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                V -
Royal S opi^iyy      - n k : i m

        •FoUffDET     5
 Incorporated by F    Charter 1834
    ^ New Chartei  1907
Gift to tfe Library

     Presented by

  LIr. Henry Curti a
  date ..FeJaxaary  1925.




  NATIONAL LIBRARY OF MEDICINE

|         Bethesda, Maryland 
Y; <Fr~
fH

^<^tfrru&£
 
 
TREATISE,

         On the following

 Chirurgical Subjects.

Chap. I. On Ruptures.
    II. On Fractures of the Skull.
    III. On Fractures Simple and Com-
         pound.
    IV. On Amputations.
    V. On fbme African Diftempers.
    VI. Of Luxations.                *
    VII. On the Venereal Disease.


 By John Atkins,  Surgeon.


Nemo unquam legendo, fit Artifex,


         LONDON:

Printed  for T. Warnery. at the Black
  Boy  in  Pater-Nofter-Row, and fold
  by the Bookfellers of London and
  Wejlminfter*
 
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                THE


 PREFACE.

            HE People of diflant  Ages,
            unacquainted with the Means
            of Luxury,  extended their
            Lives to a great length, and
            enjoy d  it with Strength, and
 Exemption from  many  of the Difeafes
 and Miferies  that  now perplex and vex
 Mankind.  The Diastetick Part of Medi-
 cine (as now in Countries where Phyfick
 is not fo  well known)  was  chiefly  re-
 garded for the Confervation  of Healthy
 which at  mojl, flood only improved with
 the additional Experience of a few Herbs,
 and an Analogy they found among Difea-
,fes j  and it would be judicious to couti-
 nue the fame, even now,  in thofe Dijlem-
 pers that are Chronical, where a Regard to
 Diet and the other Non-Naturals operate
 better, and with more Certainty, towards
 the Rejloration of 'Health\  than the various
                  A 2            and
 
        The  PREFACE.
 inexplicable Prefcriptions ofPhyfick as $
 now fiands.
   ChjLrurgery feems the firjl  and  only
 Part  exercifed  in  the  Cure  of Ma-
 ladies,  as may be  imagined from the
 wounding  of  Afc!el,  and what Euftachi-
 us has from Homer'j Iliads, fpeaking of
 Chjtron, Medicaminum  repertor .• Chy-
 ronem aiunt in manu Vulneratum  her-
 bariam, excogitaf$e  Medicinam  genus
 etiam  Pfln'aces ab eo'repertHtin Centau-
 rium Qognominatur.,    Vv,  ^v;
     Chfron praBifed Surgery  is plain,
\from . thofi fiubbom Vims \he was fo
\ skilful at- curing, and whick'fill retain
 his Name, Chyronia,/, and as elder Bro-
 thertaught- Phyfick to jEfculapius (T)p-
- lores iEgrotantium Medicare.)
 :   Surgery might alfo claim.-tfe Prece-
 dency bfPbyfick, hecaufe from one the Be-
 nefits jir.e vifible, and a Patient we find
 often  irretremafrle without it, and the
 ether - Tt>e\ fee <ifull of Incertainty,  and
 built on precarious  Reafoning and Con-
 sequence\- Indeed'  Phyfic^ as it  relates
 ■ to  Surgery,''  is neither fo ample  or my-
 zflerious,  but that  an ordinary Capacity
  may comprehend and direft init^ it lies,
 yinmy Opinion,, only in knowing the dif-
 vferent Secretions of the Body* whether 
       The  PREFACE.
too  copious jr\ deficient,  and.  which one
or more,  either by9promoting or flopping,
will befl ferae the End and Intention
aimed at,, trt [alleviating  Nature from
the Pains and Accidents fie is incident
to  in  all Chyrurgical  Cafes,,  and the
timous  Ufe  of  them,  fo  that fepa-
rating Opiats,   evacuating  Medicines,
Reftriclives and Cardiacks, we feem to
have  the whole for chirurgical Ufe -,  and
perhaps,  if we add two or three Speci-
fic ks, and a Knowledge in the'Non-Natu-
rals, we have all ofPhyfick.that is ufe-
ful in mbfi other Cafes: But the Sons of
^fculapius,  by the Degeneracy and In-
temperance'vfi Mankind, have taken Oc-
cafion to inlarge (rather than improve)
the" Branch  of Prefcription.to fuch an
enormous Magnitude  and Variety, and
have fo multiplied Difeafes  and  Hypo-
 thefes, that the Age of Man isfcarcefuffi-
cient to  make, a Difquifition into, and for
that Reafon it is to be feare(Loftentimes^
 ft  hm.n^np.re  Method^anitjafe and ju-
dicious  o?ily6  when harmlefs,  and not in-
 hibiting the  Operations of Nature.
    Chyrurgery as  it (lands  under the
four comprehenfive Terms  of Synthe-
 fis,  Diaerefis, Exxrefis and  Profthefis,
 fi. e. Reuniting, Dividing^  Ext ratling
                    A  3             or 
       The PREFACE.
or Adding,)  mufi firiBly  be defined an
Art, whereby the Cure of thofe Accidents
a humane Body is fubjeB to, is wrought,
jirfar  as manual Operations, and  out-
ward Applications can doit:, but in none
of  its Sitb-divifions can  a  Surgeon be
excufed in his utter Want*, either of ana-
tomical or ploy fie al Skill,'which are to
contribute their Share  in perfeBing of
Cures.
   Anatomy  is umverfally acknowledged
neceffary, PraBice without it being lame
and imperfeB:, f r how can a Surgeon,
■remarkably defeBive in this Part, judge
what principal Bowel, (if in the  Cavi-
ties) is wounded, or what the Accidents or
Parts  (tnakingthofe diffimilarQnesofthe
J^imbs)  are  that  labour, and how un-
skilfully  will he apply the Remedies, who,
after  knowing this, is fiill ignorant of
their Conftitntion, NatureyJJfe and ABi-
ons, by which alone fe can fecurely make
Prsgnoflich
   As  Anatow  teaches when,  fo Phy-
ficks teaches  how,  the Symptoms pecu-
liar to any Part or Bowel are  excite^
and Re afons and  DireBs accordingly }
fo  that they feem  infeparable Qualifica-
tions,  and as the Artifi  is  deficient  in
one or other,  he  mufi be proportionably
                           ' '......d\f- 
        The PREFACE.
difqualified as a Surgeon : This will be
farther apparent under the feveral Heads
treated  of in this Book,  where it will
be  obvious,  how impofjlble it is tofpeak
of, or manage any chyrurgical Cafe  with-
out them \ and how abfurdly it may be
undertaken,  when two of different Judg-
ments attempt it, one  by Internals, the
other by Externals,
   The Phyfician,  tho  of extenfive The-
ory, yet  when wanting in  chyrurgical
Knowledge, and arguing in general from
the Solids, fluids, &c. cannot take  his
Indications right, becaufe the particular
Cafe moft often points out the Remedies,
and a Procefs for Relief
   I  have endeavoured on  the enfuing
*SubjeBs, to  retrench  as much as pojfible,
fuperfluity of Prefcription,  and been as
 concife through the whole, ar would con-
fifi with Pertinency and Information.  If
 InfiruBive,   it will  be better for  being
fhort, and if not, pleads  a  more favou-
 rable Excufe -, for long and unneceffary
 Diverfifications hinders a Conception of
 the SubjeB, and naturally leads into Er-
 ror andConfufion.
    As  each Chapter  has a Jhort Proem,
 initiatory of the Defign and Contents, I
 jhall  anfwerably thereto prefix  m  the
                   A 4             %*- 
        The  PREFACE.
  Remainder of this, fame  Relations from
  Authority, either  of  the Dangers  and
  Mifihiefs attending Ruptures, or offome-
-  thing uncommon in the  Cure$  which I  »
  found coul4 not be well  inferted in the
  Body  of the Chapter' without breaking in
  upon  the plain and  eafy Connexion J
  think it now has.
     The general Fault whence  proceeds
  the Mtfohiefs  Ruptures #re incident to,
  is trufting them in their Recency to  un-
  skillful People, who  not under/landing
  any Part of Surgery, cannot difiinguijh
  Tuinars^ and if they  did, would fiill be
  moreto feet in proper Remedies-^ or elfo
  it is from  a carelefs ^gligence in th$
  Parties  themfelves,- who,  thd  well ad-
  vifed, may not follow it.
   .  Br. Linacre4 Founder) of the College,
   and  Phyfician  tp K.  Henry VIII.   died
   with the breaking of a Hernia.
     A. Parasus mentions  a Surgeon,, who
   on opening an abcejfed Navel, the Bowels
   inftantly fell  out  j #nd cautions others
  ■Qgainfi meddling with  fuch Ruptures,
   particularly in Children.
     In another  Place,  he tells   us  of a
  ' Jfa¥fil™b°W ke cured of an Enterocele,
   VkP^fiV£Vrfix T*W-after this, dyings
   qptastyeng^-mqIan:a4ijpofiSubflance3 of
   ./.;           "",. /.  ;";           the 
      The P R E F A C E.
the Bignefs of an Egg, found round.the
Hole, in the Procefs .of the Peritqiiasua^
flicking fo fafi it was fearce to be reypov*
ed without tearing.  '...,-..        ,
   Blegni tells you of a Perfon labouring
under  an Abfcefs in Liguine,  attended
with great Putr.efaBion,   and that a
Tortion of the  Ileon,.four Inches lo?igy
fuppurated j  and althd' the. Excrement
came that Way, • and the  Patient,:Six^
ty  Tears of tigex was cured.   Of ano-
ther, which was a compleat Enteroqele,
not. to be  reduced j "'but  the Matter .in
the. Intefiine was brought to Suppurati-
on with  the ProduBion of the.. Perito-
neum, even in  the Intefiine itfelf^the
Extremity of the  lafi  agglutinating to
the Circumference of the Aperture of the
 Abfcefs,  and  fo could not be clofed by
 Suture.   Some again have  had.  three
 Hernias viz. Of the Navel, and one in
 each Groin.     .
    Fabricius  mentions a monfirous Ex>
 omphalos in  a Woman  of 50 Tears of
 Age.   In another, a ruptured Navel, at
 which came forth part of the Intefiines
 as well as Omentum, occafioned. by dif-
 ficult Labour.  A Gentleman of 73 Tears
 of Age,  who, for 3 5 of it  lafi pafi, load
 felt a Tumor in the right Inguine, gradually
                                Increa- 
        The  PREFACE.
 increafing  to the Bignefs of a Pigeons
 Egg, without any great Pain j  and that
 20 Tears after  the Appearance  of the
firfty came  another  Tumor  in the  left
 Groin, foon exceeding the other in Larg-
 nefs, and  by  the Increafe of both,  the
 Bubonocele came to an Enterocele, with
 a great Tumor of the Scrotum :  He notes
 that on the Right-fide could be  reprefo
fed by the Hand, the other not j on which
 he argues  the former rnufl be  intefiinal
 or omental, tho* by fo long Continuance
 and often  ReduBion, fome Tumor were
fill  left from the frequent fir etching of
 the  Parts j and that the other on  the
 Left-fide, which would not be reprejfed,
 mufi be one  of thofe peculiar  to  the
 Scrotum'. (Aquofa,  he  thinks^) and ob-
ferves from fuch a Hernia,  that JiriB
 Ligature or Bagging up, is hurtful j and
 alfo  that the Weight of the Water, by
 Means of the Muiculi redli,  inferted at
 the  Sternum and Cartilages of the Co-
 fte nothas,  will fometimes effeB a Strait-
 nefs  of Breathing.   In another Place he
gives an Account of an Enterocele, from
 a Dilaceration of the Peritoneum,  and
 the Gentleman being negligent of his Trufs
 in riding, it Jlid down and became very
 troublefome, with Infiawation and great
                                Pain, 
      The  PREFACE.
Pain,  through the Abdomen  as well as
Rupture: The Intefiine, fays he, was
now in Scroto, fluffed with Excrement j
Clyfiers he threw up at his Mouth, and
the  Symptoms increafed with greater
Severity, till emollient Cataplafms having
lain an Hour or two, and the Patient in
a  quiet Pofiure, it fubmitted to a gen-
tle handling, and was returned \ Broths
and compofing "Draughts, fitted him for
the Ufo of the Trufs again.  A Woman
alfo troubled  with grievous  Torfions in
the Belly and Stomach, with Vomitings,
Watchings,  <SCc. throwing up all Clyfiers
at her Mouth \ on enquiry it was found,
that fome Months before, fie had a Tumor
 inlnguine,  which infix Days increafed to
 the Bignefs  of  both Fifis, and  was  a
 Rupture of the Peritoneum, thro'  which
 the Inteflines with their Excrement had
jell, not to be eafily returned.  In order  to
 it, he fomented with a DecoBion of Mal-
 lows, Chamomil,  Linfeed, Sic.  making
 up the Faces  and fome  Sheeps Dung into
 a Cataplafm, and re?iewing it on the Part
 every Hour for  a whole night, which fo
 fuppled them, that in  the Morning  the
 'Gut was repreffed,  the Excrement came
 off with a Glyfier,  and foe  recovered.
 Another on  a Strain felt the Hypogafii-
                                    um 
       The  PREFACE.
 urn crack, and the  Inteflines to jlide in-
 to the Scrotum,  which not beting-able to
 rfduce, threw him into an HiackPaffion,
 and next Day was troubled with contl-
 nual EruBations and Vomiting, Co (live,-
 and his Urine faffed with gH-at Difficul-
 ty,:.  The Symptoms increafing,  and  Lly--
fie-rs being thrown up at his:m.puth, with
 mitch Bile and  Excrement, t gave little-
 Hopes of his Recovery^ dying  on  the
fourth Day. .■ On opening  his Body,  the
 lieon was found:in Scroto livid,  and in
 i-he Beginning cf the Procefs above the
 Qs Pubis, was  found a fpongy Fungus
 involving.the  Intefiine, and adhering to
 the  Membranes, which he judges arife
from the Blood effufed at  the fir ft Day's
 Hurt.
 (He gives  like wife, an  Account of a
 Cooper s  Wife,  who helping  her Hus-
 band in  his Trade, received a Blow in
 her left lnguine, by zvhich the  Peritone-
 um was ruptured; foe had a large  Tu-
 mor there„ increafing fofaft, it  could not
 be  retained within the Abdomen,  and
 being with  Child, the Uterus was di-
fijeyided,  and  therewith the Skim of the
 Left. lnguine fo ftretched,  the Child
 might be felt  pendulous \  however, fie
                                  we?tt 
        The  PREFACE.
went her due Time, but the Child had
a CAfarian Birth,  which the Mother was
in a fair Way, of recovering, till  being
foiled n&tkfa Syncope, rather for mint
ofmeceffaiy^Supports y. than any thing elfo
difdfudmftlg.^     .^..^-.^.w.---,^
   All other Authors on this SubjeB, fre-
quently abound  with  fuch like Cafes ,
Ruptures  that not being timely reduced,
or negleBed, have fell  into  the Scrotum,
where the Excrements hardening, Gripes
and Iliack Pajfion have followed, or On
Inflamation,  Vomitting, Suppreffion of
Urine,  Watchings, Singultus, Languors^
Death.
THE 
( 'OS)
        THE

CONTENTS.

     CHAP.  I.
Of Ruptures.    Page  I.

     CHAP.  II.
Of Fractures of the Skull.
                P 39-
    CHAP.   III.
Of Fractures  Simple and
  Compound.      P.  11 o.

    chap.   IV.
Of Amputations.  P.  140.
               CHAP. 
  The CONTENTS.

     CHAP.  V.
A Journal  of the  Sick on
  the  Coajl of Guiney.
                P. 177.

     CHAP  VI.
Of Luxations.     P.  209

    CHAP.  VII.
Of  the Venereal  Disease.
                p. 1.
CHAP. 


-. -a
no-"
V" ■  5*



.■'•.•::-.:.-iV" ■■ :•' 
            CHAP.  I.

         Of RuPTURES.

                \NT of Health is not
                always from Intempe-
                rance and irregular Li-
                ving }  it fometimes de-
                pends on a due Confri-
                tution  of the Parts of
                the  Body.  The wea-
kening of any one of which is a Difeafe,
and this  weakening, among other vari-
ous Caufes, maybe occafioned by a vitia-
ted Site, that probably induces an Atonia:
And this, in refpecT. to Ruptures, may ei-
ther be through the Fault of  the Part it
feif,  or elfe thofe that contain it.
B              To 
               (*)
  To a right Undemanding the Nature
of our prefent Subject, it is neceflary to
be acquainted with the Parts immediate-
ly concerned, i. e. the Peritoneum, 0-
mentum,  and Inteflines,  Scrotum and
Mufcles of the Abdomen \  for whoever
fhall  be unacquainted with  the Make
and  Ufe of thefe  Parts  (that  lye very
nigh to thofe necelTary for the Conferva-
tion of the hidividuum*ox Propagation of
the Species) will  be fo far from redref-
fing, that.it is a Qhance if he  does not
aggravate the  Evils  they y may fuffer
under.
   But, previous to this Tranfcription of
their Make and Ufe, it will be necelTary
to obferve iri  general, hrft, from their
Site, that in umbilical Ruptures the I?ite-
Jliiiwn Jejunum always comes forth firft j
in Prolapfit Ani, the Returnj that no o-
ther than the  Ileon paifeth the left An-
mdi Mitfculorum, and that fometimes part
of the Colon on the right Side may be
protruded further.   If the Ligaments of
the Colon may  be dilated enough, the
C#cu?n may fall down into the lnguine:
It feldom happens fo indeed, but, 1 thinkj
would'be of lefs Admiration than what
Authors tell us of the Ventricle,  or of
 the Spleen and Liver falling downwards)
                                   by 
                (  3 )
by a  Relaxation of  their  Ligaments.
Secondly, From their Magnitude we may
obferve, that the Caul cannot in its pro-
per  Dimenfions  touch the  lnguine or
Scrotum } when increafed in Thic.knefs
and Weight indeed,  it may dilate or break
the Peritoneum, and this again may be
cafually broken  or diflended (as other
external Hurts  happen)  and fo let the
contained Parts  fall even into the Scro-
turn, but where the Bubonocele (hall be
large,  whether  or  no  part of  it might
not be fafely cut off > Nay, whether ever
the Parts can  be reflored  to their na-
tural State, or fecured  from  intermina-
ting Symptoms without it? From the Pre-
cedes of the  Peritoneum  (thro*  which
Ruptures in both Sexes fall,) it does no
way appear that any confiderable part of
the Intefiine (efpecially fluffed with Ex-
crement) can pafs, and that therefore their
arriving fometimes to fuch Largenefsand
Eafinefs of flipping down,niuft be from
the frequent flretching, and: dividing the
mufcular Fibres, by a long and mire*
guarded Bearing and Tendency of the
Caul  and Inteflines towards the lnguine
and Scrotum:, external Hurts and Strains
now  and  then contributing a  Share;;
                   B  2          From 
               (^
From which Frequency, and theOcca-
fion of it, we frame our Prognoftick.
  Laftlv,Ona Repofition of the prolap-
fed Parts, there muft be a due Regard to
the Obliquity of the Proceffes, which are
made to  pafs aflant through the Annuli
Mufculorum \ and therefore muft be re-
prelied  towards  the Margin of the Os
Ileum on the hurt Sid,e:  Unskilfully to
force a way between the Mufcles, would
be painful and dangerous *, and fo would
the miftaking a Teiiicle in lnguine  for a
Rupture.   But to be more particular in
the  Parts concerned.
  The Mufculi Abdominis help to fup-
port the Vifcera, and hinder the Defcent
of the Inteflines, through whofe Annuli
they difficultly flido,  and are as difficult-
ly returned, as will beft be made appear
from their Conflru&ion.
  I.  Mufculus  Obliquus  defcendens  is
fattened  above to the Cofle nothe, and
foine of the Cofle vera,  on the hinder
Part, to the Mufcles  of  the Back, from
whence it proceeds on  each Side, and
comes to  the  linea alba \   beneath to the
Os  Ileon,  and Margin of  the  Os Pubis,
nigh which it- Fibres are opened to make a
Space for the Paflage of* the Spcrmaticks.
                              2.  Obli^ 
                I  5  )
   2. OMiquus Afcendens-,  they  lye un-
under the former, a little larger, higher and
more remote from the linea alba,  affor-
ding a Paflage alfo to the Spermaticks,
called Annulus fecundus.
   3.  ReBus goes directly from the Carti-
iago Enfiformis,  to the Os Pubis.
   4.   Pyramidalis, fometimes   one   on
each Side, and  fometimes fmgle, lye un-
der the former,  and at  joining of the
Bones.
    5. Tranfverfalis goes  from  the Ap-
pendices of  the Vertebra  Lumbares  a-
thwart the Belly, its upper Part is fa-
ttened to the Cofie Not he, the  lower to
the Offa Ifchii  and Pubis  \ where,  like
the oblique Mufcles, it  forms another
 Ring  for the PaiTage of the fpermatick
 Veflels, larger,  higher,  and  at greater
Diflance from the middle of the Bellv.
    6.  Cremafter lies on the Folds  of the
 Inguen,  according  to its Length,  and
 propagates its  Fibres to  the Teflicles,
 becoming their proper Sufpenfors.
    All thefe Mufcles  on the infideof the
 Abdomen, are covered by the Peritoneum,
 whofe Productions,  without feparating
 any of  its Fibres, are carried alfo to the
' Scrotum,  and are the Parts which prima-
 rilv fuffer in Ruptures.
    J                  B  3        P'«- 
                  (6)
     Peritoneum is a membranous Duplica-
   ture,  covering  and  containing all the
   Vifcera of the Abdomen, thickeft  from
**  the Navel to the Os Pubis  (efpeeially in
   Women for  Dittention in Gravidating.)
   Its internal Surface fmooth and unduous,
   from a Number of fmall Glands that be*
   fpreads it, which 'in hydropick Bodies
   grow  (as the Membranes dp,) more large
   arid vifible.
      It  is conne&ed on  the outride to the
   tranverfe Mufcles and Linea Alba, be-
   low to, the Os Pubis,  on the Sides to the
   Of la IIii, behind to the  Os Sacrum and
   Vertebra Lumbares :  It is alfo reflected
   from  the  inferior  Surface of the Dia-
   phragmatotht con vex Surface of the Li-
   ver, which it fufpends, called Ligamentum
   Hepatis  Sufpenfiriimi.    The  exterior
   Coat  hath two ProcefTes falling down in.-
   to  the  Scrotum in Men, and make each
   Tunica Vaginalis \  and  in Women the
   Invo lucrum for the Ligament a Uteri Ro-
   tunda.   Ignorance  fometimes of;,know-
   ing precifely where  thofe ProcefTes pafs
  ■ the Perforation of the Mufcles,  has made
    Ruptures taken for  Tumors of another
   fort attempting Suppuration •, and eontra-
    rily  has  been the Occafidn of putting *
    Trufll-s on Apoftemations that fhoqld 'be
                                 opened. 
                r  7  >
 opened.  In morbid Cafes great Quanti-
 ty of Serum hath been found between its
 Duplicature, when there hath'been none
 in the  Cavity of the' Abdomen -y  and is
 fuppofed the true Tympany, frequent in
 Women whofe Ovaria are probably firtt
 affected.
   Funiculus UmbilicaUs confitts of aVein,
 two Arteries and  the Urachus,  which
 foon-after the Bjrth  dry into the Liga-
 vientum Xlmbilicale,  or Sufpenfor of  the
 Bladder. The Knots in it are flefhy Mem-
 branes, to moderate the Motion  of  the
 Blood  towards  the Infant j'  and Care
 mould be taken that the Ligature made
 on it at the Birth-thou Id not be too flack j
 a Miftake that has been the Occafion of
 flefhy Excrefcences of confiderable Bulk,
 frequent among  the Negroes, of Africa,
 and, if ever cured, requires afecond Li'
 gature,  and perhaps Efcharcticks iNor
 mould, it be cut between the Ligature
 arid  phild,  but without it.
   Omentum covers and fluctuates on the
Inteflines, extends from the bottom  of
 the Stomach to the Navel, where it com-
 monly ends,  or rather a little lower  on
the left Side j which is the Occafion that
the Lapfe of it is generally there  down
into the Region of the Hypogajlrium, and
                    B 4 "       fome- 
               (8)
fometimes  the  Scrotum caufing Hernia
Epiplocele : When in Women it happens
to  flip down between the Matrix  and
Bladder,  it makes a Comprefllon on the
Orifice of the Uterus, and thereby hin-
ders Generation ^ its Weight commonly
about half a  Pound, but in  hydropical
Perfons much more j Fabricius Hildanus
faw it of 56 Pound.
   The Stomach, in its natural Site feems
fo couched as to  be unable to give any
D fturbance to the Hypogaflrhtm, yet ac-
cidentally may contribute much  to the
Production of Ruptures, either as it is pref-
fed downwards  by the Diaphragma in
violent Coughing, or  through  intempe-
rance in eating and drinking.  For as the
Stomach  may ordinarily  hold  three or
four Pints, f0 if  it  be diftended beyond
that, by voracious and debauched Meals,
or by  Flatulencies  from  improper  Diet,
it may  thus accidentally  help to  prefs
the Inteflines towards the Procefs of the
Peritoneum.
   Inteflines :  The  Intefiine commonly
falling into the Scrotum, and  caufing a
Hernia Intejlinalis,  is the lleon ^  being
about twenty one  Hands breadth long, it
poiTeiTeth almoft all tie  circumferential
Space below the Navel. Ic is not fatten :d
                                   to 
               (9)
to the  neighbouring Parts, as the Colon
and Cecum are, which, for that Reafon,
fall later into the Scrotum, and not till
the Rupture is large.
   The Scrotum is  externally divided by
a Seam  from the Anus to the Penis,  and
and has an outward mufcular Coat, which
contracts it into a  Purfe as it were,  and
aninward one called Dartos, which gives a
Covering to both Tetticles. Each Tetticle
befides hath three Tunicles-, the ErythroU
des from the crematter  Mufcle, which
fufpends it \ the Elythroides or Vagina-
lis, from a Produdion of the Peritoneum,
and the Albuginea,  nervous white  and
thick, which immediately clothes it, and
whereof the Teflicle being diverted, ap-
pears  to be a foft loofe  Body,  compofed
of feveral feminal Veflels, and many ca-
pillary  Branches  of Veins,  Arteries,
Nerves, and Lympheduds, like a Glan(\
They have alfo pertaining to them,  the
Epididymides and  Vafa  Deferential the
former  fmall round Bodies ariling from
one End of the Tetticle, and running
their whole Length \ their Ufe is to re-
ceive the Semen feparated in the Tetticle,
and pour it into the Trunks of the Vafa
Deferentia, with which they  are conti-
nous.
                               Uterus. 
               (  io  )
   Uterus. The  Uterus  is*  fmall,  but
being membranous, very diftendible, pla-
ced between  the  Bladder and Retlum,
having  two  broad Ligaments, which;
from  its  Bottom  are fattened towards
the Kidneys, that the Weight of the Foe-
tus do not bear it downwards.   And
two  round  Ligaments, which  palling
with the Proceffus Peritonei, are fattened
to the lower Part of Os Pubis, and upper
Partof the Thighs, to hindet its Afcent,
which might difturb Refpiration, or the
Office of the Stomach. The exterior Parts
are obvious, arid need no Defcription.
   Definition.  Burftennefs, termed Rup-
tura & Hernia^  are Tumore's contra, na-
turama partium quorundam ?nembranacei
arum  imi  ventris ProduBi fitu deprava*-
to, i.e. A depraved Site of fome  mem->
branous Parts of the Abdomen :(the In-
teflines or Omentuni) breaking forth at the
Navel, or what is more common, fliding
into the Inguen ax  Scrotum *,  the former
imperfed from a Relaxation of the Perh
toneum, the latter perfed, and more pro-!
perly  termed  a Rupture..  :   • »  '
   Sorts.  In  Refped of this 'Site they
are termed Omphalocele, or Hernia, Um-
bilicalis, Bubonocele, ox Hernia^ Inguinalis.
and Ofcheocek or Hernia Scroti,
    :'">                            In 
              (  " ;
  In Refped of what membranous Pari;.
it is that has thus changed its Place, (In-
tefiine or Omentum), they are termed In-
tejlinalis or  Epipfaele (Zirbalis.)
  And the  Hernia Scroti from the. pe-
culiar Matter fixed  in it mSfe^other De-
nominations, Ventofa, Aquoja, Carnofa,
and Varicofa, (Pneumatocele, Hydrocele,
Sarcocele and Circocele \) and fometimes
by a Complication ■Hydro-Pneumatocelei
Hydro-Sarcpcele,  as well as  Ewteropiflo-
celep                          .;" >:■
   Caufes.:  The immediate antecedent
Caufes of Ruptures are  various j Owpha- •
locele and Bubonocele are from- a Rupture
or Dittention of  the interior Part of the
Peritoneum •, but .when either the Caul
or Gut appear in Scroto, there is  not on-
ly this interior Rupture, but alfo the ex-
 terior Apophyfis,  or Procefs  of the Peri-
 toneum, muft be  relaxed, if not ruptured.
 Again,  in  'Hydrocele ^and Pneumatocele,
 there is no Occafion for Ruption or Re-
 laxation, for thefe proceed  from the.im-r
 •moderate Moifture and  Laxity of the
 Peritoneum, as is mamfeft  in Children.
   External Caufes are any violent Mo-
 tion of the Body,  the eager crying  of
 Children,  Dittention of the Abdomen by
 hard Labour, immoderate  Venery, hard
                                Riding, 
               (")
 Riding, carrying heavy Burthens, Falls,
 {training the Voice, hard Stools,Coughing,
 Sneezing j  and even  tjie very Weight of
 the Vifcera in fat Perfons, has caufed im-
 perfed, and when negleded, perfed Rup-
 tures.
   $ig?js.  Signs of Bubonocele is a round
 Tumor in  lnguine ,  it begins from Os
 Ifchii, increafing by little  and little, and
 when  prefled does  readily go back.   If
 an Enterocele is in Scroto,  the  Tumor
 feems hard, and when prefled goes back
 with  Noife:  If Epiplocele,  the Tumor
 will feel  foft like  Wool} but unequal,
 and does not  go  back fo eafily  as  the
 Intefiine.  Signs of  the Peritoneum rup-
 tured, are a fudden increafe of the Tu-
 mor with acute Pains \  in a  Relaxation
 not fo, they are lefs,  and  come and  va-
 nifti together.  Windy Meats, and plen-
 tiful Meals increafe all thefe Tumors.
   The watry and  windy Ruptures in-
 creafe gradually, but are perpetual, i.e.
 do not difappear by  laying down,   nor
 are to be repofited as the others, and may
 be thus diftinguifhed.  The Hydrocele
or watry  is  foft  and fmoth, until  the
Augmentation of Humor  has greatly di-
ftended it,  and then is tranfparent by a
Candle  light: The Tumor may be ei-
                                 ther 
               t  n )
ther feated  between the Coats  of th
Tetticle, or included in a proper Cyftis,
j udged of chiefly from their Figure.  The
former afluming  that of  the Tetticle,
and is oval or oblong ^  that in the Cyftis
round.   The Pueumatocele or windy,  is
much lighter and fofter than the other, and
makes a kind of Sound when ticked upon.
Sarcocele is known  by  its  Unevennefs,
Hardnefs and dark Colour.  Circocele by
the knotting and Diftention of the Veins.
If the Omphalocele he from the Omentum,
it retains the  natural Colour, is almoft
without Pain,  and returns without Noife
as foon as the Patient is laid on his Back \
if the Tumor be from the  Intefiine,  it
is more uneven j if fuperfluous Flefh, it is
more difficult to prefs in \  if Wind it is
fofter,  flipping with Noife under  your
Finger,  without going back  \ if Water,
it is of a darker Colour* \  and lattly,  if
the Tumor be from Blood, it is livid like
an Ecchymofis.
   Prognoflicks.  Children from their vio-
lent crying,  the Softnefs of the Berito*
neum,  and  feeding  on crude Milk, are
moft fubjed to  Ruptures,  efpecially in
their earlieft Months.   If their Ompha-
locele is caufed  by the  Intefiine, Omen-
tum, Wind  or Water, it is curable -,  if
                                 from 
               (  H)
 from Flefh or Blood, doubtful and diffi-
 cult.  Again, their Hernia Omentalis and
 Inteftinalis maybe cured by proper Means
' till Puberty, but in adults, fcarcely with-
 out Surgery.  The two forts of Bubono-
 cele are common to Men  and Women,
 though not fo frequent with  the  latter,
 by reafon of the greater Thicknefs of the
 Peritoneum.   Thofe  in Scroto are pecu-
 liar to Men, though  a Refemblance hap-
 pens fometimes  in  the  other Sex,  for
 their Ligamenta  Uteri  teretia  pafs  be-
 tween the Lamina,  as the Vafa Spewna-
 tica in Males do.
   The left Enterocele is more grievous
 than the right, becaufe the Cecum is al-
 ways replete with Excrement,  and not
 fattened to the Omentum, but prelTed up-
 on by  the letter Inteflines.   Moft dan-
 gerous of all are when the Gut is doubled
 and filled with Feces ; the Patient ofteq,
 in this  Cafe, fuffering a Fever and Gan-
 grene,  and goes off with Singultus.
   Sarcocele and  Circocele,  if large, are
 not fafely managed,  either by Pharmacy
 or Surgery.  When they are recent, and
 only the EfFed  of too hafty and quick
 Purges  in  Gonorheas,  they fubmit  to
 mild and  anodyne Topicks \ but when
 confirmed, they  take the Nature of  a
                              Scirrhus 
              C  1.5  )
Scirrhus on the Tetticle, and will be dan-
gerous tampering with,  left they turn
cancerous and  mortal.   Hydrocele and
Pneumatocele are in the Beginning curable
by Medicaments j  but when the Tumor
forms it  felf large, Surgery is requifite.
  Hernie Intejlinales in People of full
Growth, are, for the  moft part, capable
.only of being kept up by goodTruffes and
Bandage, which Patients muft  be  wary
in neglecting j for grievous Pain fucceeds
their difufe, Cholick  and Fever :  And
fometimes, when the  Excretion of the
Feces  are  ftopped, there follows vomi-
ting, and an Inflammation of the Gut, a
Singultus and Death.  Yet it may be ob-
ferved, when theDiruption of the Perito-
neum is large, a Tumor in Scroto may be
produced as big as one's Head,  and nei-
ther much Danger or Pain will be obvi-
ous  to any one in theObjeds of this Sort
that prefent in the Streets, who have as
free aPaflage, no doubt, through thepro-
lapfed Inteflines, as  if they were  Intra
Peritoneum Abdominis.
   Hernia Omentalis is  difficultly redu-
ced  and retained, yet lefs fo in Perfons
of a humid than dry Habit j  in the In-
guen than  Scroto ^ it will  be moft hard
when  any Excoriation from rough hand-
                                  ling 
           .    (  16  ;
ling has been the Occafion of generating
fome intervening vifcid Subftance to hold
it faft.
  The Cure.  In general, we fhould pre-
fcribe a Diet warm, drying, and of good
Nourithment,  as Mutton,  Veal, Lamb,
Pullet, and the like, keeping their Bodies
foluble by this,  or  purging }  avoiding at
the fame  time, all Herbage, Fruit,  Fifh,
and Milk Meats, with what elfe are fup-
pofed to engender  Crudities.   Their
Drink, a red Wine with Water, wherein
if Steel   be quenched it is  better; a cha-
lybeate   mineral Water, or a  medicated
Ale •, if a Cough, obtrude the proper Re-
medies muft be adminiftred, and all In-
temperance and Excefs muft  be forbid,
whether  it relate to eating and drinking,
or  to Exercife, as Walking, Running,
Leaping, Riding, Coughing, Sneefing, and
inordinate Laughter. Confequently Reft
and an eafy Pofition muft be  obtained,
as far as  poffible, and Freedom from Paf-
(ion, and every Difturbance of the Mind.
This is  fo neceflary, that perfed  Cures
have been wrought by Sicknefles that have
confined  Patients tp their Bed.
   So much may fuffice for a general De-
meanor herein j the particular Cure comes
under three Intentions.
                                 Inten* 
                ( «7 )
   In'entions.  I ft Intention, is .a. due Re-
 pofition of the  prolapfed Part into the
 proper Place^ done by fattening and dif-
 charging the Excrements, by laying the
 Patient on his Back with his Buttocks
 raifed  :,  and then with fomenting warm
 Cloaths, and  gently reprefling it  with
 your Hands :, if it does not fubmit, Mr.
 Wifeman advifes the putting him  on the
 Back of a  ftrong Man,  with his Head
 downwards.
   2. Is to keep it right when it is redu-
 ced  \  done  by proper  Bandage and
 Trufles.
   3. Is to give a Contradion to  the re-
 laxed Parts  \ done by the cold Bath, by
 aftringent Fomentations,  Cataplafms and
 Emplaifters.
   The cold Bath, as it has proved of in-
 finite Service in many Diftempers,  invi-
 gorating both Mind and Body} fo it will
 be particularly ufefulherein the relaxed,
 weak and paralytick  State of  the  con-
 taining  Parts,  provided  due Regard be
 had to Age,  Strength, and Time of Con-
 tinuance in it.
   Aftringent and agglutinative Simples
are Rad. Biflort.  Symphiti, Tormentill, Of-
mund. Regal. Fol. Fragar.  Millefol, Pen-
taphyll, Prunell^ Tapji Barbati, Equifet :
                    C           Burf. 
               (  18  )
Bitrf.  Paflcr.  Plantag.  Sumach.  Cort.
Querc. ^Granator,  Flor.  Rofar.   Ba-
lauft, Nuces Cyprejf. Lap. Hematit. Terra
Sigillat.  Bolus  Vents,  Acetum,  Oxycra-
ttim, Vinum rubrum, Aq. Fabrar.  G.Ara-
bic. Ammoniac, Tragacanth, OpoponacMa-
fitch.  Thus, Aloes, Sarcocol, Ichthocol,
'Terebinth. Gypfnw, Farina, Amy turn, Her-
niarium, Sang. Dracon.
   Thefe  may  be varioufly ufed in Fo-
mentations, Baths, Cataplafms,   dr Em-
plaifters :  Your Emplaifter,  whether it
be any Compofition from thefe, or  the
Ad Hemiam of the Difpenfatory, fhould
after Fomentation, be applied with  Com-
prefs and Trufs, and left on for a  Month,
without removing,
   Internally is recommended Troch.  de
 terra Lemnia cum Carabe jj. tn  hauflulo
 v>n'r albi.
   Sttcc. Symphiti, vel tapfi barbat. Jij-
 (vel Pul. SigtU. Solomonis jj.) in vin. alb.
 Swnend.
    %. Rad.Sigill. Solomon. Symphit. ma).
fern. Anifi a. jj. F. Pulvis ad hemiam de^
 tur' Infant i bus ter in die ad gr.  xv.   A-
 dultis 3if. fuperbib. DecoB. MiUefol. vel
 Symphit. hauflum.
    Father Cabrere\ Secret was  Sp. Salis
 bene rec'iificat. jif. in vino Clareto lb> de
                                    quo 
                c  '9;.
 quo fumat haufiuhim (je)wio flomacho)
pro tribus feptimanis } and the following
 Emplaifter, #. Pul. Maftich. 51*. Labdan.
 £iij. nuces  Cyprefs. 2Vviij. Hypocif.  gj.
 Pul. Rad.  confoiid. ?n).  §f. Ptiis nigri
 §ij. Tereb. Ven. %}. M. F. Empl.
   Vigerius has #. Conf. rof.  rub. Rad.
 Symphit. a. %]. cort. (ydonior. Condit. Jf.
 G. Tragacanth. terra Sigillat. Cor all. rub.
 Pul. Hemiarie a.zf.. Croc.  Mart. A firing.-
 Magnet, a.  Bj.  cum facchar. rofat. F.
 Conditum vel addito fyr. de rofis ficcis, cil-
jus capiat  ^ij. fmgulis Aurorh fuperbib.
 haufi. vini.
   \. Confer.  Rofar. rub. Abfynth. a.  %].
 Species Diarrhod. Abb at. ^ij. M.F. Condit.
   As Ruptures  differ  not only in the
Part falling, but  alfo according to the
Place it falls to,  and the Matter it con-
fifts  of}  fo it  is  evident befides generjl
curative  Intentions,  there  is required
fomeVariety of Method peculiar to each.
   Hernia Umbilicalis.  Fir ft, the Umbi~
licalis. Am brofe  Pareus direds the Pa-
tient to  be laid  on his Back, and with
Fomentations to reprefs the Caul, or Gut,
with the Fingers :  If it fliould not yield
to this, through its Largenefs, or other
Circumftance,  then to take up the Skin
round the Tumor,  and having brought it
                   C  2       between 
               (  20  )
between your Fingers,  to make a ftrait
Ligature on it with Needle and Thread,
to fcarify the circumjacent Parts, and cut
off what is without fide the Ligature :
To this  if we add a quiet Pofition  and
Repimen till a  Cicatrix is formed, it  is
probable  the  mufcufir  containing Part
may contrad fo as to keep the Internals
reftored.  Mr. Wifeman, and others, for
the larger Ruptures of the Navel, do, af-
ter Redudion, ufe a Bracer to lace on the
whole Belly, under which a Bolder may
be placed of proper Dimentions' on the
Navel,  and  under that an Emplaifter ad
Hemiam.   H the Skin  ihotfld mortify
through  negled, Stitch, fays he, the Pe-
ritoneum per  Gaflroraphiam.   Though
others,  as Fabricms, ab Aquapend. will
fcarce allow the Peritoneum to be rup-
tured in Hernia Omentalis.
   Hernia Inteflina is.  Secondly, the In-
teftinalis, more frequent than the former,
and of worfe Confequence.  In  order to
Redudion, the Patient fliould be placed
on  his Back,  with the  Buttocks  raifed
higher than  the Head j then with  warm
Cloaths  and  Fomentations  endeavour
gently to reprefs, and that Part firtt which
came out laft, whether it be in Scroto,  a
Procidentia ani,  or an Examphalos,  be- 
              (  21  )
ing very careful againft rough Meafures,
which  fometimes  produce  Inflammation
and Gangrene.
   In Children, the Impediments to Re-
dudion, by the Softnefs of their Confti-
tution, is eafily fuperfeded, and  with an
aftringent Fomentation,  a  convenient
Comprefs and Bandage, ufing all  careful
Means againtt crying and coughing, and
retting the Child for fome Days (if pof-
fible on his Back) will generally bid fair
for a Cure.   But in Adults  the Cafe is
altered, violent Pain, Inflammation, and
fometimes a fpeedy Death enfuing •, and
this perhaps never more frequently than
from a Plenty and Induration of the Ex-
crements, the common Incentive of all
thofe  Symptoms we denominate under
the Iliack Paffwn, (a Diftemper arifing
from an Inverfion of the perijlaltick Mo-
tion,  and not  any pretended doubling,
twitting, or Inverfion of the Gut it felf,)
for if a Stop be made in the Paffage, whe-
ther by fuch Induration I have been fpea-
king  of,  or  a fudden Fluxion  of Hu-
mours inflaming any Part of the Gut,
(and  efpecially when difplaced,) what
mutt the Confequence be but acute Pain,
a  return  of every thing upwards, Lan-
guors and Syncopes? For relieving thefe,
                   C  3            and 
              (™)
and foftening the indurated Excrements,
Embrocations of emollient Oils may pre-
cede, and then carminative Clyfiers, Fo-
mentations   and  Cataplafms,  renewing
them often.
   R-.  01. UUior. rofar. a. pe. A Clytter
of Vini  Canarienfis cum Oleo Nucis,' qr
   R.  Alt he, Malve cum r a dice fol. Ori-
gan. Calamenth. Summit, Anethi a. Ms).
fern. Anifi pj. Flow Cham. Melilot. Samb.
a. p. i. F. DecoBio ad lb j. in qua dijfolve
Diaphen. ^j. pro duobus Clyfteribus.
   Eodem decoBo cum vino foveatur pars
twnefaBa.jex fecibus,  feu Magmate F.
Cataplafma Aadendo farm, Lint fenug-
rec.  Ax wig. Pore in. & butyri recent.
   R.  Rad. /dthe lillicr. a. fyj-fem.  lini
fenugrec. a. §if, Fol.  Malve Violar. Pa-
tietar. a. M). Qoquantur in Aq.  commwi.
pojlea tundantur & trajiciantur per f t.i-
 ceum Addendo butyri fine fale 01. hllior.
* q s. Fiat Cataplafma Calide Scroto & re-
gioni Hypogajirii applicand.
   If the Clyfiers come  off without Ef-
 fect, and the fame Means already men-
 tioned are ineffectual to Redudion, it is
 a Pradice to inlarge the Rings of  the
 Mufcles, (where the Stoppage ufually is)
 by Incifion, which need not extend  to
 the Scrotum, unlefs the prolapfed Part§
                                adhere 
              (*l)
adhere there -, nay, when the Pain and
Induration are obferved to increafe, and
the Danger more imminent.   Authors go
farther, and prefcribe the  PunBum Au-
reum,  as fome others have done an adual
Cautery, or Caufiicum Medicamentum, to
compleat a Cure.
   The PunBum Aureum being neither
very common or fafe,  fhould be under-
taken only in extream Neceflity, warily,
and at the Impetration of the Patient.
   An ingenious Author thus defcribes it.
You are  to make, fays he, your Incifion
on the Os Pubis, fo that you may pafs a
Diredor under the Procefs of the Perito-
neum, according to its Reditude : Then
having raifed  it up, feparate it from the
Fibres and nervous Bodies, to' which  it
adheres, being particularly careful in re-
moving the Vafa Spermatica and  Crema-
Jler Mufcle, without hurting them. That
done/ take hold of fo much of the Pro-
cefs as is now loofe, with a Pair of For-
ceps,  and pafs it through with a Needle
and Thread five or fix double, as clofe
to the Spermaticks and Cremafter Mufcle
as may bedone, without moletting them.
JUftly, pafs through the Middle of that
part of the Procefs which remains with-
out your Forceps,  and take up the Lips
                    C 4            of 
              (  H )
of the Wound together with it, draw a
Arid  Knot, and leave the Ends hanging
cut  at the Wound, till they drop off
themfHves, and- that is agglutinated. Non
temere (fays  Celfus) nee nimis Cito ad
Set'iionem veniendum quia fepe preter
fpem hernia Curatur.
   To check the Inflammation that may
r^-ifeon this Operation, the Tumor fhould
be moitten'd  with Oxycrate ex Aq. La-
BuceCocleariV). Ace turn rof.Coch. i. and
hy 6n the'Ceratum Galeni, vi-z>. R. cere
Alb.^ij.OLRofar.  OmphachuXf]). Con-
quajfentur cum mo die o clari <&• albi aceti
~itt F.  Ceratum.
   Pneumatocele or Hernia  Vent of a,'& A-
quofa. Tfi3 Ruptures are properly only
of the Intefiine or Omentum, and  perfed
only  when in Scroto : Yet other Tumors
in this Part from a Refemblance have ob-
tained the Name  of Hemiie , there are
four  of thefe Tumors, the two  above
mentioned having fome Affinity with each
other fhall be confidered with little Di-
ftindion.
   The Ventofa is moft frequent in Chil-
dren,  the  Tumor  of  fudden Growth,
round, and affeding different Parts of
the Abdomeny but chiefly the Tetticle be-
ing contained within the Tunica Vagina-
                                  lis, 
               (^5 )
Us, and in fuchCafe approaches towards
the Shape of it.
   They are generally of eafy Cure, it
confifting   in  difcutient Fomentations,
gentle Laxatives, avoiding all things fla-
tulent, KnEmpl. e.Cymino velebaccislau-
ri, and a Bag-Trufs: This only is to be
obferved, that  when the Tumor is very
tenfe, your  CompreiTion  and Bandage
fhould be lefs ftrait, for fear  of inciting
Pain and Inflamation.
   •y.. Flor.  rofar. r. Hypericum Cham. a.
 M). Cort. Granator. (vel querc.) Gallar.
 mices Cyprefs  a. §j. coquantur  in Aq.
 Fabror. vel Calcis liv. ad medietatem Ad-
 dend, fub fin. Alum. roch.  9ij. S. V. §iv.
 F. lotus.
   Et mutters Fomentation.  %.  Stercor.
 ovilis q. v. Coque in laBe Vaccin. q. s* et
 Cola.  Valet  (fays  Fuller) cum  Inteftin.
 flatu diflentum,  aut indiiratis fecibus
 InfarBum vix reduci potefl.
    V.  Fol. Verbafci A\the  Flor. Cham.
 rofar. rub. a. |ij. farina fab arum, Or obi.
 fem.  Dauci. Cymini Carui  a. ^j* Bacc.
 Juniper, lauri a. §if. Summit. Rute Ori-
 gan, a. M). F. omnium Pulvis,&cum li-
 xivlo & vino rubro F. Cataplafma.
     X.  Empl. Diachyl  cum  G. ad Stru-
 mas Cymini a. §j. liquatis adde Tere-
                                  binth. 
               f a6)
binth. Cypri. \L 01. Hiper. 31J. Pul Rad.
Iridis 31J. Argent, viv. Axung. Porcin.
a. §f. M. F. Empl Scroto Adultorum Ap-
plicandum.
   It is always fuppofed after the Ufe of
Fomentations, a Stupe wrung from it, an
Emplaifter or  a Cataplafm  be retained
on with a  warm  Bag-Trufs, and the
Perfon recommended  to a quiet Pofition
and  Regularity of  Life.
   Inwardly,  V. Aft. Carminat.  vel Cha-
mem. Com. §vj. Sp. Cymini  * §if. Juni-
per.  §iv. EJJent. Cort. Aurant. Citri.  a
3J. Effent. Opii B]. 01.  Puleg. gutt xij.
M. hujus detur |if. in Vehiculo P. valet
etiam in  Paffwne  Colica, Hyjlerica, &
torminis Inteflinorum.
   Hernia Aquofa.  The Hernia Aquofa
js an hydropical Tumor,  poflefling  or
contained  between the Membranes  of
the Scrotum or Tefticle,  or  both j gene-
rally Anafarcous,  i.  e. bred ab extra,
from a Poverty of the  Blood, whence
its Compages is loofe and watry, emit-
ing this Serofity on a Part weakned  per-
haps by fome precedent Irregularities j
And that  it  is thus,  and  not from any
lapfe of Water out of one Cavity in the
other, is plain from our Obfervations  on
afcitical  People j  who, altho* the Tu-
                                 mors 
               ( *7 )
mors  be very  large, yet if the inner
Membrane  of  the  Peritoneum  conti-
nues whole,, lets not any water  down-
wards :  And  alfo that this Tumor  fre-
quently  arifes  here, when no Part of
the Body elfe appears hydropical.
   The beginning Tumor, and in  young
People,   is  very likely  to  refolve  and
diflipate, wi^h Bleeding,  Purges,  a Bag-
Trufs, an afliduous Ufe of difcutient Fo-
mentations and Cataplafms, and  a good
Regimen,  »
   The  Fomentation  may  be made ex
floribus Balaufi.  Rofar.  nuces  Guprefs,
SCc or   R.  Sem. Cymini  Anif.  a. jij.
Alum. roch. 9j. Cort. Querc. Gran at.  a.
"z^.'Coq. in vin.  rub. & Aq. Fabror a  lb IS.
Fiat Fotus ope Pannorum applicand.
   The  Cataplafm,  ex farinis Hord. fa-
bar,  &c. or R. Fol. Hyofciam.  Cicute
fol. Malv&FIor. Cham. a. Mj. Rad.  Bry-
on.  lillior. a. §iv. fern, lini fenugrec. a.
5ij. coquantur  in brodio ex Capite ovinis
F. Fotus.
   Ex Fecibus Fiat Cataplafma cum Me-
 dul  Panis  triticum  Mell  Commun. &
 Axung.
   Or inftead of thefe, the Prefcripts un-
 der the Head  of Hernia Vent of a.
Cataph- 
               (rt)
   Cataplafms  I take it, arc moft effedu-
al for  refolving* thefe incipient Tumors,
becaufe the Membrana  adipofa,  being
wanting in Scroto, the Coldnefs of  the
Part is a fufficient Check to DiiTipation,
nor can that Impediment  be overcome
by Application  lefs  retentive,  or  lefs
communicable of Heat than they are.
   They  will ft ill be of greater Eftima-
tion in the  increafed Tumor,  when-
ever it fhall be thought neceflary to give
a Vent by Blitter, or  a fuperficial  Sea-
ton, efpecially the lafi, (which is urged
as a preferable Pradice, when the Hypo-
gajlrium is Anafarcous, becaufe the co-
pious Difcharge it  makes,  keeps  off a
Load from the vital  Parts \ ) for open-
ning fuch cold Tumors, and in fuch cold
membranous Parts, will ever give great
jealou fy  of  an  Extindion of  Heat,
which  no Applications whatever are more
likely to conferve than Cataplafms.
   But when the Tumor is fo increafed,
as to want  external  Operation to dif-
charge the Contents of it, Incifion by
Lancet or Knife is the common and  ap-
proved Pradice-,  Caufticks are  lefs  eli-
gible, becaufe as I obferved, the  fatty
Membrane is wanting.
The 
               (  *9 )
  The  Pre-requiftes to this  may be.
Firft, in refped to time,  that is, prope-
rett for Apertion in  Adults, when the
Tumor is  judged to  contain upwards of
a Pint of Water,  lefs may make yon
fearful  of hurting  the Tetticle j and
a very large Quantity (for I have heard
of feven Pints and more being let out in
a Day) hazards  more  eminently  the
Mortification,  by  the Lapfe and grea-
ter  Flacidity of the Membranes on  its
difcharge.   Secondly, It may be  obfer-
ved, that  one Pundure is fufficientwhen
the Water is  without the Tetticle,  or
contained  in  a Cyttis \  but  a double
opening will be required, fliould there
be any  Water contained within the Tu-
nica Vaginalis of each.   Thirdly, You
are immediately after Apertion, to thruft
in the Canula, for when the Scrotum is
as yet diftended, the Membranes  com-
pofing it,  anfwer  to one  another  in the
Orifice,  which will not fo  eafily  be
when flagged, nor fo promotive of the
Difcharge;  Fourthly, It may be consi-
dered,  that if a Flux  of Blood  fhould
happen,  from  wounding  fome   fmall
Veffels in  the Pundure,   the  Canula
fhould  be withdrawn,  and Comprefles
fpread  (to  reftrain it)  with  wheatea
                                 Meal 
               ( 30)
 Meal  beat up with the  whites of Eggs:
 But herein be not too credulous, for a very
 fmall matter of  red, gives Tindure  to
 the Serum in this Operation.   Lattly,
 chufe  a depending  Part,  (not  on the
 Seam,) and then tteddying the whole,
 thruft your Lancet in,  and make an
 Orifice of a fit Capacity to receive the
 Canula,  which  ought  immediately to
 follow, and  be continued  there untill
 the  Water is all  drawn off} moft con-
 veniently done at  once, unlefs the Quan-
 tity be very large,  and  the  Patient in
 any weak or ill Plight of  Health} and
 then it is better at two  or three Times
 in the  fame Day.
   The Drefling need be no more than a
 Pledgit  fpread with  fome  Digeftive,  an
 Empl. ebolo, aCattiplafm exfarinis, and
 a  Bag-Trufs, fomenting at each fubfe-
 quent Drefling.   The Orifice foon heals,
 and  then  it would be neceflary  to ■ add
 a  Purge  or two, and prefcribe a  dry
 Dieting and  Courfe  of Ba th-Waters j
 for even under the moft cautionary Me-
 thods,  they frequently fill again  in a
 Year or two.
   Fabric ins Hilda mis, on this Head fays,
the Hernia Aquofa is fometimes Com-
plicate,  i. e. fometimes the  Inteflines,
                                 and 
              (v  )
and  fometime a  Sarcocele  intermixes :
Flefh growing  and hardening  through
want of Heat to  the Tefticles, and their
Tunicles to  a  great  Bignefs^  advifing
from the cancerous Nature  of thefe lat-
ter Tumors to extirpate, unlefs the Root
extend to the  Procefs,  or  is communica-
ble with any Part of the Abdomen, which
then to do, he fays, would be  mortal j
and  gives an  Inftance wherein he at-
tempted by Incifion to difcharge the Se-
riofities in the  diftended  Scrotum,  of
fuch a  complicate Sarcocele, and the Con-
fequence was an Increafe of the Pain,
Inflamation,  and cancerous Malignity.
His  Advice is not fo judicious in ano-
ther Place, where he talks of long thick
Tents, and continued for the Space of
two  Months in one of thefe watry Tu-
mors he had  opened, contained within
the tunica Erythroides.
   The  two other  Tumors  peculiar
to  the  Scrotum,   are   the Sarcocele,
or Hernia Camofa,  and the  Circocele
or  Hernia  Varicofa,  of fome Affinity
alfo, as having probably the fame Ori-
g:nal,  but  I  fliall  choofe  to diftinguifh
them  (as  they fometimes  may be) by,
the  one  being  a gelatinous   Humor
                                   or 
               (  3* )
 or Fungus,  that  overfpreadfc  the  Tetti-
 cle,  and commonly  takes its Rife from
 fome external  Bruife:, the  other  a Di-
 ttention of the feminal Velfels, and as
 commonly arifes from the indifcreet flop-
 ping of a virulent  Gonorrhea.
   Prcgnoflkk.   In the Beginning they
 are both  curable,  the former by difcuti-
 ent Fomentations.  Riverius fays, he cu-
 red one to the Bignefs of his Head, with
 thefollowing Cataplafm. R. Farin. Hord.
 et fdbar. fern.  Cimini for. Cham.  Meli-
 lit. & rofar.  Pul. cum Oxymel coquantur
 ad Cataplafma.   The other term'd at
 firft,  Hernia Venerea, frequently  refol-
 ves,  by forcing the Running again thro'
 the Penis,  or  at  leaft by Salivation :
 But as Negligence in the Patient, or want
 of Skill  in  the Surgeon,  may lofe the
 Opportunities  of   retreiving  Miftakes,
 this  Tumor frequently hardens into the
 Nature of a Scirrhus, uneven, under very
 imperfeB Degrees  of Senfation, and is
 then the confirmed and trite  Sarcocele,
incurable, and  admitting  only of  fuch
 palliative chyrurgical Help, as will con-
duce to mitigate Uneafynefs,  hinder the
farther Growth, or qualify other  unto-
ward Circumftances to the Patient's Con-
veniency, as may from time to time occur.
                                   In 
        ....   :W.)
   In the Circocele,"/we repeat Bleeding,
 gentle  Purges, emollient  Embrocations
 and Fomentations, a warm Stupe wrung
 out of  Sp. Vinu.ot an Emplaifter.
   fy.Emp.Vigdniscum%ioquadrtiplo^\].
 Diachyt.  Ire at.  §ii j .Gum.  Amnion iacwn
 folut.  in fuccis Hyofciam.  & Cicute §j«
 Pul fubtilis rad. Scrpphulflr. Gladiol. a.
 §f.  Camphbr.  jj. 01.  Catellor.' q. s. F*
 Emp. Continuo Gejlandam cumfafcia.
   Internally medicated Ales from Sajfa-
 phras,  Sarfap. Scrophular. Salvia, Men*
 thd, Lig. Juniper. Guaicum, China, %an-
 tal  and the like,  giving every Morning
 Pul  rad  Ononid.  7f\. In  hauflo  vini
 Amdri.
   If the Tumor  doth not tend to Sup-
 puration,  Chalybeats, Mercurials, Mine-
 ral Waters, and the following Suffitus may
 contribute towards the Difperfion  and
 Waft of it.
   R. Thuris Majlich. Sandarach. a. |j.
 Colophon |ij. Styrac. Calam. Benzoin a.
 §f. Camphor. 3J. Cinnabar. §if. Antimon.
 Crud. ^iij. F. Alcohol. & cum tereb.  q s.
fiant Trcchifci  pondere 31 j. vel^hjfumus
 excipiatur in fella perforata bis indie Ca*
 vendo ne quid exhalet.
   But the longer the Sarcocele has con-
 tinued,  the  unfafer it will be to make
                  D            tryal 
tryal of other than the mildeff Pallia-
tives, left we redintigrate the Diforders
that firft gave Rife to it ^ for if Pain and
a new Fluxion fliould feize the Part,  it
almoft infallibly  Mortifies  •,  and  then
nothing remains but Extirpation, which
cannot have the defired Succefs, if the
Tumor have any Communication  with
the Parts within the Abdomen.
  To  Perform the  Operation,  you are
to make Incifion to  the Tumor, and ex-
tend it above the affeded Tefticle,  that
fo a Needle  with ftrong Thread may be
pafs'd  conveniently  through the Procefs,
a firft and  fecond  Time for Ligation :
When clearing the Tefticle from the Scro-
tum,  you may bring that  and the part
of the Procefs without the Ligature  a-
way, leaving the Ends of the Thread out
to digeft off: The Drefling  may  be  an
Egg or two, beat up  with Rofe-Water,
a thick Comprefs  fpread with Cataplafm,
and a  proper Bandage.
   I  fhould  take no farther Notice  of the
Circocele, whofe  curative Intentions are
equally comprehended in the former,
 only  for this Peculiarity   by  fome that
 they are what Varices are  in other Parts
 of the Body j a Difiention  of the Vejfels
from feculent Blood, and  propofe  Inci-
                                  fion 
               (35>.
(ion Ligatures,  and operiihg the varicoug
Veffel as in other placed, ft aliqud vafd
teftem Nutrientia Fuerint faBa Varied*
fa, eafolum modo refecdnda & Stpeton-
da tene repofitq, <3ec   I  am obliged to
take Notice, that the  Method may be
eafy and fuccefsftil in the  Scrotum j but
if the Circocele  be allowed to  be a Tu*
mor affeding the feminal Veffels, (which
it ought,) then  it  canflot  be done with-;
out the greateft Danger,  at  leaft  fuch
Attempt muft  prove of  worfe Portent
and Confequence, than the refting  far*
tisfied with Palliatives.
  Uteri & Ant Prolapfus.  On a Chap**
tare  of Ruptures •, I could not pafs hf
thofe  of the Uterus and Retlum, which
I think may more properly  be impu-
ted Herme,  than  either of the four lafi
Tumors,
  The  Prolapfus Uteri, take their Rife
from  hard  Labour, Indifcretion  of a
Midwife,  or Weaknefs of the Woman^
from an immoderate Flux of the Menfe^si
Humidity, relaxing the Parts,  or laftly,
from rough Handling j but in all  thefe
Cafes, the Hurt may extend  no farther
jhari the inner Membrane of the Vagina;
what is eommonly reputed a  facing of 
              (  36  )
the Womb:, being  nothing more than a
Relaxation and  Extention of that Mem-
brane^, •* •  ^   • v>.
 ..  In orderjtf redudion and cure. Bleed
and  empty the .Bladder,, and Ini'ifiinwt)
reBum  by a  Gjifter^ then Place  the
Patient.on her Back,  with the Hips  rai-
led, as in other Ruptures^  and with warm
Cloiths,. or Stupes out of warm Wine
and Water, (or other Fomentation,) en-
deavour by gentle Preflings to reftore it ^
if too  deep  for, your Fingers, it  may
not be  amifs to rufe a Stick armed with
 Linnen, of a proper Size.
   When  the Womb is replaced, nothing
 better contributes to the Retention of it,
and recovering the Laxity of the Parts,
than keeping the Woman in Bed on her
 Back (if pofliblej and  quiet, her Legs
 a-crofs and raifed:  And when a Flowing
 of the Lochia  ox  Menfes  inhibit not
 the  following  aflringent Injection, and
 a Spunge wrung out of the fame, to keep
 in uteri Vagina.
   R.  Rad. torment ill.  cort. Querc. a.
 §f. Abfynth. Salvia Mentha a.Miij. Flo-
 res Rofar. balaufiior. a.  Mj. Alum. ufl.
 Sulphur, a pj. Coque in Aq. Fabror. Cong*
 Colatura adde Vini Clareti tbij.
If 
  If thefe Tumors have been of confl-
derable flanding,  and- through the Indif-
pofition  and Weaknefs- of the  Woman
eafily apt to prolapfey flie then requires
to be put under a Courfeof Dscofi.-Gua-
ici  Sarfa,&c.  and  to adhefe to a long
continued Ufe of a Peflary.
  Fabricius Hildanur  orders them  of
Cork, ovaUy or fphaerically maped^ and
to be  fpread with the following* -i
  R. Cera nova §iij. Colopbon.&.'Elem.
a. 5j. Tereb. |iv.  Pul. rofdr. r. Myriillor:
Balaufi. R.ad<  Confolid.Maj.'al-^yMa-
ftich. Glib an. a. §f. Mifceantur cum Oleo
rofar* q s. F. ceratum.
  Or R. Fol.  Plantag. folic. -Mefpilor.
querc. pmnor. jilvefir. fummiP ri&Pr&fdrv
a Mj. Rad tormentill.  biflort. fymphit. a.
%j.  Balaufi. nuces Cuprefs. a. ^Lfem. anifi
§if. incidantur  & contundantur  omnia
craffo mo do pro Sacculo intertexto.
   Procidentia Ani.  A Prolapfus Ani,  is
what we meet with frequently,  and  is
more troublefome  than  dangerous;  it
proceeds from  hard Straining at  Stool,
Laxity of the Sphincter, from too much
Serofity in the inteftinal  Glands, from
Fluxes of  the  Bowels, where the Acri-
mony as well as Moifture  difpofes  to-
                 D 3            wards 
               (  3»)
wards it, andoftentimeitisa Confequefcce
of the Hamorrboids.
  Prognoftifk.  The longer the Inteftine
has  been  down, the lefs  able  it is to
contract, (or  be reduced,) the  external
Gold weakening that Property, and tu-
mefying the  rugous  Coat of  the  Inte-
ftine, then thruft outwards-
  Redu^ion may be obtained after  the
fame Manner as the Uteius, viz,, by a
QyfUr, warm Stupes, or Spunges wrung
out of an aftringent fomentation, Forge-
Water, or Qare^ heated j  but when the
Gaufe is from a Diarrhaa, a Dyfenteria,
or the Hamorrhoids,  refped muft be hac]
tp thofe Diftempers,  before thefe  exter-
nal  Means can effectually prevail.
CHAP. 
( 39 )
         CHAP.  II.

