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A Collection of Chirurgical Tracts. Beckett William
Читать онлайн.Название A Collection of Chirurgical Tracts
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Автор произведения Beckett William
Жанр Зарубежная классика
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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.
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