The chirurgicall lectures of tumors and vlcers. Delivered on Tusedayes appointed for these exercises, and keeping of their courts in the Chirurgeans Hall these three yeeres last past, viz. 1632, 1633, and 1634. By Alexander Read Doctor of Physick, and one of the fellowes of the Physitians College of London.

A TREATISE OF ULCERS. The second Treatise. (Book 2)

LECT. I. Wherein the Authors, and Definition of Vlcers are set downe.

BEfore I addressed my selfe to discourse of any particular matter belonging to the course of Chirurgerie, I allotted in my first Lecture, foure parts to Chirurgerie: whereof the first was 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which teacheth to unite parts disjoyned.* 1.1 Solution of unity I made two fold: either intelligible, to bee apprehended by reason or understanding, or sen∣sible, which may be perceived by the very senses. The intel∣ligible I named a Tumor, in the which very often no so∣lution of unity doth offer it selfe, either to the sight or

touch, as in many cholericke Tumors, and others in their beginning. Sensible solution of unity, I affirmed either to be in the soft parts, or in hard. As for the solution of unity in the soft parts, I appointed two differences of it; to wit, Vlcus and Vulnus, and ulcer and a wound.

But here,* 1.2 not without a cause, a question may be moved, which of those two, in methodicall proceeding, ought to have precedencie. It is an undoubted truth, that the first man that lost his life was Abel, and that by wounds; so that by all likelihood, men first of all bent their wits to finde out meanes to cure hurts received by externall violence: for the neerer they lived to the creation, the more pure their bodies were, no hereditary diseases being left by parents, if you except mortality by reason of old age, which no man could escape by reason of the sentence of death pronounced for the sinne of disobedience against Adam and his posteri∣ty by Gods owne mouth: and so being little troubled with either inward griefes, or outward sores, they troubled not themselves about the invention of medicaments to cure these; so that by the right of time, the treating of wounds ought to precede the handling of ulcers.* 1.3 Neverthelesse, in our times my opinion is, that the discourse of ulcers, for sun∣dry reasons, [ I] ought to goe before. For first of all, an ulcer doth proceed from an inward Humor corroding, but a wound from an outward instrument dividing: so that a silly Empirick, yea a doting old woman, may go about the curing of wounds in fleshie parts, and compasse it; but to the cura∣tion of ulcers, the knowledge of Humors, and the constitu∣tion of the bodies affected are required, which require a man well versed in that part of Physicke called Physiologia. Secondly, [ II] greater variety of medicaments is required in the curing of ulcers, than there is in the curing of wounds, & so still greater skill is required in the curing of the one than of the other. [ III] Thirdly, greater estimation doth acrew unto those who take upon them the curing of ulcers, than unto those who deale with wounds, and that by all sorts and degrees

of persons, whether they be rich or poore, rude or civill, learned or Ideots; so that I need not to retract my opinion in ascribing unto the tractation of ulcers the precedencie, before the discourse of wounds.

* 1.4In my proceeding, I will handle these ten points: First, I will point out the Authors who have written laudably of this subject. II. I will set downe the definition of an ulcer. III. The causes of an ulcer. IV. The differences of ulcers. V. The generall signes of ulcers. VI. The generall progno∣stickes of ulcers. VII. I will set downe such medicaments as are fit for all ulcers in generall. VIII. Of the generall indications of curing of ulcers. IX. Of their times. X. I will discourse of every particular sort of ulcers.

[ I] To make the tractation of ulcers perfect and compleat; First then to come to the Authors,* 1.5 I meane not to name all who are come to our hands, and have written of this subject; but such as are famous for their skill and experience. Hippocrates and Galen, although they have not left to poste∣rity particular large monuments of this matter, yet when occasion is offered, they omit not to set downe both the in∣dications of curing, and medicaments effectuall to cure. Hippoc. in his 6. Sect. of ulcers and fistulaes. Galen in those excellent bookes of his which he penned, De methodo me∣dendi, Lib. 3. of a simple ulcer, Lib. 4. or an ulcer with ac∣cidents; of the orderly way to cure diseases, for the most part doth illustrate his precepts by examples borrowed from the Practice of Chirurgerie.

If you demand why he did so?* 1.6

I will tell you the cause in Fallopius his words,* 1.7 in his first Chapter of ulcers, Quoniam ut ait Celsus, lib. 7. c. 1. Quum eadem est. Seeing according to Celsus, the meanes which Physicians use in curing, sometimes take effect, sometimes availe not, it may be doubted whether health may be ascri∣bed to the good constitution of the body, or to the meanes applied, but the effect of Chirurgerie is most evident. O pregnant testimony to evince the certainty and excellencie

of Chirurgerie. Let those Physicians who slight the pra∣ctice of Chirurgerie, thinking themselves to be chicks of the white hen only, consider and weigh the weight of this testi∣mony of Celsus and Fallupius in the impartiall ballance of reason. Avicen the chiefe of the Arabick Physicians, hand∣leth this matter in the fourth Booke of his Canon, and the third Treatise: although he doth write confusedly, yet the reading of him will profit such as understand him, and will not be fruitlesse. Albucasis hath some good things, but the number of the trifles are many moe. Paulus Aegineta in his fixth Booke of the Art of curing, onely toucheth some points of this matter, as a dog doth Nilus when he drinketh. Gabriel Fallopius followeth, who hath written an excellent Treatise of this matter; but whosoever shall peruse him, shall finde him in sundry things intricate enough: I will bring him a new companion, but farre surpassing all other moderne Writers, Minadou••, one of the famous professors of that renowned University of Padua, in his three Bookes w^ch he penned of the curing of the deformities of the body of man: whosoever he be who shall go about to make a pa∣rity between these two and others of the late Writers, I shal judge him worthy of Midas his eares, and after that hee hath proceeded, & been promoted in Germany, to be saluted a Doctor with foure feet. To these two Italians, I joyne the German Samuel Hafenrefferus, in his foure Books of the af∣fections of the skin, in whom there are many varities, if one with judgement discerne them. The rest that can be named are of the lower bench, as Guido a Cauliaco, and he who hath onely taught him to speake a little more eloquently, Ioannes Tagaultius, in the third ••ooke of his Institutions of Chirurgerie. Ioannes de Vico accounted the father of Em∣perickes. Marianus Sanctus in the third Treatise of his com∣pend of Chirurgeric, and Angelus Bologuinus in his two Bookes of ulcers, shall beare him company. I must not o∣mit that painful and judicious Chirurgeon Ambrose Parrey, unto whom Chirurgerie is much beholding. Vesalius also

deserveth praise. The two latest who have written are the two Fabricii, Ierome and William: Hieronymus Fabricius in the third Booke of the second Part of his Chirurgicall workes: Guiliel•••••••• Fabricius in his learned Chirurgicall observations, who in this course out-strip all their fellowes. These Authors of all others are most to be perused, for in reading of them one shall become both more understan∣ding, and more able to performe the cures which shall be committed to his care and skill. As for the rest, I leave them unto those who rather chuse to feed upon ackornes, than pure manchet. Riola•• the father, Iaques Guilmeau, Pec∣cetius and Pigra••••, although they deserve their owne praise, yet in my opinion they are to give place to those whom I have named. If any one would mispend good houres, let him read Paracelsus his great and little Chirurgerie, which are like clouds without raine. If you would be furnished with forrests of Chirurgecall medicaments, peruse the Trea∣tise of the learned Hollerius de materia Chirurgica, of Chi∣rurgicall meanes, and Iacobus Dondus in his enumeration of Chirurgicall remedies, both simple and compound.

As for those medicaments which in my proceedings I shall from time to time set downe, they shall not be a con∣fused heape, but a choice of the best approved, to ease you of the labour of election.

[ II] Now are wee to descend to the definition of an ulcer, which was the second point:* 1.8 I will not stand upon the set∣ting downe of sundry descriptions of sundry Authors, and the examination of them, because this labour would take up too much time, and little edifie you, which was appoin∣ted the end and scope of these Lectures. An ulcer in English is deriued from the Latine ulcus, and this from the Greeke 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, because it disjoyneth the part which it possesseth, and so this tearme, in its generall signification, comprehendeth every solution of unity: and so Hippocra∣tes in his Treatise concerning wounds of the head doth en∣title it.

But seeing solution of unity may proceed from two causes, to wit, an externall instrument dividing, and a sharpe humor eroding,* 1.9 according to Galen: there must be two differences of solution of unity likewise according to the same Author, de constit. art. c. 6. Ʋulnus, a wound, procured by an externall instrument, and ulcus, an ulcer, caused of an inward cause eroding. Thus then an ulcer is to be descri∣bed: It is a solution of unity proceeding from an inward cause eroding the part.* 1.10 The subject of an ulcer, I make not onely the fleshy part, (whereby I understand, not onely all the parts which cover the bones) but the bone it selfe also. Unto the ulcer of a bone the Author of the book de constit. art. cap. 6. giveth a peculiar name, calling it Teredo, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which properly signifieth the little worme which pierceth wood, and consumeth it. I see no reason why the name of an ulcer may not be ascribed to the solution of unity in a bone, if it proceed from an inward cause eroding, as the terme of a wound is, if it bee divided by an externall in∣strument, as a sword or hatchet. An ulcer then is a compound disease: for in it there is both solution of continuity, and losse of substance.

LECT. II. Of the causes of ulcers.

[ III] IN the third generall point concerning ulcers is set downe by me the causes of ulcers.* 1.11 These are either an∣tecedent or conjunct: The antecedent causes may be redu∣ced to foure, to wit, Cacochymia, or the evill habit of the body, Contagium, or the communication or imparting of an infecting quality, vapour or humor, by the which an ulcer is caused in any part; a venomous moisture, as in biting and stinging of serpents.

[ I] As for Cacochymia, the speculation of it doth belong un∣to* 1.12

the practice of Physicke: yet in my discourses of Tu∣mors I set downe the signes of every humor, redounding as much as was requisite for any to know, who onely medleth with the practice of Chirurgerie. While any of the three humors (bloud being excepted) in the masse of bloud con∣tained in the veines, is faulty and peccant in quality, it is accounted the cause antecedent of an ulcer. Somtimes these humors are solitary, somtimes they are associate together.

[ II] Contagium, or infection, it is communicated sometimes by a rotten and corroding vapour, and so very often, if one visit often one having Pthysis, such vapours being mingled with the aire, infect the party who visiteth, especially if he draw too neere to the diseased party. So ulcers of the yard come from dealing with women whose secret parts are tou∣ched with venereall ulcers: yea the itch it selfe, and scabbed∣nesse, is gotten by either lying with one troubled with it, or sleeping in a bed where a scabbed person hath rested.

[ III] As for the distemperature of the part, it may be procured either by cold, as appeareth in kibes, or by heat, as we may see in a gangren; because the bloud flowing copiously to the part pained, and not being concocted, it putrifieth and erodeth the part. Last of all, by biting or stinging, as of a mad dog, or a venomous serpent, a corruption of the hu∣mors may be caused, the conjunct cause of an ulcer: so that e∣very humor that is changed from it owne naturall tempera∣ture, whether it be by putrefaction, adustion, or commix∣tion of any thing unnaturall, may procure an ulcer in what∣soever part it seateth it selfe.

* 1.13But the followers of Hippocrates and Galen, speake o∣therwise of these humors than the Chymists doe. The Ga∣lenists, make the three humors of the masse of bloud, to wit, choler, flegme, and melancholy, to be the causes both antecedent and conjunct of all ulcers, if they become con∣trary to nature. So they will have rheumaticke ulcers to be caused of salt flegme, Herpis exedens to be caused of erugi∣nous choler; cancerous ulcers of Bilis atra, which are the worst and most deplorable of all others.

* 1.14The Chymists on the other part, affirme that the dis∣course of humors doth not manifest unto us the essence, and proper nature of any disease. So Quercetan in his ad∣vise of curing the gout, bringeth in the stone, which he af∣firmeth not to be ingendred of the Galenicall humors. Pe∣trus Severinus the Dane in his Idaea medicina philosophicae, or Pourtrature of the philosophicall Physick, wondreth at the folly of those, who make those fantasticall humors, bloud, choler, flegme, and melancholy the causes of diseases: wherefore they out of minerals, salt, sulphure, and mercu∣rie, fetch out the causes of all griefes. Although Galen call sometimes humors salt, nitrous, and eruginous, yet the Chy∣mists have no reason to reject the ordinary names of humors, and to call contumeliously dogmaticall Physicians Humo∣rists, and to deny any disease to proceed from the ordinary humors of the body becomming unnaturall: for seeing that according to Galen 1. de loc. affect. c. 2. that is to be accoun∣ted the cause of a griefe,* 1.15 which being present the disease continueth, and which being removed the griefe ceaseth: and seeing we perceive diseases to be caused of vitious hu∣mors abounding, and these being expelled the griefe to vanish, I see no reason why these humors may not be ac∣counted the true causes of griefes; and that it is a meere folly, and an affection of novelty, to baptize these by names of minerals farre fetched; as to call that which in fevers is cast up by vomit, rather sulphure than choler. Besides this, the Chymists are injurious to dogmaticall Physicians, in la∣bouring to perswade men that they by the name of a hu∣mor understand nothing else, but a waterish substance void of all other faculty, which should be the principles of all bodies,* 1.16 and the causes of all diseases: whereas every ratio∣nall Physician, by the terme of a humor, understandeth a liquid body mixed with bloud: which seeing it is a seve∣rall body of its owne kinde, and is more compound than water, so it hath farre more excellent qualities than water. The Physicians their owne selves have set the Alchymists at

worke, while talking of humors, and the causes of diseases, so much talke of the first qualities, heat, cold, moisture, and drynesse. For although sundry diseases are caused of heat,* 1.17 cold, moisture, and drynesse, yet we shall finde other quali∣ties in the Humor, which may as well hurt the body as these: for Hippocrates in his booke de prisca medicina, or ancient physicke affirmeth, not that which is hot, cold, moist, or soft, to be most powerfull, but that which is bitter, salt, sweet and sowre, unsavourie, and sharpe with some sowre∣nesse; these and a thousand such, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 being exalted in their faculties, he will have to bee the causes of diseases, and not the first qualities onely: and from these the diffe∣rences of symptomes in fevers of this same kinde doe de∣pend. These whilest they are exquisitely mixed in the bo∣dy are harmelesse, yet when one of these is severed from the rest, and is exalted in its quality, it manifesteth it selfe, and annoyeth man; so the corrosive salt doth bewray it selfe in cancers, and corrosive ulcers.* 1.18 Neither is it to be thought absurd, that minerals are in the body of man, for seeing man is fed by plan••s, and beasts, which feed also up∣on the plants; seeing also the herbs have their aliment from the ground, which is not alike in all places, but often is min∣gled with a salt juyce, and other minerall spirits, which the beasts and herbs cannot perfectly convert into their owne substance; one can hardly thinke that a man can live upon these, & have no such thing participate. So we see what va∣riety of wines the diversity of the soiles bring forth; & that in every wine there is tartar or argol, which appeareth also very often in podagricall persons. In vomiting, sundry times substances like to leekes, green, and eruginous, exceeding hot and sharpe are throwne up, which being received into ba∣sins, dry them with a bright eruginous colour. See histo∣ries in Shenki•••• ••ed. obser. lib. 3. ob. 62. in the third booke of his physicall observations, the 62. observation. Michael Dor••••gius lib. 1. de ••edico & ••••••••••ci••a, in his first booke of the Physician and physick reporteth, that a certaine Lawyer

made such urine, as did fret the linings, as if it had beene the spirit of vitrioll; such humors appeare plainly in scabbed∣nesse, fretting ulcers, but specially in a cancer. Wherefore Bertinus is his third booke and eleventh of his Physicke, doth rashly and inconsiderately affirme, that not one whit of mercurie, salt or sulphure, lieth hid in the body; for in the itch, scabbinesse, some catarrhes, inflammations of the eyes, and fretting ulcers it may be perceived; but in urine, which is also an excrementitious humor, the salt may be se∣parate, & presented to the sight: yea, besides the salt in urine, another substance the cause of diseases may be marked: for if you take a cleare urine, and suffer it to settle, a matter like unto the powder of bricke, and sometimes a white muddie substance will so cleave to the sides of the chamber∣pot or urinall, that it can hardly be sometimes washed away; of such a matter tophes in gouty persons, and stones in the bladder, are ingendred.

* 1.19Whosoever shall goe about to reduce the causes of all diseases to bloud, choler, melancholy and flegme, shall wrap himselfe into a number of difficulties: I will desire him to yeeld me a reason, why he calleth salt flegme so, seeing flegme is said tobe cold, but this hot? Why is Atrabilis comprehended under melancholy, seeing it is very hot, but this cold? Besides this, if any Physician goe about to cure diseases procured either by contagion, or poison, without any great respect to the humors, he presently goeth about to minister either a Lexipharmaca, as in the plague which is gotten by contagion, to abate the force of it, and then he addresseth himselfe to the preparation and evacuation of the humors. If poison be ministred to any one in meat or drink, which according to Cardan, commenting upon the 62. aphor. of the 4. sect. may be suspected, if he finde gri∣ping in his stomacke, if he vomit and goe to stoole, if with∣in six houres the akin become greenish or spotted, then An∣tidotes are ministred, and not such as respect choler, melan∣choly or flegme. Let the Humors then which are ingende∣red

in the body retaine the accustomed names, but if an ex∣ternall cause make them degenerate from their nature, let these be distinguished from the ordinary, and have their denomination from that which altereth them. If salt, niter, alome, vitrioll, verdigrease be mingled with any humor, let it be called from the minerall mingled with it, salt, ni∣trous, alominous, vitriolate or eruginous. And for this cause some late judicious Physicians writing of maligne and pestilent fevers, and considering their notable differences, have affirmed some to participate the nature of arsenick, some of mercurie, some of hellebore, some of opium, some of the leopards bane, some of the hemlock, some to partici∣pate of the poison of a viper, scorpion, mad dog and such like, noting the variety of symptomes in sundry per∣sons.

* 1.20One doubt doth remaine concerning the melancholy humor, whether it be onely thin and waterish, as Reusnerus affirmeth in his booke of the Scurvie, exercit. 4. out of sun∣dry places of Hippocrates, who calleth melancholy 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, as in his booke 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, in his booke de worh is, and in his first booke de worh is mulierum, or whether it be thick and ear∣thie, according to the vulgar and received opinion. Before this doubt be solved, some propositions are to be permitted. I. In the Chylus there are two substances, one liquid and thin, the other thick and terrestriall, which can no more nourish than ashes. II. Nature doth mingle these which are not sent away by stoole, with part of the aqueous and super∣fluous humidity caused of drink and liquid meats. So in a lie the falt and some adust parts are so mingled, that they are not discerned before separation.

* 1.21I say then, that this thick and feculent humor tempered with much moisture, is to be accounted the superfluous me∣lancholy humor, and that it is attracted by the spleene. For firt, seeing this feculent humor is altogetherunapt to nou∣rish, it must be separate from the Chylus, which cannot bee performed by any other part befides the spleene. Secondly,

the spleene is of a darker red colour than the liver is, which proceedeth from the thick, feculent, and terrestriall humor which it imbibeth. Thirdily, Hippocrates de aere, aq. & loc. affirmeth, that such persons as dwell in fenny places are sub∣ject to passions of the spleene. The cause is, because the wa∣ters are not pure, but muddie. Fourthly, if the spleene did draw onely thin and waterish humors, it could not bee so subject to obstructions as it is. The feculent humor mixed with much humidity, is the cause of sundry diseases: the thin part sometimes ascendeth to the upper parts, the grosse to the lower parts of the body, as wee see in the scurvie, wherein the gummes are ulcerated, and the legs tumifie. The spleene being spungeous draweth much humidity to it, wherefore spleenetick persons ought to drink sparingly, for if they bib too much, the naturall heat of the part is easily oppressed,* 1.22 and so they become hydropick. The waterish hu∣mor of the spleene is not insipid, but sharpe and biting, and copious: so we see those who are troubled with quartanes, about the end of each fit to sweat plentifully; and those who are oppressed with melancholy to spit much. In the thick, feculent, & terrestriall blackish matter, somtimes there is no excesse of the spleene: in qualities, sometimes there is, and those are two: Acerbitas, an astringent sharpnesse, such as appeareth in greene unripe fruits; and Aciditas, sowrnesse: from these qualities intended and exalted, atra bilis becommeth so corrosive. So much I thought good to set downe of melancholy, to cleare the doubts which are moved of it, and to shew one use of the spleene.

To returne then to the carbonary crue of unlearned Al∣chymists,* 1.23 They object thus, The rationall Physicians af∣firme the body to be nourished by the foure humors, how can they then be causes of the diseases?

It is strange that any men should wilfully shut the eye of the mind,* 1.24 understanding I meane, that they may not see the truth, seeing man, as Aristotle in the very first words of the booke of his Metaphysicks affirmeth, naturally coveteth

knowledge, and witnesses are our first parents to their owne and our losse. No dogmaticall Physician ever affirmed any disease to be caused of any humor of the body, as long as it continueth in its owne naturall estate; but then to stir up griefes, when it is separate from the rest, when it doth putri∣fie, when forraigne substances and qualities are added, which make it of a familiar humor, a prosessed enemy to health, consisting of the natural constitution of the body, resulting of the laudable commixtion of the foure humors naturall. I have insisted somwhat long in the setting down of the cau∣ses of ulcers, because he (whosoever he be) that goeth about to cure ulcers without the knowledge of the causes, is like one, who being blindfolded, is set to thrash a cocke.

LECT. III. Of the generall differences and signes of ulcers.

OF the ten Points, within the limits of which I resolved to include all my discourses of ulcers, in my former Lecture I dispatched three; in the first I nominated the prime Authors, who have written of this subject: in the se∣cond, I set downe the description of an ulcer: in the third, I discoursed somewhat largely of the causes of ulcers in ge∣nerall.

Now the fourth Point, concerning the differences,* 1.25 and sundry sorts of ulcers, offereth it selfe to be handled, and in truth the course of nature so requireth: for the forme of every particular ulcer doth spring from the cause conjunct of the same: for example, a cancer ulcerate is discerned from all other ulcers by its proper and pathognomonicall signes, all which as effects, are ascribed to Atra bilis, im∣pacted in the part the cause conjunct of the same.

Here of purpose I omit the idle and fruitlesse distinctions of ulcers,* 1.26 set downe by sundry Authors, which neither bet∣ter

the understanding, nor further the curation. These on∣ly I will set downe, * 1.27 which are matteriall. The matteriall differences then of ulcers are taken either from the nature or constitution of an ulcer, or from the subject or part af∣fected. From the nature and constitution, an ulcer is either simple or compounded.

In a simple ulcer, nothing is offered which may stay the Chirurgeon from going about the consolidation of it, as the cause conjunct, a cruell symptome, adjuncts, or some disease.

* 1.28A compound ulcer wherein either some of these, or all are found, which must be removed before unition be procu∣red, is either of the milder sort, or maligne.

The more milder sort of ulcers yeeld to ordinary and usu∣all medicaments, if they be judiciously applied.

The maligne yeeld not, and besides have fearefull symp∣tomes: those maligne ulcers proceed either from inward, or outward causes.

From internall causes spring a cancer ulcerate, Phageda∣na, Nome, fretting ulcers, and others which are called Chi∣ronia, or Telephia, which denominations insinuate nothing unto us concerning the nature or curation of an ulcer, but bring onely unto our memory the names of these who are celebrated by Poets, which belong more to Grammarians than Physicians or Chirurgeons to be knowne.

The externall causes which procure ulcers are two, to wit, Contagium, contagion, or a venomous quatity, vapour, or humor, comprehended under the name of Venenum, or poison.

* 1.29The differences taken from the subjects or parts affected are two, for either an ulcer possesseth the outward part, and is called Externum, or outward, or it afflicteth the inner parts, and is named Internum, or inward. Other differences are taken from the continuance, figure and quantity, are here impertinent, and further only predictions, of the which I will speake in the prognosticks of ulcers.

* 1.30As concerning the signes of ulcers, an internall ulcer is found out and discerned by the excretion or matter expel∣led. As for example, if the urine be purulent we conjecture the kidneyes or bladder to be ulcerate.* 1.31 If purulent matter be voided by coughing, it is like that the lungs are ulcerate; if much of such matter be rejected, and signes of an apo∣steme have gone before, it is an apostematous ulcer; if the purulent matter be but little, and no signes of an inflam∣mation have beene noted, then it is but a primarie ulcer proceeding of erosion, by reason of a sharpe humor separa∣ting the unity of the substance of the lungs. These internall ulcers I will leave to the consideration of Physicians, unto whom they are most commonly presented to be cured, who very often purchase fees with no small discredit to the Art and themselves. Onely I will set downe such things as tend to the curation of ulcers of the externall parts. I need not to busie my selfe about the setting downe of the generall signes of such, seeing they are presented to the view of the Chirurgeon by the parties grieved. Onely let me give you warning, that you mistake not a wound for an ulcer: into this errour you may easily fall, if you admit the most ordi∣nary description of an ulcer, set downe even by judicious Physicians and Chirurgeons; which is,* 1.32 that it is a solution of continuity in a fleshy part, yeelding quittor; it skilleth not, they think; Whether it be laudable or illaudable. It is strange that there should be set downe no other difference between a wound & an ulcer, than this, that the one is blou∣dy, and the other purulent. Doth not, I pray you, a wound become purulent of it selfe, although no Chirurge on deale with it, and may not an ulcer become bloudy if incision be used, as it may dayly be seene? Frivolous it is also in my judgment, that a solution of unity inflicted by an instrument that woundeth in a bone, as a sword, may be caned a wound, and that a solution of unity in a bone, procured by an ero∣ding humor, may not be termed an ulcer.

Seeing the causes conjunct make the true differences of

an ulcer and wound:* 1.33 which are an externall instrument divi∣ding, & a sharp humor eroding the parts. Who can imagine that in a venereall ulcer, wherein these is corruption of the bone, there should be two sorts of ulcers specifically diffe∣ring, to wit, one in the fleshy part, and another in the bone, the same humor causing both.

But a solution of unity in the bone by a corroding is cal∣led Teredo, say they.

What then?* 1.34 Must a maligne ulcer in the face, because it is called Noli me tangere, be exempted out of the list of can∣cerous ulcers?

No.* 1.35 Let this then be accounted an undoubted truth, that a solution of unity procured in the body by a humor e∣roding, whether it be in the flesh or bone, may be, yea ought to be called an ulcer, as a solution by an instrument separa∣ting, is called a wound in both.

LECT. IV. Of the generall prognisticks of Ʋleers.

NOw I am to descend to the sixt point touching Ul∣cers,* 1.36 proposed by mee in the beginning, which is of their generall prognosticks.* 1.37 The consideration of these will make one circumspect, when an ulcer is offered to him to be cured, in the election of his cures: for whosoever ta∣keth in hand a griefe uncurable, hee discrediteth himselfe, and causeth the art to be contemned by those, who are sim∣ple and ignorant, imputing the error of the practicer to the insufficiencie of the art. [ 1] Let this be the I. praediction: an ulcer in a body of an evill complexion which may bee con∣jectured by the colour of the skin, if it bee of a tallowie whitenesse, yellow or swartish is not easely cured: for it is likely, that corrupt phlegme, vitellin choler, and feculent melancholie doe abound, which humors hinder the rege∣neration

of flesh: but by the contrarie, an ulcer is easily cured in a person of a good complexion, who digesteth well and doth not increase superfluous moisture. [ 2] II. ulcers in bodies, which are either very moist or drie are hardly cu∣red. This is plaine in the bodies of hydropicall persons, and those which ars aged, for as superfluous humiditie con∣trarie to desiccation hindereth the healing in those: so in these the defect of radicall moisture. [ 3] III. ulcers in chil∣dren by reason of their excessive humiditie, and in women with child, because the most laudable part of the blood is turned to the nourishment of the child, are not easely cu∣red. IV. ulcers which fall out after criticall apostemes in the spondils of the back, [ 4] or great joynts of the body, for the most part are mortall: because after sicknesse, and aposte∣mation, nature must be exceedingly weakened, the naturall heat much abated, and the radicall moisture almost spent. Such apostemes doe fall out when as sharpe fevers end not crittically in the decretory daies by some evacuation, as blee∣ding at the nose, vomiting, sweating, purging by stoole and urine, but extend themselves to the fortieth day. [ 5] V. If the place wherein the ulcer is seared be blackish, blowish, or greenish, it hardly can bet cured: for the bloud must bee naughty, and the flesh corrupt. [ 6] VI. Ulcers of around fi∣gure are cured with difficulty, the reason is this, Consoli∣dation is procured by unition of the parts; now the farther the parts are asunder, the more slowly it is procured: but a round figure, of all other within the same bounds, is most ample. VII. Painfull ulcers in children are dangerous, [ 7] because their bodies being raw, and the spirits subtill, they are easily spent, which is the cause that they are much wea∣kened, and so disposed for death it selfe. [ 8] VIII. If an ulcer become either blewish or pale, the party being ill, death is not farre off; for these colours shew the mortification of the part; and drynesse sheweth that the naturall moisture is gone. [ 9] IX. If an ulcer be cōplicat with a disease which main∣taineth it, the ulcer, according to the nature of the disease,

is either of easie or hard curation. So a venereall ulcer in a succulent and strong body is easily cured, but if the party be in a Marasmus, neither the ulcer nor the disease can be cured; because the use of desiccatives, which onely availe in these infirmities, will onely hasten death increasing the ex∣tenuation of the body: in like manner ulcers in hectick and hydropick persons are hardly cured; in these because super∣fluous humidity hindereth desiccation of the ulcer; in those because laudable juyce floweth not to the part ulce∣rate. X. If tumors in ulcers suddenly vanish without any evident and manifest cause, [ 10] as bleeding, or application of a discussive medicament, they portend no good: but convul∣sions; if they appeare in the hinder parts, because the Spins is very nervous: and madnesse, pleurisie or suppuration if they were red, [ 11] and in the forepart. XI. Soft tumors in ul∣cers are laudable, because they will yeeld to medicaments, but hard, not easie to be cured, because the humor is more rebellious. [ 12] XII. If the haires fall in places of the body about the ulcer, it is an evill signe: for then there must be great a∣crimonie, and corruption of the humors, as in quartane a∣gue••, the pox, and leprosie. [ 13] XIII. If in an ulcer where there is cariosity of the bone, the colour of the flesh be of a livid colour, the party must be in danger: for it is a signe of the extinction of the naturall heat. [ 14] XIV. Ulcers which afford quittor, which is white, smooth, and uniforme, and not stinking, promise an easie cure, for these qualities in the quittor, shew the dominion of the naturall heat, and the soundnesse of the solide parts. [ 15] XV. A flux of bloud com∣ming in an ulcer after strong pulsation is ominous, accor∣ding to Hippocrates Sect. 7. aph. 21. for there must bee a strong phlegmon, and the arteries must be much pressed, so that a gangren may be expected: howsoever of such furious bloud no flesh can be regenerate. [ 16] XVI. If an Erysipelas ap∣peare, the bone being bare, it is no good signe, Hipp. Sect. 7. aphor. 19. for neither can flesh be regenerate by such a sharp humor as this, [ 17] that causeth so hot a tumor. XVII. From

maligne ulcers two forts of quittor flow; One thin, and it is called Ichor, or Sanies; such a virulent matter issueth also from the pricking of the nerves, and corruption of the pe∣riostion. The other sort of quittor is thick, and is called Sordes. [ 18] XVIII. In ulcers which have continued a twelve∣moneth or longer, the bone must be scaled, and the skinning be hollow, Hipp. lib. 6. aph. 45. But to make good this Apho∣risme of Hippocrates, some conditions are required: The first is, that much flesh above the bone be not in the part ulcerate. Secondly, the humor which floweth to the part must be very corrasive. Thirdly, it must not have beene dealt withall by any Physician or Chirurgeon. If one or more of these conditions faile, the Aphorisme must misse of its pre∣diction. What Galen and late Writers have set downe in the explication of this Aphorisme, cleare not the truth of this Aphorisme: onely these conditions set downe by me doe. The signes which leade you to the knowledge of a bone corrupted are these: 1. If the ulcer having beene skinned,* 1.38 breaketh out again, for it is likely that the bone casteth out an ichorous substance, which is the cause of this recidivation, 2. If the ulcer yeeld more and thinner matter then the big∣nesse of it requireth. 3. If the brims of the ulcer will not come in. 4. If the brims become reddish. 5. If the bone, being presented to the sight, it appeare rugged, and of a blackish colour, not smooth, or a ruddy white colour. XIX. Whatsoever ulcers cast out much Sanies or Ichorous matter, [ 19] which is too thin, of a leady, pale, or black colour; or glutinous, or stinking, and which fretteth the skin adjacent, are hard to be cured, for this humor keepeth the ulcer moist, and cannot easily be dryed, even if you apply powerfull Topicks. XX. Inveterate ulcers which cast out a quittor, [ 20] called by the Grecians 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, like unto white oyle, are hardly cured: for this signifieth a colliquation of the part, and an extenuation of the rest of the body.

LECT. V. Of the generall curation of ulcers and their times.

HAving set downe the generall prognosticks of ulcers in the sixth Point, now the seventh Point concerning the generall method of curing of all ulcers doth offer it selfe.

The universall curation of ulcers is comprised in this one proposition: All ulcers ever desire desiccation, so Hippoc. in princ. Lib. De ulcer. & Galas. Lib. 3. method. c. 3. for whether we goe about to ingender flesh, or to seale up an ulcer by cica∣trization, desiccative medicaments are still required.

* 1.39There are foure times to be observed in ulcers.

• ... [ I] I. Principium, the beginning; In it the quittor is thin and waterish.
• ... [ II] II. Augmentum, the proceeding; In it the quittor flow∣eth more sparingly, and thicker.
• ... [ III] III. Status, the consistence; In it there is no ichorous matter, but 〈◊〉〈◊〉, yet somewhat thinner it appeareth.
• ... [ IV] IV. Declinatio, when the ulcer is in the mending hand, then laudable Pus sheweth it selfe.* 1.40 It is white, being altered by the naturall temperature of the veines, arteries, nerves and membranes, whose substance is white. Secondly, it is uniforme, not grumous or cruddy, naturall heat working equally upon every part of it. Thirdly, it is without all ill smell, seeing the naturall heat hath corrected all the evill qualities of it.

* 1.41The curation of ulcers is performed by two meanes: The 1. is the removing of the causes antecedent. The se∣cond, is the artificiall dressing of them.

* 1.42The causes antecedent are foure: Cacochymia, Conta∣gium, Venenum, and the distemperature of the purt.

[ I] The ill habit of the body is to be removed by alteration and evacuation, if the humor abound.

[ II] Contagion is to be overcome by Alexipharma.

[ III] Poison is to be contemperate by Aeidota.

[ IIII] The distemperature of the part is to be removed by things contrary unto it. And that we may the more easily attaine to these scopes, a convenient order of diet must ever be pre∣scribed.

The cause conjunct, which is the eroding humor,* 1.43 that is setled in the part, is surprised by such medicaments as sute for the foure times of an ulcer before mentioned by.

* 1.44In the beginning then Suppuratives or Digestives are to bee applied. First, because the matter which hath left the vessels, and hath insinued it selfe within the porosities, putrifieth: wherefore it ought to be concocted, that it may become laudable quittor.

Secondly, good flesh cannot be procured by sarcoticall medicaments, unlesse the matter be concocted; for so the ulcer is made apt to admit the generation of flesh. These Suppuratives ought in the first qualities to be proportio∣nate to the temperature of the part unto the which they are to be applied, so to parts hot in the first or second degree Suppuratives hot in the same degrees are to be applied: for if they exceed, they are so farre from strengthening the na∣turall heat, that they rather pervert it, making it aguish and unnaturall: if the part be temperate let temperate Suppura∣tives be applied.

* 1.45But Digestives ought not to be applied, First, to putride ulcers; for seeing Suppuratives are hot and moist, if they should bee applied, [ I] they would cause the greater putrifa∣ction.

[ II] Secondly, they are not fit for rheumatick ulcers, for such medicaments relax the part, and make it more subject to re∣ceive the matter that floweth, and so a tumor might bee caused. And as Suppuratives are to be applied to the parts ulcerate, because the humor which is hot and sharp would inflame the part if it were not suppurared and cleansed.* 1.46

Sorepelling Topicks are to be applied to the parts about

the ulcer to repell the matter which floweth. [ I] I. That the heat of the Suppurative medicament draw nothing from the parts adjacent.

[ II] II. To strengthen the parts that they may resist fluxion.

[ III] III. Because by the repelling of the humor, the desicca∣tion of the ulcer is furthered.

[ IV] IV. Because the heat of the part ulcerate is intended and strengthened, it being kept in by the coldnesse of the repelling medicament.

* 1.47And for as much as I affirmed that ulcers alwayes require desiccation, it is not amisse to mix with the Suppuratives some driers, yet that in the beginning the Suppuratives have the upper hand, but in the end the desiccatives.

After that the ulcer is well digested, and yeeldeth lauda∣ble quittor,* 1.48 Mundificatives are to be applied: for if you ap∣ply farcoticall medicaments, before the ulcer is well dige∣sted, spungeous and naughty flesh will grow, which will admit no cicatrization. In mundifying we must not use too sharp medicaments, for these may cause an unskilfull Phy∣sician or Chirurgeon to beleeve that it is a corrosive ulcer. The paine which the Patient feeleth in the part ulcerate wil bewray this errour. These three scopes being compassed to overcome the cause conjunct, nothing remaineth, but to seale up the cure by cicatrization.