   Fractures of the Skull.

       fHE Fradures of the Skull are,
        perhaps, more abftrufely han-
        ded to us byAuthorsftfTan any
        other Part of Surgery; all who
have  hitherto  writ on them, have ra-
ther  perplexed  than removed the Diffi-
culties to their  right Underttanding and
Management:  They have multiplied  a
Parcel of infignificant Terms and Names,
without any Ideas annexed to them, and
faifly deduced the Symptoms appropriate,
and  Necefiity of the Operation fubfe-
quent thereto.   This  I mall endeavour
more fully  to explain in the Sequel, and
fubftitute a Reafoning and Method more
adequate to Truth and Pradice.
   Sorts.  Ancient Authors have reckon'd
up, or rather divided, thefe Fradures in-
to a  Multitude of Sorts, diftinguifhed by
proper Names, which, M. Dionis fays, he
has reduced to twelve,  and  thofe again
                 D 4           into 
              (^)
into three, to wit, Inciftons, Cracks and
Contufwns-^ of thefe the former have more
ordinarily the Procefs of Woundsy and
unlefs by the latter be meant t>eprejfions,
it is an  unintelligible Term,  and there-
fore 1  chufe to make my own Divifion,

   A FraBure  or Fiffure, a Contra-Fra-
Bure or Fiffure,  and a Deprejfwn, Names
which carry their own ExplanatiG££ and
comprehend every Sort, which, ^s.'they
ttand  further diftinguifhed, exprefs mote
a Variety of Caufe then any thing elfe,
and are an unedifying "Amufement.
   Of thefe  the Conird-FraBure, or Fif-
fure,  is fomething particular, being op-
pofite to that Part  of the Skull the Blow
was received, and is fuppofed to happen
from  a Concufiion of that fmall Portion
of Air contained within fide \ where the
Force of the Blow driving, and the Su-
tures  being very clofe it flies to the op^
pofite, and meeting Refiftance there, oc-
cafions the Fradure.  What may come
under this. Denomination alfo,  is when
the fecond Table  is broke,  the  firft re-
maining whole *, a Cafe that may happen,
and to which the fecond Example at the
End of; this Chapter has fome- Refem-
bknee,
                               Cdufes* 
              C  4»  )
  Caufes. The Caufes of Fractures are,
any great Blows or Falls.  The Convexi-
ty of the Skull is an additional Strength
againft them, becaufe the Preffure in fuch
Strokes declines towards the Cohefion of
its Parts, but ftill not fufficient to over-
come every Violence.
   Signs.  The Signs of a fradured Skull
muft be, feparated into thofe that imme-,
diately happen, and fuch as fucceed not
till after a Time: Thofe that immediate-
ly happen are either evident to Senfe, or
are deduced from Reafon :, it is evident to
the  Senfe when  the  Largenefs  of the
Wound makes the Fradure vifible, or  is
fufficient for a Difcovery by the Finger:
or Probe, or when without a Wound, the
 Depreflion is plainly felt. All other Signs
 accompanying them are Dedudions from
 Reafon, and  are taken  (when the Scalp
 is  entire, and thofe Demonstrations  of
 Sight and Touch wanting) from a Com-
 parifon between the  Circumttances  of
 receiving  the Hurt, and  the Symptoms
 conjundly.
    The Signs that apply to our Reafon, are
 Vomiting, a Dizzinefs,  and Bleeding  at
 the Nofe or Ears, and more violent are,
 when (with them) the Patient alfo lies
 fenflefs, ftupid and  fpeechlefs j  all,-  or
                                  fome 
                (V)
  fome of thefe follow a Fradure imme-
  diately, and the Meafure of a good or
  bad  Prognoftick  is taken  according to
  their Degree, and Time they continue.
    Tttofe that arrive not till after a Time
  are,  Firtt, The Patients  feeling a Pain
  on biting any hard Body, and perhaps an
  often reaching of his Hand to the afflid-
  ed Part.  Secondly, When a Dulnefs of
  Memory and Underftanding, or a Coma
  follows.  And  lattly,  when  Fevers,
  Deliriums, Convulfions or Palfy, which
  do often unhappily fucceed, and are the
  Fore-runners of Death.
    It is with the firft Order of Symptoms,
  viz.  Thofe  which prefently appear on
  the Hurt,  that I am at  prefent concerned
  to examine,  and what I am able to fay
  on them, in reference to  the Progno-
  fticks and Cure, I fhall deliver by Way
  of Anfwer to the following Queftions.
    Firft, That fince the Signs  enumera-
  ted will equally appear in  a Concuflion,
  whether it be or be not attended with a
  Fradure •, how fhall it be known when
  they are the Indications of fuch an Acci-
dent  and when not >
    Secondly, Why a Concuflion attended
  with  thofe Symptoms fliould not require
  the Terebra  as much as a  Fradure > In
                               anfwer 
               t 43  )
anfwer to the firft of them j thp' it  be
true, that the fame Symptoms happens in a
Concuflion with or without a Fradure j
aqd that there is no certainty of arguing
from one to the other \ yet if on examin-
ing and comparing the Blow and Symp-
toms, they are fcverally found great and
violent: It is incumbent  on us to dilate
the Wound for furer Information •, and
tnis when we do, fhould be rather by a
crofs Jncitipn, than any other, becaufe if
right in the Cpnjedure, it can with faci-
lity be ftretched to where the Fradure
tends, or if not, it is a Wound (of any
that are propofed for this  Purpofe)  the
moft eafily re-united.
   To the latter  Queftion, viz. Why a
Concuflion  under  the  fame Symptoms,
with a  Fradure  does  not equally re-
 quire the Operation of the Trepan ? We
 cannot refolve or determine our felves in,
 as to any particular Cafe, better than by
 confulting what is propofed by the Opera-
 tion } the Reafons for,  and the Objedi-
 ons againft it.
  1 The chief Defign of this Operation, is
 faid to be be  for  difcharging Blood or
 Matter extravafated  between the inner
 Superficies of the Skull and Dura Mater,
 the Retention  of which would  occafion
 lli                               thefe 
              ( H  )
thefe Symptoms we have  afore  recited,
fphacelate the Brain, and kill the Patient.
  Now this being the Foundation on
which  the Operation  of  the Trepan is
grounded,  the Truth  of  it fhould _ me-
thinks be better eftablifhed to vindicate '
that  Pradice  in  every Fradure  of the
Skull, then to me it is.
  For firft, That fuch an Extravafation
is  there, or  does inevitably follow on
a Fradure, I cannot from my own Ex-
perience fo  conftantly affent to: I have
met with fuch a Cafe once,  but it was
from a Laceration of the Membrane, and
mortal j but  from  others that has  hap-
pened under  my Care,  (and,_ nigh the
Sutures too,) lam convinced fuch Extra-
vafation between  the  Skull  and Mem-
brane, is  feldom the Confequence of a
Fradure :  And  if  fo,  then  whatever
may be, fa id  in Defence of it, when to
relieve the  Membrane fo opprefs'd \ yet
here (which will be the greater Part of Fra-
dures) thealledg'd Neceflity of the Ope-
ration  ceafes, at leaft it proves  in fuch
of ripSignificancy to their Amendment.
   Secondly,  If an  Extravafation muft
follow  both  on a Concuflion  and a Fra-
 cture,  (as from  equal Symptoms,  we
 have ecpal Reafon to fuppofe,) then therie
                                 feems 
               (45;
feems a greater  Neceflity for the Ope-
ration  in the former,  than the  latter,
tho' not pradiced, becaufe the latter may
poflfibly now and then  be large  enough
for  the  Tranfmiflion  of fuch extrava-
fated Blood,  and anfwer the End of a
Perforation-,  whereas in a  Concuflion
without a Fradure, we are  fure it muft
be fatally confined.^
   Thirdly, Such Extravafation muft hap-
pen either from the Skull lacerating the
Dura Mater ab extra, or an Eruption
 thro' it ab intra, which considering the
 Toughnefs of that Membrane, the Stroke
 fhould be mortal that effeds it.
   Fourthly, It is difficult to conceive
 after allowing fuch an Extravafation how
 it will! account (abftradly  considered)
 either for immediate or fubfequent Symp-
 toms.
    And lastly,  I would be refolved of
 this Extravafation,  whether it of Necef-
 fity muft lay near the Fradure ? Or not
 fometimes in a diftant Part? Or that if
 at firft it were nigh,  yet while it conti-
 nues  fluid, it may  not  fettle farther, es-
 pecially to  Parts depending? And  how
 when  it is coagulated at  a Diftance,
 the Operation conduces to its Difcharge? 
For the reconciling of thefe preliminary
Queries,  will be  always  rieceflary to
juftify the Operation.
   I have only started the Objections, and
fhall leave their Removal to others more
opiniated, of the Neceflity of the Opera-
tion in all FradureSj than  my felf, and
proceed now to explain my own Noti-
ons about the Original and Caufe of thefe
Symptoms, with  a Method more fi/ita-
ble to their  Relief.
   Thei' Symptoms fradured Skulls are
incident  to,  whether immediate  or at
Distance, do not proceed frdrri Fradures
feparately considered, but from the Cort-»
cuflion  made at the fame  time  in the
Brain, by the Blow that occasioned them \
for the  Subftance of the Brain being a
Congeries of Veifels of  foft and fine
Texture, the  violence  that  can break
fo folid a Bone as the Skull, (that con-
tains  it,)   muft  indifputably rupture
fome of thofe Capillaries,  and  caufe an
Extravafation  within, at  the  Fountain
of Irradiation and Efflux of the Spirits *,
whence  in the Beginning  comes Vomi-
ting,  bleeding at the Nofe and  Ears,
Stupidity and Speechleflhefs ^ and whence
in further Procefs pf Time, if happy and
                               proper 
              f  47;
proper Means be mifs'd of relief,  com$9
Comas, Senfleflhefs, Lethargies, Deliri-
ums, Palfies, and  Convulsions:  For as
the Original of a Nerve or Nerves, hap-
pen  to be divided, obumbrated, or af-
feded with any Heterogeneity of Particles,
it is an undeniable Confequence -,  the  -
different Senfe or Adions  they ferve to,
muft fuffer and fail, or be involuntarily
and  preter-naturally exerted.
   Mr. Turners remarkable Cafe confirms
a  great Part of what I  have advanced \
he fays, that although the Depreflion in
that fradured Skull he  was cajfd  to,
made a Cavity  that  would almoft hold
two Ounces of  Liquor,  (which muft
needs have made a prodigious Stretch on
the  Dura  Mater,") yet  that  the  Mem-
brane appeared fair after  the Operation.
Further  he fays,  that about the tenth
Day from receiving the  hurt, he per-
ceived a greater Difcharge on the Row-
Jer  and  Drefling than could be exped-
ed,  and upon fearch found a foetid Mat-
ter erupting thro' the Dura Mater, from
the  Subftance  of  the  Brain.   Lastly,
the Patient lived from Feb.  to May, dis-
charging  more or lefs of this Matter^
without any Symptoms  of  very ill bo-
ding Prognoftick, till two pr three Days
                                before 
              V  4§ )
'before  his Death, and  then was feized
 with Convulfions.
   The Learned align the Caufe  of Con-
 vulfions to an Admixtion  or  Meeting
"of» Particles incongruous and difagreea-
 ble  to the Nerves  and nervous Fluid:
 This Incongruity as fome  Caufes exift,
 (efpecially PoifOn,) lie in fuch Particles,
 bemg fharp pointed and vellicating, (bear-
 ing fome refemblance to thofe  external
 Instruments which more certainly'effed
 it by pricking on1 them,) and feldom in
 Repletion or  Exinanition,  particularly
 as to thefe which fucceed Fradures of
 the Skull: We find  that Convulfions do
 not immediately feize, but after a Time,
 when it may be fuppofed the extra vaca-
 ted Blood has attained fuch an Hetero-
geneity.
   They  do likewife afcribe Apoplexies
 and Paifies to  fuch an Effufion and E-
 clipfe of the Spirits,  tho* thot external
 Force which advantages, the Argument
 here be wanting.
   From  the whole therefore, I would
 make this Dedudion j that if rise Dulnefs.
 Slumberings and Stupidity, often feen at
receiving  Fradures, approach in  their
Mature  and immediate  Caufe^nish to-
 that of an Apoplexy,  (^witWtnTJ
                          A     Men- 
Meninges) aosbsa Evh'jHnftiimi.-adLhr
tan ^  then like that  it is reafonable to
conclude,  Revulfions  will contribute
more  to  the  Cure,   than  the Opera-
tion of the Trepan can: and what con-
firms  me  in this Senfe is,  that I  have
known  both Fradures and  Concuflions
(more efpecially the latter) to have  been
relieved and recovered  without Trepan-
ning, and that by large Bleeding, Enemas,
Purges, Fontanels, and nervous Admi-
nistrations,  and fometimes   the natural
Paflages by the Nofe and Palate aflift to
this Purpofe ^  much more likely fo to do
when both Cold  and Air  is  excluded,
which all allow  to  be inimical to the
Membranes and Brain.
   Though not one in five of thefe Fra-
dures call in  my Opinion for the  Ope-
ration ', yet there are  fome Circumstan-
ces that may make it more defensible at
one Time than another.
   Any extraneous Body flicking fa ft in
the Bone, or  a Depre/pon,  whether of
one or feveral Pieces j the former can-
not be removed,  nor  the  latter  eleva-
 ted (its faid)  without it: And befides, if
 at any Time an E#ravafation may be ex-
 peded,  it  is  moft  probably when the
 Bone preffes on the Dura Mater $ and,
                 E                yet 
               ( 5°  )
yet even here, unlefs a Man could for-
fake his Sight and Reafon for Authority,
there arifes fome infuperable Difficulties
in an immediate Elevating any depreffed
Part of the Skull.
   Firft, The depreffed  Part commonly
remains  firmly  Contiguous with the
whole, and being Solid will (like Iron or
other hard malleable Bodies) require as
much  Force to  ftraiten as  bent it j be-
sides in restoring to a Sphaericity we are
narrowing the Diameter, which  confe-
quently augments the Difficulty.
   Secondly, The Elevator  it is  attemp-
ted with, muft be of fine Make,  or  it
will not be fo fafely introduced between
the inner Lamina and Dura Mater\ and
the finer the Inftrument, the lefs Force
can be ufed j or  if more could,  there  is
ftill left a greater Obstacle to contend
with •, for  the  Diploe, which divides the
Lamina of  the Skull, will  intercept
and hinder any effed of it  on the out-
ward Table,
   The Tirefond  (if any Thing)  to fix
externally, feems fittest to anfwer the
End propofed; but if every way be thus
perplexed  with  Difficulty to elevation,
it may be asked  to what Purpofe  is the
Skull traphined  at all, either when any
                                extra- 
extraneous Body  ftrikes there, or when
deprefs'd?  Why  in the  firft Cafe  the
Body may be fo fixed  as  to be paft  any
other  Method  of removal:  And  in a
Depreflion, there is Danger of Extravafa*
tion  and Accelerating of fatal  Symp-
toms,  judged  of by  the Depth .and
bearing the Bone makes  on  the Dura
Mater j  in the firft  Cafe it is  visibly
wanted, and in the latter I believe it
will be thought no ill Pradice to repeat
the Operation  of the Traphine, until
the whole deprefs'd or central Parts  are
removed, as more interminating  of JVJif*
chief.
            The  Operation*
  The  Operation when  undertaken, is
direded to be near the Fradure, in  on
der to raife any Part of the Bone depreift
ed, depending, for the more  favourable
Pifcharge of what is extravafated ; Jn 4
clofe  Place, and  by Candle Light,  Air
according to the Aphorifm, being an Ene»-
my to the Brain and Bone: Quickly alfo,
becaufe procraftinating i* dangerous, and
not on or nigh the  Temples or Sutures,
  The Nignt before the Operation,  we
are to make our Way clear to  the SK^U,
by extending either Line of that cipft
                   E 3       brcifcm, 
               ( 5». )
Incifion, ^(fuppofed to have been made
at firft,) and feparating entirely one or
j^preof the Angles as fhall be thought
jequifite to anfwer the Purpofe before us.
   It is ufual to flop the Ears with Cot-
ton, for preventing ■ an  ungrateful Sen-
fation, and then fmearing  the Crown of
t)ie Tre pan with Oyl, for its easier Mo-
tion,  apply  it firft.on the Skull,  with
the Pyramid or Pjn in, till an Impref-
fion be -fnade,  and then  leave it out j
lean hard 911 the Top with  the left Hand,
and turn round  with the other.
   The Trepan in the Beginning is beft for
difpatch and fixing the Crown, but theTra-
phine is fafeft to conclude the Operation
with, becaufe. the Manubrium in this lat-
ter is fixed, and, moved,  from right to
left,^ndfo back again at half Turns j the
conveniency of which, for finifhiiig be-
yond .the other is, that we have a grea-
ter Command of the Inftrument, and as
tr^e Perforation  is found nearer through
in one  Part than  anotherj  we can ac-
cordingly bear more on the thickest Side
to bring it  to an equality,  and the fur-
ther we advance, the more  this Care will
be wanting, left the Inftrument at the
End of the Operation ttioqld break thro'
and...touch the D:rmMater, (which,  if
                                 not 
              (  53,)
not Contiguous,  yet swells hy the  Pul-
fation of the Brain, clofe to the: inner
Superficies of the Skull,) or elfe,  least
it break  off fome  Particles  that might
prove equally Offensive.      ^ IU
  The  Teeth of the  Crown touching
the Membrane,   indeed  is "in-'a  great
Meafure^ guarded  againft, by the  Dia-
meter enlarging  upwards •, and thebeft
Caution we can take1 againft the latter, is,
to remove the  Instrument., frequently,
to clean  it and  the*x!Skull from Duft
with a little Feather-.Bruffi, and to fearch
the Depth of the Bote with a* Probe, that
fo the Surgeon may cut equally,' by be-^
ing informed at What  Point f to  prefs
hardeft.                    .  -^    :.
  Sometimes the Piece corner  out  en<-
tire,  and fometimes the  two Tables are
divided j this lhe~Operator will perceive,
and take away the" firft when loofe, be-
fore he proceeds  on, the other j and both
removed, the Perforation is to be smooth-
ed with  a'Lenticular, flipping "fi^ ah
unduous Sindoh,  (i. eY a Bit of fine Liti-
nen cut  round, and  rather larger  khan
the Perforation,) whofe Edges may fli<jfe
between the  Skull arid  Membrane, * to
catch the abraded Dust and Particles. ■t
                            -.*l;..;i  '1!
                  E 3           The 
   The Drefling  to the Membrane f af-
 ter  the Operation iscompleated) should
 be  a Sindon  dipped  in the following
 Mixture made warm, and before  intro-
 ducing fhould have a tingle Thread thro'
 the   Middle,  for the  eafiet  bringing
 it away.
   R.  Rezin.  Com. %t. 01. Rofar. jij. M.
 or Yk.Spt.Vin.  vel TinB. Myrrh. Mell.
 "Rofar, ana p. a.
   The Perforation muft be fitted with
 a Dpffil of dry Lint,  and the  whole
 Jnter-fpace of the bared Cranium with
 Others: To theWounded Scalp fomePied-
 gits  of a Digestive (N° 2$)  and over
 ali a good Comprefs,  and the Head Ban-
 dage.   The Head Bandage is a double
 Rowler, the Ends of unequal length, and
 feginning on the Fore-Head, you carry it
 Mind 2 with  the fiortefi End you pafs
 lackwards and forwards til the  whole
 Head is ccv:red, and the longefl conftanU
 ly going round bin Js at every Turn. Ovef
Jhis may be a woollen Cap.
   The Profecution of this Cure may re*
 quire fome Variation of Method, which
 I fhall  animadvert upon in a  Word or
 two, as it  may refped the Membrane or
 the Bone.
From 
              (  55  )
  From  the Membrane (Craffa meninx)
it muft be noted, an Incarnation or Sub-
ftance arifes that fills the  Perforation,
and does in time harden to a Callus •, It
begins to appear in about  a Fortnight,
and is at firft nothing but a Tranfudation
of Blood from the Capillaries difperfed
through  it, and may  be  furthered  or
hindered in too quick  a Growth, partly
as we drefs with the firft or laft of thofe
Receipts above:  How thisTranfudation
or Supply after trepanning, oomes from
a particular Part of the Membrane, when
the reft remains fmooth, feems to be the
wonted Comrjreflion of the Skull, being
taken off whereby the air Globules  cir-
culating with the Blood, fwell  the Ca-
pillaries, and  thruft out their Contents
here.
  The Bone being long expofed in thefe
Cures,  does  ufually  exfoliate j   but if
we  would not be wanting in our endea-
vouring  to prevent  it, then  we muft
rafp, and pierce the Cranium a  Line or
two (or to the Diploe) at feveral Places
with the  Pin of the  Trepan, and fo a
bloody Matter will exfudate, that  in a
little Time will cover the whole •, Dref-
fings afliftant  thereto,  may be  Pledgits
of  the following.
                  E  4          R.5/?. 
              C  56  )
  R.  Sfa Kin. in quo Pul. radic,  Arifto-
hch..wl iridis  Infufus. — & MeU  Ro-
far qfi                          p
  If an Exfoliation, cannot be avoided,
we may allow a Month  or five  Weeks
to perfed \t the thrufting it off then,, is
by a like flefliy Substance that arifes un-
derneath^ and  which  daily  encreafes
till the whole  Vacancy  be filled,;  and
make one .> uniform Figure with jthe reft
of the Ciypemn. w:
  , .When..a:new- Flefls -has  fpread  the
Membrane and Bone,  the greatest Dif-r
ficulty left to encounter will be preven-
ting its; Fungofity, either in the Hollow
or the Lips of the Wound.  The  beft
Means fo? this will be Evacuatipns, Diet-
ting aa<L externally dry Dreflings, filling
the Space fuch a Height as the Bandage
may  prefs  and refill sits  Growth \ or if
that avail not Efcharpticks*
   Laftly,  asthe Wound is filling,  we
fhould begin timely with our Deficcants,
and heal from the Edges, U. Diapom-
phol.  Tutia,  or Deficcat. Rub.  will do.
And  when the Cicatrix is compleat, it
remains  on us for fome Time  to defend
the Part.against  the  Injuries  of Cold4
Blows and other Accidents.
Firft 
              ( 57)
  Firft Example, Ab r.  Ma s c o ll.

  This and the two next  Obfervations
happen'd in the Engagement, under  that
great General Sir George  Rook,  Anno.
1703.   The  Wound : here was. large,
and  laid open the Fradure to fight on
the right fagittal Bone 5,  but  the Pa-
tient appeared  frightened and  mekn-
cholly  with'the Blow,  and would not
on any Reprefentation of  Danger, ad-
mit of the Operation,  tearing off the
Dreflings were made to his Wound,»for
feveral Days  together.
  His  Hands: were tied to  prevent  as
much as pofflble fo delirious  a Beha-
viour^ he  was blooded  every  Day for,
a Week,  fometimes in the Jugular, and-
fometimes  in the Arm or  Foot,  and
had a Fontanel cut inter Scapulas.
   Without any other Means the Wound
in a Month was contraded-to a fmall Com-
pafs, and the Dilirium off: But as it became
fecmingly healed, the Matter increafed up-
on us^ and having a foft  Tumor about it,
gave Reafon  to fufped  a Translation  of
Matter  from within, and of fore-bod-
ing very bad  Confequences,  but it  pro-
ved  only prascurfary of  an Exfoliation,
and in two or three Days having extra- 
                 r  5«)
   ded all the loofe Bone, the Matter lefTen-
   ed, &c.
     While I knew him, he continued trou-
   bled With a Giddinefs, Pain in his Head,
   and epileptick Fits (the latter  perhaps
   rather imputable to the Fright than Fra-
   dure.)

     Second Example, JohnUsher.

    THIS Perfon was ft ruck by a  fhort
  Splinter of Wood  in the fore Part of
  the Os Sincipitis, no Symptoms of a Fra-
  dure followed, but  to appearance as well
  as ever he had been in his Life.
    We dilated  the Wound, in order to
  extract this Splinter with a Forceps or
  other  Inftrument,  but finding  our En-
  deavours in vain, and not being able to
  judge  at what Depth it ftuck, or the
  Accident that  might enfue from leaving
  it any Time:  We  thought  proper next
  Day to apply the  Trepan,  and found
  an odd Circumftance after  the  Opera-
  tion j for the  firft  Table being remo-
  ved, the inner  appeared  depreiTed to a
  pretty large Circumference.
    The Operation was repeated  through
.  both   Lamina,  till  the  Splinter  was
                              brought 
               ( 59 )
brought away, and the deepeft Part of
the Depreflion j  we found  no Extrava-
fation, and dreffed the Membrane Per-
foration, &c.  in the Manner has been
already recited.
   Fourteen or fifteen Days pafs'd with-
out any  remarkable ill  Symptom, and
then the Patient was fuddenly feized with
a great Pain in his Head, foon followed
with  a Sopor, Stupidity  and Loofnefs;
I blooded him,  gave an eafy Purge  of
Pul. Rhabar. kept him to the white De-
codion, and  fome volatile Smells j  but
about  the twentieth  Day, he was far-
ther feized with a Palfey of his  Tongue
and   left  Arm,  and died  in  twenty
four Hours after.
   From the  former Inflance we fee the
Probability of Succefs without the  Ope-
ration,  tho  attended  with  Symptoms^
that are faid to indicate it.  And in this
how fallacious the Dependance  on it ist
tho* there feemed nothing to ftruggle with
more than a Skilful Management  and Di-
reBion of the Operation it felf.

    Third Example,  John Bull.

   WAS  of a large Fradure and De-
preflion by a  Splinter:  The  Wound
                                 was 
               ( 6o  )
 was immediately ftretclfd  with a crofs
 Incision,  and  next Day the  Operation
 performed.
   I paill-d the Elevator after  finifhing
 between  the Membrane and Skull, at-
 tempting to raife  the deprefs'd Part, but
 as much in vain,, as if  it had been laid
 under a Corner of St.  Paul's -y nor is it
 reafonable toexpedotherways, for if a
 depreffed • Part  has £o  firm a .Contiguity
 as to bear the Preflure of Trepanning,
 how abfurd muft it be to think of  rai-
 ling it by fo weak a Power.
   Finding my felf (not unexpedeqyy)
 difappointed,  and  that the  Depreflion
 rested fo  clofe  on  the Craffa  Meninx,
 that it was with fome violence the Sindon
 could be  thruft between,  I  refolved to
 take away with the  Trepan,  as  much of
 the Depreflion as  feemed to'interminate,
 and did at  three feveral Perforations more.
 On the  Dura Mater, immediately under
 rhe Depreflion  were  found  fome very
fmall Globulations of Blood.
  We  gave the ufual Dreflings  to  the
 Membrane and  Bone,  and in a Fortnight
found.thefe feveral Alterations,  thofe
little* Coagulations to maturate off-^  the
Dura Mater  to fpread with a ruddy
 Subfiance j The expo fed Part of the Skull
                                   to 
              (  6i  )
to grow difcolouredj and, after a tonget
Communication  with the Air  and Me-
dicine, came (to  thtbefi of my Remem-
brance') more flexible, and yielded (the
fmall remaining  depreffed Part) to ele-
vation : Whence 1 would J^^er -
when Exfoliation is inevitable,Ait is not
better  to aflift and forward the Molli-
fication of the Bone, by unduous  Ap-
plications?
   Our Bufinefs  in the Progrefs of the
 Cure, was to prevent too quick an In-
 creafe of Flefh,  and to wait for the Ex-
 foliation :  The firft we helped by dry
 Dreflings and a Compreflion,  the  latter
 Nature effeded in about thirty Days: A
 new Incarnation from beneath thrufting
 it off, and gradually filling the Vacuity.
   After Cure he continued the remainder
 of the Voyage, fubjed to Pain and Ver-
 tigo.
            Fourth Example.

    I WAS fent for  to advife  about  a
 Lad that had fell from the Main-Yard
 of  a Ship,  and who  was fuppofed  to
 have fradured  the  Skull,  he  having
 vomited,  bled  at  the  Nofe and  Ears,
 and befides lay fpeechlefs and infenfi-
 ble.   On the  fore  Part  near the frontal
                                Suture 
               (6.)
 Suture was  a fmall Wound,  the only
 hurt that could be perceived  thro* the
 whole  Scalp, which  was laid  open by
 a crofs Incision a considerable Length,
 and the Patient prepared by Bleeding,
 for the Operation.
   Not  difcovering the Fradure,  it was
 however omitted  fome Days,  untill  a
 Continuance  of the  Symptoms  made
 us apprehend the utmoft Danger,  and
 put us on the Performance to avoid Re-
 fledion the constant Attendant of Mifcar-
 riage and Omiflion, but found the Dura
 Mater clear of any Extravafation.
   Our  Drefling was a Sindon out of Sp.
 Vin. and Mell.  Rofar.  a little Ball of
 the fame to fill the Perforation', and all
 the reft of our Dreflings Doflils of dry
 Lint,  excepting  only a large  Pledget
 fpread  with  Liniment,  for  the  easier
 bringing them off: Comprefs and Bandage,
 # About a  Week after the Patient ha-
 ving been often obferved to lift his Hand
 towards the  hinder Part of  his Head:
 We found there on fearch, a Tumor with
Matter  colleded  in it, as appeared on
opening \ and what was  more  furpriz*
ing, a Fradure that gip'd wide enough
to pafs a Probe through, and ftretchinga
great Length  on the Os Occipitis; Here
                                 We 
we applied the Traphine  again, imagi-
ning with Reafon the Difcharge was ab
intra, and found fome Maturation then,
and  more next Day: That the Mem-
brane fhould be pundured, is plausible
and  prad cable, for the  Relief  of the
Brain,  which  thus  is   in., Danger  of
Sphacelation, but whether in the prefent
Cafe it could turn to any better Advan-
tage than the imperceptible Paffage that
Nature had already made, was a Que-
ftion ? We thought not, and omitted it \
fhaved the Head, blooded, and ufed fpi-
rituous Embrocations, and internally Car-
diacks.  He continued Speechlefsand ema-
ciating until the third Day, after the
laft Operation,  and died.

           Fifth Obfervation.

   A ConcuJJion of the Brain.  A young
 Lad ftanding in a Boat under the Bow of
a Ship,  a great Dog accrdently fell from
 out of  her,  and brought his Head and
 the Boat's Thwart togetherj he bled
 at the  Ears and Nofe,  and  kept  doing
 fo by Intervals for  twenty four  Hours ^
 fpeechlefs alfo  and  infenfible, yet  no
 Wound or Appearance of Hurt  through
 the whole Head,
                                I took 
               r  64)
   I took away §xij. of Blood immedi-
 ately, had the Head fhaved, and rubb'd
 his Temples and Nostrils with an equal
 Mixture of Sp. Lavend.  and  Sp. Sal.
 Vol. 01.
   The next Day I blooded him again,
 applied a large Vesicatory to  his Neck,
 and  made a contemperating Julap j  but
 this he conftantly  regurgitated  as often
 as he attempted to  fwallow.
   On the  third Day  I repeated Vene-
 fedion,  injeded  a stimulating Enema,
 and  towards Evening  he fpoke, which
 was  the firft Time from his  receiv-
 ing the Hurt.
   We daily after this found fome Pro-
 greflion in the Recovery, but the Stupi-
 dity wearing  off flowly, I cut him an
 Iffue, and left him to the Ufe of Errhines,
 and  have Reafon to think they were of
no fmall Benefit.
   I  could  instance  others,  but  they
bearing fo  great  a Similitude  both in
 Symptoms and Cure, with  this laft, it
 would be Prolixity to repeat.
CHAP. 
w
            CHAP.  II.

        Of Fragt^rej?.



 |f FfH pound, are fome of the commoneft
 fe^ffS £^/£j  p Surgery  (efpctally jn
 War,)  andyet theSiibjeB  hitherto  but
 trdnjientfy and infujficie?}tly handled, as
 though  not liable to any extraordinary
 Accidents,  or  required much  Skill in
 Pure.
   If he following incidental Remarks arq
 <lefignea for fupplying this Deficiency, and
 pook their Rffe from that excellent Order
 in the Navy,  of fiurgeons keeping Jour-
 nals of $heir Practice j  ai\ Order'rha^
f$$tfle(( at fir (I defigned to give Preference
fo Mgns £htalifications, but at prejent has
 fio efh?? View in it (either, by the Phyfl-
 ffan pr the ffalf)  than retaining fome fit~
 tie and in$Qnfiderabfe Fees that'are a  Re-
proach to them,    I Jp.ave altered the com- 
              (66)
won Way of Procefs,  where reafonabJe,
and chiefly  i/ififled on the Rife  and Na-
ture of:attendant Symptoms, which,  in
my Judgment, evidently proceeding from
the Managing andTreatment of FraBure s,
have there  their fafefi andbefl Remedy.

