ePub 版

cellary, are much less frequent than has transversely, otherwise convulsions, para hitherto been supposed.”.

ticularly the spasmus cynicus, will ensue. This position, he says, is founded on Several of the aponeuroses, efpecially his own observations in the military ho- that of the biceps, ought likewise to be spitals, during the late bloody war; where cut transversely : the tendons allo must he remarked, that in a great number of be cut in the same direction. If the cases in which amputation was judged ne. wound or ailment happens to be near the cesary by the physicians of the army, it articulations, be also cuts through the did not answer the end : he had also un- ligaments. These incisions must be longder his iminediate care a great number of eit where the sore has spread the wideit, patients, whose limbs had been shot of, and deeper in the middle than at the exand the stumps left shattered in such a tremities. The number may be from manner, that a fresh amputation was u three to eight, as the case may require. niversally thought neceffary, and whom After these incisions, the mortified he cured without that dreadful expedient: parts must be separated from the sound by and he cured, without amputation, inany a bistory, as one muscle is divided from patients whose limbs were not entirely le-, another in diflections : but paris not toparated, but so much detachod, contused, tally corrupted may be {pared; for, apand Thattered, that the ablest surgeons ter the removal of what is totally dead, thought it indispensably necessary to take they will recover. Great care must be them wholly off.

taken in removing the gangrened parts M. Belguer re luces the cases in which that lie near large vessels, that such vel. amputation has been universally thought sels are not wounded ; and it is hetter to necessary, to six.

leave a sinall part of the mortified field 1. A mortification, which spreads till that adheres to them, behind, and trust to it reaches the bone.

its separation by the dreslings, than to risk 2. A limb so hurt that a mortification breaking them; and, in general, the inis highly probable.

cisions (hould be made with as little erfu. 3. A violent contusion of the felh, fion of blood as possible. If the neighwhich at the same tiine has shattered the bouring parts are tainted, the corțupted bones.

humour must be squeezed out by gentle 4. Wounds of the larger blood-vessels compreslion, and wiped off with a soft linen of the limb, when recourse is had to am rag: afterwards, proper external applicaputation, as the only means of stopping tions must be used. the hæmorrhage, or through an apprehen The bone, whether the periosteum be Gon that the limbs should perilh for want found or destroyed, must be dressed with of nourishment.

the following medicine : 5. Ao incurable caries of the bones. " Frankincente, maftich, farcocolla,

6. A cancer, or tumour in danger of be. and myrrh, finely pounded; true ballam coming such.

of Peru, and genuine essential oil of He lays down his method of cure in cloves, of each equal parts ; of balsam of each of these cases separately.

fioraventi as much as may, in mixing ail 1. In a mortification be begins by ma the ingredients over a very gentle fire, king incisions on the part affected, to pro: form a thin linimeni." cure a discharge of ihe corrupted matter, This must be used warm, and poured and allilt the action of the medicines, He plentifully into the wounds, so that the makes these incisions of a considerable bone may be well moistened with it. length, not only on the mortified parts, Some dry lint must then be laid on, and but those adjacent; and as near to each the fleshy parts dressed by sprinkling upon other as the large trunks of the blood- this lint a powder composed of “ an ounce vefleis and branches of nerves will allow, of myrrh finely pounded, half an ounce of not more than an inch distant from each fal ainmoniac, camphor and nitre, each a other, and always to the quick. If the drachın." After the first laver of lint is bone be affected, he cuts through the pe- thus covered, fresh liot must be applied, rioleom, and lays it bare. These inci- and sprinkled with the powder, till the fions are in the direction of the fibres of wound is quite filled up with alternate the muscle on which they are cut. But layers of the lint and powder. he observes, that when the gastrocnemii,

'If the bone is roi ailectesl, or the pethe glutei, or delioid nucles, have been riofteum laid bare, the liniment may be wounded by a ball, tliey must be cut on.ed, and the lint and power only !!! VOL. XXVI.


