Part 50

5, And lastly, if all these Attempts are fruitless, the Operation must be resolved on, without losing a Moment's Time; as this local Disease proves sometimes mortal in the Space of two Days; but for this Operation an excellent Surgeon is indispensably necessary. The happy Consequence with which I have ordered it, in a most desperate Case since the first Edition of this Work, on the sixth Day after a Labour, has convinced me, still more than any former Observation I had made, that the Trial of it ought never to be omitted, when other Attempts have been unavailing. It cannot even hasten the Patient's Death, which must be inevitable without it, but it rather renders that more gentle, where it might fail to prevent it. When it is performed as Mr. Levade effected it, in the Case I have just referred to, the Pain attending it is very tolerable and soon over.

I shall not attempt to describe the Operation, as I could not explain myself sufficiently to instruct an ignorant Surgeon in it; and an excellent and experienced one must be sufficiently apprized of all I could say concerning it.

A certain Woman in this Place, but now dead, had the great and impudent Temerity to attempt this Operation, and killed her Patients after the most excruciating Torments, and an Extirpation, or cutting away of the Testicle; which Quacks and ignorant Surgeons always do, but which a good Surgeon never does in this Operation. This is often the Custom too (in Country Places) of those Caitiffs, who perform this Operation without the least Necessity; and mercilessly emasculate a Multitude of Infants; whom Nature, if left to her own Conduct, or assisted only by a simple Bandage, would have perfectly cured; instead of which, they absolutely kill a great many, and deprive those of their Virility, who survive their Robbery and Violence. It were religiously to be wished such Caitiffs were to be duly, that is, severely punished; and it cannot be too much inculcated into the People, that this Operation (termed the Bubonocele) in the Manner it is performed by the best Surgeons, is not necessary; except in the Symptoms and Circumstances I have mentioned, and that the cutting off the Testicle never is so.

Of Phlegmons or Boils.

Sec. 480. Every Person knows what Boils are at Sight, which are considerably painful when large, highly inflamed, or so situated as to incommode the Motions, or different Positions of the Body. Whenever their Inflammation is very considerable; when there are a great many of them at once, and they prevent the Patients from sleeping, it becomes necessary to enter them into a cooling Regimen; to throw up some opening Glysters; and to make them drink plentifully of the Ptisan, No. 2. Sometimes it is also necessary to bleed the Patient.

Should the Inflammation be very high indeed, a Pultice of Bread and Milk, or of Sorrel a little boiled and bruised, must be applied to it. But if the Inflammation is only moderate, a Mucilage Plaister, or one of the simple Diachylon, may be sufficient. Diachylon with the Gums is more active and efficacious; but it so greatly augments the Pain of some Persons afflicted with Boils, that they cannot bear it.

Boils, which often return, signify some Fault in the Temperament, and frequently one so considerable, that might dispose a Physician to be so far apprehensive of its Consequences, as to enquire into the Cause, and to attempt the Extinction of it. But the Detail of this is no Part nor Purpose of the present Work.

Sec. 481. The Phlegmon, or Boil, commonly terminates in Suppuration, but a Suppuration of a singular Kind. It breaks open at first on its Top, or the most pointed Part, when some Drops of a Pus like that of an Abscess comes out, after which the Germ, or what is called the Core of it may be discerned. This is a purulent Matter or Substance, but so thick and tenacious, that it appears like a solid Body; which may be drawn out entirely in the Shape of a small Cylinder, like the Pith of Elder, to the Length of some Lines of an Inch; sometimes to the Length of a full Inch, and even more. The Emission of this Core is commonly followed by the Discharge of a certain Quantity, according to the Size of the Tumour, of liquid Matter, spread throughout the Bottom of it. As soon as ever this Discharge is made, the Pain goes entirely off; and the Swelling disappears at the End of a few Days, by continuing to apply the simple Diachylon, or the Ointment No. 66.

Of Fellons or Whitlows.

Sec. 482. The Danger of these small Tumours is much greater than is generally supposed. It is an Inflammation at the Extremity or End of a Finger, which is often the Effect of a small Quantity of Humour extravasated, or stagnant, in that Part; whether this has happened in Consequence of a Bruise, a Sting, or a Bite. At other times it is evident that it has resulted from no external Cause, but is the Effect of some inward one.

It is distinguished into many Kinds, according to the Place in which the Inflammation begins; but the essential Nature of the Malady is always the same, and requires the same Sort of Remedies. Hence such as are neither Physicians nor Surgeons, may spare themselves the Trouble of enquiring into the Divisions of this Distemper; which, though they vary the Danger of it, and diversify the Manner of the Surgeons Operation, yet have no Relation to the general Treatment of it; the Power and Activity of which must be regulated by the Violence of the Symptoms.

Sec. 483. This Disorder begins with a slow heavy Pain, attended by a slight Pulsation, without Swelling, without Redness, and without Heat; but in a little Time the Pain, Heat, and Pulsation or Throbbing becomes intolerable. The Part grows very large and red; the adjoining Fingers and the whole Hand swelling up. In some Cases a Kind of red and inflated Fuse or Streak may be observed, which, beginning at the affected Part, is continued almost to the Elbow; neither is it unusual for the Patients to complain of a very sharp Pain under the Shoulder; and sometimes the whole Arm is excessively inflamed and swelled. The Sick have not a Wink of Sleep, the Fever and other Symptoms quickly increasing. If the Distemper rises to a violent Degree indeed, a Delirium and Convulsions supervene.

This Inflammation of the Finger determines, either in Suppuration, or in a Gangrene. When the last of these occurs, the Patient is in very great Danger, if he is not very speedily relieved; and it has proved necessary more than once to cut off the Arm, for the Preservation of his Life. When Suppuration is effected, if the Matter lies very deep and sharp, or if the Assistance of a Surgeon has arrived too late, the Bone of the last Phalanx, or Row of Bones of the Finger, is generally carious and lost. But how gentle soever the Complaint has been, the Nail is very generally separated and falls off.

