The whole course of chirurgerie wherein is briefly set downe the causes, signes, prognostications & curations of all sorts of tumors, wounds, vlcers, fractures, dislocations & all other diseases, vsually practiced by chirurgions, according to the opinion of all our auncient doctours in chirurgerie. Compiled by Peter Lowe Scotchman, Arellian, Doctor in the Facultie of Chirurgerie in Paris, and chirurgian ordinarie to the most victorious and christian King of Fraunce and Nauarre. Whereunto is annexed the presages of diuine Hippocrates.

THE SEAVENTH TREATISE of vlcers which contayneth Ten Chapters. By Peter Low Arellien. (Book 7)

• Chapter 1 Of vlcers in generell.
• Chapter 2 Of vlcers s••nious and their curation▪
• Chapter 3 Of the vlcer Ʋirulent.
• Chapter 4 Of the vlcer profound and Cauernous.
• Chapter 5 Of the vlce Sordide and Putride.
• Chapter 6 Of vlcers difficill to Cure.
• Chapter 7 Of vlcers with corruption of the Bones.
• Chapter 8 Of vlcers Cancrous.
• Chapter 9 Of Fistula.
• Chapter 10 Of Burninges.

The first Chapter, of vlcers in generall.

CO.

Seeing wee haue amply spoken of tumors and wounds, of their definit••n, cause, signes, and cure, so in like manner we will proceede in vlcers, seeing many tumors and woundes doe suppure and degen∣der in vlcers, so it is needefull after the Treatise hereof to speake of vlcers,* 1.1 and first I demaund, what is an ulcer?

LO.

It is a solution of contim••t•• made by erosion in diuers parts

of the bodie out of the which procedeth a ma••ter purulen••, which hindereth the consolidation thereof.

CO.

Are they not different?

LO.

Some differ in nature, in substance, in quantitie, figure and accidents.

CO.

How differ they in na∣ture & substance?

LO.

Some are simple in the flesh, with∣out any other indisposition, as saith Galen, or are compo∣sed with one, or mo•• maladies, as vlcers with intemperie, corruption of the bone, aposteme, nodositie and diuers o∣ther accidents.

CO.

How differ they in figure and quantitie?

LO.

Some are round, long, profound, superficiall, great and small.

CO.

How differ they by accidents?

LO.

Some are putride, dolorous, fistulous, cancrous, some are inuete∣rate, some recent, some in on member, some in other pla∣ces.

CO.

How many causes are there of vlcers?

LO.

Three primitiue, antecedent, and coniunct.

CO.

Which are the primi••••tiues?

LO.

Contusion, scratching, heates, apply∣cation of sharp medicaments, corrosion, great cold, that extinguisheth the the naturall heate, chiefly in the extre∣mities.

CO.

Which are the causes antecedent?

LO.

E∣uill humors in the bodie, which come of euill nouriture, or euill disposition of the bodie, or some part thereof,* 1.2 chiefly the ly••er and milt.

CO.

Howe are these humors causes of vlcers?

LO.

Partly by their euill qualitie, partly through abundance thereof do spoyle, open & co••ode the most de∣bill parts of our body, not hauing force to resist such malig∣nitie, and so causeth vlcers.

CO

Which are the coniunct causes?

LO

The foresayd humors conioyned in the partes vlcered, as also all other violent thinges, that haue force to vlcerate the same part.

CO

Which are the signes?

Lo.

They are euident, or are in the body, & are knowne by the dolor,* 1.3 nature or the place, accidents & excrements, & such as you shall heare in the sixe kinds of proper vlcers.

CO.

Which are those sixe kondes of vlcers?

LO.

The first is sanious,* 1.4 2. virulent; 3. filthie, 4. cancrous, 5. putride or stinking, 6. corrosiue or rotten awaye.

CO.

Haue they no other names?

LO

They haue fiue other names, and first by the humors, secōdly of the matter, that cōmeth frō them thirdly

of the accidentes, fourthly of the sicknes, fiftly by compa∣ring them to the similitude of beastes.

CO.

How take they their names by the humors?

LO.

Some are of the Phleg∣matick humor, and are called Phlegmaticks, some by the blood, and are called sanguinis, by the choller, chollerick, and by melancholy, melancholick.

CO.

Howe take they the nemes of the matter?

LO.

Of the great abundance of sany or humidity, it is called vlcer sanious, of the pus, pur••∣lent, of the sordidities, it is called ••ordide, of the virulence, it is called virulēt.

CO.

How take they their names of the ac∣dents?

LO.

Of the hardnes called callositie it is hard and callous, of the cau••••ns of it, it is called cauernous, of the fistule, it is called fistulate, of the putrifaction, putride, of the corosion or malignitie of the matter, corosiue, of the cankers, or hardnes turned ouer it, called cancrous, of the dolor, dolorous, of aposteme, apostemus. In all vlcers, where any of these raigne, they heale not, till they be takē away.

CO.

What is callositie?

LO.

It is a drie flesh without dolor, because it hath no veine to make it humide, nor nerue to giue it feeling.

CO

Howe is that called, which commonly commeth from vlcers?

LO.

It is called sanie or matter.

CO.

What is sanie?

LO.

It is a corruption of the part, which nature cannot digest, and make it to nou∣rish the same.

CO.

How many sortes of sanie is there?

LO

Two, to wit, that which is commendable, as it ought to be, and that which is not.

CO.

Which is commendable?

LO.

It is, that which is white, light, equall in consistēce, neither thick, thin, nor euill tasted.

CO.

Which is not commendable, or euill sanie?

LO.

It is a corruptiō of the in∣••••ument, much altered, through vnnaturall heate, & accor∣ding to that alteration it produceth euill sanie.

CO.

What call you pus?

LO.

It is a kinde of sanie made of the nouri∣ture, and superfluitie of the mēber tending to corruptiō by the alteratiō of the naturall heate, & debilitie of the mem∣ber, out of the which cōmeth a matter called virus & sor∣dities.

