CHAP. XIII. Of an APOSTEME.

I. AN Abscess or Apo∣steme, is an Aggre∣gation of Matter in a mus∣culous or fleshy part, with an intention to break out; the Precursor of which, is always Pain and inflamation: And it is for the most part known by tumour or swel∣ling of the part, with great heat and continual pain.

II. If therefore pain seize any part of the Body, and there be a suspicion that Matter is gathered there; if the Sick sweats, or there be a natural Diaphoresis, especi∣ally about the Face, and the pain yet continue, you may certainly conclude, that Mat∣ter is gathered together in the part, though the Colour thereof be not changed; and Page  65 therefore in its due season it must be opened, that the congregated Matter may be let out.

III. I remember once I was sent for to a little Boy, about ten years of Age, who at play had hurt his Leg: The Child complained ve∣hemently, and almost always cried out, yet no great ap∣earance of an Aposteme: There was no outward dis∣coloring, or inflammation, or scarcely any appearance of a Tumor; but at length a small general swelling over the whole Leg, and the ve∣hement pricking pain was only in one particular part thereof: I applied Matura∣tives or Ripeners, which made the general Tumor more apparent; but the pain equally continued, and the Colour of the Skin was the same as formerly, or as that of the other Leg, without any protuberance, or place pointing out, where it ought to be open'd. When I thought it was time to open it, I did it with an Incision-knife, up∣on the very place of the pain, which was about three Inches, or more, below the Knee, on the outside of the Leg; after opening of it, the Child had immediately ease; and I took out of the Aposteme, of well-digested Matter, about three quarters of a Pint, at several times: And then I cured it after the general method of healing Apostemes. Salmon.

IV. 'Tis true, Guido ad∣vises to 〈◊〉 till Nature causes an Aposteme to break, because he thinks that which is made by Nature, is better than that which is done By Art 〈◊〉 by Experience know otherwise, and, with Avicenna; 〈◊〉 fully of Opi∣nion, That an Apostome which is brought to ripeness, ought immediately to be opened, for that many evils flow from Matter kept too long in the Abscess, and sometimes 〈◊◊〉 seize upon 〈◊〉 noble Parts, in∣fecting the 〈◊〉 and Mus∣cles, and sometimes 〈◊〉 the Bone, to the very great if not irreparable dan∣ger of the Sick.

Page  66 V. And for this Reason it is, That Buboes (in the Plague, or a Pestilential Fever) when they appear, we ha∣sten their ripening with so much vehemency, and some∣times are forced to open them before they are per∣fectly ripe, lest the poiso∣nous Matter should revert inwardly, and its malign Fumes, strike to the Heart, and smite the vital Spirits.

VI. But again on the con∣trary, too much haste ought not to be made to open an Aposteme, before it be throughly ripe, (except in malign Diseases, as aforesaid, and where the hazard of Life, for that Cause is very great, or a Mortification is beginning,) lest a mortifica∣tion of the part (from the Crudity of the Humour, not yet turn'd into Pus) should ensue, or a violent Fever, with sometimes Convulsions; for that such an untimely Operation, does indeed much more excite the pain than the Tumor it self, and causes a new conflux of Humors.

VII. But beside the for∣mer Reasons, for a hasty ope∣ning of the Abscess, these following also conclude it: I. Where the heat of the part is languid or weak, and the Sick wants sleep. 2. Where it is evident, there is is a very great plenty of Mat∣ter, which Nature cannot dispose of. 3. When the Matter is seated deep, thick, and wide at bottom. 4. When it is adjacent to a principal Member, which may be in danger of being hurt or affe∣cted by the malign Fumes thereof. 5. If it be on or near the Joints, lest the cor∣roding Humor, thus detai∣ned, should seize upon, or eat the Ligaments. 6. If it be in a glandulous part, be∣cause they are more subject to putrefaction, and the cut∣ting of them hurts but little. 7. Lastly, If it be upon Bones, Nerves, or Tendons, as in Whitoles and Fellons, which happen to the Nails and Fin∣gers ends, where for want of seasonable opening, the Bone is many times putrified and corrupted, to the losing sometimes of a Joint, some∣times Page  67 of two. So Hippocra∣tes advises, concerning an Abscess upon the Perinaeum: When (saith he) any such little Tumour shall begin, cut it forthwith, while it is yet unripe, lest the suppuration should reach to the Intesti∣num Rectum, or Arst Gut.

