Chapter III: Part 3

The Liver, being the thickest of all the Bowels, is plac'd in the Right _Hypochondrium_, at the distance only of a Fingers breadth from the Diaphragm; its Figure much resembling that of a thick piece of Beef: It is Convex on the outside, and Concave within; its Substance is soft and tender, its Colour and Consistence being like coagulated Blood: It is cleft at bottom, and divided into two Lobes, _viz._ one greater, and the other less: Its Office is to purifie the Mass of Blood by Filtration; and it is bound by two strong Ligaments, the first whereof adheres to the Diaphragm, and the second to the _Xiphoides_ or Sword-like Cartilage. Two great Veins take their Rise from hence, _viz._ the _Vena Portae_, and the _Vena Cava_, which form innumerable Branches, as it were Roots in the Body of the Liver. The Gall-Bladder is fasten'd to the hollow part thereof, and dischargeth its Choler into the Gut _Duodenum_, thro' the Vessels that bear the Name of _Meatus Choledochi_, or _Ductus Biliares._ This Choler is not a meer Excrement, but on the contrary of singular Use in causing the Fermentation of the Chyle, and bringing it to perfection. {73}

_What is the Spleen?_

The Spleen is a Bowel resembling a Hart's Tongue in shape, and situated in the Left _Hypochondrium_, over-against the Liver: Its length is about half a Foot, and its breadth equal to that of three Fingers; its Substance being soft, as that of the Liver, and its Colour like dark coagulated Blood: It is fasten'd to the _Peritonaeum_, Left Kidney, Diaphragm, and to the Caul on the inside; as also to the Stomach by certain Veins, call'd _Vasa Brevia_; nevertheless these Ligatures do not hinder it from wandering here and there in the lower Belly, where it often changeth its place, and causeth many dreadful symptoms by its irregular Motions. Its Office is to Subtilize the Blood by cleansing and refining it.

_What are the Reins?_

The Reins or Kidneys are Parts of a Fleshy Consistence, harder and more firm than that of the Liver and Spleen: They are both situated in the sides of the Umbilical Region, upon the Muscle _Psoas_, between the two Tunicks of the _Peritonaeum_; but the Right is lower than the Left: Their Shape resembleth that of a _French_ Bean, and they receive Nerves from the Stomach, whence Vomitings are frequently occasion'd in the Nephritical Colicks: They are fasten'd to the Midriff, Loins, and _Aorta_, by the _Emulgent_ Arteries; as also to the Bladder by the _Ureters_. The Right Kidney likewise adheres to the Gut _Caecum_, and the Left to the _Colon_. Their Office is to filtrate or strain the Urine in the _Pelves_ or Basons, which they have in the middle of their Body on the inside, and {74} to cause it to run thro' the Vessels call'd _Ureters_ into the Bladder.

Immediately above the Reins on each side, is a flat and soft Glandule, of the thickness of a Nut; they are nam'd _Renal Glandules_, or _Capsulae Atribiliariae_, because they contain a blackish Liquor, which (as they say) serves as it were Leaven for the Blood, to set it a fermenting.

_What is the Bladder?_

It is the Bason or Reserver of Urines, of a Membranous Substance as the Stomach, being plac'd in the middle of the Hypogastrick Region; so that it is guarded by the _Os Sacrum_ behind, and by the _Os Pubis_ before: Two Parts are to be distinguish'd therein, _viz_. its Bottom and Top; by its Membranous Bottom it is join'd to the Navel, and suspended by the means of the _Urachus_, and the two Umbilical Arteries which degenerate into Ligaments in adult Persons: As by its fleshy Neck, longer and crooked in Men, and shorter and streight in Women it cleaves to the _Intestinum Rectum_ in the former, and to the Neck of the Womb in the latter. Lastly, its Office is to receive the Urines to keep them, and to discharge them from time to time.

_What are the Genitals in Men?_

They are the Spermatick Vessels, the Testicles, and the _Penis_. The Spermatick Vessels are a Vein and an Artery on each side; the former proceeding from the _Aorta_, or thick Artery of the Heart; and the other from the Branches of the _Vena Cava_ of the Liver. These Arteries and Veins are terminated in the Body of the {75} Testicles, which are two in Number, enclos'd within the _Scrotum_.

The Office of the Testicles is to filtrate the Seed, which is brought thither from all the parts of the Body, thro' the Spermatick Vessels, called _Praeparantia_, and afterwards to cause it to pass thro' others nam'd _Deferentia_, to the _Vesiculae Seminales_, from whence it is forc'd into the _Ureter_, thro' two small and very short Canals.

The _Penis_ or Yard is a Nervous and Membranous Part, well furnish'd with Veins and Arteries, containing in the middle the Canal of the _Ureter_: Its Extremity, which consists of a very delicate and spongy sort of Flesh, is call'd _Balanus_, or _Glans_, and the Nut, the Skin that covers it being nam'd the _Praeputium_, or the Fore-Skin. Thus by the means of this swell'd Part, and stiff thro' the affluence of the Spirits, the Male injects his Seed into the _Matrix_ of the Female, to propagate his Kind.

_What are the Parts appropriated to Generation in Women?_

They are the Spermatick Vessels, the Ovaries or Testicles, and the _Matrix_. The Spermatick Vessels are a Vein and an Artery on each side, as in Men: The Ovaries or Testicles, situated on the side of the bottom of the _Matrix_, are almost of the same bigness with those of Men, but of a round and flat Figure. The _Vesiculae_, or little Bladders which they contain, are usually term'd _Ova_ or Eggs by Modern Anatomists; and the Vessels that pass from these Testicles or Ovaries to the _Cornua_ of the _Uterus_, are call'd _Deferentia_ or _Ejaculatoria_. {76}

The _Matrix_, _Uterus_ or Womb, is the principal Organ of Generation, and the place where it is perform'd, resembling the Figure of a Pear with its Head upward, and being situated between the Gut _Rectum_ and the Bladder: It is of a fleshy and membranous Substance, retain'd in its place by four Ligaments, fasten'd to the bottom; whereof the two upper are large ones, proceeding from the Loins, and the two lower round, taking their Rise from the Groin, where they form a kind of Goose-Foot, which is extended to the _Os Pubis_, and the flat part of the Thighs; which is the cause that Women are in danger of Miscarrying when they fall upon their Knees.

