Part 2

Friar _Theodore Chalk_’s Chirurgical Receipts, on Vellum. Dedicated to Archbishop _Valentine_.

Here beginnen gud Medicenes for all Yevels yat any man may have yat gud Leches have drawn out of ye Bokes yet Galien Aschipeus Ypocras hadden. For yai were the best Leches yat were in ye World. On Vellum, in my Possession.

I proceed now to give an Account of some of our early Writers, besides those already mentioned. And first of _Maugantius_, who was by Birth a _Briton_, a famous Physician and Mathematician; who, says _Leland_, for his eminent Learning, was made President of a noble College (in those Days) of two hundred Philosophers; which _Geofrey_ of _Monmouth_ extols to the Skies, under the Name of _Legionum Urbs_; which _Bale_ supposes to be _Chester_, excelling all other _British_ Cities, at that Time, in Wealth and _Roman_ Structures. This Place being most pleasantly situated, Astrologers, and other Artists, settled in it to observe the Motions of the Stars, and undertook to forewarn Mankind from the Comets, and certain Indications of the Planets, what should come to pass. Hence _Maugantius_, said to be superior to all others in this Art, being questioned by King _Vortiger_, whose chief Physician he was, about the prodigious Conception of _Ambrose Merlin_, after a Recital of various Philosophical Reasons, did, at length, it seems, give him Satisfaction therein. This Person, who was the most renowned Scholar of his Country, and who is said to have composed several Books, flourished in the Year of Christ 470, when King _Vortiger_ was much distressed by the invading _Anglo-Saxons_. I have before observed, that there were several Dignitaries of the Papal Communion as well as those of inferior Orders, besides the _Monks_, who very early took upon them to practise Physic; and that they were absolutely forbid to exercise that Profession, by the _Roman_ Assembly, in 1139. Of this Sort was _Frabricius_, or _Faricius_, as he is sometimes written, who practised Physic not long before this Time. He was the eighteenth Abbot of the Monastery of _Abington_ in _Berkshire_; to whose Care _Godfrey de Vere_ committed himself, to be cured of a grievous Disease he then laboured under; and, as an Acknowledgment for the Care the Abbot had taken of him, he bequeathed to the Abbey before-mentioned, the Church belonging to his Estate, in the Village of _Kensington_, near _London_, with 240 Acres of Land, _&c._ which was confirmed by the King; a Copy of which Grant will be given in the Antiquities of that Town, and the History of it’s Abbey. This Abbot departed this Life the VIIth of the Calends of _March_, _Anno_ 1117. Soon after him flourished _Athelardus_, a Monk of _Bath_, who was so diligent in searching out the Mysteries and Causes of Natural Things, that he deserves to be equalled with some of the ancient Philosophers. Having a very promising Genius, while very young, and continuing, as he grew up, to improve his Parts, and fit himself for great Affairs, he left his native Soil, and, with much Alacrity, went to visit foreign Parts. In his Travels through _Egypt_ and _Arabia_, having found many Things he sought after, he came Home again with good Fruit of his Labours and Improvement of his Learning. He was, without Dispute, in Philosophy, Astronomy, Physic, Mathematics, and Rhetoric, no ordinary Proficient. Some of his Works he Dedicated to _Richard_, Bishop of _Bayeux_: In the first Work he treats of the Principles, Qualities, and Effects of Natural Things, against the vain Opinions of the old Philosophers. In the Preface it appears, he wrote in the Year 1130, under the Reign of _Henry_ I. I might here enlarge upon the great Fame and Merits of _John Giles_, a Native of St _Albans_, who made such Progress in the Study of Physic, that he was made Professor of that Faculty at _Paris_ and _Montpelier_, and Physician to _Philip_, King of _France_. After his Return to his own Country, he was, according to _Matthew Paris_, consulted by _Robert Grosthead_, the learned Bishop of _Lincoln_, in his last Illness; of which he died in 1253. He has written, _De re Medica_, and _de Prognosticis_, and some other Things. He flourished about the Year 1230, in the Reign of King _Henry_ III. _Hugh de Eversham_, deserves in this Place to be remembred, who was a Man of great Learning, a Physician by Profession, and perhaps the best of his Age. He was well known in many Countries, being a great Frequenter of the Universities. With the severer Studies of his Art, he mingled the pleasant Science of the Mathematics, and particularly Geometry and Astronomy. This made him known to many in _France_ and _Italy_, and among the rest, to Pope _Martin_ IV, who invited him, by Letters, to come to him, and solve some Questions in Physic, which were then newly started: Accordingly he went without Delay, and performed what was required readily and learnedly. He published _Super Opere Febrium Isaac_. _Medicinales Canones_. _Problemata quædam_, and some other Things. He flourished the Year 1281; when he was created Cardinal Presbyter of St _Laurence_, by the said Pope _Martin_, in the Reign of _Edward_ I. He is said to have died by Poison at _Rome_, _Anno_ 1287; although _Cicæonius_, to palliate this Matter, says he died of the Plague.