VIII. When therefore an In∣flammation with pain is pre∣sent, and that it appears, the Tumor will apostemate, it is necessary to apply Suppu∣ratives, to bring it to a com∣plete maturation or ripeness: Such as this: Take Yolks of Eggs, Honey, Oil Olive, ana two Ounces, Pulp of Figs, Rai∣sons, ana three Ounces; Mi∣thridate four Ounces, Pouder of Aron-Roots, enough to bring it to the consistency of a Pultise, which renew twice a day: Or this, which is stronger: Take Basilicon minus, Ox Gall, Black Sope, soft Hens dung, ana two Ounces; Onions, Gar∣lick, Leeks, ana an Ounce and half; Mithridate, Gum-Elemi, ana an Ounce; Saffron half an Ounce; Pouder of the Roots of Aron and Briony, of the Leaves of Dittany and Rue, ana enough to make it into the consistency of a Pultise. It will bring it to maturation in a short time.

IX. But if you would have the Maturative much stron∣ger, as in those cases where Life is in imminent danger, as in the Plague, and other malign, poisonous, and pu∣trifactive Distempers, you must add to the Compositi∣on, Salt of Tartar, Nitre, Quicklime, Pouders of Genti∣an roots, Ranunculus, Pyre∣thrum, Hellebore, and Mustard∣seed, with other things of like kind, which you must apply, and renew it every twelve hours.

X. The Abscess being now brought to ripeness, or a ne∣cessity of opening 〈◊〉; the next thing to be considered, is, the best way of doing that operation. It is done either by a potential Cau∣tery, or an Actual, or the Knife.

XI. Celsus, lib. 7. cap. 2. saith, If the malady be deep, it is to be considered whether that place be nervous, or no: Page  68 If it be without Nerves, the Actual Cautery, as a red-hot Iron is to be chosen; (because it strengthens the parts it touches;) but if Nerves be near, the Actual Cautery, or Fire, is not proper, for that it is certainly (according to Hippocrates) an Enemy to the Nerves: In this case, you ought to use the Incision-knife, or Lancet.

XII. It remains then to be determined in other cases, whether the potential Caute∣ry, or the Knife is best; or if each at some times are best, which that best is. We will consider, from Barbet, the Conveniencies and Incon∣vonience of each: First, As to the potential Cautery, it has these Convenieneies in it: 1. That it does not af∣fright a faint-hearted Pati∣en. 2. Nor does it cause very much pain, especially if you use the famed Caute∣ry or these times, viz, Dutch Soap mixed with Quick-lime, which eats deep enough to the Flesh, and much more gentle than the Holoserick Cautery of Paraeus: Yet these Inconveniences are apt to attend it: I. It corrodes sometimes much deeper and farther about than is needful, by reason of its spreading, notwithstanding the defen sative. 2. It is some hours; before it perfectly does the operation; which, if the Hu∣mor be maligant, will not permit of it. 3. The Eschar does not presently fall off, so that if you would have the Matter brought forth pre∣sently, you must use the In∣cision-knife or Lancet, for all that; nor is it possible to avoid these Inconveniencies.

XIII. Secondly, As to the Knife, it has these incon∣veniencies; 1. That most Patients are afraid of it. 2. That it is supposed to cause much pain; but the fear is prevented by not speaking of it; and the pain is of no great moment, be∣ing more in name, than in power: yet it has these Conveniences withal. 1. By the Knife, or Lancet, you may make the Apertion as long, and as deep, as you please, or the Aposteme requires. 2. You very quick∣ly come at the Matter, Page  69 whereby it is evacuated, and the Patient eased. 3. The remaining Matter, not yet digested, will be more easi∣ly maturated, by external applications, assisted with Internals. 4. There will not be a long continued gleet∣ing (which often attends Tumours, or Apostems up∣on the Glandules) being opened with Cathereticks. For Apostems behind the Ears, in the Neck, Arm∣pits, and Groins, arise from hardned Glandules, fill'd with preter-natural Hu∣mours: These Glands are covered with a proper Coat, which being hurt, a gleeting necessarily follows; for the Tunicles being broken or opened, the Glandule can neither preserve it self, nor its Humour, but a gleeting will continue so long, 'till the hole in the Tunicle is cured, or the whole Kernel is vanished and consumed.