The Exterior Neck of the Womb, call'd _Vagina_, is made almost in form of a Throat or Gullet, extending it self outwardly to the sides of the Lips of the _Pudendum_, and being terminated inwardly at the internal Orifice of the _Matrix_, the shape whereof resembleth that of the Muzzle or Nose of a little Dog. The outward Neck of the womb is fasten'd to the Bladder and the _Os Pubis_ before, and in the hinder part to the _Os Sacrum_: Between the Lips of the _Pudendum_ lie the _Nymphae_, which are plac'd at the Extremity of the Canal of the Bladder, to convey the Urines; and somewhat farther appear four Caruncles, or small pieces of Flesh, at the Entrance of the _Vagina_, which when join'd together make the thin Membrane call'd _Hymen_.

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{77}

CHAP. XIV.

_Of the Anatomy of the _Thorax_, Breast, or middle _Venter_._

_What is the Breast?_

It is a Cavity in which the Heart and the Lungs are principally enclos'd.

_What is to be consider'd outwardly in the Breast?_

Its extent, and the situation of the Parts therein contain'd.

_What is its extent?_

It is extended from the _Clavicles_ to the _Xiphoides_, or Sword-like Cartilage on the fore-part, and bounded on the hinder by the twelfth _Vertebra_ of the Back, having all the Ribs to form its Circumference, and the Diaphragm for its Bounds at bottom, separating it from the _Abdomen_ or lower Belly.

_What is the situation of the Parts contain'd in the Breast?_

The Lungs take up the upper Region, and fill almost the whole Space, descending at the distance of two Fingers breadth from the Diaphragm; the Heart is situated in the middle, bearing its Point somewhat towards the Left side, under the Lobes of the Lungs, which are divided by the _Mediastinum_ that distinguishes them into the Right and Left Parts.

_How is the Breast Anatomiz'd or open'd?_ {78}

After the dissection of the five Teguments, and the removal of the Muscles, as in the lower Belly, the Anatomist proceeds to lift up the _Sternum_ or Breast-Bone, by separating it from the Ribs; then it is laid upon the Face, or else entirely taken away, to the end that the internal Parts of the Breast may be more clearly discover'd; whereupon immediately appear, the Heart, the Lungs, the Diaphragm, and the _Mediastinum_, which sticks to the _Sternum_ throughout its whole length.

_What is the Heart?_

It is a most noble Part, being the Fountain of Life, and the first Original of the Motion of all the others; on which account it is call'd _Primus vivens_, & _ultimum moriens_; that is to say, the first Member that begins to live, and the last that dies.

_What Parts are to be consider'd in the Heart?_

Its fleshy Substance, with all its Fibres turn'd round like the Skrews of a Vice; its _Basis_, Point, Auricles, Ventricles, large Vessels, _Pericardium_ and Ligatures or Tyes: The _Basis_ is the uppermost and broadest part; the Point is the lowermost and narrowest part; the two Auricles or small Ears being as it were little Cisterns or Reservers, that pour the Blood by degrees into the Heart, are situated on each side above the Ventricles. The Ventricles, which are likewise two in Number, are certain Cavities in its Right and Left Sides. The large Vessels are the _Aorta_ or great Artery, and the _Vena Cava_ together with the Pulmonary Artery and Vein. The _Pericardium_ is a kind of Bag fill'd with Water, wherein the Heart is kept; which is {79} fasten'd to the _Mediastinum_ by its _Basis_, and to the large Vessels that enter and go out of its Ventricles.

_What are the Terms appropriated to the continual beating of the Heart?_

They are _Diastole_ and _Systole_, from whence proceed two several Motions, the first whereof is that of Dilatation, and the other of Contraction, communicated to all the Arteries which have the same Pulse.

_To what use serves the Water contain'd in the _Pericardium_?_

It prevents the drying of the Heart by its perpetual Motion.

_What are the Lungs?_

They are an Organ serving for Respiration, of a soft Substance, and porous as a Sponge, being all over beset with Arteries, Veins, Nerves, and Lymphatick Vessels, and perforated with small Cartilaginous Tubes, that are imparted to it from the Wind-Pipe, and are call'd _Bronchia_. Their Natural Colour is a pale Red, and marbl'd dark Brown; and their whole Body is wrapt up in a fine smooth Membrane, which they receive from the _Pleuron_. They are suspended by the Wind-Pipe, by their proper Artery and Vein, and by the Ligatures that fasten them to the _Sternum_, _Mediastinum_, and frequently to the _Pleuron_ it self: They are also divided into the Right and Left Parts by the _Mediastinum_; having four or five Lobes, whereof those on the Left side cover the Heart. Their continual Motion consists in _Inspiration_, to take in the Air, and _Expiration_, to drive it out. The _Larynx_ makes the Entrance of the Wind-Pipe {80} into the Lungs, and the _Pharynx_ that of the _Oesophagus_ or Gullet, at the bottom of the Mouth to pass into the Stomach.

* * * * *

CHAP. XV.

_Of the Anatomy of the Head, or upper _Venter_._

_What is the head?_

It is a bony Part, that contains and encloseth the Brain within its Cavity.

_What is most remarkable in the outward parts of the Head?_

The Temporal Arteries, the _Crotaphitae_, or Temporal Muscles, and the Sutures of the Skull.

_Why are these things considerable?_

The Temporal Arteries are of good Note, because they are expos'd on the outside, lying even with the Skin. The _Crotophite_ Muscles are so likewise, in regard that they cannot be hurt without danger of Convulsions, by reason of the _Pericranium_ with which they are cover'd. And the Sutures, because the _Meninges_ of the Brain proceed from thence to form the _Pericranium._

_What is the _Pericranium_?_

It is a Membrane that lies under the thick hairy Skin of the Head, and immediately covers the Skull.

_What are the _Meninges_?_

They are two Membranes that enclose the Substance or Marrow of the Brain.

_What is a Suture?_ {81}

It is a kind of thick Seam or Stitch, that serves to unite the Bones of the Skull.

_How many sorts of Sutures are there?_

There are two sorts, _viz._ the true, and the false or Bastard.

_What are the true Sutures?_

They are three in number, namely the _Sagittal_, the _Coronal_, and the _Lambdoidal._

_What is the disposition or situation of the true Sutures?_

The _Sagittal_ is streight, beginning in the middle of the Fore-head, and sometimes at the root of the Nose, and being terminated behind, at the joining of the two Branches of the _Lambdoidal Suture_.