* 1.49Seeing most ordinary ulcers proceed from fluxion, it is to be withstood, First, by Revulsion. Secondly, by Repul∣sion. In Revulsion, wherein the matter is drawne to parts farre distant, the rectitude of the part, and vessels is to bee observed. So if the ulcer be in the right leg, Revulsion is to bee procured in the right arme, if you respect the rectitude of the part; but if you consider the rectitude of the vessels, Revulsion is to be used in the left leg, if the ulcer be in the right: for so the communion of vessels is kept.

* 1.50Revulsion is performed by attractives, and these are three; Heat, paine, and the shunning of vacuity. Hot thing which procure attraction, are hot inunctions, and baths: straight

ligatures cause paine; but both paine and heat are caused, Ventoses, and Vesicatories. Fontanels attract by reason of the shunning of vacuity; for they sending out sill some sub∣stance, some other must bee drawne to fill up the place of that.

Repulsion, wherein the humor is stayed in its passage,* 1.51 is performed by applying those medicaments, which common∣ly are called Defensives:* 1.52 these medicaments are astringent and cold, and rather dry than moist in ulcers. Now that you may know whether you proceed according to Art in the curing of ulcers, receive this Aphorisme:* 1.53 When medica∣ments applied to ulcers doe good, or at least hurt not, it is a signe that they are convenient; but if they doe harme, by making the ulcer hotter or colder, drier or moister than is fit, then you may gather that such are to be changed,* 1.54 and their contraries applied.

* 1.55To conclude this Point, nine things make ulcers hard to be cured.

• I. The defect of good bloud in bodies extenuate.
• II. The impurity of bloud in cacochymicall persons.
• III. Is the filthinesse of the ulcer.
• IV. Soft and cadaverous flesh about the ulcer.
• V. The malignity of the humor.
• VI. The hardnesse of the brims of the ulcer.
• VII. A secret cause in the aire of some places, they be∣ing hot and moist.
• VIII. When the bone is corrupted.
• IX. The application of unfit medicaments.

LECT. VI. Of the medicaments be fitting ulcers in generall, and first of repelling medicaments.

NOw at the last I am come to the last generall Point, set downe by me in the first Lecture concerning ul∣cers, of the which I intended to discourse, which is, of the medicaments befitting ulcers in generall. I meane to spend this Lecture upon this subject, to the end that you may be so furnished with good and approved medicaments, as that you shall not need either to envie or wonder at such as brag of secrets.

It is not unknowne to your selves how many sawcie and malepert Empiricks there are here in London, who basely and irreverently speak of those who are skilfull indeed, and deserve well of the Art of Chirurgerie, (purchasing unto it credit, and to their owne selves profit and renowne, by their methodicall and successefull practice) and so impu∣dently boast of their secrets, and exalt themselves as if they had no forehead. But surely it is to be thought, that there is too great a distance betweene it and their tongue, that the forehead cannot stop the tongue from uttering Thraso∣nicall speeches of themselves: it is great pity such are so countenanced as they are. The Magistrates let them pro∣ceed in their extravagant courses, thinking it not fit for an Eagle to stoope to a gnat. The ruder and ignorant sort, ra∣ther consider the promise, than the performance, thinking that there can be no cloud without raine.

That you may be the more able, not only to encounter with these confident cowards, but to overthrow them also; I will endevour, according to that talent of skill which I have, to furnish you with competent both Theorie and Practice. It is a shame for a Chirurgeon not to be furnished with admira∣ble

variety of medicament, seeing nature hath beene so pro∣vident for him. Turne your eyes whither you will, and be∣hold the fertility of nature, and you shall see and finde that in her works she hath not beene unmindfull of you. As for plants, you have Dioscorsdes and Galen, yea all who have written of them, witnesses; that the greatest part of them have fallen to your share. As for the things which lie hid in the bowels of the earth, as metals, spirits, marcafites, doe they not serve your turne? The metals for your instru∣ments, the rest for your medicaments. Let no man think then, that a skilfull and industrious Chirurgeon can by his Art performe no other cures, but such as may be compassed by the compositions in his Salvatory. These he must have in readinesse, other medicaments he is able to fetch out of the treasure of nature, which he hath at his command. This I will make good by the setting downe onely those medica∣ments which are known to belong to the curation of ulcers. Of these there are two orders or rankes: for some serve for ordinary ulcers, some for those who have a malignity an∣nexed. Those that serve for ordinary ulcers are of five sorts, for some are Repelling, some Digesting, some Mundifying, some incarnating, and some Cicatrizing, and the Medica∣ments which performe these offices, are either simple or compound.

The Simples repelling are these that follow.

Of these, some are of an Aqueous substance, as Water it selfe, Lettice, all sorts of Succorie, Knot-grasse, Horse-taile, Perwinckle, Nightshade, Comfrey, Purselaine, Navell-wort, House-leeke, these foure yeeld not their juyce easily; where∣fore they must be beaten in a mortar, and some verjuyce, vineger, or juyce of Quinces mingled with them. There be some Simples not so wa••••rish as these are, as the Plantane, Millefole, Vine-leaves, astringetred Wine, Verjuyce, Vi∣neger, the fruit of the Barberry, the fruit of the Quick∣beame,

Sloes, Mirtle-berries, Pomegranate-rindes, and Flowers infused in red Wine which is astringent, Tanners Woose, which will be more effectuall if these Simples to∣gether with red Rose-leaves dryed be boyled a little in it; but the Woose must be taken when it is newly made, and before any leather be put in it. The Leaves and Apples of the Mandrake, the Henbane, the Leaves of Stra∣monea, she black Poppie, and the deadly Night-shade are more cooling than the former, but they must be left before the part become livid, or of a leady colour. If you use the juyces or decoctions of the aforesaid Simples, which you shall be enforced to do, if the curation of ulcers and wounds be presented unto you, being in the countrey, where no A∣pothecarie is by whom you can be furnished with medica∣ments which are fit to repell, then you mist apply to the parts adjacent to the ulcer, pledgets of wooll or tow moi∣stened in them, then above these stups of linnen or woollen cloathes, according to the temperature of the party, and season of the yeere, moistened in the same and wrung; are to be applied.

Last of all, the part ulcerate is handsomely to be rowled, the rowler having beene moistened in these juyces or deco∣ctions. One thing is to be noted, that it is the best course still to mingle some astringents with those which have a waterish juyce: for as these coole best, and represse the flu∣xion and inflammation, so these by wrinkling of the skin repell more effectually. As you rowle up fractures, so must you rowle parts ulcerate. Of this kinde of rowling I will speak in its proper place.

The compound medicaments that repell are these.

I. Oyles, as the Oyle of Roses made of greene Oyle, the Juyce of unripe Grapes, and the Juyce of red Roses, boyled together over a simpering fire untill the Juyces be consu∣med. Last of all, infuse some Roses picked in the Oyle: the

Oyle of Mirtles, the Oyle of Quinces, the Oyle of Mastick, the Oyle of Henbane, Poppie, and Mandrake. The sallet Oyle whereof these compound Oyles are made must not be old, or rank. If an inflammation hath possessed the parts adjacent, use not Oyles▪ for they are easily set on fire.

II. Cataplasmes, made of the aforesaid Juyces, and Bar∣ley-flowre, with some of the aforenamed Oyles, or Bole, Terra sigillata, or Amber tempered with some of the afore∣named named Oyles, and whites of Egges beaten, Vineger, or Ver∣juyce.

III. Unguents, as Triupharmacum, Ʋnguentum album, Camphoratum either of it selfe, or mingled with Vuguaz∣tum Populeum.

IV. Emplasters, as Emplastrum de minio, the Sope Pla∣ster, Diapalma made with the juyces of Plantane, Horse∣taile, Knot-g••asse, Yarrow, Comfrey, and Perwinkle. When you make your Diachalcithes, reserve one part for the juyces, which must be added by litte and little, as you bring your Emplaster to the consistence. This medicament is second to none.

Of Suppuratives or Digestives.

Being furnished with medicaments repelling, which are to be applied to the parts adjacent to the ulcer to hinder fluxion, you are to looke for medicaments which are to be applied to the ulcer it selfe: Amongst them Suppuratives of∣fer themselves first; Those as the former, are either simple, or compound.

The Simples are these, which are to be temperately warme and moist.

The flowre of Wheat and Barley, Swines-grease, sweet Butter, Capons-grease, Calve-tallow, ripe Oyle, black Ro∣sin, the juyce of the flowers of white Lilies, the pulp of

Figs, and Raisins, the mucilage of the Marsh-Mallow, Fe∣nugreek, and Linseed: these are convenient, if any hardnesse or callosity be in the ulcer, Saffron, Bird-lime, Pitch, Sto∣rax, Galbanum, Gummi & Lemni, the Burre-Dock, Meli∣lot, the Flowre deluice, new Wax.

of Compounds.

Tetrapharmacum of the Ancients, which is made of Pitch, Rosin, Wax, and any of the forenamed fats; Dial∣thaea simplex, Basilicum majus & minus, Vuguentum aureum; if a little Mercurie precipitate washed in Plantane, and Rose-water, be mingled with these unguents, as a scruple with an ounce, they will be the more effectuall: for the pre∣cipitate doth excellently thicken and digest any ichorous matter. Above these, applied unto the ulcers, either upon Lint or Tow, lay Emplastrum diachylon simplex in the sum∣mer, and Cum gummis in the winter, if the brims of the ul∣cer be hard: otherwise use your Diapalma cum succis, for there is no Emplaster comparable to this.

Of the aforenamed Simples, as your Flowers, or Meales, Pulps, Mucilages, and Juyces, you may frame unto your selves sundry Suppuratives, according to the temperature of the party, the condition of the ulcer, and season of the yeere. Let this be an example, Take of the pulp of Figs and Raisins, of each one ounce, of the Mucilage, of the Marsh∣mallow, Linseed, and Fenugreek, of each two drams; of the juyce of the flowres of the white Lilly, two drams and a halfe; of Barley-meale, three drams; of Saffron beat to powder, halfe a scruple, make up a medicament. This is powerfull in callous ulcers.

Of Mundificatives.

When the ulcer is well digested, which you shall conje∣cture if the quittor be somewhat laudable, if the brims of

the ulcer be soft and well coloured; and lastly, if you finde no ill damp to rise from the ulcer; then you are to addresse your selves to the application of Mundificatives, for if you use sarcotick or incarnative medicaments before mundifica∣tion, onely loose flesh will arise, which will admit no cica∣trization.

The Simples that mumdifie are these.

Aristolochia or Birthworth, whereof there be two sorts, the long, and the round; Horehound, Smellage, Vitrioll calcined to rednesse, Verdigrease, Orpiment, Arsenick natu∣rall and sublimed, ☿ sublimate and precipitate, the yellow Turbit, if you use it before it be washed, it is as powerfull as Arsenick, or Mercurie sublimate; but much more safe, for it dispatcheth its operation sooner, causeth not so great in∣flammation, and is more familiar to the body of man. Ho∣ney also mundifieth, Savin, Cockle-shels burned, Alome burned or calcined, the flowre of Verches. All Vegetables calcined mundifie, by reason of the salt in the ashes, but some more powerfully than others, as the ashes of Tobac∣co, the Vine-stalkes, and the stalkes of Beanes: joyne to these, the juyce of Celandine, the root of the Cuckow-pit, Wormewood, Centorie the les••••, Cardum benedictus, the Beete, Colewort Gentian, bitter Almonds, Scordium, the white and black Hellebore.

Compound mu••difying medicament.

l. 15. of Fabricem ab aqua pendente: ℞ Terebinth ʒij. sy∣rup. Ros. Vel mel res ℥ss suci apii, ℥iss farin. hord. & lupin. aq. q. s. ut inspicentur. That which is call Paracelsus mun∣dificative, is second to none: It receiveth these things, Take of Honey iiij ℥. Of Turpentine ij ℥. Boile these with a very soft fire, until they come to the consistence of a solt ••••∣guent; then take them from the fire, and mingle with it the

yolke of an Egge; incorporate all well together. If a foule ulcer be offered unto you, mingle with an ounce of this un∣guent a dram of Mercurie precipitate, washed with Plan∣tane and Rose-water, and you shall finde it to excell all o∣ther Mundificatives. In the shops you have Vaguentum Ae∣gyptiacum, and Apostolorum: Aegyptiacum is good to bee injected into sinewous ulcers, being mingled with White∣wine, and Melrosatum: Vnguentum Apostolorum is best for plaine, and superficiall ulcers. If you mingle with your Basilicum and Aureum precipitate, mingled with Alome calcined, you shall have a medicament which will both di∣gest and mundifie. Take of your precipitate two parts, and one of Alome, and grinde them upon a Painters stone un∣till they come to an impalbable powder. Of the enumera∣tion of these medicaments you may gather of what quali∣ties Mundificatives ought to be. They are drying without astriction, without any notable cold quality, or great heat; but of a subtill substance: by reason of the drynesse, they consume the humidity of the ulcer; and by reason of their siccitie & tenuitie, they take away the glutinousnesse of the quittor. These must not passe the second degree of dry∣nesse; otherwise they would consume the flesh it selfe. Ex∣tersion then is the removing of filth cleaving to the ulcer, by drying of it, and abati•••• the viscosity by the which it cleaveth to the part.

Of Incarnatives.

When the ulcer is sufficiently mundlfied, which you shall learne of Celsus lib. 5. cap. 20. If the ulcer appeare red, sen∣sible and cleane, and neither too dry nor too moist, then it is sufficiently mundified: but by the contrary, if it appeare pale or whitish, or of a livid or blacke colour, and want sense, and bee either too moist or too dry, then it is not cleansed sufficlently. These signes may be seene in a plaine and open ulcer.

* 1.56But you may aske, how shall we know when a sinewous ulcer is sufficiently mundified?

* 1.57Galen will tell you, l. 4. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 cap. 2. That you shall con∣jecture a hollow ulcer to be cleane, when the part begin∣neth to be more sensible of the mundificatives than it was before.

When these signes of sufficient mundification appeare, then you must goe about the incarnating of the ulcer. And al∣though incarnation be the effect of nature principally, that is, of the temperature of the part, from whence the faculty of the part, the cause of all the ordinate actions of the part do flow: yet it is requisite that the Physician & Chirurgeon should help nature now, being weakened by the griefe, by removing the impediments and lets which hinder the na∣turall constitution of the part. Nature when shee is in her vigour cannot totally convert the aliments into the sub∣stance of the solid parts, but after she hath had a care of the preservation of them, hath a task to expell both a waterish or thin, and a thick excrement by the pores of the skin to the outward superficies of it, (as is manifest in the mor∣phew,) when she is disabled by a solution of unitie, much lesse can she effect her purpose, where of the thin excrement a humid ulcer is procured, but of the thick a sordid. Where∣fore if you will goe about to cure an ulcer, you must labour to dry the humid ulcers by desiccatives, and the sordid by mundificatives: and because in all solution of unity, nature is ever vigilant and busie; and in ulcers to regenerate flesh, in perfecting of which work, these two excrements must be separated; it is manifest that there cannot be one mo∣ment defigned in the curing of ulcers where drying and mundifying medicaments are required. Now medicaments indued with these two qualities of desiccation and mundi∣fication in a temperate degree, are called Sarcoticall or In∣carnative Medicaments.

The Simples are these.

S. Iohns. wort, the Clownes-panax, Millefoile, Knot∣grasse, Horse-taile, the garden and mountaine Avens, our Ladies-mantle, Sanicle, Salomons-seale, fresh Gales, Barley∣flowre, Mastick, Myrrhe, Aristolochia rotunda, Harts-horne calcined, Bones calcined, Sarcocol, Rosin, Pitch, Gummi Elemni, Butter, Turpentine, Swines-grease, Sheepes, Goats and Deeres-suet, sweet Tallow, Olibanum. Frankin∣cense, the powder of Snakes and Adders: these most effectu∣ally. The greene Tobacco.

The Compound are these.

And amongst the first of these, suffer me to commend un∣to you this of mine: Take of Swines-grease eight ounces, of Rosin iij ℥ of Wax, and Gummi Elemni, of each one ounce, of the juyce of the aforesaid Vulneraries one pound, of the leaves of Tobacco stamped two handfull: boyle all these over a soft fire untill the juyces be consumed, then straine the Unguent. Make triall of this, and leave it when you have found out a better. You have in the shops Vnguen∣tum Basilicum majus & minus, and Aureum set out with glorious titles: and why not, seeing the Farthing-tokens beare the Armes and Crowne. I will shew you anon, how these cannot fit all bodies: Vuguentum de tutia is in much use. You may use these compositions if you will, or you may frame unto your selves, of sarcoticall simples, such compositions as you shall think most fit for your purpose.

But let me warne you,* 1.58 that your Incarnatives must not exceed the first degree in drying: yet seeing there is a lati∣tude in this degree, for some are milde, some more harsh; you are to apply them according to the constitution of the party, [ 1] temperature of the part, [ 2] and the quality and quanti∣ty of the ulcer it selfe. [ 3] So if the party be of a tender, and

soft constitution, milder driers are required to ingender soft flesh: but if a party bee offered to you to be cured, who hath a firme and dry flesh, more strong desiccatives are to be applied. If the ulcer be in a place not so fleshy, as in the joynts, the beginning or taile of the muscules, then your desiccatives must be forcible. Last of all, if the ulcer be large and moist, more strong desiccatives are to be used in it than in small and not very moistulcers.

When you goe about your compositions of Incarnatives for ulcers, observe these rules: The first is, that they bee neither too soft, nor two hard; for if they bee hard, the weak part cannot easily take benefit of them; if they be too liquid, the heat of the part will cause them to spred, and fall from the ulcer: besides these are apt to ingender spun∣geous flesh.

The second is, that they be smooth, and equall: other∣wise they will cause paine in the part.

Of skinning medicaments.

The ulcer being filled with good and laudable flesh, now are you to skin the part ulcerate. Nature in the wombe doth frame first the skin, but it being afterward lost by any accident, she cannot repaire it any more lacking seminall matter: wherefore here, there is need of the help of Art to supply this defect. This is done by hardening and thicken∣ing the upper part of the flesh regenerate, untill it be able to supply the office of the skin.

The Epuloticall medicaments which bring this to passe, must be, I. Cooling, for so the thin parts are wrung out, and the thick parts are brought together, as we may see in the ice.

II. They must be drying, for these consume the thin parts; so the hands of Saylers, and Felt-makers, become dry and hard. Then a Cicatrix is nothing else,* 1.59 but flesh thick∣ned, dryed and made callous.

* 1.60These medicaments ought to be drying in the third de∣gree: for incarnatives are dry in the first degree, because they only are to dry the excrements, which are superfluous in the generation of flesh. Glutinative medicaments are dry in the second degree: for they are not onely to dry the ex∣crements, but whatsoever else floweth to the part, although it be alimentary. But Cicatrizing medicaments are dry in the third degree: for these are too dry not onely excre∣ments, and what floweth from other parts; but the naturall humidity of the part it selfe also. But Cathereticall or cor∣rosive medicaments are drying in the fourth degree: for these consume not onely the excrements, and that which floweth to the part, and the naturall humidity of the super∣ficies of the part;* 1.61 These Epulo∣ticall medicaments are in the like maner simple or cōpound.

The Simple are these.

Aes ustum, Lead made to powder, the Amalgama of Lead and Quicksilver beat to powder. When you would make this melt two ounces of Lead in a Crucible, then take it from the fire, and put to it an ounce and a halfe of ☿, these will incorporate together: when the masse is cold you may beat it to a powder. The Pumick-stone, and Cuttell∣bones calcined, Stags-horne calcined white, all Bones well calcined , the dead of Vitrioll after the spirit is drawne, well washed and dryed; it is called by the Chymists, Henri∣cus Rubeus, and indeed it is a potent desiccative. Talke powdered is good; to drive it into powder, you must rub it upon a broad file somewhat fine, and then searce it; other∣wise you shall hardly doe it. Terra sigillata, Bole-Armeniack, Umber, are good; and unslaked Lime, well washed and dryed, Alabaster beat to powder, Minium, Litharge, Ce∣russes, Calaminaris, Tutia, the Regulus of Antimonie, Crocus Martis, Gales, Pomegranate-flowers and rindes, the Comfrey roots, Sandarach of the Grecians, Egge-shels calcined, the roots of Tormentill and Bistort, Swines-grease, Deeres and Sheep-suet.

Skinning Compound medicaments.

Sundry very effectuall medicaments may be made of the aforesaid Simples; wherewith I meane not to burden you at this present, onely I will commend unto you one of Fal∣lopius, and another of my owne. That of Fallopius is thus described, ℞ ol. ros. & ol. ompliacin. an ℥vj. ol. myrtin. & unguent. popul. an. ℥iij. fol. plantag. & solan. hortens. incis. an. man. 2. Bulliant ista ad consumpt. succorum ac colentur: colaturae adde cerae ℥iiij. Spatha liguea misceuntur: Quum incipiunt frigere adde, lytharg. aurivel argenti ℥vj. cerussae ℥ij. tutiae praparat. ℥ij. plumbicalcinati ℥i ss. Ducantur ista in mortarie plumbee per hor. 2. The ingredients doe shew what is to be thought of this medicament. That which I use is this, ℞ sevi evilli lib. ss. axung. porc. ℥iij, cera, verni∣cis, colophon. an. ℥ij. liquescant istasimul. Amotis ab igne ac coeuntibus adde, litharg. auri, cris usti, tutiae praeparat. Hen∣rici rub. an. ℥ss, calaminaris, ℥j. fiat ceratumexl.a. You have in the shops Diapalma, Emplastrum de minio, Vnguen∣tum comitissae, Desiccativum rubeum, & Emplastrum contra rupturam Fernelii. Now seeing amongst these, some doe more weakly, some more strongly dry, the gentlest are to be applied to tender and moist bodies, but the strongest to solid and hard bodies: wherefore neither are milde skin∣ners to be applied to the bodies of clownes, and artificers; nor strong to the bodies of children, and dainty women: to these use Emplastrum album coctum. Before I conclude this Point, two things are to be set downe: the first is, when these Epi••oticall meanes are to be applied. Secondly, how they are to be applied.

As for the first, they are to be applied before the flesh be even with the skin, according to Galen 13. method. cap. 5. otherwise the cicatrix will be higher than the natulrall skin, which will cause deformity: wherefore they are to be ap∣plied while there is some cavity.

As for the second, seeing alwayes in skinning there is left a greater cavity in the middle, than about the brims of the ulcer, stronger desiccatives are to be applied to the brims, but milder to the middle, that the flesh be not too soone dryed. Wherefore powders and cerots are to be ap∣plied to the brims, but onely cerots or unguents to the middle. When you have cicatrized an ulcer by methodiall proceeding, there bee some persons, who will not rest so contented, as Ladies, who make much of their skins, and whores, who gaine much by theirs; but will desire to have the Cicatrix made by any meanes somewhat beautifull to the eye. I will furnish you with two medicaments, that you may be the more enabled to fulfill their defires.

The first is this, ℞ unguent. rosat. Mesuis ℥j. ol. de Been. ʒij, talci pulv. ʒiij. fiat li••ementum.

The second make thus, ℞ Axung. porc. aqua furum fabar. lotae ℥j. spermatis ceti, ʒij, ol. amygdal. dule. ʒi ss. talcipre∣parati ʒij ss. fiat linementum.

Every night a little before bed-time anoint the Cicatrix with some of either of these linements, and apply a soft lin∣nen rag moistened with the same.

LECT. VII. Of the curing of a plaine and hollow ulcor, being Simple.

HAving passed thorow the ten points whereof I inten∣ded to speake, before I was to meddle with the curing of any particular ulcer, now it is time to deseend to the set∣ting downe the method of curing of ulcers in particular. I would have you to call to remembrance the materiall dif∣ferences of ulcers delivered by me in the third Chapter, which were taken either from the nature and constitution of an ulcer, or from the parts affected: from the nature of

the ulcer I deduced two sorts of them: some I called sim∣ple, some compounded. Now the simple ulcer is to bee ac∣counted such an one, as hath neither a disease, cause, or symptome annexed to it, or complicate, besides the solution of unitie caused by crosion. Of these simple ulcers there are two kindes: for some are plaine, and equall to the naturall skin, wherein only the Cuticula and Cutis are lost.* 1.62 Some are hollow, cav••, wherein besides the Cuticula and the Cu∣tis, a part of the flesh is lost. It is not needfull severally to set downe the curation of ulcur planum, or aequale, a plaine, or even ulcer; because in prosecuting the indications of cu∣ring of ulcur cavum, a hollow ulcer, I must set downe the meanes of curing a plaine one: for this is contained as a part in the other.

Seeing then there are two affections in a hollow ulcer,* 1.63 to wit, solution of unitie; and cavitie, three scopes of curing offer themselves, unition, incarnation, and cicatrization. Wherefore if the quittour be white, smooth,* 1.64 small in quan∣titie, reasonable thicke, and not evill smelling: If besides the ulcer it selfe be red, and sensible, then we may goe about to gender flesh, by applying sarcoticall medicaments: But by the contrarie, if the Pu•• bee blacke, uneven, grumous, rough and stinking, and if the ulcer it selfe bee not red and sensible, the ulcer cannot be incarnate, before it be prepared by suppuratives and mundificatives.* 1.65 Besides Pu•• which is reasonable thick, three sorts of excrements appeare in ulcers.

The first is thin, watrish, [ I] like to water wherein flesh hath beene washed: this hath received no alteration, but hath flowed pure, as it is in the veines and flesh; this is called Ichor. The second is thin too, [ II] but it hath received some al∣teration by the temperature of the part, this is called Sanies, or Virus. The third is verie thicke and glutinous, [ III] and is called Sordes.

Now the excrements which are thin moysten the part ulcerate, that it cannot sufficiently discharge it selfe by breathing out the humiditie. Wherefore Desiccatives are

to be used to consume this superfluous moysture: but the excrements which are thick cleave to the part, and hinder the addition of flesh.* 1.66 These are met withall by abstersives or mundificatives. The ulcer being prepared by suppura∣tives and mundificatives, you are to ingender flesh by inca∣nating medicaments.* 1.67 There are two causes of this flesh which is to bee procured: 1. Is the efficient cause: This is nature it selfe not onely of the whole body; but of the part it selfe also, which is called Temperies, the naturall tempe∣rature or constitution of it: whereby it attracteth, conco∣cteth, applyeth and assimilateth the nourishment to it selfe. 2. Is the materiall cause: this is sincere and pure bloud. If the part ulcerate enjoy such, then nothing remaineth but to maintain it: If the bloud be not pure, ••hen it is to be altered, if it be too hot it is to be cooled, if too cold it is to bee war∣med, if it be too thin it is to be thickened, if it be too thick it is to be attenuate; if there be too great plentie of it, it is to be diminished; if it be too little, then it is to be encrea∣sed by convenient order of diet.

* 1.68To come necrer to the curarion of a simple ulcer: First, we must discreetly order those things which are called not naturall: seeing a convenient diet preserveth and maintai∣neth the good constitution of the whole body, and tempe∣rature of the part:* 1.69 Wherefore all those meats and drinke which make the bloud too hot, too sharp, too thin, or too thicke, are to be shunned, and those onely to be permitted which afford good juyce, and are of easie concoction, espe∣cially if the diseased partie be tender and weake. Besides this they must be taken moderately, and at convenient times. The part it selfe must bee kept quiet:* 1.70 for motion hea∣teth the part. Care also is to bee had of sleeping and wat∣ching: for as watching dryeth the body, and consumeth superfluous humiditie, so sleeping moysteneth the parts; but those chiefly which are nervous or sinewie, as mem∣branes, tendons, ligaments. If then the ulcer be humid, en∣joyne watching; if it be drie, command sleeping. As con∣cerning

vacuation of the excrements, let it bee appointed that they may answer in quantitie the food which the dis∣eased partie taketh. If he prove costive, either minister unto him a glyster, or give him an ounce of Electuarium leniti∣vum in chicken broth. As perturbations of the minde change the state of the whole body, so the tranquillitie of it maintaineth the same. A speciall care is to be had of the aire; for it wonderfully preserveth the temperature of the part. Southerly and Northerly winds or not fit for ulcers: for as the first moysteneth and heateth, so the second doth much coole and dry: but cold is an enemy to ulcers. So it is observed that the aire in Angieu is hurtfull to ulcers in the legs, but in Paris good. So in Pise and Ferrara it is hurt∣full; but in Florence wholsome.* 1.71 As for the prognosticks of simple ulcers: If I should set downe any, you might justly thinke I did abuse the time: for there is none so sim∣ple, who may not gather out of the verie denomination of them, that they are most easie to bee cured, and that great skill is not required to compasse the same: onely let mee give you warning that the cure may be either more easie, or hard, according to the nature of the part ulcerate, and the diet of the patient. So simple ulcers are more easily cured in a fleshy part, than in the joynt or a nervous part; for in these stronger desiccatives are required, and in them the na∣turall heat is not so powerfull to make use of the medica∣ments applyed. In like manner a simple ulcer is more easily cured in the body of a temperate person, than it is in the bo∣dy of one given to deboshry. Having set downe the right use of the things not naturall, as diet, sleeping and watch∣ing, evacuation of the excrements, the perturbations of the minde and aire, I am to deliver unto you some locall medi∣caments for the accomplishing of the curation of these ul∣cers, according to the generall indications of curing set downe in the fifth Chapter.

As for the digesting, mundifying, and incarnating of a simple ulcer if it bee hollow,* 1.72 these intentions and scopes

shall be performed by the application of my Basilicum: The description of it is this: ℞ Cera & resin. an. ℥vj. picis nava∣lis ℥iiij. gummi Elemni ℥ij. Ol. Olivar. ℥v. & semiss. vernicis clare ℥iiij. Seviovill. ℥ij. Terebinth. ℥iiss. Olib. mirrh. pultae an ℥j. fiat unguentum ex l. a. If you make triall of this you shall finde it not a little better than the ordinarie two bea∣ring this name, to wit, Basilicum magnum and parvum: If an hollow simple ulcer prove sordid, mingle with an ounce of this my Basilicum two scuruples of the cathereticall power made of Precipitate and Allom calcined: or if you apply Paracelsus mundificative tempered with the same, you shall haply mundifie it; but if a plaine or equall ulcer be uncleane, the yellow Turbith or Precipitate washed, be∣sprinckled, and covered with a pleadget of lint will serve. A∣bove these medicaments apply Diapalma cum succis, and above this a double cloth moystened in red astringe wine, having some Allome dissolved in it. If you be in the coun∣trey, apply to the parts adjacent to the ulcer, clouts moyste∣ned in the juyces of cooling and astringent herbs, as Plan∣tane, Garden Night-shade, Knot-grasse, Purselaine: If you a••bint these parts with: Triapharmacum, and Vuguentum po∣puleam mingled to gether, you shall prevent fluxion and in∣stammation.

When you have filled an hollow simple ulcer with flesh,* 1.73 nothing remaineth but to cover it. Now the cover of the flesh is the skin it selfe: and as the flesh lost is to bee repai∣red, so that which covereth it. But seeing the skin is framed in the womb of a seminall matter, it being lost it cannot be restored by reason of the defects of matter: Wherefore we must finde out another cover. This cover is called by Artists Cicatrix: This is nothing else but the uppermost Superfi∣cies of the flesh so dried, that it doth represent the skin. And as in ingendring of good flesh in the ulcer, laudable bloud was the materiall cause of it, so good flesh is the materiall cause of the Cicatrix.* 1.74

This Cicatrix is procured by three meanes, by nature it

selfe, the aire, and epuloticall medicament. [ I] That nature hath an hand in this businesse it doth appeare many wayes: for we may see daily ulcers skinned with these same medica∣ments by Empiricks, which they used in incarnating: so that nature must bee the chiefe efficient cause. Secondly, many times a scab covereth such ulcers being incarnate, which being removed, or falling away of it selfe, the place appeareth skinned: onely nature is the cause of this: for no medicament was applyed. Thirdly, if nature had not a hand in this businesse, such an order would not be observed, that the brims of the ulcer should first be skinned, and then the middle. Fourthly, nature worketh in her actions to the period appointed: so in an ulcer shee not being hindred fil∣leth the ulcer with flesh even unto the uppermost Superfi∣cies, which being done she ceaseth from affording any more matter of flesh, whereby it commeth to passe that the upper Superficies being deprived of further nourishment must be∣come dry.

[ II] What power the aire hath, doth manifestly appeare in the bodies of infants newly borne, their whole skin is soft and red: the cold aire afterward doth repell the bloud, drieth the skin, and maketh it more hard.

[ III] But seeing nature verie often in such an action proveth slow, so that if you should wholly rely upon her, and expect her leasure, you should seeme of purpose to protract time, & be indanger to lose your patient, it is the safest & best course to aid nature by bringing to aid convenient & good epuloti∣call or skinning medicaments. In the monuments both of ancient and moderne writers one shall finde great varietie, whereof notwithstanding a discreet and judicious choyse must be had, if hee meane to make good use of them; for I dare bee bold to affirme, that there are almost infinite de∣scriptions of medicaments, where of the: first describers ne∣ver made any triall, but set them downe, being inducell onely by imagination. And amongst these medicaments, you shall finde not a small number, which are either ••idicu∣lous

or superstitious,* 1.75 or both. Seeing then the case so stan∣deth, I will onely commend unto you three medicaments fit for ••kinning of simple ulcers: The first is, Diapalma cumsuccis. The second my Epuloticum, which I described in my former Lecture. The third shall be Heuruius Spara∣drop. The description of it is this, taken out of his Method to Practise Lib. 1. pag. 81. of the Leyden edition. ℞ ol. om∣phacin. & axung. porcin. an. ℥iij. lythargyr. auri vel argent. ℥iiij. cerussae ℥j. Goq. ista lento igne ad emplastri consisten∣tiam: tum: adde cerae, picis an. ℥i ss. colophon. ℥ij. plumbi pul∣verizati ℥i ss. fiat emplast. see. art. Sparadrops made of this, not onely simple ulcers, but parts of the body excoriat by reason of long lying in bed caused of weaknesse brought by chronicall diseases.

LECT. VIII. Of the Compound, but milder ulcers, in generall

IN my former Lecture, I set down what did belong to the curation of simple ulcers, as well plain, as cave or hollow, wherein no other offence besides the losse of the skin and flesh is found. Hereafter I am in like manner to discourse of ulcers compounded,* 1.76 wherein besides solution of unitie, caused by erosion, there is somewhat else that hindereth the consolidation of the ulcerated part.

* 1.77These compounded ulcers are either of the milder sort, or else maligne. Those of the milder sort, have annexed either a disease, or a cause, or symptomes, which hinder the Chirurgeon from going about the unition of the part ulcerate.* 1.78 Sundry diseases in the body of man may keepe ul∣cers from healing: some from corrupting the humors, as the leprosie & pox. I meane the French: some hindering of laudable bloud in sufficient quantity to be sent, as Pthysis, and a Hectick f••ver: some by sending too much waterish

humidity with bloud, hinder the unition of the part ulcera∣ted. If ulcers in such persons be presented to you to be cu∣red, you are seriously to ponder in your minde, how hard a taske is put upon you, if any of the former diseases be com∣plicat with the ulcers, if you onely except the French-pox in a reasonable strong body: but if the body of one troubled with the French-pox be extenuate much, then permit the cure of him also amongst the rest, to the charge of such as are onely 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or citizens of the world, having no permanent habitation; and resting contented at the first with halfe of the bargaine made for the cure, willingly, al∣though nor honestly, commit the second paiment to the ar∣bitration of fortune. They during their life time, continu∣ing scandals to Art and Artists, it is strange, if at the houre of their death, their consciences for the present seared, grow not tender, and fearefully accuse them. Seeing the practice of Physick and Chirurgery are severed within the Liberties of the city of London, I hold it to be the safest course for you to leave the cure of the diseases to learned Physicians, and to assume onely to your selves, the methodicall dres∣sing of the ulcers: for so the whole discredit, (if any re∣dound) will fall to the Physicians share, who cured not the griefe, the onely stay of the curing of the ulcer. This is my advice, if an ulcer complicat with a dangerous disease, come at any time to your handling: (It is not your desire (I know) that I should set downe the manner of curing of any inward disease: for then I should be bu••ie with my siccle in the harvest fields of other men) that then in this case, you have recourse unto some Author, who hath written most lear∣nedly of the manner of curing that disease which is an∣nexed to the ulcer, and follow his indications in dealing with the disease, if you have not the opportunity of a Physi∣cian, whose advice you may follow.

* 1.79In the cure of the French-pox, if you int end to use the unction, be directed by Ambrese Parrey, or Master Clowes, who, while he lived, was a famous member of this Compa∣ny

If you resolve to insist the kingly, and cleanly way of curing this disease by dyet, then follow renowned Fallo∣pius or Capivaccius. There is a Volume in foli•• wherein are contained the monuments of such as have written of this disease, according to the talent of skill granted unto them: I rather would have you acquainted with these, than to range much, and imitate the swallow, which flyeth much, but prayeth onely upon flies.

As concerning the Dropsie, the Cough of the Lungs, the Hectick fever, or Maras••••us, the extenuation of the body: if these being complicat with an ulcer, hinder the curation of it, have recourse to the learned Works of the famous moderne Writer, Daniel Sennertus, the late Professour of Physick in Wittenberg, who hath couched in his learned bookes, what almost can be spoken, either by Galenists, or Chymists, concerning these and other diseases. The Plagi∣ary Barow in his Method of Physick, and Bruel, are but like unto rotten reeds, appointed for the ruine of impotent, and lame persons, if they relie upon them.

[ II] From a disease joyned to an ulcer,* 1.80 I will descend to the causes hindering the cure of an ulcer. These are two, the humors that flow, and the distemperature of the part.

