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country practice, which certainly points out, that much more may be expected from the resources of nature, than some ima. gine; because the escapes with life and limb are not very rare, but frequently happen. You see Mr. Gooch, who has wrote well on this subject, is not in general for speedy amputation ; and I ain certain you will have much more satisfaction, and acquire more reputation by the discerning part of mankind, in preserving a limb, than in taking it off,"
The following are part of the author's remarks on the use of oil of turpentine in wounds of the tendons and ligaments.
• Perhaps it may seem strange to you, that I lo frequently used greasy applications in wounds of the ligaments; as they have in this case been decried by almost every writer, since Celsus : and more especially, as the oil of turpentine is still used and recommended by very eminent men, both in this and other nations, as a specific in wounds of the tendons and ligaments, because it is an old practice.
• But I am apprehensive the use of oil of turpentine in these cases is very pernicious; for I do believe, it has not infrequently, by irritating and inflaming, brought on abscesses, and mortifications, which were thought to be in consequence of the accident alone. I know an eminent writer says, “ Oil of turpentine has the virtue of allaying pain, arising from wounds of the tendons and nerves, as is confirmed by the practice of Parey, by the opinion of all authors, and his own continual experience." And yet there is not a lad, that has played tricks with a mountebank's horse, who does not know, that it has directly a contrary effect; and only reflect one moment upon the application of this remedy to an infamed nerve ! but I cannot any way so effectually explode this practice, as by giving you a short view of the principles upon which it was first introduced ; and I hope you will give me the hearing a little longer, as the getting clear of this remedy, in this case, seems to be a matter of consequence.
• Hippocrates, who used the word nerve to signify a glutinous, (such as the tendons, ligaments, and the like) instead of a medullary substance, says, that cold is injurious to the nerves, and a moderate warmth, which does not exceed the third degree, useful. Wherefore, he orders them to be dressed, when wounded, with myrtle roots powdered, sifted, and knead. ed with oil; and with five-leaved grass, rubbed in oil, which are to be removed the third day; which applications, he says, had better be used in winter, than summer. And Celsus, who used the word nerve in the same classical sense, says with Hippocrates, that they are injured by cold, recommends the application of agglutinants to heal recent wounds of them that
would admit of cure by the first intention ; but where the wound was severe, emollient cataplasms were outwardly ap. plied ; in ulcers where the nerves were laid bare, he first covered them with linen to prevent their being injured by remedies which might be necessary to cleanse the fore ; and mild digestives were also used in ulcers amongst the nerves. But this practice Galen overturned.
• He had learnt the improvements made in anatomy by He'. rophilus and Erasistratus, and after making a new distinction betwixt nerve and tendon, and then again, confounding these different substances under one name, we are informed, that his principal aim in the cure of wounded nerves, was to guard against putrefaction. " Seeing, says he, (De comp. med. foe cund. gener. lib. 3. (that putrefaction in all things is produced by heat and moisture, I always think the cure, in wounds liable to putrefa ftion, should be attempted by cold, and drying applications,”-Again : “ I agree with Hippocrates, that cold is an enemy to the nerves, and imagine, that that medi. cine is the properest for wounded nerves, which dries, and is of a middle nature betwixt heat and cold, or rather inclining to heat ; for heat without humidity cannot moilten.—In punctures, therefore, of the nerves, after opening the external wound, medicines of thin consistence, vehemently drying, which will excite a moderate warmth, penetrate to the bottom, and draw from afar, without giving pain, or injuring the interjacent parts, should be applied.—But warm water, though it mitigates other inflammations, yet it is very prejudicial in wounded nerves, &c. For the same reasons, relaxing cata. plasms Nould not be applied : nor are things of thick confirtence of service. It is better to foment with old thin oil made warm, for cold obltructs the small opening, &c. and the nerves are the most sensible parts, being a continuation of the brain, of a cold nature, and easily affected by cold, Or with oil, in which the feeds of the fir tree and poplar flowers have been boiled; or the oil of savin, which is void of aftringency and of thin part."
Compound medicines for the same purpose were made of refin, turpentine, euphorbium, fagapenum, opopanax, and the like. But when the nerves were laid bare, he advised milder applications, that would dry without irritating; for he says they will not bear the force of euphorbium, &c. as when the skin interferes ; he therefore in this case used washed lime, or pomphylyx mixed in a large quantity of oil, &c. but when the wound was accompanied with pain, he applied a caraplarm made of bean flour, and tie lixivium stillatitinin called stacte.
• Now, though it is true, that heating and drying sub. Itances prevent putrefaction in dead bodies; yet in living bodies, and especially in tendinous parts, they produce exactly a contrary effect, by hardening and inflaming the vessels and fibres. However, this theory and practice, with very little variation, was implicitly copied by the Greeks, Arabians, and Latins, except that, by some unlucky mistake, instead of the lixivium stillatitium, which is a liquor that sweats from the myrrh tree, before it is lanced, they used common ley, which, I dare say, you will easily conceive, could not afford much ease, when the injured parts were inflamed and painful. And yet, upon no better authority than this blunder, a soap suds poultice was applied by Parey to the King's arm, Charles IX, of France, when he was pricked in a nerve, in- * stead of a veinOil of turpentine so perfectly agreed with the remedy described by Galen for pricked nerves, that it immediately caine into use, when the method of making it was known; and, perhaps, more especially, as Galen himself had usod oil in which the feeds of the fir-tree had been boiled. And to the oil of turpentine, fome aqua vitæ, you sce, was added, to make it still more capable of exhausting and drying up the serous and virulent humour, which sweats from the substance of the pricked nerve ; of preventing bad symptoms, and of mitigating pain by its actual heat !
