Of ULCERS.
WHEN a Wound or Abscess degenerates into so bad a State as to resist the Methods of Cure I have hitherto laid down, and loses that Complexion which belongs to a healing Wound, it is called an Ulcer; and as the Name is generally borrowed from the ill Habit of the Sore, it is a Custom to apply it to all Sores that have any Degree of Malignity, tho' they be immediately formed without any previous Abscess or Wound; such are the Venereal Ulcers of the Tonsils,
Ulcers arc distinguished by their particular Disorders, tho' it seldom happens that the Affections are not complicated; and when we lay down Rules for the Management of one Species of Ulcer, it is generally requisite to apply them to almost all others. However, the Characters of most eminence are, the callous Ulcer, the sinuous Ulcer, and the Ulcer with Caries of the adjacent Bone; tho' there be abundance more known to Surgeons, such as the Putrid, the Corrosive, the Varicous, &c. but as they have all acquired their Names from some particular Affection, I shall speak of the Treatment of them under the general Head of Ulcers.
It will be often in vain to pursue the best Means of Cure by Topical Application, unless we are assisted by internal Remedies; for as many Ulcers are the Effects of a particular Indisposition of Body, it will be difficult to bring them into Order, while the Cause of them remains with any Violence; tho' they are sometimes in a great Degree the Discharge of the Indisposition itself, as in the Plague, Small-pox, &c. But we see it generally necessary in the Pox, the Scurvy, Obstructions of the Menses, Dropsies, and many other Distempers, to give Internals of great Efficacy; and indeed, there are hardly any Constitutions, where Ulcers are not assisted by some physical Regimen. Those that are cancerous and scrophulous seem to gain the least Advantage from Physic; for if in their Beginnings they have sometimes been very much relieved, or cured by Salivation, or any other Evacuation, they are also often irritated, and made worse by them; so that there is nothing very certain in the Effects of violent Medicines in these Distempers. I have seen also great Quantities of Alteratives tried on a variety of Subjects; but I cannot say with extraordinary Success: Upon the whole, I think in both these Cases, the Milk-diet and gentle Purging with Manna, and the Waters, seem to be most efficacious; tho' brisk Methods may be used with more Safety in the Evil than the Cancer; and sometimes, particularly in young Subjects, the Decoction of the Woods is extremely beneficial for scrophulous Ulcers: but it has lately been attested by Men of great Skill and Veracity, that Sea-water is more powerful than any other Remedy hitherto known, both for scrophulous Ulcers, and scrophulous Tumours.
When an Ulcer becomes foul, and discharges a nasty thin Ichor, the Edges of it, in process of Time, tuck in, and growing skinned and hard, give it the Name of a callous Ulcer, which, so long as the Edges continue in that State, must necessarily be prevented from healing: but we are not immediately to destroy the Lips of it, in expectation of a sudden Cure; for while the Malignity of the Ulcer remains, which was the Occasion of the Callosity, so long will the new Lips be subject to a Relapse of the same kind, however often the external Surface of them be destroyed; so that when we have to deal with this Circumstance, we are to endeavour to bring the Body of the Ulcer into a Disposition to recover by other Methods. It sometimes happens to poor laborious People, who have not been able to afford themselves Rest, that lying a-bed will in a short Time give a Diversion to the Humours of the Part, and the callous Edges softening, will without any great Assistance shoot out a Cicatrix, when the Ulcer is grown clean and filled with good Flesh. The Effect of a Salivation is generally the same; and even an Issue does sometimes dispose a neighbouring Ulcer to heal: but though Callosities be frequently softened by these means, yet when the Surface of the Ulcer begins to yield thick Matter, and little Granulations of red Flesh shoot up, it will be proper to quicken Nature by destroying the Edges of it, if they remain hard. The manner of doing this, is by touching them a few Days with the Lunar Caustick, or Lapis infernalis, and some choose to cut them off with a Knife; but this last Method is very painful, and not, as I can perceive, more efficacious; tho' when the Lips do not tuck down close to the Ulcer, but bang loose over it, as in some venereal Bubos where the Matter lies a great way under the Edges of the Skin, the easiest Method is cutting them off with the Scissars.