As for the humor,* 1.81 if it be in flowing, then you are to meet with it with the ordering the things called, not natu∣rall; as aire, meat and drink, sleeping & watching, evacua∣tion and such like, and by purging of the humor offending: whereof I spake sufficiently in the doctrine concerning Tu∣mors.* 1.82 If it hath flowed to the part, and be impacted in it, then it is to be removed by three meanes: to wit, by drying, expressing, and removing of the causes of the fluxion.

You shall dry the humor, if you use sarcoticall medica∣ments, [ I] drying at the least in the third degree, as Bones cal∣cined, Harts-hornes calcined, and made up in Trochisces with Plantane, and Rose-water, Aesustum, the Pumick∣stone calcined, Calaminaris, Borax, the powders of Tor∣mentill, Bistorts, Comfrey, and such like; whereof I have

spoken sufficiently before: yet Nunquam satis dicitur quod nunquam satis discitur, a thing remarkable can never be too much pointed at; so fluxible and gliding are the objects of our memory.

You shall expresse the humors: First, [ II] by using such re∣pelling medicaments as I have often spoken of, which are to be applied to the parts adjacent to the ulcers.

Secondly, by rowling the ulcer, as Hippocrates prescribeth in his Treatise of Fractures, that it begin about the ulcer, using so many revolutions, or windings of the rowler, as are fit, and ending in the sound part.

As for the causes of fluxion they are three; transmission, [ III] attraction, and the furious motion of the humnor it selfe.* 1.83 A part sendeth either moved by the superfluity of the humor, or urged by the offending quality, or both. If the humor of∣fend in quantity abounding, then it is to be abated by phle∣botomie, purging, slender diet, and such meanes as have been delivered by me in the Treatise of Tumors, to lessen pleni∣tude, or Plethora, the signes whereof I delivered there al∣so, so that I need not to repeat them here. If the humor offend in quality, urging and pricking the part to the ex∣pulsion of it, as the liver, which being tainted with the French-pox, sendeth the humor to the groynes, yard, ma∣trix, the fundament and throat. When wee have observed and noted the quality and nature of the humor, then wee are to goe about the expulsion, or alteration of it, or both.

If the humor offend both in quantity and quality, then are we to use both purging and altering. Now to finde out the humors in quality offending, seeing I have set downe their pathognomonicall, & proper fignes, when I discoursed of every speciall Turnor, I will remit you, at this time, to the places where they were set downe. If humors doe flow by reason of the attraction of the part; it is procured either by the heat, or the paine of the part.* 1.84 If a humor flow to the ulcer, neither being sent from a part, nor received by a part; but because the humor it selfe is eliquat, either by the

vehement perturbations of the minde, or an aguish consti∣tution, or the exhibition of an eradicative, or strong medi∣cament: then the tranquility of the minde is to be procu∣red, the aguish heat to be abated, and the exhibition of such medicaments to be stayed. Having spoken of the fluxi∣on of humors so much as is fit for our present purpose, now I am to touch briefly the other cause of milde, yet com∣pound ulcers: to wit, the distemperature of the part.

* 1.85 The single distemperatures are in number foure: to wit, toodry, too moist, too hot, too cold. A dry distemperature is found out by these signes: the colour of the ulcerate part is ill-favoured, not lively, little or no matter floweth from it, in touching it seemeth hard and dry.

This distemperature is removed by two meanes: First, by drawing out the naturall humidity to the part affected, by opening the passages, which before by reason of immo∣derate drynesse were drawne together. In this case friction is excellent.

Secondly, drynesse is removed by the application of hu∣mecting medicaments. Two such are commended by the Ancients, pure Spring-water, and Water and Oyle mingled together.

As for the use of Spring or River-water, it must bee ap∣plied luke warme, not very hot; for if it be very hot, it dis∣cusseth; because the humors having beene attenuate by it, they are turned into vapours, and so resolved: but if it be temperately hot, and the part fomented by it, it moi∣steneth.

The second medicament composed of Water and Oyle, by the Ancients is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. The ulcerate part im∣moderately dry, is to be fomented with this medicament warme: Take either two parts of Water, and one of Oyle, or equall; warme them in a single Viall-glasse, then shake them well together, that they may be mingled, and apply the medicament. This is a convenient Topick in the win∣ter, for although warme water warmeth the part during

the time of fomentation, yet after fomentation it leaveth the part cold, because it drew out the heat to the Superfi∣cies of the body: wherefore oyle is excellent, for it stop∣peth the pores and keepeth in the heat. These two medi∣caments are to bee applyed to the ulcerate part by ••••upes, spunges, or pledgets.

* 1.86One thing you are to looke unto you, and to provide be∣fore fomentation, that the body of the partie unto which they are to be applyed bee neither plethorick, for then too much moysture may bee attracted; nor cacochymicall, for then corrupt humours may be drawne, both which will hin∣der the curation of the ulcer: use therefore first of all phle∣botomie, or purgation, according as you shall see cause.

* 1.87But you may not without cause aske, When fomentation Quefl. is to be left?

* 1.88I answer, that two things shall declare unto you the pe∣riod of fomenting: the first is the substance of the part, the second is the colour: wherefore when you see the part a little tumified, soft and moyst, and of a ruddy colour, desist from fomentation, otherwayes the humour attracted will be discussed.

* 1.89If a moyst distemperature hath possessed the part, then the flesh of the part will be moyst, spungeous flesh will bee apt to grow, and plentie of excrements will flow from the ul∣cer: In this case strong Desiccatives, or Sarcoticks mingled with Basilicum aureum, or Arcaeasliniment are to be used: with an ounce of any of these unguents you may use one dram and an halfe of these Desiccatives: such are the Regulus of Antimony, Lead calcined, Calaminaris, Bones and Hornes calcined, the powder of the root of Iris, Mastick, Olibanum, and such like. Aes ustum, the Pumick stone calcined, and Henricus rubeus are excellent.* 1.90 If the part bee distempered with heat, then the part ulcerate will bee somewhat tumi∣fied, hard and red, and befides the relation of the diseased partie, your owne feeling will assure you. In this case use Aqua calcis viva, so called; but more properly Lixivium

calcis vive, wherein some litharge of silver hath beene boy∣led: you may use also snow water, wherein some of your Vitriolum album or white Copperas hath beened dissolved: In a quart of Apsame water dissolve two drams of Roman Vitri••l, you shall have a water of the colour of a light Emerauld colour fit for your purpose. In a pint of Plan∣tan•••• water dissolve two drams of ordinarie Vitriol or Al∣lome, and this also is a fit medicament. Let mee acquaint you with one thing, that in Redriffe a Copperas is made of Mars or Iron, which is most sit in the cure not onely of or∣dinarie ulcers, but of those also which are in the eyes, blad∣der, throat, and the Intestinum rectum. Make triall as I have done, and you shall finde that true which I say. You see how plaine I am with you concealing nothing, which may purchase unto you credit and gaine.

* 1.91If cold distemper the part, which you shall discerne by its colour, hardnesse, sense of the patient, and your owne fee∣ling, then apply to the ulcerate part Basilicum magnum, my Basilicum, Arcaeas his liniment upon pledgets, and above these Diachyl••n cum gummis, Emplastrum de mucilaginibus, or Paracelsus his Stictick Emplaster. But before the appli∣cation of these, foment the part with, a fomentation made of Sacke and March-Beere, wherein Calamint, Centorie, Wormewood, Spike, Camomil, Tansey, Scordium, Rue, and Bay-leaves have beene infused and boyled.

[ III] The third thing which wee affirmed to make up a com∣pound ulcer was a symptome annexed to an ulcer.* 1.92 Now of all other, Paine is the cheifest: for first, paine by attraction bringeth much moysture to the part, and so hindreth the curation:* 1.93 Secondly, it inflameth the parts: Thirdly, it cau∣seth watching, fainting, and oftentimes convulsions.* 1.94 Paine is removed two manner of wayes: First, by raking away the cause of paine, which is affluxion of humors: How this is to bee done wee have spoken already: Secondly, by application of Anodine medicaments. These ought to bee temperately hot, & subtill. Simples of this kind are the wa∣ters

of warme baths, Camomil, Dill, Millet, Linseed, Fe∣nugreeke, the marish Mallow, the pulp of Cassia, Raisins, sweet Apples, and Turneps, with a little Saffron they are effectuall, Milke, Butter, Oesypum, or the greasinesse of wooll, Sapa, new wine boyled to the third part, Swines, Hens, and Mans grease, the fat of Ecles and Calves, Oyle of Egges, Earth-wormes, Foxes, Swallowes, Rue and El∣der: the oyle of Wax, & Sallet oyle, wherein Sulphurvivum hath beene boyled, are excellent in painfull ulcers of the joynts, Oyle of Camomil, Dill, and Roses: Of these you may frame unto your selves compositions, as occasion shall require. Take this for an example; ℞ Farin. hord. Milis, Furfur. an. ℥ij. Lact. recent. lb. ss. coq. ad consistentiam cata∣plasmatis, tumadde Pulp. Cass. & Passul. major. an. ʒvj. Pulp. Pomor. redol. ℥j. Ol. ℞ of. Lumbric. aneth. Cam••wil. & Overum an. ℥j. O••sypi ℥j ss. Croci ʒj. Make a Caraplasme. Sometimes the paine will bee so great that you shall bee en∣forced to use narcoticall medicaments:* 1.95 The simples are Opium, Henbane, Hemlock, the Apple of Peru, Mandrake: Of these adding white Bread crums, Milke and Saffron, you may make Pultices: I will set one downe as an example, after which you may frame others: ℞ Lact. rocent. lb. ss. Mic. pax. albiss. ℥iiij. Fol. Hyosciami, Solani, Cicut. Contus. an. man. 1. 〈◊〉〈◊〉 ista ad cataplaswatis consistentiam: tum adde ung••••••. popul. ℥ij. Dresse the ulcer with Plantane water, wherein some Allome is dissolved, or Roman Vi∣triol. Then apply Diap••••••••cumsuccis, and above it this Cataplasine. Dresse this ulcer at the least morning and eve∣ning untill the paine be gone.

LECT. IX. Of the Differences of the milder sort of compound ulcers, and first of a sinewous ulcer without any callositie.

HAving discoursed in my former Lecture of those things which make the milder sort of ulcers to be accompted compound, to wit, a sicknesse, cause, or symptome compli∣cate with an ulcer. In this Lecture I will set downe the dif∣ferences of milder ulcers, and the curation of them. These differences are taken either from the figure or adjuncts: from the figure these. Of the milder compound ulcers some are plaine, some sinewous. I call that a plaine ulcer, wherein the skin is eroded, and the subjacent flesh, and the whole ulcer is presented to the sight, being bare and unco∣vered. No compound ulcer is to bee accompted of an easie curation: because both skill and experience are required in performing this.

And although these plaine ulcers be subject wholly to the sight, yet let no man imagine that all of them are of equall facilitie to be cured; for according to the nature of the griefe, the qualitie of the cause, and the invasion of the symptomes, the ulcers with the which these things are com∣plicate, are either of more easie or difficult curation. A plaine compound ulcer hath three scopes in curation of it: for first,* 1.96 that must be removed which maketh it compound, whether it be a disease, cause, or symptome: secondly, that which is by erosion lost must be repaired: and thirdly, the part must be cicatrized: How all these three indications are performed, I have set downe at large in the former chapter, so that I need not to repeat any thing.

* 1.97Vleus sinuosum, or a sinewous ulcer, I call that which is like to a Cony-burrow; for sinus, or sinuositie, is a cavitie or

hollownesse of parts under the skin, seperate by afflux of an eroding humour, which according to nature were uni∣ted. There bee two causes of these sinuous ulcers, to wit,* 1.98 Apostemes lying deepe along time, or not timely opened, although they be not so deepe: and wounds not well cured: for quittour lurking a long time, either in a tumour suppu∣rate, or in a deepe wound not well cleansed, must needs cor∣rupt and get a sharp qualitie, which maketh to it selfe these cavities, which are not so easily filled with flesh and united: for unto the part affected, now weakened, excrementi∣tious humours flow, not onely from the parts adjacent, but from the whole body also, which make the ulcer hard to be cured. These burrowes are found out by probes of silver, or lead, & wax-candles: If there be more orifices than one, by injections. They sometimes are superficiall,* 1.99 sometimes deepe, sometimes straight, sometimes oblique, sometimes there is but one caverne, sometimes there be more.

* 1.100Of these sinuous or cuniculous ulcers, some have either hardnesse nor callositie, such I will terme Vlcera cavernosa, hollow ulcers; some have both hardnesse and callositie, these are termed Fistulae.* 1.101 First then I will shew you how cavernous ulcers are to bee cured, and then how Fistula's. There are two waies of curing of a cavernous ulcer: the first is by injection of medicaments: the second is by opening & dressing, according to Art. If you goe about to cure such an ulcer by medicaments, without opening, then two scopes offer themselves, to wit, the filling of the cavitie with flesh, and the agglutination of the parts disjoyned. The Incarna∣tives must be drying without erosion, and the Glutinatives must have astriction, besides desiccation. Both these inten∣tions you may performe with the injection of this medica∣ment following, ℞ Aq. decoct. hord. lb j. Mollis rosat. ℥iij. Sarcocoll. ʒijss. Mirrh. Thur. an. ʒij. Rad. Tormentill.* 1.102 Bi∣stort. Symphyt. a••. ʒjss. Balaust. ʒj. Baccar myrt. ʒijss. [ I] Su∣mach, ʒjss. Vini od••rifer. ℥vj. Bulliant ad consumptionem tres partes, ac coletur decoctum, cui adde Spirit. vini ℥j. If you

perceive that the ulcer is not sufficiently mundified, which you may conjecture if the quittour be either stinking, red∣dish, pale, blackish, or thin and warrish; then apply this medicament: [ II] ℞ Vini in quo infusa fint marrhubium album, Centaurium minus, Absynthium, Flores Hyperici, & Carduus Benedictus lb. ss. Ʋnguenti Aegyptiaci ʒij. Mol ros. ℥ss. misc. inject this. You can hardly devise more effectuall me∣dicaments than these are for agglutination of a cavernous ulcer:* 1.103 Yet whosoever shall apply them, not dressing and binding the ulcer artificially, shall hardly cure any such ul∣cer: wherefore I thinke expedient that I shew you the way of dressing: First, lay upon the whole processe of the cavitie Diapalma cum succis, or, Emplastrum album coctum, or Em∣plastrum contra rupturam: Then inject your medicament warme. Thirdly, in the orifice put in a leaden tent, or pipe; but short, hollow, wider in the upper than lower part, & having the brims of the upper part turned, that it may be kept from slipping in, shut the orifice and the upper part of the tent or pipe with an emplaster; let it be one of those named before: the emplaster must bee snipt, that it may give way to the quittour which floweth out of the cavitie: above the emplaster apply a peece of a spunge, which must be soft, moystned with the medicament with the which you dresse the ulcer, and wrung out: for the spunge sucketh in∣to it selfe the quittour, keepeth the brims of the orifice dry, and preserveth them from excoriations: above the spunge lay a pledget of tow: the lower cavitie, or from the bottome of the ulcer to the orifice it must be bonistered. Above all lay a double soft linnen cloth. Begin your rowling at the bottome, where it must bee somewhat strait, to bring the sides of the ulcer together, both to expresse the quittour, and to procure agglutination, but let it cause no paine; for it would distemper the part: towards the orifice the row∣ling must bee somewhat slacke, that the quittour may have way to issue out. Everie third day (if much matter doth not flow) dresse it, loose first the rowler, the turnings whereof

are about the orifice, take away the spunge and emplaster; first, that you may come to cleanse the ulcer; secondly, that you may make triall whether nature doth goe about to ag∣glutinate the parts: which you shall discerne,* 1.104 if the excre∣mentitious matter abate, bee laudable in colour and consi∣stence, and have no ill smell, and if the cavitie bee without paine, and without any remarkable tumor: By the contra∣rie, if the quittour be plentifull, ill-coloured and stinking, if the cavitie be painfull, and a conspicuous tumor appeare, you may perswade your selves that no unition is procured. Dresse the ulcer according to this manner, untill perfect ag∣glutination be caused, which you shall know by the signes aforesaid going before, if no quittour or verie little appeare in the orifice, if the cavitie be equall without tumour, and no paine be felt: when you perceive these signes, then ad∣dresse your selves for the cicatrizing of the ulcer. If after a dressing or two, thin gleeting matter appeare, yet despaire not; for often times such matter is wrung out of the parts by reason of the medicament drying: the nature of the part, as being nervous, membranous, or glandulous; or lastly, by compressing of the ulcer by bolstering and row∣ling. As for the emplaster applyed to the cavitie it selfe, it is to be renewed when it is defiled with quittour, or leaveth cleaving. Dresse the ulcer as seldome as you can,* 1.105 contrarie to the practice of Empyricks; for often dressing doth give way to cold aire, which is hurtfull to ulcers, and hindreth unition. Thus you may proceed in curing of cavernous ulcers, if the excrementitious matter have way to flow from them freely, which will be if the orifice be in a depending part, or late∣rall, the cavitie or sinus being laterall also; for then, such a posture may be appointed, as will further the evacuation of the matter: But if by reason of other figures of the cavitie, the cavitie cannot discharge it selfe of the filth of the ulcer,* 1.106 then untill this impediment be removed, no expurgation, in∣carnation, or agglutination can bee expected: wherefore way is to be made by incision or caustick.

* 1.107This you must doe, first, if the cavitie bee lower than the orifice, either directly or obliquely; but not verie deepe. Secondly, if it goe verie deepe also, as in fistula's, and such ulcers penetrating in the brest, where the cavitie most com∣monly is lower than the orifice. Thirdly, if the hollownesse be verie broad. In these cases way must bee made by these meanes for the matter, that it may bee expurged; other∣wayes if it be kept in, it will erode the parts adjacent, and no incarnation or consolidation can bee looked for. Wee may make way for the quittour two manner of wayes: first, by opening the lower end of the sinus only; Secondly, by opening the whole cavitie.

* 1.108The first course we are to take, if the sinus be of an enorme businesse, or if it be in a great joynt; for great wounds in such joynts are mortall, according to Hippocrates: or if there bee great vessels, nerves or tendons of muscules in the way, which are like to bring fearefull fluxes of bloud, or lamenesse: which things skill in the Anatomie will teach you. If none of these cases hinder you, then it is the surest way to lay open the whole cavitie, which is the second way. These two scopes wee may attaine unto by two meanes, to wit, by causticke and incision.

* 1.109The causticke wee are to use, first, if the partie be timo∣rous, and will not admit section: Secondly, if the cavitie be in a part, wherein a great scarre may cause deformitie: Thirdly, if there be feare of a great flux of bloud: Fourth∣ly, if the diseased partie be sicke and weake.

* 1.110If the causticke be to bee applyed, if the situation of the part wherein the sinus is bee in the upper side, then apply your Lapis infernalis: for it corrodeth soonest, deepest, with lesse paine, and will not bee so apt by running and spreading to burne the parts adjacent, or to cause a greater solution of unitie than wee intended. But if the sinus be in the lower fide, as in the sole of the foot, or in a part verie depending; then I advise you to use the causticke made of strong sope lees, and unslaked lime, which will not run. It is

an ordinarie practice of some to rub the part with the Cau∣sticke stone, and when the part is mortified then to open it: First, this is not to be done, but when the skin is verie thin; besides this, this rubbing causeth farre greater paine, than the application of it to the part being defended: Be ever of this minde in your practice, to use the mildest meanes; the fruits which you reape by so doing will be respect, love, cre∣dit and gaine. When you have perceived that the force of your corrosive medicament hath mortified all to the verie cavitie, then procure the fall of the eschar, with the applica∣tion either of Dialthaea simplex, or Butter without salt: there is no substance comparable to this in this purpose. When the eschar is gone then proceed in curing of the ulcer, as hath beene said, by mundificative, incarnative, and cicatrizing medicaments.

* 1.111If the partie be couragious and strong use incision: this is sooner performed, hath lesse paine, and sooner will bee cured. When you have made incision, arme dosils and pled∣gets with a medicament which strongly dryeth and mundi∣fieth; such is this: Take of Aloe Hepatica two drams, of blacke Rosin and Amber, of each a dram and an halfe, of Mill-dust two drams, of unslaked Lime two drams and an halfe; with this powder, and the white of an Egge, and the yolke beaten together, make a medicament in consistence representing an unguent: then apply the medicament to the Sinus incised, filling it well that the brims may bee kept asunder. Open not the sore till the end of the second day, at the least; for this medicament will both dry the superflu∣our humiditie of the ulcer, and will excellently digest it. Af∣terward dresse the ulcer as the methodicall indications of curing shall move.

* 1.112If you finde these ulcers thus handled not to heale to your minde, then hold your patient to the decoctions of Sarsapa∣rilla, Guajacke, and the China root, with the which mingle some of your most effectuall Vulneraries, as Agrimonie, S. Iohns woort, Sanicle, Avens, our Ladies mantle, Virga

aurea, Salomons seale, the roots of Comfrey, Tormentill, Bistort, Horehound, Borrage and Buglosse. I will not con∣ceale from you the description of a decoction, whereof I have made often proofe in ulcers of the brest, joynts and belly: ℞ Sols. parill. ℥vj. Rad. Sassafrus ℥jss. Scob. Guajac. ℥iij. Eupator. Scahies Tussilugin. Sanicul. Hyper. an. man. 1. Rad. Syn phyt. Tormentill. Bistort. an. ℥ss. Rad. Borrag. Bu∣gloss. an. ℥j. Passul. major. enucleatar. ℥iij. Liquirit. ℥ij. In∣fundantur infundenda per noct. in aq. font. fervent. lb. xxiv. se∣quente die coquantur lento igne cum reliquis ad consumpt. lb. viij. Bibat aeger singul. dieb. lb. iiij. hujus decocti: Hauriat lb. ss. mane, ac tantundem hor. quarta pomeridiana: In prandio bibat lb. j. ac tantundem in coena: Quum sitit super∣est lb. j. haurienda. The simples of this composition may plead for the efficacie of it. Let him continue the taking of this decoction for the space of 21. dayes: during which time hee is to use a spare diet, and to eat flesh affording a good juyce, and of an easie concoction. As for the locall medicaments which are to be applyed to the ulcer, I have spoken of them already: too much repetition will breed loathing.

LECT. X. Of the palliative cure of a sinuous ulcer with callositie in generall.

IN my last Lecture which I delivered from this place, the vacation from these exercises being at hand, I spake of a sinuous or hollow ulcer, without a callositie or hardnesse of the inner Superficies of the parts disoyned: Now the or∣der of doctrine requireth that I discourse of a sinuous ulcer, which hath a callositie in these same parts. In times past it hath been accompted a master-peece in the practice of Chi∣rurgerie to cure such: In so much that Master Boovie the

Counsellors father, a brother of this Companie while hee lived, dwelling in Tower-street, set up above his doore a new signe with this inscription; Here dwelleth one who can cure a Fistula: young Hall having acquainted him with his fathers practice. And in truth not a small skill, or ordi∣narie proceeding is required to effect this matter: for the greatest part of such an ulcer lyeth hid, and little is offered to the eye. Besides this, ordinarie meanes are for the most part here ineffectuall, and so magistrall meanes are required. Wherefore I have diligently laboured to couch in this my discourse whatsoever can be required in the curing of such an ulcer, as you shall perceive in my proceeding.

First then, I will deliver the generall doctrine of this kinde of ulcer: then I will set downe the manner of cu∣ring of such in some particular parts of the body. A sinu∣ous or hollow ulcer with a callositie or hardnesse in the in∣ner superficies of the parts disjoyned and separated is called in Greeke 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, from the similitude which it hath with the long and hollow windie instruments of Musicians: in Latine it is called Fistula, and so in the English tongue for this same cause.

* 1.113A Fistula then is a sinuous ulcer, narrow and long with callositie. Here you are to observe, that a Fistula besides si∣nuositie, must have callositie and narrownesse. It happe∣neth most commonly, when apostemes having been opened,* 1.114 the inner Superficies of the parts kept asunder by a sharp hu∣mour, become in progresse of time callous. The humour which causeth this callositie must bee more astringent than sharp; for it rather tanneth the part by reason of its acer∣bitie, than erodeth by reason of its acrimonie: besides this, Fistula's are for the most part indolent, unlesse they end in parts verie sensible, as nerves, tendons, membranes and joynts. Wherefore the Chymists will have this humour to be the Salpeter of the little world, or man, separate from the naturall salt of the Balsame, or radicall moysture of the body: that this salt is cooling and anodine, the Practicers

of Physick doe beare witnesse: for in burning fevers it is added to Juleps, which are appointed for cooling, and as∣swaging of paine under the name of Sal prunellae: It doth also, by reason of its stipticitie unite the spirits, and stay the immoderate exhalation of them.

* 1.115The signes are taken either from the essence of a Fistula, or from the accidents. Callositie then with a Fistula, or whistle-like figure, is the pathognomonicall signe of a Fi∣stula. The signes taken from the accidents are two-fold: for they are taken either from the quittour, or the manner of paine. In a Fistula the quittour is ever virulent, ugly and stinking; as for the manner of paine it is but small, unlesse it be by reason of the sensiblenesse of the parts named by me before.

* 1.116As for the differences, or divers kindes of Fistula's, I will onely set downe those, which further either curation, or prediction. Let this then bee the first difference: Fistula's either goe shallowly alongst under the skin, or they passe deeper to the subjacent parts. Secondly, Fistula's end ei∣ther in the fleshy parts, or they passe to the bones, or to the cavities themselves. Thirdly, some are straight, some croo∣ked. Fourthly, some are single, some manyfold, yet pro∣ceeding from one orifice. These are the materiall, or pro∣fitable differences of Fistula's.

* 1.117Now followeth that I speake of the signes of these dif∣ferences. 1. Whether there be more callous sinuofities than one, you may conjecture by the quantitie of the quittour; for if more copious quittour flow from a Fistula than can be expected from one Sinus, it not passing to any remarka∣ble cavitie, it is likely that there are more than one. The changing also of the position of the body, and compression of the part will shew this; for the flowing of the matter having ceased, if after the changing of the position of the whole body, or one member, it run out againe, it is proba∣ble that there are more sinuosities. Moreover, if varietie of quittour flow, it is an argument that sundry parts are

affected, and more sinuosities like to be. But to what parts the Fistula passeth, receive these signes: If it passe to the fleshy parts, the quittour appeareth white, smooth & plen∣tifull; besides this, the part whereon the end of the probe stayeth seemeth soft. If it passe to a nerve, a fattie & oleous matter doth issue out, the motion which is caused by that sinew is impaired, and the Fistula is more painfull than o∣thers are; besides, the probe touching the sinew, causeth a pricking paine, with a certaine numnesse. If the Fistula passe to the veines and arteries, yet so that the coats of them be not eroded, then the matter which it yeeldeth is like un∣to the lees of Claret wine; for bloud swearing thorow the coats of porosities of the vessels mingled with the quittour, causeth such a substance.

If the coat of a veine bee corroded, bloud issueth thick, of a dark colour, and without quavering and leaping; but if the tunicles of an arterie bee pierced, then the bloud is redder, of a more bright colour, and commeth forth with ejaculation. If a Fistula reach to the bone, that which the end of the probe toucheth appeareth hard, and yeeldeth not to the probe, neither is any paine felt. If the probe being pressed slip, no cariositie hath seised upon the bone; for a sound bone is smooth and slipperie: If the probe stay upon it appearing smooth, it is disposed to cariositie; but if the bone appeare unequall and rough, then it is undoubtedly carious. Besides this, the quittour which floweth from a corrupt bone is thin, yellow, and ill-smelling. So much then concerning the signes, which shew us the divers kindes of Fistula's.

Now let me deliver unto you some remarkable presages or predictions, touching the curing of them, that you may become circumspect in undertaking the curation of such as shall be presented to you. Let this then be the first:

No Fistula is of easie curation. First, [ I] by reason of the unaptnesse of the part to admit the convenient application of medicaments: for unlesse they reach to the verie extre∣mitie

of the Fistula, which is not so easie a matter, as you shall finde by practice no good can be done. Secondly, by reason of the qualitie of the medicaments, which are able to remove the callositie; for these must be sharp and biting, and so cause paine: from whence come symptomaticall fe∣vers, and fainting verie often, especially in tender and young bodies. And thirdly, by reason of the humour, which cau∣seth a Fistula, which yeeldeth not to ordinarie and vulgar medicaments. Let this be the second.

[ II] Fistula's which are shallow, passing no deeper than the Membrana carnosa, or at the furthest than the membrane of the muscules, or muscule subjacent, are more easily cu∣red than those which pierce deeper; for those by incision may easily be cured, but these not so.

[ III] The third shall be this: Fistula's wreathed, or with mul∣tiplicitie of sinuosities, require incision, that medicaments may be conveyed to all the parts.

The fourth: If a Fistula no passing further than the fleshy parts, bee not of a long continuance, and that in a young and a strong body, it affordeth good hope of curing: Imagine the contrarie event, if contrarie circumstances bee accompanied.

[ IV] Receive this as the fourth: If the extremitie of a Fistula end in the tunicles of veines or arteries, or both, (the signes whereof I have delivered, when I spake of the differences of Fistula's) then you are to meet with the symptome of hemorrage, the coats being eroded: for if you labour ei∣ther to enlarge the orifice, or to take away the callositie by sharp medicaments, the flux will bee encreased. This acci∣dent happeneth most commonly in Bubo's of the groyne not speedily cured, and Parotides under the eare, and Phleg∣mons in the arme-pits: These parts being emunctorous, and nere to the divarication of the great vessels, to wit, the Vena cava, and the Aorta descending and ascending.

[ V] Fistula's ending in verie sensible parts, as nerves, tendons, the bladder, the Intestinum rectum, and the like, are care∣fully

and mildly to be handled, by reason of the symptomes which often ensue, as accidentall fevers, Lipothimies, losse of appetite and sleepe: all which are apt to bring an exte∣nuation unto the whole body, and so to defraud the part of more than requisite nourishment, without the which con∣solidation cannot be effected.

[ VI] Fistula's in remarkable cavities, as the throat, brest, belly, are hard to be cured, because the end is more dependant than the orifice, which hindreth exceedingly consolidation.

[ VII] If in Fistula's of the back the Spina be carious, shun the care; for these at the length bring an extenuation of the body, the animal spirits not being with requisite plentie communicate to the extremities of the body.

Fistula's in the joynts are dangerous; for if great wounds of the joynts, even in bodies of a good habit, bee pronoun∣ced by Hippocrates to be mortall: what shall wee deeme of Fistula's in these parts, where besides the enorme dilatation that must be procured in curation, there is of a necessitie an ill complexion of the body. Secondly, seeing the joynts are framed of parts verie sensible, as tendons, nerves, membranes and ligaments, exceeding great paine must be caused by the application of corrosive medicaments, without the which a Fistula cannot be cured, and so the partie exceedingly bee troubled and perplexed. Thirdly, seeing the joynts are sea∣ted in depending parts, and are not fleshy: and so as they are apt to receive humours attracted by paine, they are lesse able to discusse the humours received, partly by reason of the thicknesse of the membranes, partly by reason of the weaknesse of the naturall heat: who may not easily perceive the difficultie of curing of Fistula's in these parts?

[ VIII] Fistula's having sund y sinuosities are more hardly cured than those which have but one, both because the labour is the greater, and the medicaments cannot so conveniently be applyed.

[ IX] Fistula's which have continued a long time seated in a depending part, remote from any principall, by the which

nature hath beene accustomed to discharge superfluities of the whole body, and not painfull, but rather slovenly or sluttish, are rather to be kept open than cured; for they pre∣serve the health of the body, and hinder the assault of other diseases.

* 1.118I knew a Gentleman who had a Fistula in ano about 20. yeares, yet unknowne to his wife, who lived notwithstan∣ding verie healthfull to the last period of his life: having sent for me a few dayes before his death, he acquainted me with it: having taken a view of it, and perceived that it was dry, and of a livid colour, I pronounced his end to be at hand, which accordingly fell out.

* 1.119Now it is time to hasten to the setting downe of the cu∣ration of Fistula's in generall. In the sixth Section of the Treatises ascribed to Hippocrates, there is one of Fistula's: In it he doth speake somewhat particularly of a Fistula in ano, and of the curing of it by ligation. Whatsoever is deli∣vered in that Treatise, seemeth to be an exscription of notes out of his Adversaria or Note-booke, rather than a delibe∣rate or methodicall discourse of the subject. Howsoever, it is to be embraced rather as a pledge and signe of his willing minde to pleasure his posteritie, than a patrimonie to en∣rich the knowledge, and further the practice of any one, who shall goe about to cure any meane Fistula. Peruse the Treatise, and you shall finde me to speake a truth, if you shew your selves impartiall censurers. Seing I have delive∣red unto you in the presages of Fistula's, that sometimes it is most expedient to leave some Fistula's uncured, I must make mention of a two-fold manner of curing of them: The one shall be called palliative or cloaked;* 1.120 the other true and reall. The first affordeth some consolation and ease to the patient; but the second procureth perfectest health. A palliative cure, I would have you to understand, to be when sinuositie is inwardly dryed for a time, and the orifice see∣meth to be shut up by a thin skin, untill fresh and new hu∣miditie bedew the inward sinuositie, and open the orifice

againe. This kinde of curation is most fit to bee used to∣wards those, in whose bodies a Fistula supplyeth the place of a fontanell, to discharge superfluous humours, which nature turneth out from the principall parts, for the preservation of the health of the body.

You shall know this manner of curing to be used, if the partie immediately before the opening of the orifice finde some distemperature, and afterward the orifice being ope∣ned, ease. To compasse this manner of cure three intentions are required.

First, convenient diet must be observed: This is perfor∣med by feeding upon such meats as are of easie concoction, and afford good juyce, and in such measure as Leonardus Lessius in his 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 prescribeth, and Ludovicus Cornarus observed from his constant to his decrepit age. They advise moderation both in meat and drinke. Patients now adayes would thinke themselves hardly dealt with, if they should be stinted everie day to eat no more bread and meat than a pound, and to drinke no more drink than fourteene ounces. It is an easier matter to satisfie nature, than the appetite.

Secondly, the body is to bee purged not by any eradica∣tive medicament, wherein Scammonie, Ellebore, or Colo∣cynth entreth; but a purging diet, or a purging Ale; I will deliver unto you a patterne of both. Let your purging diet be thus dispensed: ℞ Sars. ℥iij. Rad. Tormentillae, Bistortae, & Symphyti, an. ℥j. Polypod. querc. ℥iij. Hermodactyl. fol. Sen. & Semin. Carthami, an. ℥ij. Rhab. ℥j. Semin. Anisi, Coriandri, & faenicul. dulc. an. ℥iiij. Glycyrrhiz. ℥jss. In∣fundantur infundanda in aq. font. fervent. lb. x. per noctem: deinde additis reliquis lento igne coq. ad med. atque aromati∣zetur decoctum cinam. ℥j. ac coletur: Stumat ager mane. lb. ss. calid. hyeme, ac tantundem hor. quarta pomeridiana. As for the purging Ale receive this description. ℞ Scob. Guajaci & Sars. parill. an. ℥iiij. Rad. Tormentill. Bistort. & Symphyti, an. ℥jss. Polypod. ℥iij. Eupat. Sanicul. Alchymill. an. man. j. Fol. Sen. Hermodactyl. an. ℥v. Rhab. ℥j. Semin.

Anisi, Coriand. & Fenicul. dulc. an. ʒvj. Glycyrrhiz. ℥ij. fiat ex omnibus pulvis crassiuscalus indendus sacculo lan••o ra∣ra texturae, qui suspendatur in gallon. duobu•• Zythi non lupu∣lati recentis & fortis. Let the Patient begin to drinke of this Ale the fourth day. Hee is to take halfe a pint in the mor∣ning, and to sleepe upon it; and so much about foure a clock in the after-noone. When either of these purgatives are ministred, let the Patient about ten a clock in the fore∣noone take some broth without bread, made of a Chicken, Mutton, or Veale, wherein Mallow, Parsley, Fennill, and Succorie roots, with some Raisins, Prunes and Dates have beene boyled. Let him dine on the boyled meat; but sup with rost meat. The purging Ale is more convenient for aged persons, than the decoction, and for such as have a weake stomack.

Thirdly, convenient locall medicaments are to bee ap∣plyed, to further the drying of the sinuositie, and skinning of the orifice. I will onely set downe two injections for the first. The one is this: Take of Aqua calcis, wherein some Litharge either of gold or silver hath beene boyled iij. o℥. and of the Syrup of red Rose leaves dried, or of the Mirtill berries one ounce: mingle these together. The other is this: Take of Plantane water iij. o℥. of Roman Vitriol beat to powder, a dram and an halfe: let the Vitriol dis∣solve in the water: inject these medicaments warme; apply to the orifice a pledget of lint wet in either of these medi∣caments, and above the lint Diapalma cum suceis. Dresse the Fistula everie other day only, unlesse the quittour which floweth from the Fistula be plentifull. So you have the palliative cure of a Fistula. In the next Lecture I will deli∣ver the true and reall curation of Fistula's in generall, wher∣in you shall heare sundrie things worth the noting.

LECT. XI. Of the true curation of Fistula's in generall.

NOw am I to accomplish and performe my former pro∣mise in setting downe the method of curing truly and really Fistula's in generall, and the practice of the same in the curing of some Fistula's of some speciall places of the body, which require some extraordinarie confiderations. Such are Fistula's in the great corners of the eyes, Fistula's in the brest, Fistula's in ano, and Fistula's in the joynts.

* 1.121The meanes to attaine to this manner of curation are three-fold; Dieteticall, Pharmaceuticall, and Chirurgicall.