   Divifion.  Fradures  are Simple  or
Compound.
   Definition.  A simple Fradure is defined
by Authors (a Solution  of Continuity
in the Bone,) and, in Refped of Figure,
it may be Oblique, TranCverfe or Lon-
gitudinal.
   It alters  into  a compound  Fradure,
and is ftridly fo called when the Cutiada
is broke through by the End of the Bone
thrufting outwards, or by Wounds made
to it:, but may properly  alfo have that
Appellation where there happens a dou-
ble Solution of the fame Bone, or  is ac-
company'd  with a Luxation.
   Caufes.  Some reckon a Fradure may
be produced from an internal, as well as
an external Caufe\  the former is alledg*d
from fome  Examples in  the Lues  and
Scurvy, where the Blood  has been found
degenerated to fuch a Degree, as to cor-
rode the Bone, or confume it in the fame
jNature as  Confamptions are obferVd to 
                (h)
 do the flefliy Parts. I have feen a Thigh
 Bone emaciated rb half the Bignefs of its
 Fellow,  and a Jaw Bone not above  one
 Third of its natural Bignefs.  And there
 is an Instance in the Biblioth.  Ghirurg.
 from Dominique Gayliard,  of the Bones
 all turning cartilaginous, but yet none
 of thefe  are properly brought under the
 Species of  a Fracture ^ at least they re-
 quire a very  wide and different Procefs
 from  thofe externally occafioned,   and
 therefore out  of our prefent Enquiry.
   But external Caufes are  evident, fuch
 as Blows, Falls,  Preflure,  Wrenches, or
 Gunfliotj and, in my Opinion, one or
 other of thefe mutt always concur to dif-
 unite,  and make a  Fracture.  There is
 one rare  and extraordinary Caufe Of this
 Kind,  and that is, a violent Contradion
 of the Mufcles j this, Mr.  Douglafs,  in
 his Ledures of Osteology instanced to be
true in two Cafes there lhewn }  one,  of
a Porter  that  fradur'd a tranverfe Pro-
cefs of the Vertebra, by stepping over
 a  Kennel with a Burthen, and another
that broke the Os Humerus by flinging
 a Stone.
   Where befl.  Fradures happen best in
middle-aged People  -, very young or  old
Folks have each  their Inconveniency \ in c
                     F 2          the 
              (68  )
the firft, a Quicknefs  of Senfation and
Circulation makes the  Pain more acute,
and fubjeds them in the Beginning to a
Fever and its Confequents, and, in the
Progress,  too liberal a Supply of Nou-
rifhment makes the Fradure more ob-
noxious to a Deformity, or bunching out.
In old People the reverfe of  this j for
in them the Bones having arriv'd at their
utmost Extent and  Solidity,  grow dry,
and  the Veifels importing Nourilhment
being almost obliterated, there is always
a Defeft in the Generation of Callus.
   A Fradure may likewife be faid  to be
beft when the  Solution Js but in one
Place •, when it is not near a Joint,  and
when  it happens where  there is two
Bones, and only one of them broke (as
in the Cubit or Leg,) a Limb requiring
lefs  Art then,  either to reduce or pre-
fers it fo, becaufe the Firmnefs of that
Bone  which  remains  whole, facilitates
the Work 5 nor is this commonly fubjed
to fo fevere Symptoms as where the Bone
is tingle (fuch is the  Arm or Thigh J
but  especially the laft, becaufe here the
Mufcles being large, the Limb cumbrous
and  more expos'd, the Prevention of Ac-
cidents, and a good Conformity, are more
particularly owing to  Care and Art.
                             Fradures 
                («■?.)
   Fractures  are alfo better iti the Arm
 than Thigh or Leg,  becaufe the Pofition
 of the inferior Limbs is  more difadvan-
 tageous and uneafy, and  the Quiet of
 them  necessarily more disturbed.
    Signs.  Among  what are reckon'd
 Signs  of a  Fracture, I can feparate but
 two peculiarly fo.  The firft is a fudden
 Impotency  and Inaptitude of the Limb
 to move it  felf,  which will immediately
 fucceed a Solution of Unity *, for Bones
 being  the Prop and Foundation of Mo-
 tion, it follows the Mufcles, incerted in-
 to them, muft be neceffariiy render'd ufe-
 lefs, but then it is an Error of thofe who
 exped the Parts diftant fliould be under
 the fame Incapacity, fuch I mean  as mo-
 ving trfe Toes, on a Fradure of the Leg
 or Thigh,  or Fingers in that  of the
 Arm or Cubit \ for, let thofe Bones be
 never fo fhatter'd, it will not destroy the
 Motion of thefe, becaufe they imply no
 Difturbance to the Fradure which tho* it
 affeds  all the Joints above, does only de-
 prive  the  next below it.  The  fecond
 and infallible Sign of a Fradure is, when
 on handling the Limb we feel the Ends
 of the  Bone to  crufli and pass  by one
another, without Stability to relist any
Motion is made with it j  and of this,
                 *  F  5         unlefs 
              (7.o).
unlefs we have loft our Feeling, we can
hardly be deceivedj it is fo much depen-
ded on, that without it neither Pain, Tu-
mor, Distortion,  Shortnefs of the Limb,
or any Difparity with the found One,
(though reckon'd r Symptoms  of a-Fra-
cture) arefufficient Indications of them-
felves, becaufe they  all feverally do hap-
pen to the Limbs  on other  Accidents,
and, in their Turns, may be feparate Di-
stempers of  them.,
   Intentions of Cure.  A  Fradure being
known, the Cure of it lies principally
in the Treatment of the Part itfelf j the
Method I propofe for it, I fhall reduce
to two general Heads, under which may
be  compriz'd  all other  fubfequent In-
tentions of Cure, and thofe are osd^ firtt,
ReduBion, and fecondly,  the preventing
or correBing of Accidents.  Thefe, and
thefe only,  are  principal Intentions  of
Cure : Extention, Deligation, and the like,
though they have their proper Mention,
are  only Acceffaries and Affiftants  of
thefe, and (as many other Circumttances
may)  contribute their Share to a good
Reposition, Quiet and Eafe of the Limb.
By Redu&ionis meant the fmooth and even
Reposition of the Ends of the  fradured
Bone, and is always to be done as foon as
                   •          possible, 
              (  V  )
poflible to prevent the Pain,Tumor and In-
flammation that is expeded, and will cer-
tainly follow, if deferred long.  In or-
der to this, Extentiqn is abfolutely ne-
ceffiry to reftore the Distortion, of the
Member to its natural Conformity, and is
beft done with your. Hands, both becaufe
as great Extention maybe made with, them,
as any Fradure can require •, and  alfo
becaufe the Violence of any other Inftru-
ment might help, on thofe  ill Accidents
it,fhould be our Care to prevent.  ,
   Extention.,-We perform  it by placing
two Affiftants, the one above, the other
below the Fradure  ,  the Bufinefs of the
firft is to hold the Limb steady,  and
at the  fame time  to make fuch aContra-
Extention as may hinder its giving  way
to that greater Extention that muft be
made below,  by which  the Bufinefs of
Redudion is chiefly to be  compleated.
This  latter  Part  fliould be strong,,gra-
dual and fteadyy  and,when yourTelf,
by feeling, fhall find it made to a Qegree
fit for rejoining,  you are,  by the  Appli-
cation of your Hands, to prefs and re-
place the Ends of the Bone fmoqth dnd
even.  And  take this particular Notice
with you, that it is  your feeling now
that muft afford  you the true and only
                      F 4       Signs 
Signs that you can' or  Will  IiaVe of a
ftriobth tina*7ven  Coaptation: For, as" td
its'  answering the1  fpuhd Limb* iri  its
Shape, LerigtH and Figu're^ with the Pains'
being abated after  the Dreflings ate on,
and the Patierit laid  in a  proper Place and
Posture, .tKey are all-Very fallible;
   Paid, every one  Inflows;  will utiavol*
dably accdmpahy a Fradure; and to  rid
firiall Degree affe.d the Patient, though
It be well reduced} -and if it be hot fo,
yefc the'Appearance of Eafe^ when tha
LimB is reclined bri  a^fbft-Bed^and at
it eft,  ma^ deceive us into a contrary Be-*
Jief 5 fbt*  it is only with moving that it
becomes  moft fetthbfy affected,  arid this*
it will  be, whethet hV  be well or ill te-«
ddcedi.  .,,■         --iiU
  'Arid fecondly, asJto its  kefetoblahee
With  the  fourid Member;  I cantiot  fotrrl
td.  rnyfelf any fure Rules of judging aft
terilte t>?efling&are on ^ for, what Like*
hefs foever they might have  had before;
it. will  be loft therij"arid in this We  are
ii6ver fo  freqiieritty deceived  as  in a
Thigh* for Pain*  With the Weight and
Uriweildine&df the Jvleniber, always finks
trk Pdtierit td the hurt  Side, and impo-
ses on lis  a falfeXehgth j fo that I have
teen a thigh; wHich^ by its Afpeararice
                                    in 
iri a Cradle; hag been  merrily exacted
longer than the other,  mad yet prove,
when come to be made Ufe of, an Inch
or two fhoifteri  But to taturr^ Extention
{jerformed, and the Borie re-placed, with-
out arty perceptible Inequality, Redudion
is fkslhed.
   id. Mention. *f he ofhet general In-
tention of preventing and correBing Ac*
cidentsi I design very comprehensive, not
dnly td include  the Dreflings and Ma-
nagement that is" instantly required, but
to take in the whole Procefs of Cure from
Redudion to Recovery*  And iff,  the
Prevention of Accidents will depend ve-
ry much oil a well ordering of our Dreft
firigsV which take as follows \
   Supposing the Fradure  reduced, and
Affiftants ftill holding the  Limb, we be-
girt our Dreflings by enwrapping the Part
round With a Comprefs of fumble Large-
nefs dipp'd in fed Wine,  or Oxycrate,
or elfe, what fome think more preferable,
art Emplaifter ^ mine is generally  Empl.
eboloi. Fidt exDiapal. dcet. Bob Ol. Rofar*
 M. S* A* or the Defertfative NQ. #31, in
 either of them, I always chufe to add a
 little Turpentine, becaufe its Stickinefs
 brings and preferVes the Flefh tort about,
&rid fits it the better for Bandage*
                                  The 
              (7+;
   The Rowlers are next in courfe \ the
Number unhwrfally adhered too are
three, two of them Angle, and one dou-
ble,  and has all  the  Advantages  that
any Rowling in the Cure can have *, they
are ufed according to Hippocrates** Di-
redion,  thus.
   The firft (ingle Rowler is begun with
three Turns at lea ft,  about the Fradure,
and finifhed upwards with Edgings j the
other single  Rowler is begun  with the
fame Number of Turns about the Fra-
dure,  but rowled to the contrary Hand,
and finifhed downwards.
   Over thefe  comes the double headed
Rowler, begun alfo like the former, on
the Fradure, and has one  Head carried
and finifhed  upwards,  the  other down-
wards:  Thefe Rowlers are to vary jin
their Length, in Proportion to the Bulk
and Largenefs of. the Limb fradured ^
are to  be made  of Linnen, (as leaft
ftretching,) and to be ufed in fuch a
Degree of  Tortnefs,  as may fupport the
Fradure, and yet not endanger illSymp-
toms. *A Medium not attainable but by
Pradice.
   Gompreffes and Splints  follow ^ the
firft are made of Linnen, the other of
Paft-Board or Wood, and armed with
                              Towj 
              f  75  )
Tow *,  their  Number,  Length  and
Breadth,  are to be more or lefs, accor-
ding to the Part fradured, and fo placed,
as to bear equally and fill up any Vacu-
ities or Slendernefs the Limb may have
in  one  Part  more than another,  and
then fattened with four or five Tape Li-
gatures, beginning on the Fradured Part^
among thefe  Splints, (whether the  Fra-
dure be of the Arm,  Leg or  Thigh,)
there fhould be alwaysa.very large one
of Paft-Board, for-the under  Part  of
 the Limb,  rounded  at the Edges and
 armed with foft  Tow, (if need be,)" to
 fit eafy in the Axilla. or lnguine-, wet in
 Oxycrate, that it may mold to the Shape
 of the Limb, and fhould enclofc fomuch
 of it as that the reft of the Splints ufed
 (which  need not be above two more)
 may be moved  and/ihifted, if Occasi-
 on require)  without;1 Trouble' to the
  Patient.,
    Some chufe to wet  all thefe  Dreflings
 in Oxycrat cum albumin, Ofwww^whjch
  I cannot acquiefce yi, becaufe, I  think
  the Cold and Weight retained by it,  in-
  duces  more Pain, and that as  they  be-
  come dry, they grow  flack and expofe
  the Fradure.
When 
               (1t>)
   When the Dreflings are ftnifhed, the
Position of the Member  requires our
next Carej  for it often happens  that
altho' a Fradure be well  reduced, yet
the carelefs and Unequal Scituation of
it after, fubjeds it  to the fame Misfor-
tunes as'art ill Redudion  would  have
done:  But as Diredion, for this  muft
vary according to the Limb fradured,
it Will be more ufefully  obferved under
the Notes that follow on each  particu-
lar j only this I fhall take Notice of at
prefent* that  the  fame  Splints,  ftho*
there be  a double  or a compound  Fra-
dure,) fhould be only on necessity ad-
mitted to  come above arid below the
fame Joint ^ for tho* fuch a large Splint
as I  here mean, is of great Support and
Service in  the irifefiour Limbs,  (the
Thigh in particular,) yet,  as we find
the  Continuance in one Posture only,
will frequenlty induce a Stiffncfs  and
Rigidity  in fuch  Joint, and this  the
more the Patient is  in Years j fo when
we lend a helping  Hand, and '.h&it ini-
moveably  as it were by Bandage  and
Splints, we have Reafon to fear an An-
chilofis by it:  The Synoviam the Joints,
by fo long a Stillnefs and Inadion, glue-
ing the Heads of the Bones like a Callus^
                               I  have 
              177;
J have feen the Tibia and Femur,  the
Ulna and Radius,  from  fuch a Caufe,
fo cemented,  as to appear like one  con*
tinued Bone.
   J come now to  account for, and cpr-
red in the beft Manner I am able, fuch
ill Accidents  as in the Courfe of Cure
are the Attendants of Fradures, to wit,
Pain, Inflamations, Fever, Tumor Abfcefs
and Mortificatiori.
   And firft of Pain, this is an infepara-
ble Concomitant of a  Fradure,   and
 therefore never to  be considered or at-
 tended to as a dangerous Symptom, till it
 becomes more than ordinarily acute, and
 then as  it is productive of every other
 111 a Fradure can flitter under, (Inflam-
 mation,  Fever,  Tumor, Fluxion  and
 the like,)  it is worthy  our exadeft
 Jnduftry to fearch the Caufe, and  pre-
 vent or  corred it.
   The common  Caufe of Pain here, is
 the Solution  of  Unity,  but what par-
 ticularly aggravates, will be found either
 from  the Fradure's being  waved into
 (harp  Points, or from  fome Pprtion of
 Bone  entirely feparated,  either of which
 Accidents, as they prick and vellicatethe
 Membranes  where they lodge,  fail not
 to excite this Affedion, elfe it may be 
               ( 7*)
the EfFed of too hard Bandage j too hard
Lodging \ ill Reduction or Position ? or
finally, a bad Habit of  Body, joined
to either, will from fmall Beginnings, im-
prove to a Fever j for Pain, which in a
great or lefs Degree,  is the certain Con-
fequence of every Mifmanagement, is
always  attended with a Contradion^ of
the   pained  Part,  which  contradion,
according to  the modern  Hypothesis,
extending to all the Parts of the Body,
leflens the Secretions, or, which  is the
fame Thing, ading as a Stimulus, di-
vides the Blood into fmaller Parts, ei-
ther  of which  increafes its Quantity •
which is the immediate Caufeof a Fever.
   Pain and  Fever constantly follow one
another, like Caufe  and Effed, and by
removing one, we feldom fail to fubdue
the other-, accordingly therefore as any
of the afore-cited Caufes fhall take Place,
we mutt diversify our Remedies : Any
Teparated Portion of Bone, that we  think
cannot  be  replaced  and  reunited, we
mutt cut too and take it away \ Lodging
or  Bandage  too hard,  we muft eafe^ ill
Redudion  redify by going over our
Dreflings again •, and if a Dyfcracy and
ill  Difpofition  be the Caufe, we fhould
endeavour to amend it with a Courfe of
                                gentle 
               ( 79  )
gentle  Cathartioks and  Alteratives, be*
caufe not only a Fever will be the Con-
fequence  of increafing Pain j but we
ought  to  fufped Tumor,  Fluxion, In-
flammation , Apoftemation,  and  even
Mortification.
  A Tumor here is either the Effed of
Pain -, of  too  ftrid a  Bandage j  an ill
H«bit of Body, or Plethora j or it is from
the general  Imbecility of Nature,  as in
aged  afcitical  or  confumptive People.
When thefe latter Caufes exert, the Swel-
lings are only JEdematous, fignifying a
general Weaknefs, and will difcufs very
probably  from any particular Part,  by
Fomentations, and as it regains Strength.
But, when the Tumor happens through
ill Redudion, or future Mismanagement y
an ill Difpofition, or a Plethora: It is as
one or more fuch Caufes vigoroufly con-
cur, attended vvith a Fluxion of Humours j
and  as the Blood is faturated with acri-
monious  or bilious  Particles,  becomes
a Phlegmon or Eryfypelas, which,  again
may not (impossibly)  end in Apoftema-
tion, Abfcefs or Mortification.
   I  have  already obferved, that the beft
Prefervative,  is  the recovering  a good
Redudion,  a fmooth Application of our
Drefling,  and an etfy, even Position;
                                  But 
              (So  )
Put though  they are the fplid Fpunda^
tions of Succefs  to  a Surgeon,  yet  the
general  Jndicatipns  for cprreding them,
when prefent, muft not  be pmittedj I
mean  fuch  Administrations as  tend  to
the Mitigation pf Pain, and Reyulfjoi?
of  Humours.   V, Section, JEneqaas  or
Laxatives, Anodynes,  and a ffrid Re?
gulatipn in the fix N, Naturals,     ft
   #, DecoB, commur?, pro Cljrflww
5x, Oh Chdin. |ij. Mell Mercurial. Syr?
Yiolar. d. I). Oh Mji. Jt ¥? Fr £nm
jnjiciendumf
   fcPecotf. hujuslxij. Syr, Rofar folut,
Btttyr.fali, fdcch? hth 0< l)r Oh 4nifl
gviij, Mt pro pnem#f       M
   #. Aq. Qnwtn H, X\\i /%  Eptdemf
Syu de Mecon. d,  |t U fiqiM gxf Jj£
pro Anodyn.  borafimwfi*mendf
   R. Aq. Cerafor  W, § Uj. Aqf  Cinnam,
F. |C Syrf de Meton. jvj, L.' fiq, gxvj,
hord decubitus exhibend,  & ref*f0!lHS
pro tres vel  quat9 Diebus.
   Alfo to direct their Diet may be low?
and fuch as  is pf light and eafy Dige-
ftion, (as Gruel or Panama,) abstaining
from Fiefli j and for  a common Drink,
Sack-Whey, Pr jthe following,   $. Aft
HorAWfif Safhdr AlbffJ Sp, $m Vs1 Oh.
Vitriol a* qC dd grtfaw ftp WW: 
               (Si  >
   R. Succ. Limon.  §ij. Aq. Hord. Tbij.
Sacchar Alb. §j.  M. pro potu Ordinario.
If the Accident  fliould  ftill  encreafe,
and  the Patient be rendered weak and
faintby them, fome Alexipharmick fliould
be exhibited.
   R. Pul. e. Chel.  C. gr. xvi. Spec. Di-
amb. f. o.  gr. xij Conf. Alkerm.f. o. £f. M.
F. Js Bolus fexta quaq; horafumend. Su*
per bib. Cocbi]. Jidap.fequent.
   R. Aq. Cera for N. |viij.  Aq.  Peon. C.
Theriac. a. |f.  Margarit ppt. §ij. Sacch*
albifs q. f F. Jidap.
   Or, the Pulvis Alexiterius, and Julap.
Volatile Ratcliffianti.
   We fliould likewife, for obtaining this
End, relieve the Limb of all that Lum-
ber  of Drefling that by its Weight may
incommode it \  preferve it in a quiet
and  steady Pofition, and prohibit the En*
creafe of Fluxion by a Defenfative on the
Joint  next above  the Fradure,  and a
cooling and difcutient Ointment  and Em-
plaifter to the Part  it felf, u.fing alfo now
an eighteen Tail Bandage, instead of the
the  circular, for the Conveniency of ap-
plying thefe Topicks daily.
   R.  U. alb. S^ populn. a. p. a. partem
Exungitur & cirta lumcrem Empl. Cer.iti
Diapalm.
                    G              Fot 
   For a stronger Difcutient the follow-
ing -Cataplafm,
   R.  Fol. Altha Mi). Sem. Lint  F&nu-
gr&c. a. ^f. Flor. Chamem. Melilot a. jij.
fiatCataplafm addendo 01. Rofar. ^ij.
   If Eryfypelatofe.
   R. Succ. Sambuc. 01.  Lini. a. §ij. coq.
ad fucci Confumptionem deinde adde tan-
tillum Lithargyri/vel R. Sp. Vini. §iv.
Sacch. Saturn $]* M.
   If it be simply a Tumor, (^Edematous)
we muft  consider what  Remedies we
have  againft  Age,  an  Hydropical, or
weak and hedick  Difpofitionf that Oc-
casions  it, and the quicker Foresight we
have  of them, the  better able are we to
fence againft Dangers,  which tho' not
threatening,  as to the  Patient's  Life,
may,  as  to the  Ufe  of  the  Limb.
I  fhall, previous   to the Remedies, lay
down thefe two Propositions.
   Firft,  That ^edematous Tumors do
foon  appear in imbecillitated Constitu-
tions ^  for by whatever Caufe the  Blood
becomes depauperated, whether thro'Age
or other chronical Diftemper, the  Juices
will  fluduate but  flowly through their
Channels, and the  folid Parts  having
loft affo of the'r,  Terfity, it cannot but
                               happen 
happen that  every light  Compreflion
will obftrud their Circulation, and caufe,
a Tumor.
   And fecondly, fuch  Tumors will  be
of longer Continuance, and more  Trou-
blefome to diflipatej than the  others  by
Fluxion, becaufe the  Fibres,  as they
have been a  lefs or longer Time ftretch'd
beyond their natural Make,  do lofe of
their  vibrating  Power j  or in  other
Words, the  Tone of the Part is  weak-
ned or destroy'd.
   We are therefore by heeding to thefe
Propofitidhs, more eafily led to a Reme-
dy,  and fhould  no fooner  have Appre-
hensions of  the Debility and- Weaknefs
of a Constitution, but we fhould  imme-
diately flack the Bandage, and change it
for  the  eighteen  Tail, tho' never fo
fmall a Distance of Time from the Re-
ception of the Fradure,  that the  Blood
and Spirits may have a freer Recourfe
there, of which thefe congested Tumors
(as I have faid) always  argues a Defed ;
and  there will be no fear of a Distortion
from  this Liberty, becaufe the Coldnefs
of  their Constitutions fuppreffes the In-
clinations to Motion  and  Uneafinefs,
which are more familiar and perplexing
                  G  2             in 
               (8+)
in brisker  Circulations ^  and the more
the Tumor fpreads and increafes, the lefs
will be their  Incitements to disturb  it;
infomuch that I have wholly laid  afide
Rowlers, and trufted fuch Fradures  to
Compress and Splints, contriving only the
eafieftPofition poflible, and helping Perfpi-
ration and Strength forward, with warm
Bathing, fpirituous  Embrocations,  and
nourifhing Diet.
   R. Abfynth commun.  Altha, Centaur.
Hyperic. a. Mij. bacca Juniper §j. Semen
Fenic. Carui a. Vb). contundantur  femina
omnes in Aq. Commun. Cong iij. coquantur
ad tertiam partis Confumptionem Colatura.
adde Sp. Vini. qf.  & fervetur'0 poji ufum
Foti  utimur  EmbrocatiGnem.
    R. U. DialthA  Sp. Vini a. %]. 01.
 Abfynth.  g. vj./vel. R. Pingued  human
,.§ij. U. Nervin. §f. 01. Euphorb, Petrol, a.
 zj. M.  Internally it will be proper to
 keep the Body open, and prefcribe good
5tomaticks and Diureticks.
    R. Pul Semite, Crem Tartar  a. 3J. 0/.
 Anifi gr. viij.  EleB.  Leniti. ^j. M  pro
 quatuor dqfibus  Vefpertinis Affwendis.
    R. Vin. Alb. Ibij. fal Abfynth §if.  hau-
 flum ad Libitum fumend. J vel.  R. Vin.
 Alb. %\\. Ciner. Genift. ^j. filtretur  add
 TinB.Lign.  Saffaphr.\[. M.Jvel.  R. Ze-
                                   doar 
               ( %)
doar. GalangA, Cyperi, Calam.  Aroma-
tic.  Jsuces  Mofch.  Cinnam.  Macis  a.
§f. Cubeb. Gsryophill  a. jj. Croc. Angli
c. ^j.  nodu'o  ligat.  fient frigide infu-
fione Vin. Alb.Cong. i. tempore ufus filtre-
tur. capiat  haufl mane iejuno Stomacho
& quarta Pomefidiana. \ Vel.  R. hujus
Vin. VbjRhabarb.TyX). Infunde & Colatune,
capiat Hauflulum omne mane.
   Should there be Danger at last, of a
Mortification from the Encreafe of  this
Tumor, or from  the  Exafperation  of
Symptoms in a Phlegmon or Eryfypelas,
or the  Greatnefs  of  the  Contusion, I
have considered the  proper Applications
at the End of the Chapter of Amputa-
tions,  to which I refer.
    Dijlortion.  There is another Acci-
dent behind, to which Fradures are fre-
quently  fubjed, and  that is Distortion:
This happens by ill Redudion at firft,  or
Mifmanagement afterwards.
   From ill Redudion, when the Ends  of
the  Bone do not anfwer Fibre to Fibre,
and this, in  all likelihood,  they will  be
the wideft from where the Obliquity  of
the  Fradure is greatest.  There is  like-
wife another Evil,  wliich  I think is not
commonly meant when we fpeak  of a
Diftortion,  tho' it be a very great one,
                     G 3         and 
              ,r86>
and may riot only produce the  ordinary
Effed of it, a Weakness  and Lameness,
but be a ivlifery, and that is, when the
fupefior Part of the-fradured Bone over-
hangs,  ana' for want"of meeting  the other
to intercept the Superfluity of  Nourifti-
irient,  flioots  forth  into  Proceffes;  I
have feen  them i'tt a Thigh Bone to the
Length of fix  or eight Inches.
  From  Mifmanagement,   a Distortion
happens, and that chiefly in the  Thigh
or Leg, when in our future Attendance,
we negled the  Position, and fo in Pro-»
portion as  it is wreathed to one Side, or
the Heel is raifed or let fall too much
and  inadvertently continued  fo,   the
Edges  of  the Borie meet  clofer  in one
Part,  and  recede in the Opposite; which
Space  or Vacuity filling with the Matter
of a Callus, brings a Curvity.    As this
Accident is feldom heeded,  or known 'till
late, foit is paft any other Remedy, but
Breaking  again, which is looked on as
the fole Refort.
  The firft Time of opening a Fradure,
is direded by Mr. Wifeman and others,
to,be the  feventh Day from Redudion,
assigning thefe two Reafons. First, That
if,the  Bone, has been ill reduced, or any
other Mistake  made, it is then feen and
                                 may 
              I  «7)
may be redify'd.   And fecondly, there
is  Opportunity to  bath  the Part,  and
allay  the Itching that has arifen there
through the Detention of Humours.
   The Purpofes here are right, but the
Seafons of  pursuing  them,  strangely
mif-timed, and Would be ill Pradice to
obferve; for firft, if it be  apprehended
the Bone is ill reduced, we fliould corred
the Miftake fooner, even the  fame Day.,
An  Adherence  to  fuch  a superstitious
Septinary Period, when  our Procefs has
been  wrong,  is only  inviting the very
Accidents we  are careful to fhun: And
as  to itching, it does not happen, or is
not troublefome till Pain abates, which
we know is as the Part strengthens, and
the Callus confirms; But grant it fhould,
I cannot think the eafing of that,  is to be
put in Competition with  the  hazards of
difplacing and distorting a Bone; as for
Instance, in the  Thigh, how impossible,
almost, is it to open at feven Day's End,
without destroying our former Reduction,
and all that has been done for the Pati-
ent's Security.
   It may be  then  ask'd,  at  what Di-
ftance of Time it will be proper to open
a  Fradure ? to which  I  anfwer, not un-
till a Callus has knit the  Ends of a Bone,
                   G 4        which 
               (88)
 which,  for  a common  Computation,
 may  be in about three Weeks.   Some
 extraordinary Accident may  fupervene,
 that feems to be of greater Confequence,
 and exads Attention before the Fradure:
 Such may be very acute Pain, Inflam^
 mation,  or other aggravating Symptoms
 already taken Notice of,  But  what  is
 the moft common, tho' infufficient Pre-
 tences for it,  is the Slacknefs of the Ban^
*dage, when a Fradure receives no Sup-
 port from it, a Defed that I have always
 thought more  f^fely fupplied by draw-
 ing the Splinters tort from Day to Day.
   Callus.  A  Callus is  the Medium that
 unites the divided  Bone,  it  is a white
 thick vifcous  Subfiance part of the Suc-
 cus Tfutritius,  fupplied there by the Fi-
 brilU difperfed tho* the Subfiance of the
 Bone and is a Juice that by its being fo con-
 tinually, at Hand in Fradures,  has pro-
 bably a  constant   Circulation  through
 the Bone?; for if it  was to stagnate, I
 fee no Reafon but that it might harden
 to the fame Degree it  does on  Extrava-
 fation v and fo  prevent by this Obftru-
 dion of the Paffages, any fradured Bone
 from  ever uniting; but whether this be
 fo, cr that the Marrow they contain by
 diitilimg or fliding through their Poro- 
              ( 89  )
fity, from  the  interior to  the  exterior
Lamina, be the supply I cannot refolve.
The former which is Dr. Havers's Opi-
nion is  moft probable, and that nutriti-
ous Veffels run thro'  their Subfiance \
which by  their Discontinuity whzre  a
Fradure  happens,  the  Nourishment
they contained naturally ouzes from their
fmall Orifices and fpreads or extravafntes
it felf round the Edges of  the difunited
Bone, cementing  them  with  an  eafy
Adherence only the firft Days but in a
Jonger  Time the  thinner  Parts being
diffipated by the Heat of the Body, the
Remainer becomes fo hard  a Substance,
that the Bone fooner breaks in any other
Place, than there  again \ the Reafon  of
which may be alfo  (if the ftrength  of
a Bone more in one Place  than another,
be  as  its  Diameter) that it  becomes
thicker there.
   From the Nature of this Supply, let
us consider of  the proper Means  to ge-
nerate a Callus and how we are to cor-
red its Defed or Luxuriancy.
   For obtaining this uniting Subfiance,
there are two controverted  and very op-
posite Opinions,   in refped to internal
Means, the one would help and forward
its Generation by incraflating Medicines,
                                  fuch 
               (9°;
fuch  as  * Lap. Ofteoeolla,  and  other
fhelly and teflaceous Powders,  and the
other by attenuating Medicines.
  The latter of thefe feems to have the
greatest Weight of Reafon j  for as the
FibilU importing this nutritious Juice,
r<re  fo fmall as to be almost indifcernible j
fu.h Medicines as  attenuate muft give
it an  easier Transit,  and  fooner accom-
plifh the  End ^  Experience confirms this,
since  we  find  Bones  fooneft  unite  in
young People,  and  in Winter Seafon,
which I think can be for  no other Rea-
fon  than that  the  Circulation  being
quicker,  the  Particles of Blood are  by
that Means more comminuted and  fitter
to pafs thefe flender Fibrils into the No-
rifhment  of the defedivePart.
  On the other Hand, incraflating Me-
dicines,  whatever Faith any of  our fore
Fathers ,have put in them, (particularly
OJle'acolla, which fome have  faid, would
knit a Bone in  four Days  Time,  I can-
not  but think  muft impede this Work
  * Lewry&ysy'tis called fo from ofieon and Colla.
Which is; as rhuch as to fay Bone Glew. It is a chalky
White  Subftance, the  great Pfeces hollow, (the
imall ones not fo) and grows at the Roots of Trees •
there is two Sorts, Engtfp and VaUtinau. '        '

                                   by 
              f 9i;
by thick'ning a Juice too unapt before to
pafs thro' fo fine  Capillaries, and particu-
larly in aged People, for their diminifh'd
Heat and Circulation is already fo oreat
an Impediment in the forming a Callus,
that fometimes neither Fridions,  ftrong
Fomentations, flack Bandage,  a nourish-
ing  Diet,  and the  like proper Means
can prevent an Irremedilefs Atrophia.
   Authors alfo for this end,  order nou-
rifhing  Diet,, fuch  as ftrong  Broths  of
Veal, Kid,  &c.  and externally Empla-
fticks, fuch as Empl.jliB.  Paracels Ox-
ycroceum,  G. Thus  Myrrh,  Labdanum
Aloes, and  the  like  mixed and apply'd
Piaster-wife: Thefe byobftruding Tran-
fpiration, and. retaining the warm  Efflu-
as  are fuppofed to encreafe the natural
Heat, and  promote  a Callus) but  the
beft Praditioners, (altho' they  do not al-
together fhun their Ufe,) yet efteem them
of little Service j and  that the beft, if
not the only help neceflary and condu-
cive  to that End is  the Quiet  and Eafe
 of the Limb.
   There is an opposite Fault to thisDe-
 ficiehcy of Callus, and that is its abound-
ing too much,  for  which I fee nothing
but Preffure with  a  thin Plate of  Lead,
ftrid Bandage,  and a Retrenchment in 
               (9>  )
 the Patient's Diet, can be of any Service,
 an Empl. de Cicuta, de Ranis cum Merc.
 or fuch like may be apply'd alfo for this
 end, tho* they feem of inferior Efficacy.

         "Notes on the  Finger.

    A,FINGER  is  feldbm  fradured:
 without  a  Wound,  and muft be diffe-
 rently treated,  as it is the firft  fecond
 or third Phalanx.
   When it is the third Phalanx,  or Ex-
 tremity that is fradured, we need  not be
 hafty in the Extirpation of that  Joint,
 how irrecoverable it may appear at first
 for Nature  fometimes  exceeds  our  Ex-
 pedations,  and no doubt  it is better a
 Joint  be preferved  (tho' fumbly  cica-
 trized) then loft ^  nor needs there any
 other  Regard   here,  then  what  the
 Wound would  have required, had there
 been no  Fradure, excepting only, that
 we change  the  Rowler one Day  to one
 Hand,  and  the next to the other,  to re-
 ftore the preceeding Deflexity.
  But if it  be  the  Middle, or the firft
Phalanx that is fradured,  there is a lit-
tle  more care and Consideration wanted
both to replace the Bone, and to preferve
irfb.
                                 And 
              TT?)
  And firft, the ftreightning of  a Fin-
ger  is  the  replacing  of if, if any Par-
ticle of Bone is an  Obstruction to this,
or feparated, it is to be removed ^ and if
the  Wound  be fo large as to fhow  the
Bone,  it fhould be  covered  with dry
Lint,   or a Doflii  preffed  out of  TinB.
Myrrh.
  To  fecure  the  Fradure,  I ufe only
an  Empl. (lomprejfes  and  two Splints j
rowling I think inconvenient here, in that
it wreaths the Finger aside, and  makes
a diftorted Unition : The middle Part of
the Empl. is to be applied on the Wound,
and  to come  round  the Finger, (firft
cutting out fo  much  as may leave room
for Drefling.)  The  two fmall  Splints
with each  a Comprefs, I  place  on  the
upper  and  under Part \ more  than thefe
would be troublefome,  and indeed can-
not be ufed- efpecially  in the firft Pha-
lanx \  but that the PrefTure may  not be
unequal  or give   room to  the  Bone's
receding that  Way, we fupply the want
with more litrle linnen CompresTes one on
each Side,  and having tied the  whole
with  a couple of narrow Ligatures:
Place it to the Breaft to be out  of  the
Way.
This 
              (  94- )
This preffinghasall the Benefit that can
be  propofed^  it is of Support  enough,
keeps the Wound  from the injury  of
Cold, and  by only untying the Liga-
tures, they are all  eafily removed, and
the Wound prefented for your Infpedion.

  Notes on the  Cubit and Humerus.

  IN Fradures of the Cubit ex Humerus,
the Elbow muft always be  kept clear  of
the Dreflings  that  the fore  Arm  may
bend to reft eafily  in a Sling, which is
to be placed to the Breaft, and  the ex-
tremity a little elevated.
  This  is required  in  common, but in
their  particular  Treatments they  may
have a  Variation to their Advantage j
as for Instance,  the Cubit requires not
fo confined a Posture as the Humerus,  but
maybe fuffered to play from the Breaft a
little, without the  Fear of any ill Con-
fequence enfuing }  it is on the Advan-
tage of this free Position, and its being
fo little affeded with the Motions of the
Body,) that makes it of the least Diftur-
bance to the Patient, and  fubjeel: to the
fewest ill * Symptoms of any fradured
Limb^ but the Humerus being a fingle
Bone, ought to be more fteddily fix'd, to
                             prevent, 
"-■—— ...L?5  )
prevent the ill Accidents  a loofe Scitua-
tion will expofe it to}  and if broke near
its  Jundure with the Scapula,  it muft
be  treated like aDiflocation} I fhall give
one Example both to explain this Cafe,
and farther illuftrate  the  Truth  of
what I have before advanced, in Rela-
tion to the Accident  that befel it.
   I had a Fradure of the Humerus fome-
time ago, as near the Jundure as I think
could  poflibly happen, after an Exten-
tion and Reposition of the Bone, I ap-
ply'd a defenfative  Empl. a large Com-
prefs  that  enclofed  the whole  Joint,
fome foft ones of Linnen in the Axilla,
and the  Bandage called Spica,  pinning
down the  Arm,  clofe  to  his Side, and
railing theCubit in a Scarf to his Breaft;
nothing  of Splints  could  be ufed  here,
nor do I think them  or any Thing har-
der or  uneafier then  what I have men-
tioned,  can  be forced on  fuch a Fra-
dure, without disturbing and rendering
the Contributions of Nature abortive.
    The  Patient being old, and at that
Time in an hydropical State, a very lar^e
aedematous  Tumor quickly fpread thro*
 the whole Arm,  yet, suffering  very  lit-
 tle Pain from it, which whether I might
 Account as a Sign  of good Redudion,
                                    or 
                 r  96  >•
   or the Largenefs of the Tumor deadening
   the Senfe, 1 could not then tell} however,
   I took off the Bandage, believing that
   might be one  great Occafion, and with
   Hopes  a Fomentation and  Spirituous
   Embrocations might help towards its Dif-
   perfion, but was in a few Hours obliged
   to re-apply  them, the Limb becoming
   (as he expreffed him felf,  fo heavy and
   painful a Load, that he could not  en-
   dure it.
     I aflifted thefe  external  Applications,
   by keeping him to Diureticks and good
   Stomaticks, throwing  in  a Purge now
   and  then, as his Strength  would  bear}
   but the  Weaknefs and Tumor, for all
   this, continued, and stretching the Cu-
   iicula  into Veficks at  feveral Places,
   and at feveral  Times, for the Space  of
   three Months,  at  length a  Callus having
' (  formed, a Diminution  of the Tumor gra-
   dually  fucceeded,  and after a long tedi-
   ous Ufe of Fomentations; and Spirits, it
   was  brought to fome  Share,  tho* never
   wholly to its Ufe and  ftrength.

           Notes  on the Clavicle.

     FOR the Redudion of the Bone, the
   Patient is to be fcated  on a Stool, while
                                      aa 
an Afliftant behind with  his  Knee  up
the Back, and his Hands on each Shoul-
der, pulls both backwards, at which Ex-
tention the prominent  Part  of the Cla-
vicle may be eafily preffed down to join
with the other.
   After Redudion the Cubit muft  be
flung to the Breaft, (as  in the Arm,) and
the Patient very careful in its Quiet and
Repofe, for tho' it be  eafily reduced, it
is difficultly retained fo, becaufe a Sted-
faft Compreflion is hard to be  preferved
for any Time.
   The Clavicle being lefs folid than many
other Bones of the Body, makes a Callus
the fooner thruft out,  for  that is what
depends muchon a greater or lefs Porofity.
   If it do not unite   evenly,  the illeft
Confequence will  be  the  Motions  of
the Arm forward being impaired.
   The Drefling to this  Fradure is a de-
fenfative Emplaifter firft, a  large Com-
prefs over it,  and then the Splints, the
Number of them may be either three or
one, as  different  Judgments  fhall ap-
prove } if three,   then  the two longest,
with each a Comprefs  under, are to be
placed  one above the  other, below the
Bone, and the third, which need be but
very fhort, is to go crofs  them dired-
                   H             ly 
               (98)
ly over the Fradure,  the Vacuity be-
tween having been firft filled with other
Comp effes to make the whole bear equal-
ly ., if but  one Splint, (which is what
I always chufe  my felf,) it muft be cut
parabolical, as beft adapted to the Shape
of the Part,  and  to make it fit  with
greater Security to the Fradure:  I put
befides the Compreffes,  ordinary for fil-
ling up the Vacuities,  another crofs that
Part of the Splint which is to reft di-
redly on the Fradure,  that fo the Pref-
fure  may be  clofeft  there :  Over either
of thefe  muft  be brought the Bandage
called Capeline, defcrib'd by M. VClerc,
taking  Care to fill the Arm-Pits  with
Tow or foft Linnen, to prevent Galling
and  Uneafinefs.

           Notes on the Leg.

  Tho' the Length and Conformity of
a Leg is very much  conferved when the
letter Focil is entire,  yet  it may be fo
bowed, as  to create great Lamenefs, and
this from a heedlefs Elevation,  but more
from a Depreflion of the Fleel }  where-
fore  a conftant  Care  will  be requifite
for  a firm, steady and  equal  Position,
particularly from  the  Fradure down-
                               wards, 
               C  99)
 wards, for that is moft yielding} and a
 Negligence in fixing it will produce a
 Qurvity, and  this the  more likely  the
 higher  the Fradure  is  on the  Tibia.
 But fuch a  Depr.flion (by the Way) can-
 not have  the fame Influence on a fra-
 dured Thigh, becaufe the  Joynt of the
 Knee intercepts fuch Motion from it.
   The Dreflings  for  the Leg,  are, as
 in the general Account} it has only this
 in particular, that it  may be placed in
 a Cafe,  filling up the void Spaces on
 each Side, from  the Knee  to the Ancle,
 with Compreffes to fteady  and  prevent,
 as  much as we.can, its yielding to the
 Motions of the  Body.
   We muft alfo  apply a Defenfative to
 the Knee,  the better to  prevent Tumor
 and Fluxion, and place it in a  ftrait
 Line with the Body,  for thofe  heavier
 Parts  next the  Body, finking by their
 Weight, will foon make this in an Afcent.
   The'Signs of a good Redudion will
 be  a foft Tumor below the Bandage, and
 having had  that  Appearence,  and the
 Painno more than what ordinarily accom-
'paniesa Fradure, we may fubmit  it
 to  our firft Dreflings, without  any Al-
 teration for a Month} then, or before,
 the entire Slacknefs  of  the Bandage,
                   ri  2           and 
             (  ioo )
and Itching of the Part will call for an
Opening} and having given a Perfora-
tion to it,, by a Bath of warm  Water,
the Dreflings may be re-apply'd, or left
off as the Callus is  found more  or lefs
confirmed.

          Notes on the Thigh.

   A FRACTURE of  the Thigh is
the moft considerable of any, the  moft
difficult  to manage  and  preserve in  a
good Site, has  the worst Symptoms at-
tending  it, and  the ofteneft  ends  in
Lamenefs }  and  this   firft,   becaufe
its  being  the   compadeft  Bone  of
the Body, and  environ'd with  thick
Mufcles,  the Force  that breaks  it muft
be greater, and confequently the  Con-
tusion, Pain, &c. aggravated.
   Secondly, becaufe being a single Bone,
and destitute of any other Help to pre-
ferve  it  in a true Position, than  what
 the Dressings give, it fuffers unavoidable
 Difturbance from Stooling, and the reft-
 lefs Motions and Longings,  that will
 ever happen from one long confined  »
 aS unaltered Pofture.
    Thirdly, becaufe the  Thicknefs  of
 the Flefh  makes  the Bandage lefs Effe-
                                 dual 
              ( ioi)
dual to prevent it, and  ftill the  worfe
when they slacken, which will be always
before a Callus is formed.
  And  fourthly, the  Obliquity of the
Fradure here,  is for the fame Reafon
of worfe prognoftick, then in any other
Bone, for when it is very great, the Pain
that  stimulates the Mufcles, will  draw
up the  inferiour Part,  in fpite of any
circular Bandage}  and  the  farther the
Fibres   in Unition  depart  from  their
Opposite,  the fhorter the Limb, and
greater  muft be the Lamenefs.
  To  find in what Part of the  Thigh
the  Fradure  is,  Aide  one  of  your
Thumbs gently on the outfide, for there
the  Bone is nearest  the Touch, and by
giving the Thigh a  little Motion  at the
fame Time with the  other  Hand, you
are prefently convinced  of the Place.
  Extention for Reducing it  fhould be
ftrong,  least  the Ends  by their  Attri-
tion, fhould  break off fome  Particles,
and create a future Difturbance.
  The  Signs of a good  and equal  Coap-
tation,  are taken from  its anfwering in
Length and Shape,  to that of the found
Thigh, and from the Surgeon's own Feel-
ing   who  fhould  move his  Thumb
  &'          H 5          fmoothly 
             (  ioa  )
fmoothly up andj' down, till  he is entire-
ly fat sfied.
   The Dreflings for this Fradure  take
up-Tune,' and  fliould therefore always
be in Readin. fs.  In order to apply them,
the two Afliftants who make Extention,
ftdl  continuing to hold the Limb fixed
and 'fteady,' you are to apply an Emph
E. boh, the Defenfative  Number  31,
or tlie:like, and three Rowlers} under
the firft,  I include an indifferent thick
Comprefs directly' on  the Fradure,  and
on that  Side,  the End of  the inferiour
Part of the Bone was felt,  for thither it
will always have the greatest Tendency\
thelaft is a double Rowler, and within that
half of  it which goes downwards, I com-
prehend a large Comprefs, thick enough
to bring the leffer Part of the Thigh,
toTuch  a Bignefs, as that the Splints
may  bear  equally, and then  finifh  the
"End below the  Knee.  The next in or-
der  are  the  Splints  and   Compreffes :
There muft'be a large Splint fhaped for the
"under part of the Thigh, and about three
mdre of lefs Magnitude, all armed  with
-Compreffes, which for supporting the
"Redudion, are to be tyed fa ft about the
'•Limb with three or  four  Tape  Liga-
V:ijy'li-          :. •*--      •   turcs: 
              (IO? )
 tares: Further,  it is, after this, conve-
 nient  to  kn. >- where  the  Patient is to
 continue, that fo the Bed,  Pillws, Li-
 gatures and ju 4s'-(whie:i are to lay un-
 der him,  in the Ord r they are menti-
 oned) may be placed fo  as fhall  bat
 fuit Eafe and Convenience: For Instance,
 if a Cot be foread over the Bed, if the
 fradured  f high be outfide, and the Pil-
 lows the  Limb rests on very foft,  they
 are  each more  convenient than  the
 Contrary, (for why,) a foft B d  finks
 the Body and  Limbs  unequally,  and
 hard Pillows fit  too  uneafy}  and on
 the other Side,  keep the   Limb  f om
 falling porportionably  with the Trunk,
 both of  them incommodious and hurt-
 ful.
    The  Junks (only  in this  Fradure
 neceflary) are two,  made of Spunge or
 Mop-Staffs, armed with Tow, and row-
 led up in Lmnen or Bunting,  conti'u-
- ous.   The outer Junk muft be longest,
 and reach from  the Ancle to abov; the
 Hip. The inner muft come as near the
 Groin as will confift with the  Patien;'s
 Eafe} both are rowled  up clofe on eaci
 Side,  anc1 faftened  with  the Ligatures
 that lay next under them } at convenient
                    H 4      Distances 
             (  *°4 )
Diftances; Pillows are alfo tied, rounding
upon the Thigh and Leg, and  the Hol-
lows of the  Ham and Heel,  filled up,
to hinder fwaying  either to the Right
or Left.
   The Sole  is of Paftboard cut near the
Shape of the Bottom of the Foot, with
Holes peirced through for a narrow Tape
which  is to be faftened to fome or other
of the  Ligatures that  ties  the Junks}
the Ufe of it is to  keep the  Foot up-
right,  and ftretch out the Tendo Achil-
las, which  otherwife would  probably,
by long laying, contrad.
   There  muft be lastly, fome Contri-
vance  to  prevent  the Weight of  the
Bed-Cloaths affeding the hurt Part: In
a  Cradle  it is done by  a Hoop or two
pafling from one Side to the  other, and
in a ftanding Bed, by  a wooden  Pin,
of a proper Height, fixed at the Feet of
the Bed-Poft*
   Having thus briefly run over the Me-
thod  and  Treatment of a Thigh, the
moft considerable  of  all Fradures,  I
fhall conclude it with an Obfervation  or
two,   to fupply any remaining  Defir
£iency.
The 
             (io5;

         The Firft Example.

  IN the hard Winter 1709, A young
Man of 20 Years of Age fradured his
Thigh by a furging of the Cable, about
four Fingers Breadth above the Knee } I
reduced it,  and  proceeded  in the Me-
thod  before  laid down, only, inftead
of Junks, I infixed the Dreflings with
a Sheet of Paft-Board (that .came from
above the Fradure, to below the Calf)
placed the Leg and Thigh even, and in
a Position eafy to him} kept the great
Toe  in a Line with his Knee, and care-
fully filled up the Vacuities at the Ancle
and Ham with Compreffes:  I alfo  bled
him, and in the  Evening gave the  fol-
 lowing composing Draught.
   R. Aq. Theria. Syr. de Mecon. a. §f.
 Laud.  liq. g.  xvj.   Aq.  Hord. |ij. F.
: Haufi.
   The next Morning I found him eafy
 beyond Expedation,  (the  beft Sign  of
 a good Redudion,) and as it  is an Ar-
 gument of the Dreflings being well ap-
 ply'd, and the Fradure in a right Order}
 fo after fuch Assurance, there feems lit-
 tle more required from us,  or wanting,
  to fuccefs.
                                  The 
                (io6)
    The prefent Cafe,  I submitted to the
  firft  Applications  about three Weeks,
  only attending  to  keep  the  Limb in a
  due Order, and preferve a Conformity
  by a  fmall  daily  Extention:   In  that
  Time he became able  to walk about  with
  ^Crutches,  and foon after  without, which
* .quick, Cementation was  to be attributed
  principally to the Patient's Youth, and
  the Coldnefs of the Seafon.