CO.

Whot is virus?

Lo.

It is that, which is ingēdred

of the most subtill and hotte parte of the pituitous humor, which nature cannot digest for the great abundance there∣of.

CO.

What is it, thou callest sordities?

LO

It is a grosse matter, ingendred of grosse humors.

CO.

What callest thou durities or hardnesse?

LO.

It is a thing hard and solide, not easie to bee corrupted, which may come of three causes, that is, great heate, congelation, repletion.

CO.

What callest thou fistula?

LO.

It is a profound vlcer,* 1.5 hauing the entrie, hard, narrow, deepe, cauernous, from the which proceedeth a matter virulent.

CO.

What is putre∣faction?

LO.

It is a chaunge of the substaunce of our whole body, or of some parte thereof, through an vnnatu∣rall heate.

CO.

What is the cause of putrefaction in our bo∣dies?

LO.

It commeth, either that the spirite animall is corrupted, or cannot goe to the parte, for colde, heate, a∣postume, pustulles, vlcers ambulatiues venenous, also put∣ting of oyles and such like in deepe vlcers, doth corrupt the fleshe, also too much vsing of refrigeratiues in hotte apo∣stumes, and ligators which intercept the spirite.

CO.

How many sortes of putrefactions are there?

LO.

Three, ro wit, Gangren, Estachiles, and Histiomen.

CO.

What is Gan∣gren?

LO.

It is a putrefaction of the parte, hauing yet fee∣ling, and differeth in that from others.

CO.

What is Est••∣••ache••?

LO.

It is a putrefaction of the member, or parte thereof, without feeling, corrupting both flesh and boane.

CO.

What is H••stiomen?

LO.

It is a whole corruption of the member, eating & consuming the whole bodie away.

CO.

What is Corrosion?

LO.

It is a consumption of the fleshe, through the bitternesse and sharpenesse of the hu∣mor.

CO.

What are the causes of Corrosion?

LO.

The malignitie of the fleshe, the humor cholericke, phlegma∣ticke, salt, admixed.

CO.

What callest thou Cancer?

LO.

It is a maladie of a matter colde and drie, being hotte by putrefaction, hardnesse and other signes, as ye shall heare in his proper Chapter.

CO.

What are the Iudgementes?

LO.

There are diuers,* 1.6 according to the accidentes that

fall, and first, that vlcers remaining a yeere or more vncu∣red, make the boane vnder them altered & rotten, & whē such vlcers are whole,* 1.7 there remaineth a cauitie in the part vlcered: all vlcers that are euil colored blacke are esteemed malignes, if any vlcer being filled vp & ready to cicatrice, begin sodainely to runne againe without manifest cause, it is in danger to become fistulous.* 1.8 Hippocrates saith that vl∣cers, which haue no haire about them, are vneasie to heale and cicatrice, also those vlcers which come, by reason of some maladie, as hydropsie, & cachexie, are hard to heale. Hippocrates saith also, if any man haue an vlcer, whether it be come to him before his sickenesse,* 1.9 or in the sickenesse, and the sicke die, that vlcer shall bee before hee die, drie, blewe, or pale. The same Hippocrates saith also, that those, who haue vlcers accompanied with tumor,* 1.10 doe neither fall in conuulsion, rauing, nor phrensie, but if the tumor goe away without manifest cause, & if the vlcer be in the backe, the sicke falleth in spasme if before in the bodie, in rauing and phrensie: if in the thorax before, he falleth in emp••••m and pleurisie, all vlcers accompanied with varices, or intē∣perie, and those also, that haue the sides hard, are difficill to heale, all vlcers in the extremities of the muscles of the legges and armes are difficill and dangerous, as also those, which penetrate in the bodie: such vlcers as chaunce in the extremities of the bodie, as in the feete, or handes, make oft phlegmons, or other tumors against nature, and in cri∣sis of a maladie are difficill.

CO.

Which are those, which are of easie curation?

LO,

Those which happen in bo∣dies of good complexion, & in the which none of the fore∣said accidentes doe happen.* 1.11

CO.

Which are the chiefe causes,* 1.12 that hinder the healing of vlcers?

LO.

According to Galen, the chiefe cause is want of good bloud, to ingen∣der flesh, or else that it is euill, either by quantitie or quali∣tie of it selfe, also dolor, intemperie apostume, contusion, erisipelas, echymois, superfluous flesh, hardnesse, callositie

of the sides, corruption of the boane, varices, hemoragie of bloud: also roundnesse in figure, for the which Hippo∣crates counselleth if the vlcer bee round, to put on it an o∣ther forme. Imbecillitie of the part vlcered, indisposition of the lyuer or milte, retention of the monethly course in women, and of the hemerroihdes, and also the applying of medicines vnmeete for such vlcers. Many ignorant bar∣bors faile herein, thinking one kinde of emplaister to bee good for all sores, in the which they are deceiued: for hee that would cure vlcers, must first take away the cause, as al∣so the impedimentes and accidentes, otherwise he trauai∣leth in vaine, as saith Paulus, for the perfourmance where∣of, we must ordayne first good dyet, secondly take away the cause antecedent, to witte, the humor which falleth,* 1.13 which shall be done by purging bleeding, according to the cause on the parte: thirdly correct and heale the acci∣dents and indispositions which accompanie the vlcer, these thinges done, hee may come to the curation hereof, as shall be particularly set downe of euery kinde of vlcer, in his proper place.

The second Chapter, of Vlcers sanions and the Curation thereof.