* 1.122As for the Dieteticall, I have set it downe amongst other points, which are required in the curation of an ulcer in generall. It shall be sufficient to insinuate now onely, that the diet of those who are troubled with Fistula's must bee verie sparing, and of meats and drinks which afford a lauda∣ble juyce, and are of easie concoction, that crudities and sharp humours flowing to the affected part, hinder not the euration. And undoubtedly too liberall a diet, unto the which the Inhabitants of these parts are too much accusto∣med, is the cause of the recidivation of these, and other griefes.

* 1.123As for the Pharm••ceuticall meanes, they are of two sorts, to wit, Purgative and Consolidative.

[ I] If the body of the diseased partie be cacochymicall, with some Plethora, minister the purging decoction,* 1.124 or Ale for the space of a weeke, described by me in my former Lecture. And while these are in preparing, you may make for the better operation of these, minister this or such like a por∣tion: ℞ caric••stin. & Electuarii de succ••••of. an. ʒiij. Syrup. ••os. solut. cum Agari••o ℥j. Aq. cichor. ℥iij. mise. ut fiat po∣tio, sumenda cum cerp••ri•• custodi••. These two Electuaries

purge the body of thin, hot, and sharp humours; the syrup and water correst the malignitie of the humours.

[ II] The Consolidatives are either Rsimple or compound. The principall simples set downe by most authentike Authors,* 1.125 and tried by practice are these; Gentian and the roots of the round Birthwort, a dram of either of these mingled with iij. ℥. Of white wine, and ministred everie other day in the morning, and fasting three houres after the taking of the medicament. The lesser Centorie, Osmunda regalis the root of it, Agrimonie, Virga aurea, the white Hore-hound, the roots of Borrage, Tormentil, Bistort, and Comfrey, Sarsa∣parilla, the rasping of Guajack, Plantane, Vinca, Pervinca, and Equisetum. Of the juyces of these herbs mingled with Ale, you may make possets; the wig whereof strained and sweetned with some Saccharum rosatum, or the Conserve of red Roses, you may minister morning and evening to young persons, and those who are either weake, or abhorre all physicall meanes, whereof there is no small number now adayes, who hasten by their owne misdemeanour to bring on griefes; but when they are to use meanes, esteeme them harsh: not knowing that God of his infinite goodnesse and providence towards mankinde, hath appointed the meanes of recovering of health to be unpleasant to nature, that man should refraine from sin, the primitive cause of griefes.

* 1.126Of these simples afore-named, you may frame unto your selves sundrie compositions: for a patterne I will set downe one decoction: ℞ Sars. parill. ℥iiij. Scobis. Guajaci. ℥vj. Rad. Tormentill. Osmund. Regal. Bistor. Symphyt. an. ℥j. Eu∣pat. Ʋirga aur. & si uil reslat prater consolidationem & cica∣trizationem, Summitat. Hyperic. & Sigill. Salomon. an. man. j. Passular. Major. Exacinat. ℥iij. Liquirit. ℥ij. Semin. Coriand. & Fenicul. duleis, an. ʒv. Infundantur infundenda in aq. font. fervent. lb. xx. deinde coq. Lento igne additis reliquis ad con∣sumptionem lb. viij. ac coletur decoctum. If the partie bee strong, let him drinke three pints a day: One halfe pint in the morning, and another about foure a clock in the after∣noone,

for dinner and supper there remaineth a quart. If the partie be young, or cannot take such a quantitie, by rea∣son of the weaknesse of the stomach, make halfe of this quantitie, which being vj. lb. adde to the decoction of Su∣gar and Honey, of each lb. j. and by gentle vaporing away some humiditie, bring the decoction to the consistence and taste of a pleasant Julep, which minister according to the to∣leration of the partie. This Pharmaceuticall course you shall (I dare assure you) finde effectuall to your owne cre∣dit, and comfort of the patient.

* 1.127The Chirurgicall meanes afford unto us five intentions.

First of all then the Fistula is to be dilated; for seldome doth it fall out otherwayes, that this indication is not re∣quisite, unlesse it be in a Fistula in the cheeke, [ I] which was caused and maintained by a corrupt tooth, which being drawne, the Fistula will heale of it selfe, a consolidative em∣plaster being applyed to keepe out the aire.

* 1.128The Fistula may bee dilated three manner of wayes, by Incision, by putting in tents framed of such things as swell, after they have imbibed the humiditie of the Fistula; [ I] and last of all by the Fistula tent.

* 1.129As for Incision, it is to bee used in strong bodies, if the Fistula be not deepe and onely runneth alongst under the skin, no deeper than the membrane of a muscule, if it be in a fleshy part. Secondly, if the Fistula have many sinuosi∣ties: before the Incision is made, the Fistula is to be dilated by some of the three other meanes, which I will deliver pre∣sently: secondly, the medicaments which remove the cal∣lositie (whereof anon must be applyed) both these intenti∣ons must bee performed before Incision, otherwayes you shall hardly know how far your Incision is to bee extended, and shall leave some part of the Callus still, which will make way for recidivation and relapse.

[ II] The second way to dilate a Fistula, is to use instead of tents such things as swell, whereof there bee sundrie, as the Gentian root, the pith of the Elder, or Dane-woort; but

the spunge twisted with threed,* 1.130 after that it is wrung hard and wrea••hed, far exceedeth all these; for it both imbibeth more moysture, and dilateth much more. I will acquaint you with a preparation of the spunge, which is excellent, and this is it: Melt a rowle of your simple Melilot empla∣ster; when it is yet verie hot, let a thick spunge imbibe it. This spunge having so drawne unto it selfe the emplaster, put betweene two trenchers, which trenchers with the spunge put into a strong presse, and presse them hard. Af∣ter an houre or two, when you thinke the spunge to bee cold, unscrue the presse, and take out the trenchers with the spunge, you shall finde the spunge become a firme sub∣stance, resembling greene cheese. Of this substance you may cut out tents of what fashion you will: This will not onely exceedingly dilate the Fistula, by sucking unto it the humiditie; but will also digest the callositie.

[ III] The third way of dilating a Fistula, I set downe to bee by the Fistula tent. It is this way to bee made; Make good store of fine lint, from the which draw away all the threeds, that nothing remaine but the fluet, or the soft downe of it; of this downe with the white of an egge beaten, make your tents of what thicknesse or length the sinuositie of the Fistula requireth, by adding still some of downe: doe this upon a peece of a Deale-board smooth and even: If you still enlarge the quantitie of the tents, you may dilate the Fistula as much as you will; for these tents being dried, will pierce unto any cavititie as a probe without bending (if they bee well made) by reason of their stiffnesse. Of this manner of tent there is great use, in taking away the callo∣sities of some Fistula's, and in healing of them, besides this use, as you shall heare anon.

* 1.131The second Chirurgicall intention is to remove the Cal∣lus: this is bred by reason of the influxion of an humor, not of an uniforme substance; for besides the thin parts, which are discussed or dryed,* 1.132 by both naturall and extraneous heat, it must have a thick substance to cause this callus, it being

indurated: this must bee either flegme, if the callus bee white, or melancholy if it be livid, according to the dog∣maticall Physicians, the Chymists appoint it to be Salt-peter, as I have said.

* 1.133In the beginning this callositie is bred rather in the ex∣ternall orifice, than in the inner sinuositie: for first, the skin which is thick of it selfe, sooner groweth hard than the flesh which is soft: Secondly, because nature still laboureth to thrust out excrements to the skin. In progresse of time Fistula's having become inveterate, the whole passage con∣tracteth callositie.

* 1.134You shall know by this, whether the passage be fistulated or no: If by the intrusion of the probe great paine is felt, and bloud issueth out, the Callus is not confirmed; but if no bloud follow, an little paine be felt, bee sure then that it is confirmed.

* 1.135The callositie is removed either by medicaments, or the actuall Cauterie. The medicaments are of three degrees: for some are more milde, and these are of an emolliating and digesting qualitie, fit if the callositie bee but small in a fleshy part and a young body: such are Diolthaea cum gum∣mis, and Vnguentum de poeto. Everie ounce of either of them having a dram of the Turbith minerall, or Precipitate mingled with Allome with it, is effectuall.

Secondly, some are more harsh; for they must mundifie strongly, if the Callus bee somewhat hard, and the partie somewhat aged: such are Vnguentum Apostolorum, Avicen. having Precipitate and Allome, or the Turbith with Al∣lome mingled with it, Aegyptiacum is stronger than this; but I should rather use the Vnguentum Apostolorum than it, adding more of the aforenamed cathaereticall powder to it; for it causeth greater paine, and procureth not so good quit∣tour as the Apostolorum.

Last of all, the medicaments which are to remove an in∣veterate Callus are Caustick: and even of these some are more gentle, some exceeding fierce. The more gentle are

these. I. ℞ Auripigment. Sulphur. vivi, & Calcis vivae, an. ℥j. fiat pulvis-subtilis. II. is Pulvis sine pari, cujus haec est de∣scriptio. ℞ Auripigmenti, & virid. Aeris, an. ℥ss. Vitriol. calcinat. ℥j. Alumin. usti, ℥ij. fiat pulvis subtilis. III. ℞ Turbith. mineralis non loti, V••trioli v••mitivi, & Boli orient. optimi. an. partes aequales.

Of the strongest of all I will deliver unto you two magi∣strall descriptions only, farre surpassing all others. I. is M. Hale his powder, who was famous in his time for curing of Fistula's: this is the composition of it, ℞ Aquil. mineral. Vitrioli vomitivi, & Terraerubr. oriental. an. part. aequales. II. is this which Iuse in Fistula's and Struma's: ℞ Realgar. albi, Auripigment. & Calcis vivae, an. part. aequales.

You may enquire how these are to be used: If you have dilated the Fistula by incision, besprinkle the Callus with some of the powders; but if you have done it by the second way set downe by me, then use the powders mingled with Vnguentum Populeon, wherewith arme your Fistula tent: or apply a Trochisk made of these powders and Populeum, and afterwards dryed.

After the application either of the Fistula tent armed with the unguent, or of the Trochisk, two things you are to observe: I. That you apply an anodine caraplasme, the fellow to this which I shall now deliver unto you shall not be found. It is also matchlesse in raging paines of the Gout: ℞ Lact. Vaccin. lb. j. Mic. Pan. albi, ℥vj. coq. ad cata∣plasmat. consist. tum adde Vuguent, popul. ℥ij. Gummi Hyose. ℥ss. Croci pulti ʒjss. fiat cataplasma, quod applicetur parti affectae mane & vesperi. IJ. You must not force out either the tent armed, or the Trochisk, before they pop out of their owne accord: for so they bring the Callus out with them, and the tent with the Callus will represent a finger within a glove. If there bee many sinuofities, yet doe not pierce to any remarkable cavitie, as of the brest and belly, then you are to dissolve these powders in some liquor, as in Aqua calcis, Plantane water, Metheglin, a gentle Lee, Allome

water, or Vitriol water. Alchymists exceedingly commend in this case the spirit of Niter.

The second way to remove a Callus by an actuall Caute∣rie is an invention of ab Aquapendente: He will have an in∣strument like to a setting Iron to bee made, the case to an∣swer the widenesse and length of the Fistula, and to bee thrust into the bottome of the Fistula, then must the other round Iron fill the cavitie of this, toward the point onely, and be round an inch long, and bee put in red hot. It is not to stay long where paine is caused, because there is no Cal∣lus; but to be rubbed up and downe where the place is in∣dolent, untill paine be caused by reason of the removing of the Callus by the fire. And although hee highly commend actuall sire, and discommend the potentiall; yet I am not of his minde in sundrie cases: As for this invention, whosoe∣ver shall goe about to practise it, I shall hold him much like to him who is to throw at a Cock blind-folded.

The third Chirurgicall Intention is, to mundifie the part:* 1.136 this medicament will performs this: ℞ Vini albi. lb. ss. Vnguent. Aegyptiaci ℥ ss. Spirit. vini, ʒvj. misc. Inject this this warme, but once a day. You shall conjecture that the Fistula is sufficiently mundified, if the quittour have no ill smell, if it be uniforme, thick, and white.

Then you are to addresse your selves to the fourth Inten∣tion Chirurgicall,* 1.137 which is to unite and consolidate the parts disjoyned. To accomplish this:* 1.138 first draw first draw by an Alembick the spirit of these herbs following, putting so much spring∣water as will bee three inches above the simples to them: the roots of Aristolochia rotunda, Tormentil, Bistort, Com∣frey, the lesser Centorie, Ʋirga aurea, Burnet, Plantane, Knot-grasse, Yarrow, and Salomons seale. Reserve the spi∣rit by it selfe: take the decoction remaining in the pot from the herbs by straining; for everie quart of this decoction take halfe a lb. of Honey, and so much Sugar: This mixture being clarified with the whites of Egges, and strained a∣gaine, let it bee boyled by a soft fire to the consistence of a

Syrup.* 1.139 Take two ounces of the spirit, and one ounce of the Syrup, which mingle, and inject into the sinuositie, and deale with it as I prescribed, when I delivered the manner of dressing a sinuous ulcer. If any man deliver a more pro∣bable way than this to consolidate a Fistula after the extir∣pation of the Callus, I shall willingly lend him mine eares.

The last intention chirurgicall is to skin the orifice,* 1.140 which requireth no new directions. You shall know a Fistula to bee neere whole, when the humour which floweth is little, thick, concocted, and the place voyd of paine and tumour: If it be altogether dry, you may pronounce the orifice to be skinned, and the Fistula perfectly cared.

From the premisses you may gather that foure things hinder the curation of a Fistula. I. Is the afflux of a vitious humour. II. Is the narrownesse of it, which hardly admit∣teth the application of convenient medicaments. III. Is the deepnesse which hindreth the conveighing the medica∣ments to the bottome. IV. The callositie which contem∣neth ordinarie medicaments. Seeing I have shewed you the way to remove these lets and impediments; I hope you will give me leave to conclude this point, of the curation of Fi∣stulas in generall. In the next Lecture I shall discourse of the curation of Fistula's in particular places, which when I have done, I will put an end to this Treatise of Fistula's.

LECT. XII. Of Fistula lachrymalis.

IN my two last Lectures I discoursed amply enough of the nature of a Fistula, by setting downe its description and pathognomonicall or proper signes, and the generall me∣thod of curing all Fistula's indifferently. This only resteth to be done before I put an end to this point, to set downe the curation of some particular Fistula's differing onely in

subjects, which are the parts wherein they are seated, where∣in some speciall directions are required. I will onely speake of three, to wit, of Aegylops in the great comer of the eye, of a Fistula in the brest, and last of all of a Fistula in ano.

First then I will deale with Fistula lachrymalis, the Fi∣stula in the great corner of the eye. In Paulus Aegineta, De Arte medendi, lib. 3. c. 22. there are words in sound much like 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; but in signification different: He will have 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 to be a tumour or Aposteme before it is opened; but 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 he affirmeth to be when the tumour is opened, whether it bee fistulated or no: his words are these: Aegilops abscessus est, qui inter majorem oculi angu∣lum & nares fit: qui ruptu•• si negligatur, usque ad os Fistu∣lam aperit. I demprinsquam ruptum exulceretur apostema an∣chilops appellatur. So according to the version of Albanus Torinus, Thus it may bee Englished: Aegilops is an Apo∣steme betweene the great corner of the eye and the nose: which if it be neglected, it maketh way to a Fistula, even to the bone: this aposteme is called Anchilops before it is bro∣ken. All moderne Authors, who left any monument of Chirurgerie, follow him. This kinde of Fistula is called by the neoterick Chirurgeons, Fistula lachrymalic.* 1.141 By A∣vicen lib. 3. can. fen. 3. tract. 2. c. 14. the aposteme is called Kakilus, or Akilus, and the Fistula it selfe, Garab, or Alga∣rab. Fabriciu•• ab aquapendente, de operat. chirurg. part. 1. c. 21. purposely handleth this matter, and Ambrose Parrey, lib. 16. c. 15. and Taliacotius in chirurg. curt••r. lib. 1. c. 21. The place then wherein this kinde of Fistula is seated, is the inner corner of the eye: although it beginneth first at the holes of the upper and low eye-lid, from whence the teares flow.

* 1.142The signes are manifest to the senses: for first, the orifice doth offer it selfe to the view: secondly, by compression the quittour issueth out: thirdly, a small probe may bee thrust within the cavitie to the very end of the Sinus.

* 1.143As for the Prognosticks: First then, all these Fistulas are of

hard curation, for the moystnesse of the place much hin∣dreth desiccation, which is required in the curation of ul∣cers. Secondly, the part (while one is awake) is in conti∣nuall motion. Thirdly, by reason of the nicenesse of the part, choyse of medicaments must be had. II. If the quit∣tour hath made way for it selfe to the inner passage of the nose, by that hole which passeth thorow the bone of the nose from the corner, then we are only to procure the shut∣ting up of the upper orifice, and not to goe about the sca∣ling of the bone by a fruitlesse labour, which will notwith∣standing cost the patient great paine and griefe. III. If a Fistula in this place become cancerous, which you shall con∣jecture by the hard and livid brims, a stinging paine, and stinking virulent matter, you arc onely to use a palliative cure, applying those medicaments which are fit for a cance∣rous ulcer, whereof in the curation of a cancer I will speake at large. IV. If this continue long, it causeth a consump∣tion of the eye, called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, sometimes blind∣nesse of that eye, and corruption of the aire, which we draw by the nosthrils, if the quittour passe from the glandule, tho∣row the bone of the nose to the nosthrill.

* 1.144Now to come to the differences of these Fistula's: Some are maligne, the signes whereof I have delivered in the Prognosticks: Some are not maligne. Of these wherein there is no malignitie, some are without cariositie of the bone, and some with cariositie of the bone: you shall know that there is no cariositie of bone: First, if the aposteme was not long continuing before it brake; for if the tumor was first an Oedema Scirrhodes, and continued a long time so before it brake, then it is likly that the humor corrupted the bone before it brake. Secondly, if the probe rest not upon a part hard and rugged. Thirdly, if after dilation of the Fistula, the cariositie bee not presented to the sight. If circumstances contrarie to these be offered, you may con∣jecture that there is a cariositie in the bone.

* 1.145To hasten to the curation of these Fistula's: If a Fistula

lachrymalis, without corruption of the bone, bee offered to you to be cured, proceed after this manner. First of all, you are to dilate it: secondly, you are to remove the callositie: thirdly, you are to mundifie it: fourthly, you are to conso∣lidate it: and lastly, to cicatrize it.

* 1.146You shall dilate it by the Fistula tent framed (as I taught in my former Lecture) according to the proportion of the sinuositie in the beginning: then you shall enlarge it more by spunges prepared with the Melilot Emplaster, which I likewayes set downe, when I taught here last. This manner of dressing will discover all corners of the sinuositie. The Fistula having beene thus dilated, you are to goe about the removing of the Callus. Now in performing this there is not so great libertie granted, as is in Fistula's of other parts. For first, fluid and running meanes having a remarkable acrimonie are not safe: for passing unto the Conjunctiva, and from thence to Cornea, they are able to erode it, from whence an ulcer may ensue, and so the griefe bee doubled. Secondly, even meanes solid carefully must be applyed, that they goe no further than the sinuositie of the Fistula. It is not unknowne unto you, what horrible symptomes often∣times afflict the eye, by reason of a familiar humor only ex∣alted in degrees of acrimonie: What mischiefe then is to be expected, if heterogeneall bodies, endued with extraor∣dinarie sharpnesse, as these must be which remove a Callus, doe seise upon the membranes of the eye, adjacent unto the part affected.

Some there are who cure these lachrymall Fistula's with liquid medicaments, as with the water of Elder, or Wall∣woort flowers; in everie pint of these dissolving two drams of Mercurie sublimate, or more, according to the hardnesse of the callositie. The proportion of mixture you must con∣jecture by the continuance of the Fistula, by the age of the partie, and constitution of the body. If therefore a Fistula be offered to be cured in a body young, of a short continu∣ance, and of a tender constitution, then the water is to bee

mild; if contrarie conditions doe offer themselves, then you are to make it more strong, according to discretion. If you take two parts of Plantane water, and one part of the spirit of Niter, you shall have an excellent Topick according to the principles of the Chymists.

One thing is to bee observed,* 1.147 that these liquid medica∣ments bee sparingly applyed to the sinuositie, that no part of them touch the membranes, to avoyd the accidents whereof I spake before.

* 1.148As for mine owne part, I more commend the solid medi∣ments than these fluid: for first, their facultie is more du∣rable: secondly, they are more secure, because they are not so apt to spread. If the body be young and tender, this me∣dicament will serve: Take Mercur. Praecipitati, aut Tur∣bith loti ʒij. Aluminis calcin. ℥j. Exquisite misceantur. postea ℞ Vnguent. popul. ℥j. Pulveris praedicti ʒij. Misceantur ut resuliet unguentum. When you apply this medicament, ar∣ming a tent with it: pull it not out forcibly; but suffer it to pop out of it selfe. Continue the application of this me∣dicament untill the Callus bee removed, which you may ghesse if the processe of the sinuositie appeare soft, and the quittour which cleaveth to the tent appeare laudable.

The Callus being thus removed,* 1.149 you must mundifie it: To this purpose you shall use this locall medicament: ℞ Aq. Chelidoniae aut Rutae, ℥ij. Syrupi è succorutae, aut Mellis rosati ℥j. Misc. applicetur calefactum. Dresse the Fistula but once a day.

The part being mundified,* 1.150 which you shall know by the rednesse and tendernesse of it: Then goe about the conso∣lidation. This you shall procure by this medicament: ℞ Aq. Plantag. ℥ij. Syrupi Mirtillorum, aut Ros. rub. siccat. ℥j. Misceantur. Apply this, and renew it but everie other day;* 1.151 if no remarkable store of quittour flow.

As for the skinning: Diapalma cum succis, de minio, or Emplastrum rubrum astringens will serve.

If in an Aegilops or lachrymal Fistula the bone of the

nose be corrupted by the humor staying in the embosment, then two wayes of curing are offered unto you: The first is by actuall cauterie, the second is by Incision. Peruse all who have written of the curing of this kinde of Fistula, and you shall finde that all with one accord subscribe to the a∣ctuall cauterie.

The actuall cauterie must represent in figure the stone of an Olive: The parts adjacent must bee defended from the fire, either by an hollow plate according to Parrey, or a cane according to Ab aqua pendente: you may make choyse of which you will: you must effectually impresse it, to drie the humiditie, and the sooner to procure the scaling of the bone. And although Authors, after the application of the actuall cauterie, prescribe fattie things to hasten the separa∣tion of the eschar, yet I advise you not to use them; for the part is moyst of it selfe, and so the application of such me∣dicaments would procure a sordid ulcer: Apply therefore onely pledgets, or tents dipped in red wine, and above all Diapalma, or Emplastrum de Minio, or de Smegmate. When the bone hath cast a scale, then consolidate and skin it, as I have set downe before.

It is not unknowne unto you, with what difficultie pa∣tients admit the application of an actuall cauterie, to a part much distant from any of the principall, and wherein there is but small sensibilitie. What will a patient troubled with this griefe doe, if you make mention of cauterization to be made in this place, so neere the eye and the braine it selfe? If at any time you make mention of such a kinde of curati∣on to a patient, to try how hee doth stand affected to this operation; let me entreat you not to urge it too much, as if the cure of the Fistula could not otherwayes bee compas∣sed, if you finde the patient averse, lest you drive him away, and so you lose both credit and gaine. When in the Coun∣trey I practised Chirurgerie, sundrie times this kinde of griefe having beene presented unto me, I ever found the pa∣tients strucken into a terrour and amasement, as soone as

mention was made of cauterization; wherefore I set my imagination at worke, to finde out a way to cure a Fistula lachrymalis, lesse, terrible, but more sure and effectuall, which I will not conceale from you, because this griefe doth often come to your hands, and both great credit and gaine is pur∣chased by performing the curation.

* 1.152My manner of curation is this: First of all, having with a small probe bended, found out the cavitie both upwards and downewards, I draw a line with inke betweene the Glandule of the eye, & the Trochlea or the pulley, through which the small tendon of the first oblique muscule called superior, or major, the uppermost and greatest passeth, and endeth obliquely in the uppermost part of Cornea: then I make incision to the bone; the part incised I divide with the nailes of the fore-fingers, untill the incised bee so much dilated, that it will without difficultie admit a prettie pled∣get: this being done, I thrust in a small Trochiske made of the Turbith minerall before it be washed, the vomitive Vitriol, and the best Terra sigillata wrought with Populeum to the forme of a stiffe paste, and afterward dried. About the Trochisk I apply a pledget armed with Populeum, which I keepe to the Fistula by an Emplaster of Diapalma cum succis, malaxed with the oyle of Henbane. Afterward fil∣ling the orbit of the eye with little bolsters made of soft lin∣nen-cloth folded, and moystened in Aqua spermati•• ranarum caphurata, I rowle up the eye. These same dressings I use morning and evening, untill the Trochisk with the Callus fall out of it owne accord: which when I perceive, I dili∣gently view the bone, to see how much is carious: unto it I apply the powder of Euphorbium, if the diseased partie be aged, and of a firme constitution of body; but if the partie be young, and of a tender constitution, I besprinkle the bone with Pulvis Cephalicus. The cavitie of the part inci∣sed I fill up with a peece of the spunge dressed with the Me∣lilot Emplaster, as I delivered in my former Lecture: about it I apply a pledget armed with Populeum, all which I couch

downe close, with the emplaster and bolsters kept to the eye with a rowler.

This manner of dressing I continue untill the scale of the carious bone cast, which most commonly falleth out about the twentieth day. When the scale is removed, I mundifie the part with Mel rosatum, or Melrutaceum, then I pro∣cure consolidation by the Syrup of Mirtles, or of the red Roses dried. And last of all I cicatrize the part affected with some epuloticall Emplaster, whereof I have set downe suf∣ficient store heretofore, and shall hereafter when I shall dis∣course of an ulcer which hardly admitteth skinning. I have made sufficient experiment of this manner of curing an Ae∣gilops in sundrie persons. And I truly affirme, that I never miffed of the cure of any one with whom I thus dealt: nei∣ther shall you (I hope) if punctually you observe these ob∣servations in your proceedings.

* 1.153It may fall out that the whole substance of the bone of the nose subjacent to the Fistula may be carious, being of it owne nature thin, and the head of the partie besides verie rheumatick, so that being often cured in the opinion both of the Chirurgeon and discased partie, yet it doth breake out againe. In such a case you may demand of mee, how you shall fall off from such a cure with your owne credit. To this I answer, that there is yet a Subterfuge, and a way left to give contentment to the afflicted patient: To com∣passe this, first dilate againe the sinuositie, untill the corrupt bone appeare, as hath beene shewed heretofore: Secondly, pierce the bone of the nose with a gimlet, that the quittor may have recourse to the nosthrils, which are appointed as shoares to discharge the flegmatike excrements of the braine, and to draw in fresh aire for the refrigeration of the lungs: & then cure the superjacent fleshie and skinnie parts, as I taught you, when I set downe the palliative manner to cure a Fistula. This manner of curation being the last re∣fuge, it will undoubtedly give contentment to the patient: for the eyes of the beholders shall observe no deformitie

externall in him, and he himselfe shall not be able to dis∣cerne the turning of the quittor from the glandule out∣wardly, to the nostrill inwardly: besides this, he himselfe shall perceive no smell that shall offend him; the smell of Garlick is not offensive to those who have eaten of it.

Now to conclude this my discourse of a Fistula lachry∣malis, if you perceive any such Fistula maligne, or to tend to a cancrosity, which you shall discerne by the signes set downe, when I delivered unto you the Prognosticks: then use this medicament of Heurnius the father, set downe in methodo ad praxin. lib. 1. pa. 106. which he purchased both with money and entreaty, of one who got much money by it.

This is the description of it: ℞ calaminanter usti, atque in vini aceto extincti ℈ j. myrrha, plumbi usti ac loti an. ℈ss. croci gr. v. opii gr. ij. aeris usti ℈ iiij. decocti fenugraeci ℥ j. Misecantur exquisite omnia super lapidem pictorum. If you meane to make an oinement to continue long, instead of the mucilage of Fenugreeke, use new Swines-grease washed in Rose-water. This is admirable eie-salve in all ulcers of the eyes: (whereof I have made often triall) whether they be maligne or no.

LECT. XIII. Of Fistula's of the Brest.

HAving spoken in my former Lecture of Fistula Lachry∣malis, I am now to set downe the method of curing other particular Fistula's, according to my promise. Of these, Fistula Thoraeis, a Fistula of the brest doth fist offer it selfe. Of the which Cornelius Celsus l. 7. Ambrosius Param l. 9. ca. 31. and Fabricius ab aqua pendente de operat. Chirurgic. part. 1. c. 47. have written.

* 1.154This kinde of Fistula happeneth by two manner of

wayes: First, by reason of a penetrating wound of the brest.

Secondly, by a Phlegmon possessing the intercostall Mus∣cules, and the Pleura.

It is a superfluous matter to set downe any signes, seeing they appeare to the eye, and are easily found out by apply∣ing the signes set downe in the generall method of curing of Fistula's, to every Fistula in particular.

* 1.155As for the differences, a Fistula ensuing a wound pene∣trating to the cavity of the brest, hath but one orifice, the passage and sinewosity whereof is according to the penetra∣tion of the wound; but a Fistula following after an Apo∣steme hath frequently more orifices than one, whereof some passe to the cavity of the brest directly, some windingly.

* 1.156To come to the Presages. All Fistula's of the brest are hard to be cured, and that for seven reasons; [ I] for first, the brest is in continuall motion by reason of its dilatation and contraction caused by the intercostall Muscules: now that motion hindereth the curation of any sore, it is so manifest, and confirmed by experience, that it needeth no probation.

[ II] Secondly, because in penetrating Fistula's of the brest, the Pleura is alwayes ulcerate; which being thin, without bloud, and membranous, as the bladder hardly admitteth any consolidation.

[ III] Thirdly, seeing the Virus of the Fistula doth often cor∣rupt the rib; and seeing the internall substance of the rib is cavernous, and so apt to lodge corrupt matter, the difficulty of curing is increased.

[ IV] Fourthly, in Fistula's of the brest, the end of the Fistula is often lower than the orifice, which hindereth the expur∣gation of the superfluous matter.

[ V] Fifthly, the sinewosity within, in penetrating Fistula's doth frequently extend it selfe betweene the Pleura and the upper rib, to the distance betweene it and the lower rib. Now how hard a matter it is to cleanse this cavity, I referre it to your owne consideration.

[ VI] Sixthly, that liberty of applying of medicaments, which is permitted in sundry other parts of the body, is here de∣nied; the lungs and heart being lodged in this cavity, whereof speciall regard is to be had, seeing from the safety of these parts the life of the Individuum dependeth.

[ VII] Seventhly, because these Fistula's bring an extenuation of the body, and a Hectick fever.

Let this be the second Prognostick: If the party afflicted with a Fistula in the brest be fallen unto a Hectick fever,* 1.157 and his body begin to be extenuate, pronounce the griefe to be incurable: for if you use deficcative meanes, which are required in curing of ulcers, you shall increase these symp∣tomaticall griefes, and hasten death.

[ III] The third Prediction Celsus delivereth unto us in these words, Solent quoque, &c. Fistula's use sometimes, when they have passed by the ribs, to corrupt the midriffe; which may be gathered by the place affected, and the greatnesse of paine, in this case there is no hope of cure.

* 1.158 As for the curation of a Fistula of the brest; to it three meanes are required, a convenient diet, pectorall decocti∣ons, and locall applications.* 1.159 In a Fistula, which hath cau∣sed neither a Hectick fever, nor extenuation of the body, a greater variety of meats is permitted, than when these symptomes are annexed. Howsoever meats of easie conco∣ction, and which afford laudable nourishment, are to bee appointed for the Patient, and a moderate use of them is to be prescribed: of these two meanes I have spoken amply e∣nough, when I set downe the generall curation of ulcers.

* 1.160As for pectorall decoctions, upon the use of which, the greatest part of the cure of such Fistula's dependeth, you shall finde divers descriptions of them in divers Authors. The Simples whereof these Decoctions are made are these;* 1.161 The flowers & leaves of Colts-foot, Maiden-haire, the white Horehound, Comfrey, Tormentill, & Bistort-roots, Violet-flowers, Borrage-roots & flowers, Ellacāpane-roots, Hyssope, Germander, the flowers and roots of Mallowes, the roots of

Parsley and Fenell, Liquorice, Scabious, Valerian, Burnet, Sarsaparilla, Guajak, the China root, Raisins of the Sun, and blew figs: of these Simples you shall finde sundry decoctions set down by Authors who have written of wounds and Fi∣stula's of the brest.

Amongst all others, the Pectorall Decoction of Francis∣cus Arcae•••• you may most safely and securely trust unto: He white he lived, was so fortunate in the practice of Chi∣rurgerie, that he drew that eminent Linguist and Divine, Arrias Montanus, very often to be a spectator of his opera∣tions. The Decoction I need not to set downe, because you may fetch it out of the Author himselfe, who is translated into the English tongue.

* 1.162I will not stick to commend unto you one of my owne, whereof I have sundry times made experiment. This is the Composition of it: ℞ Sars. parill. ℥ vj. scob. guajac. ℥ v. rad. Chin. ℥iij. rad. enuh. campan. ℥ j. capill. ve••••r. scabios. fol. tussilag. scolop••nd. sumitat. hyper. an. man. 1. f••or. borrag. buglos. viol. beton. an. pug. 1. polypod. ℥ iij. liqu•• it. ℥ ij. pas∣sul. major. exacinat. & ficu•••••• pinguinu•• incisar. an. ℥ii ss. In∣funde••tur ista per noct. i••aq. font. f••rventis lib. 24. deinde lento ig•••• coq. ad consu••p. lib. viij. a•• col••tur decoctum. Bi∣bat ager singulis di••bu••lib. iiij. Let the Patient every mor∣ning about five a clock drink halfe a pint of this Decoction warme, and so much about foure a clock in the afternoone: at dinner let him take a pint, and at his Supper another: the third pint he may drink between meales,* 1.163 Marvell at not this quantity, for a lesse will little availe; for strong desiccation is required in this cure.

[ I] Three things vehemently hinder the curation of these Fistula's: The first, is the inconvenient situation of the o∣rifice,* 1.164 when it is higher than the ending of the Fistula.

[ II] The second extenuation of the boyd.

[ III] And the third is a Hectick fever: of these in order.

* 1.165If then the ending of the Fistula be lower than the exter∣nall orifice, a lower orifice is to be made by incision. In this incision.

operation two things are to be diligently noted: The first is the place. The second, the cautions to be observed in the section.

* 1.166As for the regions of the brest: The left side is more safe than the right: for in this side the liver by its gibbosity bea∣reth up the Diaphragma, and doth insinuate it selfe to the cavity of the brest: If then either one of these, or both should be wounded imprudently, it is an easie matter to prognosticate the tragicall event of this operation.

* 1.167As for the determinate part of the brest, which is to bee opened, let it be about the beginning of the next rib, and not at the lower end of that rib, above the which the orifice of the Fistula sheweth it selfe; for under it are couched a veine, a nerve, and an artery.

* 1.168In your Section proceed thus: First, divide the skin to∣wards the upper part of the lower rib, then make way tho∣rowout the incostall muscules: These things being done, dry all things with a spunge, and put into the new orifice a swelling spunge, both to dilate it, and to draw to it selfe the quittor. If you goe thus to work, you need not feare any danger, if you passe no farther than the division of the Pleura: so that neither the Diaphragma, nor the lungs, or the Pericardium be touched.

* 1.169 If with a Fistula of the brest, a Marasmus or Hectick fe∣ver complicat, the difficulty of curing is exceedingly in∣creased; two diseases joyntly conspiring to the ruine of the diseased party, which notwithstanding for their curation require advers indications, the Fistula requiring desiccati∣on; and Marasmus and the Hectick fever craving humectati∣on. If then a Fistula of the brest be offred to any one of you, first of all be sparing in your promises, lest you be accounted clouds without raine: who but an ignorant will give free raines to liberall promises to cure a Fistula of the brest complicat with other Deutoropatheticall greefes of their owne nature hard to be cured; when as it is a difficult mat∣ter to cure a solitary Fistula of the part?

* 1.170Marasmus, in Latin•• Authors Marcor, is an immoderate drynesse and consumption of the whole body, by reason of the defect of the substantiall humidity, according to Trallia∣nus. According to Galen li. de marc.* 1.171 there are two degrees of it:* 1.172 The one is when this extenuation of the body is in Fieri, in consuming; The other is, when it is in Facto effe, or consummate.

* 1.173If it be in Fieri onely; the muscules begin to fall, the skin becommeth flaggie and loose, strength and agility de∣cay, and the party findeth a manifest defect, and impotencie in all the actions of the body, whether they be animall, vi∣tall, or naturall. Againt this degree, you may contend by instituting a diet moistening.

* 1.174If a Marasmus be in Facto esse, or consummate; then the eyes grow hollow, and seeme to bee hid in pits▪ the live∣ly colour of the skin fadeth,* 1.175 the skin of the forehead seemeth dry, and stretched like the head of a drum; the eye-lids seeme heavy, and scarse able to lift themselves up, as it hap∣peneth to those who are wearied by reason of watching; the temples are hollow: in the cavities of the brest and belly, one would think, that there neither Viscera members con∣tained, or guts: for the muscules are so consumed, and the cavities so drawne in, that nothing seemeth to remaine be∣sides the fibra and the skin. To conclude, one having a con∣summate Marasmus, seemeth to be nothing else, but a wal∣king scel••t••s. Whosoever shall undertake the curation of such a one, and performe it, I will give him leave to give himselfe out for another Saviour, and to publish a fifth Go∣spell, which the itching cares of our age would willingly perhaps entertaine.