             Second Example;

     WAS  another  Fradure,  by the fall
,  of a Tent-Pole, above  the  Middle of
  .the Thigh} he ha*d  lain feveral Hours
  in  the Cold  and  Rain before I .was
  brought to him,  and the  Limb  very
  painful,  fliff  and 1  fwelled}^ however,
  with ftrong Extention I reduced it, but
  before the finifhing of the Rowler,' heard
  the Ends  of tne  Bone  grate  and pafs
  one another} from whence it  was  eafie
  to conclude the Work  undone, yet in
  regard to.the Trouble and Pain he had
  fuffered}  I only breathed a Vein, and
  gave  an  Anodyne Draught,  deferring
  Reduction till next Morning.
    Before  the renewal  of my  Procefs,
  I had been debating the Difad vantage of
                                 a cir- 
               (  io7  )
a circular Bandage,  when the  Fradure
is  hgh, there is Difficulty in fupporting
a  Thigh fteady for  fo long a Time, as
it takes up in finifliing: There is Trou-
ble and Aukwardnefs to us in making it,
And  afterwards in  giving  the Limb'a
proper and eafy site }  Disturbances, that in
my  Opinion,  leaves very great Uncer-
tainty,   whether  (after  all  our  Pains)
the  Ends of  the fradured  Bone  meet
one another,  or no}  wherefore,  I con-
cluded  to chanpe  for the 18 Tails,  and
ordered that, and the reft as follows.
   Before Extention,  I placed  the  Pati-
ent in the Cradle he was to lay in, with
the Pillow the Thigh was to  reft on un-
der him}  upon  this, I firft  put  fome
long Ligatures, for  the  Junks, then the
Junks  themfelves }  other  Ligatures to
fatten the Splints, then the large Splint
and Comprefs } the * 18  Tail Bandage
   * The make -of this Bandage is defcribed in the
Chap, of Compound Fractures; and tho' it be called
pf 18 Tails, yet there needs  no confined Number,
but at Difcretion,as may  beft fuit the Security of the
Cafe.  It ihomd be fo contrived,  that  the thickeft
Number of Tails may come on  the Fra&ure, and
 thofe Tails rather too long than ih^rt, becaufe the
■ former (when thought NecefTary) may be fliortened
 or doubled in the Ufing, but there is no Remedy for
 the other, but by changing. In ufing this, the Com-
 prefles mentioned before in the circular Bandage,
 may as conveniently be included here.
                                     next 
              (  io8 )
next, and laft of all a Defenfative Em-
plaifter, becaufe they fo follow one ano-
ther in the Application.
   For  extending,  I raifed his  Leg  and
Knee,  but  a fmall Distance  from  the
Pillow, while another made a  Preffure
or  contrary  Extention above} the Stiff-
nefs and  Tumor became  now  indeed a
great Impediment} but having furpaffed
thefe Difficulties and reduced it, I made
the  whole fmooth, equal and well fup-
ported, repeated  V.  5.  the Anodyne
Draught, and forbid any  other  Food,
than Gruel, Panada, or the like . eafy
Sustenance.
   Next  Morning  I  found a high and
quick Pulfe,  a great Pain and Tumor
about  the Thigh}  but supposing thefe
Symptoms to proceed  rather from  the
repeated  Difturbance given to the Part,
than any Error  in Redudion,  I  would
pot meddle with the Dreflings,  but pre-
scribed as follows.
   R. Aq. Hord^blj. Spt. Nitri. Dul. g. xxx.
cu tantillo Saccharo ut Palatum placeat
fro potuOrdinario. In Pulmento adjicemus
Manna Calab. Syr. Rhabar. cum dehor,
d. 3Ji> autem Alvus non promovens ufum
fiippofiter. Inflititi quod in hoc Cafu pr&
enematibus Exiftvttatus.
                                This 
             (  lo9  )
  This procured a Stool, but he never-
thelefs continued very feverifh, reftlefs
and uneafy} the fucceeding Day I gave
as follows.
   R. Corall Ppt. Ocul Cancror a.^\. Sal
Tartar 9ij. divid in Chartulas 0B0 qua-
rum fumat unam  quatia quacfa  Hora in
Coch. ij.  Julap. feq.
   R.  Aq. Epidem Mirab.  a. Tp].  Aq>
Cinnam. H. LaBis a. §iij. Margarit Ppu
jj. Sachar. Albifs qf. f. Julap.
   R.  Aq. LaBis |j.  L.  lig. CydonidU
g. vj. Sp.  Nitri did g. x. Aq. Mirab 31J.
Syr. de Mecon. qf. Hora fomni fumend.
   I was very doubtful of him for  about
a Week,  but  then the Pain  and Fever
began to mitigate, and the Tumor fall,
after this, with due Management of the
Part he gradually recovered  from  all
thofe  ill  Symptoms,  and was able to
walk with Crutches at the End of  fevea
 Weeks.
CHAP. 
( uo  )
          CHAP.  II.

   Of Compound Fractures

        HE Term of Compound may
          ignify a double Fradure of the
         fame Bone, or when  the Acci«
         dents  of Inflamation,  Eryfy-
 pelas, and confequent Apoftemation, has
 Succeeded to a fingle Fradure} but Cu-
 stom has confined the Appellation ftrid-
 ly to fuch Fradures as  are immediately
 accompanied  with a Wound,  whether
 the Bone appears through fuch Wound
 or no?
   What I have to fay under this Head,
 fhall be on thofe  of them,  that are oc-
 cafioned  by Gun-Shot} where, if  the
 Circumttances and Mothod of Cure be
 well adjusted," there will be  nothing
 wanting to make it ufeful in a compound
 Fradure, from any other Accident.
   Signs.  The Signs denoting a com-
pound Fradure, are the fame with thofe
of a, Simple, only as it is accompanied
with a Wound, we have fometimes to
                                the 
              ("1)
the Impotency of the Member, and our
feeling the fradured Part, the additio-
nal and indifputable Evidence of Sight.
   Prognofticks.  The Danger of  thefe
Fradures is more or  lefs, as the Bone is
more or lefs fplintered, and  its Subfiance
loft, as it is nearer too, or  farther from
a Joint} as the Intrusion of foreign Bo-
dies  is  more or  lefs,  and the Wound
great or fmall,  convenient or  inconve-
nient for their Extradion,  according to}
what Limb it is}  and lattly, as the Habit
is good or bad.
   Remarks on  thofe Prognofticks.  For
firft, if there be a great deal of  the Sub-
stance of  the  Bone  loft, we are appre-
hensive that fo large an Interval or Space
can never fill  up with Callus to fupport
the  Adions of that Limb} what this
Distance  is,  and how  far Nature may
be expeded to exert it felf in the Supply
of a Callus,   I  can from my own Ex-
perience aflign  above  two Inches,  but
have heard Relations, and feen Inftances
of  greater,  particularly at our  Hall,
where a greater Focile of the  Leg was
fhown, from which had been taken away,
of  the Subfiance of  the  Bone, to the
Length of five  Inches, and that  inter-
medial Space  fupplied with  a strong
                                Callus 
             (1")
Callus}  now altho' we cannot rationally
exped  the like Succefs of this  every
where,  yet fuch Examples are Encou-
ragement to wait the Strength of Na-
ture, in  any great  Lofles  of the  Bone,
and  not immediately refort to Ampu-
tation  but to  be armed with Patience
againjt  the Tedioufnefs of  Recovery }
for as the Distance to fill  up is great or
fmall fo muft the Time to perfed it be.
   Secondly,  if a compound Fradure
happen in or near a  Joint, it augments
the Danger, becaufe  the Mufcles there
become  tendinous } and  therefore, firft,
as being endued with  a  more exqui-
site'  Senfe,  the acute  Pain  that fol-
lows, will always  create Fear and Sus-
picions of its terminating in Fever, Con-
vulsions and Death}  nor is this the lefs
to be dreaded if they fhould not imme-
diately fucceed  the Inflidion} for  it is a
common obfervation that fuch Symptoms
are not  the dired and immediate Confe-
quence of Gun-Shot Wounds, but come
after a Time, as the Parts recover their
Senfe, and the Sloughs feparate: Second-
ly, they are dangerous,  becaufe the De-
ficiency of natural Heat will keep them
indigested, and  in  the End make them
fistulous} and  thirdly,  becaufe it h a
                              Chance 
              (us;
Chance if fuch compound Fradures cure
without leaving fome irremdiable Maime
or Lamenefs.
   Thirdly, when much Rag or  Filth
has entered the  Wound, or the Bone is
fo comminuted, as that feveral Particles
and Shivers of it are to be brought away}
a large Wound is  fafer and  more  com-
modious,  for this End, than' a fmall}
and wdiere the  Smallnefs  is visibly an
Impediment to Extradion, as in  Fra-
dures from Musket-Shot,  (whofe Ori-
fices contrad,) there is abfolute Necessity
of dilating.
   But then, it may be remarked of this
Extradion, that  whatever   has  been
omitted of it, at the firft Drefling (which
fliould be  made  prefently on the  In-
fiidion of the Wound) is  better after-
wards left to the expulsive Power  of
Nature which more  kindly thrufts  to-
wards the  Orifice, any  remaining Ex-
rraneofity than  can be effeded by any
dark  Search with  Probe or Forceps,
efpecially in thick mufcular Parts : And
again, there is not a Necessity that every
large  Portion  of Bone,  becaufe  loofe
fhould be brought away,  no, if it  ad-
heres  to  the mufcular Parts,  returning
fuch to  its natural Position,  will unite-,
                    I             and 
             (  "*+■);
and for the fame Reafon as any double
Fradure of a Bone would, there appearing
the fame Necefiity of removing the whole
intervening Portion, in fuch double Fra-
dure, (let the Distance be what it would)
as there does for taking away the former.
  Fourthly, In reference to the Limbs,
considered feveraliy,  one compound Fra-
dure may  be worfe  than  another, the
inferior, thaii the superior  Limbs, the
Thigh than  the  Leg.   A Thigh is fo
unmanageable,  and with ail, fo flefliy,
that any Thing extraneous once lodged
there, quickly Aides through the Intersti-
ces of the  Mufcles, and fo alters its Sci-
tuation, as  makes the finding it  difficult,
and frequenrlv eludes the nicest Search}
however,  in this, or  any other thick
mufcular Part where a Bullet  or other
foreign Body is lodged, we fliould ufe
our utmost and  immediate Endeavours
to furmount  the  Difficulties of Extra-
dion,  becaufe  tho* fuch Extranea have
fometimes lain Years with  little Incon-
veniency to the Patient, there is yet grea-
ter Reafon  to exped that their Lodg-
ment,  (efp^cially  on the  membranous
and tendinous  Parts)  will  be  quickly
produdive of acute Pains, Fever, Spafm,
Convulfions vand  Death.
                               Intcn* 
              (  "5 ),
  Intentions  of Cure. The  Rules and
Method of treating a compound Fradure,
may be comprehended under four Inten-
tions,   fome   of  which  regards both
Wound and  Fradure, as they are con-
sidered  together, others  the Fradure
only, and they are,
  Firft,  The  ExtraBion of  extraneous
Bodies } fecondly, ReduBion -, thirdly, Re-
tention, and fourthly, the preventing and
correBing of Accidents.

           Firft,  ExtraBion.

  Firft,  The  Extradion of extraneous
Bodies is our  firft and immediate  Care,
and is by no  Means  to be deferred, left
the Tumor and  Stiffness of the Part
prove afterwards an infuperable Difficul-
ty:  In order to it, the Patient is to re-
fume as near as he can,  the  Posture he
was fhot in}  and the Mufcles being as
yet pliable and foft, there is great pro-
bability our  feeling  and Instruments to*
gether, will  inform and  help  us to get
out all foreign  Bodies,  with Eafe,  the
fame Way they  entered}   an  Incision
(if needful) may be made to facilitate it,
but if it has near made its Way through,
it will be propereft in the opposite Side,
                    1 2             or 
              (n6)
or where  it  would have  patted if the
Force -had not failed.
   In extra ding thefe Bodies, the  For-
ceps mould not be opened till you touch
them, left you indole fome Flefh or Ten-
don, that  will both frustrate  the Re-
moval and give unneceffary Pain.
   When all  is extraded, that is within
reach of  your Fingers  or Forceps, it
maybe proper toinjedfome warm Wine,
or the Decodion of fome vulnerary Herbs,
to  bring  away any remaining  indifcer-
nable Ossicles or  Bits of Garment.

           Second, ReduBion.

   Redudion  follows Extradion, it  is
the Reposition of the fradured Ends of
the Bone, fmooth and  even, performed
by a due and fteady Extention}  but of
this,  I have  fpoke  fufRciently in the
Chapter  of simple Fradures, and fhall
therefore  decline any Repetitions, and
come to the Retention of it when redu-
ced, in  which we take a different Pro-
cedure.
Third, 
               f."7)

           Third, Retention.

   Retention of the Bone in  its Place,
consists, I think,  in nothing more than
a proper Bandage and  Position of  the
Limb:  To  anfwer the  firft  of thefe
Intentions,  we  always chufe  that  of
18 Tails, for the Conveniency and Eafe
of daily drefling the Wound.
   In using this Bandage,  the Middle, or
undivided Part of it, is to lay underneath,
or as opposite to the  Wdtind, as you can}
and tint it may be kept longer clean, we
are, after every drefling, to interpofe a large
Comprefs between  the Wound and  it}
and upon  that Comprefs again, it  will
not be amifs to lay  three or four other
Linnen Splenia fecundum Longitudinem,
for the better  Support of the  Fradure.
  * This Bandage is made of three Doubles of ftrong
Linnen fown in the  Middle, and divided at each
End with two Cuts of your Sciflars, a fit Depth.
  There is another Way of making it, and which I
think better anfwers the Purpofe, and that is, tearing
otf 9 or 10 Lengths of Linnen ; thefe arc fpread with
fuch an Edging to one another, as may make  the
Breadth of it fuitable to the Length or* the Limb
fractured, then an entire Piece bf Linnen, of the fame
Length being put  on them, they are together fown
well down ui the Middle.
                  I 3                All 
All thefe to be retained  with the Row-
ler,  each Lamina  of it enfolding  the
other ^ regularly,  and  that  done,  the
Limb is to have a Scituation, foft, fmooth
and equal.
   I fhould, before applying the Bandage,
have given the Drefling  of the Wound,
as what mutt  precede it} but as it re-
quires  a  daily  Renewal,  and   as  the
Treatment will contribute very much
towards  preventing any ill  Accidents,
the Order and Alteration of fuchDref-
fings,; from Time to Time;, will be more
methodically obferved under  our next
and last Intention.

          Fourth Intention.
  Preventing and corr.eBing Accidents.
   THIS is an Intention of large Scope
and Implication, including in  it the Me-
thod of Cure  for every  Accident  thofe
Fradures can  be fubjed  to}  I fhall  in-
sist here only  on thofe  peculiar to it,
as compounded, and refer my felf for the
reft, to what has been, before more am-
ply delivered of simple Fractures.
   When to the Greathefs of the  Hurt is
joined  either  a  bad Habit of Body on
the Patient's fide, or ill Management  on
the Surgeon's, there frequently and  al-
                                 most 
              O'9  )
 moft unavoidably succeeds Pain, Tumor,
 Qonvulfion, Eryfypelas, or Mortification.
   Ill Management of the Part,  is prin-
 cipally the Surgeon's Care  to  corred,
 and in which he fhould be  the more fol-
 licitous, not  only becaufe  Negligence
 refleds difcredit, and expofes to  a Pro-
 fecution } but  becaufe it  mutt be his Skill
 in a proper Treatment  of  the  Part  it
 felf, that will  moft effedually  prevent
 or remove all dangerous Symptoms } and
 for this End,  when  alarmed  with any
 unufual Appearances, he  fliould look back
 on  the  three former Intentions,  how
 well they  have been comply'd  with }
 whether skillfully managed or not: Ei-
 ther the Bone  lies uneven  and diftorted,
 having  jagged Ends that become uneafy
 to the flefhy Part they reft on } or, what
 we ought ftill to be jealous of, fome ex-
 traneous Body, yet behind, pricks on the
 foft  and fenfible  Parts  exciting thofe
 Symptoms} or lastly, that our Dreflings
 are difagreeable,  either  as they refped
 the Wound or the Fradure.
 '  In anfwer to thefe, firft, if any acu-
 minated  Particles of Bone  is by its Con-
 tiguity  visibly (as in laro;e compound
fradures they often are)  the  Occafion
of Pain, Tunaor or  Infiamation, it  is
                  I 4           eafily 
             (  lao  )
easily removed  with Forceps and  Sci£
fars } but when this  is not fo  apparent,
(the Narrownefs  of the Wound, feclu-
ding Infpedion,) and yet. the Symptoms
ftill  fo increafe as to give juft  Appre*
henfions of it}  or that fome loofe Body
remains ftill behind, covered from  our
Sight: I fay, when we have this Mistrust,
and thus reafonably grounded, the Que*
ftion occurs, wrhether the Wound fliould
be dilated, or no, for the Removal of it?
Becaufe  the  prefent  Circumstances  of
Tumor and  Inflammation, in  my Opi*
nion, make a wide Difference  from  the
Wound firft received.  For the  Difcuf-
sing  of this,  it will  be proper to ftate
the Inconveniencies on either Hand} if
fuch an  Incision cannot be propofed, as
will   render  the  Search  lefs difficult
and  difappointing,  as  fometimes  the
Depth neceflary, and Parts to be divi*
ded, make a Question, (efpecially among
large  Arteries  and Tendons,)  then we
muft avoid it.   The Symptoms will be
aggravated from the very Thing we hoped
a Remedy, adding Pain to Pain, and in-
creafing the Fluxion: But on the other
Side,  if an extraneous Body be evident-
ly lodged on fuch fensible  Parts, as irri*
tate to  thefe  Accidents,  then  dividing 
that Tendon, Nerve  or Artery, to ex-
trad it will be of lefs noxious Portent,
then  permitting  the  Exaggeration  of
Symptoms that diredly tend to the De-
ftrudion of the Patient.
   My own Pradice has been after a di-
ligent Search and Extradion at firft, to
leave the  Remains to the Expulfiori of
Nature,  by  an Apofteiriation, assisting
hereto by anodyne Administrations, mild
Cataplafms of Farina Avinac. and a foft
quiet Position}  for there is no fear that
the will ever fit down eafy with fb inhos-
pitable a Gueft:  Nature will, as the is
wifer than we, effed the Exclufion of
it, in her own Time, by a  gentler and
easier Way, than making a blindfold In-
cision.  The only Inconveniency of Abf-
ceffes here (wThich is indeed a very great
one) is, that the  Matter of them (in
fpite  of any Means to prevent it)  will
Aide  between the broken Ends of the
Bone, and caufe them to foul and exfo-
liate }  yet even this may in a great Mea-
fure be avoided by making a Vent in fome
depending Part,  and diverting the Dif-
charge } fo that on the whole, I conclude,
it is  fometimes fafer  trusting to Nature
than our felves.
Secondly, 
              (  ***■)
  Secondly, the Dreflings to the  Fra*
cture maybe hard and ill apply'd, which,
if fo, muft be amended in thofe Refpeds,
or our  immediate Application  to  the
Wound, may be difagreeable and excite
Pain, &c.  by being  improper in their
Nature, or unfeafonable in their Ufe.
  All  thofe are improper in their Na^
ture,  that harden the Efchars, and ren-
der  the Wound  crude  and indigested,
fuch as fpirituous  and abstersive Appli-
cations  which  Serjeant  Wifeman, in his
Treatife  of  Gun-Shot  Wounds,  con-
demns in  a very plain parallel Cafe, for
fays he, take an IsTue  made by a C^.u stick,
and after  you have cut  through  the Ef-
■char;,  continue but to drefs it hot a few
Days, with a Pea  dipt mTinB.  Myrrh*
and it will not be  unlike thofe Wounds*
Inflame and Tumefy, if not Gangreen }
what > has led fome  to this Pradice,  he
fays,  was the Blacknefs and  ill  Colour
of thofe Wounds,  which did  not ill re-
femble a  Mortification} but  tho' there
may be an Extindion of Heat,  it is su-
perficial and very unlike that} and lam
convinced the beft and quicker Way  of
recovering it again, is by good  Fomen-
tation  to  cherilh the Heat, and,.-imme-i
diately to the  Wound it felf, Lenients
                                  and 
              (  I!?  )
and Digestives} but thefe again, we muft
mind, will be unfeafonable in their Ufe,
when  they encreafe  the  Matter  too
much, or give Rife to a Fungus. .
   For a Digestive, N°  25, or R. U.Ba-
Jilicon ^iv. Tereb Ven. Linimt. Arcei. a.
gij. 01. Hyperi. §f. M.
   This (having firft  dretted  the Bone
dry) is with Pledgits to be apply'd warm
over the reft of the Wound, a  Comprefs
out of Spt. Vin. is to cover them, and
then your Splenia and Rowler, as before
delivered.
   When the Efchars are feparated, De-
tergents muft  fucceed  to  cheque the en-
creafe  of Matter: Incarnatives and De-
ficcatives to thern again in their Order,
but of this,  more in the following Ob-
fervations.

            Firft Example.

   A Compound FraBure of the Leg. Was
of a Man aged 28, who received a com-
pound Fradure of his Right Leg,, by a
Splinter in an Engagement with the Ene-
my :  The Wound was  large and com-
modious for Extradion,  and through it
I prefently brought away feveral loofe
Pieces of Dirt and Boce} there was one
                                larger 
              (  *H )
larger thbn the reft, which not  being
feparated from the Membranes, I replaced
and found afterwards to unite with  the
whole: After having cleared the Wound
of Extranea,  I found  the  Ends of  the
Bone  near two  Inches afunder, a  Di-
stance that furprized a little, but having
known as large a Void  as  this, to  fill
with Callus, I refotved to wait the Event
of Nature in it, and preferve the Limb,
if poflible.    The  Bone I drefted with
Tinct. Myrrh, the Wound with the fame
Digestive,  and the Fradure with  the
fame Compreffes  and Bandage as above,
taking particular Care in the Scituation
of it, that the Ends of the Bone pointed
to each other, and  that the whole  lay
fmooth.  The better alfo to keep off a
Fever with  its Train of Confequences,
I bled him, kept him to diluting Drinks,
and a very fpare Diet.
   In a Fortnights Time, I found fome
of the Efchdrs feparated, and with them,
at feveral Times, OJficles^  he varied  in
his  Difpofition during  this,  and was
fometimes very eafy, and at other whiles
jfullof Pain and feverifh } at length both
encreafing on us, a  Fluxion of Humors
at onCe  diftended the  Limb from  the
JCnee to the Ancle, a considerable Quan-
                                  tity 
              ( I35  )
tity of bloody Serum  difcharged from
the WTound, and fome fmall Veficulu arife
about it.
   I began now to repent of not  having
amputated  this Leg at  firft, and had
done it now,  if  his Fever and  Weak-
nefs had not put me in Difpair of Suc-
cefs, and  therefore almoft hopelefs  of
any good Iflue, I applied round the whole
Limb, the Cataplafm of Farin. Avinac.
N°  33, and  prefcribed internally the
Cortex, as follows.
   R. Pul Cortic. peruv. 9ij. Syr de Me*
con qf. F. bolus fexta quaq. hora fumend.
 Super  bibend Cochlear Julap. Analeptic.
 N° 9.
   This, I found on the  firft Opening,
 had made a vast Difcharge through the
 Pores,  and confiderably every Day after,
 which, for that Reafon, I continued al-
 ternatively with Fomentations,  till the
 Limb was entirely disburdened} when
 the Wound  became  clean, the  Tumor
 fallen, and the Fever  gone off,  I made
 him a laxative Drink, and returned  to
 Incarnatives} thefe filling the Wound too
 fast, gave me a tedious Trouble  again in
 the Exfoliation, but that at laft  being
 obtained,  we cicatrized  the whole  in
 about three Months.
                                Second 
              ( i36;

          Second Example.

  A compound  FraBure of the Thigh.
Three or four Days  after the taking of
a Prize, we  had a  Prifoner brought on
Board with a compound Fradure of the
Thigh } the Bullet had entered on the
upper and outward Part, wounding  the
Membranofus and other Mufcles, but did
not pafs through.   Before his  coming
here, the French Surgeon had extraded
fome Bits of Garment  that was carried
in by Force of the Blow} but the great
Pain that continued, efpecially on any
Motion  of  the Limb,  the  Tumor,
Inflamation, and Way of receiving  the
Wound, gave  both him and I juft Rea-
fon to  fufped  the Bullet and  other  fo-
reign Bodies,  ftill  lodged within, con-
firmed  every Day  more to us,  by  the
Pain and Fever increafing, and abun-
dance of bloody Serum from the Wound.
  As the Cafe appeared with all imagi-
nable Danger  to the Patient's  Life, I
proposed an Incision,  as thinking  we
could never  incur worfe Accidents {how
deep or large  fo ever we made it)  than
what  threatened us already}  but  the
Gentleman  being of Opinion fuch In-
                               cision 
              (}*1)
cifion would be giving unneceflary Pain,
and  that the  finding  the  Bullet under
thefe Circumstances,  would be  almost
(if not altogether) as difficult after  as
before,  we declined it,  and  gave inter-
nally Anodynes,  and the Mixtura Febri-
fuga in temp eft ivis*
   To  the Wound we ufed a fliort foft
Tent,  moistened with a Digestive, an
Embrocation of Ol. Rofar warm, and the
Cataplafma  refolvcns,  the Bandage  for
a compound Fradure, and a proper Sci-
tuation.
   The Pain,  notwithstanding,  became
in a manner agonizing,  and  what com-
pleated the  Misfortune, inftead of In-
cision a thick dry Tent was. thruft in to
dilate  the Wound, and give free Vent
to this  bloody Serum,  which  was now
in greater Abundance.
   This had all  the ill Effed that could
be,  the Tumor and  Inflamation were
extravagantly  encreafed by next Day,
the Limb convulfed, and  a fpafmus Cy-
nicus followed.
   We made a warm Embrocation of the
affeded Part,  and down the  Spine, with
Ol. Rutp, Succin. a.p. &. breathed a Vein,
and gave a  quieting Porion, but to  no
Purpofe }  he continued  fo 24  Hours^
                                 and 
              ( 1*8  )
 and died  the  fourteenth  Day from re-
 ceiving his Hurt:  What I fhall further
 remark from this and other the like Ob-
 fervations 1 have met with, is, firft, that
 in Gun-Shot Wounds of the Nervous,
 or other very fenfible Parts} their  worst
 Symptoms feldom  appear immediately,
 becaufe, as I take it, the Efchars fupply
 for the prefent,  that  Fence they  natu-
 rally had againft  external Injuries, but
 when thefe  are  feparated, they  become
 expofed to the Intrusion of  Air  and
 more inimical Applications,  (fcarce any
 Thing agreeing with them,) and  then
 Convulsion, &c. enfue.
   And fecondly, when Convulfions do
 happen, particularly the Spafmus  Cyni-
 cus, it is of fatal  Prognoftick, even when
 the Wounds to all outward Appearance
 are very inconsiderable.

   A Compound FraBure of the Cubit.

   T. T. received a fmall Shot through the
 inner Part of the Cubit, about four Fin-
 gers Breadth below the Joint, fraduring
 the Radius: After I had  extraded  what
 Bodies I could  find, that were  carried
 into the  Wound, (which were many,)
I drened each Orifice with a fmall  ihort
                                Tent. 
             f  129 )
Tent  in  a Digeftive, applying an Em-
plafter, Comprefs and Bandage as has
been repeated, and placed it to his Breaft j
for a few of the fucceeding Days, I made
Ufe of a Fomentation, and embrocated
the whole  Fore-Arm with  a Difcuti-
ent Liniment to further  Digestion,  and
refolve the Hardnefs  of the Tendons
that accompany'd it} but Pain encrea-
fing,  an Inflamation fpread it felf to the
Joint, poffefling almoft the whole infidc
of the  Arm.
   I made feveral  Scarifications round this
inner   Orifice,  and fomented it well,
which  had the  defired  Effed, gave a
Breathing to the Wound, and in a few
Days the external Efchar feparating, the
Tumor diflipated}  I  then  altered my
Dreflings by  Addition of Pals, virid. to
mundify  and hinder too quick a filling
up of the Wound*  which would have
impeded  the  Extrusion  of  fome little
Jaggs  of-Thread and Rag, that  I now
and then  obferved  to come  away with
the Difcharge: When that Fear was over
I threw out the Tent and cicatrized.
  ' I fhall finilh this Obfervation and the
Chapter, with an Excursion on the Ufe
of Tents.
K              Mr. 
              (  I?° )
   Mr. Bellofte condemns them  heartily,
 he fays, the End propofed by them vi&a
 keeping open the Orifice of the Wound,
 conveying Medicines fo  their Bottom^
 furthering the Extrusion  of extraneous
 Bodies,  and imbibing the Matter geneV
 rated, are fo far from being  performed^
 that they are an Impediment to it} and
 to prove this, he abounds with Relations
 of the contrary  Confequences,  to  wit,
 great  Pain,  Inflamation, Convulfions,
 Abfceffes, Gangrene, finuousand fiftulous
 Ulcers.
   But Nbtwithftanding his  Authority,
 I  think  they are not to be  univerfally
 exploded,  a  foft and  fhbrt Tent for a
 Time  is  in niany Cafds not only ufeful
 but neceflary ^ thofe ill Symptoms he in
 fo many  Obfefvatiohs repeats  to  have
 happened  from  them, have  had other
 conjoint  CastfeSj and when  apply'd to
 Tents, fhould  rather have been afcri-
 bed to their too great Length, Thicknefs,
 Hardnefs  or  Continuance,  for  in thofe
 refpeds they Jmay, and frequently are ex-
 ceeded to a FadJt.
   I fhall reduce the whole of this Sub-
jed into two: .general Cafes, where the
Ufe of Tents feems  prepoflerous,  and
yet in which they are the moft (tho'
                               inex- 
              (1*1)
 inexpertly)  ufed,  and  that is when the
 Quantity of Matter in  a Wound or Ab-
 fcefs, is very large, or when it is little
 or nothing.
   In the firft Cafe, Tents manifestly do
 hurt,,the Matter being pent in, as it were,
 With a'Spiggot, and tho'we fhould make
 them fmaller than the Diameter of the Ori-
 fice of theWound, yet they by imbibing the
 Matter, fwell up to it, and equally hin-
 ders the Vent and Eruption, and from
 this  Retention  both oh Account of  the
 Pain it gives, (and alfo of that Maxim,
 that Corruption breeds  Corruption,)  the
 Quantity will  be increafed,  and  of Ne-
 cessity  tranflate it felf (when thus flop-
 ped J elfewhere,  and  fo Apoftemation
 on Apoftematiori,. may prove the Re-
 ward of  our  Inexperience} whereas,
 throw afide Tents, and only make good
and  advantageous Compression in your
Rowling,  and there is no fear of  the
Wound or Abfcefs clofing, till emptied
 of all or moft of the Pus or Sanies, col-
leded} but if there fhould, Dilatation
by  Incision  better fecures   our  Fears,
and will be a much more elegibie Expe->
dient againft it, than  Tents.
  Again in the other Cafe, when there
is little or no Matter,  and the Wound is
                 K 2            what 
what we call indigested, the  Hurt that
Tents  do is obvious}  for as  it is the
Pain that attends Wounds, which makes
them, for the firft Days after Inflidion,
a  little  inflamed  and  tumefy'd,  and
which, in other Words, is but the croud-
ing of  Humors,  or Dittention of the
Veffels  from that Attradion,  foft and
eafy Applications  difpofes  the  Wound
to digest, and thofe Accidents   to  dif-
perfe  and diflipate} but if by a wrong
Method  (fuch as Tents) we pervert Na-
ture's  Operation,  the fenfible Parts are
further irritated and Painencreafed, &c.
   It will be neceflary then, in thefe two
common Cafes, and alfo in very fenfible
Parts, wholly to  abstain from  the Ufe
of Tents, but in  penetrating,   and in
deep Flefh Wounds, where the  Quanti-
ty of Matter generated, will of Necef-
fity be out of Proportion to the outward
Orifice:   Soft fhort  Tents  helps the
Digestion of the   inward Wound,  fur-
thers the Extrusion of extraneous Bo
dies, and  conveys the Medicines proper
to abfterfe,  cleanfe and  heal.
Exam* 
(  *33)
              Example.
  ApenetratingWound of the Thorax.

   IN GAGING a  Privateer in  the
Tartar Man of War, 1707, James Smith
("one  of our Seamen) received a Muf-
quet Shot thro' the Thorax} it struck on
the Body of the right pedoral Mufcle,
and paffed  out clofe to the fifth or fixth
Vertebra of the Back, breaking off Part
of their  tranfverfe Proceffes, as appear-
ed by feveral  Oflicles difcharged  after-
wards at that  Wound}  I imagined this
being the lowest of the  two, the Erup-
tions from  the Thorax would have been
here} but it not proving fo,  I fhall only
take Notice,  that  it healed in a Fort-
night  or three Weeks, with as little  Pu-
rulency  as might be expeded  had it
been only fuperficial.
   The  Stress of the Cure  lay  at  the
Orifice before, which I fhall the more pre-
cifely examine : I extraded thence, at the
firft Drefling, fome Bits of Rag, which
had entered with the  Bullet, and were
within View,  dipped my Tent in warm
Ol. Tereb.  becaufe  of a little  Bleeding
that appeared, a Ceratum Diapalm. over,
placed him in  Bed, half ered,  but lean-
      •              K  3           ing 
              f 134  )
ing  towards the Wound,  blooded and
prefcribed as follows.
   R. EleB. fmcaftor. 7f.  Antim. Dia-
phoret. gr. x. fiat Bolus fuperbib.  Hauft.
Sequent is.            '.•'.'" '
   R. Herb  PeBoral pj. Radliquirh 2J.
Sem calid. £f. caquant in Aq. Hard lbii(j
Colatur add. Vin. Alb. §iv. Mell Anglican^
qs. propotu  Goimtiune.
   For the  firft Week the Patient was
feverifh, fpit now and then Moody, had
a  very large -Tumor  fpread over tk
whole Breaft, made up of extravafated
Juices, that  might be felt fluctuating bet
*ween the Mufcles .}  and what was worfl
of all, a DifSeharge of fix or eight Oun«
ces from the Wound, at every Drefling;
(which was twice a Day) of a-bloody
Serum, fometimes mixed "with Grains of
a  flefhy Substance,"'that, prostrated his
Strength and Appetite,  and made hiiri
Mm.       ;;•/. ;
   The Question now  turned, whenea
this Difcharge- was > whether: beneficial)
And  the Service* Tents contributed to*
wards it? Neither of them,  perhaps, im-
proper to expatiate on in the Pf dfecution
of this Cure. And firit, The Difeharga
was  partly  external, might  be  judged
by the daily finking  of the Tumor on
                                  the 
             (  '35  >
the Breaft,  and yet the Quantity,  Li-
quidity,  and particularly  its, Expulsion
on the Patient's coughing,  were convin--
cing Proofs the greater  rart was  inter*
nal: How it fliould rather take' its Courfe^
this Way, th^n fall on the Diaphragma,
is, I think,  evident, not only in that the,
flatter of it was not from the Cavity,
but Subfiance of  the Lungs, and from
the peculiar iMake and Adhejjon of thgt
Bowel to promote  it} for if they are not
immediately tied to the Pleura,  yet they
have fp clofe  an Adherence (efpecjally jf
tumefy'd)  as makes the Wound but one
continued Orifice,  or conduit from with-
out into their Subfiance, demonftrable
by the Force the  Air  comes out with
when  they are penetrated, which woul£
rpe fcaroe perceptible, wlere the Wounc}
there to recede any Way from the exter-
nal one, arid again, wlere they pot clofe
to'the Pleura, more than does, wou 14
fall (between it and the outer Membrane)
pn the  Diaphragma-,  but by  this, apt
 and convenient  Scituation,  and  peculi-
ar Make, (feparate little Lobes,) it comes
 to pafs, that when the  internal Mem-
branes  and Vesicles,  constituting  their
 inward Subfiance, are swelled  and  load-
 ed  with extravafated  Juices,  from the
                   K 4           torn 
              (1 36)
torn lymphatick and  capillary Veffels }
that the dired  Courfe of throwing off
this Incumbrance,  muft be through the
Wound }~and the Breast being more di-
latable than the hind Part of this Cavity,
their expulsive Tendency is  more  that
Way,  and therefore the Wound that is
forward,, though  higher, can, arid will
better  (with ,.a proper Posture)  diveft
them of  any  extravafated  Load? than
that behind, though inferior.
   Hence  we  may learn, that whoever
fhall endeavour to  pervert this Courfe
of  Nature, in  Wounds of the Lungs,
under Pretence the muft be relieved by
an  Empyema, difcharge, by Urine,• Ex-
pedoration, &c. n*mt"inevitably hur-
ry on fatal Symptoms,  since none of thefe
Ways  can difcharge fo much  or fo  fea-
foriably as' is  requifite} arid  alfp  that
thofe dp endeavour it, who obftrud  this
fiatural Courfe at the Wound,  with large
£hick Tents," and tort Bandage.'  ',  .
  Secondly, as to Tents, how arid" in
what Manner they were ufeful here, and
thar'was by keeping the Wound  open,
they facilitated the  Expulsion of thofe
"tinctured  Scrofities,  and' Bits, 'of 'ftferii-
brane  fha't I, have obferved difcnarged
from within,  arid "at, the" fame Time, 
              (  '37.;
conveyed a proper Medicine to the Bot-
tom  of the  external Wound,  for for-
warding the Separation of the Efchdr^
which being always fponeft  at the out^
ward and moft expofed Part: It would
have fell out had the Orifice been dref-
fed only with a  Pledgit, that the  Efchar
had  come away  fooneft  there,  and fa.
contrading,  had prevented, or at least im-
peded the neceflary Work of Extrusion}
they were ,. therefore. highly  neceflary j
and  my Manner,: pf making them more
effedual at  this  Time, to the Purpofes
intimated,   was  to have them foft, flen-
der, of a-Length, flfort of the  Thick-
nets of the  containing Parts, and dipp'd
in a warm  Digelfeve  of U.  Baftlc. OL
Hiperic. a. p. a.  -I left a Thread to it
always, made Illiniation over the Breaft,
a large difcutient Emplaifter,  and thick
linnen Compreffes, braced on with a flan-
pel Jacket.
   I hive hitherto confidered the Pati^
ent  only, to  the  firft Period of feven
Days}  it remains to  give other  Obfer-
vations in the Sequel of the Cure, - par-
 ticularly as they relate to the Tents,
   About the feventh Day, the Air came
 out at the Wound,  with considerable
 Noife and Force, which, till then, had
                                 been 
              (  i38)
been fcarce  perceivable, either  becaufe
the Patient's want of Appetite, and Weak-
tiefe, made the Office of the Lungs per-
formed lefs laborious and eafy} or that the
Efchar Gun-Shot leaves  obftruded  its
Exit} or laftly, that Pain and the Tumor of
the Mufcles contra ded it closer} or per-
haps altogether, and  now as the Tu-
mor began to difcufs,  Appetite and Ex-
pedoration mend,<ahd the  Efchar to
drop off, the Air and Extravasation had
a freer Paffage,  and-the  Difcharge lef-
fened.
-About the 14th Day,  the Difcharge
having diminiflied:cortfiderably,  and a
Digeftibn appearing (gi the Tent, I  ra-
ther lengthened-: it," atod  fprinkled the
upper  Part (as often  as wanted) with
3ri Efcharotick,  -to  prevent the Orifice
contracting  toof faft,  and-  for laying a
Foundation of 'Incarning from  the Bot-
tom j every Thing now  contributed to
help us, for after two or three  Days
more,  fcarce any Thing came away at
the Wound with coughing, and having
a  plentiful  Expedoration,  and  fome-
times a thick  muddy Urine }  I  endea-
voured to aflifl thofe favourable Evacu-
ations, with  pedoral Drinks, Apozems,
&c. fhortening the Tent gradual lv,  and
                                   at 
              ( '39 )
at the End  of  a Month or  five Weeks,
threw it quite  out and healed.  He con-
tinued,  after this, afflided with an afth-
matick Cough  for two or three Months,
but recovered of that too at length, and
remained only impaired in the Motions
of that  Arm.
  From thefe latter Periods of the Cure,
we may farther obferve concerning thefe
penetrating Wounds by Gun-Shot.  That
they are lefs dangerous than Wounds by
jharp Inftruments, becaufe the Cekrity
of  their Flight makes a fuperficial Ex-
tindion of Heat, which, lies as an  Ef
cfcar  oV cover on the torn Veffels, and
whichis thrown off by a fucceeding Sub?
ftance that  dpfes them.  .  ,
■s;jorif
CHAP. 
               (  H°)




           CHAP.  IV.     '     ;

      0/ Amputation5.    °

   %^ N this Operation, the#firfl Thing
      ;g we ought to have in9Intention,
  sp&s?*1 is the stopping of the Blood, that
 fo. when Excision is made of  a  Limb,
 we may not be at a Lofs for the Apparatus,
 nor a Prefence of Mind to apply  it:
 Too copious a Flux may not only be of
 immediate Hazard, but by difpiriting a
 Patient,  and abating of thofe  Supplies
 every Part fliould receive,  fubject  the
 Stump hereafter to the worst of Symp-
 toms, viz. Pain, Indigestion and Mor-
 tification. *rr-*^:  "..,'"    '>".
   It is  therefore  a neceflary Interrup-
 tion to adjust  now,  the pjopereft  and
 fafeft Way of flopping the M&morrhage }
 that at the*Operation  wq rrjay not feem
 plunged in Difficulties, a„Thing terrify-
 ing to a Patient, and of great Difadvan-
 tage to the Succefs of it.

'"                             There 
             (  Ht  )
  There are three Methods in Pradice :
The firft is  by Medicines Aftringent or
Styptick.
   Second, by  Cauteries adual or po-
tential.
  And the  third is by a Deligation of
the Artery.
  Firft,  Aftringents.   In this Clafs we
may reckon all  Earths,  Terra Sigillat.
Lemnia,  Pul.  Aftringens,  Bolus  Vera,
Sang. Dracon. Flor. Balaufi.  All Vine-
gars and rough  Wines,  and  to fpeak
generally,  all fuch Things as are  dry,
and have an Afperity of Tafle} alfo Me-
dicines of a gummy, flicky or glutinous
Nature, fuch are Whites of Eggs, Hare's
Hair, Aloes,  Thus, Myrrh  Terebinth of
all  Kinds.  The  Manner  of ufing the
Powders, is mixing them  to  a Consist-
ence with Oxycrate and Whites of Eggs,
and then fpreading them thick on Pled-
gits of Tow.
   Astringents,, when they are moft  fuc-
cefsfully ufed, are not from any irrefifti-
ble Stop,  their Stipticity  can make  to
the rapid  Current  of the Blood  thro'
the Arteries which is  abfurd, but  from
the Circumstances of their Application}
 For when thick  Pledgits  are ufed, one
comprefling another, crofs  Cloaths and
                              Rowlers 
              (  H>  )
Rowlers on them again, ftraitty. bound
on: The Stump muft needs be as fecure.
from a Flux, as if a ftrong Compression:'
were made with the Thumb immediately
on the Veffel it felf*
   Ol. Terebinth,  is  of general  Estima-
tion among Astringents } Mr. Toung ce-
lebrates it extraordinarily in feveral Ex-
periments he made} in the prefent Cafe
he explains its Operation in thefe Words^
That it reftrdins an Hemorrhage by con-
traBing the Orifice, and begetting a firm
Coagulation of the Blood, which Coagu*
htm,  he  thinks, probable, heals the Ori-
fice   of the bleeding  Veffel,  either by
uniting its Coat, per Symphiftn, or by Con-
carnation,  i. e. begetting fome interme*
diate Subfiance, which it will nimbly do.
   And I muft confefs it an excellent Me-
dicine in Amputations, not only in its con-
flringing, as effedually as any other of
the Clafs, but principally  from the ad-
mirable Property it has of restraining that
frequent and troublefome Attendant a Sy+
novia.
   The juices effusing  and maturating
on the Stump,  being by a skilful Ma-
nagement thereof,  justly proportioned
(thro' the whole Cure) from the  Ex-
tremes of Indigestion and Putrefadion:
                                  But 
              C r43  )
But whoever hopes more  from this,- or
any other Astringent, that is, fhall ex-
ped  their bare Application fufficient to
refift fo impetuous a Motion, as the Blood
flows with, through the crural or axil-
lary Artery,  builds on a very  fandy
Foundation,  and  will, on  tryal, find
himfelf deceived. .
   Befides, Astringents ufed  alone, have
thefe further Inconveniences.
   The firft  and greatest is,  our being
neceflitated to make a  very  ftrid Ban-
dage,  and  that  efpecially   with fuch
whofe Crafis  of Blood is hot, thin and
ferous} the  Confequence of which  is
prefent exceflive Pain, and often in the
Sequel Mortification.
   A  fecond  is,  that  there  being con-
feffedly only a Coagulum, on  the  Orifice
of the Veffel, by Astringents}  it is very
 much to  be  feared the  firft  Dreflings
 (clogged  and cemented by Heat and the
extravafate Blood) cannot  be removed
 without  occasioning  a frefh   Flux }  or
 fhould that  be  avoided by a cautious
 handling and  undretting the  Stump, yet
 there  ftill remains Danger from the Pul-
 fation of the  Artery, the Obstacle it has
 to break  through, being weak, when
 the other Fences of Rowlers and Com-
 preffes are removed.               And 
             (  'W  )
   And therefore Thirdly, for Security,
.we are obliged to  make a crofs Stitch,
to let  the firft Drefling abide longer on,
and perhaps to fatten on the Turniket at
undrefling} all which contributes to give
unneceflary  and greater  Pain, to dimi-
nish  the  natural Heat  of the Part,  and
to occafion Faintnefs and Indigestion.
   The fecond Method for  flopping an
Haemorrhage in Amputations is cautery,
potential or adual: Thefe  fecure from
bleeding,  by the Efchar they make on
thejOrifices of the Veffels.
   The potential Cauteries are lefs eligi-
ble,  as their Bffeds are  more tragical}
they gnaw and corrode on  the Ends  of
the Nerves and Tendons, and fo infinu-
ate and fpread their Malignity,  that you
never  fail of extreme  Pain  from them,
a  large Synovia, and  too often Fevers,
Convulfions and Death, as may be eafily
concluded from the Tribe of them. Aq*
Fortis, Ol.  Vitrioli, Mer. Sublimat. cor-
rofiv. Arfenic. Chalcanth.  Vitriol, r. &c.
   If ever you fliould be engaged to their
Ufe, the Pul. Vitriol. Roman, is the rea-
dieft and beft:  A thick Pledgit or But-
ton is  firft to be preffed out of warm OL
Terebinth, and  when  fprinkled or dip- 
              (  H5  )
ped in this Powder, applied to the Mouth
of the Artery.
   The  aduai Cautery has heretofore
been of common  Ufe  in  thefe Opera-
tions,  tho'at  prefent exploded, and by
the beft Praditioners rejeded by Reafon
of  the  Terror ^nd Anguilh  conveyed
with it}  yet may this*  in fome Refpeds,
claim the Preference both of Astringents
anK&eligation, becaufe, althp* applied
to the Orifice of one  Veffel, it  Influ-
ences  thofe  of the whole Stump,  not
only giving a violent Contraction  to the
Coats  of the  Artery touched,  but the
Meinbranes nigh the  Contad} fo that
the Veffels pasting  through them, have
their Diameters leffened, if not clofed.
  > And this cannot be faid done in Deli-
gation, fince there we  only tye the  (in-
gle and larger. Branch  of an Artery,
leaving the letter to common Applica-
tions,  from which  may fometimes hap-
pen Danger, and more  particularly when
the Blood is thin and volatile.   An adual
Cautery is here likewife a Prefervative
againft Mortification.  Firft, by  its Ef-
char,  and  fecondly by invalidating the
Neceflity of ftrait Bandage.
    To ufe the Cautery  aright,  there
fhould be a flat Iron  Plate  to preferve
                    L             the 
 the  adjacent Parts, with a Hole  thro*
 the  Middje, made fit to receive the End
 of the" heated  Button  on the Artery}
 and in applying  it we areIJto obferve,
 'that if not hot  enough, jit  makes'no
 Efchar, giving only unnecessary Anguifh
 to the Patient: And on the other Side,
 if too hot, it then makes an 'Efchar in-
 deed/ but feparates and loo.fens.it at'the
 fame Time, :the Security intended being
 either  Way  equally  eluded:  But this
 -is" an  Inconvenience1 that may be  ob-
 viated  hy1 a quick or flow Application,
 *asr the  Surgeon fhall -judge to  the Degree
 bf Heat in fiis Button.1  ri ^f:-!  r
 5V: The third and 'fafeft' Method againft
 an Hemorrhage,  is tying' the Artery} It
 hasi justly the Preeminence in Practice,
 neither carrying  the' Dread  a Cautery
 <does, ner  the  Infeclirity mentioned  of.
 Astringents: It can orilyfc£ unsafe, when
 by a mistaken Method, the Knot is flip-
 ped'over  the* Forceps, (inftead of pier-
 Icing the circumjacent Fledf,) which fort
 '' of Knot, indeed, the Piilfation of the Ar-
 tery foon  throws  off:iL^   '*• '
   * The proper and fecufe  Way  of De-
 ligation, is-thus:  Firft,'a  loofening  of
-the  Turniket being made, and the Arte-
' ry difcovered1 by its Impetus,  you imme-
                a              diately 
              (  H7  )
diately lay hold of it with a fpring For^,
ceps}  and having the Arterial  Needle
ready armed, with double Silk, and wax-
ed, you  are  to pafs  it round,  taking up
a fmall Circle" of  Flefh, nigh the Mouth
of the Artery, then  comprehending a
very fmall Linnen Comprefs between the
Tye and it, you  make faft with a clofe
double Knot.:) v     n
  Some  are  of Opinion that the larger
Portion of Fiefli you include within this
Circle, the  fecurer  muft the Artery: be
from bleeding, becaufe ("fay they J Na-
ture takes up a longer Time in fepara?]
ting  a  great  than a finaller Portion}" a
Reafon.not ofJ, much Weight, for how
fmall foever is the Portion of Flefh in-,
eluded,   yet  being  fufficient  to flop a
prefent, it will be fufficient to prevent a
future  Flux}  becaufe any  Portion when
tied'and feparated thus from the Life of
the whole, rjs thruft off by a Syffarcofts
of. Concarnatipn  }   and ^therefore  the
Mouth of the Artery muft*bi^as fecurely
fiiut up  by  that  intervening, Subfiance,
at the  throwing f off a fmall as  a great
Portion.-:) }h  ;;      ■  *. i.. '*n
, What may be added to either of thefe
three Methods, as Co-juvant are V.Sedi-
on, Enema's, cooling Emulfions, Opiats
*m\                'U 2            or 
or'other  different Means of Revulfioti
and Derivation.