AS in the former Chapter I haue spoken of Vlcers in generall, of their difference, cause, signes and iudge∣ments & cure, so now I will particularly intreat of them. All Vlcers are either simple or composed,* 1.14 with some other maladie, the simple Vlcer requireth onely desiccation, those which are composed, and ioyned with some other acci∣dent, except those accidentes be taken away, cannot heale, for the cure of the which, there are foure Intentions, first in the way of life, which shall bee according to the strength of the sicke, nature of the maladie, & aboundance of the

humors in the bodie, as if the humors be hotte and sharpe, we ordaine colde thinges, The second Intention is, in di∣uerting and intercepting the matter antecedent, which is done by purgations and bleeding if the strength permit, al∣so by frictions, ligators, application of emplaisters, that haue the force to repell the matter. The third Intention is, in correcting the accidents ioyned with the vlcer, as do∣lor, tumor, contusion, excrescence of the flesh, callositie of the lippes, rottennesse of the boane, varice and wormes. First then, wee must labor to take away the intemperie, which shall be knowne by the colour of the member, by the touching and feeling of the patient, which sometime is hotte, sometime colde, which if it be drie, wee remedie it by purgation and bleeding, also if neede be, foment the place with hotte water, till it growe redde, as counselleth Galen: thereafter vse this vnguent made of mallowes, sod∣den in water with a little hogges grease and honney mixed with nutritum,* 1.15 ceratum galeni rosatum, populeon, incorpo∣rate with plantaine water, morrell and housleeke. If the Intemperie be humide, vse vnguents that drie, as pompho∣ligos, de plumbo, cerusa, allom water, vnguent basilicon, citrinum, fuscum de althea: or this fomentation of claret wine in the which hath beene sodden roses, betonie, wormewood, roch allom. If the Intemperie bee cold, we foment the part onely with wine, wherein wormewood hath beene sodden, hyssope, calamint, rosemary, vnguent basilicon & de althea. If the Intemperie be hotte, we re∣medie it by water of plantaine, solanum, housleeke, or vn∣guentum rubrificum cum camphora, or cerat galen: if there be dolor with vlcer, which commeth of intemperie, erosi∣on, of a subtill humor or solution of continuitie, or pleni∣tude of grosse humors, or a flatuous spirite, for the which take vnguent populeon, oyle of yolkes of egges, vnguen∣tum album camphoratum, with other such as are in tumors, if the dolor be vehement, we make a cataplasme narcotick of barly flowre, oyle of roses, henbane, mandrager, poppie,

all sodden in milk, If the dolor be accompanied with tu∣mor, first looke to the cause of it, thereafter, ordayne the dyet straight and cold, bleeding, purging, according to the nature of the humor, with such particular remidies, as ye haue heard in tumors; The excrescence of the fleshe shalbe taken away with ca••ters, rasors, sheeres, pouder of mercur•••• burnt allom, ••••••stum, squama aeris, vnguentum aegiptiacum, apostulorum, vitrioli romani. The hardnes is cured by Remollientes and Resoluentes, as goose, henns, ducke and calues greace, oyle of Lillies, lumbricorum, vul∣pinum, muscilaginis of althea and fenigreci, basilicon, dia∣chilon magnum de muscilaginibus, thereafter scarifie as coū∣selleth Auicen,* 1.16 then put pouder of mercurie or cut it with a Rasor to the soft part. If the vlcer become blacke and Red, scarifie it, and lette it bleede well and applye thinges drying. If it bee accompanyed with Varice, it must bee taken awaye as yee haue heard in the Chap∣ter of Varix. If there be rottensse in the bone, yee shall haue recouse to the proper Chapter. If there be wormes in the vlcer, wee must consume the rottennes and hu∣miditie they are ingendered of, and kill them also, take the decoction of Wormewood, Agrimonie, Centorie, Calamint, which is to wash the vlcers also in the eares,* 1.17 fasting spittle is good for vlcers in the eares, and make the Cicatrize well fauoured with the foresayde dococ∣tiō wash the vlcers, as also with Oyle of Wormwood, the pouder Aloes, mixed with the Oyle of Absynthe and a little waxe is verye good. Millefolum taken the weight of one dramme in white Wine sleaeth the wormes in bellie also. The fourth intention consist∣eth in healing of the places vlcered,* 1.18 which shall bee doone in taking away the impediments as ye haue heard, thereafter, ci••atrize the vlcer with such thinges as are set downe for the consolidation of woundes.

The third Chapter, of vlcer virulent and Corrosiue.

HEre yee shall heare of those two vlcers which are not much different: those vlcers which haue certaine viru∣lencie and venenositie are virulent, but after the bitternes augment and corrodeth the flesh and maketh 〈◊〉〈◊〉 greate▪, it is called corrosiue,* 1.19 or eating vlcer, if eate much of the flesh nor going deepe, it is called ambulatiue, if yet it doth aug∣ment it becommeth in cancer or lupus as yee shall heare. The Cause of these vlcers are euill bilio••s humors sharpe and byting,* 1.20 the which get some malignitie venenositie by their adustion, and happen oft after Herpes, or woundes that haue been irritated by shar•• and byting medicamēts. The C••re is first in the manner of life according to the di∣sposition of the bodie and humors,* 1.21 that raigne, nexte in purging partly for the euacuation of such sharpe humors, thirdly in applying fit medicins on the vlcer, as if it be very humide, the medicaments must he more drying and lyke to the parr, as this, take water of allom or playntine, decoc∣tion of Cypres,* 1.22 Mirabalon, ba••k of Pomegarnet, & such like. If there be great heate in the place coole it by refri∣geratiues & desiccatiues, Guydo for such vlcers vseth a cake of leade rubbed with quicksiluer, vnguentum pompholigos, de minio, or de plumbo, vnguentum rubrum cum camphora, take any of these mixed with a litle tuthiae preparate, plumbi vsti, cerusae lotae, beaten in a morter of lead, with water of plantaine, a little terra sigillata, with a little oyle of Roses, make an vnguent. If the malignitie be great oft the body, is drie and consume these humors, with canters actuall, pouder of mercurie mixed with vnguent rosat, till such time the malice be consumed, thereafter wash it with the decoction aboue specified. If by all these remedies, wee profit not, we vse the thochisces of diandron de musa, arsnic, copporous, vsing alwaies defensiues to repercute the fluxion, which may come through the violence of these remedies. If these be not suffitient Auicen counselleth to cut the member infected and vlcered.