To digest the Ulcer, or to procure good Matter from it when in a putrid State, there are an Infinity of Ointments invented; but the Basilicon flavum alone, or softened down, sometimes with Turpentines, and sometimes mixt up with different Proportions of red Precipitate, seems to serve the Purposes of bringing an Ulcer on to Cicatrisation, as well as any of the others. When the Ulcer is incarned, the Cure maybe finished as in other Wounds; or if it do not cicatrise kindly, it may be washed with Aq. Calcis, or Aq. Phag. or dressed with a Pledgit dipt in Tinct. Myrrhæ: and if Excoriations are spread round the Ulcer, they may be anointed with Sperm. Cet. Ointment, or Unguent. Nutritum.
The red Precipitate has of late Years acquired the Credit it deserves for the Cure of Ulcers, but by falling into general Use is often very unskilfully applied: when mixed with the Basilicon, or what is neater, a Cerate of Wax and Oil, it is most certainly a Digestive, since it hardly ever fails to make the Ulcer yield a thick Matter in twenty-four Hours, which discharged a thin one before the Application of it. As greater Proportions of it are added to the Cerate, it approaches to an Escharotick; but while it is mixed with any Ointment, it is much less painful and corrosive, than when sprinkled on a Sore in Powder; tho' in this Form it is almost universally employed, but I think injudiciously: for as it is a strong Escharotick, much of it can never be used without making a Slough, and therefore continually repeating it Day after Day, will be making a Succession of Sloughs; or if it be sprinkled (in a Slough already formed, in order to quicken the Separation of it, so much of the Powder as lies on the dead Surface, will be of no Force, and the rest that lies at the Bottom, and about it, will produce other Sloughs there, by keeping under and destroying the little Granulations of Flesh, which in their Growth would elevate, and push off the first Slough, so that it cannot be a proper Remedy in this Case. If it be answered, that daily Practice should convince us that Precipitate has not this ill Effect, since we see Sloughs continually separating, notwithstanding the Use of it; the same sort of Argument may be used in favour of any bad Practice, since Nature often surmounts the greatest Obstacles to a Cure: But whoever will attend carefully, without any Prejudice from this Reasoning, to the two Methods of promoting the Separation of an Eschar, will find it not only more easily, but also more readily effected by soft Digestives, or the Precipitate Medicine, than by a great Quantity of the Powder.
If the Ulcer should be of such a Nature as to produce a spongy Flesh, sprouting very high above the Surface, it will be necessary to destroy it by some of the Escharoticks, or the Knife. This Fungus differs very much from that belonging to healing Wounds, being more eminent and lax, and generally in one Mass; whereas the other, is in little distinct Protuberances. It approaches often towards a cancerous Complexion, and when it rises upon some Glands does actually degenerate sometimes into a Cancer, as has happened in Bubos of the Groin. When these Excrescences have arisen in venereal Ulcers, I have pared them with a Knife; but the Flux of BIood is ordinarily so great, that I do not recommend the Method, and rather prefer the Escharoticks. Those in use are the Vitriol, the Lunar Caustick, the Lapis Infernalis, and more generally the red Precipitate Powder; but even in this Case, I do not think that Powder the best Remedy; for tho' I have said it is always an Escharotick, yet the PuIv. Angel. which is a Composition of the Precipitate Powder and burnt Allum, eats deeper, and I think is preferable to the Precipitate alone.