* 1.176A Marasmus is two-fold: For one is accompained with heat, and may be called a dry Marasmus, [ I] and this is nothing else but a Hectick fever, which hath consumed the radicall moisture of the solid parts, and it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or an extenuating fever.

The other is accompanied with cold. [ II] This is two-fold:

The one is naturall,* 1.177 and it is decrepit old age: for old age is defined by drynesse, and coldnesse.

The other is unnaturall, and it is called Senium ex m••rb••, a decay by reason of sicknesse: old age commeth by the course of time.

This last of a violent cause, for it followeth after a bur∣ning or a Hectick fever; and that by reason of the sicknesse it sefe, or by reason of the medicaments used in the curing of the aforenamed griefes: for a Hectick fever doth not onely waste the naturall humidity, but the naturall heat also seated in the humidity: wherfore the heart it selfe, the well∣spring of this heat must become colder than it ought to bee. In this case the pulse is small & weak, and slow: in like man∣ner the breathing is weak, slow, & cold. By reason of the use of refrigerating medicaments appointed by the Physician in curing of a Hectick, or a Febris Morasmodes, many times Senium ex morbo succeedeth: and this is more tolerable, be∣cause the heart being somewhat immoderately cooled, the lesse of the radicall moisture is spent, than would be if the Hectick had its full course.

* 1.178A Hectick fever, is an unnaturall heat which hath seized upon the solid parts, and wasteth the moisture of them: But seeing there is a three-fold moisture in the body: to wit, bloud in the small veines and arteries of every part, a dewy substance in every part, by the which it is nourished; and gluten, which keepeth together the terrestriall substance of each part, moisteneth it, and keepeth it from falling to dust.

* 1.179There are also three degrees of a Hectick. In the begin∣ning, when the two first humidities begin to faile, the He∣ctick fever is not easily discerned, although it may be with∣out great difficulty cured: But if the radical moisture be consumed, as it is easily discerned▪ so it is hardly cured. As long as this moisture is somewhat plentifull, sufficient to ••ntertaine the naturall heat, the body feemeth well colou∣red, of a comely figure, and of a decent quantity.

* 1.180If therefore you perceive the body of any one having a Fistula in the brest, by reason of the defect of this gluten, orradicall moisture to become discoloured, the figure to be altered, some parts bunching out, some growing hollow and the thicknesse of the members to become slenderer, the flesh colliquating; leave such a one to himselfe, that he may march peaceably to the period of his life. Having deli∣vered unto you of a Marasmus or extenuation of the body, and a Hectick fever, so much as is expedient for you to know in your chirurgicall practices; without the knowledge of which, you cannot possibly proceed, warily and cir∣cumspectively, in curing Fistulaes of the brest. I am to shew you what uses you may make of what hath beene deli∣vered.

* 1.181If therefore one having a Fistula in the brest be brought unto you, whose body seemeth to be nothing else but skin and bone, (as the vulgar proverbe is) acquaint him with the danger wherein he is, lest death seize upon him unprepared. Neverthelesse, if he implore your aid, of Christian charity withdraw not what comfort you are able to procure unto him: appoint then a diet moistening and nourishing, if no Physician be at hand, which I will set down anon; and dresse him with those medicaments which are anodyne & healing. Inject into the Fistula Plantane-water, having some of the syrup of red Rose-leaves dryed, mingled with it; cover your tent and pledget with Diachylon simplex. If you per∣ceive that there is so much of the radicall moisture remai∣ning as is able to cherish the naturall heat, which you shall discerne, if the colour of the body be fresh, if the figure be decent, if the proportion of the parts be according to na∣ture, and the diseased party can In some good measure per∣forme all actions; you may conceive some hope of his re∣coverie.

* 1.182Wherefore if a Marasmus hath extenuate his body, appoint for him a diet, which is likely to repaire the natural moisture impaired. Let him then take broths made of Mutton, Veale,

or Chickens, wherein Damaske Prunes, Raisins of the Sun stoned, Currans washed and bruised, Mallow-flowers and roots, Marigold-flowers, Cinquefoile, Cowslip flowers, and Colts-foot leaves and flowers have beene boyled: Gel∣lies are good, made of young Cockrels, and a knuckle of Veale; use no other spice to it than a little Mace, and Nut∣meg. Let him betweene meales take Almond-milks, made of the broth of a Chicken boyled with French-Barley. It is good for him also every morning and evening, to take a draught of Asses or Goats-milke; or in want of these, of Cowes-milk, milked thorow the Conserves of Borrage, and Buglosse-flowers; Calves and Sheeps-feet stewed with Curranes are good: sometimes let him eat Pigs-flesh. If he have a minde to fish, grant unto him Whiting-mops, Smelts, Perches, young Pickerels, Trowts, yea sometimes Eeles: the Sole, Flownder and Plaice, may also be permitted; poched Egges, and sweet Butter without any Salt, or Almond-But∣ter, are good for break fast.

* 1.183If an extenuation of the body doe proceed from a He∣ctick fever, then you must not onely moisten the body; but coole it also. In the broths then-boyle Borrage, and Succo∣rie-roots, common Sorrell, wood Sorrell, Primrose, Violet, Borrage and Buglosse-flowers▪ let his Sallets be Lettice, Spi∣nage, & Purselane, boiled in Chicken-broth. An Almond-milk made of the Decoction of French-Barley, wherewith the e∣mulsion of the seeds of the Pompion, Musk-melon, Cucum∣ber, Purselane, and white Poppie hath been drawne, is excel∣lent taken morning and evening. Permit no Milke but But∣ter-milke, and that when it beginneth to be a little sowrish, with a little of Sugar, of Borrage, or Buglosse. If the disea∣sed party complaine of immoderate heat, and watching, minister unto him twice a weeke Philonium Persicum, with the syrupe of white Poppie, red Poppie, Gillie-flowers, Maiden-haire, Colts-foot, or of the juyce of Limons, or Citrons, in Aqua Spermatis Ranarum, or red Poppie. If you perceive that by the following of these courses, the party

hath recovered his strength, and a good habit of body, then you may conceive a good hope of his recovery, and put him in good comfort: and so boldly proceed in the Cure, still endevouring by following the indications (as Theseus did the threed of Ariadne to come out of the La∣byrinth) to restore perfect health to the Patient. In the be∣ginning of the Lecture, Lappointed three indications for the curing of Fistula's in the brest; to wit, a convenient diet, pectorall decoctions, and locall applications: I have suffici∣ently discoursed of the first two; the third then remaineth of locall applications.

* 1.184In setting downe of these I will be briefe, because they little differ from the generall, if you except a few observa∣tions. You may safely dilate a Fistula of the brest, with the Fistula tent and spnnge; but in removing of the Callus you be wary, for if you apply the Trochisck, it must not reach to the cavity the brest, for the point of it will re∣lent, breake, and fall upon the Septum transversum, which undoubtedly will crode it, cause an inflammation, procure a sharpe fever, a P••raphre••i••is, and at last death it selfe. Ap∣ply then a tent armed with Populeon, wherewith the Fistu∣la powder must he mingled, as hath beene taught: The Cal∣us being removed mundifie the ulcer with Aqua calcis, and Mel rosatum mingled together: Take heed that you inject no better medicament, for such medicamen•••• are easily suc∣ked in by the lungs, from whence by the Tracha•• Arteria, they easily passe to the throat and mouth, from whence there is felt a horrible bitternesse, a desire to vomit, and an overthrow of the appetite. Para•••• lib. 9. c. 31. affirmeth this to have happened unto him twice t•• be you ware by the ex∣ample ample of others. The ulcer having beene mundified, pro∣ceed to consolidation, for sores in this part are not to bee long kept open. This you shall procure by injecting two or three dayes the syrupe of red Rose leaves d••yes, mingled with Plantane-water; and then onely moistening a pledget wet in this syrupe, or the syrupe of Mirtles. Above the

pledget apply Paracelsus his Stictick Emplastrum, for in this case it exceedeth all others; for it doth not onely draw the brims together, but it skinneth also.

LECT. XIV. Of Fistula's of the belly and joynts.

Having infisted so long in discoursing of the nature and curation of Fistula's, you may think, not without cause, that I ought to hasten to an end. In this Lecture I will set downe the indications of curing Fistula's of the belly and joynts, and so I will conclude this point.

* 1.185The Fistulaes of the belly are two-fold: for they are ei∣ther in the Iuguinal parts, or else in An••.

[ I] Of these in the groynes I will discourse; because they most frequently fall out, being accidents, for the most part, which ensue after Ʋenereall Bub••'s, either neglected, or ill cured: yea, they fall out in plethorick and cacochymicall bodies very often, wherein there is no Neapolitane seed: and that somewhat above the emunctorie it selfe; the mat∣ter not comming to the emunctories themselves, which re∣ceive the excrements of the liver; but being hindered, ei∣ther by reason of the weaknesse of the expulfive faculty, or by the crossing and thwarting of the muscules, oblique and transvers in those places, as you, who are skilfull in the Anatomie, well know. It is no wonder that both Abscesses, and Fistula's often fall out in these places, seeing the belly is as a draught or a sinke in a house, or a keele in a ship, whi∣ther all imparities flow. Yea, such plenty of sharpe humors sometimes floweth to these parts, that perforation of the guts is caused, and that the excrements come out at the ori∣fice of the Fistula; a lamentable case, noisome to the disea∣sed party, and intolerable to the company. It falleth out

sometimes that some of the Vertebra of the Spina are cor∣rupted.

As for the Presages: The Fistula's in these places, which passe not to the cavity of the Abdomen, are hardly cured.

[ I] First, because the liver is still apt to afford new matter.

Secondly, because great circumspection is to be used if you shall use either incision, or corrosive medicaments, by reason of the fibra of the muscules, and the branches of the Vena cava, and Aorta descending.

* 1.186I visited once in Smithfield, a Preacher who had a Fistula by reason of a Venereall b••be ill cured, who entertained for his Chirurgeons Master William Clowes of famous memory, Master Authony Spademan, & William Bray, brothers of this worshipfull company while they lived. Although no con∣venient meanes were omitted, yet the Cure came but slow∣ly on. The diseased party impatient of delay, and not being comforted by any certaine hope of recovery, addressed him∣selfe to one in the countrey, who was accounted famous for curing of Fistula's: for Master Hall at that time had ac∣quainted sundry with his practice of curing of Fistula's. After the Chirurgeon had applyed his corrosive to remove the Callus, it corroding, the tunicles of the great vessels de∣scending, the eschare parting from the sound parts, in the night a strong flux of blond ensued, which deprived him of life before the curer c•••••• come. Wherefore let me advise you, diligently to obs•••• whether the bottome of the Fi∣stula doth reach as deepe as the great vessels, that you may avoid the like fatall event.

[ II] The second Presage is this: If the Vertebra of the Spina be corrupted, pronounce the Fistula to be incurable: you shall conjecture the Vertebra to be soule, if extraordinary store of stinking sanies issue out of the Fistula, and the party daily grow weaker, and more extenuate, notwithstanding that you use all convenient both internall and externall meanes.

[ III] The third Presage shall be this: If the guts be eroded, & the excrements come out at the orifice of the Fistula, the life of

the diseased party is in great hazard, because the guts are thin, membranous, and destitute of store of bloud.

Secondly, because the Fistula is apt to ereepe thorow the distances betweene the muscules, which in those places are many; to wit, the oblique and transvers, one placed a∣bove another.

Thirdly, because in curing such Fistula's, we finde little helpe of hand and eye.

Fourthly, because topicall meanes can hardly be kept to the guts to helpe consolidation.

* 1.187As for the curation of these Fistula's: If they be not deepe,* 1.188 but run alongst superficially, the best course is to make incision, and then to apply one of the Fistula pow∣ders described by me, care had of the age and constitution of the party.

* 1.189As for the mundification, consolidation, and cicatrizati∣on of such, seeing no speciall observation is required, you are to have recourse to that, what I have copiously delivered heretofore. If the Vertebrae of the Spina be foule, you are to promise no cure.

Neverthelesse, if persons of worth will (upon good consideration) entertaine you to dresse them, they find∣ing a comfort by your pains: Make an injection of Plantane, or Carduus Benedictus water, adding some fragrant water of Medow-sweet, the syrupe o•••••• Rose leaves dryed, and the spirit of Wine, having the tr••••ture of Aloe, Myrrhe, Mastick, and some Saffron. Let your emplaster be Diachy∣lon cum gummis, or Paracelsus his Stictick. If the guts fall out to be perforated, having acquainted the friends of the party with the danger, yet despaire not, but goe on, and use methodicall meanes. Let the party eat Calves and Sheeps▪ feet stewed, Sheeps and Calves heads, for they afford a gluti∣nous juyce; Rice boyled in Milke, wherein steele hath beene often quenched, is also good. Every morning and evening let the party take a draught of Allagant, warmed with a wheat tost, when he hath drunke off the wine, let

him eat the toast. Make injection of red Wine, having a little Alome dissolved in it, & some of the syrup of the Mir∣tles-berries: keepe the orifice open with a spunge, untill the gut be consolidate; then proceed to the extirpation of the Callus, mundification, consolidation, and cicatrization, as hath beene often heretofore taught. Event oftentimes falleth out above expectation.

* 1.190Not long agoe a countrey youth, who had an Enterocele, was bound to a Barber in Aldersgate street; one applying to the Rupture a Trusse somewhat strait, caused and sideration or mortification of the part, so that the excrements came out plentifully, with much stinking matter, out of the ca∣vity of the belly. Notwithstanding, by diligence, and ap∣plication of convenient meanes, the gut was consolidate, and the youth kept alive. So much I thought good to deli∣ver concerning the curation of Fistula's which happen in the inguinall region.

* 1.191Now it followeth, that I speak of Fistula's in An••, which was said to be the second kinde of Fistula's invading and possessing of the Abdomen; or the lower belly.

This kinde of Fistula very often followeth after a Phleg∣mon in the Anus, broken and ill cured.

There be two sorts of these Fistula's, for some pierce not the Intestinum rect••••••, and some doe: and both these are ei∣ther shallow or deepe.

* 1.192You shall conjecture the Fistula to passe thorow the In∣testinum rectum: First, if after breaking of wind, part of it make way thorow the sinus of the Fistula.

Secondly, if the excrements appeare mingled with the quittor, or if the quittor smell as the excrements use.

Thirdly, if injection being made at the outer orifice of the Fistula, part of it passe within the Anus.

Fourthly, the forefinger being put into the Anus, if you feele the probe bare it being thrust thorow the sinnus of the Fistula, this is an infallible and certaine signe.

As for the Presages of these Fistula's:* 1.193 First, no Fistula

ani is of an easie curation: for this part being the jax of the body, it affordeth great plenty of impurities, and much su∣perfluous moisture, which hinder the curation.

Secondly, if a Fistula in this place be not very painfull, and noisome, by reason of much & stinking quittor, but shut∣teth and openeth it selfe sundry times, it is expedient for the health of the Patient, if such a one be left uncured; for by this meanes the body is discharged of superfluous hu∣mors, and the body kept in health. I have knowne this accident to have happened to sundry, and to have conti∣nued to the end of their lives. Some I know yet living thus affected, neither doe I doubt, but that sundry of this wor∣shipfull Company have observed the like.

* 1.194Now to come to the curation of these Fistula's: The meanes to attaine to this are sive: to wit, Diet, Internall medicaments, Incision. Deligation, and Topicall meanes.

As for the Diet and Internall medicaments, I have dis∣coursed sufficiently heretofore, so that I need not, distrust∣ing your memories, to repeat any thing.

As for Incision and Deligation; they have place when the Fistula is shallow, but if the Fistula be deepe, neither of these meanes are to be attempted.

* 1.195If therefore the Fistula be shallow, and passe not to the Intestinum rectum, after you have dilated it, and removed the Callus, upon a tent incise all the hollownesse: then fill it with dosels, armed with a medicament made of a restrictive powder, and the white of an egge, to keepe the brims of the incised parts asunder; for if you goe about to unite the parts too soone, it may be feared that a cavity will still re∣maine, and make way for recidivation: wherefore it be∣hooveth you, to see that sound and laudable flesh be ingen∣dered in the bottome. Let not your incarnative medica∣ments be fatty, for such will cause loose and spungeous flesh: use therefore the sanative syrup made of the vulne∣rary plants, having some Pulvis cephalicus mingled with it. If the Fistula goe deepe inwardly, so that you cannot use

conveniently incision, dilate the Fistula with the Fistula tent, and the spunge; then remove the Callus with a Fistu∣la trochisk: the trochisk being come out, and the Callus quite spent, mundifie it with Mel rosatum, mingled with Aqua calcis: when you perceive laudable quittor, ende∣vour to consolidate the part, by applying die sanative sy∣rup, and Pulvi•• cephalicu•• upon the tents, which you must day by day shorten, until at the last the whole sinus of the Fi∣stula is shut up; which you shall conjecture by the little and laudable quittor which the Fistula yeeldeth. Then nothing else remaineth, but to cicatrize the part with your Dia••al∣ma, or Vuguentum de minio.* 1.196 If the Fistula penetrate to the Intestinum rectum, then cutting asunder of the whole sinus of the Fistula by deligation is most sit. But first of all, you you must dilate the sinus, and remove the Callus, (as hath beene said) for so the part which is to be bound will be more thin, and so more easily cut asunder. As for the threed wherewith you are to binde the sinus, two I commend un∣to you; first, sealing threed, which is made of the best hemp, unboyled, and unwhitned: for it is exceeding strong, and will not rot before it hath wrought its effect. The second, is a strong threed of silke, twisted; there is no great matter in the colour, whatsoever scrupulous Authors affirme: you may use either of these as opportunity shall be offered.

* 1.197When you goe about to binde the sinus, put in one end of the threed in the eye of a small and flexible probe, then thrust the eye with the threed thorow the sinus into Intesti∣num rectum: this being done, put into the Anus your fin∣ger, and with it pull the threed out of the eye of the probe, and draw it out at the Anus, or having bent the eye of the probe, bring it without the Anus; and then putting the threed into the eye, draw that end thorow the outer ori∣fice of the Fistula, If the sinus be not very thick and long, you may by one strong deligation binde off all the sinus, but if the sinus be thick and long, you must use sundry constri∣ctions, tying still the ends of the threed with a running

knot, that it may be the more readily loosed. Some after one deligation onely, more and more draw in the ends of the threed, with a round piece of a sticke turned about. When all the sinus after division, by deligation, lieth open, goe forward in the cure, as hath beene set downe when the sinus was incised. Now nothing remaineth to conclude these discourses of Fistula's, but to speake somewhat of the curing of the Fistula's in the joynts. These griefes, what paines they procure to the Patients, and troubles to the Chirurgeons who dresse them, it is so well knowne to those who have beene imployed in such businesses, that I need not to use many words to perswade any to beleeve this: ex∣perience bearing witnesse.

[ 1] The differences of these Fistula's are these. Some are without corruption of the bones and cartilages, and some have these annexed.

[ 2] Againe, some of these are without any tumor of the ad∣jacent parts, and in some there is a remarkable swelling of the parts adjacent; so that the skin it selfe is either brawny and hard, or loose and oedematus; and some of the tendons of the muscules are foule, and corrupted very often: such tumors often fall out, when Fistula's happen in the wrists and anckles.

[ 3] Thirdly, in some of these Fistula's the joynt abideth firme, but in some it becommeth loose and weake, by rea∣son of the relaxation of the membrane which covereth it, and the ligament by the which it is strengthened.

* 1.198Before I come to prognosticate of the events, let me ac∣quaint you with one thing, and that is this; that if you bee called to children or young persons troubled with a Fistula, or Fistula's in the joynt or joynts, that you make triall of the sinus with a Mallow stalke answerable to it: for this kinde of probation is of all others lesse painfull, and will in∣courage the diseased persons to commit themselves to you care, when they perceive that you searched the sores so easir hoping that your proceedings will be according to you-beginning.

The small stalke of the Mallow next to the leafe is alwayes slimie and flexible, and so is apt to slip into the sinus, causing ei••her no paine, or very little.

* 1.199As for the presages: I. No Fistula of the joynt, although it be without corruption of the cartilages or bones, is of an easie curation: for first by reason of the paine which is cau∣sed by reason of sensiblenesse of the part, and the increase of it by reason of the sharpe medicaments which must be applied to remove the Callus, symptomaticall severs, losse of appetite, watching, and at last extenuation of the body; and at last a Hectick fever may be procured.

II. If a Fistula of the elbow or knee, have corruption, either of the cartilages or bones annexed, it will require a long time to have it cured: for the joynts themselves being very sensible, it must be gently dressed.

III. If in Fistula's of the wrist, the bones of it, or of the backe of the hand, be carious, you shall finde the cure to be difficult: for these bones are very spungeous, apt to receive superfluous humidity, and so are hard to be scaled.

IV. For these same reasons, the bones of the joynt of the foot and the instep are hard to be cured.

V. If Fistula's in the wrist or instep be accompanied with large and hard tumors of the hands and feet, pronounce the cure to be uncurable: for then the membranes, tendons of the muscules, and bones most commonly are corrupt.

VI. If an extenuation of the body, or a Hectick fever doe accompany Fistula's in the great joynts, shun the cure: for the indications of curing, which prescribe drying and cooling, in drying increase these griefes. Besides this, com∣plicate diseases are more hardly cured than those which are solitary.

If you shall demand of mee,* 1.200 what course is to be taken with those who are possessed with such uncurable Fistula's, if you bee intreated of the diseased party, or the parties friends to doe your best?

I answer, that if after some triall,* 1.201 you perceive the party

to be uncurable, you ought to move the party to suffer ex∣stirpation, and dismembring of the limme, whether it bee foot or arme, before he grow weake, and become unable to endure any such operation. In young persons you may at∣tempt this operation; for I have adventured it with good successe; but in aged and crazie persons be not too bold: for the losse of the radicall moisture is more easily, by diet and medicaments, restored in those, than these: the other may, but these must die.

* 1.202Now to come to the Topicall meanes, which are conve∣nient for the curing of Fistula's in the joynts, (for as concer∣ning the diet, and internall medicaments, I have spoken of them sufficiently already) you must note that you must have good anodine Cataplasmes to asswage paine, and good, ea∣sie, and effectuall meanes to remove the Callus. If you ap∣ply Mercurie sublimate, or Arsenick to remove the callosi∣tie of Fistulaes in the great joynts, you shall alwayes cause a symptomaticall fever, and sometimes a mortification of the part, if the party be of a cacochymicall constitution.

* 1.203As for the meanes which mitigate paine, I commend un∣to you Fallopius his Cataplasme which he describeth in his Treatise of Ulcers, cap. 17. And it is this: ℞ ol. ••umbrie. chamemel. & aneth. an. ℥ ij. furfur. flor. chamem. farin. hor. esypi. an. ℥ ii ss, vius allagant. ʒ x. fiat cataplasma. Renew it every twelfth houre.

* 1.204As for the removing of the callosity, no medicament is comparable in parity with the powder of Turbith minerall, before it be washed, being mingled with Terra Lemnia, si∣gillata, Orientall bole, and the vomitive Vitrioll; this com∣position may bee applied, being made up in forme of a trochisk, or mingled with populeon, and applied upon a tent. This medicament neither procureth extraordinary inflammation, or any horrible symptome.

As for the mundification, consolidation, and cicatrization of any Fistula in the joynt, after the removing of the Cal∣lus, seeing these intentions may be compassed by the meanes

which I delivered in my former Lecture, I will cease to trouble you with the repetition of them, and so will con∣clude this Treatise concerning Fistula's.

If in Fistula's of the joints there be carosity of the bones, I will deliver the meanes to meet with this accident, when I shall discourse of the accidents of ulcers, before I make an end of this subject.

LECT. XV. Of Herpes Exedens.

HAving delivered unto you, what I thought pertinent of compound ulcers without malignity, method doth require, that I speake fully in like manner of maligne ul∣cers.

* 1.205Maligne is that, which differing from ordinary ulcers is not easily cured. By Gal. de erisib. l. 1. c. 3. not ulcers only, but all diseases which have a malignity annexed to them, all cal∣led 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. As a milde griefe hath a mild cause, and no horrible, or extraordinary symptomes, and yeeldeth to ordinary medicaments: so that which is maligne hath a fierce cause, extraordinary symptomes, and yeeldeth not to ordinary medicaments. These maligne ulcers doc happen, when such a 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 hath possessed the ulcerate part, that it doth corrupt the good nourishment which is sent to the part affected. The aliment sent to the part is corrupted,* 1.206 either by putrefaction, or a venomous quality communicated.

Then the signes of a maligne ulcer are three: First, it corrupteth the part which it invadeth, either by putrefacti∣on, [ I] or a maligne fretting quality.

[ II] Secondly, It causeth extraordinary symptomes, as paine, and plentie of virulent and stinking matter.

[ III] Thirdly, It yeeldeth not to ordinary medicaments.

* 1.207The differences of maligne ulcers are these: First, these ulcers are either ancient or moderne. I call those ancient, whereof mention is made by the ancient Authors: those I call moderne, which were onely knowne to late Writers: such are those ulcers which appeare in scorbuticall, and poc∣kie persons, whereof I meane not to speake in this doctrine of ulcers, because they are symptomes of the scurvie and pocks, which cannot be cured unlesse the griefes themselves be cured. Now the setting downe of the curation of these diseases, will require large and particular Treatises.

Of maligne ulcers knowne to the ancients, some are lesse maligne, some more maligne. Of the lesse maligne there are three sorts: Herpes exedens, Phagedana, and No∣me. Herpes exedens 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek,* 1.208 being caused of thick and sharp choler, it corrodeth the skin even to the subjacent musculous flesh. It differeth from Phagedaena, because it erodeth the skin onely; but Phagedaena, both the skin and subjacent flesh. Celsus lib. 5. cap. 28. thus descri∣beth it: Herpes fit cum cutis exulceratione, & est sine alti∣tudine, latus, sublividus, inaequalis tamen, medium que sanescit extremis affectis, &c That is, a Herpes is caused when the skin is ulcerate. It is not deepe, but broad, of a livid colour, uneven; notwithstanding, the middle doth heale, the brims remaining sore. Wherefore if you perceive an ulcer to spread, and cause sundry other small ulcers, which reach no deeper than the skin, you may pronounce it to be Herpes exedens, or Formica ambulativa, or Corrosiva.

One thing is to be noted in the words of Celfu••,* 1.209 that a Herpes exedens may be of a livid colour; & so with thick and corrupt choler, that melancholy must be joyned, w^ch is bred of Bilis atra, and so it must somewhat participate with a cancerous ulcer. And in truth, such ulcers often shew themselves in old persons about the beginning of the tailes of the muscules of the legs; and from these a moist noisome and stinking virulent matter will flow, and the ulcer it selfe will be very painfull, and rebellions.

* 1.210The signes then of a Formica corrosiva are these: It onely corrodeth the skin, and so is not deepe, but broad; uneven it is, and sometimes of a livid or leady colour, if melancho∣ly caused of Bilis atra be joyned with thick and putrid cho∣ler: otherwise the brims of this ulcer, and the parts adjacent are of a yellowish colour, bewraying the humor, which is the materiall cause of this kinde of ulcer.

* 1.211As for the Prognosticks: First, that Herpes exedens, which is caused onely of thick and putrid choler, is not ea∣sily cured. [ I] For first, the body which is troubled with such an ulcer, is not so soone altered; for the liver, the gall it selfe, and the Porus biliarius must be much out of frame, when they cannot make shift to dispatch this humor by the passages appointed for the evacuations of it; to wit, by the guts, and passages of the urine; but suffer it to passe to the habit of the body by the vessels which carry nourishment; to wit, veines and arteries.

[ II] Secondly, because this humor being altogether contrary to nature, it causeth a 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or ill constitution of the part; by the which the profitable nourishment which is sent to the part, for preservation of it, is corrupted: and so not onely the part affected is defrauded of aliment, but the parts adja∣cent also are drawne to the same society of corruption.

[ III] Let this be the third Prognostick: If a sincere Herpes exedens, proceeding onely of thick putrid choler be hardly cured, as hath beene proved; then if Bilis atra be annexed, surely the curation must be much more hard; for this is a humor which causeth more fearfull symptomes; as extreme paine, greater corrosion, and rebellion to ordinary medica∣ments: and if the body hath gotten a habit of breeding of it, it is hard, without regeneration, to reduce it to its naturall constitution, and to hinder the provent and increase of it. Alchymists promise much, but for the most part they prove clouds without raine.

* 1.212The Alchymists will have the efficient and materiall causes of all ulcers, to be the superfluity of the salt of the naturall

balsome of the body, consisting of a due proportion of salt, sulphur, & Mercury. This superfluous salt being separate from the natural balsom by the expelling faculty, it is turned som∣times to one, & somtimes to another part of the body, accor∣ding as it is apt to be moved, according to its thinnesse or thicknesse, volatility or fixation. It setling in the part, it is more coagulate and calcined (the expelling faculty not be∣ing able to expell it by the pores of the skin) and so it acqui∣reth able to expell it by the pores of the skin) and so it acqui∣reth a certaine corrosion, and is the cause of those ulcers, which luxe no maligne quality accompanying the salt. They will have a volatill and subtill salt, such as is in the nettle, and crowfoot to be the cause of an Erisypelas, and Herpes milia∣ris; but a thicker and more fixed salt, such as that is of the Vitrioll, to be the causes of these ulcers, which corrode the parts adjacent: such a salt then as it, not very thicke, and throughly fixed, they will have to be the cause of Herpes ex∣edens: but such a salt as is dense and thick, and throughly fixed, having some malignity, to be the efficient cause of a Phagedaena and Nome. This is their Philosophy of the ef∣ficient, and materiall causes of these ulcers. And in truth it doth fitly represent to the eye of the understanding the na∣ture of the humor, which dogmaticall Physicians will have to be the causes of ulcers. It is no herefie to maintaine ei∣ther opinion; but he deserveth both credit and gaine, who shall performe the curation of those ulcers which the taketh in hand. Most Patients require rather speedy and easie cu∣ration of their griefes, than learned discourses of them. Howsoever, these discourses are requisite for you, who meeting sometimes with scrupulous Physicians and Pati∣ents, shall be drawn to shew your Theoricall as well as your Practicall part.

* 1.213As for the curation: Three intentions ar required to cure a Herpes exedens: The first is, that the humor which floweth to the part be stayed. The second is, that the humor which is impacted in the part, be evacuate. The third is, the curation of the ulcer it selfe by convenient meanes.

* 1.214The first intention, which is the staying of the humor from flowing to the part affected, is performed by purging of the body from thick choler, and Bilis atra, if the Formica corro siva be of livid colour. To this purpose prescribe such a Potion ℞ electuar. lenit. ʒ vj. pulver. sancti ʒ j. aq. endi∣viae ℥ iij. Misc. ut fiat potie. Or if the Patient be of a dain∣ty taste, and loath electuaries and powders, then such a po∣tion as this which I will set downe will be convenient: ℞ rhab. ʒ j. fol. sen. ʒ iij. ziij. zinzib. ʒ ss. spicae ℈ ss. Infundantur istaper hor. 2. in aq. font. serventis ℥ vj. deinde lento igne ex∣halent ℥ iij. ac coletur decoctum, in quo dissolve mannae, & syru∣pi decichor. cumrhab. aut syrup. Augustan. an. ℥ j. Misc. ••t fiat potie. If the body of the party troubled with the ulcer, be plethorick and cacochymicall, it is convenient that hee take a purgative decoction for sundry dayes together. I will set downe such a one as a patterne; according to which you may frame unto your selves others like unto it in effi∣cacie. ℞ rad. eichor. malvar. horrag. an. ℥ i ss. polypod. querc.* 1.215 ℥ ij. flor. borrag. bugloss. viol. an. pug. 1. fol. sen. & hermodactyl. an. ℥ ij. semin, anisi & faenicul. dulc. an. ʒ vj. rhab. ʒ vj. liqui∣rit. ℥ i ss. Infundantur infundenda per noctens: in aq. font. fer∣vent. lib. viij. sequente die adjectis reliqui•• coq. ad medias ac coletur decoctum, quod aromatizetur cinan: ʒ vj. sumat ager mane lib. ss. ac tantundem hor. quarta pomeridiana. Between ten and eleven a clock in the morning, let the patient take some broth without bread, or a caudle, or aleberrie. These medicaments must be ministred cold in the summer time, and warme in the winter.

The second intention in curing of Herpes exedens,* 1.216 was said to be the vacuation of the humor impacted in the part. This is effected by cathaereticall medicaments, or such as correct spungeous flesh: they are sharper than the strongest mun∣dificatives.

* 1.217In the momuments of the Ancients, we finde the tro∣chisks of Audron, Polyides, and Musa, exceedingly com∣mended in such fretting and creeping ulcers: which I will

set downe both to case you of the enquiring of them, and the better to apprehend and understand them. The Tro∣chisci Andronis are thus deseribed: ℞ malicorii ʒx. alu∣min. ʒiiij. vitriol. ʒxij. mirrh. ʒiiij. thur. aristol. rot. gal∣lar. an. ʒviij. sal. armoniac. ʒiiij. fiat ex omnibus pulvis. Trochises Polyida are thus set downe: ℞ malicor. ʒvj. myrrh. ʒviij. alumin. ʒv. thur. ʒiiij. vitriol. ʒiij. The Tro∣chisci Musae receive these things: ℞ alum. aloes, myrrh. vi∣triol. an. ʒvj. croci ʒiij. malicor. ʒiiij. I should advise to cal∣cine both the Alome and Vitrioll, which enter into these Trochisks, because they more strongly drie than those which are uncalcined. No substance is so fit as Vnguentu•• populaeum to make up the Trochisks. When you are to use these Trochisks, you are to beat some of them to a subtill powder, and to mingle some of the powder with some con∣venient unguent, taking a dramme of the powder for every ounce of the unguent: but what unguents are most fit you shall heare anon. These are the magistrall meanes, which the Ancients used in curing spreading ulcers.

* 1.218The moderne and neoterick Chirurgeons, not conten∣ted with these, have found out other meanes not inferiour to these: The one is Mercuric precipitate, first nobilitate by Iohn de Vico, and fithence his time much used by all fa∣mous Chirurgeons. This powder being washed with Plan∣tane and Rose-water, and mingled with sarcoticall un∣guents, doth admirably heale rheumatick ulcers in tender persons. If it being unwashed be mingled with alome cal∣cined, taking ʒ ij. of it, and ʒ j. of Alome, it is a cathereti∣call medicament, and fit to be applied to foule and spreading ulcers, such as Herpes exedens, Phagedaena, and Nome are. The other medicament invented by the late Chymists, is the Turbith minerall precipitate by the oyle of sulphur, or Vitrioll; it is now much used both in the practice of Phy∣sick & Chirurgeric; it is ministred with good successe to per∣sons infected with the Neapolitane lues; if they have either Cephalas Gallica, extreme paines in their heads, or venereall

ulcers. As for the use of it in the practice of Chirurgery, I dare ascribe to my selfe the invention of it (in these parts) without suspition of any arrogancie. After that is precipi∣tate and calcined, it is very white, and is an excellent escha∣rioticall medicament, farre surpassing either Mercurie sub∣limate or Arsenick: for it is more safe, and is not so painfull: besides this, it doth not cause such inflammations as these do, neither doth it procure so promptly symptomaticall fe∣vers. Being washed, it is used to work these effefts which Mercurie precipitate doth, but much more effectually. To cause these medicaments to evacuate the peccant humors out of the parts affected, you are to mingle these with Para∣celsus his mundificative; taking for every ounce of the un∣guent, a dram either of the Mercurie precipitate, or of the Turbith minerall washed, if the parties grieved be of a ten∣der constitution: or a dram of either, washed and mingled with Alumen ustum, in that quantity as hath beene said, if the bodies of the persons who are troubled with the ulcers be firme and hard, such as labouring men have. You are to continue the use of these topicall meanes, untill the ulcer spread no more, and be red, and very cleane. Having the two first indications required in curing of Herpes exedens, the third indication so followeth: which is the curation of the ul∣cer it selfe.

To effect this, two scopes are required: The first, is to fill up the cavity caused by the losse of the skin. The se∣cond, is to cicatrize the ulcers.

* 1.219 As for the first scope, those medicaments are to bee used which drie strongly, yet have no corrosive facultie. Paulus Aeginet. de art. wedond. lib. 4. cap. 20. hath sundry medi∣caments for this griefe: if you peruse the Author, and con∣fider the descriptions, you will esteem them but sorry ones. Tagaultius in institut. Chirurgicis lib. 1. de tumoribus praet. naturam,* 1.220 hath transcribed them, whom you may see: he hath done this, for no other cause (as I suppose) than this, that he had no better of his owne. Ambros. Para•••• lib. 6. c. 14.

hath some medicaments for this griefe, which are not to be contemned. The first is this: ℞ ceruss. & tut. praepar. an. ℥ j. ol. ros. & adipis caprae an ℥ ij. cort. pini ℥ ss. cer. q. s. fiat unguen∣tum. If you adde to these things some lead calcined, Pome∣granate-rindes and flowers beat to powder, the unguent will be more effectuall. The second is, unguentum enulatum Mercurio, which he commendeth as an infallible medi∣cament: if to every ounce of it you adde ʒ j. of the flowers of brimstone, you shall not misse of your purpose. He doth give one good note, that if you perceive the brims of the ulcer more and more to be eroded, you touch them with Aqua fortis, Oleum vitrioli, or Sulphuris, for by these meanes, sores which seeme uncurable are often healed. Hie∣ron. Fabric. ab aq pendent. part. 2. lib. 1. cap. 28. adviseth to minister inwardly either Goats-milke, or the decoction of Sarsa pariglia, and without all doubt both are good; but there is no parity betweene the Goats-milk, and the decocti∣on of Sarsa: there is none of this company, who is igno∣rant of the faculty of Sarsa in curing all maligne, and cree∣ping ulcers: Goats-milke may have some place, if the party be extenuare, and a Hectick fever feared.