_Chirurgical Remarks_

ON

A WOUND of the HEAD

RECEIVED

By a CHILD from the Blow of a Cat-Stick in throwing at a COCK on Shrove Tuesday, 1709.

Addressed to

Mr _WILLIAM COWPER_, Surgeon.

_SIR_,

I do not question but you have had the Curiosity to read over a very _remarkable Case in Surgery_, not only upon Account of the Recommendation the Name of the Author[2] gives it, but partly because I know you have been for a long time of opinion, That this Age wou’d distinguish it self by the Advances that _Medicine_ has, and will receive; I need not observe, to a Man of your Capacity, how just, according to my Opinion, our Author has been in relating all the Particulars of the Case he gives us the History of: Nor need I intimate to you how peculiarly the Prescriptions were adapted to the several alterations that were observable in that little Patient: I will only take the freedom to make some Remarks on a considerable Circumstance, which perhaps we shall find obstructed so methodical a Procedure, in order for a Cure.

[2] This CASE was published by Mr _Daniel Turner_, Surgeon.

Our Author is of opinion, _That his Death was owing to the effused Blood from some Vessel upon the_ Pia Mater, _which had been ruptured by the Concussion or Shock of the said Vessel, from the Force of the Blow; which Blood pent in (for want of a Discharge) had formed an Abscess, thereby deluging the Surface of the Brain with Matter: And this, tho’ continually draining off thro’ the Orifice in the upper Membrane, yet some part thereof lying beyond the Elastic Power of the said Membrane to raise up, and out of the Reach of Medicine to deterge and mundifie, was at length imbibed by the Vessels, where missing the Salutary Crisis, sometimes observed in the Empieme and Pleuritic Cases, it was conveyed by the Circulation to the Heart, and at length, we are to suppose, somehow effected the Nervous System, bringing on the fatal Spasm._

Thus you see, _Sir_, how plain and consequential the Account of the Child’s Death is; but even here, I hope, I shall do no Injustice to the Author, if I inform you, I cannot perswade my self that the Matter was imbibed by the Vessels, purely because _some part thereof lay beyond the Elastic Power of the_ Dura Mater _to raise up, and out of the Reach of Medicine to deterge and mundifie_, as our Author’s Words are; but that it is reasonable to believe, that some part of it was reassumed by the Vessels, when it could no longer discharge it self as before; for if you will give your self the trouble of looking back to the 32d Page, you will find, that no sooner was the _Orifice choaked up by a caked Matter_, but the mischievous Effects of the Suppression of the Discharge soon began to discover themselves by the Rigours the Child was attended with; and we find our Author soon after fearful of such a thing.

By this we may see how circumspect we ought always to be, lest we interrupt the Design of Nature when she is about to expel any morbifick Matter, the ill Effects that attend it oftentimes discovering themselves after different Manners; We look upon a continued Discharge of Matter to be, as it were, a natural Evacuation, and that it’s immediate Stoppage, without other Means, being made use of to divert and evacuate it, to be succeeded by a greater Fulness and Distention of all the Vessels, as is observable upon the Suppression of the _Menses_, _Hemorrhoides_, or _insensible Transpiration_, there is this Difference to be observed that the ill Accidents that attend the Stoppage of the Discharge of Matter are not so much owing to the Distention and Plenitude of the Vessels, but according to the ill Quality of it, ’tis disposed to render the Patient feverish more or less, which is generally ushered in by Rigours, and sometimes succeeded by Spasmodic Contractions.