The fourth Chapter, of the vlcer pro∣found and Cauernous.

The vlcer cauernous hath theorifice staight & the bottō broad many cauernes some right, some oblique,* 1.23 with diuers fractuositiues without hardnes & callositie, & so differ from fistules.* 1.24 The cause of such vlcers is apostemes wounds euill healed, in the which the matter hath b••n lōg retayned & the orifice higher than the bottom, as ye haue heard, the party debilitated, so causeth defluxion of super∣fluous humors, not only of the part but of al the body. Thou shalt know these cauernes by the sonde, either of lead,* 1.25 sil∣uer, or a wax candle, & therin cōtained by the iniection if it be white & cernsse, it is cold, if it be subtil & reddish, the matter is hot, those that are easie to heale haue litle matter with diminitiō of dolor & humor.* 1.26 The cure of such vlcers cōsisteth first in the way of life with remedies,* 1.27 according to the quality of the humor & nature of the part vlcered, as al∣so the situatiō, the dolor, intemperie & other accidēts, that entertaine the vlcer. As for the topicall remedies if the ori∣fice be in cōmodious situatiō that the matter may euacuat, by vnguēts emplasters mūdificatiues, de••iccatiues with ly∣gaturs, cōpresses, fomentatiōs & iniectiōs of red wine, if the orifice be high. & the bottom low, the mēber must bee si∣••uat in such fashiō that the nethermost be as ye haue heard in woūds cauernous. If by the situatiō, the matter doth not euacuat or if it be in such places, that it cannot be so situa∣ted, thē make an incisiō frō the orifice to the bottom with mete instrumēts, thereafter appease the dolor, and flux of blood, if it be in such parts that this incision bee not sanely done, thē make an issue in the bottom, & put a seton as in wounds caneruous, or a tent wit some fit medicin, that mū∣difieth as ye haue heard in tumors, or this Rec. mellis lib. 2. viridis aeris 3 5 olei rosati lib. 1. aristolachiae longe, alluminis cerusae an. onc. 1. fiat vnguentū, or wash with wine & honey called mulsum. If the humor bee sanguinolent and euill sauored, wash the vlcer with Oxymell, Allom water or honey, aqua marina, with a little egyptiac. Al∣bucrasis

counselleth to dissolue egyptiac with Hydromell, which mundifieth and corecteth the maligninie. If the matter be subtill and waterie, take barley, agrimony, cen∣tory, worme wood and seeth in honey and vineger, it be∣ing cleansed vse this in carnatiue and glutinatiue,* 1.28 take the rootes of Iris, Plantaine, Agrimony sodden in water and honey. Auicen councelleth the emplastrum catholicon & centorium which is of a merueilous effect in this, put also the emplastrum de minio, di••calciteos or nigrum, composed with galles, honey, pouder of Iris, aloes, mirre and suc••∣like. Togat. setteth a marueilous good medicine to con∣g••tinat vlcers made thus, Rec. decoctionis hordei lib. 1. mel∣lis rosati onc. 3. sacroc••llae d••ag. 2. mirr••thuris an. drag. 1. vini odoriferi onc. 3. bulliant ad consumptionem tertiae partis addendo aloes parū, straine this & put it on & in the vlcers & bynd it vpward, shift it once a day till the vlcer be whole.

The fift Chapter, of the filthy & rotten vlcer.

THese vlcers which are oppressed with abundance of matter thick,* 1.29 tough and euill coulored are called by Guydo and others sordids and filthie, if they augment rot and mortifie the f••esh, vlcered voyding a matter euill sauoured and cadauerous, they are called vlcers putrids. If the malignitie and rottennes continue it is gangren and is called vlcer gangrenous of the which ye haue heard.* 1.30 The Cause is abundance of grosse humors,* 1.31 proceeding of an a∣dustion and ebulition of blood, for the which they become venemous and maligne as chaunceth after carbuncles tu∣mors and woundes euill dressed.* 1.32 The Cure of them con∣sisteth in regiment as ye haue heard in the Chapter of car∣buncle, the vsing of the decoction of gaiac is good to dry vp the humors and eucuat them by sweating. Auicen cō∣mendeth much purging of the bodie to discharge the part of these euill Humors, by medycines mundificatiues,

like as humiditie by drying medicines, by ventouses, scar∣cifications▪ horsleaches, epithems. Topicall remedies are, first to wash the place with hydromell and aqua marina,* 1.33 a∣postolicon or egiptiac and put on the vlcer, applying on it an emplaister de bolo, with cloth wette in oxicrate. If the matter gender in corruption, wash it with oxicrate, water of cenders or white soape, with this emplaister made of salt fish,* 1.34 flowre of aristolochia longa & orobie sodden in wine and put on the sore. If this be not sufficient, take this me∣dicament, quod recipit dragaganti rubri dicti auripigment. onc. 1. calcis vinae alluminis corticis mali punici singulorum onc. 6. thuris, gal••••rum singulorum onc. di. cerae et olei an. quā∣tum sufficit, fiat vnguentum, with defensiues of bol. If for all this, the vlcer augment and grow worse, we vse more strong remedies to consume the putrefaction, as canters actuals, or rasors, or medicaments, that haue vertue to make a scale, according to the saying of Hipp. that which healeth not by medicaments, it healeth eyther by iron or fire,* 1.35 which shall be continued till ye come to the good flesh, and shall be knowne by the colour. Arsenic or vitriol roman is good to separate the rotten from the whole, being mixed with a∣quauitae, honney and egiptiac. If by all these remedies ye profite not, but that the euill doth augment, the parte must be cutte off, for the safetie of the rest, as counselleth Celsus.

The sixt Chapter, of the Vlcer difficill to heale, called Cacoethes.