The Coronal appears in form of a Crown, passing to the middle of the Head, and descending thro' the Temples, to finish its Circumference in the Root of the Nose.

The _Lambdoidal_ Suture is made like an open Pair of Compasses, the Legs whereof are extended toward the Shoulders; and the Button is in the top of the Head backward.

_What are the Bastard Sutures?_

They are those that are call'd _Squamous_ or scaly.

_What is the disposition of natural situation of these false Sutures?_

They are plac'd at the two sides of the Head, and make a Semi-Circle of the bigness of the Ears, round the same Ears.

_What difference is there between the true and spurious Sutures._

The true Sutures are made in form of the Teeth of a Saw, which enter one into the other; and the false or Bastard ones are those that resemble the Scales of Fishes, which {82} are join'd together by passing one over the other.

_What is the Use of the Sutures?_

The Ancients were of Opinion, that they were made to hinder the Fracture of one Skull-Bone from passing thro' the whole Head; but there is more reason to believe that they have the three following Uses, that is to say, 1. To promote the transpiration of the Brain. 2. To give Passage to the Vessels that go to the _Diploe_. 3. To retain the _Meninges_, and to support the Mass of the Brain, which is cover'd by them.

_What are the Names of the Bones that compose the Skull?_

The Bone of the fore-part of the Head is call'd _Sinciput_, or the Fore-head-Bone, as also the _Frontal_ or _Coronal_ Bone. The Bone of the hinder-part, enclos'd within the _Lambdoidal_ Suture, is term'd the _Occipital._ The two Bones that form the upper-part, and are distinguish'd by the Sagittal Suture, bear the Name of _Parietals_, one being on the Right side, and the other on the Left. And those behind the Ears are call'd _Temporal_, _Squamosa_, or _Petrosa_. These also are distinguish'd into the Right and Left Temporals, and are join'd to the bottom of the Parietal by a bastard squamous Suture.

_What is most remarkable in the thickness of the Skull-Bones?_

The _Diploe_, which is nothing else but a _Plexus_ or Contexture of small Vessels, that nourish the Bones, and in the middle of their thickness make the distinction of the first and second Tablature of the Bones; whence it sometimes {83} happens that an exfoliative Trepan, or Semi-Trepan, is sufficient, when the first of these two Tables is only broken, the other remaining entire.

_Is the Brain which is preserv'd in the Skull all of one Piece, or one equal Mass?_

No, it is distinguish'd by the means of the _Meninges_ into the Brain it self, and the _Cerebellum_ or little Brain; the Brain, properly so called, takes up almost the whole Cavity of the Skull, and the _Cerebellum_ is lodg'd altogether in the hinder-part, where it constitutes only one entire Body; whereas the former is divided into the Right and Left Parts by the _Meninges_, which cut it even to the bottom; whence these Foldings are call'd _Falx_; i. e. a _Scythe_ or _Sickle_.

_What is chiefly remarkable in the Substance of the Brain?_

The Ventricles or Cavities which are found therein, together with the great Number of Veins, Arteries, Lymphatic Vessels, and Nerves, that carry Sense to all the Parts of the Body, and Spirits for their Motion.

_An exact Historical Account of all the Holes of the Skull, and the Vessels that pass thro' them._

To attain to an exact Knowledge of all the Holes with which the inside of the _Basis_ of the Skull is perforated, they are to be consider'd either with respect to the Nerves, or to the Sanguinary Vessels. {84}

There are nine Pairs of Nerves that arise from the _Medulla Oblongata_, and go forth out of the Skull through many Holes hereafter nam'd.

The first Pair is that of the _Olfactory_ Nerves, appropriated to the Sense of Smelling, which are divided below the _Os Cribiforme_, or Sieve-like Bone, into divers Threads, that passing into the Nose through many Holes with which this Bone is pierc'd, are distributed to the inner Tunick of the Nose.

The second Pair is that of the _Optick_ or Visual Nerves, that pass into the Orbits of the Eyes, thro' certain peculiar Holes made in the _Os Sphenoides_, or Wedge-like Bone, immediately above the _Anterior Apophysis Clinoides_.

In the Portion of the _Os Sphenoides_, that makes the _Basis_ of the Orbit, lies a Fissure about seven or eight Hairs breadth long, which is to be observ'd chiefly at the bottom, that is to say, below the Hole, thro' which the Optick Nerve passeth; where it is almost round, and larger than at the top, where it is terminated in a very long and acute Angle.

There are many Pairs of Nerves that enter into the Orbit thro' this Fissure, _viz._ 1. The third Pair, call'd the _Motorii Oculorum_. 2. The fourth Pair, nam'd _Pathetici_, by Dr. _Willis_. And 3. The whole sixth Pair. Besides these three Pairs, which go entire thro' this Cleft, there is also a Passage for the upper Branch of the foremost Fibre of the fifth Pair, which the same renowned Physician calls the _Ophthalmick_ Branch. Beyond the lower-part of the said Fissure, toward the hinder-part of the Head, is to be seen {85} in the _Os Sphenoides_ on each side, a Hole that doth not penetrate the _Basis_ of the Skull, but makes a kind of _Ductus_, about an Hair's breadth long, which is open'd behind the Orbit on the top of the Space between the _Apophysis Pterygoides_, and the third Bone of the Jaw; thro' this _Ductus_ runs the lower Branch of the foremost Fibre of the fifth Pair.

About the length of two Hairs breadth beyond these _Ductus's_, we may also discover in the _Os Sphenoides_, or Wedge-like Bone, two Holes of an Oblong and almost Oval Figure, which are plac'd in the hindermost sides of that of the _Os Sphenoides_, and gives passage to the hindermost Fibre of the fifth Pair.

