on one Leg to a Chest, where sitting I took it off, (he not expressing the least sign of pain or sorrow,) and afterwards when well, was by his Majesty's favour made Cook of a Second Rate Ship. CHAP. XXXIII. Remarks on some Errors in Surgery. AFore mast-man on a Second Rate, (where O. R. was Surgeon, and a Male Practiser) had by a great Shot his Leg dashed in pieces; the Surgeon aforesaid made no other Amputation, than by cutting off the Leg with his Knife, and dividing it from the parts it hung by. I wondered much at the strange sight, when I came to Unroll him; for there I found the shattered parts of the Tibia lying lose, and split up to the Juncture, the Gasterocnemii turned back like the flap of a Shoulder of Mutton, and with a Rowler bound back above the Hamm; so that I was forced to make a new Amputation above the Knee. CHAP. XXXIV. I Can insert a great deal more Surgery of this kind (for I had too much occasion for such observation) but I will forbear. However before I take leave of this, let me give you a taste of that Famed Surgeon Y. F. from whom after several Fights I received aboard divers Amputated Persons, who needed no other Certificate for their Passport into the other World, than his: His custom being after Amputation to apply to the Stump Mercur. Sublim. by which means was always procured a Mortification, Malignant Fever and death; which might have been avoided, had he made the happy exchange for Calcined Vitriol; but I will leave him among his dead Patients. And here I protest, I have not made these remarks upon any one out of ill will, but out of mere love to Surgeons, that notice being given them by the Sandy and Rocky errors of others, they may the better, and with more safety steer their course, till they arrive to the Haven of fair and reputable Practice, it being the safest Harbour for their Patients, and most reputable to themselves. FINIS.