It is but seldom, that these inveterate Funguses appear on an Ulcer; but it is very usual for those of a milder Kind to rise, which may often be made to subside with Pressure, and the use of mild Escharoticks; however, if the Aspect of the Sore be white and smooth, as happens in Ulcers accompanied with a Dropsy, and often in young Women with Obstructions, it will answer no Purpose to waste the Excrescencies, 'till the Constitution is repaired, when most probably they will sink without any Assistance. In Ulcers also, where the subjacent Bone is carious, great Quantities of loose flabby Flesh will grow up above the Level of the Skin; but as the Caries is the Cause of the Disorder, it will be in vain to expect a Cure of the Excrescence, 'till the rotten Part of the Bone be removed; and every Attempt with Escharoticks, will be only a Repetition of Pain to the Patient without any Advantage. In scrophulous Ulcers of the Glands, and indeed of almost every Part, this Disorder is very common; but before Trial of the severe Escharoticks, I would recommend the Use of the strong Precipitate Medicine, with Compress as tight as can be born without Pain, which I think generally keeps it under.
When the Excrescence is cancerous, and does not rise from a large Cancer, but only from the Skin itself, it has been usual to recommend the actual Cautery; though I have found it more secure, to cut away quite underneath, and dress afterwards with easy Applications; but the Cases where either of these Methods are practicable, occur very rarely. As to the Treatment of incurable cancerous Ulcerations, after much Trial, Surgeons have at last discovered, that what gives the most Ease to the Sore is the most suitable Application; and therefore the use of Escharoticks is not to be admitted on any Pretence whatsoever; nor in those Parts of a Cancer that are corroded into Cavities, must the Precipitate be made use of to procure Digestion, or promote the Separation of the Sloughs. The best way therefore, is to be guided by the Patient what Medicine to continue, after having tried three or four, if the first or second do not agree with him. Those usually prescribed are Preparations from Lead, but what I have found most beneficial, have been sometimes dry Lint alone when it does not stick to the Cancer; at other times, Lint Dossils spread with Basilicon or Cerat. de Lapid. Calam. and oftener than either with a Cerate made of Oil and Wax, or the Sperm. Cet. Ointment; and over all, a Pledgit of Tow spread with the same, Embrocating the neighbouring Skin and Edges of it with Milk, is of Service; but the chief Good is to be acquired by Diet, which should be altogether of Milk, and things made of Milk, tho' Herbage may be admitted also. Issues in the Shoulders or Thighs do also alleviate the Symptoms, and Manna with the Purging Waters, once, or perhaps twice a Week, Will serve to keep the Body cool. All Methods more violent, generally exasperate Cancers, and are to be rejected in favour of this, which is sometimes amazing in its Effects, not only procuring Ease, but lengthening Life.
When Ulcers or Abscesses arc accompanied with Inflammation and Pain, they are to be assisted with Fomentations made of some of the dry Herbs, such as Roman Wormwood, Bay-leaves, and Rosemary; and when they are very putrid and corrosive, which Circumstances give them the Name of foul Phagædenick Ulcers, some Spirits of Wine should be added to the Fomentation, and the Bandage be alto dipt in Brandy or Spirits of Wine, observing in these Cases where there is much Pain, always to apply gentle Medicines till it be removed.
As to the Frequency of dressing and fomenting, I think it may be laid down for a Rule in all Sores, that where the Discharge is sanious, and corrosive, twice a-day is not too Much: if the Matter be not very putrid and thin, once will suffice. When the Pain and Inflammation are excessive, Bleeding and other Evacuations will often be serviceable;. and above all things, Rest and a horizontal Position; which last Circumstance is of so great importance to the Cure of Ulcers of the Legs, that unless the Patient will conform to it strictly, the Skill of the Surgeon will often avail nothing; for as the Indisposition of these Sores, is in some measure owing to the Gravitation of the Humours downwards, it will be much more beneficial to lie along than sit upright, tho' the Leg be laid on a Chair; since even in this Posture they will descend with more Force, than if the Body was reclined.