YEe haue heard, that some Vlcers are easie, some hard, and some indifferent,* 1.36 but those vlcers which heale not after all thinges duely vsed, are called Cacoethickes or ma∣lignes and long in healing, and by Galen, dispulotica. The Cause is, the euill temperature of the bodie, as,* 1.37 if the hu∣mors be vitiated, called by the Greekes cachochymie, or if there bee aboundance of humors, called by the Greekes

plethorie, they must be also euacuated, also that that the cal∣lositie or intemperie in the parte must be taken away. The Signes are,* 1.38 the diuturnitie of the Vlcer, the indisposition and malice of the humor, the hardnesse and callositie of the lippes tumified, there commeth Sanie in quantitie, but thin, euill sauoured, little dolor, sometime healeth, and oft ope∣neth vp againe,* 1.39 chiefely in the feet and legges. As for the Cure,* 1.40 ye must take away the cause and reduce the parte to the naturall, otherwise it is impossible to heale it. If there bee plenitude, cachochymie, intemperie, either of all the bodie, or some parte interne, as the lyuer, the milte, the sto∣macke, or else of the part vlcered about it, vice in the hu∣mor, or some varix, roundnesse and hardnesse of the vlcer: first ye must purge the body, as yee shall finde expedient, bleede if cause require, vse good dyet, eate thinges that in∣gender good humors, vsing decoction of falseperell made thus. Take salseper••ll onc. 4. guiac onc. 1. di. macerentur per noctem in lib. 8. aquae purissimae, bulliat lento igne, ad consump∣tionem mediae partis, addendo in fine saniculi buglossi, pilosel∣lae, pimpernellae, quinque nerui••, ga••••ophillate, consolidae maioris et minoris, capill••rium omnium an. m. di. glicerize rase onc. di. fiat decoctio, capiat summo mane et sudet, et a prandio onc. 4. sine sudore et aliis horis si voluerit. This is a most excellent helpe for all vlcers. If the fault be in the liuer, milte or sto∣macke, corroborate these partes by aduise of the learned Physitian, if the fault be in the part vlcered, eyther beeing tumified with varix & such accidentes, it shall be corrected as in vlcers sanious,* 1.41 as also if it be rounde. If the fault be in the humors which occupie the vlcer, they must be euacua∣ted. All Vlcers which are difficill to cicatrize, must haue the bloud about them euacuated, either by scarrifications or horsleaches and washing it with allom water and such as ye haue heard in vlcer putride. If the parte about the vlcer be blacke, liuide or redde, scarrifie it and euacuate wel the bloud, applying a drie sponge, with medicamentes de∣fensiues, as in vlcers sanious. If the lippes of the vlcer be

callius hard and liuide, it must be consumed with medica∣mentes, if not that way, we••••t the hardnesse to the quicke flesh,* 1.42 and let it bleede well to diuertise the fluxion & inter∣cept the cause of the hardnesse. These thinges all obser∣ued, thou shalt followe out the rest of the cure, as is set downe in the simple vlcer.

The seuenth Chapter, of Vlcer with corruption of the Boane.

THere are some Vlcers, which after they are healed and cicatriced a certayne space,* 1.43 become tumified & sup∣pure and renue the vlcer agayne, which chaunceth when the vlcer hath beene long in healing, maligne, fistu∣lous, gangrenous & cancrenous, by the defluxion of the hu∣mor in the proper substance of the boane, as wee see in the virulence of the venerian sickenesse, the which consumeth the periost, rotteth the boane, and consumeth the bloud,* 1.44 which is the proper nouriture thereof, also application of oyle or thinges vnctuous on the boane, which corrodeth This corruption commeth by degrees: first becomming fat, through the humor which is soaked in it, next,* 1.45 either black or rotten, and is knowne by the mattir that commeth from it, which is viscous and stincking, also great store of spon∣gious flesh, the corruption is also knowne by the sight, not being white as it ought, also by the sounde, not equall but knottie and soft. For the Curation, after remedies vniuer∣sall, let there be vsed a good dyet, purging and bleeding,* 1.46 and vsing this potiō in the morning, not eating foure houres afore, nor three after. Rec. hor dei mundi partes 3. gentianae partes 2. centaureae minoris parta 1. coquantur in vino albo, putting to it a little gaiac, this potion is good for the sup∣puration of the boanes as is learnedly written by Togatius. The particular remedies are of three kinds, that is, rougins,

canters potentiall and actuall, before the application of the which,* 1.47 we must be assured what quantitie of the boane is altered, then incise the vlcer, discouer that which is offen∣ded, and if the rottennesse be but superficiall, we vse rougin till we perceiue the bloud, which sheweth it not to be alte∣red. The boane which is neere consumed, as in the head and such places as be neere the noble partes and ioynts and in the ridge of the backe, we vse also the rougin with this pouder of the rootes of aristoloohia, iris▪ florentiae corticis pini, thuris, aloes, s••oriae, aeris an partes aequales. stampe them in aquauitae and drie them in an ouen, which shall bee done twise or thrise, and lay these pouders on the boane, with the emplaister diacalciteos or betonica: ye may also mixe these pouders with a little honney or aureum. If these thinges be not sufficient, and the alteration be greater, we vse can∣ters potentiall, as oyle of vitriol, oyle of cloues, mercurie, camphire, sulphure, salis, antimonij, incense and such like. But if the rottennesse be great, fat and vnctious, wee apply canters actualls once or twise, to separate the whole from that which is rotten, perfunding till the outmost of the al∣tered thing, which ye shall know, when there commeth no more humiditie: if you continue them longer, you con∣sume the humiditie naturall, which shoulde ingender fleshe betwixt the rotten and the whole, for the which haue good Iudgement. This remedie hath vertue to corroborate and comfort the parte, and drieth and consumeth the euill hu∣mors, and helpeth the separation, the which beeing percei∣ued, shake it by little and little, and draw it not by force: if it be drawne, before the flesh be growne on the whole, the ayre will alter the other also. Of this remedie commeth no dolor, if yee touch nothing but the boane, after the canters are applyed, we vse oyle of roses with whites of egges for the first two dayes, then mixed with whites of egges and fresh butter with honney, thereafter some mundificatiue till the boane bee exfoliated, and then vse the powder a∣boue written mixed with honney, to incarnate & cicatrize,

thereafter consolide the vlcer. If the rottennes come to the marow and the bone be all corrupted there is no remedy, but amputation, except in the head, haunch, and rigge backe, in the which we vse remidies palliatiues as ye haue heard.