As for the locall medicaments, he commendeth this ce∣rat. ℞ succi depaeto ℥iij. cera citrinae ℥ ij. rosin. pini ℥ ss. ol. myr∣tini ℥ ss. terebinthin. ℥ j. Bulliant ista donec consumptus sit succus tabaccae, ae fiat coratum molle. I will not stick to com∣municat with you the description of an unguent of Tabac∣ca which I use mine owne selfe, neithe•• ••m I ashamed to preferre it before all others of this kinde: the descriptions whereof I have seene. Thus then it is to be made: ℞ axung. porcin. ℥ viij colophon. ℥ iiij. cer. ℥ iij. succi de pato lib. 1. pae∣ti contus. man. ij. coq. haec ad succi consumpt: tum adde gani∣••••i Elemni, vernicis alb terebinthin. an. ℥ j. ac coletur un∣guentum. It is an excellent incarnative in wounds as well as ulcers: besides this, no better mundificative can be devised in tender bodies, if one dramme of Mercurie precipitate washed, or of the yellow Turbith be mingled with an ounce

of it. When you perceive the ulcers to bee filled up;* 1.221 then skin them with this Desiccative of mine: ℞ Sevi dmar. lb. ss. Axung. porcin. ℥iij. Cer. veruic. colophon. an. ℥ij. hisce ab ••gne amot is insperge calaminar. in vino albo ter extinct. ℥j. Lythargyr. Plumbi calcin. Aeris usti, Henrici rub. an. ℥ ss. fiat ceratum. The two prime medicaments which are set downe in Anndotaries to effect this, are Deficativum ru∣brum, and Ʋnguentum de minio, otherwayes called Vuguen∣tum rubrum caphuratum. Your Emplaster de Minio doth not come neere to these in efficacie. Let this which I have delivered serve for the discerning and curing of Herpes mi∣liaris, or Formica ambulativa, or corrosiva.

LECT. XVI. Of Phagedena end Nome.

HAving discoursed in the former Lecture of the first kind of the lesse maligne ulcers, which were said to be Herpes exedens, or Formica ambulativa, or corrosiva, I am to procced to the other two, to wit, Phagedaena and Nome and because they have not a small resemblance, by reason of the similitude of Symptomes, I will joyntly speake of both: and because what latter barbarous writers have delivered of them is confused, I wil labor diligently to distinguish them, that you shall not need to feare to talke of them before the most learned, if occasion shall be offered. These late writers, in the number of whom are Gordonius, Buyrus, Ʋalescus de Taranta, Ioannes de Vigo, Petrus de Argelata, Guido de Cau∣liaco, and sundrie others, who lived in our fore-fathers times, when barbarousnesse had exiled eloquence, and ig∣norance learning: and when all liberall Arts and Sciences had suffered a strange and fearefull eclips, although they set downe sometimes medicaments not to bee rejected; yet I would not have you to trust much to their discourses, or to

labour to imitate their phrases. And as the Arabian Physi∣cians doe farre exceed these, so the Grecians are to bee pre∣ferred unto the Arabians in their discourses, although they come not neere unto the Arabians in seeting downe reme∣dies for the griefes.

If you consider either the varietie or pleasantnesse of them: for many ages together here in the West, Hippe∣crates, Galen, Paulus Aegineta, Oribasins, Alexander Trallianus, and the rest of the Greeke Authors lay unrespe∣cted, and the Arabians only were in request, although most rudely and barbarously translated; which no judicious and impartiall Preader of their monuments will or can deny. Wherefore concerning these griefes, I will deliver unto you what the Grecians, the parents of Physicke, and all other liberall Arts and Sciences, have delivered methodi∣cally: As for the medicaments which are to be applyed, I will pick out the best, which either the ancient or the moderne writers have revealed to us: neither will I conceale from you what I have found effectuall in mine owne practice.

* 1.222 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 then is a Greeke denomination, derived from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which is edo, to eat: so that 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 may be called in Latine Vlcus exedens: in English an eating ulcer.

* 1.223It signifieth two things: First, it is taken for all manner of corroding ulcers, which seize not upon the skin onely, but upon the subjacent flesh also: In this signification it is taken by the ancient Physicians, who flourished before Ga∣len•• time. Secondly, it is taken for a speciall kinde of ulcer by the later Physicians, as Galen. Comment. In aphor. 45. lib. 6. aphor. Hippoc. witnesseth. And it is fit that in discourses and writings all things bee set downe distinctly; for this much helpeth the memorie.

* 1.224It being taken thus for a particular kinde of ulcer, it may be described an ulcer tumified without putrefaction, deepe and corroding the parts adjacent: In that it is said to bee an ulcer tumified, it is distinguished from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, the third kinde of eating ulcers, which corrodeth the sound

parts neere unto it, without any remarkable tumor, as mor∣at large you shall heare anon. It is said to be deepe, becaus It fretreth not onely the skin, but the fleshy part also unde the skin. And by this circumstance it is distinguished from Herpos exedens, which is an exulceration of the skin only. So this kinde of ulcer is not without cause called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or ulcus exedens, because it eateth and fretteth the sound parts neere unto it, making them of this fame condition with the diseased.

* 1.225It is caused of the bilious humor adust inclining to that melancholy humor, which is superfluous and not naturall; yet it is not to bee thought that it it very thicke, as is that which procureth a cancer: or so thin as that which causeth Erisypelas and Herpes. This humor, by reason of the plentifulnes of it, doth fill the brims of the ulcer, and causeth a swelling to appeare; but by reason of its malignitie and acrimonie, it fretteth the parts adjacent which are sound. Neverthelesse this humor is without putrefaction, which is alwaies in the ulcer called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or ulcus depascens, an ul∣cer which feedeth upon the parts adjacent that are sound; for in Phagedaena there is erosion proceeding of a ma∣ligne qualitie without putrefaction, or corruption of the whole substance, which is alwayes joyned with malignitie in a 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

* 1.226Then the pathognomonicall signes of a Phagedaena are these: First, it corrodeth not the skin onely, as Herpes ex∣edens doth, but the subjacent flesh also: The second is this, that in Phagedaemicall ulcers the brims are tumified: The third is, that although there is erosion of the sound parts adjacent, yet there is no putrefaction: And by these two last signes it is distinguis••ed from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉,ulcus depascens, a consuming ulcer.

〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greeke, in Latine Vleus depascens,* 1.227. in English a feeding or consuming ulcer. It is derived from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉,* 1.228 Depas∣cor, I feed upon: for it passing from the diseased parts, it seizeth upon the sound and whole parts, and feedeth up∣on

them by communicating unto them both malignitie and putrefaction. It may be thus described.

〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, it is a corrosive ulcer; without any tumor in the brims,* 1.229 indued not onely with malignitie, but putrefaction, or corruption of the part, also feeding upon the adjacent sound parts, and that deeply. In that it is termed a corrosive ulcer or maligne, it agroeth in this with Herpes miliaris and Phagedaena. But whereas it is said to bee without any tu∣mor in the brims, I meane remarkable, and to have putrefa∣ction annexed, by these two signes it is distinguished from Phagedaena, or Vlcus oxedens, an eating ulcer: for so I think fit to name it; that in denomination also it may bee knowne from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉ulcus depascens, a consuming or feeding ulcer. Last of all, where it is affirmed that it doth corrode not superficially onely the skin, but the subjacent fleshy parts also: as it hath this common with Phagedaena, so by this it is knowne from Herpes exedens; for this causeth ex∣ulceration onely in the skin.

* 1.230But seeing there is often mention made in the monuments of the ancient Physicians, of 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, of Chironian and Telephian ulcers, as of Galen, Paulus Aegi∣neta, and others who follow them, it will not bee amisse to discourse a little of such ulcers: that you may know what is meant by these denominations, and bee able to answer any, if you be demanded what is meant by these termes.

Of these ulcers thus speaketh Galen. de tumorib. praeter nat. c. 13. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, &c. whose discourse may bee thus Englished: Those ulcers which consume, and meddle with the sound parts adjacent, or about, corroding them; all these are called Phagedaenica. So that Phagedaena is framed of the ulcer and the tumor. Herpes in like manner doth erode the parts about it; but it resteth in the skin onely: but Phage∣daena doth extend it selfe as well to the subjacent parts as to the skin. But it is to no purpose to call ulcers Chironian, or Telephian. It is sufficient to call all such ulcers 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ma∣ligna: that is, of an ill condition or qualitie. By this pas∣sage

of Galen translated by mee, you may gather three con∣clusions.

The first is, that in a Phagedaena there is an erosion not onely of the skin; but of the fleshy parts subjacent also, by the which it is distinguished from Herpes exedens, or For∣mica ambulativa, whereof I discoursed in my former Lecture.

The second is, that in a Phagedaena there is a tumor in the brims of the ulcer, whereas there is none in a 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or a consuming ulcer, called by Latine Authors Vlcus depascens, to distinguish it from Vlcus exedens, an eating ulcer.

The third is, that the denomination of Chironian and Telephian ulcers, doe onely signifie maligne ulcers in gene∣rall; but no speciall kinde of ulcer in particular. In Paulus Aegineta de art. medend. lib. 4. c. 46. bearing this inscrip∣tion of ulcers of an evill condition, which are called Chiro∣nian and Telephian by Physicians: these words are read as I have translated them. Old and inveterate ulcers, which hardly admit skinning, which are named 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or ma∣ligne, some call Chironian, as if they did require the hand of the Centaure Chiron, the most excellent in the Art of curing: others call them Telephian, such as Telephus was troubled with, which require the helpfull hand of Achilles, who cured him. So hee jumpeth with Galen, that these ti∣tles were ascribed to all maligne ulcers; but did point at no particular kinde of ulcer.

Now it cannot be amisse briefly to shew unto you what men Chiron and Telephus were, seeing they are so famously recorded by the Poets: They who are Scholers amongst you, cannot but be delighted when the studies of the youth are brought to remembrance.* 1.231 Chiron then was one of the Centaures, which were a people who inhabited the places neere to Pelion, the hill of Thessaly. These first began to breake great horses, and to fight on horse-back: wherefore the neighbouring people, when it first saw them, belee∣ved them to bee strange creatures, composed and framed

partly of humane, partly of horses members: O strange simplicitie•• This Chiron was the sonne of Sa••••ne and Phillyra. It seemeth that he was called Chiron, because hee had a singular dexteritie in the manuall operations of Chi∣rurgerie: for 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, in Greeke is an hand. He taught Aesculapius the Art of curing: Pelcus, Achilles his fa∣ther, was his sonne in law, of whose daughter Thetis he be∣gat Achilles, so much commended for valour and strength by the Heathen Poets. He taught Achilles being his grand∣child, Chirurgerie, playing upon the Citherne, and horse∣manship. The two kindes of Centorie, the greater and the lesser, Centaurium majus & minus, are named of him, where∣of there is great use in the practice both of Physick and Chirurgerie. It is like that hee was fortunate in the curing of maligne ulcers, by reason of the great skill which he had in the knowledge of the facultie of plants. Hee lived but 2690. yeares after the creation of the world, that is, 77. yeares before the destruction of Troy, which fell out Anno mundi 2767. Then 2685. yeares are expired sithence fa∣mous Chiron lived. This may serve to prove the antiquitie of Chirurgerie. Posteritie for his worth named the ninth signe of the Zodiack Sagittarius, who ruleth the thighs, from him: From whence Ʋirgil of the twelve Signes:

Armatusque arcu Chiron, & corniger hircus. Chiron armed with bow, and the horny goat.

By this we may gather how vertue and learning were regar∣ded in the rude and simple ages, which are verie little estee∣med in these civill times, wherein most men are given to en∣joy their pleasures, which will cost them too deare, when the generall accompt shall be made.

Telephus was one of Hercules his sonnes,* 1.232 who being a∣dopted by the King of Mysia who then reigned, after his death succeeded him in government. When he would have hindred the Grecians marching towards Troy, from passing

thorow his countrey, in combat he was wounded by Achil∣les; but afterward being reconciled to Achilles, he was cu∣red by him, hee mingling with either an unguent or a cata∣plasme, (for Malagma signifieth both) the rust of his speare, and it is not unlikely; for there is none here (as I suppose) who knoweth not the facultie of Crocus Martis in cicatri∣zing of rheumatike ulcers, it drying strongly without any sharpnesse; unto which the rust of old iron washed and pre∣pared commeth verie neere. So Achilles made sufficient proofe of his skill in the Art of Chirurgerie, which he lear∣ned of his grand-father Chiron. Goe to then, let effeminate Hind-calves despise the Art of Chirurgerie, which so emi∣nent a person as Achilles was, was not ashamed to practise. From Achilles Millefole is called Sideritis Achillea, Achilles his Star-woort: and it may bee that it was one of the chie∣fest ingredients of the cataplasme: surely it is an excellent healing plant. To conclude then this point: maligne ul∣cers who are not easily cured, are called Chironia, because Chiron was able to cure them, and Telephia because Tele∣phus was troubled long with such an one.

Now time calleth to goe forward in the handling of these corrosive ulcers: but before I set downe the manner of cu∣ring, the predictions of the events which are like to fall out in the course of curation are first to be set downe. I.* 1.233 Neither of both these corrosive ulcers are of easie curation, what body soever they light upon; and for three causes: for first, there is a 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, an ill constitution and temperature of the part, by the which the aliment which is sent to the part, al∣though it be good, is corrupted. Secondly, a fresh supply of noxious humors is sent most commonly to maintaine the griefe. Thirdly, because the ordinarie medicaments which are applyed with good successe most commonly to other ul∣cers, in these ulcers are ineffectuall. II. If these ulcers light upon a cacochymicall body, the case is yet worse: for the constitution of the body must be altered before these griefes can be cured, which is a matter of no small difficultie. III. If

these seize upon decrepit persons, the case is in a manner de∣sperate: for in such the naturall heat is weake, and the radi∣call moysture almost spent: so that great store of corrupt and saltish humors are bred in the bodies of such, which being sent to the weak parts ulcerate, increase these griefes.

* 1.234The curation is performed by three meanes: to wit, a convenient diet, internall medicaments, and locall applica∣tions: As for the diet,* 1.235 those meats and drinks must be used which afford a laudable juyce; whereof I have spoken be∣fore: and in that measure that the naturall heat may bee able to concoct them, that no superfluities be bred. Besides this, meats which are easily corrupted in the stomack are to be shunned, as milk meats, summer fruits, and salt meats: slimie fishes, and Swines flesh are to be shunned, because they afford no good nourishment.

* 1.236Of internall medicaments I meane not to speake much, because this would require a longer time than now can be permitted. If a person be troubled with an ordinarie Phagedaena or Nome, be of strong constitution and pletho∣rick, you may minister unto such Hiera Diacolocynthidos magistralis,* 1.237 or Pilulae aggregativae majores: If the partie be weake, you may minister Piluae stomachicae: Those which I use are these: ℞ Aloes ʒij. Rhab. Agar. Trochiscat. an. ʒj. Mirrhae, ℈ij. Mastich. ℈j. Syrup. Augustani, q. s. ut fiat massula. dos. Pilul. 2. pond. ʒss. à primo somno: vel sumat unam paulo ante coenam, alteram paulo antequam ineatur som∣nus. Whether the parties be strong or weake, who are trou∣bled with these corrosive ulcers, they are to use decoctions made of Sarsaparilla, Guajack, Radix Chinae, Tormentil, Bistort and Comfrey roots, with the which you are to joyne some Vulneraries, as Agrimony, the tops of S. Iohns woort, Sanicle, our Ladies mantle, mountaine and garden Avens, Salomons seale.

* 1.238Nomae of the privie parts were knowne to the ancient writers, as we may perceive by Paulus Aeginetae de Art. med. lib. 4. c. 44. sub finem. In our times they seldome are seene

to proceed from any other cause, than impure copulation. Such are often seene, in the which the whole Praepatium doth sometimes rot away. These corroding venereall ulcers require the generall cure of the Neopolitan disease, besides effectuall Topicks.

* 1.239Now followeth the last indication of curing these cor∣rosive ulcers, which is the application of locall medica∣ments. In a Phagedaena wherein there is a tumor of the brims, you are to apply Vuguentum populeum, and Vnguentum album caphuratum, mixed together in equall quantitie to them. The second thing which I would have you to observe is this, that Nome, or ulcus depascens doth require stronger Topicks than Phagedaena, or ulcus exedens. Marke then these medicaments which I have picked out of Aegineta: I. ℞ Calcis viva, Vitriol. Vomit. an. ʒij. Auripigmenti ʒj. fiat pulvis subtili•• ex his. For a Phagedaena apply the un∣guent of Tobacco, having some of this powder mingled with it, as ʒij. for an ounce of the unguent. If you have to doe with a Nome, make a liniment of this powder and Oxymel, and apply it to the ulcer. II. ℞ Vitriol. albi ℥jss. Croci Martis, ʒvj. Gahar. ʒviij. Crocus Martis well prepa∣red farre exceedeth their Squamae ferri, the scales of iron. Receive this medicament of my description: ℞ Calc. viv. Vitriol. albi, Auripigmenti, an ℥j. Malicor. Balanstior. cornu Cervi ust. Gallar. Pumicis calcinati, Alum. usti, rad. Aristol. rot. an. ℥ss. Croci Martis, Plumbi calcinati, aris usti, an. ʒvj. Cum melle despumate fiat Electuarium. Let mee commend unto you an Aegyptiacum which is not the vulgar: Primo infundantur absynthium, Cardum benedictus, Centanrium mi∣nus, Scordium, Chamaedrys, Malicorium, Balaustia, Gallae, & rad. Aristol. rot. in aceto fortiffimo: ℞ hujus Aceti colati ℥vij. Aerug. ℥v. Mell. ℥xiiij. coq. lento igne ad unguenti con∣sistentiam. This medicament is effectuall in venereall ulcers of the throat, and privie parts, and in all sordid ulcers.

* 1.240You are to continue the application of these medica∣ments untill you see the corrosion stayed, and the ulcers red

and well mundified. When you have perceived this, incar∣nate the ulcers with some of the consolidatives before set downe by me. Last of all, cicatrize the sores with such epu∣loticall meanes as I set downe in my former Lecture.

* 1.241But to shut up the delivery of these ulcers, which are of the mildest sort of the maligne, so much as concerneth the knowing and curing of them: let mee advise you that you promise no sudden cure of any ulcer, if it hath continued but one moneth: for the bodies of the inhabitants of this Iland, are for the most part plethorick, they will observe no good diet, and will not bee estranged from the sacrifice of Ʋenus. It is a strange thing to see what corrupt and ugly stuffe is covered by the curtaines of a beautifull skin, in a number of them. I make no doubt but many amongst you, who are least employed in practice, have had sundrie pati∣ents, who have come to you pretending that they were only troubled with a pimple of the forehead, a red eye, a diffi∣cultie of swallowing, shedding of the haire, watching in the night time, and paines betweene and in the joynts: whereas indeed these griefes were venereall pustules, the Neapolitan Opthalmia, virulent ulcers of the throat, Alope∣cia Gallica, the vigils of Venus, & last of all the pockie joynt ague. It is no hard matter to those who are judicious, to finde out the symptomes of that griefe, which Vigo, the fa∣ther of Empyricks, doth affirme to be able to bring the ac∣cidents of all diseases in particular, according to the diver∣sitie of the constitution of the bodies upon the which it sei∣zeth. If therefore you see any ulcers, in what part soever, more painfull than the solution of such an unitie requireth, that it yeeldeth not to ordinarie medicaments appoyn∣ted for ulcers, than suspect that there is a latent malig∣nitie. Value not therefore your credit at a trifle, bee not too bountifull in promises, lest they bee required at your hands: suspect and pronounce in doubtfull cases alwayes the worst; for the best will save it selfe. Thus doing, you shall bring in no new practice. Many practicers there be, it

is uncertaine whether of ignorance or policie, who aggra∣vate the griefe of those who wholly commit themselves to them, that the greater credit and gaine may redound unto themselves, if the persons diseased escape, and the lesse blame may be laid to their charge if they die. In these proceedings there are two excellent teachers, Skill and Conscience: The first is to enable, the second is to direct practice. So much I thought good to deliver unto you of the three mildest kinds of maligne ulcers, to wit, Herpes exedens, Phagedaena, and Nome.

LECT. XVII. Of a Cancer and a cancerous ulcer.

WHen I ceased from reading last, I put an end to the doctrine of ulcers lesse maligne. Now am I to discourse of these ulcers which are accompted most maligne, and are to indeed. Of these there are two sorts, a cancerous ulcer, and a leprous ulcer: of purpose I referred the hand∣ling of a Cancer and a cancerous ulcer to this place, because it fitteth them best, as you may perceive anon. First then, I will discourse of a cancerous tumor, and then of a cance∣rous ulcer. A cancerous tumor is called by Galen, de tumor. praet. nat. c. 12. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, in Latine Cancrosus tumor; It may be thus defined:

* 1.242It is a tumor proceeding of Bilis atra, round, hard, un∣equall, of a leady colour, hot, verie painfull to the patient, and having full veines implanted in the adjacent parts. For as a crab, in Latine Cancer,* 1.243 hath a body and feet of a livid colour, and whatsoever it claspeth with the clawes, it hol∣deth it firmly, so this griefe is of a livid colour, and so gir∣deth the part which it possesseth, that it seemeth to bee nai∣led to the part, and about it the full veines exquisitely imi∣tate

the feet of a crab: and from these similitudes the tumor hath its name.

In the description the tumor is said to proceed from Atra bilis, or melancholy, or choler adust; for it signified both:* 1.244 for there are two sorts of Atra bilis: the one is caused of naturall melancholy adust: the other is caused of yellow choler burned, and it is much more maligne than the former. See Galen, lib. 3. de atra bile.

* 1.245There are sundry efficient causes which ingender these humors in our bodies: First, a strong hot distemperature of the liver, which burneth the naturall melancholy and yel∣low choler, and so hatcheth this Bilis atra. Secondly, accor∣ding to Galen, c. 10. lib. 2. ad Glaucon. the spleene by reason of its weaknesse and distemperature, doth not draw unto it selfe the superfluous naturall melancholy, and so staying long without it owne proper place it is inflamed and burned. Thirdly, sometimes this humor is caused of the menstruall courses, and Hemorrhodes stopped. Fourthly, verie often an ill diet breedeth this humor, as when one useth meats of an ill juyce, and of a thick substance and hot qualitie, as gar∣lick, onions, leekes, snailes, venison, pease and beanes, and such like. But there is nothing more pernicious than the immoderate use of potent and strong wines, such are all kindes of Sacks, and Greeke wines, which exceedingly burne the humors in the masse of the bloud. An hot aire and perturbations of the minde set forward also this hu∣mor. But seeing there are degrees of malignitie in Atra bilis;* 1.246 the cancerous tumor, or Cancer not ulcerate, is cau∣sed of the milder sort of it; but a Cancer ulcerate is procu∣red of that kinde which is most maligne.

* 1.247Take heed that you imagine not any sort of Cancer to be engendred of natural melancholy, which Galen, de art. curat. ad Glaucon. c. 10. lib. 2. affirmeth to be that part of the bloud which representeth the wine lees, when it is made by the li∣ver, which is drawne by the spleen, wherwith it is nourished: for superfluous naturall melancholy causeth only Scyrrhus.

* 1.248Of the materiall cause of a Cancer thus speaketh Galen, De tumor. praet. nat, c. 12. When Bilis atra seateth it selfe in the flesh, if it bee sharp it corrodeth the adjacent flesh, and doth cause an ulcer; but if it be milder, it procureth a Can∣cer without ulceration. Aeginet. lib. 6. c. 45. hath these words: A Cancer is a tumor unequall, with tumified brims, ugly to behold, of a leady colour, indolent, sometimes not ulcerate, which Hippocrates calleth 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or hidden; sometimes ulcerate: And seeing it hath it beginning from Atra bilis, for the most part it becommeth ulcerate: So he.

* 1.249Where you are to note, that he affirmeth a Cancer to be indolent, or without paine, which is contrarie both to ex∣perience and reason: Celsus also, lib. 5. c. 28. seemeth to grant some Cancers to be without paine. For first, [ I] there is a solution of unitie, by reason of plentifull matter stretch∣ing the parts, and pressing the sensible parts. Secondly, [ II] there is a verie hot distemperature, by reason of the humor which cannot be discussed, which of a necessitie must cause paine. The explication of the rest of the particles set downe in the description, shall be set downe in the deliverie of the signes, to avoyd tedious repetition of the same things.

* 1.250The signes then of a cancerous tumor are these. I. Ac∣cording to Galen, lib. 14. method. c. 9. A Cancer in the be∣ginning is hardly discerned: for the symptomes are but mild, and sometimes it is no bigger than a pease, or a beane, or a filbert-nut. II. It is hard, by reason of the thicknesse of the humor, which withstandeth the touch. III. It is of a leady colour, representing the colour of the humor where∣of it is bred, yea the more maligne it is, the more livid and black it appeareth. IV. The tumor is verie painfull: First, because Atra bilis the materiall cause of it is hot: Secondly, because no heat can breath out, the substance of the Cancer being so compact. V. It is round, because the matter being thick, is not so apt to fleet abroad. VI. It is unequall, by reason of the ebullition of the humor, which notwithstan∣ding is not equally active in all parts of the tumor. Last of

all, a Cancer bath black or livid veines extended to the ad∣jacent parts; for this atrabilious humor cannot sweat out of the veines, which is the cause that they appeare verie full.

* 1.251As for the parts which a Cancer invadeth, although it may breed in all parts of the body, yet it is most often seene in the brests and matrices of women, and in the lips and nose of the face. I have seene it also in ano, and in the top of the yard.

* 1.252The brests most promptly receive this atrabilious humor, because they are of glandulous and loose substance: Besides, the Mammariae veines meet with the Vterinae under the straight muscules of the belly; so that the matrix may dis∣charge it selfe of adust and feculent melancholy bloud by regurgitation, which may cause a Cancer if it passe to the dugs.

* 1.253A Cancer in like manner doth appeare verie often in the matrix, by reason of the detention of the menstruous bloud, which staying above the ordinarie time is burned. The lips also are spungeous & soft, and so apt to receive atra bilis, the materiall cause of a Cancer. Galen, de art. curat. ad Glauco∣nem, lib. 2. c. 10. hath these words: Cancerous tumors may bee in all parts of the body, but chiefly in the paps of women, which have not their purgation according to na∣ture. Aeginet. lib. 6. c. 45. saith; A Cancer doth happen to sundry places of the body, but chiefly to the matrix and paps of women.

As for the predictions before curing,* 1.254 receive these: I. Al∣though Cancers may appeare in all the quarters of the yeare, yet most commonly they shew themselves about the ending of the summer, and during the whole time of the harvest: because in these seasons, the melancholick exceedingly in∣creaseth, and humors become adust. II. No Cancer is easi∣ly cured; for if all ulcerate Cancers be incurable, according to Galen, c. 5. lib. de atra bile: no cancerous tumor can easily bee cured, it having the same efficient cause. III. A

Cancer not ulcerate, if it hath possessed any deepe cavitie of the body, as the matrix or anus, it is not to bee dealt withall, according to Hippoc. lib. 6. aphor. 38.

* 1.255You must understand that hee meaneth the curing by ex∣cision, causticall meanes, or ustion: for the ulcer will not admit cicatrization, and so the diseased parties live in conti∣nuall paine and filthinesse, and at the last die miserably. But hee forbiddeth not the application of locall meanes, which asswage paine and gently mundifie. IV. Cancerous tumors in the outward parts, and onely superficiall in the begin∣ning, may be cured according to Galen, lib. 2. c. 10. ad Glau∣con. V. When cancerous tumors are come to a remarkable bignesse, they onely can bee cured by extirpation. VI. If a Cancer not ulcerate hath possessed the matrix, the partie fee∣leth great paine in the groines, and hath often a difficultie in making of water: If the Cancer be ulcerate, it sendeth out a loathsome and cadaverous smell, the vapor whereof ascen∣ding to the heart and braine, causeth sometimes fainting. VII. If the afflicted partie be weake, and the cancerous tu∣mor be inveterate, or of along continuance, it is not to bee dealt withall with excision, adustion, or potentiall cauterie: onely lenitives are to bee used to procure a palliative cure: for sundry have continued even to their decrepit old age, with a Cancer not ulcerate.

* 1.256Now it is time to addresse my selfe to the setting downe of the curation of a cancerous tumor: The meanes appoin∣ted for it are three, Dieteticall, Pharmaceuticall, and Chi∣rurgicall.

[ I] As for the Dieteticall meanes, all thick and strong wines are to be shunned, course bread, Cabbage, and Colwoort, Cheese, old and salt flesh, old Hares, and Venison: Watch∣ing, immoderate labour and griefe are to be shunned; as also all other things, which thicken the bloud, and inflame the humors. Let the diet bee cooling and moystning. Barley creame is good, and Ptisan, Mallow flowers and roots, Succorie flowers and roots, Borrage, Buglosse, Violet〈2 pages missing〉〈2 pages missing〉

vineger. Many commend a cataplasme of Raisms stoned, Rue, and the leaves of Night-shade. This Fabricius, ab a∣qua pendent. commendeth: ℞ Solan. hort. virg. aureae, son∣chi, an. man. ij. coctis in aqua & contusis adde far. siligin. lb. j. Ol. ros. ℥v. fiat cataplasma. The Chirurgeons in Italy had in Fabricius his time, a medicament of greene Frogs effectuall against a Cancer, and in the Gout: thus it is made; Take a good number of greene Frogs, whose mouths fill with sweet butter, afterward put these Frogs in an earthen pot well glazed, having a cover, and the bottome full of holes: place this pot in the mouth of another earthen pot placed in the ground; lute these well together, and the cover of the upper pot: then for the space of three houres, let a gentle fire of Charcole bee set about the upper pot, to drive downe all moysture and fat to the lower: when the pots are cold, take out the Frogs out of the upper pot, and beat them untill you feele no roughnesse betweene your fingers: Last of all, mingle the fat and moysture in the lower pot, with this substance, and keepe this mixture in a cleane gal∣ley-pot. Receive also this medicament from Parrey. Lib. 6. de tumor. praet. nat. c. xxx. ℞ Theriac. veter. Succi lactuc. & o. Ros. an. ℥j. Succi cancrorum ℥ss. Vitellos ovorum indu∣ratos numero 2. Ducantur in mortario plumbeo ad unguenti consistentiam. Hee also in this same chapter commendeth a thin plate of reed anointed with quick-silver.* 1.257 The Cancer is to be dressed morning and evening. So much then of a cancerous tumor, or a Cancer not ulcerate, now am I to de∣liver unto you the curation of a Cancer ulcerate.

* 1.258A cancerous ulcer is an ugly ulcer, having a most stinking smell, thick lips, and turned outward, greenish and fretted, which yeeldeth a Sanies black, or of a dark yellow colour, and is exceeding painfull Riolan the father in his Chirurge∣rie, in the second Section of ulcers, c. 13. affirmeth this sa∣nious matter to be a strong poyson. No death could be de∣vised too cruell for such an one as should give it to a man.

* 1.259The partials of the definition containe the signes of a

Cancel ulcerate, so that I need not to insist longer in the explication of this point.

* 1.260Of a cancerous ulcer there are two meane differences, Lupus and Noli me tangere: that is in the thigh or leg, this in the face. A Cancer in other parts of the body hath no particular denomination; but doth retaine the generall ap∣pellation, with addition of the part affected, as a Cancer of the brest.

* 1.261One thing is to bee noted, that in other countries, if a Lupus be troublesome, they apply the flesh of an hen, chic∣ken, pigeon, whelp, or kitling cut asunder, according to the length: for so the furie of the disease ceaseth, the malignitie of the sanies is eased, and the corrosion is stayd: Sec Riolan and Ambrose Parrey in the places before cited.

* 1.262As for the prognosticks: First, if a Cancer not ulcerate be of hard curation, an ulcerate must bee of an harder: Se∣condly, if the partie bee weake and feverish, [ I] the matter is desperate. [ II]

* 1.263As for the curation, the diet, phlebotomie and purging, which I have set downe for the curing of a cancerous tumor will serve here also: wherefore this onely remaineth to set downe the locall medicaments.

* 1.264This then shall be the first: ℞ Plumbi usti & loti, Tutiae & Thuris, an. ℥v. Absynthii. ℥j. ol Ros. lb. ss. Cerae, ℥jss. [ I] Succi Solani, q.s. Ducantur in mortario plumbeo ad unguenti consi∣stentiam. Apply this upon pledgets of lint, or fine tow: a∣bove this, to asswage paine, apply a cataplasme of the leaves of Succorie, marish-Mallow, and the white Poppie bea∣ten, and tempered with oyle of Roses.

[ II] The second shall bee the application of the juyce of Night-shade out of Tagaultiut, tractat. de ulcer, c. 19. Moysten a double cloath in the juyce of the Night-shade, and apply it to the ulcer; then apply above this cloath a pledget of tow or wooll moystened in this same liquor. You may keepe the juyces of herbs all the yeare long,* 1.265 by putting them in a glasse, having a fosset in the bottome, and

powring oyle upon the juyce, that it may bee three inches thick above the juyce.

[ III] You may also use the juyce of our English Tobacco, and those which I named in curing of a Cancer not ulcerate.

[ IV] The distilled water of the herbs with Camphir, applyed after this manner is effectuall.

[ V] If you dissolve the Camphir first in the spirit of wine, it will mingle the better with the waters: ℞ Mellis verbascini, ℥ij. pulv. Malicor. ʒiij. ol. Nuc. ℥j. Misc.

[ VI] This medicament of Fallopius is excellent: ℞ ol. Ros. & Omphacini,* 1.266 an. ℥vj. ol. Myrtini & unguent. popul. an. ℥iij. fol. Solan. & Plantag. an. man. ij. Bulliant lentissimo igne ad Succorum consumptionem, tum colentur: colatura adde cera ℥iiij. hac eliquata omnia amoveantur ab igne: Quum adhue tepent adde lithargyr. ℥vj. Cerussae. ℥ij. Tutiae, ʒij. Plumbi usti ʒijss. Ducantur in mortario plumbeo per duas horas. All these medicaments which I have set downe only are to stay the increase of a Cancer, and to abate the raging paine in those Cancers which are large and deepe.

* 1.267If a Cancer be but superficiall, it may bee eaten out with Arsenick sublimed: The manner of the sublimation of it and use I did shew, when I discoursed of Fistula's.

* 1.268A Noli me tangere in the lip, if it hath not eroded a great quantitie, it may bee cured as an hare-lip, with little de∣formitie.

* 1.269As for a Cancer in the matrix or anus, use this medica∣ment: ℞ Stercor. bubul. lb. iiij. herb. Robert. Plantag. Sem∣pervivi, Hyoscyami, Portular. Lacturend. an. man. j. Canc. fluviat. numero 12. Contundantur omnia, ac distillentur in Alembico plumbeo, imbuatur caphura, ac frequentèr injicia∣tur aut sola, aut cum aqua spermat. ranar. As for the method of the extirpation of a Cancer, I will reserve it to that part of Chirurgerie which teacheth the way to remove things inconvenient to nature, called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

* 1.270The medicaments in the Apothecaries shops fit for Can∣cers are, Vnguentum de tutia, de lithargyr. de minio, De sicca∣tivum

rubrum.* 1.271 Fabricius ab aq. pendent. de tumor. c. 3. set∣teth downe a method whereby an Empyrick cured sundry Noli me tangeres, and Cancers in other places: and it is this, ℞ Vitriol. lb. jss. Auripigment. Sulphur. vivi, an. ℥iiij. Sal. gemm. ℥iij. cum aceto fiat pasta. In ollaterrea probè lutata sic∣cetur in furne. With this powder he consumed the Cancer, but by divers applications.

* 1.272You shall know that the Cancer is quite extirpate, if laudable flesh appeare, like to the seeds of the Pomegranate, if it yeeld good quittor, and no sanious and stinking matter: then he healed it with this unguent: ℞ Mell. despumat. ℥iiij. Sevi hircin. limatur. capri, an. ℥jss. Litharg. auri, ℥j. Misc. Another in Essex about thirtie yeares agoe, in curing of Cancers, used onely the greene Treat, and white Vitriol, for everie ounce of the Treat taking ℥j. of the Vitriol: and by all likelyhood the medicament of Payne the Smith, with the which he went about to cure Noli me tangeres, was but a medicament composed of Arsenick, Orpiment, unslaked Lime, Bole and sweet Butter. You see how I conceale no∣thing from you.

* 1.273The Chymists will have arsenicall, realgarian, and orpi∣mentall substances separated from the naturall balsome, or composition of the body, to bee the causes of these cance∣rous tumors and ulcers, when they settle in the parts, and cannot bee discussed: howsoever, they represent fitly the nature of a Cancer: for as it is, so are they of a putrefa∣ctive qualitie. Let no man marvell, that sundry minerals may be in the body, seeing we see stones in the gall, kid∣neyes, and bladder

* 1.274For the curing of Cancers they commend Antimony so prepared, as it doth not vomit, or trouble they body; but ei∣ther procureth sweat, or purgeth downward: and indeed it is an excellent medicament: for it changeth the constitu∣tion of the body, and mundifieth the masse of bloud.