For a further Illustration of this, we will take the liberty to relate the Case of a Man of about Forty Years of Age, who was for a considerable time incommoded in his Business, by reason of a violent Contusion he had received on the Upper-part of his Left Arm, a little below the Shoulder: After some time it was succeeded by an Apostemation, upon the opening of which I was informed, a considerable Quantity of Matter discharged, which was not of any ill Colour or Smell, the Matter continuing to make its Exit the same way for several Weeks, at length formed a _Sinus_, which might be easily traced to the Upper and Fore-part of the _Os Humeri_. The external Orifice of this was endeavoured to be dilated, but it not only put the Patient to a great deal of Pain, but pent in the Matter, and caused the contiguous Parts to tumifie very much. About this time the Axillary Glands began to swell and pain him, and by their Pressure on the Limphaticks the whole Arm became Oedematous; soon after some part of the Matter made it’s way out under the Arm, upon which it almost ceased to flow from the _Sinus_ on the upper-part of it. In short, upon this the Patient found himself very much indisposed, he lost his Appetite, was attended with Shiverings, became feverish, and at length died violently convulsed.

On Dissection we found the Surface of the Lungs to be interspersed with blackish Specks, the left Lobe adhered to the _Pleura_, and the _Pericordium_ contained a much greater Quantity of Liquor than usual, though its Colour was natural. The Right Auricle and Ventricle of the Heart were very much distended, and the Diameter of the _Arteria Pulmonaris_ considerably enlarged: on the Division of the Integuments of the Abdomen, a very large Quantity of yellowish fœtid Matter discharged it self, which was somewhat viscid; we found that the Intestines floated in this, for the Abdomen was full of it. In the lower-part of the Concave Side of the Liver there was a very large Abscess discovered, which contained a Fluid of the same Colour and Consistence with that which we took notice of before. There was an Orifice in the lower part of the Abscess capable of admitting the End of one’s Finger; by which, without doubt, Matter discharged it self into the Abdomen. The Spleen was of a very odd Figure: On it’s convex Side there were a Multitude of Streaks, that proceeded from all Parts of it, and centered in one Point, which proceeded only from the Disposition of the Fibres of it’s internal Membrane. It was almost full of Blood, which in the middle was corrupted, and stank abominably. After it was cleared from the contiguous Parts to which it adhered, and taken out of the Body, it weighed four Pounds and a half.

There might have been something more observable upon the Dissection of this Body, but the short time that was allotted for it did not give us an Opportunity of making that strict Enquiry as seemed to be necessary. _Blancard_. in his _Anat. Pract. Rationalis_, _p. 252_. has much such an Observation as this which we have related. See likewise _Schenckius_, _Lib._ 3. _Obs_ 26. But I do not doubt, _Sir_, but you have made some curious Remarks on Cases of this Nature, tho’ I am pretty positive you will agree with me in this, That the immediate Cause of the Death of the Person we have been speaking of, was the giving a sudden Check to the Discharge of the Matter. It was the Work of Nature in this Case (and what she was endeavouring to perform) to disburden herself of those disproportionate and offensive Particles, which by their Continuance in the Body would but have occasioned an irregular Motion of the Fluids, and consequently a Discomposure of it’s whole Frame: For the animal Body being nothing else but a Congeries of Canals, filled with different Liquors, it must necessarily suffer very much, and it’s Actions be irregular, if any Heterogeneous Particles become incorporated therewith. We must here allow, that in Discharges of Matter of a long Continuance, sometimes the Diameters of the Fibres and Vessels may be so much enlarged, that the nutritious Juices may be thrown out with the other, and so occasion a general Emaciation: But this may be easily rectified at the Beginning, without Detriment to the Patient, by making use of some spirituous and moderately astringent Remedies, to recover the natural Tone of the too lax Fibres and Vessels, and give the Matter a proper Consistence. It is to be observed in such Cases as these are, that the Part from whence the Matter discharges, if it be the Leg or Thigh, first loses it’s former Fulness and Dimensions, tho’ soon after there appears an Emaciation of the whole Body. Such an Abscess as we discovered in the Liver of the Person before mentioned, we are inclined to believe might have been found in the Child, had the Abdomen been dissected; for several Authors have assured us, it has frequently been observed to be the Consequent of Fractures of the Skull, tho’ I am apt to believe it never happens, but when the Matter has received a Check in it’s Discharge.