The Hole thro' which runs the _Auditory_ Nerve, that makes the seventh Pair, is in the middle of the hinder-part of the _Os Petrosum_, that looks toward the _Cerebellum_: This Hole being very large, is the Entrance of a _Ductus_ that is hollow'd in the _Os Petrosum_, and which sinking obliquely from the fore-part backward, for the depth of about two Hairs breadth, forms as it were the bottom of a Sack, the lowermost part whereof is terminated partly by the _Basis_ of the _Cochlea_, and partly by a Portion of the Mouth of the _Vestibulum_. At the bottom of this _Ductus_ are many Holes, but the most considerable is that of the upper-part, thro' which passeth a Portion of the Auditory Nerve. This is also the Entrance of another _Ductus_ made in the _Os Petrosum_, which is open'd between the _Apophysis Mastoides_ and _Styloides_: These other Holes afford a Passage to the Branches of the soft Portion of the same Auditory Nerve. {86}

Below this _Ductus_ there is a remarkable Hole form'd by the meeting of two hollow Cuts the larger whereof is in the Occipital Bone and the other in the lower-part of the _Apophysis Petrosi_: From the middle of the upper-part of this Hole issueth forth a small Prominence or bony Point, whereto is join'd an Appendix of the _Dura Mater_, which divides the Hole into two parts; so that thro' the foremost Orifice passeth the Nerve of the eighth Pair, and that which is call'd the _Spinal_ Nerve. We shall have occasion hereafter to shew the Use of the hinder Orifice.

Near the great Hole of the Occipital Bone from whence proceeds the _Medulla Oblongata_, we may observe a Hole almost round and oblong thro' which passeth the Nerve of the ninth Pair. This Hole is entirely situated in the Occipital Bone, and making a little Way in the Bone passeth obliquely from the back-part forward. In the inside of the Skull this Hole is sometimes double, but its two Entrances are re-united in the outward-part of the Skull; and the two Branches that form the Origine of this Nerve and which pass thro' these two Holes, are likewise re-united at their Departure, These are the Passages of the nine Pairs of Nerves that proceed from the _Medulla Oblongata_, and it remains only to show that Paths thro' which the Intercostal Nerve goes forth, as also that of the tenth Pair. The Intercostal runs out of the Skull thro' the _Ductus_ that gives Entrance to the Internal _Carotick_ Artery. As for the tenth Pair, in regard that it ariseth from the Marrow which is enclos'd between the Occipital {87} Bone and the first _Vertebra_, it goes forth thro' the Hole of the _Dura Mater_, where the Vertebral Artery enters.

To know well the Holes thro' which the Vessels that belong to the inner-part of the Head enter, and issue forth, it is requisite to distinguish them into those which are distributed to the _Dura Mater_, and those that are appointed for the Brain. The Vessels of the _Dura Mater_, are Branches of the _Carotick_ or Vertebral Arteries.

In the _Os Sphenoides_, or Wedge-like Bone, behind the Hole thro' which passeth the hindermost Fibre of the fifth Pair of Nerves lies another small Hole, almost round, that gives Entrance to a Branch of the _External Carotick_ Artery, which in entring, immediately adheres to the _Dura Mater_, and forms many Ramifications to overspread the whole Portion of this Membrane, which covers the sides, and the upper-part of the Brain.

At the bottom and top of the lateral outward part of the Orbit of the Eye, above the acute Angle, for want of the _Os Sphenoides_, there is a Hole thro' which passeth an Artery, being a Twig of a Branch of the _Internal Carotick_, which is diffus'd in the Eye, and distributed to almost the whole Portion of the _Dura Mater_, that covers the fore-part of the Brain.

The Vertebral Artery in entring into the Skull, furnisheth it on each side with a considerable Branch, which is dispers'd throughout the whole Portion of the _Dura Mater_ that covers the _Cerebellum_. {88}

As for the Veins that accompany these Arteries, they almost all go out of the Skull thro' the same Holes where the other enters.

There are four thick Arteries which convey to the Brain the Matter with which it is nourish'd, and that whereof the Spirits are form'd, _viz._ the two _Internal Caroticks_, and the two _Vertebrals._

The _Internal Carotick_ Arteries enter into the Skull thro a particular _Ductus_ made in the Temporal Bone, the Mouth thereof being of an Oval Figure and situated in the outward part of the _Basis_ of the Skull, before the Hole of the _Internal Jugular._ This _Ductus_ extends it self obliquely from the back-side forward, and after having made about three Hairs breadth in length, is terminated in the hinder-part of the _Os Sphenoides_. The Artery traverseth the whole winding Compass of this _Ductus_, which resembles the Figure of the _Roman_ Letter S, and at the Mouth of the same _Ductus_ runs under the _Dura Mater_ along the sides of the _Os Sphenoides_ to the _Anterior Apophyses Clinoides_, where it riseth up again, to perforate the _Dura Mater_, and to adhere to the Root of the Brain. These Vessels, in like manner, after their departure from the Bone of the Temples to the place where they pierce the _Dura Mater_, make a second Circuit in form of the _Roman_ Character S. At the place where these _Carotick_ Arteries penetrate the _Dura Mater_, they send forth a thick Branch, which enters into the Orbit of the Eye, by the lower-part of the Hole, thro' which the _Optick_ Nerve hath its Passage. {89}

The _Vertebral_ Arteries proceeding from the Holes of the transverse _Apophyses_ of the first _Vertebra_, turn about in passing under the upper oblique _Apophyses_ of the seven _Vertebra's_: Afterward they perforate the _Dura Mater_, and running under the Marrow, enter into the Skull thro' the Occipital Hole; then inclining one toward another, they are re-united, and form only one single Trunk.

The Veins that bring back the Blood from the Substance of the Brain, are emptied into the _Sinus's_ of the _Dura Mater_, which are all discharg'd into those that are call'd _Lateral_, which last go out of the Skull immediately under the Nerves of the eighth Pair, thro' the hinder-part of the Hole made by the meeting of the _Occipital_ Bone, and the _Apophysis Petrosa_. These Lateral _Sinus's_ fall into the _Internal Jugulars_, which are receiv'd into a considerable Sinking hollow'd on each side in the outward, part of the _Basis_ of the Skull, which is nam'd the Pit or Hole of the _Internal Jugular_.

In the upper and hinder-part of the Hole, from whence the lateral _Sinus's_ issue forth, is to be seen an opening in the Extremity of a _Ductus_, the Mouth whereof lies behind the _Condyli_, which are on the sides of the Occipital Trunk: This _Ductus_ is extended about the length of two Hairs breadth in the Bone, and the Canal enclos'd therein is open'd immediately into the _Vertebral Sinus_: So that one might affirm it to be as it were its Original Source. Whence it appears that the Blood contained in the lateral _Sinus's_ is emptied thro' two places; the greater Portion thereof descending in the _Jugulars_ {90} from the Neck, and the other in the _Vertebral Sinus's_: Sometimes those _Ductus's_ are four only on one side, another while both are stopt up, and the Blood contain'd in the lateral _Sinus's_ is discharg'd into the _Internal Jugulars_.