XIV. The Aposteme be∣ing opened, you must not let all the Matter (if it be much) out at once; for there would be a too great∣spending of the Spirits at one time: But for the asswa∣ging of the pain, you must let out only some part of it; and afterwards make the evacuation by degrees; be∣cause that the remaining concocted Pus helps to ri∣pen that which is yet unripe, if any be; as also to keep the natural heat of the part, to cut, deterge, soften, and dissolve all the Reliques of the Aposteme, beyond the power of any Topick Medi∣cine whatsoever.

XV. When all the Mat∣ter is evacuated at once, it often causes a fainting or swooning, from the excee∣ding great loss of Spirits; the remaining undigested Mat∣ter oftentimes grows so hard and scirrhous, that the Af∣fect becomes incurable, to which Resolvents or Emol∣lients are applied in vain; the first consuming what is thin, leaving the remainder hard like a Stone; the latter, wanting strength and an at∣tenuating force, to divide the Matter into its smallest Particles: Nor can this be done by any thing but the Pus it self, which is both con∣tiguous Page  70 and continuous, with the remaining undigested Humor, being the nearest efficient, and of the same Species, and therefore only and alone able to cut, atte∣nuate, and prepare the re∣maining Matter.

XVI. Therefore, as soon as the Skin grows soft with the Matter in it, the Apo∣steme is to be opened, and, if the Patient be not fearful, with the Lancet or Knife, that such other proper Re∣medy as Nature requires may be applied, lest the pu∣rulent Matter should corrupt other parts or Vessels with∣in; and the Incision or A∣pertive ought to be so large, as the nature of the part, and magnitude of the Aposteme require: Which if it be skil∣fully done, afflicts both less and a shorter time than a Cautery; and immediately also brings the desired help, without any prejudice to ei∣ther side, the Skin being on∣ly cut in a right line; where∣as a Caustick will ('spight of all prevention) extend it self both lengthways & breadth∣ways; whence many times arises cruel pains, and great inflammation, both in the parts immediate, and those adjacent to the Caustick, and so leave a large Eschar; which is not only long in falling off, but the part laid bare, is slowly and with dif∣ficulty restored.

XVII. Moreover, Tumors which keep the native Co∣lour of the Flesh and Skin, and but slowly maturate, sel∣dom grow copped or rise much; (as in our Example of an Aposteme in the Leg, at Sect. 3. aforegoing;) and therefore you must not wait for a head before you open it.

XVIII. If you open an A∣posteme near some internal Cavity, as the Breast, or Abdomen, you must whol∣ly reject Injections made with a Syringe, left some part of it should enter into the Cavity, where it might not only cause grievous Symptoms, but also prove the death of the Sick.

XIX. Apostems in the E∣munctories, Throat, and Page  71 behind the Ears, ought to be opened rather too soon, than to stay for a full ma∣turation; not only because ill Symptoms many times succeed, but Life it self is lost: Of which Fabricius Hildanus gives you some ex∣amples, which are worth noting.

XX. A certain Woman in this City had an Aposteme on her left side, near the Reins of her Back, so that when ripe, it covered partly the Side, partly the Back, and partly the Hip, being as large as an ordinary Four∣penny-loaf. This had been twelve or fourteen Weeks a gathering; several Physici∣ans and Chyrurgions were entertained, and many things were done without any profit to the Patient; nor indeed could they all tell what the Disease was. At length the Aposteme ap∣parently manifested it self; they were then consulted about opening of it, but none of them was willing to do it, they all fearing her immediate death. At length I was sent for, to view it; it was a great and wonderful Tumor, and not without apparent ha∣zard and danger; yet it was my Opinion it should be opened, (for as the Proverb is, While there is Life, there may be hope;) the Patient consented to it, and I did it: There was near two Quarts of digested Matter gathered together; (for the timerousness of the Physi∣cians and Chyrurgions had kept it too long from being opened) this Matter I eva∣cuated by degrees; I took out almost a Pint at the first, (giving the Sick immedi∣ately a Dram, or two, of my Aqua Bezoartica, to support her Spirits,) and in about five or six Days time, the whole substance of the Pus was evacuated. And finding that it had made no inroads into the cavity of the Abdomen, I soon clean∣sed the Ulcer, and in less than six Weeks time left the Patient perfectly well.