           The Operation.

 - Ttt ERE  is a Neceflity for this Ope*
ration, either when a Limb is fo* fil-
tered  by a Shot or Splinter,1 as to be
plainly  paft a Pcflibility of Re^uelwrVj
dr when a Wound (tho' not large) hap-
pens in a great Joint,  fuch  as the KMee
or Elbow, whence acute Pains arid Con-
vuMons are excited, (or probably would
be) endangering Life} arid  if healed
be not only  ufelefs,  bur troublefome i
or laftly, when  any  fcreeeed'rWg tturt
or Drfremper has1 induced aSrihacelatiott i
Thefe a*r£ other Cafes that m#y iridic
re Amputation,  but it* thef^there  is hfo
tk Room' for  Strlpence.
   ITbtrf  Apparatus ftiould be  \M  in
three Ditties, the firft fhoifH hold ydur
fhftrurrrrerfts,  Kttffe, C8flin,  Saw, Ar-
terial,. Forceps attd Needie} the feeetto*
a firit Pfedgft or two, half at ftor6 othefa
tmte of foft Tow awd different Skes.
and with them a large round  one caHed
a Cap, fpread with fome aftringent Wafs
to cover  tht reft } arid in  the third
your Rowfets and  Crdfs-Ckftfr.
                               Jhus 
             (  H? )
   Thus ready,  your Patient  fhould be
placed on a Stool, both that he may be
fupported behind,  and that the Aflift-
ance about you may be more commo-
dioufly ufed} as to  the Surgeon's Po-
fture, it may differ to advantage.   When
there are two Bones to  divide, the in-
fide is undoubtedly heft,  becaufe  taking
the leifer Focil with your Saw at the
fame  Time, with the greater, there is
not that  Hazard of a Fradure or Lux-
ation} but if your  Amputation is to
be made above the right Knee or Elbow,
then your  right  Hand fhould  be  out-
ward,  you have greater Liberty in this
Pofture,  more Scope for performing the
Operation, and ftand  better for applying
the Drettings.
   We begin  with fixing the Ttirniker,
and  for  this Purpofe,  having  drawn
the Mufcles tort upwards, we enfold the
Thigh or Arm with a thick linnen Com-
prefs :  If it be the Thigh to amputate,
we put alfo a Wadd under this enfold-
ing Comprefs, on the inside, for a  bet-
ter CQmpreflion  on the larger Veffels
that defcend  there \  then  placing the
middle Part of the Ligature exadly on
jt, the Ends are brought  over the Com-
prefs with a double Hitch, and being
                L 3             tied 
              f'5°y.      .
tied down to the upper or outward Part
of the Thigh or Arm,  the Turniket  is
put in and twitted to a Degree fufficient
to check  or interrupt the Courfe  and
Motion of the Blood.   . This Ligature
ought to be a Silken, or other Cord  that
is not too hard, but very, ftrong, for  if it
fhould break  in the Operation, (unlefs
ycjii are very quick in fuppjying its want
with  a ftrong Gripe,)  your  Patient  is
infallibly loft.
   Befides thefe, we fatten two other tape
Ligatures, at the very Place we are to
make Amputation,  leaving only room
between them for the Knife to go round:
The  Ufe of thefe  are tp fwell the Flefh
to  the Knife,  and guide it  for a smooth
Circumcifion, which you are now to make,
bringing it at once  as near the Bone as
you  can, and as far round: What  is
wanted of a  compleat  circular  Cifion,
you are  to fupply with another Stroke
of the Knife or Catlin}  with which lafi
alfo you  are  to feparate the Flefh from
between  the  Focils, and clear it for
the Saw.
   The Saw is to be fet  on both Bones
at once, (if two,) and divided at as few
„ Strokes as poffible, taking heed in the'
Divjfion, that the nearer you come thro',
;'  .                               the 
              (  15«  )
the eafier to move, least the Bones fhould
Splinter}  if that mould happen, there
is a  cutting Forceps  defcribed  in the
Chyrurgia Curiofa Tab.  2d.  proper for
pinching fuch  Proceffes off.  ,
   Where the Bone is Angle, we chufe to'
take a Piece of firm Cloath to hawl up the
Flefh from the Saw, (the Bone proving
always  better   covered  for  it} ) it  is
made by  only flitting to the Middle, '
the Slit falls oh the Bone, and crossing
the Ends underneath, you ufe one Hand
there, the other above: In doing all this,
a Limb is to be kept fteady and firm by
an Afliftant at  each Hand of  you, or in-
ftead of them  (when it is a Leg  to am-
putate) that  Inftrument in  Chyrurgia
Curio fa Tab.  4.  made  in Shape of  a
wooden  Leg,   and fixed  to a proper
Heighth for resting the Ham in.
   The  Limb  being off, I fhall foppofe
the Haemorrhage  has  been  ftopp'd by
Deligation  (the Method moft  approved)
and  proceed to the Remainder of our
Work, viz. the Dreffing and Bandage.
   The Ends of the Bone are to be co-
vered according to  Custom,  with dry
Lint, (ficcdfiecisGaudent})  and  to the
Artery  we apply  thick round Pledgits,
dipped in warm Ol. Terebinth, one on
                L 4    ' s    another 
              (  i53  )
 another, to render it ftill the fecurer }
'for as that will be the deepeft Part of the
 Stuinp where the Artery is, fo without
 this Caution  of raiting it, at least, to a
 Smooth,  the Compreflion  in  rowhng
 would be least where  it's moft wanted ;
 The reft of the  Stump alfo we cover
 with an anfwerable Number  of Pled^
 gits preffed out of the fame, over them
 a large Cap armed with fome aftringent
 Mafs, a Bladder  of the like  Dimen-
 sions,  (made pliant by immersing in
 warm Water,) two long Compreffes to
 crofs on  t]ie Stump, and come  a Hand's
 Breadth or more apove  it, and to fatten
 all two Rowlers,
  I  chufe to ufe both of them  tingle
headed:  Tfye firft is  fhort  and  begin-
ning clofe to the Edges  of the Stump, is
Shifted witftfix or feven Turns upwards}
the other is very long, and having beguq
witji  a Turn  or  two,  at a convenient
^feigW,  is  immediately  carried crofs
the $tump as  high on the other fide, an*}
fp jetufjaed feaekwds and forwards over
ajipapfcjcjfik  as oqr Length will  ajlow^
teferving only fo  mucli at laft as will
fatten, with fix or feven ftreight Circinrv-
yolutjtons to m,ake the whofe fit fmooth
ancl equal} if it  be a Leg, the Knee
                              fhould 
             (  153)
fliould be always bent before Rowling,
Otherwife the Joint contrads a  Stiffneft
that  will difficultly fubmit to  it after-
wards.
   To cure an  amputated  Limb,  our
Endeavours are in the Beginning to pre-
vent  Pain and Fever, and  to  procure
Digeftion} in the Progrefs to hinder a
Fungus and Exfoliation } and laftly, to.
produce a fmooth  Cicatrix:  The attain-
ing thefe feveraj Ends,  refting chiefly
in the Management of the Stump, is th^
Surgeon's peculiar Province, to which
I fhall principally confine my felf.
   Our first Dreflings have this  in parti-
cular, of being  always found  troubler
fome to remove, for the moift and aque-
ous Parts of the Blood  being diflipated
by the Heat of the Part, the remaining
Coagulum receiving fome Mixture of the
Ol. Terebinth, cements them like Glue;
However,  since  it muft fce done,  we
facilitate our  Work, by fquee^ing out
Spunges of warm Water on them, tijl
they grow fupple, and are throughly tna«»
laxed}  any Roughnefs in bringing them
away would endanger a frefh Flux, fo
would a Fprnentation t0° f°°tt ufed, be-
caufe the Warmth of it relaxes the  folid
                                Parts 
              (»54;
Parts,  and  makes  tne  Motion of  the
Blood  in the Artery stronger.
   The first opening of. the Stump fhould
be in about 4a Hours from the Opera-
tion, and the Drefling then changed for
a Digestive.
  $L Ung. Bafdkon Ibf.  Liniment Arc At
§iv. Ol. Tereb. Lini <&> Hyper, a %j. M.
  Or the unguent. Digeftiv. N° 25.
 To be renewed every twenty four Hours
after,  to be applied  warm and quick,
in a Place least expofed to Air, and when
done, the Stump placed on a foft Pillow,
with a little Elevation, and kept Mode-
rately warm.
  At our next and future Dreflings,  a
Fomentation may be  ufed, defigned  to
give a Perfpiration, and cherifh the Heat
of the  Part which of Confequence pro-
motes Digestion.
  In a Week more  or lefs according to
the Age  and Difpofition of the Patient,
a good  Digestion succeeds,  on  which the
Pain  affuredly remits,  and the  Fever,
which was only fymptomatical, vanifhes}
at  this Period  therefore  there ought  to
be a remarkable Alteration of our Dref-
fings, our great Care  becoming now to
prevent a Fungus and  an Exfoliation  of 
              (  '5+ )
the Bone, neither of which can be betT
ter anfwered  than  by forbearing any
further Ufe  of greafy Applications, for
fuch allowedly do both}  they foul the
Bone  by increafing  Corruption,  and
render the Flefh  foft and  fpungy: But
then, tho'an Alteration becomes necef-
fary to leffen too great a Difcharge, and
prevent or remove a beginning Fungus:
We muft  not on the other fide do  it,
for Medicines too aftringing } for when
the Quantity  of Matter  is  large, the
giving too  fudden  a Check  to it, will
Occafion  Apoftemations,;  Tumors  and
painful  Contradions  of  the Mufcles.
Those that I have ufed  and found befjr.-
to anfwer againft fuch Confequences, are
 the following.
    R.  Spt. Vini. Aq. Fontan. d. p- a. cum
 Mell Rofar. Edulcorat.
    R.  DecoB.ext Herb is Foment at. §viij.
 Aq. Regin.  Hungar. ^iij. Ol.  Tereb. §j.
 M. pro ufu.
    Vel fy.Vlegiata tepide expreffa a Fo-
 tu Fortiore.
    Thefe, or fuch like being moderately
 Aftridive,  engrofs  the Blood as it were
 from  flowing to the Part, in a greate.*
 Quantity then .is  requifite for its Nir
 tntipn}.and are alfo a fit Drefling  foi 
              ( »5«  )
 the Bone,  as  preventive of its  Exfolia-
 tion, as dry Lint can be, of which fome
 are fondly superstitious, and is a Choice,
 in my Opinion, more or lefs indifferent,
 as a Bone is to be a letter or longer Time
 expofed.
   Where the Bone is tingle, and weh3ve
 made Ufe of that Cloath abovemention-
 ed,  it generally appears fo well covered
 after, and  guarded from the Intrufion of
 Air, that Exfoliation is often prevented,
 or (which is the fame) becomes infen,
 Able} and on the other fide, where fuch
 a Caution cannot take Place,  (as  in the
 Leg or Cubit,) The Bones become necef-
 iarily prominent,  and  expofed to  the
 corrupting Quality of the Air, and  Flu-
 ctuation of Matter,  both which concur
 to render fuch  Prevention, difficult, if'
 not impoflible, nay perhaps it would ra-
 ther expedite the Cure (in thefe  Cafes)
 if we helped  (from the Beginning) to
 foul it with the fame  greafy  Applications
 we ufe to the Wound.
   There is another obfervable,  or two,
 to  be heeded in this   Progrefs of the
Dire, and  they are  thefe. s
   Firft, that Edgings be constantly ufed,
fpread With V. Deficcat. for facilitating
and bringing tlfe Dreflings off clean and 
              ( '57  )
eafy,  and forwarding the Cicatrix, to
which will very much contribute alfo a
good  Management of the crofs Cloathj
lenclofe the four Ends of two fuitable
Lengths of Cloth, under feveral Turns
of the Rowler above, and then crofting
the Oppofires on one another, contract!
the Lips of the Stump daily nigher.
   The fecond is to mind the Incarnation
do not fwell in one Part,- and fink in ano-
ther,  but that the whole have a fmooth
and eefual Surface, an End that muft be
anfwered  by the different Applications
of Incarnatives  or fipuloticks.
   Digeftien and Cicatrizing  being the
two principal Ends perfued in the Cure,
I  have  ihdwh how the Obftacles of
Pain and Fever to the flr-ft^ and o£Fuh-
gm and Exfoliation  to the latter, may
be beft avoided or remedy'd as far as
our Dreflings  and Management of the
St^irip can do  it: It remains  in the fe-
cond  Place to make thefe local Applica-
tions  more effedual, that we prefcribe
a Regularity in the  Non-Naturals, and
give convenient  Internals.   The  Pati-
ent fhould be kept in a warm Air,  in an
eafy Posture, free from Paflions, and with
a  fpare Diet at firft, and Phlebotomy,
Enema's,  Anodines,  cooling  Emulfions
                                 and 
              (  '5«  I
and.Julaps,>adEniniftered as they are al-
ternately indicated }  a few of the eafieft
Preparations are as follow*,'v»r
   For an Enema, R.  DecoB. Cly/ieris*
^W). Butyri  Saliti, Syr Rofar. a.\{. 01.
Anift £f.  v  j h:                     'K
_ Jc. Enemacommun. N°  18,
   R, Decoct* Clyfteris.  %jc.:0l,Cha7ft*m.
&icchar, Culinar.  a. 5fi.0nfi Gutt viij.
JEgrum in dextrumlatus ejfe] Collocandum
& upide inject. , jii. <    ; j          rb
-Foran Anodyne.  R., Laud. Londi-
nenf gr. ij. exhibehd.j Hpra fomni.
   Or, R. Eleft^Fraifcaft&r Tfi. laud. liq.
Gutt xij.  0/. £#«> Mofchat. g- j« ^
;  R. Aq*Cerafi)rMig, %ij»}Aq»Cinnamom*
Fort.Epidemia,"Q]. laud. liq.GUtt x. Syr.
deMe con. £v j. 'A F. hauftus Efctd. Decu-
bitus fitmend. \\ <jl  ■.  i-ji..  a -  I  *
ok For an Emulfifin..  R. AmygddL  Dulgt
Ejccovticat. Sem. Pap aver. Mb. a* §f» -SW-
f^^r. ^//^.  q*,-s. Gontundamtpfr deinde ad-
ditis Aq. Hord. %i\. fiat emulfio}C;apiend.
fizpain.die.,, jLnj       .fi  worn   .ii]
f :R. AmygdAlanDul.  Excorticdt. Sem.
^Erigid.  a 7^]. Sac char. Alb. q. s, opti-
ma  una contufis fenfim affunde Aq. Fon-
tan thij. colatur. :fortiter. Exprefs," adde
Aq.  Epidem.^.fumend. ad libitum.  \   .,
i; For a Julap, R:. Julap*. Analeptic.   [
tfii                               Or, 
              (  L59 i
  Or; R. Julap. perhttn: Fulliana.
  Thefe or the like will be wanted moft
in  the Beginning of the Cure^  while
Pain, Fever and Faintriefs  afflids the
Patient,  and  the Stump is indigested*,
but  as th£fe are found to remove, thofe
may  be  laid afide again, and a greater
Liberty in Diet  affumed}  yet ftill  un-
der   fuch  Rule  as  may beft fupport
Strength, and  yet not generate a Hyper-
farcofts; which too fall feeding will.
   I proceed now to:an Obfervation or
two, fbr*fupplying whatds; defedive in
the general Pradic^ particularly to fhow
what different Confequences I havefpund
under either  Method  of'flopping5 the
Hemorrhage.        .:'  ':■
              -. :t.wo-.     ■;y.s
     .  Obfervation of the  Leg. .\
   I HAD my Dreflings prepare^in the
Manner before obferved and amputated
at five or fix Fingers breadth below the
Knee, ftopp'd the Hemorrhage by Deliga-
tion, applied Pledgits of warm Ol. Tere-
binth, z Cap armed with Aftringent, <&c.
   For the Evening after the Operatibh,
he continued  very chearful,  in a Man-
ner thoughtlefs of the Lofs of his Limb }
but next Morning I found he hid been un-
eafy,  reftlefs,  and  had a high  Pulfe,
                              jblaufca 
              (  160  )
 Naufca arid Thirft} an Alteration com-
 mon indeed, after fuch Pairi and Expence
 6f Blood arid Spirits,  and may furnifti
 out two RemarkB}  firft, That the Heat
 arid Surprize in Adion makes it the pro-
 pereft-Time for amputating, Men meet-
 ing their Misfortune with greater Strength
 and Refolution,  than  when  they have
 fpent a Night  under Thought  arid Re-
 ftedion}  and fecondly, that a fympto^
 maticil Fever,  more or lefs* is  the sure
 Confequence of this Operation*
   The prefent Patient I blooded, gave
 him diluting Drinks, the following Ju-
 lap, and for two or three Night fuccef-
 lively  the Pategdrick  Draught, at the
 End of the Book.
   sJc.^Cinnam. Fort. Theridca. a. %]. Aq*
 Hord. §viij.  Sal  Abfynth.  3j.  Syr. Li-
 triom q* s. F. Julap Dof. Cochlear ij. per-
 "vices frequent es.
   With thefe* and a Fomentation to the
 Stump every Drefling,  we in  lefs than a
 Fortnight brought on  a tolerable Dige-
 ftion, the  Fervour and Inquietude  by
 that Means  gradually  vanifhing,  Cir-
 cumstances that always indicate to me an
 Alteration of Drefling, and which, ac-
cording to my  conftant  Pradice  was
thus.
                              I fpread 
              (««-;
   I fpread my Edgings with U. Diapam-
phol.  and  covered  the  interfpace with
Pledgits preffed out warm from a ftrong
Decodion of the Fomentation Herbs, re-
ferved clear for that Purpofe, and  mixed
with  a third Part of Spirit of Wine or
Brandy.
   The Reafon of this Alteration foon ap-
pears  to thofe acquainted with Pradice}
for when Digestion is obtained, and the
Fever abated or gone, fhould you continue
to Unguents and Digestives, the Stump
would be> foon over-run with  a Hyper-
farcofis, not only unsightly, but a very
great Impediment in Cicatrizing, obliging
often to the Ufe of a vitriol. Stone, or
other painful Efcharotick to keep an even
Surface neceflary to advance the Cicatrix.
  The Pradice above prefcribed, had here
the desired Succefs, the Flefh was render-
ed hard and ruddy by it, hindered in too
quick a Growth} the Wound kept clean,
and Nature left to proportion out  her
own  Meafure  in   the  Difcharge,  the
Stump from that  Time  visibly leffening
every Day.
  As it contraded into a fmaller  Com-
pafs, I found my felf obliged to wait for
an Exfoliation, which, in the whole took
up about feven Weeks, throwing off then
                    M             in 
             (  i*a  )
in a deep black Scale} after Which I met
no other Impediment,  purged him once
or twice and finifhed the Cure.

      Obfervation the id, and ^d.
John Rice and William Smith.
   IN the  fame Adion  nigh  Genoa,
March'1710, I had two other Amputa-
tions of the Leg, the Stumps of Neceffi.
ty fhorter  than  ufual^ .and flopped the
 Haemorrriages with Vitrfplum Romanum.
   The, Patients felt from  the Beginning,
a more than  ordinary Pain,  quickly in-
ducing Fever, and  the Confequence of
that large  Quantities of indigested Sy-
novid  from the  Stumps,  which,  by the
Way,  kept alfo  rigidly ftreight,  as tho'
. convulfed : Effeds that might, perhaps,
in Part, proceed from  our dividing the
Mufcles too  near their tendinous Infer-
• tions  at.the Knee, but no doubt  were
chiefly imputable to'the Efcharoticks.
   I endeavoured to relieve and strength-
en Nature againft the Affaults of Pain
by V. iSedion, Eneriias,  Anodynes and
 contemperating Julaps} and to the Stumps
an afliduous Ufe of Fomentations and
emollient Embrocations, preferving them
from  the  Air  and  Cold,  as  much as
poflible. 
              ( ,63  >.
  After a Fortnight, this was the Issue*
From one of them we never had any
true Digestion, emitting, inftead there-
of,  a deal of thin Gleet,  and ,at  length,
from the extraordinary Pain that continu-
ed with it,' a large Tumor formed round
the Jundure,  filled  with the fame in-
digested fort of Serum,   which the na*
tural Heat  was too weak to concod*   I
opened the  Tumor, and  on a Difcharge
of it, the Pain and Fever feemingly re-
mitted, and with warm Fomenting, gave
hopes  for fome Time of Succefs} but
an  obstinate Loofenefs fupervening  thro*
his  fretful and uneafy Temper, he" ;kept
languifhing for about a Month with  it,
and died,- >
  The other,  tho' much older,  Was  of
better' Habit,  and  by the fame . Means
that had proved unfuccefsful there, this
Stump was at length brought to Dige-
stion,  and  thence forward .cohtraded
every Day, which  for three Weeks af-
ter  Amputation had been indifcernible.
  What  I fhall farther  take  Notice of
from this fhort Stump is, that although
the  Joint  had  continued painful and
inflexibly ftrait forfeyeral Weeks, yet
as the'Wound closed into a lefier»Coua-
pafs, and covered the Ends of the Ten-
                    M 2         don* 
             ( i«4)
dons with a Cicatrix,  it gradually fup-
pled and became-eafy.        .s...

         Obfervation  the \th,
         Captain Walpole.

   THIS  Gentleman had  likewife in
the fame Action, the right Cubit fo fhat-
tered as to be paft any Remedy but Ampu-
tation •, A chofe to do it above the Elbow,
-becaufe the Fracture reaching very near
the Joint,  would* not admit the sustain-
ing it againft the Division of the  Bones
below.     .t   '} c'
   The firft Dreflings to flop the Flux,
was only  hot  Ol. Terebinth :  After
viewing it a Minute or two, and no
Stain appearing on the  Rowler, I con-
cluded all was fecure, and caufed him to
retire  to a Bed nigh Hand, from our
Hurry  ana4 Confusion  with the other
Wcunded.  After he had lain fome Time,
I  was  alarmed with the  News of a
frefh Haemorrhage,  and found at  lift-
ing up  his Arm,  fo great  a Quantity
had ifliied through the under Part of
the Dreflings (unheeded either by him-
felf or  Servants,)  that  when I came to
him, I found his  Speech faltering,  his
Countenance very  pale, and  fo faint 
              (,i65)
with the  Lofs of Blood,  I feared his
expiring.                     ...
   On  Circumttances  fo furpnzing,  I
faftened on the Turniket again,  dired-
ing a Cautery to be heated over half a do-
zen  Candles,  (and  finding  when the
Dreflings were off, the Blood to be thin
andferous, ouzingthro' the Veffels not-
withstanding the ftrideft Compreflion,)
I applied  it,  and as it happened  to be
with the  Cenfure of  fome fuperficial
Men,  I muft  obferve for their  Inftru-
dion (if this falls  into their Hands) that
Obloquy  is the beft Means they have to
recommend their Skill}always to fubfli-
tute it where  Capacity  is. required} is
a furer Way  to fucceed with weak Un-
derstandings.  A covetous and ungrateful
Temper!  The Patient, at taking  off the
firft Drefling, was faint and qualmifh, and
the  Stump,  thro' Stridnefs of Bandage
or Defed of Spirits, blittered  and exco-
riated }  thefe  I covered with  XI.  Album
fpread on  Linnen, fomented the  Stump
well, and dreffed with a warm  Dige-
ttive, endeavouring to relieve the other
with Cordials} and afterwards his  feve-
rifh Intemperature, by V. SeBion, an
Enema  and Emulfions.
M 3         I fliould 
             (  166  ;
  I fliould alfo,  for the fame Purpofe,
and to quicken Digestion^ have allowed
him more liberally in eating and drink-
ing, the  Fever and Danger of a Morti-
fication here,  being  plainly from a De-
fed of Spirits}   but  the contrary Rule
obtained,  and  he confined  altogether
from  his accustomed Way of Living, to
the flender Sustenance pf Gruel and  Pa-
nada;  till he perceived  himfelf starving,
and was perfwaded and  relieved, by re-
turning fo a better Allowance.
  It was a Fortnight from the Operation,
before we perceived  any Thing like a
Pus  from the Stump, an infallible Indi-
cation, when it  appears  that the Pain
arid Fever mitigate, and with cherifhing
would quickly vanifh:  But here  again,
prepofteroufly changing too foon our Di-
gestive, for Dreflings of Aq. Caleis, a ri-
gid  and  painful Contradion of the  ex-
tenfor Mufcles enfued, and which I thus
account  for } that  in Operations  like
this,  accompanied with great Pain, Na-
ture always  direds  a greater iVffluence
of  Blood to the Part} and when  by
foft  and proper Applications its Con-
version to Matter is aflifted, the Cure ad-
vances with safety and  eafe } but if the
unfeafonable Attrition  of  a ?s led icine 
             (  l67)
(Aq. Caleis)  denies this Liberty, and
gives a hafty Check to the Difcharge,
perverting, as it  were,  Nature's Courfej
then the Blood that was was wont  to
undergo this Mutation, flops  and riots
in the Mufcles,   producing fometimes
fuch painful Contradions  as  we  here
met  with,  and   fometimes Apoftema-
tions.   Agreeably to this Reafoning,  I
fhould therefore have  returned  to our
Digeftive, and took off the Reftraint in
Diet, (he was again put under  on this
Account,) but the Accident being ridi-
culoufly afcribed to the Cautery, Relief
was  attempted only by emollient Fo-
mentations and Ointments,  both indeed
of Service,  but  lefs fo, without thofe
other co-operative Helps.
  If a Cautery  exaggerates Pain, and
retards Digestion in the Beginning, yet
when the Efchar  is feparated, and the
Stump clean, it  fhewes a weak Under-
standing,  to  aflign fuch a Reafon for
their Continuance afterwards} and when
Digestion is large, there is more to be ap-
prehended from a Deficiency than Excefs
in Feeding.
  The Tumor and acute Pain (with few
or flight Intervals of  each J  continued
for  the  Space  of  a Month,  notwith-
                M 4        ftanding 
              (  .68)
 ftanding the aflidnousUfe of Emollients,
 and continual reclining of the Stump on
 a foft Pillow} but  at length the Cica-
 trix drawing in,  thofe Accidents gradu-
 ally diminifned.
   Our last Alteration was a Pledgit of
 Unguent.  Diapoinphol.  compleating  the
 Cure in eight  Weeks, but without Ex-
 foliation, which became  the Occafion of
 fome  after-trouble,  the  Bone at feveral
 Times for four Months,  throwing off
 fome  fmall  Scales:  Their firft Notice
 was by a light Pricking  under the Skin,
% which growing  ftill more troublefome,
 would make their Way  through : After
 this the Cicatrix remained firm.
Of 
 Of A  MoRTIF I CATION.

       Mortification being what I have
         feen frequently  happen  after
         an Amputation} it may not be
         improper in this  Place to fub-
joyn the Caufe and Cure of it.
  It is divided into Gangrene and Spha-
celus, which differ only in Degree, the
one being an Incipient (i. e. has invaded
fuperficially,) the  other a perfed Mor-
tification.
   In a Sphacelus, the Part is altogether
void of  Heat or Senfe,  even the Nerves
and Tendons,  and  therefore paft any
Remedy  but a new Excifion: In a Gan-
grene  it is not fo, yet dangerous  accor-
ding to  the  Advance it  has made to-
wards that, and feizes (as Mr. Wifeman
fays) in  an Order of Progreffion: Firft,
the  foft and flefliy Parts next the Ten-
 dons  and  Ligaments,  and laftly the
 Bones, but  herein  that Author is Mi-
 flaken,  a Gangrene fometimes inftead of
 last, beginning firft at the Bone.
 
              (  *70 )
   To  a right Understanding of this
truly direful Difeafe,  and the Remedies
for  it,  we muft learn to diftinguifh be-
tween what is an OEfthumenos (or ten-
dency  to) and  what  is really a Gdn-
grehe,K hecaufe ' their Treatments  fhould
be entirety oppofite.
  A Tendency to,  or the Fore-runners;
of a Mortification,,  are great Pain, in-
digestion, abundance of thin Sanies from
a Wound} a large Tumor, either Phleg-
mo»nide-or Eryfypelatous, and accom-
panied  with a Fever.  Now in  what-
ever  Wound or  Ulcer thefe Accidents
happen, if they fliould be  immediately
treated  as a begun  Mortification,  viz.
either with  Precipitate,  in hopes  to
thicken that Sanies  or Ichor, to a Dige-
stion, or with ftrong Fomentations to
the Wound, and Cataplafms of Theriac.
Venet & Spt. Vini mixed, (as are com-
ly ufed}) the Irritation they give would
increafe  the Fluxion beyond what the
Weaknefs of the Part  is able to encoun-
ter  with, and confequently suffocate its
Heat} fo that what we feared, and  as we
thought, where a refitting comes upon us,
i. e. PutrefaBion and Gangrene}  con-
rrarily  therefore  we  fhould treat fuch
                              a Ten- 
              ( 17' V
a Tendency with Lenients,  our Bufi-
nefs being here to  contrive what  may
foften the Acrimony of Humoursrrelieve
the Tenfion of the Solids, and  eafe the
Pain, as the  beft  Means  to promote
Digestion} which under the Symptoms
aforecited muft be attained, or the  Part
mortify: The beft  Medicines  for .this
Purpofe are the  mildest and leaft irrita-
ting }  foment only with a Ample De-
cndion of Sage or Elder-Flowers,^and
-r#at purely to give a Perfpiration} to the
Wound or Ulcer,U. Bafilic. Dijficat.rub.
a. p.  a. and  round  the whole apply
the following Cataplafm thick,  it is not
inferior to any.
   R. Farina Avinacea cum tantill.  Croe.
Bui Hat ad Confiftentiam Cataplafma fini->
ta adde Axung. Porcin. ^j.
   To thefe muft be added proper Eva-.
cuatiorisro divert the Fluxion} to which
likewife will contribute a fpare Diet and
an Anodyne now and then.
   If this Tendency or OEfthumenos end
in a Mortification, the Signs that evi-
dence it, are a pale and livid Colour of
 the Flefh and Skin, Veficles fpread up
and down, and a finking of the Tumor}
 but chiefly it is known from the  little
                                Share 
               ( n*)
Share of Heat, Senfe  or  Feeling, that is
found  in the Part,  and the fetid.Smell
that arifes in  Proportion  as thofe  are
extinguifhed.
  To apply  this more  particularly  to
Amputation : A Gangrene when it suc-
ceeds that Operation, is  either through
Age, ftriB Bandage,  A-bilious,  or other
vicious Difpofition of the Blood.        <
  Firft, Age Occasions it  thro' a Pau-
city of  Spirits, the Symptoms foon dif-
playing themfelves after  the Operation;
for when Men are already funk with
declining Years, their  Spirits on fuch  an
Operation,  naturally recoil, as it were
inwards, to fuccour the Principals, and
keep up winking Life, whence the Stump
becomes deprived  of  that  Supply  on
which the  Life of it depends, and fo a
low  Pulfe,  Qualms,  Faintings,  Con-
vulfions and cold Sweats enfue,  which
in a fhort Time terminates their Mifery
in Death.
   Secondly, ftrid Bandage is  a com-
moner Caufe than the former,  and Oc-
casions'it in Amputations, by intercept-  ^
ing the Blood and Spirits repairing thi-
ther, whence the Life of it is  cut off:
The only Signdifcoveringto us, a Fault
of this Kind,  is the acute and vehement
                                 Pain 
             (  '7?)
Pain that instantly fucceeds  tort Row-
ling } I have  known it fo great,  as that
a Patient has chofe to  undo the Bandage
(tho' at the utmost Hazard of his Life,
and  earnestly  fo  forewarned)  rather
than endure the  Agonies induced by it}
nor will it be advisable to preach Pa-
tience  and Resignation,  where the Pain
continues more  than ordinary  fharp,
and  we have any Room to fufped it pro-
ceeds  from  the  Bandage} for tho' the
Rigour andV iolence may feemingly abate,
it will not always be found owing to a
Virtue in Philofophy but a Mortification.
   Whence Security againft a Flux fhould
never  be owing to ftrait Bandage, and
when we fufped it is,  fhould  make pro-
per  and  immediate Relief.
   Thirdly,  A vicious Difpofition or  ill
Habit, no otherwife caufes a  Gangrene,
than as it brings on an Intemperies, Tu-
mor, Inflammation, &c. which at length
may fuffocate and corrupt the  natural
Heat.
   Let what will be the Caufe of a Mor-
tification, or let  it foon or late  take Ef-
fed, the Cure or Recovery is the fame }
which, that we may the better compafs,
we  are to understand, that  whatever has
once mortify'd,  must and will  feparate 
              .t  '74 )
 and caft off in Sloughs} fo that when
 It is faid fuch or fuch Means are proper
 with a Gangrene,  it is not meant that
 the Part fo mortify'd is recoverable  by
 thefe T nings, but only that they  ferve
 to prevent the farther fpreading of the
 Putrefaction,  and  that they haften the
 Separation of what is already dead} and
 thefe are internally Alexipharmaticks.
   ft, Lap.Contr. Terva. ty.Bezoar Or/-
 entaj^f.Cochinel. gr. xij. divid. Chartul.
fex quorum unam fumend. 4 quaq\ Hora
 Superbib Cochl. ij.  julap feq.
   ft. Aq. Epidem. Theriac. a.  %j. Aq.
 LaBis Cerafor. Nig. a. ^iij. Syr. Caryoph
 %j.Lap. de Go a Conf. Alkermes a. 3C M.
 F.  julap.
   Or inftead of thefe,  any other alexr
 iterial Medicines, Variety whereof may
 be  found  in Mr. Fullers  Pharmacop*
 Extemporan. his Pul. Contra Terva  C.
 his Puf. Peftilential. Pul. Alexiter. Bolus
 Cardidcitr, Julap. Id at 6CC
  They  help in  this Cafe, by refitting
Putrefadion  and strengthening the Spi-
rits againft contagious Vapors.
   Externally  a Cure  will  depend  in
making  our  Bandage at  all  Dreflings
only retentive in the beginning  Morti-
fication,  that fo  a  free Recourfe and
                              Circula- 
              ( l7%  )
Circulation of Blopd, may not be im-
peded: In an unwearied Ufe of Fometi-
tations,~£ogether with  Fridions,  Cataf-
plafms, #nid warm Covering,  to in vice
and cherifh the Heat} and laftly, in Sca-
rifications,  Lotions,.and the adual Cau-
tery.
  Fomentdtiong muft  be continued for
Hours together,  if we exped any'Be-
nefit  from it,  and then the Incisions
dreffed warm, with Plegits out of the
following Lotion*
   ft. Spt. Vini bent te&ificdt & Cam-
phor at. ^Iv.Spt.Sal.iJtmoniac. 3f.M.
   If you bring the Limb to plump arid
fwell again by thefe^ there is hopes &£
recovering it, if not^ there is none.
   Scarifications need  not be made thro'
the whole Difcoloration, where the Part
is not entirely destitute of Senfe, leffer
Means  may prevail}  but where it is we
need not fpare, cut at fmall  Diftances,
and to  the Quick,  how  deep foever,  it
makes  Room  for  Medicines  reaching
where  they can ftimulate  and  excite,
to  thruft off the Cadaverous.
   ABual Cautery is the last Refuge, and
 is without all Doubt, the beft Means can
 be ufed to refift Putrefadion: To make
it anfwer our Hopes, we fhould apply it
                                   till 
             (  '76  )
till  it's  Effed reaches the quick  Parts,
and all the nafty foul  Sanies bred from
the cadaverous Flefh, is  in a  Manner
dry'dup} then Nature immediately com-
mences  her Efforts  for feparating the
Quick from the Dead, which,  with lefs
Succefs, fhe would contend for, if the
cauterizing were done by halves.
   When we have ufed the Iron, we af-
fift Nature's Endeavours  for a Separa-
tion,  by fcarifying through the Depth
of the Efchar, and drefling thofe Inci-
sions with Lenients and  Digestives,
ufing to the whole,  Fomentations  and
Cataplafms as before:  If we fail of our
End, after thefe Tryals, I fee  nothing
remains but the Operation again.
CHAP. 
              (ln )





         CHAR   V.

A Journal of the  SICK on
      the Coaft of GuiNEY.

        AVING been in a Ship ftation-
         ed above twelve Months on the
         Coaft of Guiney, I have dige-
         fted fuch Obfervations, both of
the Country, and our Sick in  particu-
lar (whether  Europeans or Natives) in
the enfuing Sheets as may, perhaps, be
not unworthy the Notice of thofe whofe
Fortune  may carry  them in the fame
Trad.
   The Coaft of Guiney laying fo  near
the Equator, muft  of courfe be  very
hot, but there are two Advantages met
there, which are a fort of Counterpoize
to the Sun's Vicinity, and makes it lefs
troublefome or hurtful than one would
exped, viz. the  Breezes from Land or
Sea, that constantly fan upon us, (Calms
being rare and of fhort continuance}  )
and fecondly,  the Thicknefs of the Air,
                   N             the
 