I shall now take the Liberty to observe, that the imprudent Application of Repellents to some Tumours, and inconsiderate Healing of old Ulcers, with the unhappy Method of Procedure, in order to the Cure of some Diseases, very often discover themselves, by their being succeeded by very ill Effects. _Non tamen in omnibus Huxionibus repellentia adhibere licet,_ (says _Sennertus_) _Partibus ignobilibus, præcipue iis, ad quas natura interdum humores protrudere solet, ut sunt Glandulæ post aures, & in collo, sub axillis, in inguinibus adhibenda non sunt, ne humor ex iis repulsus ad partes principes & nobiles feratur._

The same Author informs us in his _Paralipom._ _ad lib._ 5. _Pract. Med._ of a Boy, fourteen Years of Age, that died upon the Accession of an Epileptic Fit, which was caused by the striking in of the Scab by the imprudent Use of Liniments. And _Baglivi_ allows, that the irregular Cure of the same Disease may be succeeded by a Spitting of Blood, an Apoplexy, Dropsy, lingering Fevers, _&c._ The Healing of old Ulcers, without having a Respect to those Circumstances that ought to precede such an Undertaking, generally lays the Foundation for a Train of mischievous Accidents; for the Patient soon begins to be sensible of an Unactiveness of the whole Body, is sleepy, has a weak Digestion, Head-ach, and is feverish, which is attended with very profuse Night-Sweats; and these we have several times observed to be the Forerunners of the Patient’s Death, though sometimes all these ill Accidents may be prevented by an Imposthumation in some part of the Body or other.

Now to account for such remarkable Alterations, in such Subjects, we are obliged to take notice, that here is the Suppression of the Evacuation of a Humour, that had been constantly discharged for a long time; and this, we have before observed, will cause a greater Fulness and Distention of all the Vessels. Now the Quantity of the Blood being very much encreased by the Addition of this viscid Juice, the Celerity of its Motion must be considerably abated, upon which Account it will enlarge the Diameters of the Vessels, by relaxing their Coats, and pass with so great a Difficulty through the Capillary Vessels, that if it arrive at any Part where the Fibres have lost their due Tensity and Spring, it is disposed to stagnate, and produce an Imposthumation. If this does not happen, as the Motion of the Blood continues to be very languid, the Quantity of Spirits filtrated in the Brain will be less upon two Accounts: _First_, Because as the Blood moves more slowly, all the Parts of the Body through which it circulates, will receive a much less Quantity of it in a given Time, than they must have done, had it moved with a greater Celerity. _Secondly_, The Viscidity of the Blood, together with it’s Motion diminished will lessen the Quantity of Spirits, according to the 20th and 22d of Dr _Wainright_’s Propositions of Animal Secretion.

Now this being so, it is no wonder to observe such an Inactivity of the Parts, Sleepiness, weak Digestion, _&c._ to attend a Person under such Circumstances: For the Quantity of Spirits being so much diminished, the Parts can never be sufficiently influenced by them to perform their respective Functions with that Force as usual. To this we may add, that they are in a great measure deprived of their Power and Spring, and Sensation in general is not near so strong and lively. From hence it is evident, that when Nature has found a Passage whereby she may disburden herself of any excrementitious Humours, we ought for a considerable time to give proper Internals, and make use of some other Method, as by Issues, or such like, whereby we may divert the Course of the Matter, which, if I may so say, has been so long together determined to pass the same way. Beside this Advantage which will accrue by that Method, there may be near the same Quantity of Humours evacuated; and so those unhappy Accidents, will be prevented, and the Ulcer cured.

I am perswaded, that it is not without a great deal of Difficulty that we can sometimes divert the Tendency of Humours to a Part; and I can bring several Instances of Sores that have been healed, where the suppressed Matter has discovered it self, by an Aposthume near the Place where the Sore was, a short time after it had been healed.