XXI. Hence it is to be observed, That though an Aposteme may sometimes Page  72 happen to be in a dangerous place, and withal, through either the neglect, timerous∣ness, or unskilfulness of the Artist, the Apertion has been too long deferr'd, whereby apparent danger is imminent; yet the learn∣ed Physician should pru∣dently put on so much Courage, as to leave nothing unattempted towards the saving of the Sick, so long as there is Life, and the case only doubtful.

XXII. Some Authors say, That Abscesses, or Apo∣stemes may be discussed af∣ter they are suppurated; two Exmaples of which 〈◊〉 brings, Observat. 473, & 474. Where one Pomeret cured a suppurated Apo∣steme in his Daughter, a∣bout eight years of Age. The Aposteme was (saith he) on the out-side of her nether law, on the right∣side of her Face, and sup∣purated. He, (from the Authority of Guido, who saith, That suppurated Apo∣stemes, are sometimes eured by discussion, and from the Experiment of Paraens, who also averrs, that he had cu∣red a suppurated Aposteme, with crude Mercury, mix'd with Diapalma Emplaster, which discussed the same,) he, I say, in imitation of them, mixed a Dram of Mer∣cury, with an Ounco of Dia∣palma, and applied it to the said suppurated Tumor, and within four days he affirms it was perfectly discussed. He also saith, that he did the same thing again on the same Daughter, who having an Oedematous or Flegmatick Tumor suppurated upon the Region of her Lions, as big as the palm of one's Hand, it was discust within a few days by the same Plai∣ster. But in order to the performance of this, it is re∣quired, 1. That the suppu∣rated Matter be small in quantity. 2. That it be thin and serous. 3. That it be near the Skin, and not in any deep part. 4. That it be in a soft-fleshed, strong and youthful Body. 5. That it also be in the Summer sea∣son of the year.

XXIII. These are great Authorities, and so much as Page  73 they may do upon their own score, may force a kind of belief: But a Mind exercised with Reason, and desirous of Truth, can hardly enter∣tain them, besides the hazard and danger that may follow after such an Operation; for where think you must that mass of Putrefaction go, if it be discust? The whole substance of it cannot pass through the pores of the Skin; if any thing, only the thin and watery part can pass: The thick putrified Matter, if it dissolves, must revert either into the Blood or solid Substance of the Flesh, or both; which can∣not but corrupt the Body, and fill it full of ill Humors springing from such a cor∣rupt Seed of Diseases, whence Tettars, Ringworms, Mor∣phew Scruf, Leprosie, King's Evil, Scurvy, Pains, Aches, Lameness, even an Army of attendent Diseases will pos∣sibly succeed. So that if the thing may be possible, I scarce think it prudent to attempt such a Work. Nor does it yet appear by all that these Men have said, that any such thing has been done, for the Tumors not being opened, their Judg∣ments might deceive them; and they may take that for granted, which never was: A very admirable Example of this kind I could instance, of a pretty large Aposteme (as it was thought) by seve∣ral Physicians and Chyrur∣gions, my self being present there also: The Man had been in much pain, but now was pretty easie: The Chy∣rurgeons were for opening of it, as judging it to be sup∣purated; but the Patient's being easie would not per∣mit it; he only kept it cove∣red with a Diapalma Plaster, and in a Months time, the Tumor was discust, and the Sick well. Now I am of Opinion, that here was no suppurated Aposteme. How∣ever, from the aforesaid Ob∣servations of those learned Men, this may be noted: 1. That a Mercurial Em∣plaster applied to several sorts of Tumors, may be ex∣ceeding useful, more espe∣cially if they be not suppu∣rated. 2. That it is possible the wisest Artist may be de∣ceived by appearances in Page  74 Diseases of this kind, where the insides of Things are not seen into, though many times they may judge right. Salmon.

