CHAP. IIII. Of the generall cure of Vlcers.
AN Vlcer is eyther simple or compound. A simple Vlcer, as an Vlcer hath one and that a simple indication, that is, exsiccation; and that more than in a * 1.1 wound, by how much an Vlcer is moister than a wound. There are many in∣dications proposed for the cure of a compound Vlcer, in respect of wch Galen would have us to keepe this order, that wee have the first regard of the most urgent, then * 1.2 of the cause, then of that, which unlesse it be taken away, the Vlcer cannot be healed. By giving you an example you may easily understand the meaning hereof. Imagine on the inside of the Leg a little above the ancle, an Vlcer very painefull, hollow, pu∣tride, associated with the rottennesse of the bone, circular, having hard and swolne Lips, and engirt with the inflammation and varices of the neighbouring parts. If you take this to cure before you doe any thing about the Vlcer, unlesse you bee called upon by that which urges, as by vehemency of paine, you must first use ge∣nerall meanes by calling and advising with a Physition; For in Galens opinion, if the * 1.3 whole body require a preparation, then must that be done in the first place; for in some Vlcers purgation onely will bee sufficient; in some bloodletting; others are better by using both meanes, which is as the cause of the Vlcer proceedes from a re∣pletion or illnesse of humors. Now by these meanes having taken away the cause of the Vlcer, you must come to the particular cure thereof, beginning with that which is most urgent. Wherefore you must first asswage the paine by application of things contrary to the cause thereof, as if it proceede from a Phlegmonous distem∣per, which hath long possest, distended and hardned the part, it must bee eased by evacuation. First, bathing it with warme water, to mollifie and relaxe the skinne, that so you may the more easily evacuate the contained humors; then shall you draw away portion of the matter causing the swelling and paine by scarrification, if the patient shall be of sufficient courage, or else by application of hose-leaches if hee be more faint hearted; and then you shall temper the heate there of by applying Vn∣guentum refrigerans Galeni.
To conclude, you shall attempt all things which wee have formerly delivered (in our treatise of Tumors) to take away the swelling thereof. When you have brought this to that passe you desire, you shall come to those which are such, that it cannot be taken away or healed without them, which shall be done by orderly helping the defects against nature which were conjoyned with the Vlcer, to wit, the rottennesse of the bone, which you shall helpe by actuall cauteries; and in the meane while you shall draw the Vlcer into another forme, to wit, cornered, and you shall cut away the callous hardnesse, and helpe the rottennesse. Then must you procure the falling away of the Eschar, and then provide for the scailing of the bone by the meanes formerly prescribed, lastly the mundified Vlcer must be filled with flesh.
For generating of flesh two causes must concurre, the efficient and materiall; The * 1.4 efficient is, the good temper both of the whole body, as also of the Vlcerated part. For this prevailing, there will be an attraction, digestion, apposition and assimulation of the laudible juice to the part affected; verily the laudible temper is preserved by like things, but the vicious is amended by contraries. The matter to bee spent upon flesh, is laudible blood, which offends neither in quality, nor quantity. In this rege∣neration of the flesh there appeare two kinds of excrements, the one more thinne and humide called Sanies, the other more grosse termed Sordes. Both of these for that they are contrary to nature, doe therefore hinder the regeneration of flesh, and therefore must be taken away by applying their contraryes, as by things