Behind the _Apophysis Mastoides_ on each side is a remarkable Hole, thro' which passeth a thick Vein, which brings back part of the Blood that hath been distributed to the Teguments and Muscles, which cover part of the _Occiput_ or hinder-side of the Head: This Vein is open'd into the lateral _Sinus's_ at the place where they begin to turn about. But in the Heads of some Persons, this Hole is found only on one side, and even sometimes not at all, in which case the Blood contain'd in the Vessels falls into the _External Jugulars_, with which the Branches of this Vein have a Communication.

In each _Parietal_ Bone on the side of the _Sagittal_ Suture, at a little distance from the _Lambdoidal_, appears a Hole, thro' which passeth a Vein, that brings back the Blood of the Teguments of the Head, and dischargeth it self into the upper _Longitudinal Sinus_. These Holes are sometimes on both; and then the Blood contain'd in the Branches of this Vein runs into the _External Jugulars_.

In the middle of the _Sella_ of the _Os Sphenoides_, we may observe one or two small Holes thro' which (according to the Opinion of some Modern Anatomists) the _Lympha_ contain'd in the _Glandula Pituitaria_ is thrown {91} into the _Sinus_ of the edge of the _Os Sphenoides_; nevertheless it is certain, that these Holes are fill'd only with Sanguinary Vessels, which carry and bring back the Blood of the Bones and Membranes, whereof those _Sinus's_ are compos'd; besides that, these Holes are rarely found in adult Persons.

Between the Spine of the _Coronal_ Suture and the _Crista Galli_, is a Hole which serves as an Entrance for a _Ductus_, which sinks from the top to the bottom, the length of about two Hairs breadth in the thickness of the inner Table of the _Coronal_: The Root of the upper _Longitudinal Sinus_ is strongly implanted in this Hole, which also affords a Passage to some Sanguinary Vessels appointed for the Nourishment of this inner Table.

Many other small Holes are found in divers places of the _Basis_ of the Skull; the chief whereof are those that are observ'd in the _Apophysis Petrosa_, and give Passage to a great number of Vessels that serve for the Nutriment of that part of the Temporal Bone which is call'd the _Tympanum_, or Drum: The other Holes are principally design'd for the Vessels that are serviceable in the nourishing of divers parts of the _Basis_ of the Skull.

_After what manner is the opening of the Head or Skull perform'd?_

It is done by sawing it asunder round about and above the Ears; then it is taken off, after having before cut off the Hair, and made a Crucial Incision in the Skin from the fore-part to the hinder, and from one Ear to the other; as also after having {92} pull'd off and laid down the four Corners to the bottom.

_How is the Brain anatomiz'd?_

It is done by cutting it Superficially, and by Leaves, in order to discover by little and little the Ventricles, Vessels, and Nerves, with their Original Sources, &c. Or else it is taken entire out of the Skull, (the Nerves having been before examin'd) and laid down; so that without cutting any thing, all the parts of the Brain may be set in their proper places, to find out those that are sought for.

* * * * *

{93}

A

TREATISE

OF

_Straps, Swathing-Bands, Bandages, Bolsters, Splints, Tents, Vesicatories, Setons, Cauteries, Leeches, Cupping-Glasses, and Phlebotomy._

* * * * *

CHAP. XVI.

_Of Straps, Swathing-Bands, Bandages, and Bolsters._

_What is a Strap?_

It is a kind of Band commonly made use of for the Extension of the Members in the reducing of Fractures and Luxations; or else in binding Patients, when it is necessary to confine them, for the more secure performing of some painful Operation: These sorts of Ligatures have different Names, {94} according to their several Uses, and often bear that of their Inventer.

_What is the Matter whereof these Straps are compos'd?_

They may be of divers sorts, but are usually made of Silk, Wooll, or Leather.

_What is a Swathing-Band?_

It is a long and broad Band, that serves to wrap up and contain the Parts with the Surgeons Dressings or Preparatives.

_Of what Matter are these Swathing-Bands made?_

They are made at present of Linnen-Cloth but in the time of _Hippocrates_, were made of Leather or Woollen-Stuff.

_How many sorts of Swathing-Bands are there in general?_

There are two sorts, _viz._ the Simple and Compound; the former are those that are smooth, having only two ends; and the other are those which are trimm'd with Wooll, Cotton, or Felt, or that have many Heads, that is to say, Ends, fasten'd or cut in divers places according as different Occasions require.

_What are the Conditions requisite in the Linen-Cloth, whereof the Swathing-Bands are made?_

It must be clean, and half worn out, not having any manner of Hem or Lift.

_What are the Names of the different Swathing-Bands?_

There are innumerable, but the greater part them take their Denominations from their Figure or Shape; as the Long, Streight, Triangular, and those which have many Heads, or are trimm'd. {95}

_What is A Bandage?_

It is the Application of a Swathing-Band to any Part.

_How many sorts of Bandages are there?_

As many as there are different Parts to be bound; some of them being Simple, and others Compound: The former are those that are made with an uniform Band; as the Bandage call'd the _Truss_, and divers other sorts: The Compound are those that consist of many Bands set one upon another, or sew'd together; or else those that have many Heads. They have also particular Names taken from the Inventers of them, or from their Effect; as _Expulsive_ Bandages to drive back, _Attractive_ to draw forward, _Contentive_ to contain, _Retentive_ to restrain, _Divulsive_ to remove, _Agglutinative_ to rejoin, &c.

There are others whereto certain peculiar Names are appropriated; as _Bridles_ for the lower Jaw, _Slings_ for the Chin, the back part of the Head, Shoulder, and _Perinaeum_; _Scapularies_ for the Body, after the manner of the Scapularies of Monks; _Trusses_ for Ruptures; _Stirrups_ for the Ankle-Bones of the Feet, in letting Blood, and upon other Occasions. Lastly, there are an infinite Number of Bandages, the Structure whereof is learnt by Practice, in observing the Methods of able Surgeons, who invent them daily, according to their several Manners; and the first _Ideas_ of these can only be taken in reading Authors that have treated of them.

_What are the general Conditions to be observ'd in the Bandages?_ {96}

There are many, _viz._ 1. Care must be taken that the Bands be roll'd firm, and that they be not too streight nor too loose. 2. They are to be untied from time to time in Fractures, they must also be taken away every three or four Days, to be refitted. 3. They must be neatly and conveniently roll'd, that the Patient may not be uneasie or disquieted.