The eight Chapter, of the vlcers Cancrous and their Curation.

HAuing intreated heretofore of Cancer in generall, here we will speke of the vlcered,* 1.48 which as saith Guydo is an vlcer round horrible, hauing the lippes thick, harde, ine∣quall sordide, turned ouer, cauernous, euill fauoured, of colour liuide and obscure accompanied with many veines full of Melancholick blood, voyding a matter virulent,* 1.49 sa∣nious worse than the venim of beastes, subtill waterie, black or red. It is so called for two causes as saith Auicen, the one because it cleaueth so fast to the part as cancer to that which it taketh holde of, the other because it hath veines about like the feete of the cancer. The cause com∣meth of the cancer vnulcered, and vlcers euill cured,* 1.50 and by the humors Melancholicke which come from all the partes of the bodie, which do putrifie and heate, so acquir a sharpnes and venenositie and breede cancer. The signes are these, the cancer vlcered is still redde,* 1.51 caue to the pro∣found of the member casting a virulent matter in great a∣bundance, pricking dolor,* 1.52 and irriteth by the application of remidies and operation manuall, so not to bee touched and therefore called Noli me tangere.* 1.53 The Cure generall consisteth in purgation and dyet, as in tumors cancrous,* 1.54 Guydo cōmendeth a potion made of capillars, herbi Ro∣berti▪ scrofuralia, cent••nodie, Treacle and Methridate are good, for they cause venim to come out in the skin. The particular is,* 1.55 if it be in such a place that it may not bee ta∣ken away with the braunches, it shalbe done by incision, canterization, or corrosion and that the blood be all well expri∣med

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out of the veines, thereafter canterize it with such as haue force to consume the euill humor, quoniam in ex∣tremis morbis▪* 1.56 extrema sunt adhibenda remedia. The arsnic sublimat is excellent, for it mortifieth in one day cancers, fi••••ules, and other strang maladies, apply defensiues and anodins, produce the fall of the scale as in the vlcer prece∣dēt.* 1.57 When ye perceiue that there is neither stink nor virulē∣cie, but good flesh, heale it as other vlcers. If it be in any part that it may not be thus handled, or the patient wil not or that it is incureable, wee vse palliatiue remedies, the which consist chiefly in good dyet, abstayning from things contrarie, vsing good things, therafter euacuation gene∣rall purgations, bleeding, applying on the part medicamē∣tis corroboratiues, linimentes and refrenantes to diuert the fluxion with proper medicines as this take the iuyce of sca∣bius & solani an. onc 2. plumbi vsti loti, vnguēti pompholigos an. onc. di. vnguenti albi onc. 2. diacalciteos onc. di. oleum ••mphacinum parū agitentur in mortario plumbeo. There are diuers other proper medicamentes for this effect as succus solani, spima argenti, cer••sae, olei, an partes equales contun∣dantur et agitentur in mortario plumbeo, donec haheant cole∣rem plumbi. When there is great dolor seeth althea in wine and honey putting thereto a little oyle of roses to make a cataplasme,* 1.58 also wash the vlcer with wine, wherein tapsus barbatus hath been sodden. There are diuers vnguents and liniments set downe afore in the tumor Cancrous.

The nynth Chapter, of the vlcer fistulous.

* 1.59FIstula is an vlcer deepe straight, round, cauernous with great hardnes & callositie frō whence procedeth an hu∣mor virulent. Paulus Aegineta saith it is a sinuosity callous not dolorous in diuers parts of the bodye chiefly after apo∣stemes not wel cured & hemorroides, which haue run lōg, as also apostemes hemoroidall.* 1.60 Of it there are diuers sorts the causes are,* 1.61 as in vlcers cauernous, but the humor which proceedeth frō it is worse cōming of an euil phlegmatick & melancholick adust causing a bitternes & venenositie.

The signes are knowne by the sound & by the humor that cōmeth out which is virulēt, stinking,* 1.62 not dolorous except it be neare the nerue.* 1.63 Galen calleth it a siring because it is caue within, Paulus compareth it to the reede,* 1.64 that haue cauities as also Aetivs. The Iudgments some heale easily, some are long in healing, & some are incureable.* 1.65 Fistules with many cauernes are difficill as saith Celsus, those that are nere to any noble part as in the thorax, allo in the blad∣der, matrix & intestins are all perillous & mortall, those in the ribbes, back ioynts are suspect and of difficill curation. Fistules in the fundament, which haue the orifice exterior, are hard to heale,* 1.66 all fistules in bodies euill disposed are of long curatiō. There are diuers sorts of fistules, for some are superficiall, others do penetrate, some a slope, some right, some simple, others composed with one or moe sinuosities,* 1.67 some end in the flesh, some in the bones,* 1.68 and some in the cartilages. As for the cure, we must first cōsider by the iudg∣ment & sound, the deepenes and cauernosities,* 1.69 if it be cal∣lons, and endeth eyther in tendons, cartilages or bones, or penetrateth within, all which things cōsidered we ordayn the way of life & purg the body according to the nature of the humor, therafter corroborate the parts intern with this potiō which hath oft been experimēted by old authos Re. hordei mundi scrofuraliae an. partem vnā agremoniae, centa••••∣re••••, plātaginis minoris an partes duas, aristolochiae partem di. foliorū oli••ae, filopendulae an. partes duas, scindātur omnia mi∣nutim pislētur bulliant in vino albo cum parrū saccari. Of this decoctiō ye shal take a draught euery morning 4. houres a∣fore meate. The particular remedies cōsist in 4. things, first to dilate orifice, if it be stright, which shalbe done by tents of gentiā, briony, spōg prepared, ciclamin if the fistule doth penetrate depe, tie a thread to the tent, the orifice being di∣lated we come to the secōd point to take away the c••llosi∣ty, which is done either incisiō or cāterization, or by reme∣dies causticks & corrosiues, or to cut it with sheres or ra∣sor, or with such remedies,* 1.70 as ye haue heard in vlcers ca∣neruons. If it be profound & such kind of places, where it