* 1.275As for the Topicks, use the oyle of Arsenick, or whereof Mercuries vitae is made, mixed with oyle of Roses in due

proportion, and these two have no fellowes; for I protest, I have often made experiment of both. If any the desirous to know, and make use of any thing which I have delivered, I will not be nice to impart it.

LECT. XVIII. Of the Leprosie and a leprous ulcer.

NOw followeth the second kinde of ulcers most ma∣ligne; to wit, a leprous ulcer. But first of all, I will discourse of the Leprosie it selfe, and then of the nature of a leprous ulcer.

* 1.276The Leprosie in the Greeke and Latine tongue is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, scaber, rough: for it maketh the skin rough and uneven: or from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, squama, or cortex, a scale or bark, because it sendeth our scales, & maketh the skin rough like to the bark of a tree.* 1.277 There be two sorts of leprosity: to wit, the Grecian and Arabian Leprosie.

The Grecian leprosity may be thus described: It is a tu∣mor with a confirmed hot any dry distemperature of the skin, both in the outer and inner part of it, wherein scales, like those of fishes, are sent out: so that Pruritus, Scabies, and Lepra Graecorum, the itch, scabbinesse, and the Graecian leprosity differ onely in degrees of tumifaction, and distem∣perature.

* 1.278In itching there is no remarkable tumor, neither doth a∣ny thing fall away from the Cuticula, unlesse it be fetched away by hard scratching. In scabbinesse there is a remarka∣ble tumor, and whether we scartch or no, both sanious mat∣ter, and scales like to the cast skin of a snake. In the Graecian Leprosie, there are greater tumors than in scabbines, and bo∣dies like unto the scales of fishes, fall from such as are pos∣sessed with this griefe: so that Avenzoar fitly calleth scabbi∣nesse Pruritum vesicalem, a blistery or powckie itching, but

the Graecian leprosity Pruritum squamosum, a scaly itching.

* 1.279The signes of this Leprosie are these: the skin is dry, rough, and full of small knobs, which itch exceedingly, and sendeth out bodies like to the scales of fishes.

* 1.280The causes of it, are either the externall efficient causes, or the internall materiall.

* 1.281The externall efficient, are I. unwholesome meats and drinks.

II. Slovenlinesse, sluttishnesse, and filthinesse. Serenus the poeticall Physician hath comprised these two causes learnedly in two Hexameter verses thus:

Illotus sudor & inopia nobilis escae Sape gravi scabie correptos asperat artus.

Sweat not washed away, and want of good food, often doe make rough the lims, being taken with noi∣some scabbinesse.

III. The menstruall courses, or hemorrhodes which were wont to flow, being suppressed, may cause this dis∣ease.

IV. Fontanells which have long beene kept open, being shut up may procure the same.

V. Varices, the veines tumified by reason of melancholy bloud, being cured, sometimes are the causes of this griefe.

* 1.282The materiall causes are discerned by the colour of the griefe: for if the knobs bee of a livid or leady colour, superfluous impure melancholy is the cause; if they be white, or of a grayish colour, then salt flegme is predomi∣nant, which is mingled with melancholy: and because aged persons multiply salt flegme, they are often troubled with this griefe.

* 1.283As for the Presages, let this be the first: this griefe if it be habituall, and of a long continuance, it is not easily cured.

Secondly, if it be neglected, it may turne to the Leprosie of the Arabians.

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pointed for them: for thorowout the whole yeere they eat cabbage salted, much cheese, old butter, and flesh dryed in the smoke, but most of all bacon. In like manner it is fami∣liar to Aegypt: because there they eat much asses-flesh, and drink standing and corrupt waters, if you except those who inhabit places neere to Nilus. Lucretius learnedly expres∣seth this, lib. 6. de natur. rerum.

Est Elephas morbus qui propter stumina Nili Gignitur, Aegypti inmedio, neque praterea usquam.

The Leprosie is a disease which is bred by the River of Nilus, in the middle of Aegypt, and no where else.

Hence it is that Moses threateneth the disobedient Iewes thus, Deut. 28. vers. 27. The Lord will smite thee with the botch of Aegypt, and with the emerods, and with the scab, and with the itch, whereof thou canst not be healed. In the He∣brew Text, it is with the ulcer of Aegypt, whereby is meant the Leprosie; by the scab, he meaneth the Greeke Leprosie, whereof I have spoken. In Spaine and Africk it is more common than any where else. In the Province of France, Delphinat, Languedock, and in Aquitane it is more fre∣quent than in other parts of the countrey, Paraeus l. 19. ca. 6. Before the time of Pompey it was not seene in Italy, as wit∣nesseth Plin. nat. hist. l. 26. c. 1.

Secondly, the Leprosie may be taken by having carnall co∣pulation with an infected person, see Gordon. l. wed. particul. 1. ca. 22. and Philippus Schopfius in his Treatise of the Le∣prosie.

Thirdly, the Arabians, Avicen, Albucasis, and Averoes, think that if a woman conceive while her courses flow, the childe will prove leprous, but it is not likely: for that bloud in sound women is good, and after conception it is retai∣ned to nourish the childe: so that if that bloud were vero∣mous (as some think) no man or woman could be sound.

Fourthly, this disease being often heredetary, it is pro∣pagate from the parents to the children.

Fifthly, continuall conversation with leprous persons cannot be but very dangerous, for if one may become Pthi∣sick, by often receiving the breath of one who is troubled with that griefe, according to Glassick Authors, much more may one be infected by receiving the aire infected with the breath of a leprous person, which is most corrupt and stin∣king: wherefore lazarous persons, in every well ordered place, dwell by themselves, that they infect not others; and so God himselfe commaded, Levit. 13.4. and Numb. 12.14.

* 1.284The internall materiall cause, by all is concluded to be Bilis atra. Now seeing this humor is caused of three seve∣rall humors altered from their naturall qualities, three kindes of Leprosie doe spring.

First, it is caused of the superfluous melancholy juyce burned; this Leprosie causeth the skin to be of a ruddie black colour: this kinde of leprosity commeth on but slowly, and hath milder symptomes.

The second is of yellow vitelline choler adust: This speedily corrupteth the inner parts, chiefly the liver and spleene, and from thence palling furiously to the habit of the body, produceth horrible symptomes: in this kinde of Leprosie the skin is of a yellowish colour, tending to greene.

The third is caused of salt or nitrous flegme burned: In this the colour is a palish white colour, the Leprosie which is caused of this humor, is not so fierce as the former. There be two other differences taken from the progression of the disease: for a Leprosie is either in the beginning, or consummate.

* 1.285The signes of a Leprosie beginning, are these: The face seemeth to be of a livid reddish colour, the breathing is with some difficulty, the voyce seemeth to be somewhat hoarse, livid spots appeare in sundry parts of the body, the skin beginneth to loose its exquisite feeling, the urine is muddy

and thick.* 1.286 Plinie affirmeth, that it was not seene in Rome before the time of Pompey, and began first in the nosthrill, not exceeding the bignesse of a lentill, and from thence pas∣sed to the whole body, producing spots of divers colours, making the skin unequall, and raising scurses, and hard scabs.

* 1.287The signes of a confirmed Leprosie are these: I. The skin loseth altogether its feeling, so that you may thrust a needle thorow it, without any offence to the diseased party; [ I] this happeneth because the humor, by reason of its thicknesse, stoppeth the sinewes, and so hindereth the ani∣mall spirit to passe. Neverthelesse, the muscules move, al∣though sluggishly; because they have veines and arteries, by whose bloud and spirit they are fed.

[ II] II. Knobs appeare in sundry parts of the body, but chiefly in the face, about the forehead; the eares become thin, the nose flat upward, the lips thick.

[ III] III. The face is of a leady reddishnesse.

[ IV] IV. The voyce becommeth very hoarse, the lungs and wind-pipe being affected.

[ V] V. The eyes become round, the thicknesse of the hu∣mor bearing in the corners.

[ VI] VI. When the griefe is consummate, warts very often doe appeare thorowout the whole body, like to haile-stones, as we see in measly hogs.

[ VII] VII. Levinus Lemnius affirmeth, that the powder of lead calcined will swim in the urine of leprous persons,* 1.288 but sink in the urines of all others.

[ VIII] VIII. They are troubled with much belching.

[ IX] IX. Their sweat and breath is most stinking; their brea∣thing is with difficulty and stinking, by reason of the con∣striction of the brest.

[ X] X. The haire of the head beginneth to fall, that of the beard to grow thinner, and those of the eye-browes and eye-lids to fall also: this falleth out, because corrupt nou∣rishment is sent to the haire, for if you pull out a few of

their haires, you shall also pull out with the roots a fleshie substance.

[ XI] XI. The nosthrils without are tumified, but within they are narrow, and ulcerate.

[ XII] XII. The veines under the tongue seeme varicous, small knobs also like to haile-stones appeare there.

[ XIII] XIII. The skin is unctuous, and will not admit water.

[ XIV] XIV. The skin is wrinkled, and full of wrinkles and chops, as an Elephants skin is.

[ XV] XV. The Muscules of the thumbe waste.

[ XVI] XVI. If the body, the fingers, and toes have stinking ul∣cers, and chops, you need not much to doubt.

[ XVII] XVII. If you open a veine, it will be thick, burned, feculent, and have as it were fat upon the top, and it being strained thorow a cloth, leaveth a greety substance behinde it.

Now it is time to addresse my selfe to the Prognosticks, [ I] wherof this shal be the first: A leprosie in the very beginning is hardly cured, for the materiall cause of it is Atrabilis: now all disease? of Bili•• atra are of hard curation.

Secondly, a Leprosie consummate is altogether incura∣ble by Art.

Now the meanes of curing a Leprosie beginning,* 1.289 are three: Dieteticall, Pharmaceuticall, and Chirurgicall.

As for the diet:* 1.290 That which I delivered for a cancerous tumor and ulcer, in the former Lecture, in this griefe is also effectuall, so that I need not idly to spend the time. It is fit that leprous persons eat of the biggest Snailes dressed as Wilks, or Perwinkles; and Frogs, and that for a moneth together; for this food doth exceedingly contemperate the heat of the bloud: the water also distilled of them is good to be drunk. Rodericus Fonseca commendeth this drink:* 1.291 ℞ rad. chin. ℥j. succi limon. ℥ iij. aq. cichor. lib. vj. Infund. per diem natural. deinde coq. in B. M. per hor. iiij. vase be∣ne clauso, decoctum postquam refrixit coletur: This same China will serve the second time, but to the third decoction

you must have new China. The flesh of Vipers or Adders eaten, is good: let them be boiled in water, with some salt and oile; eat both the flesh and broth, but the heads, tailes, and intrals must be taken away: the trochisks of the Vipers or Adders are good, being ministred in Succory water: Poul∣try also fed with paste made with the flesh of these, and Bar∣ley-flowre is good, if it be used a long time; Corall and Pearle prepared, ministred in broths, are excellent; young Hares in March are good.* 1.292 Galen commendeth the Viper wine, and setteth downe the histories of sundry who were cured by the use of it. And Aretaeus lib. 4. cap. 12. de signis ac causis acutorum: but that preparations of vipers ministred in a confirmed Leprosie, Erust. part. 4. disput. cont. Paracel and Palmarius lib. de morbis contag. witnesse to be ineffe∣ctuall, for they made triall of them.

The Pharmaceuticall meanes are of two sorts: for either they are Catharticall, or Specificall. Amongst the Catharti∣call means, ℈j. of the extract of black Ellebore is excellent: the next is the purgative, or Diaphoretick Antimonie: the third is the flowers of the Regulus, ministring gr. viij. in conserve of Roses: the fourth is the infusion of the glasse it selfe, mingling with it a spoonefull of the syrup of Vio∣lets; Mercurie precipitate with gold is admirable, gr. iij. are enough for a dose.

As for Specificall meanes, these are commended: the de∣coctions of the Elme, Larix-tree, the roots of Tamarisk, Caterach, Fumiterrie, and Juniper-berries, boyled as Gua∣jack is, and drunken for a long time; three ounces of Straw∣berry water, or of the Cuscuta, Dodder taken morning and evening. Crollius commendeth ℈j. or ℈ij. Spiritus tartari in aqua conveniente, or gr. 7. of the spirit of salt ministred af∣ter the same manner, gr. vj. Bezoar similiter laudantur, for it withstandeth malignity.

* 1.293As for Chirugicall meanes, they are two; Phlebotomie, & locall applications: If Phlebotomie be required, open the Saphena about the change, or the Hemorrhodes, but take not

much bloud at a time, for leprous persons are weak.

As for the locall meanes, they are either baths or lini∣ments; this bath is commended, Take of Crow-foot ten* 1.294 handfuls, of Colts-foot five handfull, of Tabacca two hand∣full and a halfe; boyle these in a sufficient quantity of spring water: use this morning and evening, untill the body yeel∣deth no filth.

Of all other liniments, Roderic. Fonsec. consult. 1.* 1.295 com∣mendeth this: ℞ viperas duas quas nulla parte rejecta inde phialae vitrea continent. lb. ij. Ol. ol. veter. exponatur rubru•••• & fatens, hoc ••leo inunguentur axillae, inguina, car∣pi. Intu•• autem exhibeatur ʒj. Trochis. Exviperis, velcolubr. in ℥iij. aq. card. benedict. & ℥j. syrup. aceto fit curi, per dies 14. To these ulcers apply a linement made of this oyle, and Goats-suet, taking eqnall quantity of both. Wee may make an effectuall Oyle of our Adders to this same purpose.* 1.296 Gardanus used to anoint the Spina, Joynts, and Pulses of hands and feet with the fat of Vipers, for the space of seven dayes in a hot-house, & affirmeth, that be not only did mi∣tigate the Leprosie, but did cure also consumptions of the body, and the Pthysis it selfe. If you have not these medica∣ments at hand, you may apply such as I set downe for the curing of a cancer, in my former Lecture: which require no repetition.

LECT. XIX. Of the abating of superfluous flesh.

HAving set downe the maine differences of ulcers, and the method and meanes how to cure them, I must dis∣course in like manner of the accidents of ulcers, which may hinder the prime intentions of curing of them, and so prove a let and impediment to you in your proceedings.

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to those medicaments which are called Cathaeretica,* 1.297 Aufe∣rentia, which take away the superfluous fungous flesh. These are not so hot as either escatoricall, or septick medicants, and those which blister: yet hot they are, and burne, al∣though gently; being then hot and dry in the fourth de∣gree, they are of a thick and astringent substance: wherefore such medicaments pierce not deepe, partly by reason of their thick substance, partly by reason of their rebated heat; wherefore these onely superficially dry and corrode the flesh. Neither doe they cause any great paine, because their heat is not very Intense, unlesse they be graduate by the ad∣mixtion of some other things. So we see Mercurie preci∣pitate, or burned Alome, if either of them be applied to any sore, to cause no great paine; but if they be used being mixed, both to cause paine, and a small eschar. Such are Alome calcined, Shels burned, the powder of Hermodactils, Asphodill, Vergidrasse, but Mercurie precipitate excelleth, and exceedeth all these: for it doth work with small paine, and doth by concoction make thick, thin, and ichorous quittor: yea it being washed, and mingled in small quanti∣ty with incarnative unguents, furthereth their operation. The yellow Turbith minerall exceedeth it in faculty, for the oyle of Vitrioll or Sulphur, whereof the Turbith mi∣nerall is precipitate, is more familiar to nature, and astrin∣gent, than the Aqua fortis, or Aqua regis, whereof the pre∣cipitate is made.

Two Cathereticall unguents are much used, Ʋnguentum Apostolorum, and Ʋnguentum Aegyptiacum.

Of these two, the Aegyptiacum is the strongest:* 1.298 In plaine ulcers I would not advise you to use it, for it spreadeth, and by touching the sound part causeth great paine. It is effe∣ctuall in fretting sores of the mouth, and sinewous ulcers, being dissolved, either in decoctions, or distilled waters convenient tor the kinde of sore.

As for Vnguentum Apostolorum,* 1.299 if it be made according to Art, it is a cathereticall medicament in tender bodies;

but onely a mundificative in those who have a firme and so∣lid constitution of body.

It falleth out many times,* 1.300 that the superfluous flesh is so hard and compact, that it contemneth all cathereticall me∣dicament, and cannot be abated by them. In this course we are to have recourse to those medicaments which are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or Putrefacientia, or rotting the part; and to those which are named 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or Crustam inducentia, which leave an eschar or crust after they are applied.

As for the Escharoticall medicaments,* 1.301 which are called Exedentia, or eating medicines, seeing they corrupt the naturall heat, they must be hot above the third degree, and have a thick, viscous, and terrestriall substance; wherefore by reason of their heat in the fourth degree, they burne the part, and by reason of their thick and terrestriall substance, the heat is kept durable and permanent. And we see that Pepper, Onyons, and such like, although they be hot above the third degree, yet they are not caustick; and the reason is, because although they inflame, yet because their heat is placed in a thin and subtill substance, it is more easily dissol∣ved, and at last overcome by the naturall heat of our bodies.

So when a Caustick is applied, notable paine is caused:* 1.302 First, by reason of their extraordinary and exceeding great heat.

Secondly, because by reason of their terrestriall substance, they are long in piercing thorow the part.

Of these medicaments two are most used: the Lapis infer∣nalis,* 1.303 and the white Caustick. I meane not to trouble you with the setting downe of their preparations, because they are sufficiently knowne unto all who have profited any thing in the study and practice of Chirurgerie.

Of these two, the Lapis infernalis is most effectuall, & wor∣keth most speedily; wherefore it is most fit for making of fontanels, where it may be conveniently applyed to the up∣per part of the member, and be hindered from spreading:* 1.304 but if a caustick medicament be to be applied to a depen∣ding

part, and where there is feare of running, then the white Caustick is most convenient. Besides these, two other escharoticall medicaments I will commend unto you.

* 1.305The first is Mercurie sublimate, mingled with Roman Vitrioll calcined, untill it become red, and the true Terra sigillata.

* 1.306The second, the Turbith minerall mingled with these same; but whilst it is white and not washed. These doe work more gently, if they be mingled with any narcoticall or anodine unguent, than when they are applyed to any fore without mixture. But the Turbith minerall far excee∣deth the Mercurie sublimate, because it is more familiar to nature, & doth not cause such paine; besides, it is not so vo∣latil and piercing as the sublimate is, which in tender bo∣dies assaulting the heart it selfe, doth cause sharp diaries, al∣though they be but symptomaticall.

* 1.307For the suppressing of rebellious excressing flesh in ulcers, the second meanes I appointed those to bee which are cal∣led 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or putrifacentia, corrupting medicaments. These are not so hot as those medicaments which procure an eschar, or crust, they have a more thin substance, and subtill, and have not so much terrestreitie, or astriction. These doe more easily pierce, and so cause not so great paine: the paine which these medicaments cause is pungitive, as if needles did prick being made red hot, and it quickly cea∣seth. And as caustick medicaments leave the part corrupted in manner of a crust, so these leave that which they corrupt soft,* 1.308 moyst, and of a blackish colour. If you will require medicaments moyst, endued with such a facultie, have re∣course to the oyle of Vitriol, the oyle of Sulphur, Aqua fortis, and Aqua regis. But if you will have solid and hard medicaments, then call to aid all sorts of Arsenick, as the white, yellow, and red, passing under the names of Rats-bane, Orpiment, and Roses-ager.

* 1.309As for the Septick Vegetables, because they rather mor∣tifie the inward parts, if they bee ignorantly or maliciously

ministred, then abate proud flesh in ulcers, as Dryopteris, the Ferne of the Oake, and Aconitum, or Leopards-bane, and such like, I will leave them to the consideration of the Italian and Spanish poysoners.

* 1.310But being appointed to read a Chirurgicall Lecture, and having onely made mention of abating of superfluous flesh in ulcers, by the application of topicall medicaments, you may demand of mee whether this may not bee effected by Chirurgicall instruments, as actuall cauteries, and incision-knives and razors. Truly hitherto I have deferred the men∣tion of this kinde of curing, because God of his bountie in these later times hath in all faculties revealed many things which were kept from our fore-fathers. If a patient reso∣lute offer himselfe to a skilfull Chirurgeon to be cured, let the Chirurgeon,* 1.311 in Gods name, in extremities use iron and steele: yet let me advise him not to bee too forward in three cases. I. If the partie be of a tender constitution, and unwilling for if a Chirurgeon do altogether urge these ex∣tremities, he may lose his patient, who is prompt to hearken to the Syrenian speeches of deluding Knaves and Queanes. II. If you cannot handsomely come to the part, as if the ulcer be sinuous. III. If the superfluous flesh require not onely abating, but drying also, it being marvellous moyst, then the medicament is better than the instrument, because it drieth more powerfully.

Now to end this Lecture, I will deliver unto you a medi∣cament of famous Fallopius, which is effectuall both in corre∣cting of stubborne superfluous flesh, and in curing of Can∣cers: the description of it is this: ℞ Arsen. cristallin.* 1.312 & Citri•• an. ʒss. Aristol. rot. Aerugin. an. ʒj. Opii, ℈ij. Axung. porcin. ℥jss. Misc. Ut fiat unguentum. One thing I had al∣most let passe, to wit, the description of cathereticall lint; use this of Fallopius his description: ℞ Aq. Plantag. Ros.* 1.313 Solani an. ℥iiij. Opii, ℈j. Medullapanis, ℥ij. Mercur. ssubli∣mat. ℈ iiij. super porphyritidem triti. Omnia haec commixta bulliant ad consumptionem medietatis: deinde colentur per

pannum crassi••sculum. Fila excerpta bulliant aliquandin in hoc liquore, postea eximantur, exprimantur, siccentur ac ser∣ventur ad usum. So much then concerning abating of su∣perfluous flesh in ulcers.

LECT. XX. Of the scaling of corrupt bones.

Having in my last Lecture set downe the fountaines from whence all the accidents of ulcers doe spring, and having discoursed of the manner of curing of an ulcer, wherein there is excrescense of superfluous flesh, which was set downe to be the prime accident flowing from things ac∣cording to nature, I must be carried to the second accident, proceeding from things according to nature, which is the cariositie of the bone.

Now seeing the bones are the stayes and props of the body, appointed not onely for locall motion; but for the parts also which further this action, as muscules, veines, nerves, arteries, I am with the greater care to set downe the curation of an ulcer, with the cariositie of a bone, seeing so many things of importance doe depend upon the curation of such an ulcer. In running over the whole course of Chi∣rurgerie, I have resolved upon this first triall, to set downe onely the generall practices, which they who are judicious may apply to all persons and parts in speciall. In handling of this accident, I will set downe these foure points. I. The causes which procure the cariositie of the bones. II. The signes of a corrupt bone. III. The prognosticks or an ul∣cer, wherein there is a cariositie of the bone: And IIII. Of the meanes which are to be used for removing of this ac∣cident.

* 1.314Now the causes which procure the corruption of the bones, are either externall, or internall.

The externall causes are two, to wit, too great cold,* 1.315 and too great heat: for as too great cold doth quench the na∣turall heat of the bone; so immoderate heat, by discussing the naturall humiditie, drieth and corrupteth the bones.* 1.316

The internall causes which most frequently produce this accident, are in number three. The first is a glutinous and superfluous humiditie, first softning, and then corrup∣ting of the bone, which oftentimes doth cause a distortion of the member, and a protuberance of the bone, which I have sundrie times seene, and have noted not to have pro∣ceeded from any venereall cause. Such an humor seized up∣on one, whose name was Iames Wilkinson, who dwelt neere to me when I practised in the citie of Chester, and caused a bending outward of both the shin-bones, or Ossa tibia: this happened to him when he was above sixtie yeares old: neither did this accident either cause nocturnall or diurnall paine, or hinder his going. Before this did befall him, hee had a great evacuation of bloud (by reason of the rupture of a vessell in his left kidney) together with his urine, of the which I cured him by the decoction of some of the My∣robalans.

[ II] The second inward cause of the cariositie of bones, is a sharp and maligne matter, which by touching doth corrupt the bone: this happened) most commonly in old and inve∣terate ulcers: the Periostium being once croded by the acrimony of the Sanies, it presently corrupteth the bone. It is no marvell that a sharp humor is able to corrupt bones in other parts of the body, when wee see the teeth to bee hol∣lowed by a sharp rheume, which a file of tempered steele doth with some difficultie rase.

[ III] The third inward cause is an hidden and strange qualifie of the humor, adverse to the bones, seizing not onely upon some particular bones, but upon some parts also of these bones: for if it did with any manifest qualitie corrupt the bones, it would first have eroded the flesh: this being most subject to the impression of any fretting humor. But the

bones verie often are found to be carious, when the parts covering the bones, as the Cuticula cutis, and Membrana carnosa are found whole. So when Nodes invade the Citi∣zens of Naples, they appeare most commonly in the Os frontis, or in the Ʋlna, or Tibia, and that betweene the joynts: Who is able to give a demonstrative reason of this invasion? Hee undoubtedly who is able to shew why the Loadstone draweth Iron, and the Amber and Jet Chaffe.

* 1.317The signes discovering the cariositie of a bone, are either sensuall, or intellectuall.

The sensuall are in number five.

I. Is if the bone appeare black and fretted:* 1.318 Blacknesse is caused by the corruption of the naturall temperature, by the which it is kept alwayes white with a ruddy glimps, or of an horse-flesh colour almost. Cariositie is caused by the acrimony of humor fretting the substance of the bone.

II. Is, when the bone being felt with a probe, doth not appeare smooth, but rugged.

III. Is, if the probe slip not being guided into the bone; for then the Periostium must bee gone, and so the bone ei∣ther more or lesse corrupted, partly by reason of the aire, partly by reason of the quittor settling upon the bone.

IV. Is, if the flesh ulcerate above the bone appeare soft and spungeous, or of a livid colour, it is to be doubted that the bone is corrupted: for when the bone is carious, the flesh is made soft and corrupt, so that any one may thrust a probe thorow it, without any great annoyance to the partie.

V. Is this: if a tent or pledget reaching to the bone stink the next day when it is taken out, there is just occasion offe∣red to suspect that the bone is carious.

* 1.319The intellectuall signes are in number foure.

[ I] I. Is, if more quittor doth flow from the ulcer, than the bignesse of it seemeth to afford.

[ II] II. Is, if thin and stinking sanies doth flow from the the sore, it is probable that the bone is foule.

III. [ III] If an ulcer admit skinning, and often breake up a∣gaine, it may not without cause bee doubted that the bone is foule: for an humor still flowing from the corrupt bone, doth cause a new inflammation, whereby the skin of a new is broken.

[ IV] IV. Is this. If an ulcer hath continued a long time, and is rebellious to proper medicaments, it may be thought that the bone is carious being much moystened, and so made soft by the quittor: and therefore must be scaled.

As for the Prognosticks:* 1.320 Of such ulcers as are accom∣panied with cariositie of the bone, receive these.

I. No ulcer accompanied with the cariositie of the bone is of easie curation: for it hath a malignitie annexed to the solution of unitie.

[ II] II. If there happen a cariositie passing the first table in either of the bones above the eye-browes, it will bee an hard matter to cicatrize it: If this be a true Aphorisme in wounds dividing these parts, how much more true in ul∣cers: those ondy causing a solution of unitie by an exter∣nall cause; but these eroding the parts by an internall hu∣mour: which for the most part is still supplyed by some no∣table distemperature of some noble part.

[ III] III. Shall be this: If any of the Vertebra's of the Spina prove foule, shun the cure: for first the substance of the Vertebrae being hollow, they will hardly scale: Secondly, it is an hard matter to come to apply a medicament unto them, by reason of the muscules placed above them. Thirdly, because it is an hard matter to shun the paires of sinewes, which spring from the transverse processes of them.

[ IV] Let this be the fourth: If in ulcers of the brest, the Ster∣num or ribs be foule, bee not too forward to meddle with them; for the acrimony of the quittor may easily corrode and pierce thorow the entercost all muscules, and the Pleara, and so lay open to the aire the vitall parts, which ere it be long, must cause an extinction of the naturall heat, and so death it selfe.

The fifth shall be this Ulcers in the great joynts, as the elbowes, knees, or ankles, wherein there is a cariositie of the bones, with losse of the cartilages, are for the most part uncurable, because the paine in the joynts is great, depri∣ving the diseased persons of their naturall rest and sleepe, and so of good digestion and concoction of their food: be∣sides this, they seldome fall out alone, but bring with them a Marasmu••, or extenuation of the body.

* 1.321Having set downe the causes, signes, and presages of the cariositie of a bone, I am to shew the way how the cariosi∣tie is to be removed. To performe this taske, two things are to be done: First of all, the bone is to be laid bare, and no lesse of it than is to be sc••l••••: Secondly, the scaling of it is to be procured by conv•••••••••••• meanes.

* 1.322The discovering of the bone is to bee procured three manner of wayes; to wit, by Incision, Exesion, or Dila∣tation.

As tor Incision:* 1.323 we are not to use it where the bones lye deepe, and have muscules, tendons, veines and arteries above them, as in the thighs & armes chiefly to the inner parts. Se∣condly, although the bones lye not deepe, if they have many tendons above them, we cannot use Incision safely: such ate the bones of the Metacarpium, or the upper distance be∣tweene the wrist and fingers, and the bones of the Metape∣dium or Metatarsus, which are articulate with the toes.

* 1.324Exesion is performed by potentiall cauteries; as Lapis infernalis, the white Caustick, the powders set downe by me, when I discoursed of Fistula's and cancerous ulcers.

* 1.325These are not to be used where many tendons or nerves are, lest they deprive some parts of their motion, and cause convulsions, by reason of the great paine which they, pro∣cure, as also symptomaticall fevers. Potentiall cauteries are most convenient, when there is cariositie in the Cranium, the Ulna, or Tibia.

* 1.326Dilatation, or enlarging of a narrow sore, by stretch∣ing out the circumference of it, is performed by such things

as swell, when they have imbibed any moysture, as the roots of Gentian, the pith of the Eldar, and spunges brought close together, either by threed, or the Melilot Emplaster.

* 1.327These are fit to be used in ulcers which possesse the back of the hand, or the instep of the foot. The bone being by some of these meanes laid bare, I am to shew you how the bone is to be scaled.

* 1.328This is to bee performed three manner of wayes, to wit, by medicaments, instruments, or actuall cauterie.

* 1.329The medicaments which procure the scaling of a bone ought to be verie drying, and of a subtill and thin substance: for the found bone, being assisted and strengthened by such drying medicaments, sendeth forth of it selfe flesh, which being increased, separateth the corrupt bone from the sound.

* 1.330These Desquamatorie medicaments are of three degrees. For some are mild, as the root of Peucedanum, or Sow∣fennill, Aristolochia rotunda, the root of Iris, and Myrrh: these will serve if the cariositie of the bone bee but su∣perficiall, [ I] and the constitution of the partie soft and tractable.

[ II] Some againe are yet more drying and strong, as that me∣dicament of Avicenna, which is composed of equall parts of Aristolochia rotunda, Iris, Myrrh, Aloe, the rind of the plant Opopanax, whereout the gumme issueth, the Pumick stone calcined, the refuse of brasse melted, and the barke of the Pine-tree. All these being beat to powder may bee ap∣plyed alone, or mingled with honey. Of this nature also are Aqua vitae, and the root of Dracontium or Dragons.* 1.331 Fallo∣pius hath two medicaments to this purpose: the first is this, ℞ Rad. Peucedani, Indis, an. ℥j. Euphorb. ℈j fiat ex omni∣bus pulvis: qui excipiatur pasta panis molli, atque ossi cor∣rupto applicetur. The second is this: ℞ Rad. Peucedan. A∣ristol. rotund. Opopanac. Enphorb. an. ʒss. Terebinthiae ℥j. Cera ℥ss. Aceti ʒj. fiat cerat. ex p. a. These and such me∣dicaments are to bee used, when the cariositie is somewhat

deepe, and the partie of reasonable firme constitution of body.

[ III] Lastly, some are strongest of all, as Euphorbium beat to powder, Aqua vitae having the tincture of Euphorbium, the oyle of Cloves, or Petroleum wherein some Camphir is dis∣solved, Aqua fortis, Aqua regis, the oyle of Sulphur, and the oyle of Vitriol, and Roman Vitriol calcined. These are to be used when the cariositie is deepe, and the constitution of the diseased partie stubborne and strong. When these medicaments are applyed, the fleshie parts adjacent must be verie well defended, otherwayes paine and inflammation will be caused. If the sores be well dressed, and these medi∣caments judiciously applyed, the bones will scale within the space of fortie dayes.

[ II] Sometimes the cariositie of the bone is verie deepe, so that a long time would bee required for the scaling of it:* 1.332 wherefore in this case we must have recourse to instruments: the chiefest of these instruments are the Mallet, and Chee∣sels,* 1.333 and Raspatories: First then, the corrupt part of the bone is to be knocked off with the Mallet and Cheesell un∣till you come to the sound bone; which you shall know if the bone bleed, and appeare white and firme, according to Celsus.* 1.334 Secondly, the bone is to bee made even with the Raspatories and smoothed. In this case a leaden Mallet is best; for it is weightie, and causeth a lesser noyse: this be∣ing done, some of the aforenamed medicaments must bee applyed according to the constitution of the partie;* 1.335 for by it you must be led.

In ulcers of the head it often falleth out, that both the ta∣bles of the soul are so••le, so that you shall be enforced to re∣move a great peece of the C••anium: here you must use the [ III] Trepan & head-saw, the use wherofshall be delivered, when I shall set downe the curation of the wounds of the head.* 1.336

The third way to scale bones, I named to bee the actuall cauterie: Of it I will set downe three documents: The first shall be, when it is to be applied: The second shall di∣rect

where it shall be applyed: The third shall teach, how the sore is to be dressed after the application.

As for the first:* 1.337 It is to be applyed when superfluous hu∣miditie floweth to the bone; this you may conjecture; First, by the moyst and cold constitution of the body of the person affected: [ I] the signes of such a constitution I delive∣red unto you, when I discoursed of a waterish tumor: whi∣ther I remit you.

[ II] Secondly, if after the application of your desquamatorie medicaments, the bone still appeareth moyst and soft, not changing its colour.

The second document shall be, where it is to be applyed:* 1.338 you may apply it safely to the Ulna and Tibia laid bare.

[ I] Secondly, you may use the actuall cauterie in those pla∣ces, where dilatation onely is permitted, and not incision, [ II] or potentiall cauterie, as in the back of the hand, and instep of the foot: but this operation you must doe thorow a pipe of white iron, to save the circumjacent parts from burning.

[ III] Thirdly, you may apply the actuall cauterie to the joynts, if the cartilages bee foule, and way be made. This practice Ambrose Parrey used when hee had dismembred one in the joynt of the elbow: the dismembred partie found great ease and comfort by the application of it: See the Histo∣rie, Lib. xj. cap. Xxv. What formes of cauteries you are to use, the figure of the ulcer will shew you. When the actuall cauterie is applyed, you are to bee acquainted with the manner of dressing of the bone, which was the third document.

How this is to be done,* 1.339 Guido a Cauliaco teach you in his owne words: I (quoth hee) after the application of the cauterie, apply for the space of three dayes oyle of Ro∣ses tempered with the white of an egge, & for three other, it mingled with the yolk of an egge: and afterward But∣ter with. Mel rosatum, and ever above these applications some mundificative untill the bone scale. Afterwards, I in∣carnate

and consolidate the part with Avicens medica∣ment, which I delivered unto you amongst the medica∣ments exfoliative of the second degree. Fallopius counsel∣leth after cauterization to use pledgets moystned in Rose∣water and the white of an Egge, to hinder inflammation for some few dressings: then to apply to the bone the me∣dicaments exfoliative.

* 1.340Beware of the use of the actuall cauterie, if the Scull, or any of the Vertebrae of the back be foule, by reason of the braine contained in the first, and the Spinalis medulla con∣tained in the second; which being inflamed by the heat of the actuall cauterie, will bring alienation of minde, and con∣vulsions.

LECT. XXI. Of a discoloured and varicous Ʋlcer.

THe two last differences of ulcers taken from things ac∣cording to nature, were said to bee an ulcer, wherein the naturall colour is altered, and an ulcer varicous. First then I will discourse of the ulcer, wherein the colour is al∣tered, and then of an ulcer varicous.

* 1.341 As for an ulcer having the skin adjacent, and the sub∣stance of the part altered. The unnaturall colours which possesse the part altered are most commonly foure; the red, yellow, livid, and black colours.

The red colour proceedeth alwayes from heat,* 1.342 causing, an inflammation.

* 1.343The externall efficient causes of it are superfluous hot garments, too thick boulsters, rowlers made of wooll, or of hard and stubborne linnen-cloth, the hot season of the yeare, too strait ligature, the use of hot meats and drinks, surfetting, venerie, troubling the masse of bloud, extraor∣dinarie motion of the part, perspiration hindred by reason

of the suffocation of the part, or incuneation of the humor, and solemne evacuations suppressed, as of the flowing of bloud from the hemorrhoidicall veines in men, or the men∣struous bloud from the veines of the matrix in women, by the error of the Chirurgeon, applying things actually and potentially cold.

* 1.344 The materiall cause of this colour is bloud offending: * 1.345Now the bloud may offend two manner of wayes, to wit, in qualitie, if it be too hot or fervid; or in quantitie, if the body be plethorick. * 1.346In removing then this red colour, one of the symptomes of inflammation, our first care must bee to remove the externall efficient causes.

The diet must be moystning and cooling,* 1.347 untill this acci∣dent be removed: wherefore broths made of Chickens, or Veale, wherein Sorrell, the sowre three-leaved Grasse, or Allejujah, Endive, Succorie, Purselaine, Lettuce, and such like have beene boyled, are verie convenient. If the disea∣sed partie delight in roasted meat, let him use for his sauce, sippets with the juyces of the common and wood Sorrell, with a little vinegar and Sugar.