             d*l*))
  the Horizon being always 'hazey, which
  by obftruding the  Rays of the Sun,
£ Morning-*and  Evening, fubftrad con-
  siderably from  the Time  he is in that
  Hemifphere} and altho' he comes verti-
  cal, Clouds do  at moft Seafons interpofe
  at his different Altitudes,  and break off
.  the Bughtnefs of hiss Beams, particular-
  ly at,what  we call the Rainy-Seafons,
  (Seafons which revolve with the Sun all
  down the Coaft, and have, their, conftant
* Returns in the different Parts of it,)ina-
  king the JEquinodial cooler for the,line,
.  than  Englandm March.   ,  ,*  ....«
    This Moisture and penfity of the Air,
 '"fo  vifible in the Mift and Hazvnefs of
[ the Horizon, is fuch, as torn older Cloaths,
* and ruft your Pocket Instruments, Swords,
*\ or any  Kind of Steel Implements, in a
~ DayV  Time, no Country being more
  noted for this  Particular3/nor more de-
"' fervedly} (riay, the fame Elevation of
 -Voice] is lets diftind and clear, than in
  any other Country I know }) the Rea-
: fon  of. this Mhtinef3? perhaps may be
: the/Lowhefs of the Lands,  and Multi-
  tude of Woods* and Trees upon* them,
  with fome- great,  but many fmall Rivers
'  wafliingthro' them, which fupply thefe
  aqueous Vapors, and make the Medium 
             ( l790
thick} and thisfeems evident, becaufe,as
you move from Shore a few Leagues, this'
hazinefs is lpft, as all;Ships Experience}
and alfo becaufe no Dews fall  (at  leaft
it  is  extremely rare)  a League from
Shore, any where along the whole Coaft,
yet are very great every where  at Land 2
It  is  for  this Reafon,  and becaufe the
Country is overfpread with Woods and
Mangroves,   not only  obftruding-the
Courfe  of; the Winds, and rendering it
far more fultry and hot, but stinking-and
Offensive} and alfo, becaufe that  Sea-
men do greedily purchafe. any .Thing  to
eat or drink, (the Produce of the Coun-
try) without regard to the Wholefome-.
nefsor Alteration of their Way of Diet, on
both  which Refpeds, due Caution ought
to be had} that the  Shores become  in
general more pernicious to the Healths
of Europedns, than the Sea, where  thofe
Inconveniencies are better avoided.
   Certainly nothing  contributes more
to the  Confervation  of Health,  than
breathing in a wholefome Air,  and feed-
ing in one regular and uniform  Manner}
thefe  are the neceflary Materials of our
Subfiftance,  and which we maintain  a
conftant Commerce with} Errors there-
fore,  herein,  will in a  fhort  or longer
                   -N 2         Space 
             (IW)
Space ef Time, as our  Constitution is *
more:or lefs fitted to refift, fhow  them-
felves in various Diftempers} and althp'
we may fhun the Stench and Naufbmnefs
on Shore, their piquant and unwholfome
Way of feeding, we may yet create to our
felves the fame or like Errors on Board.  .
   The Air  is very much  confined be-
tween the Decks  of "a Ship }  the. Ports
that would carry off the  bad, and im-
port . us  frefh ' Ajr,  being  obliged for
Safety to be fliut, and as great Numbers
of Men muft lodge there :  The Efflu-
vias from Perfpiration, and their Breath- -
ing  together, will load the Air.  with
corrupting Particles, and as it fills with :
fuch} Heat  weakens its Spring;arid Ela-
sticity, and  by that Means, fenders  it
unfit for receiving again:  But if we add
to this,  the Filth  and Naftinefs bred -
from fuch   a Number,  by Negled and '
 Idienefs}  the Steams arising thence and
 putrefying the Air, with which they fo
 constantly   correfpond,  muft in  Time
 Dr.ow its Effeds: From what does Plague
 and Pestilence, epidemical and contagi- ■
 ous Distempers proceed, but chiefly from
 a Disregard.in this Particular^ they reign- '
 ing, or at least arising firtt in populous Ci- *
 ties, and in Summer-Time, when Stink and •
 Putrefadion moft abounds.        This 
              r«?»)
  This,  Obfervatipn  fliould  teach, us
Leffons  of ^Cleanlinefs, to  wafts anc|
clean the Ship^ between  Decks often,  to
keep the Men fo too, apd  to let them
have asfreeandfre^uerlt^
with the frefh Air, (by operiihg the Ports)
as may be consistent with- Safety, and
their  other Affairs 1 Points  too much
overlooked and diffegarded, tho* of the
greateft Confequence to preferve aShsp*s
Company .on a Voyage.  '"'.
   Another Remark may be drawn  from
this general  Dodrihe againtt  the super-
stitious Humors or Conceitednefs pf fome
Men, who  will be as fpllicitousjif thefe
exceflive hot,  Countries, of guarding a-
gainft Cold,  as if it were  in the fame
Climate with Norway j and upon anv
Indifpotttion,  prefently feclude rhemfel-
ves from the Benefit of freih Air, keep-
ing their Cabins fo, clofe, as if they fear-
 ed aCommunication with  it of the ut-
moft Danger }  a Citcum'ftance tliat  the
 foundeft Constitution capnot abide long,
 without Languors ancf.great Ufteafinefs,
 and  the  Reafon feems^ plain, from  the
 aforegoing iParagraph}  there is only  this
 Difference, one Man, here, in. a confined
 and clofe  Apartment,  gives the fame ill
 Difpofition to the A;r in/ Time, as I .have
                   N   3            faid 
faid  Numbers°do (tho* a little more at
large), in the Body ,of  the' Ship}  for
thofe Jcorruj£ing  Effluvias that conti-
nually f^W^t^  him by  Breathing
aij3/gerfpirati6n, n$jtt at length load the
jftagnant Air, i. e. iheCabin, with noxi-
p$i Miafms viirifit tb^be  received again}
 aha*t J have  inpre  than once  feen  the
 Proof1 of this^in fuch who have obsti-
 nately persisted °in a  Refusal of what
 would have  beeri their greatest' Benefit,
j}efit Air, to "pafs offl&n  in fanguifhing
JerpettialSiveits:   lialj{:'"
.V( Another unhappy'Effed I  fear of this
itpo ,great Warmth and ill Management
%;$pt> Countries' is that Diftemper cali-
 co* me'tiry  Gripet^ 'and  its ^paralytick
'pn^rices. ; ,^\  k "
*'„'XnSfig who I have  known thus  tor-
l[h1poterJ, / have :beeh firft emirieiitiy.weak
*?M difpirited, by' the filly vf*radrce of
 promoting ;.llar]*ev  anil  partial f Sweats,
"whereby Cold'ss "rriore prevalent in the
 Evenings,  to "the  Constipation  of the
 Pores, -and fooridr  'excites Diforders in
 the lower Belly, than elfewhere," becaufe
•on Parts not accustomed to be expofed :
 J rather  judge if'to this, than any  per-
 nicious^ Quality in  the Air, or of strong
 firinks and  Acids   fwallowed,  becaufe
                                  any 
any peculiar Infaluhrity in'the. former,^
fliould make the Mifcliief more f general} ]
nor does  exceHiveV Drinking or. Acids
feem Tikely (either 'of Rum or Limes)-.
becaufe thefe are  of univerfaLUf^with
Seamen, in alt Climates, without fuch
Effed,'. unlefs we will fuppofe. the* Weak- ,.
nefs and Lofs  of Appetite lends an ac-:-
ciclehtal Help to thofe fewfeizedwith.it.  I
  'But to  return,  there is ftill a farther £
Inconvenience  attends  Heat and cMoi- "<■
fture,,in  fuch  warm Countries as Gui- 3
ney and the Weft-Indies, and contributes "
to the  Sicklinefs of a Ship's Company,
and that is, their being produdive of in-
finite NumbersTof Infeds, (ab'his oriun-
tur cuncldduobusf) Ants efpecially,,w.ho  .
raife Hills  in  Africa  to 8  or  10 Foot
high* Garrifons that will devour a dead
Sheep'in  a NightV Time; 0fnthef|w^;
get Variety, and number lefs  Cotp^ripri-*!
wealths  on Board  with our. Wood,1* as
alfo Cockroaches, Maggots, |gdTlys of.
various Specie's.            -U \, v v
   I fhall  not pretend any of thefe to  be"
 the malignant. Species., that blight.and
 destroy  Plants^ Qr-effed Murrain ih
 Cattle, or Plaluel^g Men^ut this
 Imay.be Coqfident1 ift^ tha|  Resting
 thermelvSs inJfr]fmite Number^ 'ahh'ong
                  N  4             dry 
dry Provisions, they prey on the Heart
and Subfiance of it, and fo make"them
lefs Salutary and fit for Nutriment. Salt
and Heat does the fame by wet  Provi-
sions.
  After this Pr<eloquium, I come  to ac-
count for the Sicknefs and Mortality of
our Ship*s Company, at the'Ifland of
Princes, July 1722, where we arrived
to clean aridrefit, all in very good Health^
although we had then  been full fotir
Months on the Coast of Africa,  and is
a corroborating Circitfnftance, thatNew-
nefsof Provisions, and want of Oppor-
tunity to debauch  on Shore, are two
main Pfefervatives of Seamens Health.b
  I might here firft take'Notice, that the
fudden^Phrerizies, Convulfions  and 5col-'
liquative'Sweats, tha'tfo foon  terminaT
ted fome of their  Lpei; was fufpeded,
and with Jteafofi, to proceed from eating
wild Manyocoes and Yamms} Roots, the
Growth of the Iflarid, and when culti-r
vafed and"duly prepared, is  a  common
Food  of., the.  Natives, . b*frt  otherways,
highly noxious and un whole fome  : I fay,
this might.be  farther  ihfifted  on,  but
as the/Majonty plainly became infeded
from  more explicable paufes, I mall en-'
cjeavour to  point tfte^pu't: The  Symp- 
toms attending, and my Method of pro-
ceeding.
   Firft,  of the Caufes: The Condition ;
of cleaning Ships at this Ifland, are un-
fuitable to Englifh Cohftitutions, for we :
are put under a  Neceflity of  building
Tents, arid employing half our Men on
Shore, for their  Security, and for the
Work that is wanted at them } whereby
they are more at their  own Wills  and;
Difpofals, than wifhputfuch aNecefEty,*
it is  proper they mould eyer he trufted
 with} being ungovernable in their Adi-
 ons and Appetites, pilfering  frdni^ the
 Negroes, and debauching their Wives,
 and (excepting  a very few)  moft irre-
 gular in their Way  of Living, eating
 arid drinking whatever comes in their
 Way,; fthe Produce  of  the Country,).
 Without any Enquiry how proper  pr
 wnoieipme for Food,  or having any Re-
 gard; to Custom and Manner of Living.
   ' Another Caufe, is the extraordinary
 Heat of the Sun,  (now  in the Zenith;
 more ftifling and  troublefome,) which
 the Men  are forced to work in, an$ for
  a longer Time every Day, on fuch G)c-
  cations  as Cleaning :  Thefe Heats  nigli,
  or on the Shore,  at the Tents, vastly
  furpafs thofe  at Sea, not only on Ac-
                                  count 
count1 of the Earth's stronger Reflection,
but alfo,from  furrounding  Woods.and
Hills,  .that ftops the Accefs pfWlncts
and,refre{hing Breezes.-,
   They are ftill more offensive, in that
the, fitting  Suns are fucceeded  with a
Chillynefs in the Air, filled with aque-
ous? vapors,  which condensing very faff,
by the interruption the  Hills  give  to
their Motion,  fall every Evening; at the
Shore,  in cold and .prodigious' Dews,
fufficient in a few Hours, to wel; all the
Beds thro' a double Tent.
   Lastly, thefe alternate Heats and Dews
are more hurtful to Seamen, from their
Irregularities of Life,  every Day's La-
bour muft  be  recruited,  and this they
do with Palm Wines,, plentiful on this
tfland,r and  tho' a natural Distillation
from the Tree, does, without fermenting,
becorrie intoxicating^ in large Quantities}
and: what  is worfe, they frequently lay
down in thefe  Inebriations^  expofed  to
the  Chills  and Dews' of  the  Night,
whence a fudden Check is. given; to Per-
fpiration, (at a Time it is moft wanted,)
and confequently, Fevers more  or lefs
Malignant, are brought on as their pfe-
ceedirig Condud has made  thofe'  .other
                                afore- 
              (l87),
aforementioned  co-operating  Caufes,
more or lefs powerful.
  iSecondly,  or\the Symptoms. _ The
Fever  generally  began with a  violent
Pain, and Dizzinefs of the Head, Nau^
fea  VomitmgL arid Reftleflhefs.   After
the'firft Day,  the Patient that was dry
and fcorching,  falls into excefliye. Sweats,
the Confequence of  which, is fudden
proftration of Strength  and Faintnefs,
an  inextinguifhable  Thirft, and  invo-.
luntary Urining,  the Pulfe neither  high
nor quick, but altering on light Occasi-
ons:  In the Progrefs came on either De-
lirium, Convulfions and Speechleffnefs^
 or fometimes a  Lethargy} under the
 former they  commonly  expired at four
 or five Days End, with  the latter, con-
 tinued a Day  or two longer.
    A.few Exceptions may be made from
 this  general  Rule,  of fome who lan-
 guifhed  fourteen,  or more, Days, but
 then  it was not  the malignant  epidemi-
 cal Fever, but  jfitermitting, and  occa-
 fioned, as I hintid before, from a super-
 stitious Humor of knowing better than
 ordinary, how to avoid the Evils of a hot
 Country } fome of thefe  affeded Gen-
 tlemen, I have feenfaint rather than take
                                aGlafs 
              (  .88  ^
a Glafs^to inflame their fijood,  and wear
Flannel and two or three Coats to refill
the Cofdnefs ofvthe*Air, that,  to me,"
feezed/ more  like  the,. Steam, of  a
Hot 0veh}  yet  fuch,  kept^ their Senfes
entire, and I may truly fay of thern^
when  they died, that they were  dif»
fotyed.^,.   '.         .r ^  V    • t.r.
  '"'The mitaaefs' neceffarisy bred  from
a great Nurpber of Sick in a Ship, fel-
dom wafted or cleaned,'r^elpd  to fpread
t^e jpfc^gr£and Danger, aggravating.the
Symptoms,  and at length, in a Manner,
difabled us from carrying on the Work,
required to equip us for the Sea againj
where in my Opinion,  rested :our Deft
Hopes of Recovery : The prefent Com-
fprt we had of regaining  fuch-a  Con-
dition,* was, the  falubrious and  health-
ful State of the Iflanders at this .Time',
who by Temperance (natural to  all the
Seignior Countries).keep off many.Evifs,
and is the beft Phytick for all Climates.;
  1 hirdly, my Method of proceeding,
as it refpeded  the Well and Sick,- Pre*
yen tion or Re cove r y. •?.              . ■ ^
  To .preferve thofe .who' yet continued
in Health,  .we fep.an.ted the Ship entire-
ly to rtheir  Ufe, ;.nd moved the Sick  on
Shore^to the te't Houses and  Conveni-
                                ences 
             (:'8?)
encies that could be hired,  w/fhed the
Decks every Day,  did not fuffer them •
to work in the Heat of the Sun, (excef-
five under the Hills,  from ten to four;
in the  Afternoon,) nor  to  lay at the
Tents,  avoiding by that, the Opportu-
nities'of Irregularity, and the Damp-
nefs  and Dews  they  became expofed to
utter
  The  Sick had yet this Unhappinefs,
that having deftroy'd their Healths at the
Cost of ail they  had,  (their Cloaths,
which they had bartered for Drink and
Edibles  among  the Negroe ServantsJ
they were now destitute, having neither
Bedding left, nor fo much as a Shirt to
cover  Shame,  empty Hammocks  being
their Lodging, and  the Roofs their co-
vering} a Misfortune that would, in my
 humble Opinion, become  the Wifdom
 of the Admiralty to provide againft. The
 Commanders of  French Ships of  War
 have always contingent Money advanced,
 and by that the Means of Necessaries and
 frefh Provisions lodged  with them for;
 the  Sick,  wherever they   come,  and'
 feems ot abfolute Neceflity in remote
 Parts,  to administer the Comfort which
 the Poverty and  Obedience Sailors are
 under, difables them  from, doing to them-
                               felves: 
             ( *9o  )
 felves: Difpenfed frugally would be of
 inconfiderable Charge to a Government,
 and with Strangers exemplifies a Christian
 Concern for our Brethren.
   I begun  the  Cure with Emeticks,, as
 the beft Foundation, I thought, in Fevers^
 from Intemperance} and found them fo
 far good, as to  procure a little tranfient
 fiafe and Reft,  and fo  feemingly better
 for  it  the  following  Day}  yet  at
 Night, Fever and Head-ach would re-
 turn with greater  Violence, and;break
 off in fome  lucid Interval again in the
 Mornings, at which Seafons of Remiifion
 (chiefly) we bled them in the Foot three.
 or four Times, perhaps  in eight and
 forty Hours, according to the Humor
 and Pradice of  the Portuguefe, who, as
 they prefume themfelves beft Judges in
 the  Country  Distemper, .'build  their
 Cure entirely on it, and  repeat it much
 oftner.
  I imagined after this Operation, TinB.
 Serpent, as an  Alexipharmick  and Su-
 dorifick both, would beft anfwer to thefe
 Symptoms, by expelling in the Way Na-
 ture feemed to have its Tendency.
  J£. TinB.  Serpentar. jij. Aq. Cimwm*
H. %]. F. hauftus*
Or, 
             (,'9}  )
  Or, fjc.Lap. Cont. Tervgt. xiv.Conf.
Cynbsb. q.s. F. bolus.
  But was mistaken }  as they immedia-
tely loft  all Appetite, thofe large and
perpetual.Pifcharges by the Pores emp-
tied the Veffels, and hurried  on extreme
Languors,  Faintnefs and  Convulfions,
dying in three Days, qu&cunq; Inan*-
tionein  nimiam. producunt  Caufas Con-
vulftonis fieri.
  With others again, I try'd Julaps, Vola-
tile Drops and other Cardiacks.
   R.  Vin Alb. Aq. Font. a. |iv. Aq. C?»-
nam. F. Sacchar.  Albifs. q.  s.
   R. Spt.  Sal.  fol.  5J- Ldvendul. jij.
Ol. Caryophill g. x. hujus inftilletitr g.'XJf.
in Aq* Hord. vel Cochlear. Julap feqwnt.
bis in die.
   R. Aq. Hord .Jviij. TinB. Croci  Aq*
Epidem. a. §j. Margarit. 3 j. Sacchar. Al-
bifs.  q. s.  Empl.  ex  Cephalic,  vel pice
Burgund totis pedibus Applicaterant em-
brocating the Soles and Palms, cum Lini-
ment. Saturat. TinB  Caftor. vel Ol Sue-
tin\& ad  Regionem Umbilici Aliquantfe
Empl. ex Galban. cum. Ol. Macis.
    When the Patient was found approach-
ing either to a Delirium  or Sleepynelis
 (one or other of rhef$  Symptoms certain-
                                    ty 
              (  19* )
ly enfuing^ then thefe Prefcriptions were
accompany'd  with Veficatories  both to
the Arms and Legs.
   I try'd others with testaceous Powders,
or the Cortex, and a ftrong Harts-Horn
Drink, in hopes to tie up fo loofe a Tex-
ture and Compages of the Blood, and
prevent  the Expence of Spirits in fuch
copious  Sweats*, but all equally unfuc-
cefsfull,  few furvived the Infection above
fix Days} the exceflive Heat of the Cli-
mate, and an  inextinguifhable Thirft to
luch  a  predifpofed  Difpofition of  the
Blood, quickly evaporating both Strength
and Spirits:  The  last Symptom and
fure Fore-runner  of Death, was  com-
monly Convulfions.
   This unhappy Sicknefs and Mortality
had very nigh reduced the Ships  to a
Neceflity  of  waiting a Supply of Men
from Englandi  but as fuch a Resigna-
tion is the la ft  Remedy to be flown to,
in remote Parts of the World.  So we
rather endeavoured to put a flop to  it, by
pufhing to Sea and changing the Air and
Way of Living.
   We foon found an Advantage by this
Change, to our well Men, the  epidemi-
cal Rage leifening in proportion to the
Time of leaving: thofe enumerated Caufes 
               (■'93  )
 of Infedion,  and enjoying a cooler and
 more salubrious Air.
   For  thofe  few who  had conquered
 the  Severity  of the Fever, and  were
 weak, we were ftill perplexed:  As  the
 Wine and the few Surgeon's Neceflaries,
 provided  for  fuch  Occafions, were all
 long ago   expended,  there  was   not or»4
 a  bare  want  of them to complain of,
 but  the abfolute Neceflity of reforting
 to the Ship's Vidualling for fupporting
 Life, bad  in  Kind, and in weak and re-
 duced Conditions,  we found  had  this
 melancholly Confequence, of inducing a
 feverifh Heat and thirft, and giving Birth
 to Fluxes, fo  that what  the  one fpared
 the other deftroy'd.
   Fluxes  took their Rife here from Po-
 verty of the Blood, bad Diet, Naftinefs,
 and  an infedious Air  confequent  there-
 to, and  neceflarily bred from  narrow
 and clofe Confinement.
   They were diftinguiihed into  Diarr-
 hea's and  Dyfenteria's:  Diarrhea alvi
 laxitas.  j Dyfenteria e/1 alvi cruenta ac
 Purulent a,  dejeBio a materia acri Intefl-
 ina  rodenti.
  The Intentions of Cure feem common,
 viz.   To embrue the Blood with Refto-
ratives}  to allay the painful Senfe of the
                 O           nervous 
              (  l9\  )
 nervous Fibres with Opiats } and to fhut
 the Mouths of the Vettels,  or heal their
 Erofions with Stypticks and Astringents.
    Evacuations always  preceed,  not as
 they fo immediately anfwer to either of
 thefe Intentions, as that they fit the Body
 for receiving Advantages by Opiats and
 Astringents.
   For an Emettick R. Pul. Ipecacuan Tfi.
 cum Oxymell Scillitic. q. s. F. bolus.
   A Purge, R. Pul.  Subtilifs. Rhabarb
 •}ij. in Forma boli vel in hauftul. fumend.
 ad tres doftbus.
   After  thefe  Evacuants,  I  continued
 the firft Complainants to the EleB.  Dris.
 Morton, in the Dofe and Mariner direded,
 and found  fome Succefs: That expend-
 ded, I kept others to Dr. Cockburns Eled.
 and found it did no harm: Both finifhed,
 I made up as follows.
    R. Terra  Sigillat.  Bol. Armen.  §j.
 Cort. Granat. Flor. balauflior. a. 3J. Conf.
 Rofar. §iv. Tereb. q. s. F. EleB. fumend.
 quantitat. nucis 4^ qiiaq\ Hora fuperbib*
 Hauft DecoB. Alb.
   With others,  a Bolus of  Diafcordium
 alone every Night, or  a  fmall  Pill of
 "Laudanum  rowled into a Dofe of the
 Eled.  Their ordinary Drink of Hart's
JrloriH  ft, CCC. %iv. Cinnamom. Contuf.
                               G. Ard- 
              ( m)
G*  Arabic,  d. 31J. Cort. Granaior. &
Querci a. I'j. Aq- Font. Ibvj. Coq. ad 34?.
partis Confumptionem*
   In thofe Dyfenterical,'JI breathed alfo
a Vein, now and then, and administered
Calomel, finifhing with  the following,
which I recommend  as  a Medicine of
no  fmall Efficacy.
   ft. EleB. Fracaftor. 3}. Alum Commun.
gr. iij. Laud. liq. Gutt. xv. mane & Vef.
peri fumend*
   From the Procefs  (tho' not  attend-
ed here with much Succefs) may be de-
duced a ufeful Obfervation or two.
   Firft, That where  the Caufes produ-
cing  Fluxes  irremedilefsly  subsist,  as
with Ships in foreign warm Climates,
there is little hopes of Succefs, want of
Diet and a bad Air,  are too great Impe-
diments for Medicines to contend with,
and renders ineffedual the beft Prefcrip-
tions : The eroding Particles, where we
have no healing Nutriment,  acquire
greater  Strength,  and the Flux becomes
habitual, admitting then only Palliatives
(/. *. Opiats)  which give Refpites in-
deed, but of little Confolation.
   Secondly, Aftringent Eleduarieshave
their Efficacy  from  the Quantity  of
Opium admimftred in them,  and thofe
                  O 2           rcco- 
             (  »9«)
recoverable foon  find  its  Effed after
Evacuations} if  not, they lofe of their
Virtue, by the frequency of Repetitions,
the Stomach palls  and  naufeates, and
then of Courfe the Patient  proportiona-
bly Emaciates till Death.
  And laftly, from experienced Want, I
would recommend a triple  Quantity  of
fome  Medicines ufually put up for Sea-
Service,  viz.
   The Cortex, Rad. Ipecacuan. & Rha*
barb,  Opiates,  Aq. Cinnam.  F. CCC.
Ther. Vene. Alumen Commun, EleB. Fraca-
fior. and Antidyfenterick EleBuaries, Pra-
dice  in a Manner being confined to them,
and no Hofpitals to leffen the Expence.
   I fhall conclude this Chapter with fome
Notices on the Distempers  of Africans.
   The  Negroes  are a People troubled
with  fmv of the acute or chronick Di-
stempers of the Europeans,  owing  prin-
cipally,  I think, to a happy Want, and
ignorance of luxurious Living} feeding,
for the  moft Part, on Grain, Herbs,
Roots and Fruits, bathing fometimes}
and all constantly anointing with Palm
Oyl or Tallow,  which  only, as it is an
Exercife, does, with a little fifhing, tra-
velling and dancing (their cheif Amufe-
. ments) expell eafily the Recrements  of
                                 fuch 
              ( '97)
fuch Food,  and contributes to the bet-
ter Health and Longevity of the Coaft
Negroes, which we  muft diftinguifh as
abundantly  more fprightly  and adive
than the Inland Natives (whom I chief-
ly defign  here to  regard, becaufe of
them,  the Bulk of  Cargoes  consist: )
They have been totally destitute of this
European Correfpondence that has mend-
ed the others, and are to appearance but a
few Degrees in Knowledge above Beafts.
   From Sefthos River windward, many
of the Negroes have large Exomphalos's
thro* the Ignorance  of Midwifry,  and
thofe of Whydah (where the chief Slave
Trade is) are more fubjed to Small-Pox
and fore Eyes.
   This I have thought fit to premife in
general, the  Distempers I defign to fpeak
to, as  more properly their own, are the
Sleepy Diftemper, the Croakra, the Taws,
and the Chicoes, of each briefly.

         The Sleepy Diftemper.
   THE Sleepy  Diftemper (common
among the Ne- -oes) gives no other pre-
vious Notice, than a  want of Appetite
two or  three Days before} their Sleeps
are found, and Senfe of Feeling  very
little, for pulling, drubbing or whipping
                   O 3           will 
             (•  198;
will fcarce stir  up  Senfe  arid  Power
enough to move, and the Moment you
ceafe beating, the Smart is  forgot, and
down they fall again into a  State of In-
fenfibility, drivling constantly from the
Mouth as if in a deep Salivation} Breath
floWly, but not unequally, nor Snort.
   Young People are more  fubjed to it
than the Old, arid the Judgment generally
pronounced, is Death,  the Prognoftick
feldom failing} if  now anii then one of
them  recovers, he  certainly  lofes the
little Reafori he had and turns Ideot.
   In searching for the Caufe of this Di-
ftemper,  it Will  be neceflary  to  repeal!
what  I have  above  obferved, that die
Bulk of Slave-Cargoes  mostly consist of
Country People, as  diftinguifhed from
fhe Coaft People apparent,  if  the prin-
cipal Way of fupply be considered^   At
Whydah  more Slaves are bought, than
on the whole  Coaft  befides, and why>.
the King of that Country,  and his next
Neighbours,   understand   Sovereignity
better than others, and often make War
(as they call it) to bring'in whole Vil-
lages  of thofe more fimple  Creatures
inland, to be fold at Market, and exchange
ed for the tempting Commodities of Eu-
rope, that they are  fond ani mad after. 
             (  '99 )
-  On the Reft of the Coaft, there are
trading  Towns difperfed up and down,
under  the  Diredion of Cabiceers, or
chief Men, who, as their Power is wea-
ker and more controulable,  expect fewer
Slavey and thofe they do* come most-
ly by stealing, for  they go armed  into
the Country arid feize thofe defencelefs
Creatures, a few at a Time, and expofe
to sale to the next Merchant Ship  that
touches in their  Road.
   To, return,  the immediate Caufe of
this deadly Sleepynefs in  the  Slaves,
is evidently a fuper-abundance of Phlegm,
or Serum, extravafed in the Brain, which
obftruds the Irradiation of the Nerves}
but  what the procatartick Caufes  are,
that exert  to this Produdion, and eclip-
sing the Light of the Senfes, is  not fe
eafily aflign'd.
   We find fometimes in  Europe,  that
Enormities in the Non-Naturals,  Sur-
feiting and  Drunkennefs does gradually,
as Age and Custom advances, weaken
the Tone of the Brain to the  Admiflion
of ferous and excrementitious Humors, in-
ducing Sleepynefs, &c. but here the  Cafe
is different, they being young People that
are generally atnidedj and who have been
deftitute of the Means of Surfeiting.
                04           L fhall 
             (  20O  )
  I fhall afcribe the Caufe to Cold and
Immaturity} to Diet and' Way  of Li-
ning, and to the natural Weaknefs  of
their Brain: Some or all of thefe Caufes
co-operating to it.
  In Immaturity or Childhood, it is a com-
mon and true Obfervation-, that more of
Phlegm  and recrementitious  Humor  is
bred  than  at  Manhood,  becaufe  the
Fibres  and  confequently the Faculties
refulting from  their Constitution, have
not  attained their due Spring and Per-
fedion.
   Promoted here fecondly, by their Diet
and Wav of Living. At home it is moft-
ly on Roots, Fruits and Herbage, gree-
dily devouring fuch as are wild and unr
cultered, which, together with  the in-
tolerable  Heats of the Sun,  weakening
the Concodive  Faculty,  and their Inr
adivity  renders a very recrementitious
Nutriment:  Their  Indojence  is  fuch,
(when (hipped on  Board  for Slaves)  as
to  be  entirely Difpaflionate  at  parting
with Wives, Children, Friends and Coun^
try, and are fcarcely touched  with any
other  Senfe  or Appetite, than  that  of
Hunger} and even in this, for want  of
Custom or Inftind, they  cannot diftinr
guifh proper Fopi, nor know when  to 
              (*61  )
leave off, voracioufly eating, tho* Vidu^
als be never fo  dirtily cook'd, and whe-
ther the Flefh  be raw or dreffed, whe-^
ther of the-Gutts or:a Surloyn } aPra^-
dice-alfo. that  may .tfometimehy over-
ftretcHiQg-cthe  Fibres iof the Stomach,
Occafion Orudity ancLindigeftion. : <
 ,  And laftly,  by their Sloth and 'Idle-|
nefs the Blood becomes'more depauper-
ated, and thofe-recrementitious Humors
bred; from it,  that Exeroife would throw
off through:the proper fecretoryOrgans;
 are here difpofed towards the  weakest
 Part,  whkh in the-Generality of Negro
 Slaves I take  to be the Brain.
    Thirdly,'the natural Weaknefs '.ofthe
 Brain, I am  apt to think, the principal
 Caufe of this  Diftemper.  Doubtlefs that
 Part gains Strength by  Exercife, i. e. by
 the Employment of our rational Facul-
 ties, as well as the Mufcles and external
 Fibces of -the Body} and fince the Af-
 ricahrare hereditarily Ignorant, destitute
 of all  Art and Science, or any mecha-
  nical Knowledge to exercife the Brain,it
  confequently grows weaker in its inward
  Strudure and Receffes} and fails together
  with the Judgment and»Paflions. - -  '■■ -
     The Imployment of  the  Soul  does;
  not only in  Metaphor,  but really  help
                                  .-to 
 to.strengthen  the Brain,  as  that again
 (the (jkHTdniori pf Mortality J by  the
 Fjrmnefe of its Texture, and Goodnefs
 of'Difpofition does the intelledilal  Fa-
 culties^ obvious  in the clear,  Mrakeful
 and unclouded UnderftaridirigSL;of Men
 of Learning and Genius, compared with
 the  Stupid  and Ignorant,  in whom  the
 Soul( u e. its Operations)  and the Brain
 are  reciprocally found -ftrong1 or weak:
 Where Ignorance  and  Stupidity  reign
 therefpre, and neither Sciences nor Me-
 chanicks tplanted for exercising  the  Fa-
 culties, the Brain muft grow weak, and
 fuch a Slate of Thoughtlefsnefs  'and In-
 adivity, difpofeit  for the  Reception of
 Serofiries.     jIuHt 01     rm;
   The Cure is attempted by "bleeding in
 the Jrigular, quick Purges, Sternutories,
 Veficatpries, Fontanels, and fudden Plun-
 ges into the Sea.uu?/       ilsv.'
 ;;  The Croakraffo galled by the: Negroes)
 is a cutaneous Diftemper, fomtwhatfike,
 but  not fo inveterate as, our Itch,  being
 large Blotches and Blains  d;fperfed  up
 and  down, and feem to  arife on Board
 Slave-Ships, from aTudden  Change to an
 unufual.and  courfe, if not  a fait, Dietj
 contributing  to whieh,  perhaps,  may
 be a  Negled  and Carekifnefs in drying
t\e Skin in warm Suhs<, after it has been
                                 wet 
              (  *°3 )
kwet with fait Water: It is true, they do
 not fo foon feel the Effed, but Repetiti*
 on in the End, has its Share in helping
 to fret and chap the Cuticle in this Man-
 ner } at Jeaft, I imagine fo, becaufe refrain-
 ing from fait Food and Ablutions,  an4
 feeding them wholly on Rice, Farineand
 Beans,  (the common Vidualling,) does^
 together with conftant batting in of Palm
 Oyl, generally fmooth and dry it again.
 Where this latter Pradice obtains moft,
 (iti&.  the windward Part of the Coaft,)
 there they  are the leaft troubled with
 thefe Eruptions,  and where the Custom,
 is  more intermitted, for felted Tallow
 inftead) it becomes more frequent.     ;
   In fpeaking to the distempered Skins
 of Africans, it falls naturally in the Way,
 to fubjoin a Word or two of their Colour,
   From the River Senega in Africa, 15.9
 N.  to almoft its  Southern Extremity in
 £4° they are, all  black arid wooley, the
 natural  Caufe for which, muft ever per-^
 plex Phiiofophers to aflign} t know Mai-
 pighus, and from him others afcribe thefe
 different Colours in Men,   to a Tjng?
 from that reticular or mucous Substance
 under the-Cuticle, not considering the
 Question as ftrongly returns: How that
 Subftanee becomes fo oppofitly, coloured
                                    as 
               ( 204  )
 as it does, in this remarkable Division of*
 Mankind, into Blacks and Whites? The
 gradations Europeans make  towards a
 Mulatto dye,  feem  well enough folved
 from the Finertefs of their Skins, and ap-
 proaches to the Sun, whofe Heat more
 or lefs eafily eliminates the thin Parts of
 that Mucoutyi and leaves the Reraainer
 dark, as the clearest Liquors, they fay,will
 have forrie fediment} but how fo entire and
 opposite a Change is made as in Negroes,
 is riot fo foon anfwered :  There are thefe
 Objedions} firft, that the Proximity of
 the Sun  has not the  fame  Influence on
 other Animals in Guiney, nay, their Sheep
 have hair contrary to that clofer Con-
 texture of the  Skin,  which is fuppofed
 to contribute to the Produdion of Wool in
 the humane Species. Secondly^ no Euro*
pean totally changes by lerigth of Coha-
 bitation with them, and in Generation be-
 gets a  Mulatto Race,  which ever remain
 fo.  Thirdly, the Palms and'Soles of Ne-
 groes Feet, by Fridion and conftant Ufe,
 become whiter than other Parts} fo does
 the Cuticle- fuppted in other Places of the
 Body,  after Scalds,  or  being otherwife
 peeled  off, which could  not well be me-
thinks, if the  Colour of it Were owing
b the aforefeid'Mucosity, unlefs Nature 
             (  ao5  )
be allowed to take partial Methods it)
tinging of it.  Fourthly,, Americans, or
other Nations in the fame, or Parallels of
Latitude, where the Sun equally  Influ-
ences, are not black: And laftly, even in
this Ffegroland, there are a Race of a bright
yellow Colour, as tho' painted: I faw one
of thefe in the next Town above King
Pedro's, in Rio Sefthos, who was wooljy,
and, in every Refped else, a Negro, (par-
don the Impropriety,) but in Colour,
   From the whole, I imagine that White
 and Black muft have defcended of diffe-
 rent Protaplafts,  and  that there is no
 other Way of accounting for it.

              The Taws.
    Y A W S  is their general Name for
 the Venereal Diftemper in all  its Sta-
 ges, whether it be from the fparing and
 neceflitous Circumstances they live  un-
 der at Home, or a better Salubrity of
 Air, or both •,  the Malignancy is com-
 monly better fubdued,  and  the  Symp-
 toms kept from  raging in that unhappy
 manner we find  with  us, who aggravate
 Xhe Infedion with Irregularities and un-
 skilful  mercurial  Proceffes, which the
 Negroes  fometimes  Experience  alfo,
  when they leave their  own Country, 
              (  ao6  )
 and unluckilv launch from Hunger and
 Temperance, to  Plenty and a Liberty
 of, fatisfying  their greedy x^ppetites,  es-
 pecially with ftrong Liquors}  then  we
 may fee  among  them  (particularly in
 the Weft-Indies,) very  ghastly Speda-
 cles, Eruptions,  Tumors, Blotches and
 Ulcers, chiefly of the Face and Head.
   I  fhould defcend more particularly to
 the Nature and Cure  of this Difeafe  a-
 rnong Negroes,  did not the Similitude
 rank them with our Pox and  Clap,  to
 which  I have defigned the following
 Chapter, and  fhall only here take  No-
 tice in general,   that Mercurials  more
 eafily  take  Effed with  them than  in
 northern Constitutions and Climates,

             The Chicoes.
   CHICOES or  Worms, is  another
 Distemper common with them, tho' not
 to properly faid  to be  peculiar.   Mr.
 Jenkmfon in  his Journey from  Mofcho
to Boghar in Perfta.(2$° N.) fays they
were bred in the  Legs there to an Eli
long, and  afcribes  the Caufe to drink-
ing unwholefome River Water.   And
Knivets Voyages  and our own  Experi-
 ence  confirms  their  Breeding in the
                               Weft- 
              ( *°7  )
Weft-Indies, tho' fmallsr and more Cu-
ftomarily in thest Toes.
   I cannot  agree to what moft  Travel-
lers advance (who have  visited warm Cli-
mates  and mention thefe  Worms)  of
their being bred from the Seed or Eggs
of fuch  Infeds fwaliow'd  in  drinking
unwholefome  stagnated Waters :  Anf,
Thing which has its  original  from  fo
cool an Element, in my Opinion, should
fooner be  stifled and: destroyed  by the
great Heat  and coneocKve  Faculty  of
the  Stomach,  or   at  leaft  befojre that
Courfe of  Circulations can be finifhed,
astrarifmits them to the external  Parts,
where  they increafe  and  maturate:  I
•rather think,   since they  are  only the
expofed Parts  of the  Body, they gene-
 rate in, ofteneft in the Legs and Feet,
and feldom or  never in Children} that
 they are  externally conveyed, and hap-
 pen from  Mens conftantly walking and
 trampling naked in fuch Waters as con-
 tain them.
   Among  the Africans they  are found
 to breed  in moft Parts of the  Body, be-
 tween  the Flefh  and  Skin,  are white
 and  flender   as  a Straw, and  draw
 out perhaps  to  a Foot  and  Half} I
 have  heard fometimes to an Ell long.
                                What 
             {  208 )
WhatiLife'j-or how their Maturity is pro-
moted,  lam not able to fay}'but after
Eruption of the Tumor,r they are  to all
.appearance dead.
   The Part where the Worm is lodged,
:gradually tumefies to  the Bignefs  of an
Egg, hard  and painful,  when left to
fheir own Management, and without due
Application to aflift Nature, they are
a Month, two *or three  in suppurating,
and then maturate but little.  With the
Eruption comes.out one End  of the
Worm, perfedly inanimate, which they
hawl. out gently  an Inch or two every
Day,  breaking ' off the  perifhed  Part
(without) as often, and cover the Wound
with nothing but a Bit of Linnen to hin>
der any ill Effed from .the Air  or cold,
Embrocating  With  a  little  Palm Oyl:
As the Worm is expulfed, the Pain and
Tumor abates. '
   Englifi Surgeons do fometimes take a
more  improper Way of  Cure}  impati-
ent of waiting for this  natural  Expul-
sion by Suppuration,  they open the Tu-
mor,  which is fure  to make Ends, one
of which is frivoloufly accustomed  to be
rowled on  a fmall"flick  daily}  whence
a greater Indigestion happens,  and an Ag-
gravation of the Symptoms*
5:.                              Pre- 
( 2o?  )
-S8S§i§
         CHAR   VI.

       Of Luxations.

      O underftand  Luxations, it is
     £ principally rieceflary  to be in-
     $ ftruded in the Articulation of
the Bones, in what Manner  they stand
In refped to one another} that fo we
may not  only know the Accidents we
are called to, readily, but the Remedies
they are  capable  of.   In the Limbs,
Whether perfed or imperfedly luxated,
how, and  to what  Degree,  Extentiori
is Neceflary ? That  we make if neither
needlessly nor  violently} and in othet
Parts, the moft conducive Methods of
Recovery:  Yet in none of thefe  do I
propofe to fay every Thing neceflary,
the Chapter is only Notes, and to im-
print fome  better Knowledge* on the
Subjed,  then  it  is apprehended   any
Thing writ on it hitherto has done.
   The Articulations  are by  Synchon-
drofts ot Diarthrofts, i. e. for an obfcure
                  P               ot 
               ( 2IO  )
 or manifest Motion} the  former by in-
 tervening Cartilages  (as  the Vertebra,
 Co ft a and Sternon) and  thofe do very
 difficultly luxate, npt only becaufe clofe
 and numerous for neceflary Stabiliment,
 and Defence to the vital Parts,  but alfo,
 becaufe the more obfcure the Motion,
 the  harder  and dryer thofe  Ligaments
 and Cartilages grow,  which tye them
 together,  rendering  fuch Articulations
 stronger and more firm than  if made of
 one continued  Bone.
   The  Di/zrtjorofts, which chiefly con-
 cerns Luxations, is divided into Arthro-
 dia and Giwlymiis} the one for rotatory
 Motions 01 the Limbs, the  other only
 Flexion  and  Extenfion }  the  former
 Sort, because  the  Motions are of great
 Compafs,  and  equally to either Side,
 have a membranous Bag to link  the Ex-
 tremities for their truer  playing in the
 Socket,  and which fupplies  them with
 a Mucilage  for facilitating it} and  the
 latter have the Ligaments on the Sides,
 much stronger than before,  or behind,
 that the Joints might not eafily flip.
   Inftances of, Arthrodia, are  the  Os
 Femoris  and.//£/?/«w} Humerus and Sca-
'pula, where  the fingle  round  Head  of
                                  one 
             (an  )
one  Bone is  received  above, into the
Cavity of* another;
  The Ginglyimts is of three Sorts. Firft,
when the End of a  Bone has two Pro-
tuberances,  and one Cavity,  and  that
with which it is articulated  below, has
two  Cavities, and  one  Protuberance,
to anfwer the Reception  and Infertion
of each other, as the Humerus and Ulna,
Os  Femoris and Tibia.   A fecond and
third Sort  (not  fo  material  to our
prefent Purpose) are of  the Ulnd and
Radius,  and  the Vertebra  amongft one
another.

               Caufes.

  THE  common Caufes of Luxation,
are  Falls and Blows  in the Superior,
and  violent Extentions by fudden Slips
in  the inferior Limbs}  uncommon,  is
an  Elapfe  from fome  internal  Caufe,
as when a heap of Humours is thrown
on  the Joynt, relaxing the Ligaments,

                Signs.

   THE Signs  are  a Lofs, or  at leaft:
very imperfed Motion  of the  Joynt %
                  P 2              A 
               ( an  )
 A Cavity whence the Head of the Bone
 has receded,  and  confequently a Pro-
 tuberance where  it is lodged.  The
 Limb will appear fliorter or longer, and
 the Pain attending it, more or lefs, ac-
 cording to what Bone is diflocated } and
 if it continue but fome Hours unredu-
 ced, a Numbnefs}  and if a long Time
 ah Atrophia.
   Signs of Redudion  muft be the Re-
k verfe of thefe} the  Limb will look,  in
 all  refpeds,  anfwering to  its  Fellow,
 and Pain abated.

              Prognoftick.

   Children and Women, by their ten-
 der and.lax Constitutions,  have  them
 more eafily reftored than Men} young
 Men than old}  and in  thefe again, bet-
 ter  when recent,  than of any  Time
 ftanding} for in Age there is a natural
 Aridity and  Stiffness in the Joints,  in-
 creafed  by delay in Redudion,  which
 neceflitates a more than ordinary Ex-
 tention, and  that distracts the Fibrills,
 constituting  the  Nerves and  Tendons,
 not eafily recovered, but oftentimes en-
 ding in  Weakneffes, fometimes in Palfy
                                  and 
             ("i)
and Emaciation:  The fame may be faid
of frequency of Luxation in  any Joint,
tho' the Perfon be robust and youthful.
 . o
             Intentions.

  INTENTIONS of Cure,  are Redu-
dion and preventing Accidents.  To the
former  belongs  Extenfion and  Repofi-
tion} to the latter, Deligation and Collo-
cation.
   Extention is abfolutely neceflary for
restoring any Joint difplaced, the Muf-
cles ferving to the Motions  of it, not
only  being  ufelefs for  the  Time, but
painful: And  this Extenfion we fhould
take Care be  not made by Jirks, but
fmooth and ftrong, in Proportion to the
Depth of the Cavity the Head of the
Bone  has flipped  into,  which depends
on the Make of the Mufcles,  and the
Edge  or Spine  of the  receiving Bone,
(whether superficial or deep.

              Repofition.

   WHEN you  have  the  Limb  at a
 proper  Extention, and have afore con-
 fidered which  Way the Head of it has
 lapfed,  whether  down, up, forward  or
                  P 3           back- 
backward,  you  are  at that Iriftant to
dired it  the contrary Way, and it will
fly in, facilitated  by the Make of the
Socket,  which rounds  inward  (where
the Joints  have rotatory  Motions) for
the more clofe imbracing the Epiphyfis.
If there  appears any Difficulty in  Re-
dudion,  either from the Time, (Hours,
or Days  it  his been out,)  or the Depth
it is to be extended from, it will be con-
venient before a Tryal  with Extenfion,
to ufe oyly foft Embrocations about the
Joint,  to relax the  Parts for  an eafier
Submiffion.
   Deligaiion and Collocation, are to pre-
ferve the Joint reftored, and prevent Ac-
cidents:  The  former can  be explained
only of  Bandage, but is ufually under-
stood to  comprehend the  Application?,
which fhould  be of Medicines  that can
abate Pain, relist the Influx of Humors,
and strengthen the Parts.
   Such are Embrocations  of 01. Rofar.
Terebinth,  a.  p. a.
   Ung. Dialth*. Spt.Vinr. ReB. a. p. a.
   Or,  Ol.  Cham. Hy-p?rk.Mifce q. v.
   And Emplaifters E. Polo, de Minio,
ad Hemiam,   cr that N° 31.
   Rowling will be different, according
to the  Part *o be  rowled,  and may be
                               found 
             (  "5  )
found adapted in Mon.  le Clerk.   We
may only  obferve  in  general,  that a
thick Comptefs of Linnen is to be under
the Rowler, on that Side the Bone fell
out, there bein'g more Suspicion of its
tending that Way again.
   Collocation is to be a Position contri-
ved to the Eafe of that joint in particu-
lar, that has  been diflocated, and there-
fore varies  according to where the Cafe
is.  In the inferior Limbs, a little  Ele-
vation, and a confined quiet Potture for
a  Fortnight  or three Weeks:  And if
the fuperior  Limbs,  they  fliould be fo
flung and fuftained, as that nafuccum-
bring Weight,  of the Parts below,  in-
commode it.  In all,  the Bandages and
Covering  fhould  be  foft and Smooth,
a proper Reftraint  in Diet prefcribed,
Venefedion,  fometimes Clyfiers   and
cooling Emulfions.,
   Bones joined  for  dbfcure  Motion,
feldom luxate} but when they do, are
of diflicultest Recovery.
   A Rib may flip in or  out-fide.   The
in-fide Luxation is  capable only of
internal  Prefcription,  Time and  Pa-
tience, to   relieve  the  Pain and   Dif-
ficulty of   Breathing,  attending   it :
The  out-fide indeed  may  be raifed to 
             (  «*)
Its Place by an Elevation of the Arm,
and prefling with  the Fingers  at the
fame Time } but the retaining it there,
is^ not altogether fo eafy.  So again the
(javkle may be eafily replaced,  by put-
ting fome Convex  Body between the
Shoulders, and pulling both back at the
fame Time} but then how long it will
be  retained,  may  be gueffed from the
incommodious  Make,  insufficiency  of
Bandage,  and Contradion of the Pedo-
ral Mufcle,  which will ever be Impe-
diments to preferving a true Reposition.
   The  Rotula  alfo  may start out-
ward,  and by keeping the  Leg  ftrait,
be  thruft into its  Place  again}  but as
the  Mufcles  ReBus, Vaflus  Externus
and Interims,  and the Crureus are in-
ferted into it, their Contradion  will very
much elude any Skill to keep it fo.
   Thelaft I fhall mention, of the Bones
articulated } for obfcure Motion  are the
Vertebra or Off a Spina Dorft.
   What is meant by a Luxation of them,
I do  not  well apprehend : A  Fradure
of the Proceffes may be by Shot  or Blow,
and  recoverable} but a Luxation muft
be  ever, I think, of fatal Confequence,
as it is the Effed of the greateft Strains,
and  makes a Compreflion on  the Spi~ 
             ( *!7  )
nal-Marrow, whence the Nerves, ferving
to Senfe and Motion, arife. ^
   To form the jufteft Notion we can
of thefe Hurts, we fhould  meditate on
the Conttrudion of the Vertebra} they
are fhort,  plain on the upper and lower
Sides, Convex before, and the Proceffes
by which their Jundure is made, are
the  hardeft Parts  of them} feven  in
Number,  two lateral, one acute on the
hind Part, and four oblique : Of thefe
latter,  the two afcending are received
into fmall Dimples  of the two defcending
Proceffes  of each  fuperior  Vertebra of
the Neck and Back,  and  the  reverfe
in thofe  of  the   Loyns} fo that the
Articulation  is a  Ginglymus :  Befides
this, they  are tied  together  by ji
strong Membrane  forward, the  whole
Length of the Spine} behind, by the
Tendons  of the Mufcles,  and  to one
another  by intervening Cartilages, but
not diftinB,  which are  thinnest back-
ward, to yield to  the Motions  of the
Body : Thefe Proceffes together with the
hinder or concave  Part of the Body of
Vertebra, form a  Hole for  the Defcent
of the  Spinal-Marrow,  lined with a
Membrane.
The 
              (  3-8)
   The two firft of the Neck (Atlas and
 EfUftrafbaus) have  this  in particular,
 that the oblique Proceffes  of the former
 receive the two afcending the Tuber-
 cles of the Head, on  which  Articula-
 tion it moves backwards and forwards:
 The other has a long Procefs,  called
 T>entM£,  afcending  between  the two
 oblique, and is inferted into a Sinus, in
 the foie Part of the great Hole in the
 Atlas.
   On this Tooth like Procefs, the Head
 and Atlas turns half round, but is hin-
 dered from going farther  hy the  Liga-
 ment that  ties it to the Head,  and ano-
 ther that fattens it to each Side of the
 Sinus.  A Luxation or Fradure  of it,
 is what We understand by a Perfon's
 breaking his Neck, and muft be mortal,
 tho' the Fradure not always immediate-
 ly.  I remember one Scutthorp^ in her
 Majesty's Ship Lyon,  1712,  being very
drunk, fell down  the Fore-Scuttle, and
fradured this  Procefs, his Head fell like
a dead Lump to either Side, and feemed
fo loofe that his Face might have  been
turned almoft  behind:  He continued
fpeechlefs,  infenfible,  and with  fome
Difficulty of Breathing, but lived twelve
Hours after it.
                                The 
              ( *'9  )
  The Vertebra of  the Back have  the
leaft Motion,  becaufe  their Cartilage*
are thin, their acute  Proceffes long, and
becaufe the Ribs are faftened to them.
The Proceffes of thefe Vertebrae may be
fradured by a Shot  grating (as I obfer-
ved  before) or other  external  Stroke,
and  yet be of no considerable  Confer
quence,  but  a Luxation  (confidering
their clofe Conjundion) feems impofli-
ble.  I have heard indeed, of a tranfverfe
Procefs being fradured in ftepping over
a Kennel,  with  a Burthen, and think
it probable, becaufe there are many Muf-
cles  arifing, or inferring themfelves into
thefe Proceffes, that are the Strength of
the  Back} but if their Contradion can
effed a Fradure, it will differ from the
other  Caufes  mentioned in its  Confe-
quence, and bring greater Lameness, be-
caufe it  muft  happen  within-fide their
Infer tion.
   The common  Hurt  they are fubjed
to,  is the Distortion  we  call  Bunch-
back'd,  and  proceeds   from  particular
Weaknefs in the Ligaments  and Muf-
cles} for if thofe behind, thro' any Caufe
relax,  as is too frequent in Infancy, from
the  Careleffnefs of Nurfes  in Rowling,
and  continuing a Child in  one Potture} 
             (  ISO )
j*hy then their Antagonists remain per-
petually contraded,  whereby the ob-
lique Proceffes which join the  Vertebra,
part from one another,  and the  Space
fills with a  vifcous Subfiance, not un-
like what we call  Callus, in  any other
Bone :  And if  the  Misfortune  begins
from the Birth, before Oflification, then
die  Vertebra themfelves  participate and
inlarge the Deformity.
   The Vertebra  of  the  Loins,  by the
Distance  of the  acute  Proceffes,  anc]
Thicknefs of the Cartilages, bow moft,
and therefore moft likely  to  recede at
Manhood, by violent Strains in Labour
or Exercife,  and fuch  are commonly
called  broken back'd,  fome of  which we
may have feen to go almoft double, lame,
and ft iff for their Life-Time,
   This Misfortune, I do not apprehend
proceeds from any Difconnedion  of the
Bones, for then the Bent would be fud-
den and immediate Death enfue} but it
is, as has been obferved in Diftortions of
the Back,  from the partial  suffering
* of thofe  Mufcles that extend and erect
the Body. The Sacrolumbus, Lonoijfimus
 Dorfi,  Tranfverfalis Dorfi, Interfpinalis,
 Onadratuslumborum, <kc. Thefe  having
 their  Tendons infested  into  the tranf-
                                 verfe 
              ( "I  )
verfe Proceffes,  as  heavy Burdens, or
exceflive Strains,  fhall  weaken  their
Adion, or pofiibly by Contradion, (for
they are of prodigious Force,) fracture
a Procefs} why then the Mufcles thatae-
quilibrate thefe,contract forcibly forward,
and bow the  Body,  much more than
could be accomplifhed at the Back,  not
only on Account of their superior Force
and Strength, but becaufe the Vertebras
here have moft Motion towards it, and
no Ribs to sustain againft their yielding.
*  Thefe Hurts are accompanied with
extraordinary Pain and Inability of Mo-
tion, a  Palfey or Numbnefs of the Arm,
when it is the Back or Neck:  The fame
in the inferior Limbs, when it is  of the
 Vertebra of the Loyns, fometimes alfo of
 the Sphinder Ani, a Suppreffion of Urine,
 difficult Breathing, and the like.
    External Applications are in common
 with thofe of the Joints : An anodyne
 Embrocation, corroborative  Emplaifters,
 retained with  Safh or  Napkin round
 the Body, and, above all Things, Repofe,
 to  which  a  foft  Bed  will contribute}
 Venefedion, a proper Regimen, and, as the
 Party  gains Strength, Iron Boddice. But
 becaufe  thefe  Hurts  commonly' affect:
 one or other of the Bowels,  it is ufuil
                                  with 
               ( 111  )
 with them to prefcribe Vulneraries,  the
 Simples of Sperma Cati,  Lap. Hibem.
 Cerevif. Prujfia, Caudle,  &c.
   In {pitting or in  pitting of Blood.
   ft. Conf.  Rofar. Rub. |f. Loral. Rub.
 G. Arabic, a. 3J. Miv.  Cydonior q. s.
   Or,  R. Gum. Tragacanth.  purifs. %'].
 Solut. in Aq. Rofar. Rub. Ibj. F. Gela-
 tina. M. cum Sacchar. Albifs. tbf. Nucis
 Mofchat. N° i. ^ Capiat Cochlear, fe-
 mis 8a. quaque Hora.
   I proceed now to the Bones, joined for,
 manifest Motion,  more fubjed  to Lu-
 xation,  and  firft, of the

          Os Max Mar/,  infr/tcr.

   THE Jaw Bone hath two Proceffes at
 each Angle } the  Coronq  arifes  broad,
 and ends in a Point, playing under the
 Vroceffus Zygomaticus,  where the Ten-
 don of the crotaphite Mufcle is inferted
 into it.
   The  other  called Condylus, (which
 makes the Joint,) is fhorter, lower, and
 inferted into the Sinus of Os Petrofum }
 both Sinus and  Procefs  being  covered
 with a Cartilage, and between them  a
third, to facilitate its fide Motion in chew-
ing.   Another  called Ligamentum An-
                                nulare 
             (  223 )
nulare, furrounds the Articulation, an!
the Mufcles  Majfeter^ Temporal,  and
Pterygiodes, help  to  keep it (hj  their
Contradion) fteddy.
   Any Thing that Qver-ftretdierh the
Mouth,   whether yawning, gaping or
chewing, may put the Condylus out of
its Socket, into the Cavity of the Cheek.
   Signs, are the Jaw thruft forward, ma-
king the Teeth  more prominent j or if
the Diflocation be only of one fide, a
Distortion like Spafmus Cynims, he can
neither  fwallow,  fpeak, chew,  or fhut
his Chops.
   For its Repofttion, place the Patient
fteddy,  put  your Thumbs  ciofie to the
further Maxilla ries, prefs down on thofe
Teeth, extending and railing at the fame
Time the Chin with your Fingers, with-
out fide.

             Os Humerus.