In Ulcers of the Legs accompanied with Varices or Dilatations of the Veins, the Method of Treatment will depend upon the other Circumstances of the Sore; for the Varix can only be assisted by the Application of Bandage, which must be continued a considerable time after the Cure; the neatest Bandage is the strait Stocking, which is particularly serviceable in this Case, though also if the Legs be dematous, or if after the healing of the Ulcers, they swell when the Patient quits his bed, it may be worn with Safety and Advantage. There are Instances of one Vein only being varicous, which when it happens, may be destroyed by tying it above and below the Dilatation, as in an Aneurism; but this Operation should only be practised where the Varix is large and painful.
Ulcers of many Years standing are very difficult of Cure, and in old People the Cure is often dangerous, frequently exciting an Asthma, a Diarrha, or a Fever, which destroys the Patient unless the Sore break out again; so that it is not altogether adviseable to attempt the absolute Cure in such Cases, but only the Reduction of them into better Order, and less Compass, which, if they be not malignant, is generally done with Rest and proper Care. The Cure of those in young People may be undertaken with more Safety, but we often find it necessary to raise a Salivation to effect it, though when completed it does not always last; so that the Prospect of Cure in stubborn old Ulcers, at any time of Life, is but indifferent. In all these Cases, however, it is proper to purge once or twice a week with Calomel, if the Patient can bear it, and to make an Issue. When the Sore is almost healed, in order to continue a Discharge the Constitution has been so long habituated to, and prevent its falling upon the Cicatrix, and bursting out again in that Place.
When an Ulcer or Abscess has any Sinuses or Channels opening and discharging themselves into the Sore, they are called sinuous Ulcers; these Sinuses, if they continue to drain a great while, grow hard in the Surface of their Cavity, and then are termed Fistulæ, and the Ulcer a fistulous Ulcer; also if Matter be discharged from any Cavity, as those of the joints, the Abdomen, &c. the Opening is called a sinuous Ulcer or a Fistula.
The Treatment of these Ulcers depends on a Variety of Circumstances: If the Matter of the Sinus be thick; strict Bandage and Compress will sometimes bring the opposite Sides of the Sinus to a Re-union; if the Sinus grow turgid in any Part, and the Skin thinner, shewing a Disposition to break, the Matter must be made to push more against that Part, by plugging it up with a Tent; and then a Counter-opening must be made, which proves often sufficient for the whole Abscess, if it be not afterwards too much tented, which locks up the Matter and prevents the Healing; or too little, which will have the same Effect; for dressing quite superficially, does sometimes prove as mischievous as Tents, and for nearly the same Reason; since suffering the external Wound to contract into a narrow Orifice before the internal one be incarned, does almost as effectually lock up the Matter as a Tent: To preserve then a Medium in these Cases, a hollow Tent of Lead or Silver may be kept in the Orifice, which at the same time that it keeps it open, gives Vent to the Matter. The Abscesses where the Counter-openings are made most frequently, are those of compound Fractures, and the Breast; but the latterr do oftener well without Dilatation, than the former, tho' it must be performed in both, if practicable, the whole Length of the Abscess, when after some Trial the Matter does not lessen in Quantity, and the Sides of it grow thinner; and if the Sinuses be fistulous, there is no Expectation of Cure without Dilatation: There are also a great many scrophulous Abscesses of the Neck, that sometimes communicate by Sinuses running under large Indurations, in which Instances, Counter-openings are adviseable, and generally answer without the Necessity of dilating the whole Length; and indeed, there are few Abscesses in this Distemper, which should be opened beyond the Thinness of the Skin. When Abscesses of the Joints discharge themselves, there is no other Method of treating the Fistula, but by keeping it open with the Cautions already laid down, till the Cartilages of the Extremities of the Bones being corroded, the two Bones shoot into one another, and form an Anchylosis of the joint, which is the most usual Cure of Ulcers in that Part.
