The workes of that famous chirurgion Ambrose Parey translated out of Latine and compared with the French. by Th: Johnson

CHAP. X. The cure of an ulcerated Phlegmon.

BVt it often happens, that the humor is so impactin the part, * 1.1 that it cannot be repressed, and so grosse, that it cannot be discussed; which we may know by the greatnesse of the heat and swel∣ling, by the bitternesse of the pricking paine, the feaver, and pulsation, and heavinesse.

Wherefore laying aside all hope of discussing, wee must come to suppuratives. For which purpose Galen sorments the swollen part with water, or oile being * 1.2 warme, or with both of them; and then applies this following cata∣plasme.

℞, farinae tric. vel micae panis, ℥iiij. ol. com. ℥iij, aquae com. quantum sufficit, fiat cataplasma; or ℞, rad. lilior. alb. & altheae, an. ℥iij, fol. malvae, parietar. & senecionis * 1.3 ana. m. j. coquantur in hydromelite, pissentur, trajectis adde farin. sem. lini ℥ij, ••x∣ungiae suillae, ol. liliorum an. ℥iss, fiat cataplasma: Or ℞, malvae, bismalv. violar. an. m. j. caricarum ping. n. x. passul. ℥ij, coquantur in aq. com. tusis, & traiectis, adde n•• ellis com. ℥ij, ung. basilicon. & butyri recent. ana. ℥j, fiat cataplasma. You may pro∣fitably use for the same purpose Empl. Diachylon magnum, or Basilicon. Or ℞, Empl. Dyachil. mag. ℥iij. ung. basilicon. ℥j, ol. liliorum ℥ss. Of these mixed together make a a medicine for the foresaid use.

When the heat, paine, feaver, and other accidents shall remit, when the tu∣mor hath a sharpe head, when by the pressing of your finger you finde the * 1.4 humor to flow as it were to and fro, then you may know that it is ripe.

Wherefore without any further delay the tumor must be opened, lest the matter too long shut up, corrode the adjacent parts, and the ulcer become sinuous and fistu∣lous.

For this usually happens, especially then, when the matter is venenate or maligne, or when the swelling is neare a joint, or at the fundament, or such like hot and moist places.

For by the decree of Hippocrates wee should anticipate the maturation of such tu∣mors * 1.5 by opening.

They may be opened with an incision knise or causticke, and that, either actuall or potentiall. For if the patient shall be hartlesse and lesse confident, so that he either cannot, or will not endure any instrument, you must make way for the matter by a potentiall cautery. You may also doe the businesse by another slight, as thus.

Thrust the point of a sharpe knife or lancet, through a brasse counter that it may stand fast in the midst thereof; then cover it diligently with some Emplaister or Cataplasme, that neither the Patient nor standers by perceive the deceit: then lay∣ing on the plaister as that you would make a passage for the matter by that meanes, but when you have fitted the point to the part, where it is fit to open the tumor, so guide the Counter with your fingers, that you may presently make an impression into the Tumor, sufficient for excluding the matter. I have here expres∣sed three deliniations of such Instruments, that you may use these, either bigger, lesser or indifferent, as occasion shall serve.

[illustration]

Counters with the points of Knives or Lances put through them.

A. shewes the Counter or peece of Silver.

B. shewes the point of the Lancet.

[illustration]

Other Instruments for opening Abscesses.

Rings in which litle knives lyebid, fit for to open Abscesses.

The Deliniation of a Trunke or hollow Iustrument going with a spring.

A. Shewes the thicker pipe.

B. Shewes another which en∣ters and is fastened in the o∣ther by a scrue.

C. The point of the Instrument, looking out.

D. The spring which forces the Instrument.

But there are seven things which must be diligently considered in opening all sorts of Impostumes. The first is, that you put your knife to that part of the Abscesse which is the softer, and yeelds to the impression of your fingers, and where it rises into a head, or point. The second is, that you make choise of that place for dissection which is the lowest, that so the conteined impurity may the more readily flow out, and not stay in the passage. The third is, that it be made according to the wrincles of the skin, and the right fibers of the Muscles lying next under the skin. The fourth is, that you turne your knife from the larger vessels and Nerves worth speaking of. The fifth is, that the matter conteined in them be not evacuated too abundantly at once in great Abscesses, lest thereby the strength be dejected, the spirits being much wa∣sted together with the unprofitable humor. The sixth is, that the affected part be handled as gently as you can. The seventh is, that after the opening when the mat∣ter is evacuated, the Abscesse be clensed, filled with flesh, and lastly consolidated and cicatrized. But seeing that commonly after such sections some part of the Tu∣mor * 1.6 remaines, all the conteined humor being not wholy suppurated, the Chiurgion may perceive that this is an implicite affect, that is a, Tumor and Vlcer. But the Cure thereof must be so, that you take away the Tumor before the ulcer; for the ulcer cannot be healed before the part be restored to its nature. Therefore the sup∣puratives formerly prescribed must be used, and the ulcer must be dressed for two or three dayes with this following Medicine. * 1.7

℞, Vitellum vnius ovi, terebinth. Venetae, & ol. Rosar. an. ℥ss, fiat medicamentum. Then you must seeke to clense it by this following Medicine.

℞ Mellis ro sar. ℥j, Syrupi rosar. & tereb. Venet. an. ℥jss, far. hordei ℥ij, fiat medicamen∣tum * 1.8 ad usum. For this very purpose there is a singular Detersive made of Appium or Smallage of which this is the description.

℞ Succi appij, plantag. beton. an. ℥j, Mellis commun. ℥v, terebint. Venet. ℥iiij, farin. Hordei & Orobi, an. ℥ij, pulveris Aloës, rad. Ireos florent. myrrhae, an ʒj. coquatur mel cum succis, quibus consumptis addantur sarinae & pulveres, & misceantur omnia ad for∣mam unguenti. But if you would clense it more powerfully, you may use Vnguentum Apostolorum; or Vnguentum Aureum and Aeyptiacum mixed according to the scope you conceive in your minds, when the ulcer shall seeme sufficiently clensed, it shall be fil∣led with flesh and cicatri••ed after the manner we shall declare in the proper treatise of the cure of Vlcers.

Notes

• * 1.1

  The signes of a Phlegmon turning to an Abscesse.
• * 1.2

  Lib. 〈◊〉〈◊〉 ad Glau••. Cap. 7.
• * 1.3

  Suppurative medicines.
• * 1.4

  The signes of p•…•… or matter.
• * 1.5

  Hip. lib. de Fistul••.
• * 1.6

  What the cure must be after the opening of the Abscesse
• * 1.7

  Detersive Medicines.
• * 1.8

  Vng••entum de Appi••.