_Fælix Wurtz_, who was a very judicious Surgeon, informs us, That it sometimes happens, that in a little time after a Patient has been cured of a Wound of the Head, he feels violent Pains there, which indicates that Matter is collected in the Part. He adds, That many die of it, by reason the Cause is not understood by some Surgeons. This Remark proves, that the Wounds were not kept open long enough, or else that the Surgeon acted imprudently in not making use of proper Means to divert the Tendency of the Humours to that Part; not but it will abundantly more easily happen to those Parts that are depending, and where the Weight of the viscid Fluid will incline it to settle.

I knew a lusty Fellow, about twenty five Years of Age, that had an Ulcer on the internal Ancle of his left Leg near twelve Years: It had been cured three or four times, but he always found himself very much indisposed after it, till it broke out again, and the Matter had a free Discharge: At length, upon his coming from Sea, it was healed again, upon which he was seized with a violent Pain in his Head, Loss of Appetite, which the next Day was succeeded by a violent Fever and Looseness. His Physician ordered, among other Things, a large Blister-Plaister, to be applyed to the Leg on which the Ulcer had been. The Patient recovered; but what was very observable, was, that the Sore the Blister-Plaister had made terminated in an ugly Ulcer, which would not heal, though various Applications were made use of. If Nature had been in this Case compelled, as it were, and forced to a Compliance in the healing of this Ulcer, it is probable the Matter would have been thrown upon another Part, and so occasioned a Disease there.

By this we may see how cautious we ought to be not to proceed in a Method contrary to the Dictates of Nature; for if we do, we consequently disturb her regular Motions, upon which she oftentimes commences a new Work, which, if it does not tend to the Subversion of the whole Oeconomy, there ensues a Permutation of the Disease, by the Translation of the Matter from one Part to another.

It would be impossible to recount all the obscure Motions Nature makes use of to accomplish such Ends: We will only mention some where the Disease has been perfectly changed from what it was before by such Methods. _Mear_ gives us an Instance of a Dropsie of the Breast, which succeeded an ill-cured Hydrocele. _Hildanus_ observes, that an inveterate Ulcer of the left Leg being unhappily healed up, the Patient died of a Pleurisy some Months after.

To this I may add an Observation of a Man that had an old Ulcer on each Leg, which being attempted to be cured, as the Matter gradually lessened, he was deprived of his Sight. There was no Alteration to be observed in the Eyes of this Person, but only a Dilatation of the Pupils, as is generally observed in a _Gutta Serena_, which was judged to be his Case. In short, upon the running of the Sores, though he had been perfectly blind, he effectually recovered his Sight again.

I will not tire you, _Sir_, with the Recital of any more Cases of this Nature. What has been hitherto said, I hope is sufficient to incline you to believe, that the immediate Cause of the Death of the Child I spoke of in the former part of the Letter was the Suppression of the Matter, which had continued to discharge in such large Quantities so long together. And that such a sudden Stoppage of a Discharge of Matter may procure a Patient’s Death, though the Symptoms that proceed may be different. I have likewise shewn the Difficulty there is in Diverting the Tendency of the Matter to a Part, and mentioned how one Disease is sometimes converted into another: But of what Use these Remarks may be I leave you to judge. To me it seems reasonable enough to suppose, that as a regular Method of Practice is not the Effect of a Man’s Sagacity, but the Product of repeated Experiences, every thing that occurs may tend, by a proper Application, to the Illustration of the Art. What else has made some Men so famous for their Prognosticks? Had not our great Master _Hippocrates_ a Respect to the Suppression of the Discharge of Matter from Ulcers, when he expressed himself thus, _Ulcus lividum & siccum, aut cum virore pallidum lethale est?_ And this we have known to be true in several Cases.

Well then, does not this sufficiently prove, that where we have Cause to fear a Suppression of the Discharge, we ought to remove any Impediment that may embarass Nature in her Work, and advise a proper Method to promote the precipitating the morbific Matter? For so shall we, by joining our Forces with those of Nature, still keep her in due Course; and that when she is grown languid, and departing from her former Measures.