   THE Shoulder  is capable of all
Motions,  and that they might be  eafy
and extensive, for the Necemties of La-
bour and Exercife, the Head of the Hu-
merus is larger than  the Gavity  of the
Scapula wherein it is received (which is
likewife moft of a ligamentous Subfiance,
                                   to 
             (  "4  )
to give lefs hindrance to  the Compafs of
them} but it is for thefe Reafons, alio,
more fubjed  to Luxation, than any other
Joint, flight  Accidents of Blows or Falls,
frequently occasioning it.
  It Ve2salmost ever diflocated downwards
rarely forwards,  very rarely backward,
or upward } the two latter Ways. I be-
lieve, has been  added rather  from the
Pofiibility of the Thing,  then Expe-
rience and  Fad} for it is not eafy  to
conceive what fort of Violence it muft
be, which can effed them: The Breaft
takes up  the Motion of the  Arm,  fo
effedually forwards, that how great or
fudden  foever the  Blow is,  the Joint
will ftill yield, and cannot be  flretche4
to a Luxation }  and upwards, the Posi-
tion of the Arm  (very unufual in Falls)
muft be  parallel with the Side, and the
Blow take the Tip of  the Elbow, and
even then the Spine or Cervix of  the
Scapula muft be fradured  to  compleat
a Luxation.
  Signs of  Luxation here, are a Cavity
in the upper or back Part  of the Joint,
and the Head of the  Humerus felt hard
and  protuberant in the Axilla,   or for-
ward under the pedoral  Mufcle}  the
Ulbow (as is the Prolapfe) hangs from
                                  the 
              («5  y
the Side outward, or a little  backward,
and  as the  Motion  of ther Joint is
loft,  fo  it plainly  follows,  a Patient
can reach no higher  than that  Extent
will allow, which is between the  Elbow
and Tips of the Fingets, i. e. only to the
Mouth, if the Head be kept upright.
   The reverfe of thefe will appear on
Redudion, the Joint and Arm recovers
a  Similitude  with the found  one, Pain
is abated, and what we may, add,  as a
furer Sign than all, is the knapping Noife
that will be heard at  its returning into
the Socket.
   The Intentions of Cure are properly
but two,  as  aforementioned,  Extention
and Contra-Extention, anfwers the firft,
( i. e. Redudion,)  and Deligation and
Collogation include the  Means of our
fecond, that   is,  preferving it fo, and
preventing Accidents.
   For Extention, there are two Hands,
the Heel, a Ladder, or an Ambee in ufe.
   When attempted by the Heel,  the
Potture is incommodious for Redudion,
becaufe the Patient is  laid on his Back}
however,  in  order to it, a Comprefs or
linnen Ball muft be fitted to the Hollow
of the Arm-pit,  for the  eafier  fitting
of a Girt, which  is to come over that
                   Q,             ana 
             (  n£> )
and the Shoulder, for Contra-Extention }
while  an  Afliftant  below  nxcs  his
Hands On the Cubit,  and  his Heel in
the Axilla }  where, by the Way,  it may-
be  noted, that  the Elbow Joint  inter-
posing, abates the Force of Extention.
   The next Method, is, over another's
Shoulder, or rather  the round  Step  of
a  Ladder}  here the Comprefs and Ball
being fitted to the Axilla, and a fuffici-
ent Strength placed before at the Arm,
the Weight of the Body (tripped  off the
Step) is  to be the Contra-Extention, a
more dangerous  Expedient  than any }
for  ftiould'the Weight,  by  fuch a fun-
den jirk, bring but a fmall Part  of the
Os Humerus over the Step of the Lad*
der, there would be very great hazard of
fracturing it, at leaft, it is a Violence that
will pejorate the attendant  Symptoms.
   The Ambee is an Instrument in com-
mon Ufe, and needs no Defcription, fixes
under the Arm, the Length of it, and
Extends to What  Degree you pleafe.
   But the Hands, in my Opinion, are
preferable to all thefe,  and have  been
funieient with me, for reducing a  Shoul-
der, even when the Head of the Bone
has  beeri prolapfed three Weeks } by
them Extention  is more -fteddy and con-
*J',lfi                         venient, 
              (  "7 )
venieflt, becaufe  you perceive the Head
of the Bone moving, and can more fea-
fonably help to raife it up.^
  The  Method  is to bring a Napkin
round the  Patient's Body, to fit  broad
on the Hurt-fide,  the upper  Edge of it
to come clofe to the Axilla, and on the
opposite Part to  be tied  very fast, for
fome Afliftant to make the Contra-Ex-
tention by.   He  that extends forward,
fliould be ftrong,   and  have his Hands
flowered, for the more firm holding*
  The Patient is feated on a low Stool,
fixed, fo that Affiftants can come round,
without incommoding each other} the
Surgeon over looking, claps his Thumbs
forcibly on the Cervix of the Scapula,
and his Fingers  underneath in the Ax-
illa, without any Linnen or Comprefs be-
tween, to dull the Senfe of Feeling,  when
the Head of the prolapfed Bone is moving.
  Thus ready, Extention and Contra-
Extention  fliould  be begun  together,
not by  jirks,  but fmooth, fteddy and
strong} and when the Head of the Hu-
merus  is found  moving,-  the Surgeon
muft  endeavour  with all the Strength
he has in his Fingers, to aflift its Repo-
sition,  ordering  him that extends,  to
favour this Part,  by moving the Elbow
               Q. s           down- 
              ( ^8)
downward, towards the Patient's Side,
when he is at the full Stretch of it. ^  We
may note, that very strong Extention is
chiefly of Ufe  in robust Bodies,  and
where the Bone has been long flipped,
(left  the Cupula  fradure,) for in Chil-
dren and young moift Habits,  lefs  will
do } we need only make an ordinary Ex-
tention  at the  Arm, and  bow contrary
to  the Way the Bone  prolapfed,   the
Surgeons  Hands (at the fame Time)
grafping   the  whole Joint,  will  be a
fufficient Contra-Extention.
   Deligation  and Collocation,  compre-
hend Drefting,  Bandage and Scituation.
The Drefling, where the Patient is young,
 and of good Constitution, need only be
 a Comprefs large enough to enfold the
 Joint, dipped inOxycrate, or Acetumcum
 Albumine Ovor. and if older, or an ill ca-
 chochymious Habit to deal with, the fol-
 lowing Embrocation and Emplaifter, will
 better refiftPain  and Influx of Humours.
    ft.  Ol. Lillior Hyperic. a. p. a.  M.
 R.  Empl. Diaplm, de Minio.  a. §f. Bol.
 Armen. 7J\j. Oleum  duke q. s. F.  Empl.
 extenditur fuper  Alutam.
    Or an Empl. E. Bob.
    Or that, N° 31. adding, if Occafion,
 Venefedion in the contrary Arm.
                                 The 
             (  "9  )
■ ■ The Bandage,  called Spica,  defcrib-
ed in Mon. I. Clerk,  will be  always
beft for the Shoulder,  and next to that
the Star,  (this makes  only croffes be-
hind, the other before  and behind,)  ei-
ther is ufually dipped in Oxycrate or red
Wine} and before ufing, the Hollow of
both Arm-pits, filled with Linnen Com-
preffes or Tow,  to adapt  the Bandage,
and prevent galling, and the Circumro-
tationstort,  becaufe, what with the dry-
ing of the Rowlers, and Motion of the
Breaft, in breathing, they foon slacken.
   The Scituation of the Limb fliould
be in a large Napkin,  thus; bring one
Edge of it clofe  under the hurt Joint,
carry one  Part behind, the other for-
ward, and tie fast  on  the opposite Side
of the Neck}  the inferior Selvedge  of
the Napkin bring up, having inclofed  the
Cubit, and  pin at a suitable Elevation.
   N. B. There  is one of the Tendons
of the Biceps, which paffes thro' a little
Notch or  Excavation   of this superior
Part of the Humerus, that fometimes in
quick jirks of the Arm, (Slingingor Batt-
playing,) flipps its Place,  and  imitates,
in  Pain and Imbecillity, a Dislocation}
this is eafily diitinguifhed ,by the Protu-
berance and Cavity being wanted,  and
                 d 3          requires 
             ( n°)
requires no Extention,  only an eafy
Twitting,  or Variety of Motion to the
Arm, till it Re-places.

             Os Femoris.
  THIS Joint, made by the Infertion
of the Head, or Epiphyfis of  the Thigh
Bone,  into  the Acetabulum Coxendicis,
is fecured }  befides, the Depth  of the
Enarthrofis, by a ligamentous Subfiance
round the Brim of the Acetabulum, that
makes the Diameter lefs there,  than  in
the Socket,  binding in the Head of the
Bone} which if we consider, together
with that Security  the  Ligamentwn Te-
res, longum, and the Mufcles add, it will
he almoft impoflible to allow its Ditto-
cation, but that the Accidents taken for
it are generally Fradures} a Miftake I
have more than once feen.
  I muft  acknowledge, that in tender
infant Years, where Children are weak
and  ricketty,  and  the Epiphyfis as not
united, it may he fubject  to  an inward
outward, forward  or  backward, either
Distortion or Diflocation,  as  is evident
in fome fhort Limbs that  have gone the
whole Life-Time unreduced } but in.A-
dults, the Po$bility feems only inwards,
and that firft', becaufe the Ligamentntn
                               Teres, 
              (  nl  )
 Teres, which ties  in  the Hfead'of the
 Bone, arifes not fromithe Middle of the
 Bottom of the Socket^ norj is inferred
 exadly in. th: Middle of therHead of
 the Thgh tione,  but on the-Side next
 the Groin,, molt favourable for admiring
, it.  Secondly, The Ligamentxm longum,
 arifing froirl  the Neck of iherBone, arid
 being inferted in fHe nearest Procefs of
 the Coxendix, suffers  not the Stretch
 this Way.   Thirdly, The Ligamentous
 Subfiance,  abovementioned, % not fo
 deep  inward, as at any other Part of the
 Brim } and/ >fty, The Perforation of the
 Os Pubis, is convenient :fbr the.Reception
 of the Head of the  Thigh Bom : Yet all
 thefe  concurring, with any Violence, the
 Bone fooner Fradures than Diflpcates }
 for as it muft be perfed, (or. the Head of
 the Bone would return back again pre-
 fently,)  fo that cannot well be, without
 a. Rupture of: the  Ligamenlum  Ter€s,
 an  Accident fcarce allowable, but if it
 can happen, expofes to every, fort of Lux-?
 ation as well as the inward,, g^:-   ■ ,ru
  - ,4Signs of an inward Luxation* are a Tu-
 mor  and  Protuberance on  the Hole of
 the Os Pubis, and Cavity on the opposite
 Side} the Leg appears longer than the-o-
 ther, the Knee and Foot turned outward,-
                  Q. 4            and 
              C  *3*  )
 and the Motions the Joint ferves to,
 very imperfed,  or loft.  In the exterior
 Prolapfe,'the Leg appears fhorter, the
 Leg and  Foot turned inward, and the
 Heel to the  out-fide,- requiring a stron-
 ger Extention to  reduce, as being  from
 a deeper  Cavity, and  unbending  the
 Contradion  of  fome  of the strongest
'Mufcles; of the Body.
 i j. ...  ■ rb  ■..    .
 ;'-..;.:■  f :\   Prognoftick,
 '-- A S  the   Violence  which  luxates
 the  'Hip,   muft prodigioufly  exceed
 that of any  other,   and that the Liga-
 mm Teresris broke,  fo the  Pain and
 influx of Humours (we may believe J will
 be proportionably aggefled, and  Inflam-
 mation, Apoftemation,  and  perpetual
 Lamenefs,; a more necessary Confequence.

 -* Lr            ReduBion.
 <■ IN  the inward Luxation, the Muf-
 af e  already   on  the  Stretch,  and
 therefore -requires no great Extention 5
 there feems  only to be  wanting fome
 ftrong Perfon/ between whofe Legs the
 Patient may fit, and with a ftrong Grafp
 ahout his  Body,  hinder his receding or
 giving  Way,  which is  the Contra-Ex^
 tenfion: While the  Surgeon with both
 s'-                            Hands 
             ( *33  )
Hands above the Knee, extends forward,
(an Afliftant bearing the Foot  up) and
at the fame Time carries it towards the
found Thigh and upwards.   For redu-
cing  the outward Luxation,  more is
wanting} a Pin fhould be fixed, fays Mr.
Wifeman, on a Table, to come down be-
tween his Thighs,  the  Patient on his
Belly} a Strap is to pafs up the Crutch,
with a Comprefs upon,  to defend from
any Uneafiriefs, and  forward   (if the
Hands are not fufficient) we may extend
alfo with Straps, thrufting  the Thigh
backward and  outward at the fameTime.
   After Redudion, remains Drefling and
Scituation }  and herein I fhould think a
Comprefs dipped in Oxycrate or redWine,
large enough to infold the whole Joint,
and crofting upon the  Hip,  would be
better then Emplaifters which obftrud
the Perfpiration of the Part, and by that
Means raife a  Ferment in the Humours,
more  rationally  fuppofed  aggregated,
where the Hurt and Extention to reftore
have  been  both fo very great.   The
Rowler fliould be long and double, and,
like the Comprefs, crofs over the afteded
Hip,  and fo continue with croffes and
edgings, till finifhed.^
                              A pro- 
              (  23+.)
  A proper Scituation is resting' the Hip
on  a foft Pillow, with  the Knee  and
Foot a little raifed,  and continued for
three Weeks, in the quieteft and eafyeft
Position.  Venefedion,   Clyfters,  and
Dieting,   are  to  contribute  likewife
their Share in  preventing  Fever  and
other Disturbances.

              Os Cubiti.
  THIS Jundure is a Ginglymus: The
Humerus ends wkh a double  Protubev
ranee, which necessarily makes  a Chan-
nel  between them }  on each  Side of
which there is alfo  a little femieircular
Riling: On the Fore-fide of thefe Pro-
tuberances, there  is a fmall, and on  the
Back-fide  a large Sinus.   The  Ulna,
which is the inside Bone,  and makes the
Joint, has a Cavity fuitabte to the inner
Protuberance of the lower End of the
Humerus, and it has two Proceffes like-
wife fhooting frous this Cavity,  one be-
fore, and one behind} the  foremost is
fmall and fhort, running into the Sinus,
on  rise  Fore, fide  of the Protuberances
of the Humerus  on Flexion}  and  the
hindmost called Okcranon,  (bigger and
longer than the former,)  rums  into  the
hind  Sinus on 'Extention,  flaying  the
                                Arm 
              ( '35  )
Arm at a ftrait Line.   The Radius  has
here a broad Head,  part of whofe Cir-
cumference, is received into a fmall  la-
teral Sinus of the  Ulna, bound  in by
a broad  Ligament} and  by Vertue  of
this, the Actions of Pronation  and Su-
pination are performed. The Top of this
broad Head has an  Excavation, for re-
ceiving the outer  Protuberance of the
Humerus, and fecured to it by the circu-
lar Ligament involving the Joint, and
by feveral Mufcles.
   It is verv difficult to conceive how a
perfect Luxtion of th's Joint can happen,
femi-luxated or diftorted, it may be four
Ways, inward, outward, and fide Ways}
tho' if  we consider how it is fecured
from the latter, by the make and ftrong
Ligaments on its Sides, and how impro-
bable it is for any Flexion to thruft  it
out backward} we may be apt to ima-
gine it is  more frequently,  than truely
reprefented fo,  to  increafe the Timidi-
ty of a Patient, and recommend the Skill
of the Artift.
   The moft likely Way of Luxation^ is^
inwards,  and  yet  high  Falls,  wherein
the  Fore-Arm catches, or strikes  on
any hard Body, rather makes a  Fracture
than, any Distortion at the Joint, unlefs, 
              (a36)
 in fuch Falls, the Perfon endeavours to
 fave himfelf with the Palm of his Hand,
 for then the Strain  lays entirely  at the
 Elbow,  (the Wrift  yielding, and the
 Preffure along the Cubit,  being Secun-
 dum Longitudinem,) fo that if of Necef-
 fity,  fomething muft give Way,  it will
 probably be here} but then it cannot re-
 cede far without fraduring the Olecra-
 non,  a deplorable Cafe,  and muft pro-
 duce incurable Lamenefs.

                Signs.
   SIGNS of  a diftorted Elbow,  are
 a  Protuberance  on which Side foever
 the Head of  the Bone  thrusts  out, a
 Cavity whence  it has receded, and an
 uncommon Pain  from a Diftradion  of
 the Tendons : The Flexors and Exten-
 fors of the Hands and Fingers, taking
 •their Origine from  the inner and outer
 Protuberances of the  lower End  of the
 •Os Humerus.
   To reduce, is  to extend and force the
 Head of the Bone contrary to the Way
 it prolapfed.
.  The Drefling  and  Position fhould be
 contrived Emollient and Anodyne. Em-
 brocate with Ol. Hyper. Rofar. a.  p. a.
 and dip a double Flannel, Clipped (from
                                each 
              ( 337  )
each End towards the Middle) into the
fame Mixture,  warm and apply} it is,
I conceive, better than a Plaifter, as be-
ing more foft and anodyne,  and com-
pilable to the Shape and Position we are
to put it in.   The  Rowler  fliould be
fingle} begin with one  turn on the lower
End of  the Os Humerus,  flope it down
on the bending of the  Arm, and  make
a Turn on the upper End of the Cubit}
re-afcending on the bending of the Arm
fo as to make a Crofs there, continue fo
to  do with Edgings till rhe  whole be
covered, (except the Tip of the Elbow)
and finifh at the upper Part of the Arm:
you muft give the Cubit a little Flexure
before Rowling, and the Elbow not be-
ing covered, will yield enough to fling at
a proper Elevation.

              Os Cruris.
   THIS Joint is a Ginglymus alfo,  (the
strongest of  Articulations.)  The lower
End of the Os Femoris has a double Pro-
tuberance divided  by a Cavity,  and the
Tibia or Focile majus  (on  which the
Jundure is made) has a  double Sinus
at its upper End, with a Produdion be-
 tween,  for the mutual Reception and In-
fertion  of one another.  The Cartilago
                               lunata 
              (  538)
 lunata runs between  the Extremities of
 the two Bones, and facilitates a Side Mo-
 tion.   The Fibula receives at this End,
 the external  Knob of the Tibia,  but
 comes not up to the Knee, to make any
 Part of the Joint.
   The Patella tyed down > on its fore-
 part by Mufcles patting to and beyond
 it} and by the Tendons of the Extenfors
 of the Leg add a  great Strength to  the
 Joint, and behind the Hamstrings (Ten-
 dons  of the Flexors.)  All  which toge-
 ther, renders it (unlefs where great Ener-
 vations and  Difcontradion of the Ten*
 dons has preceded)  difficult of  Luxati-
 on  Sideways  or  Backwards,  but For-
 wards feems  impoflible;  not only  on
 Account of the Pan, but becaufe Genu-
flexion can never be carried far enough.
   Signs, are what have been  remarked
 in common with others, unlefs that the
 Tumor and Cavity may be more apparent}
 and Redudion is extending and moving
 the Head of the Bone,  contrary to the
 Way  it  went out.  Suppofe  it  were
 Backwards,  you are to have an Assist-
 ant for the  Contra-extenfion above the
 Knee,  and your felf with one Hand on
the Cf If,  and the  other above the An-
cle, are to extend  forwards, giving it at 
               (  *?9  )
  the  fame  time a quick Flexion towards
  the Buttock,  and it will knapp in}  a
  certain concomitant Sign will alfo be the
  Cavity that was under  the Pan,   being
  filled up again.  The Drefling fliould be
  an Embrocation of Ol. Rofar. Hiper. M.
  a  corroborative Emplaifter on Kid Lea-
  ther, a Comprefs in the Ham,  a Flannel
  over that, and then a double  Rowler}
  begin  with the Rowler jutt above the
  Knee,  defcend  with a  Crofs   undet
  the  Ham,  bring them  up  below the
  Rotula, and  make a Crofs on  the Leg.
  Continue  thus to  do with Edgings, till
  the Knee is covered and Rowler finifhed*
  The Comprefs included here,  not only
  guards againft the Tendency of  a Pro-
  lapfe,  but defends the Tendons  behind
  from Cold and Uneafinefs,  which too
  aptly contrad them in thefe,  Fradures,
  and the like Misfortunes, that neceflitate
  a long and inadive Confinement. When
_ £uch Contradion does happen,  I muft
  recommend, befides warm emollient Em-
  brocations and Fomenting;,  a Working
  of the Limb backwards  and forwards
  on the Joint} thefe Chords  have fome
  Refemblance to thofe  without us, and
  malax and unbend with Warmth, Moi-
  sture and Motion,   I knew fuch  a Con-
                               tradion 
              ( H°  )
tra&ion of the Flexors, after a long Con-
finement, for a Fradure of the Leg, and
when Oyntments and Fomentations had
been  ufed to no Purpofc,  unbent and
ftrait'ned after about  a quarter  of an
Hours fuch Exercife with the Limb.

              Ojfa Carpi.
   THE  Radius  (on which  the Ar-
ticulation  of  the Wrift  is  made)  is
largest at the lower End,  and has two
Sinus's for receiving the firft  Rank  of
the Bones of the Wrift, (the fourth Bone
of this Rank lays  upon the third, and
feems  eafieft of receding from  its Sta-
tion-)  The fecond Rank lay even, an-
fwering to  thofe  of the Matacarpus,
which at this End  have each a Sinus to
receive them.   The Ulna is fmall here,
received into a like Sinus of the Radius,
and makes alfo a fhort Procefs even with
the outside of the Little-finger} this Pro-
cefs gives Rife to Ligaments that ties it
to the Bones  of the Wrift, and ferves
to keep them in their Place.  Laftly, they.
are strongly tied to one another by Li-
gaments  from  the Radius,  and by the
annulary one.
   From  this  Defcription. of the  Wrift
may be inferr'd, Firft, that being com-
                                pofed 
              ( H1  )
 pofed of feveral fingle Bones, they may
 recede from one another, and that chiefly
 at joyning  the two Ranks,  or in that
 fourth Bone of the  firft Rank, not feem-
 ingly fo well fecured as its Fellows* Se-
 condly, the firft Rank  may flip,  or di-
 stort from the  Radius, or  the fecond
 Rank out of the Sinus's of the Metacar*
pus,  either, according to  the partial
 Weaknefs, and as the Strain  or Preffure
 bears on a particular Point, or the whole
 Joint. Thirdly, from the manner of their
 joining and the Motions of the Wrift, we
 may conclude, any other way of Difloca-
tfion than forward or backward, impro-
 bable, excepting that fourth Bone of the
 firft Rank,  which  I have feen continue
 prominent nigh the Procefs of the Ulnai
 with little Trouble.
  As the Signs are a Prominency one way*
 and a proportionable Vacuity on the other,
 fo confequently Redudion is the Recove-
 ry of its Shape}  and tho' done eafily by
Extenfions  (their  Edges holding .ftill a
 Part with their Fellows) yet is it fubjedin
 its Confequence to great Pain and Tumor*
  Pain  is a neceflary Result from the
greater Sensibility of a Number of Ten-
dons here,  but then the Tumor is rather
an inflation \ now  according to the Me«
                R           chanica} 
             (  H* )
chanical accounting for the Operation of
Mufcles, Inflation fhould be intheBodies
of them, and none in the Tendons, yet fo
it conies to pafs, that flefhy mufcular Joints
have moft Danger of inflaming and apofte-
mating from an Accumulation of Blood,
and tendinous Joints,  fuch as the Wrift,
more evidently to a Rarefadion of Blood
and Spirits, fuch are thefe large foft in-
flated Tumors}  the conftant Attendant
of Sprains and Diftortions here.
   The Dodrine I would draw from this,
is only in refped to Rowling.  That in
Flefhy Articulations,  the Tumor, when
inflamed, being plainly an Accumulation
of Blood, and no fuppofed Expanfion or
Elasticity of Air, strict Bandage muft ob-
ftrud  the Circulation and increafe the
Accident.   On the  contrary in inflated
Tumors  (as  all thefe may be reckon'd
which carry the natural Colour of  the
Cuticle in Sprains)  ftreight Bandage is
moft advantageoufly ufed: We need not
negled the Topicks afore-prefcribed,  but
the Cold-Bath, Reft, and this, are the moft
effedual Means of Recovery.

            Offd Malleoli..
 * THE Ancle Joint is made between the
two Focils,  and the firft Bone of the Tar-
                                 fus 
                (  H3 )
  fus (called Aftrtipfahsyhy\ Ghiglymus\
  for the Tibia at this End has a Cavity
  divided byafmaif Protuberance, arid the
  convex Head of the Aftralagus (inferted
  into this Cavity) isdividedbya^iwz/j-for
  the Reception of that  Pfotublfance,  fo
  that the Fibula makes only a Part of the
•  Joint, asitdefcendsinaiaVgeProcefscn
  the butfide of the Aftragalusi forming the
  outward, as the Procefs of the Tibia does
  the inward Ancle.
     There are fix  Bones more go to con-
  flitute the Tar fus,  The OsCalcis is the
  largest,  tyed by a  Ginglymus to the un-
  derside of the Os Apragali or Tali, which
  on the hinder Part of its under Side has a
  Sinus, and on the fore Part of the fame
  under Side, a Protuberance, for receiving
  and being received, by an anfwerable Con-
  vexity and Sinus, in the upper Part of the
  OsCalcis} and from this Jundure is for-
  med  a Cavity, containing an  Oyly Sub-
  fiance for (nbrjcating the Joint.  In the
  hind  Protuberance  of it is inferted the
  Tendo AchiHeis,  and before,it has a Ca-
  vity receiving Part of Os  Citbifirme.
     The Os Naviculare is fcituated  before
  the Os Tali, receiving its Convex Head,
  and forwardits divided into-three Heads
  itfelf, and inferted into the Sinus** of the
                    R 2            OJfd 
             (  H4-  )
Qjfa Cuntifotmid,  or Wedge-like Bones;
Thefe again are joined to the three inner
Bones of the Metatarfets:  They are in
Rank, and the Os Cubiforme with them}
the latter  joined in like manner to the
two outer Bones of the Met at arfits be?
fore,, and the Os  Cakis behind.
.   The Conformation of this Joint confi-
dered, how  faft bound with Membranes,
Ligaments and Tendons,  makes it very
difficult of Luxation (fuch a Luxation,
as that any two Bones  will ride on one a-
nother.)  If the Os Tali were entirely to
flip out of the Cavity of theTibia,  how
miferabie muft be the Distortion, and how
torn theLigaments} nor could it well be,
without displacing or disturbing, at  leaft
its Jundure with the 0s Qdcis, or Navi-
culdre, and that perhaps might extend-fa-
ther to the Bones they are contiguous jto.
   Again,  the Os Oalcis, Ufavicul^r^^nd
Off a Cuneiformia, feem not capable of be-
ing difjointed at one End, without ma-
king a Separation at the fame time, from
the Bone they are contiguous with, at the
other: As for Instance, fhould the Os Cd{-
€u depart from the Aftragalus,  it muft
move the Cubiforme, or from it.  If the
Ifiaviadare recede from the Afttdgdlus,
*here muft iikewife be  feme Receflipn at
                                  its 
             (  H5 )
its' Jundure with the Cmeifbtmia.  And
they again by any Accident suffering a
Distortion frorri the Navieulare, muft in
fome Measure bear the Effed to the Bones
of the Mtiatdrfiti; to which they are join-
ed,  and this becaufe they are fhort and fa
dofely linked arid united }  whence the
Ancle, as it approaches towards a perfed
Ltrxation, suffers infupportahle Pain, a
long and  tedious Weaknefs,  and fome-
times irrecoverable Lamenefs.
  The Difl6cationisirnpetfedhere, iriay
be  imagined  from the flight  Accidents
commonly laid to induce it, fuch as flip^-
pltigon an uneven Surface,  fudden Stum-
bles and Falls} and this Receflian of the
OsTali from theFbtils, pr the OsCalcis
from that  (both gyftglymoid Jundures)
may be four Ways, Qutwdrd,; Inwdrd,
Bdchvard dnd tofibdrJ.
  Signs. To judge of it,  we muft attend
to the Nature of the Hurt, how received,
&c. The  Pain, Tumor and Deformity
of the Joint} if inward, the Foot will be
found turned outward, in Proportion to
the Diftortion}  and if outward, the Foot
turned inward,  &c. But as thefe Signs
are equally the Concomitants of Sprains,
and that it is not eafy to  perceive any
fma! 1 Distortion of the Bone thro' a large
                 R 3         Tumor 
Tumor, or a peculiar Conformity* I fay,;
in regard jo this, it is not impolitick to
recommend Extention at all times} a Pa-
tient confines himfelf with more Satisfa-'^
ctixyn, and it keeps him off from Preren*j
ders,  who never. fail on. fuch Omiflion,.
to-reprefentthe Cafe in bad Colours,  the,
better to recommend^hemfelves.    ! s
   Ext£tttuhk>.  Extention fhould be made
with oneFlandon the Met at arfus,  the o-
ther under the.- Heel,  #hile an Affiftant;
holds the Leg^the fame time: Having cpl-
leded from the aforegoing Signs, how jhq:
Head of! the 'Aftragalus  h ys diftorted,
wring the Foot  the contrary' Way,} or
when the iReceftion is;fmall or but fufpe-?
ded, prefs gently with you*Fingers.about
the Joint (when at its Extention) to re-:_
ftore the Deformity. f       ;:  '\  ■ ^  • .  ^
   Cure. The Cure consists in the prefent
and continued  Ufe  of the Cold Bath,, an
Embrocation of Ol. Rofar. Hiper. a. p. a.
a Corroborative Emplt.  ex Minio  &
Diapl. a Rowler} and what is the proper-
Test Ingredient towards Amendment, re-
tting on a foft Pillow. As it recovers,* re-
commend a fort of half Itoot, coming up
as a Part of the Shoe to lace on, and fted-
dy the Joint.         »-^••-    -.■;.•..
          '             -          Os 
             (H7 y

    Os PoUicis  & Offa Digitorum.
  THE  Thuaih is joined  to  the«
Wrift, as the Bones of the Metacarpust
are, that having a, Sinus at its upper End
for the Reception; of the other*  and the
fecond Bone of the Thumh is joined to
the firft, as the firft (orlongest) Phalanx,
of the .Finger, is t;o the Bone of the Me-.
tacarpus, i.e% the upper find has a Sinusi
for the Reception of the round Extremi-
ty of the other, therefore may bedifloca-':
ted, any way}  and has thefe Sings.
   Forward, the Flexors* will be stretch- •
ed, Backwardthe Extenfors, and theDif-
parity is  easily feen and felt.  ,; „ -■
  Extention reduces them,  and they re-
quire  (as greater  Diflocations  do)  an
Embrocation and  Emplaifter,  fuitable ,
Rowling and Repofe.

               Sprains.
   In Luxations, the Joints are always
fprained. (whence the Symptoms of Pain,
Tumor, &c) and oftentimes without it.
   According to the Violence of the Faljl
or Hurt that occafion'd the  Sprain, the
Tendpns, become more or lefs diftended,
and that lattitudinally or longitudinally,
which,allowingfor the Age of the Patient,
                   R 4            is, 
             (  hM
is the ontyfCaufe why- the Weaknefs or
Lamenefs of that Joint,  fhould  be  of a
ihort or a long Continuance}' becaufe,  as
Nature has given to alt Parts of the Body
a Peculiarity of Senfe, Texture and Figure,
which will-heft conduce to the Ufe or
A-dion its for }  and again; that the Parts
are more or  lefs folid,  as may a rifwer beft
 thofe Ends  and Neceffities} fo it ncceffa-;
rily<omestopafs,  that the more ferifihie
 any Part is/ori-which a Hurt happens, the
more acute  and  fharp muft' be the Pain}
and the more folid it is, the longer Timcit'
muft rake for Restitution, \The Tenttas
are Parts of the  acuteft Senfe^ and  ofia>
mean Solidity, having a peculiar TextureT
on which the Perfedion of Action de-
pends } if they grow dry and approach th-
wards Rigidityv by*Defed of Nourhhrheht •
and Infirmities of Age, we find theypros-
  fortionably  lofe  of their Senfe,  and.the
  imb or Limbs/become imperfect) and
maimed in their Motions } foon the other
Side,  if Strains deftend them from theit
natural Make and.Manner of Compadi*
on,!shey will, as  I obferved before, onAc-
coant of their Solidity, require a longer
Time for Recovery,which would not fome
tlmei be  protracted for fo many Months
(often a longer Time than a fraduredBone
                                   is 
             (  H9>
is uniting) if the Qukknefs of their Senfe
did not ftimulatte an, Afflux of the Nervous
Juice and  Humours to the Part,  which
promotes thofe additional Accidents that
obftrticts it,  nor are they at any time 'ir-
recoverable,  but from a  Detention and
fixing of fuch Matter as fhould have been
excerned (if poflible) and by continuing
impedes the Accefs of Spirits, dulls the
Senfe,  and confequently  fpoijs the Ufe
of the Part,
  If a Strain be therefore as thus de-
fcribed, "why then,  at its firft being re-
ceived; we fhould endeavour to  restore
the Nerves and Tendons  to a due Tenfi-
fity again} and this, in my Opinion, can
by  nothing be more  effedually  done,
than by  the immediate Ufe of the Cold
Bath, a Means that will return them theit
proper Springynefs and Stiffnefe (if con-
tinued) and reftore Strength, fooner than
%]l other in a-much longer time could do.
  Corroboratives,  whether diftinguifiYd
hy  Emplaifters, Rowling, or Bracing
may bring up the Rear,  and  have their
Vfc.

 •.rr.'ijon &■■■-
?irmpM- <.*•  ■■
:I'fiGclk//4'' :J^:'
Pre-
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                  ( 25°  )




   Prefcripta aliquot in ufum Claflis.
     -»
                     L

        ELed^Scorbuticum. R. £/*$. Lenkiv.
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                    IV. ,
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in vdfe bono Obturdto fervanda.   '•,*.'"
                 VI.
  Mixtur. Anti-Emetic. R. Aq. Menth.
S. |ij. Vin Alb. cum Menth impregnat.
§it Sal Abfynth £j. Syr. Limon.de %eo^
a. sail. F. Hauft.           . f , •  o * w,4
  5              VIL
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jimulm bdlned Mari*.        ^ ' ^

                 XI.         ''■'  "
   Hauft. Paregoric.1 R. Aq.  Font. §ij.
Aq. Ther. %£'Syr.  de Mecomtp]. L. Li-
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  - Harift. Traumatic. R. Cerevif Prujfm
§iij.  Syr. SymphitvCrocl  d. %& Sperm.
C&ti 3J.  M:
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Ther. If. M.
                XIII.
   Pul. Traumatic.  R. Terra Sigillat.
Lap  tfibern. Sang. Dracon.  Mummia.
Sperm C&ti a. ^).  Pul. Rhabarb.  3G M*
divid. in Chartulas. iij. quarum unam
fumend. 6a quaq\ Hord in  hauft pofeh*.
vel Cerevifta feu, informa bolt cum Ther.
Ventt.
                XIV.
   Decod. Amarum.  R.  Sem. Carduf.
%ad Gentian. Inch. enuU Campan. a. ji j.
fummiiat Centaur  iffinor y]. Flor. Cha-
rn&mel, qf, CofidnU'in 'Aq. Font. fbiv.
ad tbiij.
f^    J                      XV.  De. 
             ( *5?  )
                XV.
  Decod. Solutiv. Commun. R. Rhel
EleB. Incis. §f. Fid. fexnx fu). Sem. $o-
riatuL contus. F&nk.  J^kis a. If. Cum
Tartar 3vj. coquant. parum fimul in Aq.
Font.  Ibiv. Colatura Edulcorstur pro rt-
nata Syr,  e Spin.
                XVL,           {j
 * tJuppositor Eccoprotic.  ft. Put Aloes
HierA Pier* vel alumin qf. Albumifiis^
onjor M.  ad apt am Confiftentiam.
          ,.   .  XVII.
  Pit Panchymag. R. Mtr. Vul. 3$  Pil
ex duobus ^iij.  Rudii nz,. Jalap. Crem
Tartar a. tjl\. OlAnifi ^if. cum qf.Syr.
E. Spin F. Maffa Pil. Dof. 3j. ad 3C
               XVIII.
  Enema Commun* R.  Ay. Font.  gx.
Mell Opt. %}. Sal Commun. |f. Mtfcedn*
fur fimul Bene ignis Calore.
  R, Aq. Marin, %x. 01. Chamdmel^
Sacchar Nig;. |ij. M.
                XIX.
  Enema Terebinth.  R. Vrih.  humdri*
recent. |xij. Terebinth venet (cum vitel
ovor M<) 3vj.                   .  ,
              .xx.
  Collyrium Commun. R. Aq. Font. §iv.
Vitriol AIb.gr. xij.
  #. Aq. Rof. lu}. Troth dlk Rbaf.&y
  ,j .-/                         xxi? 
             ' (  *54  )

       :       - XXI.
   Gargarifma Commun. R.  Aq. Font.
Ibf. Mell Rofar. §i. Sp. Vitriol g. xx. M.
                XXII.
 -  01. Epulotic. ft. Vitriol Alb. 31J. Vitriol
Roman.  Alumin. a. 7f).   Solvuntur  &
coquantur in Oleo & Aq. Font. a. Ibf. (id
Confumprtion. Ultimi.
                XXIII.
   Ung.  Scorbutic.   R.  Ung.  Martiat.
Pialth* a. §viij. 01. Hyperic. Terebinth.
a. §j. M. F. Liniment.
                XXIV.
  Ung. Cata-Pforas. R. JJ. Popul. Axung.
Porcin. a.  Ibj.  Flos Sulphur tbf.  Mer
Sublimat  |f.  01.  Tereb  qf.  F. Ung.
MoUe. X
                XXV.
   Ung.  Digeftiv. R. Linim. Arcei, U.
Bafilic. a. fbj. 01.  Tereb. |ij. Hyperic.
Linn a. §iv.
               XXVI.
   R.  JJ. Bafilic. Liniment, a.  |iv. 01,.
Hyperic.  §ij.
               XXVII.
   Uug. Deficcativ. R. U. Deficcat rub
Di;apo?nphpL Bafilie. a. §j. AT.  "
e»,v                         XXVIII. 
             (  *55  )

              XXVIII.
   Ungr Detergent. R.  U. Digeftiv. Te-
 rebinth. Venet. a. p. a. M.         l^\.
               XXlX
   Ung. Pleuritic, R. U.Dialth* 01. Te-
 reb. a. %\. Camphor. 7JL M.  Spirituofa
 UnBuofis admifla multo Potentius t#e-
^deri Doloribus  quam per fe fold Ufur-
 pdtd.
                XXX.
   Reftridiva Maxim. R» Albumin. Ovor
 N° 2. Acetum  vinn |iij.  Pul. Reftrin*
 pens qf.
 *              XXXI.
   Ceratum Commun. R. Empl. de Mini*
 Paracels. a. p. &.
               XXXII.
   Empl. Defenfativ. R. Empl. Diapalm,
 %ivM Rofar |f. Pul Boli. |j. M.& ex*
 tende fuper Alutam*
               XXXIII.
   Empl. Anodynum. R. Empl. Saponis
 §viij.  Oxycroc. Picis Burgund. %\j. Opii
 folut.TJ]. liqueftdnt omnia ftmul in Maf-
 fam.
               XXXIV.
  %  Cataplafma Refolvens. R.  Mica Pa-
 nis Far in.  Fdbar. d.p. d. coquantur  in
                                Aqud 
              X  &<>  )
 Aqua Font, qjl  ad Qonfiftentiam aptam
 deinde 01. adde Rofar. Cham. a. Parum.
■."" Pro Fotu.  R.. E# quibuflibet Hkrbit
fequeni. Abfynth* Origan. Thym Centaur.
 Betonic. Salvia ^Hyperic.  Menth Rofma-
~ tin. Lavend;, Abrotan. Sdmbuc. M iv.
*  *Ex  hifcffloribits Balauftior^,Rofar.
■ rubd  Cham*  Melilot. p. iv. ex fminibvs
 4. calid*  mdjw  p. ij.  coqumtw. tomia
 in Lixvxiio Cong. iij. colatur. dddje Spt.
 Vini qf.
   Ufiirfetur ciim Stuphis Ldneis cdiidif-
-fime intinBis.&  Expre/fis ft SpiHtiwfks
requiritur adjice Spt. Sal Amn\onid** |j«
Camphor. |f.   .  "'.'. /i
F  X  N'  I  S. 
[ I ]
    Lues  Venerea.

         HOSE who fetch the Origi-
          nal of this Diftemper no far-
          ther back than the Siege of
          Naples by the French-, 1494,
          thence calling it  the French^
and  fometimes  the  Neapolitan Difeafe,
muft only mean  that it received its pre-
fent Name there,  that it  became more
common, or that luckily  about that'
Time fome Remedy  was found better
adapted to its Cure  than  any  before
known : For no  doubt  it  reaches in. An-
tiquity the Firft Ages ;  it being irratio-
nal either to fuppofe a World drowned
for their Sins,  Strangers to the Vice that
contracts it, or  that  their Wickednefs
any more than  ours deferved" Exemp-
tion.  No;  Providence, we may lately
                   B           be-
 
2      LUES VENEREA.
believe, stamped an immediate Punifh-
ment on this,  as on all other Intempe-
rance and Sin, ab Origine, that the Pains
and  Sufferings  fucceeding a  vicious
Courfe  of Life, might,  if nothing  elfe
would, restrain us to Vertue, and be both
a natural and moral Good to us.   We
find  Mofes defcribing  a  Leprofy, Levit.
13 and 14,  that  correfponds  with  the
Symptoms,  and feems to have been  a
Species of this Diftemper; fo does  the
Difficulty of the Cure,  Deut. 28. where
it  is faid, The botch  and fcab of Egypt of
■which thou canft not be healed:  And thofe
many Laws found here relating to a Le-
profy, would- fuffer a greater Difappoint-
ment than feems intended, as  well from
the Obstinacy as infrequency of the Di-
ftemper, if applied only to what we now
fhicfly  understand by that Term: The
fame may be faid of many Ancient Phy-
fical  Authors, who with the like or grea-
ter Plainnefs have defcribed  the Symp-
toms, tho' not under the  modern Titles.
   In the profecution of this Subject I  pro-
pofe to fet forth the Nature and Manner
of Infection in all thofe Symptoms com-
monly  understood by a Clap? viz.  the
Gonorrhea ,Chancre> Phymofis, ZJfc. and then
exhibit  a Method of Cure • mentioning 
        LUES  VENEREA.      3
  the Symptoms occasionally under either
  Head, as they ferve  to enlighten each 0-
  ther:   And Firft of the  Gonorrhea.
    The Gonorrhea  is  benign or malign :
  The firft fort is an Emiflion of Humour
  from the GlanduU profata,  a  Weaknefs
  only,  and commonly proceeding  from
  great Strains,  and  where  the  natural
  Strength has been too far exerted in any
  fort, whether by Labour orVenereal Plea-
  fures;  it has its  Symptoms as well  as
  Procefs of Cure very different  from the
  malignant,  which at prefent I fhall make
  the only Subject  of my Enquiry,  and
  that under,two Heads.
    1. By fhewing how either Sex be
  comes infected.   And,
    2. A Cure  for that'Infection.
    And  \H. Of the Woman: Her Hook
^  on muft be  primarily and originally Infe-
  £ted, that is fine amplexu infect0, to inrro
  duce the being of this Diftemper in the
  World: For let a Man correfpond  with
  what Variety he pleafes (provided tliev
  are found )  he receives no Malignancy,
  which could it be fo with her, I cannot
  fee why we ever fhould thus  unhappily
  have had its Knowledge ; butExperiencx
  too  fatally contradicting this,  is a  Con-
  viction,  that Coition with Numbers has
                    B 2           firft 
4      LUES  VENEREA.
firft  of all,  and probably does ftill, at
fome times effect the  fame,  as at other
times Communication With an  infected
Perfon;  and this I fhall endeavour to
make Out in a few Words.
  Such who fay the promifcuous Mixture
of different' Sperms excites a Ferment,
which in a little Time throws off fuch
an Exfpumation as we call a Running,
do agree  that Numbers (tho' found) car-
ry Infection, we, only differ' in the Man-
ner they  accomplifh it, which T rather
fuppofe to be thus:  When the Venereal
Appetite  is jaded with the too intempe-
rate  Efforts of feveral  Men,  it will
be next to inipottible  for thofe Pasts to
fuffer the continued Frictions made there
fas common Women do) without excori-
ating and frettirigthe Membranes of the
Vagina;  and  fuch Excoriations,   hoW
fmall foever in  the beginning, meeting
with an ill Habit of Body, together with
the natural Incalefcence and Moifture of
the Parts, will foon degenerate  to an Ul-
cer;  which Ulcer will be the Diftemper :
And perhaps herein lies the Difference be-
tween a Fluor Albus and Gonorrhea, ^wheri
thus contracted,) that the one is a Weak-
nefs  from too frequent Irritations made
these,  and the other befides that extrin'fi-
                                   cal 
       LUES  VENEREA.      5
cal Accident, has  an ill Habit of Body
joined, that  induces Intemperies.
•  ^ What I think gives Credit to this Opi-
nion is the Customs of the Jewifh, Maho-
metan,  and many other Countries, who
allow a Plurality of Wives,* and an unli-
mited Number  of Concubines, restrain-
ing their Sex at the fame  time to one:
For this,  tho7 an inferiour Motive of the
Law, argues the World to have previouf-
ly experienced  fuch a Liberty in  them
rhQre- destructive 'of Health and a found
Constitution than in us.  Among other
Creatures there is an Inftinct anfwering
fuch  a Purpofe  of the Law whereby the
Females  are provoked only at certain Sea-
fons  to Propagation^  and abftain after Con-
ception ; Nature  intimating by it a Leffon
of Chaflity to the Fair;  that it foould be
their  peculiar as well as most ornamental
Vertue.
   Againft it,  I  can form to my felf only
two Objections:  Firft, That it may  be
alleged the Activity  of  fome Men this
Way, might prejudice a weak Woman
the fame as a Number :  And Secondly,
it may be asked how an Ulcer,  inVa-
gina,  can  acquire Malignity  enough
to  communicate Infection  on Coition,
when the greatest  Degree  of Virulen-
                                    cy 
6      LUES  VENEREA.
cy  in  another  Ulcer  produces  no fuch
Effed?
  But, to thefe it may  be anfwered, That
the Strengtli and Activity of any two in
Health will  feldom be found fo difpro-
portionate  as "to become hurtful, when
it is;  the Diforder  enfuing can be no
more than  a Fluor Albus,   or a Weak-
nefs without Malignity.  And as to the
other; why an Ulcer  here fhould fooner
impart its  Mifchief  than  any other?
Is,  that the  Parts concerned are in all
Refpects more commodious  for giving
and receiving any Injury, and that the
Heat raffed  and excited by Luft  gives
a Force  and Activity to the Salts gene-
rated under the Corruption; whereas a-
ny  other Ulcer, tho'  never  fo virulent,
cannot emit Effluvia's in fuch Force or
Numbers, nor to  Parts fo fufceptible of
their Reception ;  but i^ they had thofe
Advantages,  it is likely their  Effects
would be equal, many ill Confequences
following from an Ulcer with Virulency
In any Part incautioufly dry'd up.
  That Luft alfo is a  very neceffary Ad-
junct  for communicating Infection,  and
giving Force to thofe virulent Miafms
that are as it were darted  by it from her,
we judge by that  particular  Power  and
                                  In- 
       LUES VENEREA.      7
Influence^ Imagination is found to have
in the Commotion  of thefe Parts:  In
this Cafe it is fo much, that many infe-
cted Women avoid hurting their Huf-
bands principally on the Moderation and
Coolnefs  of their Enjoyments, whereas
a Stranger inciting more intenfe and vi-
gorous Desires as feldom efcapes.   The
fame  may be faid where  two or three,
with  weaker  or stronger  Inclinations,
lie with one and  the fame infected Wo-
man, that one perhaps fhall be catclf d,
and the others come off unhurt,  chiefly
as the Fancy  on either fide is brisk and
lively, inclin'd or difinclin'd.
  Venereal  Contact feems of fuch Ne-
cessity for communicating Infection, that
with  me it  is a  very unlikely thing for
Venereal Matter  ever to do it without,
tltpfe  who  have afferted the contrary of
this have done it  in fuch improbable In-
ftances,  which whoever can affent to,
will be very unreafonable if they deny
their  Acquiefccnce in what I  have ad-
vanced of Numbers.   For Instance :
  The Practical Scheme ( Page 4.) fays,
It is  not always neceflary a Woman be
clapp'd to give it a Man,  but that  he
may take off all the virulent Matter left:
in the Paffage  by a preceding Gallant, 
8      LUES VENEREA.
and fhe  remain perfectly well;  or that
flie may give it him by only  taking the
corrupted, Matter from, her Body in her
Hand and wetting his Privities.
   And others relate its  highest Degene-
racy,  or  a Pox, to be Contagious by
wearing the Clothes,  Lyings  or Cohabi-
ting with an infected Perfon; efpecially
if we fuppofe it of that Stage of the Di-
ftemper wherein the Body becomes overr
fpread with Cutaneous Eruptions and
Blotches.                      ,
   There are but Two Way&in this latter
Gafe (for the former I have no Notion
of) whereby Contagion  can be fuppo-
fed to pafs, and that is by their throwing
off a greater Quantity  of noxious and
virulent  Effluvia,   able to contaminate
wkere they reach,  or elfe, (like what is"
related in the Philofophical Tranfactiojs
concerning Contagion in  the Itch)  A-
mmalcuU, are  bred in thofe   Globules,
difperfed  about the Skin, which making
their Way through* fhift  from Place to
Place, and fo carry Infection, they liv-
ing  (fays die  Relation,)  two or  three
Days when from the Body.
  But how  well thefe Ajjignata may re-
folve otlier contagious Distempers, they
will here  be found but light in the Bal-
                               lance, 
       LUES VENEREA.       9
lance,  Fact baffles Philofophy,  and  if
all thofe who have fuffered this Way are
like what have fallen to  my Share, there
is not one who could stand by any other
Pretence than  Coition: Whence   we
ought to account the Diftemper a Mark
bf Divine  Difpleafure,   and a prefent
bodily  Correction for our Sin, that  the
Senfe of our own Intereft, might work
on us,  and  bring us back to Temperance
and Vertue.
       How a Man becomes infected.