may be knit, we put a needle with a strong thread through it, and knit the thread euery day more and more till it bee consumed as ye shall heare in the fistula of the fundament· If it end in the bone and it be filed, it must bee discouered and handled as ye haue heard in his proper Chapter. If it end in the tendons, or membranes, it is dolorous and the matter sanious and clammie, if on the veine or ar••er, yee shall perceiue blood. All these thinges considered if the callosity cannot be taken away by manu••l operatiō we ap∣ply medicamēts caustick, as coūsel our auntiēts, like as tro∣chisces de aphrodellis or pouder of mercurie, auripigmentim or white sope, or a tent couered with arsnic, or with strōg water, or steepe any of them with vineger and distill in the wound, that is good where there are many cauities, for that liquor goeth through all, let it remaine two dayes putting about it refrigeratiues & repercussiues, some canterize thē with canter actuall. Thereafter apply on it to appease the dolor, and to cause the scale fall, oyle of roses, with whites of eggs, as ye shal find in the poore mans guide, til the gret heate bee past, & the scale fallen & that the fistule voideth matter cōmendable, which is a signe, that the caule is abo∣lished. The 3. point cōsisteth in medicamēts mundifitiues & incarnatiues, as ye haue heard in vlcer cauernous. The 4. point cōsisteth in sarcotices or cicatrisāts, as ye haue heard before. If the fistule be incurable, as ye penetrating to a part principall or such other cause as ye haue heard, as also if in curing of it, there come a more dāgerous accidēt, as in the fundamēt hapneth voluntary eiectiō of the matter fecall or cūuulsion, in such we shold not seke the perfit cure, but vse palliatines, as purgatiōs of the humor pituitous & melācho¦lick, mūdificatiues to mūdifie the euil flesh & matter in the woūd, therafter deficcatiues, as diachilon iria••ū, desiccati uū rubeū, diapalma. And this is the cure generall of fistules, as well by medicamēts as manuell operation so now we will shew the maner to cure those in the fundamēt by manuall operation:* 1.71 of the which some are apparent, others not,

hauing no orifice exterior, but either within the great pud∣ding or mus••••e sphinter, this we iudg by the matter that cō∣meth forth, also by the dolor, or some precedent aposteme in these partes, woundes euill cured, hemerroil••des 〈◊〉〈◊〉. As for the Cure, some vse canter actuall, which is in oft dan∣gerous in those parts, some counsel to cutte it with a sharpe instrument which is dangerous for the fluxe of bloud,* 1.72 and cutteth the fibres of the muscle sphinter,* 1.73 which may relaxe the matter fecall at all times. Heere I will set downe, how by the ligator this may be cured,* 1.74 which is more sure & ea∣sie then any of the foresaid: first the patient shall stande on his feete, leaning forward, either on a bedde or chaire, ope∣ning his legges, and continuing them so, till the operation be done. Of this situation ye shall aduise more amply with Paulus and Celsus, in the meane time the Chirurgian shall put his midmost finger in the fundament, to the highest part of the fistule, rubbing it first with oyle or butter, with the other hand he shall passe a sound in forme of a needle, made of siluer, lead or gold, to the ende it plie the better, threed it with a strong threede, rubbe it with waxe or me∣dicament causticke, so it shall cutte the sooner, put the needle in the orifice of the fistule, thrusting it alwayes in, till thou feele it on the ende of thy finger, and if there bee some little membrane betwixt, pearce it through with the point of the needle, that beeing done, thou must plye in a little, and drawe it out that way by the fundament, knit the threede with a running knot, meanely hard, and knit it e∣uery day straighter and straighter, till it bee consumed. If the fistule be hidden, that hath orifice interior and none ••••∣terior, it is more difficill, yet we dilate it with the specu••ū¦an•• not hurting the sicke, so wee perceiue the orifice inte∣rior, and passe a sound pliable, as before in the orifice, with a threede, turning it till it come to the bottome: if it hasse not the force to pearce through, wee make an issue on the ende of the sounde, and knitte the threede, as the other. Further wee must consider, that fistules which are high a∣boue

or in the ring of the intestine, are not to be cutte, by reason the sicke shall alwayes auoyde his mattir. This o∣peration like as diuers rare operations, are most cunningly done by my good friend Iames Hendersome a man very ex∣pert in the art of Chirurgerie in Scotland.

The tenth Chapter, of Burnings.

* 1.75BEcause of Burning and violent heate come vlcers do∣lorous and euill to heale, therefore I will set downe the way to cure such vlcers. Burning is a violence done by the ardor of the fire, hotte water, or some other hotte licour, in diuers partes of our bodie, and make many accidents. The superficiall are subiect to inflamation, the great ones to excoriation and exulceration, those which are meane, haue little blisters on the skinne, in all which is dolor, rednesse, ardor & such like with euident signes apparent to the sight. The Cure is, if the combustion be great, first in the way of life,* 1.76 tending to tenuitie, next in vniuersall remedies accor∣ding to the humors which raigne. The topicall remedies are diuersified according to the diuersitie of the accidentes: Arist. in his first probleme counselleth to holde the place burnt to the fire, and so one heate draweth forth another. Also whites of egges with rose water stay the pustuls, those which are superficiall, accompanied with inflamation and dolor, must be cured with thinges that refresh, as whites of egges, water, vineger, housleeke, lettuce, morrell, plan∣taine, henbane, solanum, roses or the waters hereof distilled and layd on the place with a cloth wette therein. Allom and Ceruse dissolued in Camphire water, is good: these thinges appease the dolor and inflamation, and heale the Burne, also the blades of leekes or onions peeled, with salt, and put on, healeth it maruailously, or lettuce with salt. The rootes of lillies fryed in oyle of roses, or the leaues sodden, will heale it also: if there be blisters, pearce them, if there