_What ought to be observ'd in fitting the Bolsters?_

Care must be taken to make them even, soft, and proportionable to the bigness of the Part affected; to trimm them most in the uneven places, that the Bands may be better roll'd over them, and to keep them continually moisten'd with some Liquor proper for the Disease as well as the Bands.

_In treating of every Disease in particular, we shall shew the manner
of making the particular Bandage that is convenient for it._

* * * * *

{97}

A

TREATISE

OF

_Chirurgical Diseases_.

* * * * *

CHAP. I.

_Of Tumours in general, Abcesses or Impostumes, Breakings out, Pustules, and Tubercles._

_What is a Tumour?_

A Tumour is a rising or bloated Swelling rais'd in some part of the Body by a Setling of Humours.

_How is this setling of Humours produc'd?_

Two several ways, _viz._ by _Fluxion_ and _Congestion_.

_What is the Setling by Fluxion?_

It is that which raiseth the Tumour all at once, or in a very little space of time, by the Fluidity of the Matter. {98}

_What is the Setling by Congestion?_

It is that which produceth the Tumour by little and little, and almost insensibly, by reason of the slow Progress and thickness of the Matter.

_Which are the most dangerous Tumours, those that arise from Fluxion, or those that derive their Original from Congestion?_

They that proceed from Congestion, because their thick and gross Matter always renders 'em obstinate, and difficult to be cur'd.

_Whence do the differences of Tumours proceed?_

They are taken, _first_, from the Natural Humours, _Simple_, _Mixt_, and _Alter'd_: _Simple_, as the _Phlegmon_, which is made of Blood, and the _Erysipelas_ of Choler; _Mixt_, as the _Erysipelas Phlegmon_, which consists of Blood mingl'd with a Portion of Choler; or the _Phlegmonous Erysipelas_, which proceeds from Choler intermixt with a Portion of Blood: _Alter'd_, as the _Melia_ which is compos'd of many Humours, that can not be any longer distinguish'd by reason of their too great Alteration. _Secondly_, the difference of Tumours is taken from their likeness to some other thing, as the Carbuncle and the _Talpa_, the former resembling a burning Coal, and the other a Mole, according to the Etymology of their _Latin_ Names. _Thirdly_, From the Parts where they are situated; as the Ophthalmy in the Eye and the Quinsey in the Throat. _Fourthly_, from Disease that causeth 'em, as Venereal and Pestilential Buboes. _Fifthly_, from certain Qualities found in some, and not in others; as the _Encysted_ Tumours, which have their Matter clos'd within their proper _Cystes_ or Membranes, and so of many others. {99}

_How many kinds of Tumours are there that comprehend at once all the particular Species?_

They are four in Number, _viz._ the Natural Tumours, the Encysted, the Critical, and the Malignant.

_What are natural Tumours?_

They are those that are made of the four Humours contain'd in the Mass of the Blood, or else of many at once intermixt together.

_What are the four Humours contain'd in the Mass of the Blood?_

They are Blood, Choler, Phlegm, and Melancholy, every one whereof produceth its particular Tumour: Thus the Blood produces the _Phlegmon_, Choler the _Erysipelas_, Phlegm the _Oedema_, and Melancholy the _Scirrhus._ The Mixture of these is in like manner the Cause of the _Erysipelatous Phlegmon_, the _Oedomatous Phlegmon_ or _Phlegmonous Erysipelas_, and the _Phlegmonous Oedema_, according to the quality of the Humours which are predominant, from whence the several Tumours take their Names.

_What are the _Encysted_ Tumours?_

They are those the Matter whereof is contain'd in certain _Cystes_, or Membranous Bags; as the _Meliceris_, and the _Struma_ or Kings-Evil.

_What are Critical Tumours?_

They are those that appear all at once in acute Diseases, and terminate them with good or bad Success.

_What are Malignant Tumours?_

They are those that are always accompany'd with extraordinary and dreadful Symptoms, and whose Consequences are also very dangerous; as the Carbuncle in the Plague. {100}

_What are Impostumes or Abcesses, Breakings out and Pustules?_

Indeed, it may be affirm'd, that all these kinds of Tumours scarce differ one from another, except in their size or bigness; nevertheless, to speak properly, by the Names of Impostumes or Abcesses are understood gross Tumours that are suppurable, or may be dissolv'd, and by those of Breakings out and Pustules, only simple Pusteal Wheals, or small Tumours, that appear in great Numbers, and which frequently do not continue to Suppuration; some of them consisting of very few Humours, and others altogether of dry Matter.

_What difference is there between a Tumour and an Impostume or Abcess?_

They differ in this particular, that all Tumours are not Impostumes nor Abcesses; but there is no Impostume nor Abcess that is not a Tumour: As for Example, Wens and _Ganglions_ are Tumours, yet are not Abcesses nor Impostumes; whereas these last are always Tumours in regard that they cause Bunches and Elevations.

* * * * *

CHAP. II.

_Of the general Method to be observ'd in the curing of Tumours_.

_What ought a Surgeon chiefly to observe in Tumours, before he undertake their Cure?_

He ought to know three things, _viz._ 1. The Nature or Quality of the Tumour. 2. The {101} time of its formation and 3. Its situation: The Quality of the Tumour is to be known, because the Natural one is otherwise handl'd than that which is Encysted, Critical or Malignant. As for the time of its Formation, it is four-fold, _viz._ the Beginning, Increase, State, and Declination, wherein altogether different Remedies are to be apply'd. The Situation of the Tumour must be also observ'd, because the dressing and opening of it ought to be as exact as is possible, to avoid the meeting with an Artery or neighbouring Tendon.

_How many ways are all the Tumours that are curable, terminated?_

They are terminated after two manners, _viz._ either by dissolving 'em, or by Suppuration.

_Are not the_ Scirrhus _and the_ Esthiomenus _or Gangrene, two means that sometimes serve to terminate and cure Impostumes?_

Yes, but it is done imperfectly, in regard that a Tumour or Impostume cannot be said to be absolutely cur'd, as long as there remains any thing of the Original Malady, as it happens in the _Scirrhus_, where the Matter is harden'd by an imperfect dissolving of it, or when the Impostume degenerates into a greater and more dangerous Distemper, as it appears in the _Esthiomenus_ or Gangrene that succeeds it.