[ocr errors][ocr errors][ocr errors][ocr errors]

4 C

fed. Slight scarifications should also be vin and rue, each two handfuls; oak. made upon the neighbouring parts, (priok leaves, a handful and a half; verdegris, ling them with the powder; and all the half an ounce ; camphor, two drams ; ca. fores should be afterwards embrocated lamin, fix drams. After having mixed with oil of turpentine, and the whole and reduced all these ingredients to possbandaged up with plain linen cloth, which der, let two ounces of the composition must be kept moistened night and day be boiled with four pints of water, or with warm fomentations.

with two of water and two of vinegar." Heister has collected a fufficient number The following embrocations applied to of these fomentations, from which a fur: parts already mortified, will stop the forgeon will easily select the most proper for ther progrefs of the mortification ; where the case of his patient. That conisting it is just beginning they will prevent it, of a pint of lime-water, three ounces of and will also help nature to separate the camphorated spirit of wine, and an ounce dead.parts from the found. or half an ounce of sal ammoniac, is uie "1. Spirit of wine, three ounces; myrrh ful in mortifications which proceed from and aloes powdered, of each half an ounce; high inflammations; so is that made with Egvrtian ointment, three drams + foap, salt of tartar, and oil of turpentine, 2. Vinous decoction of scordium, twelve diffolved in lime water.

ounces; vinegar of rue, and of roses, of When the mortification proceeds from each four ounces ; spirit of treacle, three a mere defect of the vital motions, as in ounces; and one ounce of fal ammoniac. dropsical and aged persons, the following 3. Lime water, four pints; treaclefomentations are more proper.

spirit, or that of fever few, two pints; "1. Take of water-germander, worm white-wine vinegar, one ping; elixir prowood, southernwood, rue, of each tiroprietatis

, fix ounces; Egyptian oint. handfuls ; chamomile-flowers, one hand. ment, two ounces. ful: boil them together; and to two 4. Decoction of elder flowers. lix ounpints of the firained liquor add four cun- ces; wine, eight ounces ; vinegar, camces of treacle-spirit, two ounces of Venice' phorated fpirit of wine, treacle-spirit, or foap. and half an ounce or even an ounce that of feverfew, each two ounces; fpi.

rits of salt, two drams." 2. Take of water-germander, worm Lally, in order to loften the parts, wood, feverfew, of each two handfuls ; feparate the soughs, and promote suppu, of mint and southernwood, of each à ration, the following application inay be handful : boil them together in oxycrate, ufed. so as to have four pints of the trained'lis “ Water-germander, two handfuls; quor; to which may be added half an mallows and marsim llows, cach a handounce of sal gem, and afterwards from ful; Power of lintfeed, three ounces; two to four ounces of treacle-spirit. Venice soap and fal aminoniac, of each

3. Take of martial bail * tiyo ounces, two ounces; lintseed-oil, an ounce. Let sal ammoniac one ounce ; diffolve them in these ingredients be boiled together, in about eight pints of spring, water, and vinegar and water, to the conditence of add two pints of realified fpirit of wine. à poultice."

4. Take of crude alum, and white vi. It may be in general observed with re. triol, each two ounces and two drams; gard to fomentations, that such as are elytharge of Glver and myrrh, each an mollient are serviceable when hard dry ounce; Aleppo galls, tiro ounces; juni. crusts prevent a discharge; those which per and bay berries, each an ounce; fa- abound with acid, when there is a confi

derable degree of putrefaction; and, last• The martial ball is thus made : Take of ly. those which are spirituous, faline, or filings of iron one part; white tartar two ftrengthening. are most proper when parts : let them be reduced to a fine pow. fuellings are fabby, and the body abounds der, and put into a matrass with as much with avjueous humours. French brandy as will swim about an inch above the powder ; exhale to dryness, either will in twelve hours alter the condition

The diligent use of these fomentations, in the heat of the sun, or in that of a water. bath. Pour fresh brandy upon the remain of gangrened wounds for the better ; then der, and evaporate them in this manner se † in using the external vulnerary mcdiveral times succeslively, till the mass appears cincs, in which aloes is an ingredient, it must relincus; then form it into balis nearly of the be remembered, that they often prove purbizness of an egs.