        WOmen  we have adjudged  fome-
         times  to become infected by the
  Admiflion of Numbers, tho' found and
  healthful; but a  Man  cannot by the
'  fame Means, becaufe among other Rea-
  fons there is this  invincible one, That
  Nature is not able to fupport the Repeti-
  tions of thofe Acts to fuch a Multiplicity,
  or  in fuch Meafure as with her who is
  passive; but could that be, I believe alfo
  he might  fo contract k :   Insatiable and
  impotent  Efforts,  or too painful Enjoy-'
  ments  through the Straitnefs  of the
  Vagina, frequently difcovers  fomething
  like this,  in what we call pmple Conor -
                   C            rh&£$ 
IO
LUES  VENEREA.
rhdays  and  ChriftalUns, which perhaps
Time  and an  ill  Habit would change,
and make to become  virulent, did not
Pain or the  Debility of Nature prevent
a  further  Ufe of the Caufe  that firft
produced them, and hinder our Actions
from keeping  Pace with the Vicioufnefs
of  our Wills and  Inclinations.  For this
Reafon  therefore  Venereal  Symptoms
thus contracted, never fettle or terminate
in a Pox ; and I am apt to think all Ma-
lignity that does fo to him,  or is contagi-
ous, Muft always be from an infected Perfon,
and always by Coition : For a clearer Un-
derstanding  of which, and the Manner of
Communication, I fhall Cite Two or Three
Celebrated Opinions about it, and then fub-
j^ribe my own.
   Dr. Kjil fays, lfs Conveyance is by  the
 Elaftkity  of the Air, thrufting the Morbifck
Matter into the Excretory DuBs of the Pro-
jiatd,  which are empty on Coition ; and that
a fmple Gonorrhea is nothing, but a  Corro-
fwn of the Spongious Borders  of thofe Vejfels
terminating in the Urethra.
   Some think, a Gonorrhea to be the EffeB
of a Fermentation made between the Infectious
 Liquor, and that of the ,Pzo&2it2Z,and fo with-
out C or r of on an Efflux thrown off like Teft
from Beer*
                                 Laftly, 
       LUES  VENEREA.  t    u
  Laftly, Dr. Cockburn fuppofes a Conor?
rhaa to be the encreafe of that Liquor that is
difcharged by the Excretory Glands of the U-
rethra, and done by the Venereal Stimulus^ in,
the  fame manner  as Cantharides applfd
would do ', the Quantity of Matter dif charged
being in proportion to the Stimulating Force
they are  affected with:  And this  Stimulus
(he fays ) encreafmg its Acrimony,  does in
Procefs of time, make Ulcers in the Urethra.
This he  farther oppofes to Dr. KfiPs Opi- ,
nion,by  faying,  the Urethra will admit
very  little, and that there is  no Mufcle,
Membrane, or Machine alleged  to  help it
forward.
  But thefe Opinions,  befides their Op-
position  to one  another, are deficient in
carrying their Aim fingly to a Gonorrhea,
without any Attempt at the Caufe of a
Chancre, Chordee, or Phymofis, wliich Men
often  become  infected with,  without a
Gonorrhea:  I fhall therefore  begin my'
Enquiry here,  being  affured that they
at leaft want another  and  diffesent Ex-
plication,  which  perhaps  when found,
Will facilitate  alfo  our Search in  a  Go-
norrhea ; and  if I am right in my Con-
jecture ,  They arife  from the Strength,
Activity,  and  Solidity of the Salts  hid
with   the Corruption,  which being di-
                                  fperfed 
 12    LUES VENEREA.
 fperfed about the Vagina,  are volatilized
 and made fitter for Communication by
 the Heat of Luft,  and received  by the
 enlarged  Pores  of the Penis, where, by
 their Pointednefs, they fhortly effect an
 Erofion.
   The manner of this Imbibing or  Suc-
 tion on the Man's fide, is not abfurdly ac-
 counted  for  by the  general  Relaxation
 that  attends  all fenfual  Pleafures, of
 which Coition is perhaps the greateft:
 Now, as  it moft exquisitely affects us, the
 Parts are relaxed and made more eafily
 fufceptible of any Venom to be tranf-
 mitted, and that again from her becomes
 enabled  to insinuate and efcape through
 the Pores by the Pungency of  their Salts,
 and Power they are darted with; and  if
 the Degree of Relaxation in any Part be
 in Proportion to the Pleafure, ( as in the
 agreeable Objects of any other  Senfe,
 it is,  where tho' fome Degree of it re-
 fults to the whole Man,  yet  fomething
 remains peculiar to the Senfe of which it
 is an  ObjectJ  then the Inftruments of
 Generation,by being moft relaxed,will be
alfo moft fitted on that Account for the
Reception of morbifick Matter.
  Hence the Genital Parts fhould always
fuffer  firft, and  amorous Men  fooneft.
                                 And 
        LUES  VENEREA.     13
    And if virulent Matter, thus externally
 lodged,  can act like Cantharides,  and
 produce  a Chancre, Chordee, or Phymofis,
 then I believe we may alfo, without any
 repugnancy to Reafon, think this  out-
 ward  Application  of it in Coition fuffi-
 cient to produce a Gonorrhea: The Diffi-
 culty against it being only how this Taint
 can be transmitted hence to the Proflau,
 which will not be fo hard  to  Imagine, if
 we confides what has been already faid of
< the Power  impelling, and the Aptitude
 to receive.  We find  all Parts of the Body
 Porous,  and by many  Experiments re-
 ceptive of any proper Matter incumbent
 on them, conveying and mixing a Por-
 tion  with the Humours of the Body, as
 in Bathing, iSc.
    In all Tranflations of Tumours, whe-
 ther  by Revulsion  or Derivation,  -this
 Sympathy and Communication of Parts
 is evident, and particularly in the prefent
 Cafe, where, on an improper handling,
 the Virulency will revert  into the Blood,
 and  produce all  the  Symptoms  of a
 Pox,  and indeed all outward Applications
 to any  Malady deeper  than the  Skin
 ( without this ) would  be impertinent:
 Why then fhould it  be thought fo extra-
\ ordinary for infectious Matter arm'd with
                                  other 
14     LUES  VENEREA.
other Properties than  bare  Fluidity,  to
affect thefe  Glandules at fo fmall a Di-
stance ? Since it muft be acknowledged
the feveral Parts of a Member have a
much eafier  Communication with them-
felves than with the whole,  as we often
fee in the quick and  ready Tranflation
of a Gonorrhea to the Groin  and Testi-
cles, 1$ Vice Verfa.  ■
  The  only  remaining Objection to this
Tranfmiflion by the Pores  is,  that the
greatest Corrosions at the Glaus  and Pre-
putiumzre rarely attended with a Gonor-
rhea, whereas were fuch Corrosions thus
effected, as  it would be an Argument of
a stronger Infection, and the Corrofive-
nefs of that Venereal Matter to be grea-
ter, it fliould as feldom mifs. This feems
to be from  the Contraction, Pains and
Swelling  that  attend   thofe  Ulcers ,
whereby the Paffages  to the Proflate are
ftraitned and obstructed'-, but a flighter
Degree, cseating no fuch  Impediments,
eafily paffes,  and is fuflicient to propel
that Humour from the Glands which in
a  lefs Proportion  is  their   Nature  and
Office.  From hence we may learn a Go-
norrhea  to be themildeft Species of  In-
fection.
                                    If 
        LUES VENEREA.     15
  If  any one  fliould yet  object  and
think the Mucous Glands of the Urethra
more eafily reached than  the Proftate,
and lo to be the "Seat of a Gonorrhea : I
fhall  no further infift, but only remark
to the Favourers of fuch an Opinion,Tliat
a Running is not produced by an Ulce-
ration or  Corrofion  of the OftioU of
the Glands terminating there, for fuch,
would be  an  irreparable  Lofs,  and  is
the veryCaufe of fome Gleets, being incu-
rable ; but it is rather from the Conftitu-
tingVeffels of thofe Glands being rendred
weak and flaccid , that were before vi-
gorous andelaftick,  parting eafily ffor
that reafon) with their Contents.
  From the whole  of this Explication
we may fee a  Reafon for that Custom
in many Foreign Countries of wattling
the Privities well after Coition, (to witj
that they find it preventive  of Infect ion y
and  perhaps Circumcifion was not inftituted
by that renowned Law-giver Mopes, Or
the Impostor Mahomet, nor practifed by
Ancienter  Nations, without a  View to
the Cleanliness of this Part, and Preven-
tion of foul and loatfifome Distempers.
  Thofe who  account for  a  Gonorrhea
thus, do not fay a Difuria is from an Exco-
riation in the Urethra, but that the Sharp-.
                                  nets 
 16     LUES VENEREA.
 nefs of the Infection thinning and car-
 rying off the Mucus from the  Membrane
 that lines it,  is   made  more fenfible
 of  the  pungent Salts  Of Urine patting
 through; which they would  confirm  by
 the Nature of Patients Complaints, who
 don't fpeak of the Heat of Water as a
 Pain confined  to one particular Spot of  the
 Paffage,butdiffufed, and feems an equal
 Vellication of  the whole Membrane.
   I come now to  the fecond  and moft
 ufeful Part,

 The Cure of this Diftemper: And  Firft its
               Defcriptwn.

A  Virulent Gonorrhea or CLAP, is
        the  Emiffion  of  infectious Matter
frown the corroded  Glandule Proftate,  or
thofe of the Urethra, accompanied  with
a  Disursa ;  or in other Words ,
the involuntary Flowing of Matter through
the  Urethra,  with  Pain,  Inflammation
and Heat of Urine ; Thefe are its Patho-
gnomick Signs, and the Degree they are in,
with Refpect to Confiftence and Colour
in the Running fas  Fellow, Green, or the
like,) or Pain in Water, are what we may
take the Meafure of Virulency from, and
Will be  found more or lefs in different
                                  Sub- 
        XUES VENEREA,    vij
  Subjects, according to the  Malignity of
  the infected Perfon,  and Conftitution of
  the Receiver.
    A Difuria is a Neceflary  Confequence
  6f the Running, it being a Pain from the
  Acriminiom Salts of Urine wasting  thso'
  the Parts whigll that has excoriated.
    The Cure I fhall lay down under thefe
  two Intentions :#
    Firft, To conquer and carry off the
*  Malignancy, and
    Secondly, To  heal  and  strengthen the
  Debilitated Parts.
    Mercury only is able to anfwer our firft
  Intention, and effectually to fubdue the
  Poifon of this Diftemper .-.  The Reafon
  why it has a Power beyond  other Medi-
  cines  for this purpofe, is its Gravity, and
  becaufe its constituent Parts are extreme
  fmall, fmooth and fphserical:  The latter
  Qualification fits them for an admittance
  Into the fmalleft Paffages  feven thofe al-
  most indifcernibleones of thtf Glands,) and
  its  weight breaks all Coagulations, and,.
  fits the Morbifick Matter for natural Se- *
  cretioris. And whatever flights fome may
  put on this common Road of proceeding;
  yet, till better convinced  in the Vertues
  Of the feveral  applauded Sfecificks that
  have  appeared abroad in the World, I
                       D           take 
i3     LUES VENEREA.
take leave to defend it, as a Safe Practice :
For altho' a tedious, or an ill Cure,  may
now and then happen,  it  is  not  justly
fo much a Charge on the  Medicine, as
the Method  ;  when we leave off too
foon, or continue it with Purges too long,
a Practice equally Milchievous. But mose
of this by and by.
   I am  lurprized, that every  body,  by
their Practice, fhould allow Mercury to be
the only Foundation and  Retreat for Cure,
in the last and ftubborneft Stage of this
Diftemper, a Pox, and  yet deny its Ver-
tues in a milder Ssafon.  It muft be con-
feffed, there are too often  feen many ill
Effects from this Mineral;  and on a feri-
ous Reflection, I cannot but think,  most
of thofe  deplorable  Objects  found  in
Hofpitals, or elfewhere,  whofe  ruined
Constitutions are  attributed to the Lues,
to be with more Truth and Justice,  afcri-
bed to Mercury; but. then this is not the
Ufe,  but Abufe  of it; an unskilful Ma-
nagement often  precipitating Patients,
 (and that in a fhort time)  into fuch mife-
rable  Circumstances, as the  Diftemper,
left to it felf, could not in Years (if ever)
 have produe'd :  From this Prepoffettion
many take a handle to  secommend their 
        LIJES  VENEREA.      19
* infallible Noftrums, which when good for
 any thing ftill have this for their Bafts..
    The Ingenuity of making Mercury Spe-
 cif cal,wi\\ lie in the Meafure and Manner
 of Administration ; that it fuit fuch De-
 grees of Infection, and fuch Constituti-
 ons ;  a Point wherein one Man will excel
 another, according to their different Ca-
 pacities,  and Opportunities  of Experi-
 ment: All  other ways are supported by
 nothing  but a Brafs Iront.   The  many
 fuccefslefs Attempts of thofe who publick-
 ly invite Men, to Safe and Speedy  Cures,
 have pretty well expofed their Credit; and
 People fee it to be nothing but a Compe-
 tition in  Cunning, who fhall betray with
 most fuccefs, without the leaft Candour,
 or regard to the Promifes they make : nor
 is it  a fmall Difparagement  to Arcanah
 here, that they are generally lodg'd with
 the Illiterate.  I 'fhall further strengthen
 this Argument for Mercury, in Oppolition
 to other Specificks, by a  fhort Excurfion
 on the Practical Scheme; becaufe  it has
 made the loudelt Noife of  late, and has
 been Famous, if not for attracting Poi-
 fon,  yet  for attracting the Pence, Popu-
 Iw vult decipi.
    A  Compounded Medicine,  as  is the
 Practical Schemers, tho' it fhould  feldom
                     D  2          mils,/ 
LUES  VENEREA.
  mifsthe Ends it is giv?n for,  and fo be
  faid to act Electively, yet by being Com-
  pounded,  is properly and  fignificatively
  ranked under the Name of an Arcanum ;
  which the Elder Brethren have  chofen
  with Judgment, the Term of Speciftck be-
  ing ufually apply'd to fingle Natural Bo-.
  dies,  fuch as he has mention'd (p. 12.)
  And tho' they may be diverfly mix'd for
  conveying and ufing them with  advan-
  tage,  yet the Term  is  retained singly to
  that Body which is faid to be  Specifical:
  As for instance, in-the Cortex; whatever
Si Form.or Vehicle we give it  in, there is
  nothing but  it felf has any Claim to the
  Title: Therefore making the Vertue of
  his Compofition to be the 'Joynt  Force and
  Refult of ah,  (p. 15 J is not only a Mifap-
  plication of it,  but a Confession, that this
  Specif calitj liech in none of them singly; or
  if it does, 'tis  as yet a hidden thing to
  him.   For he goes on,  and tells ye (p.i 2/
   15, 16. iS Cert if cat. p. 22*)  Their United
  Farce,  like a  Loadftone,  draws the Contagi-
  on to it, wnd exactly hits the different Confii-,
  tut ions of any Age,   and that from the Re-
  cency of the Diftemper, to their being in a de-
  plorable State.   And for further Proofs of
  thefe Abfurdities. lie fays (p.  14.) Perfons
  after  having taken the Speciftck, will'void
                                    large 
LUES VENEREA.     21
large quantities of nafty corrupted ftinking
Water, of fuch an unfufferable Stench,  they
will not be able to bear  the finell; and give
but any Dog (that will  take it)  a Quart of
this Urine, and he will in a little, time break
out with Pocky  Sores;   recoverable  again
with fo fmall a Dofe of the Speciftck  as  con-'
tains to the bignefs of a Pea, whsch will dif-
charge it in fuch ftinking corrupted Urine, as
the Perfotfs was who made it.  A plain Con-
feflion it was  the Effect of the  Medicine,
yet ferves him for a  ConviQion of the
great Power  of this  Remedy: And in-
deed,  granting the  Relations true,  it
muft be allow'd  fas Was the Gambogethe
poor Weavers tookj to be  of  Stupendiom
Efficacy (p. 14.J
   I mall  not wrong this  Gentleman,  I
believe,  in fupppofing  his Scheme to be
(like other fhorter Schemes that are daily
thrust into our Hands) for drawing  in of
Customers ; he differs^only in  having al-
tes'd their Concife way of Writing,  and
recommending " in' many Words what
they have done Compendioufty.  The ad-
mirable Vertues of their  Incomparable Never-
failing Anti-venereal  PILL.   Through
 a great part of  his Book he insinuates to
 his Readers fuch aftonifhing Performan-
 ces from the Speciftck, as come but  little
                                   fhort 
22     LUES VENEREA.
fhort of Infallibility :  It is a Cure (fays
he)  (p. 21.) /or Nineteen in Twenty.   A
very fmall Exception, yet ferves a double
End, being both Good News to the Afflicted
(Title of a Quack Bill) and a Salvo for Mif-
carriages:  For fhould the Reverfe of this
be,  and  the  Uncur'd  19 in 20, they
mightevery one fingly lamentthemfelves
and  he with them as the unhappy excep-
ted Perfon, and their Certificates muft be
wanting, becaufe like his Cures, it would
not be allowable to publifh their Names
and  Abode:'.   And indeed, he that gives
out a Bill of Promifes on this  Head, is
much more fafe from Detection  and Re-
proach than any other ;  becaufe, to con-
test the thing is taking a publick Shame,
and  may be one Reafon the Infallibility
of a Cure is oftner and  more confidently
afferted here than in any other Cafe. The
Certificates publifh'd on thefe Occafions,
(to confirm the Unbelieving) are few e-
nough to be a concerted Cheat; and if
real, is only a cunning in common with
the Fraternity.

The Pictures which efcape they wifely keep,
But HIDE -nil thofe that per ifh in the Deep.

                                 Mrs.
1 
          LUES  VENEREA.     z3
    Mrs.Averfs Cafe (poor Gentlewoman,)
  (p. 22. the Certificate) may be granted ve-
  ry bad,  and the Cure as Extraordinary ;
  yet to fhew the World fomething of a Pa-
  rallel, and that others Parts of it do not
  want for Wonders, I refer to the follow-
  ing Story, tranfcrib'd from the  Patient's
  own Lips ;  abbreviated and drawn into
  a Certificate,  will run thus:


      IT. H.  of              havig been for
      many Months afflicted with a Swelling' in
  my Belly, Gripings, great Pains in my- Limbs,
  and in a weak and languifhing Condition, for
  which I had been a long while under the Pre-
 fcriptions of feveral eminent Phyftcians,  but to
 fuch  purpofe,  that I was  reduced even to
  Death's  Door: At laft,  in a Defpondency of
  Mind, I betook my felf to little Dr. Le F ...
  at the upper end of Three C... Alley: On
  examining my Cafe, and what had been done
 for it, hefhook his Head and* faid,  His Bre-
  thren had very much mistook the Illnefs,
- or elfe they would not havebottom'd their
  Hopes on Medicine Internal or External;
  That the Planets were more concernM in
  this Affair, and had " United their feleBeft
  u Influences againft me": He bid me be
  cheery and confident in him, and only
                                    lend 
 24     LUES VENEREA:
 lend him my Servant  next Morning  at
 Three o' Clock, with fome of my Urine,j
 to Epping Eorefti  Kjiowing his Wifdom,  I
 (benfa, all the Tokens of a glad Compliance my
 weak State would permit, and begged him,  aJ
 a Chriftian, to ufe his uimoft Skill for my Re-
 covery.   He promised he would;  and accord-
 ingly took my  Man with him as  appointed:
 At his Return  he told me  My  Bufinefs was
 done : That I fiould have only one fever e Fit
 of Gripes more, but be perfectly  recovered in
 a  Week.  After  the Doctor had taken his
 Leave,  my Curioftty led me td enquire of
- John,  what had been done at the Foreft, and
 he told me,- all he  knew was ,  that be had
 feen the Doctor bore feveral Holes in an old;
 Oak, put my Water in them, and  then ftlPd
 them up with Trunnels again,mutter ing withal
fome Words inwardly which  he could not un~
 derftand.  My Heart aFd for the  Succefs of
 this Myftical way of  Application a whole day ;
 but praifed' be God his Words had Truth to a
 Tittle: I had next day, or next but one, the
 expected Fit \   and before the expiration of a
 Week  (a>s he  had  foretold)  walked about
 to  Admiration.
   What  may  compleat the  Authors Prai-
 fes, and recommend  the Cure to  the  Pub'
 lick,  is his taking but Twelve Guineas for
                                       it t 
        LUES  VENEREA.      25
it:  ThePrefents that were afterwards added
(tho'very fhort of a Requital) were, as I hope
to bef-— forced on him.
  To the Truth of all which Premises, I freely,
     and without Fee,do certifier this 2oth,i5a
                                 J.T.
  But to return  from this Digression,  I
begin  the  Cure  with a strict  Regu-
lation in  Living,  particularly an Absti-
nence  from fpirituous Liquor  and fait
Food,  and  prefcribe directly a Mercurial
Bolus.
   fy. Mer. Dul.gr. xij. Conf Rof. q.f.f. bo-
lus hora f omni fumend. purging it off next
Morning with an Infusion of Senna.  Af-
ter the firft or fecond time, I increafe the
Mercury in  the Bolus,  and give stronger
Catharticks.
   92 PiL ex duobtis £). rez, Jelap. Balf.  Pe-
ruv. anagn ij.  Calomel, gr. vj. fiat Pil. No.
V. manevorandm.    .  .  ,
   Vel, J£ Pil. CochU Sf. Calomel, gr. x.  Ol.
Junip.gr. iij. /. Pil. deaurand.
   Vel, Ifc Elect. Lenitiv. 5*ij.   Mer. dul.gr <
X.  rez, Scammon. Jalap, an. gr. iv. Ol. Carui
g.  i).  M.    Conftantly adminiftring,   at
the end of their Operation,   a  Paregorick
Draught.
    PURGES  are  given after Mercurials
 (I  believe)  not  fo much from a Suppofiti-
                          E            on 
26     LUES VENEREA.
°n that their Vertues immediately reach
the Part affected, and fubdue the Poifon
directly, as from a diftant View of alter-
ing the Habit of Body, and  carrying off
thofe vicious Humours that would  elfe
probably take their Courfe that way, and
heighten the Fury : This Opinion is foun-
ded in Practice; where  nothing is com-
moner than from two Men  infected by
the fame Woman, to fee the one cur'd in
a few Days,, when the other perhaps re-
quires Months;  which  can be from no-
thing fooner than thek different Habits.
  Purges are defign'd likewife to prevent
any ill Effect from too great a quantity of
Mercury remaining-at once in the Body.
  This may futtice for their Defence in
general.  There remains another mate-
rial Consideration in the Ufe of them,and
that refpe£ts the frequency of their Repe-
tition.   And sightly to understand a Pro-
portion, in this, we aire to Confide?', that as
the Malignancy of a Gonorrhea,  Nature
her felf, in good Constitutions, would sun
off in a  due Quantity of time; and that
our Adminilt rations are but her Affiftants
thereto: The Faults may be equal, m
leaving them off too foon, or continuing
them too long; by the former the Infe-
ction is not conquer'id, and by the latter 
       LUES VENEREA.      27
the  Conftitution is enervated,  and Na-
ture's Efforts weakned inftead of being
assisted ;  In confequence of this  I repeat
the Mercurial Bolus, and purge no oftner
than Reafon tells me their Strength will
admit, without a Hypercatharfts, Fainting
or Loathings  (which is with fome every
other Day, with others twice a Week, or
lefs;; and in the Intermiffions give largely
of the following Apoz,ems or Emulfwns.
   fy. Sew. 4. frig. *j. aq. Ment. f. Ifeij. Sal
Tartar 3j. fiat Emulfto Sacchar. candid, ad
gratiam edulcorand*
   Q Amygdal. dul. No? xij Sem. Papav 3ifi
Contundantur cjf fenftm affunde aq. Plantao.
vel decoct.Hord. Jfcij. Syr. Althdi %\.f. Emulfto
   9t Decoct. Petforal. fcij. Spir. Nitri dul.g.
xxx. /". Aposcema.
   I£ Sal Pru/iel. Sacchar. candid, p. £ M. f.
Pulvfs fumat ad quantitfltem Scrupuli in CV-
revifia tepid, ier in die.
   As thefe, or other Forms of Diureticks,
arc fuppos'd to eafe the Heat of Water by
increafing the Quantity,  and fo diluting
the Salts;  fo,  to this end fiich an Inje-
ction  may   be  ferviceahle  alfo  as  is
foft,  and can leave fomething of a Muci-
laginous Substance £0  lubricate  and de-
fend the Urethraf,
                      E  2      Solvatur 
28     L17ES  VENEREA.
  Solvatur G.Tragacanth. vel Arab'^vel Ich-
thiocol. in fero. Lactis, Colatura tepide in'ftc.
  While we  are  continuing  the ufe  of
thefe, it will be proper to weigh with our
felves, what are the Signs of Our firft In-
tention  being anfwer'd, and  fufficiently
authorize us to leave them off: For there
is no doubt  a Period, which the  Skilful
difcern, wherein  a Change for Healing
Balfamick   Medicines   is    neceflary
and required, and which  as we come
fhort oft,  or  exceed, may be either way
pernicious:  For,  Firft,  If  (while  the
Signs of Malignancy abide)  too  fudden
a Check be given to the Running, either
by  the unfeafonable ufe of Astringents, or
too quick and ftrong purging in the be-
ginning, which turns to the fame;  then
it will either revert and taint the whole
Mafs of Blood, or produce by a nearer
Trantlation acute Pain,  Tumour, and
Inflammation of the Groin or Testicles;
which may  prove of as unhappy Confe-
quence ;  particularly in the laft the Pains
are  agonizing,   and attended with  Fe-
ver, Syncope and Naufea,  and the Mem-
brane wanting Fat, never without dan-
ger of Corruption and Gangrene.
   Again: If, on the other fide, the pro-
per Seafon is mifs'd of doing it, and there
                                     is 
       LUES  VENEREA.     29
is too cautious and long an  adherence t°
Mercurials,  or irritating Medicines, whe"
ther Catharticks or Diureticks, the Run-
ning  goes  on without end,  and at laft
brings  an  irrecoverable  Laxity y  on
the  Parts  ,   converting  a  Venereal to
a troublefom Seminal Gleet.   To  avoid
thefe Extremes, I take the proper In-
dications for fuch  an Alteration  to be
Abfence of Pain and Sorenefs about the
Groin and Testicles, When the Dittention
of the Yard is gone off, When the Heat
of Urine is considerably abated,and when
the Running  is of thick and equal Conti-
nence,  chang'd in Colour and leffen'd in
Quantity ;  for as the contrary of thefe are
what constitutes its Virulency,  fo  their
Remission  muft be Signs of Amendment,
and a proper Stadium for'changing the
Method.   It is not to be expected a Run-
ning fliould ever fo intirely change as not
to leave a Stain; which fome do fillily
imagine;  no,  it will be fufficient  that
there are considerable Alterations in the
Refpeflis   abovementioffd;  the  better
thofe appear,  indeed, the safer fhall we
be in stopping it; and let -the remaining
Matter revert where it will  (feparate from
Signs of Malignancy; it can be of no more
hurt, than the drying of an Iflue, or 0-
"ther fimple or common Ulcer.       The 
3o     LUES  VENEREA.
       The fecond Intention is^ to dry up the
    Running, and  heal  and ftrengthen the
    debilitated Pasts.  The former  part Of
    this Intention I have compafs'd fometimes
    (in Athletick  Conftitutions)  by  a  fingle
    quick Purge;  which fhows, that  a Ca-
    tharttck, without any other Property than
    i:s stimulating Power increas'd, will turn
    Aftringent, and dry  up the Liquor  of the
    Glands:  But as Circumttances will pre-
    vent this from being the conftant Effect of
    it, and  that  (like Mr. Averfs CafeJ it
    will be far from happening every Day, I
    fhall felect fome of thofe Preparations I've
    moft fuccefsfully experienced, and  range
    them in their Order  of Healing and Af-
    tringency, to fort with the better or worfe
    appearance of the Indications above ; and
    doubt not but a due Obfervance to the
    Seafon of their Administration, together
    with a thick glutinous Diet (which  under
    this Intention fhould alwavs be directed;
    will make them  anfwer as effectually
    with others.
       9* Sal Prunel. 3iij. Pulv.  Rhabarb. 3ij.
    Troch. de Agaric. Alhandal. an. 3ij Antim.
    Diaphdret. CC ppt. Mer. did.  bene levigate
    rez Jalap, an. 3j.  Elect. Lenitiv. ?ij. Balf.
    Capivi q. ft fumat ad magnitud.  Caftane&
v   omni Mane (3 Vefpere:
                                     £ Pul. 
         LUES  VENEREA.      ?i
   ^ Pul. Rhabarb. |ij. Sal Prunel. |j. Nucis
 Mbjchat. 3j. B^//l C*/w. Peru, ana fjff. /*-
 w?rff omni mane ad  duas vel tres Dejectiones
promovendas.
   Jjfc Jchthyocoll. Albiff. |j; decoq. in aq. Font.
 \yi\).ColaturA adde aq. Rofar.%). M. fumat.
 Coch. ij. {in lacte vaccino dijfolut.) quater in
 die.
   5i Cor tic. Peruv. §j. decoq. in aq. Font, qf
 ad |viij. Colatur. hu'jus |ij. PP 3i. aq. Cinam
 |j. M.f. hauft. %va quaque hora fumend.
   Ifc Terebinth. Venet. |f. Vitill. ovifyr. Balf.
 |j. M.e Cyatho vin. alb. fumend.
   Ifc Bol.Arm.Z). BalJ.Capiv.z'ii].  capiat
 un.femis quotidie, femel vel bis alvos promo-
 vet.
   1* Bol. Arm.  fang. Dracon. Terr, ftgillat.
 Pul. Rhabarb. tort. an. p a Tereb. Venet. q. f.
f. Pil. -mediocres fumat quinque bis in die.
   9s PiL Cretacea B. eodem modo fumend.
   9* Decoct. Guaiac. fxpe fumat hauft. in
qua  infti/latg.xx. Tin ft. Guaiac. vel Tmct.
ex Balf. Peruv. Gilead, £jjV.
   9*  Sacch. Saturn. Vitriol.  R. an. 3f. dijfo-
lut. in aq. FerrarU lb iff.  cjf filtretur pro inje-
clione.
   9* Aa. Plan rag. Jvj. Tin ft.  Myrr* 3j. vel •
Tinft. Veneris 3if. tepide injicitur.      ~   i
   To thefe we may add the ufe of the
Cold-Bath;  it gives  a  Contraction and
                                  Tensity 
 32     LUES VENEREA.
Tenfity to the  Fibres  in  general, and
therefore muft clofe the Orifices,  of thefe
Ducts in particular.
                §■  IIL

      THE-other Symptoms of Virulency
       which  Denominate   a  Perfon
 Llapp'd, and that as well without as with
 •a Gonorrhoea,  are  the Chordee,  Phymofts,
 Paraphymofts, Chancre and Bubo.  Thefe  I
 chufe to fpeak-of feparately in their Cures,
 becaufe they require fbefidesan Internal
 ufe of Mercurials) Local Applications.
   A Chordee is a painful Contraction of
 the Frmum  in Erection, caufed from an
 Inflammation of that Membrane, which
 on that account being thicker,  is confe-
 quently fhorter, and muft  excite a Pain
 when the Erection of the Penis stretches it.
  Dr. Cockburn diftinguifhes  another Chor-
 ding Pain, arising from a Sore or Ulcer in
 the Urethra, as often as it comes to be
 comprefs'd by an Erection of the Penis,
 and infers from it,  how far  within the U-
'rethra the  Seat of a Gonorrhea is : But a-
 gainft this I object,
   That if an inflated  Penis can fo  pain-
 fully comprefs this .Uker oh all fides, why
                                fliould' 
       LUES  VENEREA;     }•>
mould not a greater Compression with the
Hand do it without Erection.
  Secondly, If a Gonorrh£a be  an Ulcer in
the Urethra, and the Chord ing Pain a Com-
preflion on that Ulcer, then they muft be
in feparable Companions j and no Gonorrhea
could be without it.
  And, Thirdly, I have known the Chordee
often continue after, a Running has beeri
ftopp'd, which by this Allegation could not
be true ;  fuppofing (as we seafonably may)
that where there is no Running there is no
Ulcer : The proper local Remedies to it are
Fotufs Of. Milk wherein Lilly, Elder,  or
Marfhmallow-Root has been  boiled,  and
a little Sacchar. Saturn, added, or in their
ftead the Cataplafma Refolvens.
  A Phymufts, is when the Pmputimh is dif-
ficult to bring  backward : A  Paraphymofts,
when it choaks at  the Neck of the Penis±
and  will  not without pain or trouble  be
brought forward over the Glans : In fome
thefe are  Natural Difficulties;  but here,
the effect of Tumour and Inflammation, as
thofe are again oiShankers.
  Shankers are Venereal Ulcers on theGlans
Praputium, or Fr*num:  They are, with
the Phymofis (as was obferved in the begin-
ning; occafioned when the Venereal Taint
is lodged here,  and does by. its fliarp Qua-
lities, both coagulate thofe Liquors that  lu-
                     F            bri- 
34     LUES  VENEREA.
bricate the Glands,  and corrode the Fibres
constituting them :  The latter are Shankers,
the  former Phymofis; for a Phymofis is  no-
thing but the  effecting a Tumour  on the
Glans and Praputium at the fame time.
   To  a Phymofis  the  Injections fliould  be
mild.
   9i Aq» Plantag. |ij.  Troch. alb. Rhaf. Sj.
Mer. Potab. gr. vi. to be  thrown between
the Glans and the Fore-skin with a Syringe,
and retained there a little  to wafh  and
cleanfe it;  a Fomentation fhould  be like-
wife ufed, and a Cataplafm of the Seeds
with a little Ol. Lilior. in it; or this follow-

   Ik Mica  Panis m.). Far in. Hord. pul. flor.
Cham,  ana m. ff.  coquantur in lacte  ad confi-
dent. Cataplafm. fnita  Decoct, adde  ol. Sam-
buc. |j.
   To a Shanker this Lotion,   fy Aq. Plant.
 Rofar. an. §j. Trochi alb. Rhaf. |ij. in hac in-
(lillat g. xv. fecpuent. liquor.
   fy. Mcr.fubiimat. 3ij. dijfolut. in fp. vin. Iff.
&>filtretur.  Or,
   % Aq. C ale is |j. Mer. fublimat 3j. folut. cjf
filtretur pro ufu.
   Ifc Uru Bafilic.  |j. Pracipit. rub. 3j. m.  pro
Unguent o.
   Dr. Cockburtfs Arcanum.    fy. Hydraroyr.
Tereb.  Venet. an* P. yE, F. Unguent.
                                        A 
       LUES  JfENtREA.     ^
  A Malign, or Venereal Bubo is dangerous
to repel,  and fliould, from the  beginning,,
be assisted to Suppuration by Emplafticks,
Cataplalms, Cupping,  and the like:   An
Intentionthatwill be found difficultly to fuc-
ceed in moft, and when  compaffed, without
great care,  will turn fistulous.
  I have run over this Section with little
more than placing fome proper Prefcripti-
ons under the feveral Heads of'Chancre, Phj-
mofis, cj?V. avoiding anjr nicer Difquifition
in the choice of them, or Seafon of their ufe,
not becaufe they are intirely void of Effica-
cy, but becaufe I am fatisfy'd neither they,
or any other Arcana will alone anfwer  the
purpofe:  They are all  fhorc of the Eu-
logiums beftow'd  on them; and if not im-
pertinent to  the Ends propofed,  are yet ve-
xatious and tedious.  And fince they are fo,
and have   a  greater  tendency to  a Pox
than  a Gonorrhm, its expedient, and I
think a very':good* Practice, prefently to
refort to Turbith for a  Revulsion, or   elfe
by   fome   other  equivalent  Mercurials
to procure a Spitting'; there is nothing thefe
Symptoms better  or fooner fubmit to; for as
the Mouth grows fore, there follows a  mi-
tigation, theMatter is diverted, the Shankers
heal,and the Parts fuddenly regain their pri-
stine Form and Tenfion.
F2         Eight 
36     LUES  VENEREA.
  Eight or ten Days continuance in  a mo-
derate  Salivation will  ordinarily fufhce to
vanquifh them; but if the Diftemper proves
more deeply rooted,  requiring one of strict-
er Confinement and Regimen, take the fol-
lowing Rules.
        SECTION  IV.

     TH E Symptons of the Pox are cuticu-
      lar Eruptions,  Blotches,  Ulcers in
the Throat and Palate, Nocturnal Pains of
the Head,  Shoulders  and Shins,  Caries,
Night-Sweats, Alopecia's,  falling off of the
Nails, Gummas, Nodes,  Talpas,  Confum-
ption and Marafmus.
   How a Clap comes to end in fuch  contu-
macious  and intractable  Symptoms, may
be partly attributed to the Malignancy of
the Original  Infection, partly to the Pre-
difpofition, or ill Habit, whereby the Blood
becomes  more eafily receptive of that  Ve-
nom, but moft often to  an irregular Ma-
nagement of Cure, and ufe:'ofSpecifcks:  It
exceeds my Defign, as well as Capacity, to
unriddle  further the Nature  of this  Ve-
nom,  in its feveral Appearances   under
that general Denomination of a Pox ; hav-
ing only  intended here the fhort Hiftory of
                                      a 
       LUES  VENEREA.     37
(i Salivation, by which the moft of them are
effectually to be removed.
   A  Salivation  is dangeroufly undertaken
with Aged People, with fuch as are lean, or
'dejected thro'   Trouble or  Misfortunes,
Or   much  emaciated  ;   but  efpxially
with  thofe whole Lungs  are  any  way
diftemper'd,  that  are  Hectical,  Phthy-
fical andConfumptive, becaufe, as this Ha-
bit is acquired by the Glanduloiis Secretions
being increas'd, Mercury pejorates the Mif-
chief, and the more fo, if fuch Indifpofitioh
has proceeded from a  former ill ufe of it.
 Dr.  Moulin affures us from  Experiments,
that  Mercury is very prejudicial to the Lungs,
becaufe they want that ftrong brisk Motion
the Mufcles have in  other  Parts, and by
their lax and fpongy TJexture are extreme-
ly unfit for clearing themselves  of fo trou-
blefome a Guest:  This  (Jays he) we daily
fee from Perfons often flux'd ; who are at1
terwards obferv'd to die  of  Consumptions,
that will not give way to any Courfe of Me-
dicine : To which likewife agrees many in-
terfperfed Places in Mr. Martin\ Collection
of BAWDY  Letters.
   Mercury ordinarily  Operates  by a  Flux
thro' the Salival Glands, and by the parvity
of its compounding Parts has a peculiar Ap-
titude thereto:   The   Benefits  from it
feem  as  much from  the  uninterrupted
.-'  ""                      -.      Con- 
 }S     LUES  VEN ER E A.
 Continuance of its Operation,' as any Speci-
 fick Vertue in tlie Mercery;   for the Blood
 has leisure by fuch a len ;th of time as a Sa-
 livation takes up, to feparate its noxious and
 incongruous Pasts,  which are daily wafhed
 and l*pewed,ou't by the tliin Liquors conti-
 nually taken,and consequently the Remain-
 der, after fuch a Defaecation,becomes more
 Homogeneous.
   A Salivation is raifed  by  Mercurials,
 and  that either  Externally  or  Internally
 ufed ;   Two  or  three  Purges always
 precede as  preparative,  and  after that,
 if we intend it by  Unction,  make  up
 the following  Ointment,  and draw  on
 a pair of Gloves and Stockings after the ufe
 of it, to keep the  Linen  and  Bedcloaths
 clean.
   9i Argent. Vivum ?iv. Axuug. Porcin. |xij.
 M.  An Ounce of this is to be ufed at a time
 for three days fucceffively, beginning  the
 firft Illination on the Wrists and Anc es on-
 ly, leaving the Patient to chafe  it ; 1 with
 his Hands warm'd before the  Fire ;  the fe-
 cond higher about the Joynts of the Knees
and Elbows;  and the third yet further up,
but cautioufly,  becaufe  tile nearer you a-
noint to the Abdomen, the more likely  the
Body will be of being Laxative, and elude
its proper Operation : If thefe  Three Indu-
 ctions anfwer not the purpofe, we muft ftill
                                  repeat 
       LU ES  VENEREA.     39
repeat it, and help forward with a Bolus of
Turbith.
  This way by Un£tion I prefer, efpecially
in weak Bodies,  the other  more certainly
caufing Naufea^ Vomiting, Loofnefs, Faint-
nefs,  and the like Accidents that interrupt"
a Regular Courfe of Proceeding,  and give
great uneafinefs to a Patient: But fince Un-
ction has alfo its Faults,  and is Offenftve by
its Smell and naftying the Cloths; fince ma-
ny alfo differ from me in this Prefesence,
and  give it to Mercurials, internally admi-
niftred ;  and lastly,  fince the Rules to pre-
vent thofe Symptoms mentioned, will re-
quire more Attention in the Internal than
External ufe of Mercury :  I fhall chufe to fi-
nifli the  Courfe in that Method, and for
eafier Apprehension, divide the Flux  into
a Beginning, a State/ and a Declension.
  In the Beginning,  or  Firft Attempts to
raife a Flux, the only thing to be fear'd and
guarded  againft,  is a Diarrhea, which di-
verts the Operation of the Mercury from the
Salival Glands : This we muft take notice
is prevented,  or abates and goes off, in pro-
portion as we can procure a Soreness in the
Mouth and Jaws, and increafe the Drib-
ling ; and therefore a very great Strefs lies
in the Manner and Method, as well as in
the Administrations  themfelves, and in a
good ordering the Patient as to Diet and
Confinement.                      Firjl, 
   40     LUES  VEN ERE A.
     Fir-ft', We have faid two or three Purges
   are to precede : And the Reafon of this  is,
   that befides preparing the Body for fucceed-
   ing  Mercurials, they leave an A stringency
   that makes a  Patient lefs apt to it after;
   wherefore thofe of them that leave more
   than others of that Property behind beft
   fuit the Purpofe ;  as the
       Potio Con/wnn is Purgativa Sydenham.
     Secondly, In adminilt ring Mercurials, the
   Bolus fliould contain but a  fmall  Dofe  at
   firft.
     I£ Mer. Dtd. gr. x.  Laud:  L. gr. ij. Conji
   Rof. q. f.fiat Bolus quaque nocte fumend. And
   be increafed two or three Grains every Re-
   petition ; becaufe large  Dofes of it in the
   beginning exert too much force in  the Pri-
   m& vi£, and by the effect of their own Irri-
   tation, are pafs'd  off with their Contents ;
   whereas a  fmall one, without giving fuch
•   difturbance,  leisurely intrudes it felf,  and
   in die  Circulation arrives at and  wounds
   the Salival Glands ; . and when once it has
   obtained that  Path,  the fubfequent Dofes
   more eaiily follow, and fupprefs all Fears
   of a Diverfion.
     Thirdly, The Diet has its Ufe  towards
   this End,and fhould be dry and astringent;
.  Rice,  toasted Chcefe,  Yolks of  Eggs  in
   mull'd  Whitewine,  a  Harts-horn-Drink,-
   and Roast-meats, in general,  are proper
    ,-                                Food; 
        L UES VENEREA.     4i
 Food ;  minding to continue the moft noii-
 rifhingofthem  (the Meats) as long as we
 can to fupport the Strength thro'; for iii
 the Progrefs the Throat will be too fore to
 bear fwallowing any thing but Liquids.
   4.  Another means conducive to it,  will
 be guarding against Cold, which would by
 constipating the Pores make the Body loofe
 Cutis  Denfitas alvi Laxitas.
   Thefe few Rules premis'd, We may go
 on with the Mercurial Bolus's for three ot
 four Nights fucceflively; and  if the Spit-
 ting in that time is found to have advanc'd
 but flowly, or the Body  is laxative, alter it
 for one of Turk Min.  a gr. v ad viij, giving
 an Anodyne Draught at the end of its Ope-
 ration.
   Two or three Turbith BoluSs following
 the other,  and increafing their  Dofe a
 Grain every Repetition  (a v ad viij)  may
 be expected to raife the Flux; but Consti-
 tutions differ, and will be  always  an Ex-
 ception to any stated number : I've known
 two Bolus's of Calomel raife a Salivation,and
 I have feen ikif. of Mercury by Unction in-
 effectual.  And here it may not be altoge-
 ther unfit to  mention the  opposite Confe-
 quences that  at  fome times proceed frorii
 the ufe of fuch a Quantity under different
Symptoms:  I have known nocturnal Pains
of the Head and Shoulders  that have been
                    G               re- 
42     LUES  VENEREA.
removed by ufing fuch  a quantity in Un-
ction, tho* a Spitting neves fucceeded ; and
yet the fame, per fitting when the Cafe  has
been Eruptions and ftinking putrid Ulcers,
has not only failed, as to the Salivation, but
render'd the Cafe deplorable, by increafing
their Number and Quantity of Matter, and
consuming  the   Patient  in  colliquative
Sweats: But in  this, Reafon and Experi-
ence muft be  our Guide; we muft be able
to know when the Mercury operates kind-
ly, and whether the Patient's  Constitution
and Courage  will fupport him thro' the
Courfe ;  becaufe now,  if the Succefs is
doubted,  we  may fafely divert with  Ca-
tharticks,  which  in the increafe will be
dangerous and impracticable; for my own
part, 1 have feldom mifs'd,  more or lefs, of
a Loofenefs in the sailing a Salivation,  and
have perttfted in the ufe oiTurbith, when a
Patient has had  fixteen or eighteen Stools
in a Night;  but  this  has  been in  robuft
strong Bodies, and with this  Caution, of
"giving a Refpit for a  Day ox two, a Hartfi
hom Drink, and an Anodyne''Draught.
   If in the beginning Of a Flux there1 fhould
. be a more tlran ordinary Pain in the Jaws
. and Mouth,  and the Saliva running off
bloody, we are not to be startled at it, they
 are  the common Attendants of Mercury.
' and reach no further than*the  Parts  imme-
                                 diate! v' 
       LUES  VENEREA.     4?
diately affected ; a Pay's Intermiftion from
Mercurials will palliate, and in a great
meafure correct fuch Uneafineffes ^ and to
prevent their return and Aggravation, we
may perfect the rerriainder of our Work by
Unction, which does not  affect with fo
much  Pain as Mercury received by the
Mouth does.
  The Spittle at firft is thick and clammy;
but as it increafes in Quantity, grows thin
and ferous.
           The   SfATE.

  By the State of a Salivation,  I meanal}
that time from a Patient's spitting about  a
Quart in .24 Hours, till' its height and returfi
to that Quantity again, which rnay Include
a Fortnight or more;  and during this, the
exadteft Regulation is required to promote
the Flux,  and avoid tile dinger of a Diver-
fion.   The beginning has lefs "regard jn Re-
gimen, becaufe the Fauces as yet fuffer fo-
Ud and nourifhing Diet to pafs and  fuftain
Nature ;* but in this then* Sorenefs will ad-
mit of nothing but  foft Liquors, as  thin
Broths1 and Gruels, which as they afford
very little Nourifhment, and that the Flux
is ftill greater, a Faintnefs and Debility of
neceffity follows,  that will constrain us to
stricter Rules.  The Patient muft be  alto-
gether confin'd to the-Bed; he muft be
kept between the  Blankets; the Bed well
                   G 2           lin'd ; 
44     LUES  VENEREA.
lin'd;  the  Room clofe and warm, and a
Julap pro Languoribus;  the Head and Jaws
fhould be covered alfo with  Flannel, it  re-
pels the Effects of Cold, and is Anodyne.
  Laftly, The Mouth fhould be frequently
wafh'd with the Liquids they drink,  to
cleanfe and fcour the Glands  from Filth,
that they may the more freely fpue out their
pontents;  for this purpofe therefore, and
alfo for quenching the continual Thirft
they will be under from a large Spitting,
plenty of them muft be in readiness; and
they fhould be ufed warm, becaufe Cold
(in this general Ulceration  pf  the Mouth)
would create'great Pain, check  the Flux,
and hazard the falling out of the Teeth.  If
there fhould be a necessity to check its  A-
ttivity, Flos Sulphuris is the Medicine.
   I account the Salivation well raffed,  if I
can make it amount to about  two Quarts
in  a Natural Day, and continue it fo  for
eight or ten:, but let the highest Quantity
be what it will,  whenever  it leflens regu-
larly, it signifies the Mercury to have fpent
its  utmost Force and  Power, and puts us
on Considerations for  our Third and  laft
Branch, The  Recovery, or State  of Detlen*
fton.
The 
LUES  VENEREA.
        The  DECLENSION.

  A Flux that has advanced kindly to its
Height, will as gradually decline, and in
the clofe of it calls for Phyfick  and Diet
Drink> to expel the Remains  and Recre-
ments of the Mercury: They are not giv-
en till the  Swelling  and' Sorenefs of the
Jaws and Mouth are well abated, and the
Draining little;  fome there will  be while
the Mouth  continues fore, becaufe, while
the Fibres are excoriated, there will be a
proportionable Vellication that will exprefs
the Juices within their Contact;  and this
might continue an inconvenient length, if
the Humours were not diverted, and the
Ulcerations dried  in  the  end, by Enema*s,
Catharticks and Gargles.
  Ifc Pil. Coch. Extr. Rud. ana gr. xv. rez, Ja-
lap, gr. iv, Ol. Carui gutt. ij. /'. Pil. no. v. de-
aurand. ad fex vices repetand. alternis diebus*
  Ifc  Fol. Senna Alex*  3J. ZJnzib. Sal Tartar.
ana 3j. Infunde tepide per noctem Colatur.^iij.
adde  Ol. Ani ft gutt. j. Syr. Rofar. Solutiv. 3vj.

   I£  Manna opt. §j. diffolv. in ifej. Aq. Stre~
thamenf. £i? fuperbib. Ibiij. Aqua efiifdem fwgu-
lis diebus.
Aq. 
 46     LUES  VENEREA.
    9* Aq. Rofar. Plantag. ana |iij. Mell rofar.
 ?j. 01. Vit. gutt. wi.pro Gargarifm. ad os eluen-
 dum.
    *£ Fol.  Plantag. Myrtill in Aq, Hord. de-
 coff.Colatur. Jviij.  adde Syr. e Moris |j. M. F.
 Gargarifm.
    Diet  Drinks  are appointed in conjun-
 ction  with thefe, and may be continued
 fix  Weeks or two Months.   They, toge-
 ther,  fubdue and carry  off the Remnants
 of the Mercury, heal the Excoriations of
 the Mouth,  and  the  Drinks, in particu-
 lar, correct the Acidities  of  the  Blood,
 and procure  a  gentle Diaphorefis,  which
 very much avails in finifhing a removal
 of all  Pains.
   Ife Baccar. Jump. 3j. Rad. Liquirit. Sem.
 Panic,  ana £j. infunde in Cerevifia tenuis conq.
 ).  Colatura, adde Sp. Cochlear. |ij. pro ufu.
   9" IJgn. Sajfaphraf. |iij.  Sarja,  Guaiac.
 ana |ij. Rad.Liquir. Sem.Coriand. Anifi,ana |j.
 CC Ran. |if. bulliant in tfcxvj. Aq. ad Cxi).
 Colatura bibat fape in die.
   fp. Tb*<e ex Sajfaphraf.  bibat bis  vel  ter in
 die.
   Ifc Cerevifia e Lignis  Doctoris Fuller.
   9t Decoct. DUteticum  Sydenham pro Potu
commune.
Suffu- 
       LUES VENEREA.     47
  Suffumigation is fometimes substituted in
room of the preceding Courfe;  and is laid
to remove Pains, and dry up running Ul-
cers, or a  Caries,  better, and with more
Difpatch.
  In the Management of it, the Patient is
ftripped naked, aud placed on a Stool with
a Hole thro', under which the Fume is put: .
He is covered all over with Blankets,  (ex-
cept the  Head,  for fear of Suffocation)
which are drawn pretty clofe about the
Neck to keep the Fume  in.  When Sweat
begins to come, he muft be put to Bed, and
there well covered for an Hour or two. and
this repeated fix, feven,  or more Days, ac-
cording to the Urgency of the Symptoms :
The Fume is made always of-Cinnabar.
   ty. Cinnabar. faBitia |iif. Thuris,  Styracis,
ana %). M.  F. Pulvis.
   Ifc Cinnabar. |ij.  Styrac. Calamit. Nucis
Mojchat. ana 3ij. Benzoin on), cum Terebinth.
E  Trochifci.
FINIS. 


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