Gun-shot Wounds often become sinuous Ulcers, and then are to be considered in the same Light as those already described; the Surgeons have been always inclined to conceive there is something more mysterious in these Wounds than any others; but their Terribleness is owing to the violent Contusion and Laceration of the Parts, and often to the Admission of extraneous Bodies into them, as the Bullet, Splinters, Clothes, &c. and were any other Force to do the same thing, the Effect would be exactly the same as when done by Fire-arms. The Treatment of these Wounds consists in removing the extraneous Body as soon as possible, to Which end the Patient must be put into the same Posture as when be received the Wound: if it cannot be extracted by cutting upon it, which should always be practised when the Situation of the Blood-vessels, &c. does not forbid; it must be left to Nature to work out, and the Wound dressed superficially, for We must not expect, that if it be kept open with Tents, the Bullet, &c. will return that way; and there is hardly any Case where Tents are more pernicious than here, because of the violent Tension and Disposition to gangrene which presently ensue. To guard against Mortification in this, and all other violently contused Wounds, it will be proper to bleed the Patient immediately, and soon after give a Clyster; the Part should be dressed with soft Digestives, and the Compress and Roller applied very loose, being first dipt in Brandy or Spirits of Wine: The next time the Wound is opened, if it be dangerous, the spirituous Fomentation may be employed, and after that, continued till the Danger is over. If a Mortification comes on, the Applications for that Disorder must be used: In gun-shot Wounds, it seldom happens that there is any Effusion of Blood unless a large Vessel be torn, but the Bullet makes an Eschar, which usually separates in a few Days, and is followed with a plentiful Discharge; but when the Wound is come to this Period, it is manageable by the Rules already laid down..
When an Ulcer with loose rotten Flesh discharges more than the Size of it should yield, and the Discharge is oily and stinking; in all Probability the Bone is, carious, which may easily be distinguished by running the Probe through the Flesh, and if so, it is called a carious Ulcer: The Cure of these Ulcers depends principally upon the Removal of the rotten Part of the Bone, without which it will be impossible to heal, as we see sometimes even in little Sores of the lower jaw, which taking their Rise from a rotten Tooth, will not admit of Cure 'till, the Tooth be drawn. Those Caries which happen from the Matter of Abscesses lying too long upon the Bone, are most likely to recover: Those of the Pox very often do well, because that Distemper fixes ordinarily upon the middle and outside of the densest Bones, which admit of Exfoliation; but those produced by the Evil, where the whole Extremities of spongy Parts of the Bone are affected, are exceedingly dangerous, tho' all enlarged Bones be not necessarily carious; and there are Ulcers sometimes on the Skin that covers them, which do not communicate with the Bone, and consequently do well without Exfoliation: Nay, it sometimes happens, tho' the Case be rare, that in young Subjects particularly, the Bones will be carious to such a degree, as to admit a Probe almost through the whole Substance of them, and yet afterwards admit of a Cure, without any notable Exfoliation.
The Method of treating an Ulcer with a Caries, is by applying a Caustick of the Size of the Scale of the Bone that is to be exfoliated, and after having laid it bare, to wait till such time as the carious Part can, without Violence, be separated, and then heal the Wound: I caution against Violence, because the little jagged Bits of Bone that would be left, if we attempted Exfoliation, before the Piece were quite loose, and disengaged from the sound Bone, would form little Ulcerations, and very much retard the Cure. In order to quicken the Exfoliation, there have been several Applications devised; but that which has been most used in all Ages, is the actual Cautery, with which Surgeons burn the naked Bone. every Day, or every other Day, to dry up, as they say, the Moisture, and by that Means, procure the Separation: but as this Practice is never of great Service, and always cruel and painful, it is now pretty much exploded: Indeed from considering the Appearance of a Wound, when a Scale of Bone is taken out of it, there is hardly any question to be made, but that burning retards rather than hastens the Separation; for as every Scale of a carious Bone is flung off by new Flesh generated best tween it and the found Bone, whatever would prevent the Growth of these Granulations, would also in a degree prevent the Exfoliation; which must certainly be the Effect of a red-hot Iron, applied so close to it; though the Circumstances of carious Bones, and their Disposition to separate, are so different from one another, that it is hardly to be gathered from Experience, whether they will sooner exfoliate with or without the Assistance of Fire: for sometimes, in both Methods, an Exfoliation is not procured in a Twelve-month, and at other Times it happens in three Weeks or a Month; nay I have, upon cutting out the Eschar made by the Caustick, taken away at the same time a large Exfoliation: However, if it be only uncertain whether the actual Cautery be beneficial or not, the Cruelty that attends the use of it, should entirely banish it out of Practice. It is often likewise in these Cases, employed to keep down the fungous Lips that spread upon the Bone; but it is much more painful than the Escharotick Medicines; tho' there will be no Need of either, if a regular Compress be kept on the Dressings; or at worst, if a flat Piece of the prepared Sponge, of the Size of the Ulcer, be rolled on with a tight Bandage, it will swell on every Side, and dilate the Ulcer without any Pain.