of lal gem.

the lint and powder may be removed, all All these dressings should be finished as the detached pieces of tortificd fleth ex. expeditiously as possible, to avoid cold ; tracted, and the dreslings renewed every the room thould be warm; and, if neces. twelve hours: at the third or fourth fary, a few burning coals held near the drellings, the wounds will discharge mat. part which is dressed, ter of a favourable alpect, and then it After these directions, M. Belguer ar. will be necessary to give the bark inter• gues thus with respect to mortifications. Dally.

They are the effect either of some interThe bark may be given by itself in pow. nal morbid cause, or external injury. IE der, or made into an electuary with any of an internal caure, amputation can do of the cordial (õrups : if it purges in fub. no good while such cause remains; and stance, it must be given in the effusion or if that can be removed, a cure may be extract. But if the fever be strong, the effected without amputation. If of an heat considerable, and the patient thir. external accident, and they continue to ity, the bark will be of no service ; but spread, there must be a fever, and genefecourfe must be had to tenperante,

ral inftanın ition; and for that reason It the bark is given. it may be in do. amputation can only accelerate the pa. ses of half a drachm or two scruples, eve. tient's death *. While the mortification ry hour at first, afterwards every two therefore is gaining ground, the method hours, and at length, once in every three ahove proposed should be pursued. When or four hours: a few drops of spirit of the progress is stopped, we Mhould conasea-falt, or dulcified spirit of vitriol, or a der whether the limb can be saved: ani few grains of alum or catechu, may be nothing but the total rottenness of the added to every dose ; and if the patient bone is a proof that it cannot; for the be very weak, a small glass of foine acid periosteum may be cut and torn, withwine. His drink Thould be water and vi. out giving pain, in a sound late, as Hal. negar, weak veal and chicken broth, and ler has deinonstrated. If the bone is togruel: of barley or oat-meal, acidulated tally rotten, amputation tlould be perwith vinegar, or lemon-juice.

formed, not by cutting througli the In this stage, the dreilings already de- quick, but by lopping off the gangrened scribed, being supposed to have procured useless mals very near it. After provia discharge of matter, the vulnerary pow. ding against an hæmorrhage of the larger der and oil of turpentine must be laid a vesels by a proper ligature; 1topping the fide ; but the fuppuration must still be progress of the gangrene must be then promoted, sometimes to the eighth day, attempted by internal medicines, and by dresling with the following digestive suitable drellings; the patient's strength ointments. “ Boil half a pint of oil-olive should be supported by a proper regimen ; and an ounce of red launders together, and if it increases, a separation of the till the oil acquires a deep red colour; soft parts that are mortified, will cere when it is strained, add a pound of yellow tainly ensue ; after which it will be easy wax, and a pound and an half of turpen- to faw off the little stump of the dead tine; when the whole is mixed, and bone that was left; and the wound may melted together over a gentle fire, a little be cicatrized by epulotic applications, ballam of Peru may be added, and it may, and such as have been just recoinmended be quickened with a little eflence of for bones when laid bare. myrrh. Suppuration must also be allisted, 2. With respect to limbs violently conby keeping the parts constantly covered tused, which fome have made a practice with einollient fomentations; and by a of cutting off before they tried

any other voiding to cleanse the wound' too much, remedy, M. Belguer declares expressly either by coinpreilion or wiping, and res against amputation, even if the bones, moving the corrupted parts without estu as well as felh, are bruised and crushed son of blood. Regard must also be had by the fall of a large beam, a mass of to the bones: after the most careful exa- stone, or by a cart-wheel, a screw, or a mination, in which dilatation is sometimes prefs. In thele cafes, he lays, the paneceflàry, all the splinters and carious tient has a better chance, even for life, parts, that can be removed without vio

• Our own countryman Mo Sharp, who lence, inust be extračied, and they must has been long an honour to his profession, then be covered with the baltam for the hus irretragably proved the impropriety of benes, of frankincense, masticis, &c. as ting on the found part while the more directed before,

siksation is gaining ground.