_Which is the most effectual means of curing Impostumes, that of dissolving, or that of bringing them to Suppuration?_

That of dissolving 'em is without doubt the most successful, and that which ought to be us'd as much as is possible; nevertheless some Cases are to be excepted, wherein the Tumours {102} or Abcesses are Critical and Malignant; for then the way of Suppuration is not only preferable, but must also be procur'd by all sorts of means, even by opening; which may be done upon this occasion, without waiting for their perfect Maturity.

_What are the Precautions whereto a Surgeon ought to have regard before he undertake the opening of Tumours?_

He must take care to avoid cutting the Fibres of the Muscles, and in great Abcesses, to cause all the corrupt Matter to be discharg'd at once, to prevent the Patient's falling into a Swoon.

_Ought the opening of Tumours always to be made longitudinally, and according to the direct Course of the Fibres?_

No, it is sometimes necessary to open 'em with a Crucial Incision, when they are large, or when a _Cystis_ or Membranous Vehicle is to be extirpated.

_How many sorts of Matter are there that issue forth in the Suppuration of Tumours?_

There are four sorts, _viz._ the _Pus_, _Ichor_, _Sanies_, and _Virus_.

_What is_Pus_?_

It is a thick Matter, and white as Milk.

_What is _Ichor_?_

It is a thick Matter like the _Pus_, but of divers Colours.

_What is _Sanies_?_

It is a watery Matter that riseth up in Ulcers, almost after the same manner as the Sap in Trees.

_What is _Virus_?_ {103}

It is a kind of watry Matter, being whitish, yellowish, and greenish at the same time; which issueth out of Ulcers, very much stinking, and is endu'd with corrosive and malignant Qualities.

_How many general Causes are there of Tumours?_

There are three, _viz._ the Primitive, the Antecedent, and the Conjunct: The Primitive is that which gives occasion to the Tumours; as for Example, a Fall or a Blow receiv'd. The Antecedent is that which supplies it with Matter, such is the Mass of Blood that thickens and maintains the _Phlegmon_. Lastly, the Conjunct Cause is the overflowing Blood or Matter, which immediately forms the Tumor.

_What regard ought to be had to these three sorts of Causes in the Cure?_

The Primitive Cause may be prevented by avoiding the Falls, Blows, or other Hurts, and the Antecedent by diminishing the Plethory of the Blood, and cooling the whole Mass by Phlebotomy. The Conjunct Cause, which is the overflowing of the Blood, may be also remov'd in dispersing it by dissolving, or else in discharging it by Suppuration.

_What is a _Crisis_?_

It is a sudden setling of Humours, which happens in Diseases, whereby they are usually terminated.

_How are these Critical Setlings effected?_

By the Strength of Nature, which either expels the peccant Humours thro' the Belly, or carries them to the Habitude of the Body; for in the former she causeth Fluxes of Humours, Urine and Blood; as in the other she excites Sweatings, Tumours, and even a Gangrene it self.

_In what Parts do the Critical Tumours usually arise?_ {104}

In the Glandules, which the Ancients call'd the _Emunctories_ of the Brain, Heart, and Liver; for they gave the Name of Emunctories of the Brain to the thick Glandules which lie under the Ears, that of the Emunctories of the Heart to those that are under the Arm-Pits; and that of the Emunctories of the Liver to those under the Groin. Now Malignant Tumours may arise in all these parts, but the Venereal happen only in the Groin.

* * * * *

CHAP. III.

_Of Natural Tumours._

* * * * *

ARTICLE I.

_Of the _Phlegmon_ and its Dependancies._

_What is a _Phlegmon_?_

It is a red Tumour occasion'd by the Blood diffus'd in some part, wherein it causeth extension, pain, and heat with beating.

_Are_ Aneurisms _and_ Varices, _which are Tumours, made by the Blood, to be reckon'd among the_ Phlegmons?

No, because the Blood that forms the _Aneurisms_ and _Varices_ is not extravasated nor accompany'd with Inflammation, but only a Tumour of Blood proceeding from the Dilatation of the Arteries and Veins. {105}

_May _Echymoses_ or Contusions consisting of extravasated Blood, be esteem'd as _Phlegmons_?_

By no means, in regard that it is not sufficient that the Blood be extravasated for the producing of a _Phlegmon_; it must also cause Pain, Heat, and a Beating, with Inflammation, which is not to be found in the _Echymoses_, except in great ones, after they have been neglected for a long time; where the corrupted Blood ought to be let out immediately, to prevent the Inflammation, overmuch Suppuration, and many other ill Consequences.

_Is the _Phlegmon_ always compos'd of pure Blood?_

No, it may happen sometimes to partake of Choler, Phlegm, or Melancholy; on which account it is nam'd an _Erysipelatous_, _Oedomatous_, or _Scirrhous Phlegmon_, always retaining the Name of the predominant Humour, which is the Blood; and so of the others.

REMEDIES.

_What are the Remedies proper for a _Phlegmon_?_

They are of two sorts, _viz._ General and Particular; the former having regard to the antecedent cause, and the other to the conjunct. The _Phlegmon_ is cur'd in its antecedent Cause, by Phlebotomy or letting Blood, by good Diet, and sometimes by Purgations, by which means the Plethory, Heat, and Alteration of the Blood is diminished; But Fomentations, Cataplasms and Plaisters facilitate the Cure in the conjunct cause, either by dissolving the Tumour, or bringing it to Suppuration. {106}

_At what time is the Opening of a Vein necessary?_

In the Beginning and Increase.

_What are the Remedies proper to be us'd immediately upon the first appearing of the Tumour?_

They are Resolvents and Anodynes; such as those that are prepar'd with Chervil boil'd in Whey, adding a little Saffron to wash the Tumour, and soak the Linnen Cloaths apply'd thereto, which are often renew'd, and may be laid on with the Chervil.

Or else take the Urine of a healthful Person, wherein is boil'd an Ounce of Saffron for a Glass, and bath the Tumour with it.

The Sperm of Frogs is also made use of to very good purpose, either alone, or with Lime-Water and Soap mixt together; or Oak-Leaves and Plantane beaten small, and apply'd. But Care must be more especially taken to avoid cooling Medicines, Oils, and Grease, which are pernicious in great Inflammations.