Sec. 484. The internal Treatment in Whitlows, is the same with that in other inflammatory Distempers. The Patient must enter upon a Regimen more or less strict, in Proportion to the Degree of the Fever; and if this runs very high, and the Inflammation be very considerable, there may be a Necessity for several Bleedings.

The external Treatment consists in allaying the Inflammation; in softening the Skin; and in procuring a Discharge of the Matter, as soon as it is formed. For this Purpose,

1, The Finger affected is to be plunged, as soon as the Disorder is manifest, in Water a little more than warm: the Steam of boiling Water may also by admitted into it; and by doing these Things almost constantly for the first Day, a total Dissipation of the Malady has often been obtained. But unhappily it has been generally supposed, that such slight Attacks could have but very slight Consequences, whence they have been neglected until the Disorder has greatly advanced; in which State Suppuration becomes absolutely necessary.

2, This Suppuration therefore may be forwarded, by continually involving the Finger, as it were, in a Decoction of Mallow Flowers boiled in Milk, or with a Cataplasm of Bread and Milk. This may be rendered still more active and ripening, by adding a few white Lilly Roots, or a little Honey. But this last must not be applied before the Inflammation is somewhat abated, and Suppuration begins; before which Term, all sharp Applications are very dangerous. At this Time, Yeast or Leaven may be advantagiously used, which powerfully promotes Suppuration. The Sorrel Pultice, mentioned Sec. 480, is also a very efficacious one.

Sec. 485. A speedy Discharge of the ripe Matter is of considerable Importance, but this particularly requires the Attention of the Surgeon; as it is not proper to wait till the Tumour breaks and discharges of itself; and this the rather, as from the Skin's proving sometimes extremely hard, the Matter might be inwardly effused between the Muscles, and upon their Membranes, before it could penetrate through the Skin. For this Reason, as soon as Matter is suspected to be formed, a Surgeon should be called in, to determine exactly on the Time, when an Opening should be made; which had better be performed a little too soon than too late; and a little too deep, than not deep enough.

When the Orifice has been made, and the Discharge is effected, it is to be dressed up with the Plaister No. 66, spread upon Linen, or with the Cerecloth; and these Dressings are to be repeated daily.

Sec. 486. When the Whitlow is caused by a Humour extravasated very near the Nail, an expert Surgeon speedily checks its Progress, and cures it effectually by an Incision which lets out the Humour. Yet, notwithstanding this Operation is in no wise difficult, all Surgeons are not qualified to perform it, and but too many have no Idea at all of it.

Sec. 487. Fungous, or, as it is commonly called, proud Flesh sometimes appears during the incarning or healing of the Incision. Such may be kept down with sprinkling a little Minium (red Lead) or burnt Alum over it.

Sec. 488. If a Caries, a Rottenness of the Bone, should be a Consequence, there is a Necessity for a Surgeon's Attendance, as much as if there was a Gangrene; for which Reason, I shall add nothing with Respect to either of these Symptoms; only observing, there are three very essential Remedies against the last; viz. the Bark, No. 14, a Drachm of which must be taken every two Hours; Scarifications throughout the whole gangrened Part; and Fomentations with a Decoction of the Bark, and the Addition of Spirit of Sulphur. This Medicine is certainly no cheap one; but a Decoction of other bitter Plants, with the Addition of Spirit of Salt, may sometimes do instead of it. And here I take leave to insist again upon it, that in most Cases of gangrened Limbs, it is judicious not to proceed to an Amputation of the mortified Part, till the Gangrene stops, which may be known by a very perceivable Circle, (and easily distinguished by the most ignorant Persons) that marks the Bounds of the Gangrene, and separates the living from the mortified Parts.

Of Thorns, Splinters, or other pointed Substances piercing into the Skin, or Flesh.

Sec. 489. It is very common for the Hands, Feet or Legs, to be pierced by the forcible Intrusion of small pointed Substances, such as Thorns or Prickles, whether of Roses, Thistles or Chestnuts, or little Splinters of Wood, Bone, &c.

If such Substances are immediately and entirely extracted, the Accident is generally attended with no bad Consequences; though more certainly to obviate any such, Compresses of Linen dipt in warm Water may be applied to the Part, or it may be kept a little while in a warm Bath. But if any such pointed penetrating Body cannot be directly extracted, or if a Part of it be left within, it causes an Inflammation, which, in its Progress, soon produces the same Symptoms as a Whitlow: or if it happens in the Leg, it inflames and forms a considerable Abscess there.

Sec. 490. To prevent such Consequences, if the penetrating Substance is still near the Surface, and an expert Surgeon is at Hand, he must immediately make a small Incision, and thence extract it. But if the Inflammation were already formed, this would be useless, and even dangerous.

When the Incision, therefore, is improper; there should be applied to the affected Part, (after conveying the Steam of some hot Water into it) either some very emollient Pultices of the Crumb of Bread, Milk and Oil, or some very emollient unctuous Matter alone, the Fat of a Hare being generally employed in such Cases, and being indeed very effectual to relax and supple the Skin; and, by thus diminishing its Resistance, to afford the offensive penetrating Body an Opportunity of springing forth. Nothing however, but the grossest Prejudice, could make any one imagine, that this Fat attracted the Splinter, Thorn, or any other intruded Substance by any sympathetic Virtue; no other Sympathy in Nature being clearly demonstrated, except that very common one between wrong Heads, and absurd extravagant Opinions.

These Creatures perhaps are fatter in Swisserland, than we often see them here. K.