[ocr errors]

setting the limb out of the question, if with herbs boiled in them, and w it is not, than if it is, cut off. Two wine and water ; he should also tal things are generally dreaded ; a mortific every four hours, half a drachm of cation, and hæmorrhage. As to the mor- bark till the pulle is sufficiently rai: tification, if what has already been said and the suppuration is laudable ; he c. is worthy of any regard, it is not pro. then be allowed meat ; and his dra bal·le. As to the hemorrhage, it has should be water, acidulated with vides - sometimes stopped, even in these very or vitriol. cases, without the allistance of a surgeon. When the suppuration is too plentil, The method of cure dire&ed by this au and the wound appears disposed to hea, thor, is as follows.

the patient Mould be purged once o When the lower arts of a Mattered twice with Epsom salt, foine ab orben limb adhere by a little flesh or skin, so powders having been previously adair. as that there is no hope of a reunion, stered for a few days. "He lould drink they Nould be separated entirely. When during the day, a slight decoction of tr pieces of bone jut out, they must be bark: before and after meals, a lite lawed off, whether firm or inoveable. strengthening acid elixir ; and, in the All the other small splinters, either held evening, he should take a small dose : by the fielli, or adhering to the bone, the bark in substance. that can be removed without violence, The frengthening elixir is thus mare or a fresh effusion of blood, should be ex. " Half an ounce of the extract of word traded by the hand, or a proper instru- wood; of that of gentian, leffer centar ment. The limb should then be slightly ry, green oranges, and buck-bean, 6 compresied between the hands, and gen- each a drachm ; rectified spirit of Fine tly stroked lengthwise from above down- four ounces; and spirituous mint-wate wards, fo as to refore it as much as pof- one ounce : let the extracts be diffelse fible to its natural thape : the fore should in the spirits, over a gentle fire ; ftra: then be dressed with a digestive, adding them; then add to the strained liquo a little effence of myrrh, or solution of half an ounce of dulcified spirit of nitre, inaftich; the whole covered with dry and thirty drops of oil of vitriol." lint, and the fame bandage applied as M. Belguer then describes a fever in amputations, but not lo tight as to which frequently fupervenes in the Cause pain, or increase the inflammation. cales, and gives directions how to stop: The whole Diould be then moistened When the bones of a limb are o with as much spirit of wine as may pene- quite broken through, and the parts trate the parts affected ; and care mult pended only by a small portion of fie he taken to extend the limb in a right and skin, but so much shattered that the line, and lay it soft.

limb may be moved any way, and see Till the suppuration becomes plentiful, to hang useless, the aperture made by re it should be drested only once in twenty- wounding body must be dilated, and the four hours, but afterwards twice a-day ; fell separated from the bone, that the and such dreslings as touch the bone or splinters and extraneous substances fiefli, should be covered with lint dipped be extracted ; the dreslings must be tie in a folution of maftich, ballam of fiora. · same as before directed. venti, or some other ballamic eflence, to If a bullet has penetrated the cavity of prevent the suppuration from becoming a bone, the bone must be laid bare, and too copious; and at each dressing, all the afterwards pierced with two or thres little Divers which do not reunite, and trepans, that the extraneous body and which by degrees come to be separated fliivers may be extracted. without violence, should be taken away. If a bullet has made its way into one

Care Bhould be taken to promote the side of a joint, and splintered several coalition of the larger fragments, by bones at a stroke, the same method mul Lipii compression of the lands, and a be followed. little tightening of the bandage. Those Care must be taken to fix the limba that do not coalesce in a month, thould its natural situation, to keep the dreilbe cautiously and tenderly loosened, so ings fuíficiently tieht above and below as to bring them away. If any are the wound; to promote the consolidation cracked os liigh as the articulation, they of the larger pieces of bone, by keeping fiould be left to nature.

firm in their places, and prevent. If the patier ? is weakened lay loss of ing the reabiorption of pus. blood, be must be furorted by broths,

[ocr errors]

M. Belguer's observations confirm those is recent and inconsiderable, there can of Horstius, that patients who have lost be no pretence to amputate, but the a great portion both of the tibia and fi- bone must be laid bare as far as the cabula, may neverthelefs, after their cure, ries extends, and scraped with a scalpel, walk with eale, and halt but very little or perforated in several parts with the [xvii. 33.]

spike of a trepan.