Some Caries of the Bones are so very shallow that they crumble insensibly away, and the Wound fills up; but when the Bone will neither exfoliate nor admit of Granulations, it will be proper to scrape it with a Rugine, or perforate it in many Points with a convenient Instrument down to the quick. In the Evil, the Bones of the Carpus and Tarsus are often affected, but their Sponginess is the reason that they are seldom cured: so that when these, or indeed the Extremities of any of the Bones are carious through their Substance, it is adviseable to amputate; though there are Instances in the Evil, but more especially in critical Abscesses, where after long dressing down, the Splinters, and sometimes the whole Substance of the small Bones, have worked away, and a healthy Habit of Body coming on, the Ulcer has healed; but these are so rare, that no great Dependence is to be laid on such an Event. The Dressings of carious Bones, if they are stinking, may be Dossils dipt in the Tincture of Myrrh, otherwise those of dry lint are easiest, and keep down the Edges of the Ulcer better than any other gentle Applications.
Burns are generally esteemed a distinct kind of Ulcers, and have been treated with a greater Variety of Applications, than any other Species of Sore, every Author having invented some new Medicine, to fetch out the Fire, as they imagine; and indeed the Conceit of a Quantity of Fire remaining in the Part burnt, has occasioned the Trial of very whimsical and painful Remedies: tho' People who talk thus seriously of Fire in Wounds, do not think of any remaining in a Stick that is half burnt, and ceases to burn any farther; notwithstanding the Reasoning be the same in Burns of the Flesh, and Burns of a Piece of Wood.
When Burns are very superficial, not raising suddenly any Vesication, Spirits of Wine are said to be the quickest Relief; but whether they be more serviceable than Embrocations with Linseed-oil, I am not certain, though they are used very much by some Persons whose Trade subjects them often to this Misfortune. If the Burn excoriates, I think it is easiest to roll the Part up gently with Bandages dipt in sweet Oil, or a Mixture of Unguent. Flor. Sambu. with the Oil: when the Excoriations are very tender, dropping warm Milk upon them every Dressing is very comfortable; or if the Patient can bear to have Flannels wrung out of it, applied hot, it may be still better: if the Burn have formed Eschars, they may be dressed with Basilicon, though generally Oil alone is easier; and in these Sores, whatever is the easiest Medicine, will be the best Digestive. I have sometimes found it necessary to apply different Ointments to Burns, where the Aspect has been nearly the same, and upon changing them, the Patient has complained of great Pain, so that we are obliged sometimes to determine what is proper, from Trial. The most likely things to succeed at first, are, Oil, Ungt. Flor. Samb. Ungt. Basilicon, and a Cerate of Wax and Oil, and afterwards the Cerate de Lapid. Calam. Ungt. Rub. Desiccat. Ungt. Sperm. Cet. the Nutritum with but little Vinegar in it, or perhaps when the Fungus rises, dry Lint. There is great Care necessary to keep down the Fungus of Burns, and heal the Wounds smooth, to which end, the Edges should be dressed with Lint dipt in Aqu. Vitriol. and dried afterwards, or they may be touched with the Vitriol-stone, and the Dressings be repeated twice a-Day. There is also greater Danger of Contractions from Burns after the Cure, than from other Wounds; to obviate which, Embrocations of Neats-foot Oil, and Bandage with Paste-boards, to keep the Part extended, are absolutely necessary, where they can be applied.