XXIV. Moreover, The declension of the Fibres are heedfully to be observed in opening an Aposteme, that you may not cut cross them: For, as Rolfincius observed, an ignorant Barber opening an Aposteme on the fore∣head, did it cross-ways: 'Tis true, the Ulcer was cured; but the Patient was ever af∣ter deprived of the benefit of his Eyes, except when he pasted up his Eyebrows with Plasters.

XXV. If pain seize any part of the Body, and you fear that Matter is gathered there; if the Sick sweats, and the pain continue, 'tis po∣sitively to be concluded; and though the colour of the part be not changed, yet it must be opened to let out the Matter; which if it be but little, it may well e∣nough, and without any prejudice, run all out at once, which is ready to run with∣out pressing; and pressing indeed is to be avoided, (because it many times does hurt,) unless the Pus or Matter be lodg'd in some re∣mote place from the Orifice.

XXVI. In opening of an Aposteme upon the But∣tocks, you must be careful not to cut the great Nerve which lies under, or lay it bare, lest it be hurt by cold; for thereby it will leave the Thigh for ever after be∣numbed.

XXVII. Sylvius saith, that a∣mong all things which move or promote the excretion of Matter, antimonial Medi∣cines are most to be com∣mended: For (saith he) I have often observed, that they have a Virtue to cor∣rect all Evils brought on the Body by Matter, and to hinder the production of new: Because Antimony is not less serviceable to the purification of Man's Body, than it is to that of Gold, if it be rightfully prepa∣red and administred. An∣timonium Diaphoreticum, more especially Bezoar Minerale) Page  75 stop the continual generati∣on of Matter from corrupt Blood; and any other alte∣rative Medicine made of Antimony, especially the Balsam, made according to Art out of its Flowers. Bal∣samum Sulphuris Anisatum, is also good for the same.

XXVIII. And to this pur∣pose I commend my Ange∣lus Mineralis, or my Piluloe Anglicoe; if given according to the Directions in my Phy∣laxa Medicinoe, Lib. 1. cap. 42, & 53. For they not only stop the Flux of Matter to to the part, hinder the ge∣neration of new, but also dispose the whole habit of the Body, and all Humors thereof to a healing tem∣per.

XXIX. If there be an in∣ward Aposteme, Nature commonly breaks it; yet things proper for the same ought to be given; for which purpose some com∣mend Anisated Balsam of Sul∣phur: When it is broken and become an Ulcer, it is clear∣ly and fully cured by taking for some time or continu∣ance Antimonium Diaphore∣ticum, or Bezoar Minerale, or some other more effectual refined Medicine made of Antimony, whose Elixir, Magistery Essence, or Pow∣ers, will perform things won∣derful, although they seem incredible to most, not on∣ly in curing this Disease, which is dangerous and hard to be cured, but also other like Distempers which may at any time seize the Vi∣scera.

XXX. Some Men com∣mend the Juice of Water-Cresses, as also the Juice of Garden Cresses, strained, and drank, for the speedy breaking of inward Apo∣stemes in the Body. This is good: Take Mustard∣seed, grind it well with Wa∣ter; then with a sufficient quantity of Water, wash out the Virtue from it, which Water sweeten with Ho∣ney, and drink it.

XXXI. To ripen also an external Tumor, you may apply a Cataplasm made of Water cresses, and Garden∣cresses beaten up with Hogs Page  76 Lard: A Cataplasm also of Goose-dung fresh and hot, or of Pidgeons or Hens dung will do the same. Or this: Take Cresses cut and brui∣sed well, Goose dung, Hens dung, Pidgeons dung, ana one handful; Goose-grease eight Ounces; with Pouder of Aron-Roots, make a Cataplasm. See my Synopsis Medic. Lib. 3. cap. 24. sect. 30.