be vlceration, vse remedies lenitiues & deficcatiues, as this, oyle of nuttes onc. 3. waxe onc. di. mixe them together and washe them in plantaine water and lay on it. Also leeke leaues sodden in wine, or the iuyce of them with vnguent rosat▪ is good, if the sore neede mundifiyng, take turpen∣tine washed in the decoction of barley, a little syrrupe of drie roses, with aloes and barley meale. The sore beeing mundified, cicatrice it with vnguent populeon, diapom∣pholigos, album rasis, emplastium de minio, or diacalciteos dissolued in redde wine, wette a cloth therein and lay on it. The foresaid remedies must be softly applyed, not touching it with the hand, the oft touching doth iritate and cause fluxion, therefore I haue set downe a secrete in the poore mans guide, to heale all kindes of burning in a shott time, with one emplaister onely, wherewith I haue had good effect, at diuers times. This remedie is very good, easie to be had, and healeth without skarre. Take the barke of an Elme tree, steepe it a night in water, take it out in the mor∣ning, ye shall perceiue a ielly on the inner side of it, wipe off that ielly with a feather, or thy finger, anoint the sore there∣with, and it healeth, as is aforesaid. And thus we ende the Treatise of Vlcers.

Notes

• * 1.1

  Definition.
• * 1.2

  Gal. de causis mo••bor. ca. 10. et cap 4. meth.
• * 1.3

  Signes.
• * 1.4

  Ga••. com. 3 aph et li 1 de offi∣cina medici et 3 de loc••s affectis.
• * 1.5

  Gal. lib. de ••••∣moribus con∣tra natura••••.
• * 1.6

  Iudgme••••s.
• * 1.7

  Lib. 45. apho.
• * 1.8

  Lib. apho. 4.
• * 1.9

  Lib. 1. prog••.
• * 1.10

  Lib. apho. 65.
• * 1.11

  Cure.
• * 1.12

  Celsus lib. 7. cap. 3.4. meth. cap. 5. et 2. Alex. apho pro. 199. lib 1. et com. in apho. 8 lib. 6.
• * 1.13

  Lib. 6. cap. 82. Galen 4. meth. cap. 1.
• * 1.14

  Gal. 4. meth. cap. 1.
• * 1.15

  4. meth.
• * 1.16

  Gal. 4 meth•••• cap. 2.
• * 1.17

  Aetius.
• * 1.18

  Ga. 5. me. ca. 17 et 3. met. ca. 3. Paul. lib. 4. cap 45.
• * 1.19

  Definition.
• * 1.20

  Causes
• * 1.21

  Cure.
• * 1.22

  Gal. li 5. meth. cap. 10.
• * 1.23

  Diffinition.
• * 1.24

  Cause.
• * 1.25

  Gal. ad glanc. ca· 8. et lib. tu∣morū cōtra na¦turam.
• * 1.26

  Cure.
• * 1.27

  Gal. 3. me▪ ca. 8. et 9. et lib. 4. ca 7 et 2▪ ad glan. cap. 8.
• * 1.28

  Lib. 3. met. ca. 3
• * 1.29

  Definition.
• * 1.30

  Fuchius lib· 8. cap. 12.
• * 1.31

  Causes.
• * 1.32

  Cure.
• * 1.33

  Gal. 3. me••h. cap. 6. et 7.
• * 1.34

  Haly abbas.
• * 1.35

  Lib. 7. apho. ••▪
• * 1.36

  Definition.
• * 1.37

  Cause▪
• * 1.38

  Signes.
• * 1.39

  Cure.
• * 1.40

  Gal. 4. meth. cap 5.
• * 1.41

  Hip. lib. de vlc.
• * 1.42

  Celsus lib. 5. cap. 26. Hip. lib. de vl∣ceribus Gal. 4. meth. cap. 2.
• * 1.43

  Definition.
• * 1.44

  HiP. lib. 6. aphor. 45.
• * 1.45

  Celsus. lib. 8. cap. 2.
• * 1.46

  Cure.
• * 1.47

  C••lsus. lib. 8. cap. 2.
• * 1.48

  Definition.
• * 1.49

  Paul. lib. 3. cap. 67.
• * 1.50

  Cause.
• * 1.51

  Signes.
• * 1.52

  Aetius lib. 4. ca 43.
• * 1.53

  Guilliel. de sali ceto.
• * 1.54

  Cure.
• * 1.55

  Gal. 2 ad glane cap. 10.
• * 1.56

  Hip. 6. apho. 1.
• * 1.57

  Gal. 14. metho cap. 10.
• * 1.58

  Gal. Paul. Cels. Actius.
• * 1.59

  Gal lib. tumor. cōtra naturam. Definition. Lib. 4. lib. 49. et lib. 7. cap. 77
• * 1.60

  Cel. lib. 7. ca. 4
• * 1.61

  Cause.
• * 1.62

  Guliel. de sali∣ceto.
• * 1.63

  Signes.
• * 1.64

  Aet••us lib. 6. Gal lib. contra naturam.
• * 1.65

  Iudgementes▪
• * 1.66

  Panlus. Arnold. de villa noua.
• * 1.67

  Difference.
• * 1.68

  Celsus lib. 5 ca. 28.
• * 1.69

  Cure.
• * 1.70

  Paul. lib. 9. cap. 77. et hipp. lib. de locis in ho∣mine.
• * 1.71

  fistule in the fundament.
• * 1.72

  Cure.
• * 1.73

  Albucrafis Pareus. Guid.
• * 1.74

  Hipp. Celsus. Paulus.
• * 1.75

  Definition.
• * 1.76

  ••ure.