The EXPLANATION.
A. Director by which to guide the Knife in the opening of Abscesses that are burst of themselves, or first punctured with a Lancet. This Instrument should be made either of Steel, Silver, or Iron, but so tempered, that it may be bent and accommodated to the direction of the Cavity. It is usually made quite straight; but that Form prevents the Operator from holding it firmly, while he is cutting; upon which account, I have given mine the Shape here represented. The manner of using it is, by passing the Thumb through the Ring and supporting it with the Fore-finger, while the straight-edged Knife is to slide along the Groove with its Edge upwards, towards the Extremity of the Abscess.
B. The straight-edged Knife, proper for opening Abscesses with the Assistance of a Director; but which, in few other respects, is preferable to the round-edged Knife,
C. A crooked Needle, with its convex and concave Sides sharp: this is used only in the Suture of the Tendon, and is made thin, that but few of the Fibres of so slender a Body as a Tendon, may be injured in the passing of it. This Needle is large enough for stitching the Tendo Achillis.
D. The largest crooked Needle necessary for the tying of any Vessels, and should be used with a Ligature of the Size of that I have threaded it with in taking up the Spermatick Vessels in Castration, or the Femoral and Humeral Arteries in Amputation. This Needle may also be used in sewing up deep Wounds.
E. A crooked Needle and Ligature of the most useful Size, being not much too little for the largest Vessels, nor a great deal too big for the smallest; and therefore in the taking up of the greatest Number of Vessels in an Amputation, is the proper Needle to be employed. This Needle also is of a convenient Size for sewing up most Wounds.
F. A small crooked Needle and Ligature for taking up the lesser Arteries, such as those of the Scalp, and those of the Skin that are wounded in opening Abscesses.
Great Care sould be taken by the Makers of these Needles, to give them a due Temper; for if they are too soft, the Force sometimes exerted to carry them through the Flesh, will bend them; if they are too brittle, they snap; both which Accidents may happen to be terrible Inconveniencies, if the Surgeon be not provided with a sufficient Number of them. It is of great Importance also to give them the Form of Part of a Circle, which makes them pass much more readily round any Vessel, than if they were made partly of a Circle, and partly of a straight Line, and in taking up Vessels at the Bottom of a deep Wound is absolutely necessary, it being impracticable to turn the Needle with a straight Handle, and bring it round the Vessel when in that Situation. The convex Surface of the Needle is flat, and its two Edges are sharp. Its concave Side is composed of two Surfaces, rising from the Edges of the Needle, and meeting in a Ridge or Eminence, so that the Needle has three Sides. This Eminence of the Substance of the Needle on its Inside strengthens it very much, but is not continued the whole Length of the Needle, which is flat towards the Eye; some are made round in this Part, but they cannot be held steady between the Finger and Thumb, and are therefore unfit for use. There have been Needles made with the Eminence on the convex Side, and a flat Surface on the concave Side, but I do not fee any particular Advantage in that Structure. The best Materials for making Ligatures, are the flaxen Thread that Shoemakers use; which is sufficiently strong when four, six, or eight of the Threads are twisted together and waxed; and is not so apt to cut the Vessels, as Threads that are more finely spun; though the Prevention of this Accident will depend in a great Measure on the Dexterity of the Operator, who is carefully to avoid the tying them with too great a Force.
G. A straight Needle, such as Glovers use, with a three-edged Point, useful in the uninterrupted Suture, in the Suture of Tendons, where the crooked one C, is not preferred, and in sewing up dead Bodies, and is rather more handy for taking up the Vessels of the Scalp.