When the caries has M. Belguer observes, that fometimes reached the opposite part of the bone, the wounds dry up on a fudden, become the crown of the crepan must be used to corrupted, and exhale an infectious take out the entire piece. Medicines stench ; the neighbouring parts are in- proper in this case are well known, but famed for fo', . days, and then leave an the mineral acids must never be employoedematous tumour, which either produ- ed, not even Hoffinan's anodyne mineral ces an abscess, with a faudable dir- liquor ; for all do hurt. When the cacharge, or degenerates into a malignant ries is removed, the cure is to be cornfore, without an abscess, which fome- pleted by a nourishing, but not oily diet. times swarms with maggots. For this The dreling should then consist only of untoward appearance of the wound he dry lint, taking great care to exclude directs proper remedies.

the access of air from without. 3. In cafes of violent contusions, where When the caries is accompanied with a great quantity of extravasated Auid una vitiated state of the blood, the exterder the skin produces the appearance of nal treatment must be the same, and proa mortified eschar, and though the skin per internal remedies must be added. A itself is not broken, yet the bones under caries from a venereal cause may be cured it are Jillocated or fractured, the treat. like any other. ment Mould be nearly the fame as in a Amputation is uselefs while the morbid mortification, and the part affected cause remains; and when it is removed, should be constantly bathed with emol- the cure may be effected without ampulient fomentations, without any stimula- tation. The portion of bone taken away ting or aftringent ingredient. If the will be supplied by a callus, as appears bones are luxated, they must be redu- by indubitable testimony. See the Media ced, but left without bandages.

cil Ellays of Edinburgh, vol. 5. p. 371. If the contusion has not produced a 6. The last case is a cancer; concernmortified Nough, but has yet fractured ing which this author fays very little, exthe bone, the applications Nould be veo cept that it thould be extirpated before ry mild, and no incisions Mould be made ; it takes root, or not at all. the two ends of the bone Should be The whole of this interesting work is brought together, and secured by com- founded on the author's own abundant presses and bandages ; and tlie whole experience in the military hospitals of dressings flouped with discutient and vul- Pruflia, during the late bloody war; nerary fomentations.

where a much greater proportion of those 4. As to wounds of the large blood. who were so wounded, as, in the genevesels, the furgeon may always, by pro- ral opinion, to justify amputation, recoper dilatations, come at the wound, and vered, ihan are known to recover of those stop the bleeding, by ligatures or astrin. on whom that operation is performed. gents, or both; so that in that case ani. The work appears to be extremely putation can never be necesiary. And well translated, and is earnestly recomexperience has shewn, that after the mended, by the author of this epitome, operation for the aneurism, the member to every praditioner in this kingdom. G. which it might be fupposed would have Independence. A poem. Addressed to the perished for want of nourilliment, has recovered heat, motion, and itrength,

Minority. By C. Churchill. 4. 2 s. 6 d. even when the trunk of the bracbial ar

Almond, &c. tery has been cut through. This there- W:

7 Eli, sir,'ois granted, we said Churchill's fore, when wounded, may be tied with.

rhymes out fear, and the preservation of the What foolish patron is there found, of his

Are sol'n, unequal, nay, dull many times, Jimb may be provided for by aperient so blindly partial, to deny us this? fpirituous fomentations, and gentle frictions, which contribute to open and en

Nempe incomposito dici pede currere versus large the small vessels

Lacilli quis tam Lucilli fautor ineptus 5. As ts a caries of the bone, when it Wibem defricuit, claria laudatur esden.

Ui, hoc non fateatur ?--Atidcon quod fale multo


« 上一頁繼續 »