Now the oil of turpentine, &c. was applied before any ferous humor could he discharged, provided the tendon had been pricked; therefore it must be used by way of prevention. But is not this ferous humor the natural discharge from a wounded tendons and therefore would not stopping it by drying remedies increase inflammation and pain ? It is highly probable the ease the king enjoyed was from the oxycrate and nutritum ; but these gave way to the poultice above mentioned, which was thought to be a better remedy for diffolve ing and drying virulent humors occafioning pain, But I dare fay, from the nature of this application, you will think the king had a narrow escape from torture, as he was to have been cauterized with scalding oil, if the pain had not luckily ceased; and the cure took up three months, which is a much longer time than is usually required for the recovery of accidents of this kind.'
V. The Marine Prašice of Phyfic and Surgery, including that it
the bor Countries. Particularly useful to all who vifte obe Eaft and West Indies, or obe coaf of Africa. To wbich is added Pharmacopeia Marina. And fonte brief Directions to be alone served by sbe Sea.furgeon in an Engagement, &c. By Williain
Northcote, Surgeon. Two Vols. 8vo. Pr. 125. Becket and • De Hondt. THough the practice of physic and surgery be the same, in
all effential points, at sea as on land'; yet, the particular circumstances of those who live on board a ship, and visat different climates, render it necessary for an author, who writes chiefly for the naval department, to descend to more minutenefs in' his instructions, and adapt them to a greater variery of situations, than other physical writers. Mr. Northcote ap. pears to be extremely well qualified for the work he has undertaken; for, he seems to be not only thoroughly acquainted with the economy of a marine life, at far as it regards the convenience and particular fituation both of the furgeon and patient; but he is also converfant in the writings of the best practical authors, and is evidently poffeffed of great experience in his profession. The first of these volumes treats of surgery, contrary to what might be expected froin the title page. We know not for what reafon such an arrangement has beea adopted; but it is a matter of no importance. In this part of the work, Mr. Northcote has omitted no article which can lay claim to any consideration; and though he descends to many minute distinctions, his divisions are seldom unneceffary, or his precepts too prolix. The following are his injundions and observations in regard to bleeding:
• Plebotomy is an artful and careful opening of a conspicuous vein with a lancet, chiefly in the neck, arm, hand, or foot ;. being the most ancient, effectual, and extensive remedy upon moft occasions with which we are acquainted, but regires judgment in the performance, to avoid the adjacent nerves, tendons, or arteries : therefore the young surgeon's reputation may suffer as much by neglect or accidents in this way, as in many of the other less usual and seemingly more difficult operations.
• A good surgeon or piebotomist Diould have a sharp eye and an undaunted mind, with a steady, nimble, and active hand; without which advantages the operator may either be. liable to miss the vein, or commit some accident that may be injurious or fatal to the patient and his own reputation. For these reasons it is, that venesection is less readily practised by the surgeon as he advances in years; because old age is gene.
rally accompanied with a weak eye and a trembling hand; which is also the case with those of younger years, that have made too free with their constitution, &c.
• When you are to bleed in the arm provide a fillet of about an ell long, a compress, a bit of lint and dia palma plaster, a receptacle for the blood, and another for water, and have some hartfhorn in readiness in case of faintness: then fingle out the vein which presents best, and apply the ligature moderately tight above the elbow by two circular rounds about the arm and with a flip-knot. Choose out a lancet either broad or spear-pointed in proportion to the depth or rising of the vein; place it betwixt your teeth, with the blade removed from the Maft so as to form an obtuse angle, and in the mean time rub the arm from the hand upward, to make the vein appear more conspicuous. Then pressing with your finger to discover the vicinity of the artery, nerve, or tendon, make a small impression with your nail upon the skin where the vein appears best for opening. Next place your left thumb upon the vein a little below the impression to keep iç steady, and taking the lancet betwixt your right thumb and fore-finger, resting upon the other fingers almost as you would hold a pen, plunge the point into the vein, so as to make an orifice tolerably large by an oblique incision carried upward, by raising a little the point, which then instantly withdraw, and press your left thumb upon the orifice, till the receptacle is ready to receive the blood ; which if obstructed from flowing freely by too great pressure of the ligature upon the artery, you must flacken it a little, and relax the kin and vein by bending the arm in a small degree, which is then to be supported by a stick, which the patient Nould keep turning round.
" When you have drawn off as much as you think proper, untie the ligature and wash off the blood; closing the lips of the orifice in their natural posture (as the skin is apt to contract, and occasion the fat to protrude, which leaves a trou. blesome little ulcer, or at best since it thus unites with a large scar) endeavour as much as possible to retain the skin together with a bit of diapalma plaster, in the middle of which fix a bit of lint or clean linen sufficient to cover the orifice ; over this apply your square compress of sufficient thickness, and retain it by the fillet, one end of which is applied obliquely across the arm over the compress, letting enough of it hang loose above the elbow to tie in a knot : then the other part being carried round below the elbow and up again, crolling the former upon the compress, is carried round above the elbow, and so on like the figure 00, leaving enough to tie