A Collection of Chirurgical Tracts

by William Beckett

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.