_What ought to be done in the increase of the Tumour and Pain?_

They are to be asswag'd by mollifying and dissolving; to which end a Cataplasm or Pultis is to be made with the Leaves of Elder, Wall-wort or Dwarf-Elder, Mallows, Violet-Plants, Camomile, and Melilot; whereto is added beaten Line-seed; causing the whole Mass to be boil'd in Whey, and allowing to every Pint, or thereabout, a Yolk of an Egg, twenty Grains of Saffron, a quarter of a Pound of Honey, and the Crum of white Bread, till it comes to a necessary Consistence. Or else take Cow's Dung instead of the above-mention'd {107} Herbs, and mix with it all the other Ingredients, to make a Cataplasm, which must be renew'd at least every twelve Hours.

_What is to be done in the State?_

If the Tumour cannot be dissolv'd (as was intended) it must be brought to Suppuration by Cataplasms, consisting of these Ingredients, _viz._ Garlick, White Lillies roasted under Embers, Milk, and _Unguentum Basilicon_.

Or else only take a Glass of Milk, in which an Ounce of Soap is dissolv'd, to wet the Linnen apply'd to the Tumour; and let it be often reiterated: Otherwise make use of Sorrel boil'd with fresh Butter, and a little Leaven or Yeast. The Plaister _Diasulphuris_ is also most excellent either alone, or, if you please, mixt with _Diachylon_ and _Basilicon_.

_What is to be done in the Declination after the Suppuration?_

The Ulcer must be at first gently dry'd with a Plaister of _Diasulphuris_ or _Diachylon_, and afterward that of _Diapalma_ may be us'd, and Ceruse or White Lead.

_What Method is to be observ'd in case there be any Disposition toward a Gangrene?_

It is requisite during the great Inflammation to make use of good Vinegar, in an Ounce whereof is dissolv'd a Dram of White Vitriol, with as much _Sal Ammoniack_, to bath the Tumour: Or else take the Tincture of Myrrh and Aloes, with a little _Unguentum Aegyptiacum_, and afterward make a Digestive of Turpentine, the Yolk of an Egg, and Honey, mingling it with a little Spirit of Wine, or Brandy, if there remains any Putrifaction or Rottenness. {108}

_Remedies for _Aneurisms_ and _Varices_._

_What is to be done in order to cure an _Aneurism_?_

When it is little, as that which happens after an Operation of Phlebotomy or letting Blood ill perform'd, it may be sufficient to lay upon the affected Part a thin Plate of Lead, or else a Piece of Money or Counter wrapt up in a Bolster, and to bind it on very streight: But a Piece of Paper chew'd is much better for that purpose.

If the _Anuerism_ be considerable, an Astringent Plaister may be us'd, such as the following.

Take _Bolus_, Dragon's Blood, Frankincence, Aloes, and _Hypocystis_, of each a Dram; mingle the whole with two beaten Eggs, and add Wax to give it the consistence of a Plaister, which may be apply'd alone, or mixt with an equal Portion of _Emplastrum contra Rupturam_, always making a small Bandage to keep it on. _Emplastrum de Cicuta_ hath also a wonderful effect.

When the _Aneurism_ is excessive, it is absolutely necessary to proceed to a Manual Operation, the manner whereof shall be shewn hereafter in the Treatise of great Operations.

_What is requisite to be done in the _Varices_?_

_Varices_ are not generally dangerous, but even conduce to the preservation of Health; nevertheless, if they become troublesome by reason of their greatness, and the Pains that accompanie 'em, they may be mollify'd with the following Remedy.

Take the Mucilages of the Seeds of _Psyllium_ and Line, of each two Ounces; of _Populeon_ {109} two Ounces; _Oleum Lumbricorum_ & _Hyperici_, of each one Ounce; and of the Meal of Wheat one Ounce, adding Wax to make the Consistence of a Plaister; part of which spread upon Linnen or Leather, must be apply'd to the _Varix_, and ty'd thereto with a small Band.

If the Blood abound too much, it may be discharg'd by the Application of Leeches, or by a Puncture made with a Lancet: Afterward lay upon the Part a Piece of Lead sow'd up in a Cloth, and let it be kept close with a proper Bandage. Otherwise you may make use of an Astringent, such as this.

Take a Pomegranate, cut it in pieces, and boil it with as much Salt as may be taken up with the Tip of your Fingers, in a Gallon of strong Vinegar; then dip a Spunge in this Vinegar, apply it to the _Varix_, bind it on, and continue the use of it twice a Day for a Month together.

_Remedies for _Echymoses_, Contusions, or Bruises._

_How are _Echymoses_ to be treated?_

All possible means must be us'd to dissolve 'em, by laying Slices of Beef upon the Part, renewing 'em very often, or applying Linnen Rags dipt in Spirit of Wine impregnated with Saffron.

They may be also dissolv'd with the Roots of Briony grated and apply'd thereto, or else with Plaister or Mortar, Soot, Oil of Olives and _Unguentum Divinum_, a Mixture whereof being made, is to be put between two Rags, and laid upon the Tumour or Swelling. {110}

If the _Echymosis_ happens in a Nervous Part, Balsam of _Peru_ may be us'd, or, for want thereof, _Oleum Lumbricorum_ & _Hyperici_, with luke-warm Wine, with which the Bolsters must be soak'd, to be laid upon it.

When the _Echymosis_ is great, and much Blood is diffus'd between the Skin and the Flesh, the safest way is to make an Opening to let it out, lest a too plentiful and dangerous Suppuration should ensue, or even a Gangrene it self. However, a Surgeon ought to proceed in the curing of an _Echymosis_ in the Face with great Circumspection, which must be always prepar'd for Incision.

_Of phlegmonous Tumors or Impostumes, and of Remedies proper for 'em._

_What are the Tumours or Impostumes that partake of a _Phlegmon_?_

They are the _Bubo_, Carbuncle, _Anthrax_, _Furunculus_, _Phyma_, _Phygeton_, _Panaritium_ or _Paronychia_, Burn, Gangrene, and Kibe or Chilblain.

_What is a _Bubo_?_

A _Bubo_ is a Tumour which ariseth in the Groin, being accompany'd with Heat, Pain, Hardness, and sometimes a Feaver.

_What is a Carbuncle?_

A Carbuncle is a hard Swelling, red, burning, and inseparable from a Fever: It is cover'd with a black Crust or Scab, that afterward falls off at the Suppuration, leaving a deep and dangerous Ulcer, and which sometimes doth not suppurate at all. {111}

_What is an _Anthrax_?_