* 1.348If the season of the yeare be extreme hot, let the roome wherein he remaineth be hung with sheets, which must bee still moystned with spring-water: In this case it is good to garnish the windowes with the Meddow-sweet, called in Latine Regina prati, and Gaule called Myrtus Brabantica.

* 1.349Let his cloaths bee neither heavie, nor heating: Let the rowlers be of soft linnen-cloth, and moystned in Rose, Eldar Vinegar, and faire Spring-water, taking two parts of the water, and one of the Vinegar:* 1.350 Let the rowling be somewhat slack, onely to keepe the locall medicaments to the ulcer; for strait ligure doth cause paine, paine at∣traction of humors, and the attraction of hot humors in∣flammation.* 1.351 The partie must abstaine from sacrificing to the Cyprian Dame: yea, hee must abandon everie violent motion. If this symptome be caused by reason of the sup∣pression of any solemne evacuations, as the staying of the

menstruall courses in women, or the suppressing of the He∣morrhodes in men, the accustomed flowing of these are to be pro••••ed againe.

* 1.352The menstruall courses are to bee brought downe; first, by opening of the Sap••ena in what foot it is most conspicu∣ous; and secondly, by exhibiting the powder of steele, ei∣ther in forme of Lozenges, or of an Electuarie or in infu∣sion in whi••e wine.

* 1.353The Hemorrhodes must be opened by application of the Leeches, and ministration of Aloeticall medicaments. That medicament, which by Paracelsus is called Elixir proprieta∣tis, and by others Pilulae pestilentiales Arabum; composed of Aloe, Myrrh, and Saffron, are excellent. These may be taken sundrie mornings together. But seeing these things are at large set downe by those who have written of the practice of Physicke, I have onely pointed at the best indi∣cations, which serve for the curing of these griefes, and the rather because the sp••••lation of them doth belong to an∣other Facultie and Art, to wit, Physick.

* 1.354If the materiall cause of this symptome, which is bloud, offend in qualitie, being too hot, then it is to be cooled by a refrigerating diet, which I at large set downe, when I dis∣coursed of a phlegmon, to the which place I remit you. If in quantitie it offend, first Phlebotomie, or opening of a veine is to be used, and bloud drawne, as the age, constitu∣tion of the partie, and nature of the griefe shall require. Se∣condly, the part it selfe is to be scarified, and other Vento∣ses or Leeches to be applyed, that the bloud may issue out plentifully to discharge the part.

* 1.355 A livid, or leady colour in an ulcer followeth. Two cau∣ses produce a livid colour in ulcers: the first is black bloud impacted in the part: The second is externall cold, or de∣fect of the naturall heat.

* 1.356This livid colour doth happen most frequently by rea∣son of black and corrupt bloud setled in the part, for as a bright red colour under white, causeth a lively blue, or azure

colour, as we may see in the veines of sound and healthfull persons; so black under white causeth a livid, or a leady co∣lour. This accident is to be removed by scatification, and application of the Cupping-glasses, Hornes, or Leeches. Afterward the scarifications are to be somented with Oxy∣mel dissolved in Cardum Benedictus water.

* 1.357If the lividitie proceed from cold, you shall perceive it by the cold constitution and temperature of the part. In this case you are to apply such locall medicaments as are able to reduce the naturall heat and complexion. Fallopius in his Treatise de tumoribus, c. 26. de Gaugraena, affordeth a nota∣ble one, and parible, which is this: Take an ordinarie Tur∣nep, and a Rettish-root of reasonable bignesse, grate or scrape these two, and adde to them of the powder of Mu∣stard-seed one ounce, of the powder of Cloves three drams, of the oyle of Lin-seed, and Wall-nuts verie old, so much as is sufficient, and make a pultice, which apply warme; he calleth this cataplasme, Medicamentum optimum & divinum, A most excellent and divine medicament; with the which he affirmeth himselfe to have cured many: so that you need not to doubt of the efficacie and certaintie of it: and the ingredients seeme to promise no lesse.

* 1.358The last unn••••••rall colour is a black colour: this may proceed either 〈◊〉〈◊〉 heat or cold. If it hath proceeded from heat, then an inflammation went before; if from cold, then lividitie did precede. The first betokeneth adustion; but imperfect: so we see wood, before it be perfectly bur∣ned, and incinerate, or turned to ashes, to become black. And in a Carbuncle, the lower part is of a dark••ed, the mid∣dlemost black, and in the top there is a white pustule, the heat beginning the adustion in the lowermost, increasing it ill the middlemost, and perfecting the adustion in the top: for it is the propertie of fire or heat to mount up, and to be most effectuall aloft. If before blacknesse lividitie did ap∣peare, it is to be feared, that the part beginneth to be mor∣tified at the least, if any feeling or heat remaine: If these

cannot be perceived, then you may boldly say, that a Spa∣celus or Mortification hath possessed the part.

* 1.359In both these cases, first, the parts are profoundly to bee scarified: Secondly, they are to bee fomented with the de∣coction of Worme-wood, the lesser Centorie, Scordium, Carduus Benedictus, the flowers of Camomil, Melilot, and tops of Dill boyled in a gentle Lixivium. Thirdly, fill the incisions of the scarifications with some of the medica∣ment following using a feather: ℞ Oxymell. simpl. ℥ij. Vu∣guent. Aegypt. ʒiij. Spirit. vini, ʒij. Miseeautur. Fourthly, this cataplasme is to be applyed warme: ℞ Farin. fab. hord. & erobi, an. ℥iiij. Lixiviimitioris, lb. iiij. coq. haec ad cata∣plasmat. consistentiam: tunc adde Oxymell. simpl. ℥ij. Vn∣guent. Aegyptiaci, ℥j. Omnia probe misceantur. Continue the use of this medicament, untill the parts bee brought to their naturall temperature and colour: then proceed as hath beene set downe, when I spake of the curing of a com∣pound ulcer.

* 1.360Having set downe the methodicall curations of the three first accidents taken from things according to nature; to wit, of abating superfluous flesh, removing of the cariositie of the bone, and reducing the naturall colour to the parts, I am to shew how the fourth accident Va••••••••s, or the tume∣faction of the veines, by reason of supernuous grosse bloud are to be cured.

* 1.361This accident is called in Latine Varix, from the simili∣tude and likenesse which it hath with the protuberances which are seene in trees above the bark, called Varices: ac∣cording to Avenzoar, lib. 2. tract. 7. c. 25 Albucasis Chirurg. part. 2. c. 93. calleth this affection Vitis, or the Vine, because these passe alongst the parts by windings, as the vine doth: In Greeke it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or as it is found in Pollux 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. It is called by Hippocrates 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and by Aristot. 3. de histor. animal. 11. and in sundrie other places.

* 1.362This affection may thus be described: A varix is a dila∣tation of a veine causing a tumefaction of it, with win∣dings

and tortuositie arising in one or more parts of the bo∣die. It is called the dilatation of a veine, because the dila∣tation of the arterie is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. This particle (cau∣sing a tumifaction) is added, to exclude veines, which are naturally big. Galen de Method. medend. lib. 14. c. 13. numereth this affection amongst the diseases which pro∣ceed from the quantitie encreased. It may bee accounted a disease, because the actions of the parts which it possesseth are hindred; for if it possesse the legs, they become exte∣nuate, and by reason of the heavinesse of the humor, they become flow in motion. If this affection invade the stones, the partie becommeth barren.

* 1.363The causes of it are either internall or externall. Accor∣ding to Aristotle, the materiall cause is bloud,* 1.364 being im∣pregnate with spirit, hee doth affirme it to proceed from bloud, Lib. 3. de histor. animal. c. 19.* 1.365 where he noteth that women are not troubled with varices; because they turne out their superfluous bloud by their naturall fluxes, and that they are lesse troubled with the hemorrhods in like manner. And although this doth prove true in most women, yet there may bee sundrie women found, who both have vari∣ces, and are subject to the hemorrhods. Hee thinketh that the bloud in the varices is full of spirits; and therefore pro∣nounceth, Sect. 6. problem. 3. & Sect. 4. problem. 21. that they who have their testicles varicous are barren, because the spirits of generation passe to the varices, and so leave the seed unfruitfull, being deprived of spirits.* 1.366 But Hippo∣crat. 3. de articul. text. 4. & 6. aphor. 21. & Galen. 4. de compos. medicament. 2^• gnrā, thinke that the materiall cause of varices, to bee grosse and flatuous melancholy bloud: yea, both Galen and Avicen are of the opinion, that the vatices may sometimes be caused of laudable bloud, onely offending in quantitie, and dilating the coats of the veines.

* 1.367The antecedent causes are in number foure.

I. Is a melancholy and pituitous temperature: so they who have a bad spleene, are most subject to this disease.

II. An hairie and an hard habit of the body.

III. The masculine sex: for women are not so fre∣quently troubled with this affection, because monethly they discharge all superfluous bloud, if they bee healthfull: as hath beene said out of Aristot. 3. de histor. animal. c. 11. & sect. 10 probl. 29.

IV. Either ripe or old age: for according to Hippoc. in Coac. praenot. they happen not before the fourteenth yeare of the age, in the legs; although even children may have varices in the testicles. Why Eunuchs are not troubled with the varices, Arist. sect. 10. probl. 29. yeeldeth a reason; be∣cause they are deprived of seed and spirits. Avicen doth adde to these sharp diseases going before: for in these the thinnest part of the humors being spent by sweat, insensible perspiration, and discussion procured by Art, the thicker part being turned to some particular places, may procure the varices.

* 1.368The primitive causes are these.

I. A thick and impure aire; because it doth weaken the legs, and maketh them the more apt to receive superfluous humors. And for this cause Hippocrates affirmeth, that men who dwell in the Westerne parts, are frequently troubled with this affection, and ulcers in the legs.

II. Immoderate exercise: so we may see Foot-men and Porters often to have varices.

III. Long standing: according to Averr. 6. collect. 2. From hence Iuvenal saith; Fiet varicosus aruspex: He shall become a varicous Sooth-sayer: for they who tooke upon them to finde out future contingents by the flying of birds, were enforced often to stand along time.

IV. Thick wine and grosse food: such are old flesh sal∣ted, or smoaked, pease and beanes.

* 1.369As for the presages, let this be the first:

I. If varices appeare in those who are mad, by reason of the melancholy humor, the griefe ceaseth.

II. The varices mitigate gibbosities, or bunchings in

any part of the body: for the humor which causeth them, is by these meanes averted from maintaining of them.

III. The varices appearing either in the right or left testicle, help a squeeking voyce; the humor being turned from the brest to the testicles, according to Hippocrates, in the 5. Sect. of his Epidemicks. This may happen for two causes. I. By reason of the content which is betweene the spirituall and genitall members. II. Because baldnesse, stut∣ting, lisping, and a squeeking voyce, according to Hippo∣crates in the same booke, are melancholy affections.

IV. They who never become bald, have not large vari∣ces. And againe, if in those persons who are bald, large va∣rices appeare, haire will grow againe, Hippoc. 6. aphor. 34. & Arist. 3. de histor. animal. 11. But you must understand this of the varices of the testicles, called Hernia varicosa. The cause of this is the consent of the braine, and of the genitall members, which is so great according to Avenzoar, lib. 2. tract. 3. c. 1. that castration doth impaire both wit and courage. Then humours melancholike being gathered in the testicles, vapors ascend to the head, which afford suf∣ficient matter for producing of the haire. And in women their courses being stopped, vapors ascend to the chin, from whence a beard doth bud out. As Hippoc. 6. Epidem. sect. 8. doth report of Pha••tusa the wife of Pythe••••, who got a beard by reason of her husbands absence from her.

V. Varices caused by reason of some griefe of the spleen, are not to bee cured, lest the diseased partie fall into some melancholy disease, according to Avicen 22.3. tract. 2 c. 8. for seeing the matter is lodged in the spleene, and the vari∣ces of the legs are stopped by curation, the humor must bee turned to some other parts.

VI. The varices are hardly cured by medicaments, ac∣cording to Avenzoar, lib. 2. tract. 2. c. 2••. Although they may bee cured by Chirurgerie without danger of life, ac∣cording to Celsus, lib. 7. c. 22. This is true, if the varices bee caused of too copious laudable bloud, otherwayes not for

the reason before assigned.* 1.370 The curation, which is the last point, is performed by two indicutions, to wit, by dischar∣ging the body of the thick and melancholick humors, and taking away the tumified veines.

The first is performed by appointing a convenient order of diet, and the administration of fit medicaments.

The second is performed by Chirurgerie.

* 1.371As for the diet, grosse, tough, and flatuous meats are to be shunned; as Beefe, Goats-flesh, Venison, Oysters, Fishes fed in muddie waters, old Cheese, Beanes and Pease, Let∣tice, Coll-wort, Cabbage, and all those things which Galen doth forbid in melancholy diseases, 3. de loc. affect. c. 7.

As for Phlebotomie,* 1.372 the liver or median is to be opened in the arme directly opposite to that leg wherein the hae∣morrhods are, or Leeches are to be applied to the haemor∣rhodicall veines, chiefly if bloud was wont to issue from them.

As for purging,* 1.373 Lenitives mixed with those which purge grosse humors are often to be ministred: Take this for a patterne, ℞ electuar. lenitiv. ʒvj. pulv. sancti ʒj. syrup. de cichor. cumrhab. ℥j. misc. ut fiatpotio.

* 1.374The Chirurgicall curation of the varices is perfor∣med by two meanes, ustion, and exsection; ustion is to be used when the varix is straight, and not much tumified.

The manner of ustion is this:* 1.375 Incise the skin untill you come to the veine, and separare it from the parts adjacent, then shunning the brims of the wound, cauterize the coat of the veine: foure inches from this ustion doe the like, and so still untill you come to the end of the varix. This being done, dresse these ustions as you use to dresse parts burned.

Excision is to be used when the varix is crooked,* 1.376 and hath windings, according to Celsus: but in my judgement a straight varix is better cured by excision than that which hath windings and creeks, because it is more easily sepa∣rate, and will admit a more beautifull cicatrix: whereas in cutting the other there must be horrible paine, and an ugly cicatrix must be left.

The manner of excision is this:* 1.377 you are to begin at what end of the varix you will, and to separate the veine from the adjacent parts, untill you come to the other end, then binde the veine hard at each end, and cut off what re∣maineth betweene the two ligatures: this being done, the brims of the wound are to be brought together, and to be healed with glutinative medicaments. Plutarch in the life of Marius writeth, that he having this griefe in both his legs, submitted himselfe to this manner of cure; and when he had put forth one, did constantly endure the excision of the varix in it, that no man should have doubted of his va∣lour: but when the Chirurgeon would have done the like in the other leg, Marius answered flatly, that he meaned not to buy beauty with such paine: it is not to be thought that any in this our tender age will admit either of these two operations.

* 1.378If a varicous ulcer be offered unto you, which contem∣neth ordinary meanes, my counsell is, that you take up the varix above and below, as you doe the veines of the temples in inflammation of the eyes, and open it betweene the deli∣gations, that the bloud may be discharged out of it. This operation any one will admit, if he be not too tender.

LECT. XXII. Of a verminous and lowsie ulcer.

IN my last Lecture having delivered unto you the two last differences taken from things according unto na∣ture, yet changed from the naturall constitution, to wit, of a discoloured and varicous ulcer; now I am to set downe the differences of ulcers taken from things aliene to nature, and strangers. These are two; wormes, and lice; from the first, an ulcer is called verminous; from the second, lowsie.* 1.379 The wormes which breed in ulcers may more fitly be called

Maggots, in Latine Termetes and Galbae, as those of the guts are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek, or Lumbrici in Latine; as we sinde set downe in a learned Epistle of Alexander Tral∣lianus intituled 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, de lumbricis, of wormes in the belly, translated by that famous and learned Physician Hie∣rony••••us Mercurialis, which hee annexed to his Treatise written of the diseases of children.

* 1.380They are ingendred of putrid humors, in uncleane and sordid ulcers negligently dressed, but most frequently in hol∣low, deepe, and sinewous ulcers: for in such the quittor is longest lodged, and the putridinall heat is greater. And for this cause they are seene often in ulcers of the eares, for the quittor is there long detained by reason of the win∣dings and labyrinths of the care.

* 1.381The matericall cause of these maggots for the most part is a pituitous excrement, as Paul. Aeginet. witnesseth, lib. 4. cap. 17.

* 1.382The efficient cause is heat, and that of two sorts: The one is extraneous, and putrifactive, causing corruption of the humors.

The other is naturall: Seeing, according to the Philoso∣pher, lib. 3. de generat. animal. cap. 2. nothing can be produ∣ced of putrefaction onely, unlesse concoction put to its hel∣ping hand. Then in a verminous ulcer which is preternatu∣rall, there is putrefaction, heat, and the ulcer it selfe, besides the wormes the effects of the first two.

* 1.383As for the signes, they are three: The first is the sense of sight, [ I] for oftentimes they are seene if either the cavity of the ulcer be ample, or that they are voided with the quittor.

[ II] The second is the motion of them felt by the Patient: their motion is called Motus undosus, like unto the waves of the sea, contracting and extending it selfe.

[ III] The third is a pinching paine now and then: for living they must be fed, and their feeding must of necessity cause more or lesse paine.

[ IV] The fourth signe is horrible stink, by reason of the great putrefaction.

* 1.384When you goe about to cure such an ulcer, attempt not the taking out of the maggots with any instrument, for your labour will be fruitlesse, and the paine of the Patient great: and grant that you take many away with your in∣strument, yet you must leave the putredinall heat, and the corrupt humor, for the breeding of more.

* 1.385I wonder that even great Authors make mention of the application of the actuall cautery in this case: they might bee borne withall, if these ulcers were plaine, and shallow; for so the superfluous humidity might be dryed, and putrefaction removed: but they with an unanimous consent confesse, that these maggots are most commonly bred in sinewous and hollow ulcers, (as hath beene said) and most frequently in the Summer time, and Southerly winds blowing; and so a great heat would be induced, and the Pa∣tient put to great paine, if they could reach to the cavity of the ulcer, which cannot be.

* 1.386These wormes then must first be killed, and then they will issue out of the ulcer without any difficulty.

* 1.387Those things which kill these wormes, doe it either of a manifest, or hidden quality.

* 1.388They which kill them by their manifest quality must be bitter, such are Worme-wood, Southerne-wood, Calamint, Aloe, the Ferne, Buls-gall, the Meale of Lupines, the Leaves of the Peach tree, Capers, the Roots or distilled Water of the Roots of the Couch-grasse, called Gramen canarium, Horehound, Scordium, Mugwort, Centorie the lesser, Mints. Of these you may make decoctions, whereof you may finde sundry descriptions in the monuments of those who have written of this subject. Ambrose Parrey, lib. 12. cap. 8. setteth downe this medicament: ℞ absynth. centaur. minor. & marrhub. an. m. 1. decoq. in lib. 1. aq. font. ad lib. ss decoct. coletur: In quo dissolve aloes ℥ss. unguent. Aegyptiac. ʒiij. he putteth in the decoction ℥ij. of Aloe, and ℥j. of Aegyptiacum: but who may not perceive the quantity of these to be too great? This of Riolan the father, in hi••

Chirurgerie, de ulcerib. cap. 8. is excellent: ℞ Ellebor. alb. rad. cappar. gentian. dictamni, alb. an. ʒij. cen••aur. minor. scord. absynth. marrhub. calaminth. an. man. ss decoq. in suf∣ciente quantitate aquae font. ac coletur decoctum. In lib. 1. co∣laturae dissolve mellis ℥ij. Aegyptiaci ℥j. Above the ulcer he adviseth to lay Ʋnguentum Apostolorum. If a tent may reach to the bottome, use this commended by Fallopius in his Treatise de ulceribus cap. 21. ascribed to Archigenes, as al∣so Ambrose Parrey, in the place afore named: ℞ cerussae po∣l••••montan. an. ℥ss. picis liquid. q. s. ut fiat linimentum:* 1.389 This cannot chuse but be effectuall, for the faculty of Tarre is knowne even to hunts-men and shepherds.

* 1.390As for those medicaments which kill wormes from a hid∣den quality in ulcers; they are taken either from Minerals, or Vegetables.

Amongst the minerals, all waters indued with the qua∣lities of Mercurie or Antimonie are effectuall: wherefore you may use Aqua aluminis magistralis of Fallopius, set downe by him in his Treatise of the French-pox thus;* 1.391 ℞ aq. plantag. & ros. an. lib. 1. alum. & Mercur. sublimat. an. ʒij. pulverizat.* 1.392 These are to be mingled together, and be∣ing put into a separating glasse, the halfe of the water is to be breathed away: Pallopius counselleth the glasse to be set upon a gridiron, and coales to be put under: but the safest way is to have this done in a pan, with some sand set upon a little furnace. After that the halfe is breathed away, the separating glasse is to stand five dayes, and then the cleare water is to be powred off, and kept for use.

* 1.393It is not to be used alone, but mingled sometimes with a double, sometimes triple, sometimes quadruple quantity of Rose, Plantane, or Night-shade-water. The ablutions of Crocus metallorum precipitate, and the Turbith minerall, are effectuall: Vitriols of all sorts, dissolved in faire Spring-water, and having some Camphire added, are very good: for they not onely kill the wormes, but powerfully cor∣rect the putrefaction in ulcers.

Amongst the vegetables which kill wormes,* 1.394 by a hidden and unknowne quality, the Tabacco doth carrie away the bell, and not onely the juyce of the greene, but the deco∣ctions of the dry also, doe effect this, being applied to the ulcers by injection, or moistening the tents or pledgets with the same. Seeing you may finde this medicament, whose faculty and operation are certaine, I will not trouble you by setting downe a rabblement of uncertaine toyes: unguen∣tum de Paeto, having some Mercurie precipitate mingled with it, is excellent in such ulcers.

* 1.395Seeing wormes in the belly, by eresion, cause ulcers in the guts; in so much that wormes have often come out at the navell and groynes, whereof you may reade memorable histories set downe by Schenkius in his third booke Pag. 407. titul. de lumbricis, it will not be a thing impertinent to discourse briefly of them, seeing they often trouble chil∣dren, and procure sometimes death.

* 1.396These wormes are called in Creek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, f••rae, because they cruelly torment the body; in Latine Lum∣brici.

* 1.397The efficient cause is the temperate heat of the guts, for the intemperate heat rather doth burne the humors, than produce any thing of them.

* 1.398The materiall cause, is the inconcocted part of the Chy∣lus, sent away to the small guts from the stomack, and left undrawne by the mesaraicall veines to the liver, there to re∣ceive the forme of bloud. This part of the Chylus being crude, and left in the intestines, mixed with the pituitous humor, is elaborate by the temperate heat of the guts, and the forme which lay hid in this matter before, is brought forth afterward by this heat: and according to the di∣versity of the latent formes, sundry sorts of wormes are bred. In the aforenamed title of Schenkius, you may reade of the stupendious figures of wormes, set downe by lear∣ned and famous men, in their monuments, who have seene them.

* 1.399As for the differences of them: they are either ordina∣ry, or extraordinary.

Of the ordinary there are three sorts:* 1.400 The first is Tere∣tes, the round ones, not unlike to the earth wormes in fi∣gure, but in colour different: for they are whitish.

The second are called Ascarides: these are like unto the wormes which grow in cheeses, and maggots in flesh: they are for the most part bred in the Intestinum rectum.

The third kinde is called Lumbricus latus,* 1.401 the broad worme; and Taenia, which in Greek is called a swadling band, by reason of its figure, for it is broad and long, and it hath sundry joynts. This worme will be of a strange length. Plin. lib. 11. nat. histor. cap. 33. affirmeth that some have beene thirty foot in length. Conciliator. diff. 101. saith, one avoided such a one fifteene foot in length. Alexand. Benedictus, in prooem. lib. 21. practica, saith he saw the like. If you desire greater variety of such histories, peruse Schen∣kius his observations, Lib. 3. pag. 411. I my selfe when I was in the Newrie, a towne in the North part of Ireland, being desired to visit a young man who had a Fistula in Pe∣rinaeo, and whose body was exceedingly extenuate; when I had ministred a dose of 2. gr. of Mercur. vitae to him, he a∣voided such a worme, tucked like a ••rabtree cudgell, about the thicknesse of a childes finger, and fifteen foot in length, he kept it in a little pewter basin for my comming: when he was in voiding of it he was in great feare, thinking that his guts came out.

* 1.402As for the signes of wormes: You shall know any one to be troubled with round wormes by these signes: The party fi••deth gnawing, and pinching paine in the belly, hath gnashing of the teeth, chiefly in the sleep; is troubled with a dry and continuall cough, the nosthrils itch, where∣fore children having them, are still picking their nose; the face is evill coloured, the cheeks are sometimes of a red, sometimes of a livid colour; the eyes are hollow, the mouth is waterish, the breath is strong, there is a desire to vomit,

the hicket oftentimes, hunger, paine, and heavinesse of the head, drowsinesse, convulsions, starting in the sleepe, stret∣ching of the belly; but an extenuation of the rest of the body; horrible dreames, loosenesse of the belly, ugly and stinking ••••crements doe fall out. This is holden for an ex∣periment, if water be powred upon the stomack in the mor∣ning, the party being fasting, he or she shall finde a drawing on of the belly, by reason of the shrinking of the wormes, shunning cold. All these fignes are not found in every per∣son, but some in sundry.

* 1.403If Ascarides, or small wormes, be bred in the Intestinum rectum, a horrible itch troubleth the party, and they are of∣ten seene in the excrements.

* 1.404 If Tania, or the long broad worme be in the guts, the party hath an insatiable appetite, the body consumeth, and some substance doth come from it like to the seed•• of a cu∣cumber. The falling ficknesse oftentimes proceedeth from the round wormes, but seldome from the broad, and the Ascarides.

* 1.405Let us now come to the presages which the diversity of wormes afford.

I. The Ascarides, if they be small, they are of all sorts lesse dangerous, for they are farthest from the noble parts, and are most easily killed, by clysters, or injections of bitter things. It is otherwise if they be big, for then they are in∣gendred of a worse matter.

II. The Tania is of all others the worst, because it is biggest, and hardest to be killed.

III. The bigger are worse than the lesser, and many more dangerous than few, and the red are worse than the white.

IV. If in the beginning of sharpe diseases round wormes come out alive, they betoken pestilent diseases.

V. It is good if round wormes come out, either when the crisis is at hand, or in the declination of the disease.

VI. If in persons not sick, wormes come out either at

the mouth or nose, it betokeneth no harme, because this they doe for lack of food.

VII. If this happen in sick persons, it is an ill signe, for it argueth the malignity of the matter, which the wormes labour to shun.

VIII. If wormes expelled seeme to be be sprinkled with bloud, it is an ill signe, for it sheweth the guts to be ill af∣fected.

* 1.406As for the curation, it is performed by two indications; the first is by killing of them; the second by expelling of them killed.

* 1.407They are killed either by internall medicaments, or exter∣nall applications.

The internall medicaments are either simple or com∣pound; the simple are either Vegetables, or Minerals, or Animals.

The most powerfull amongst the simple vegetables are these: Corallina, the dose of it is ʒj. The seeds of Tansie, and the common worme-seed, the dose of them is ʒj. the juyce of Vervine; give a spoonefull, the juyce of Scordium, Wormewood, the lesser Centorie, Carduus benedictus, or Beere or Ale brewed with these, Garlike, the roots of grasse.

As for compound medicaments, let this be the first: ℞ corallin. lumbric. terrest. nasura corun cervi, semin. santonici, & tanaceti an. ʒj. rad. dictamnialbi, rhabarb. agaric. tro∣chiscat. an. ℈ ij. fiat ex omnibus pulvis: dos. ʒj. The second shall be that medicament, which Quacksalvers in Germanie, call Panis vitae, the composition is this: ℞ mustacei ℥ iiij. semin. santonici ʒ v. mellis puri q. s. ut fiat pasta: dos. ℥ss. ad ℥j.

The medicaments taken from minerals: Mercur. crudus, dos. ℈ij. Mercur. dulcis, dos. a. gr. iiij. ad 20. secund. ratio∣nem, atatis & virium, Mercur. vita, cujus dos. a.gr. ss. ad gr. ij. vitrum antimon••i, crocus metallorum, inpulvere vel infusione.

As for externall applications receive these as patternes:

• I. ℞ aloes hepat. ʒij. fellis taurini ℥iiij. absynthii contus. ℥iiss. fiat cataplasma applicandum umbilico.
• II. ℞ farin. lupin. ℥j. myrrh. aloes an. ʒj. pulp. colocynth. ℈iiij. croci ℈j. fell. boum ℥iss. aceti acerrimi ℥ss. mese. Ap∣plicetur cuminum pultum cum felle tauri, quod commendat. Sebastian. Austrius lib. demorb. infant. morb. 42.

The death of Herod by wormes is extraordinary,* 1.408 which is set downe by Saint Luke, undoubtedly to shew what sub∣jects may offer to honour their Princes, and what Princes ought to assume unto themselves of right. Herod having begun to persecute the Church, caused Saint Iames to be killed, and Saint Peter to be laid up in prison. After he had done this, the third yeere of his raigne (as witnesseth Iose∣phus antiquit. lib. 19.cap. 7.) he went to Caesarea to keep some playes in honour of Casar. The second day of his playes, when he had given an answer to the Tyrians and Si∣donians, who sued after his favour, he being offended with them: the people cryed out, The voyce of God, and not of man. O Herod, why diddest thou accept of this grosse flattery? Had it not beene sufficient to thee to have assu∣med subordinate Majestie, and truth in thy declamation, which was (I make no doubt) in some points of it failing? Loe, whom prosperity could not bring to the consideration of his carriage, Gods visitation did. Wormes, not presented to view of men, begun inwardly to torment him, and eat up his intrailes; which caused him to burst out into these lamentable speeches; En ego ille &c. Behold,* 1.409 I whom you called God, am by fatall necessity commanded to leave life, it proving you to be liars, and I, whom you saluted as immortall, am violently drawne to death. Being horribly tormented, he died the fifth day, although the people put on sackcloth, and made supplication for him. So much Io∣sephus. O that Christian Princes would not so much labour to delight the eares of the people by eloquent speeches, as to administer justice. And although they think themselves

secure enough from such a judgement in this life as befell this tyrant: yet let them not doubt, but that there must be an accompt made after death, where every debt must be paid with interest. I have delivered unto you what I thought fit concerning a verminous ulcer, now I will in few words deliver the doctrine of a lowsie ulcer.* 1.410

* 1.411The efficient cause of lice, is the naturall temperate heat, mixed and concurring with the heat putrefactive.

The materiall cause, is the excrements of the third con∣coction, or assimilation, which are hot; but not sharpe, or maligne. This is the opinion of Galen lib. 1. de compos. me∣dicam. secund. loca cap. 7. and Avicen. lib. 4. fen. 7. tractat. 5. cap. 26. That you may the better understand this opinion, you must understand, that when bloud is turned to the nou∣rishment of the parts, divers excrements are produced: of the which, some are discharged by insensible perspiration, some by sweat, some cleave without to the skin, as the mor∣phew, and the filth which cleaveth to the soles of the feet, called Strigmenta; and scales in the head and other parts: some stay within the Cuticula; and these are either sharpe, and of a maligne quality; and these cause shedding of the haire, or they are destitute of both these qualities, and they produce lice.

* 1.412The differences of these lice are two: For some are most commonly without the Cuticula, and some within the Cu∣ticula; of those that are without, some are familiar, as the common sort; some are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, feri, wilde and cruell ones.

* 1.413As for the ordinary and familiar, most commonly in boyes and girles, they swarme in ulcers in the neck below the fu∣ture Lambdoides: but sometimes, and in some persons, they possesse the distance between the Cuticula and the Cu∣tis, divelling and separating the one from the other. If one will know what store of these moveables may issue out of the Cuticula one person, let him reade Amatus Lufitanus cent. 3. curat. 58. & schol. ad curatione•••• ea••de••••, where he

reporteth, that one of good note in Lisbon called Tabora, was so troubled with them, that two Negroes had e∣nough to doe to discharge him of them, and to carry them to the sea; and that at the last they procured his death.

The 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or feri, the crab-lice,* 1.414 are most commonly en∣gendred in the arme-pits, and in the forrests of Ʋenus in na∣stie men and women.

Those which are alwayes found under the Cuticula, are called Syrones, unknowne to the Grecian Physicians:* 1.415 they draw a trench, as Moles doe in the earth, under the Cuticu∣la••, leaving watery pustules behinde them, as they march: their seat (when they rest) is easily discerned at the end of the trench, where when the Cuticula is opened, they may with the point of a sharp pin or needle be taken out: they resemble nits in cheese, and if you place them upon the co∣ver of a booke of blacke leather, in the Sunne, they will passe alongst the cover with a marvellous agility; as often I have made triall my selfe.

* 1.416As for the Prognosticks. I. They who are troubled with any kinde of lice are nastie persons.

II. In a Hectick fever, they shew that one is entred into the third degree of it, and so is uncurable.

III. In persons not diseased if they abound, you may ad∣vise them to keepe their hands from their mouth, and to la∣bour to be cleanly.

When the lice swarme over the whole body, the disease is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, à pediculis, from lice.

* 1.417Three intentions are required for the curation of them: Phlebotomie, Purgation, and locall applications.

As for Phlebotomie, the sex, age,* 1.418 constitution of the party, and strength, with the rest of the indications are to be observed.

When you purge, use rather minerals than vegetables,* 1.419 because they more strongly evacuate, and are of a more sub∣till, durable, and penetrating faculty. These same will serve to hinder the increase of these, which I set downe as power∣full to kill wormes.

* 1.420As for locall applications, Amatus Lusitanus in the place afore-named, affordeth two: The one is a medicate vine∣gar; the other a liniment: The description of the vine∣gar it this: ℞ Lupin. amar. pug. iij.Staphisagriae pug. ij. Let these be boyled in a sufficient quantitie of vinegar, with it moysten the whole body: The liniment is thus made: ℞ Staphisagr. part. 2. Sandarach. Grac. part. 1. Salis petrae partem dimidiam, postquam ista fuere infusa in Oleo Raphani∣no, part. 2. & Aceti acorrimi, part. 3. fiat linimentum, quod illinatur toti corpori.* 1.421 Paulus Aegiueta affirmeth, that hee found good successe in the application of oyle and vinegar.

As for the Crab-lice, the waiting-maids of Venus rest contented with the application of an unguent made of sweet Sope and Quick-silver. If any one bee desirous to know more of the mysterie of these movables, I will advise him to repaire to the Pilgrims of the tribe of Gad, in the Summer time to be found by Coleman hedge, and thorow∣out the whole yeare in Batne-Elmes barne. If any be desi∣rous to read a learned and philosophicall discourse of this subject, let them have a recourse to Minadous, lib. 2. c. 9. de turpitudinibus.

LECT. XXIII. Of Ʋlcers of the Hairie Scalp.

SEeing I have set downe the generall doctrine of ulcers, sufficient to instruct any one how everie ulcer in particu∣lar parts is to be cured; yet seeing some ulcers in these parts require some speciall considerations, I will run thorow them to shut up the Lectures of this yeare: Neverthelesse, I meane not to omit any thing which shall seeme materiall. I will begin at the ulcers of the head, partly because some are uncurable of them, & that it is necessarie that you know which be such; partly because it were a foule shame, that

women should goe beyond a Chirurgeon in this businesse, who confidently take upon them the curation of these ulcers.

* 1.422The ulcers of the head are of two sorts: for some are moyst, and some are dry.

* 1.423The moyst are two, Achor and Favus. These dispositi∣ons of the head are called by the Arabians Sahafati, by A∣vicen. 7.4. tract. 3. c. 1. Serap. lib. 1. tract. 1. c. 3. Aven∣zoar, lib. 1. tract. 1. c. 7. and they are nothing else but small ulcerate tumors of the whole skin of the head, caused of sharp excrementitious humors. All small tumors, in Latine Tubercula, by the Arabians are called Bothor. So then as the Cuticula, or the scarfe skin, is the seat of Pthiriasis or the lowsie maladie, so the place of these griefes is the whole skin, both the Cuticula, and the Cutis.

* 1.424The materiall cause is a sharp excrementitious humor.

Now sharp humors are of two sorts: for some are sharp of their owne nature, as choler: and some by accident. By accident, humors may become sharp two manner of wayes. First, by exustion and putrefaction, as Bilis atra, and melancholy not naturall excrementitious. Secondly, by ad∣mistion of a sharp humor. These ulcerous tumors of the head may bee caused, not onely of simple sharp humors of their owne nature, but also of humors made sharp by ac∣cident.

* 1.425The Chymists will have the salt of Vitriol to be the ma∣teriall cause of these ulcers. See Ioan. Faber Chirurgia Spa∣gyrica, c. xv. Achor so called according to Alex. Trallia∣nus, lib. 1. c. 8. because from it a sanious quittor called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 doth flow. Galen in his booke of tumors thus discourseth of it: Achor also is a small ulcer in the skin of the head,* 1.426 you may thinke that it is caused of salt and nitrous phlegme, out of it floweth a sanious matter, which is not altogether wa∣terish, nor so viscous and thick as honey, which appeareth in those ulcers which are called Favi; for in these there is a certaine tumor, and sundry holes, out of which floweth a

matter like unto honey. He also in his Lib. 1. de co••••pos. Pharmacorum secund. loc. affirmeth the holes in this tumor to bee lesse than are those which are called ••••avi, and that out of them floweth a thin humor with some clamminesse. Oribas. lib. 4. ad Eunap. c. 4. thus speaketh: Achor is sea∣ted in the skin of the head, and hath but small holes, out of which a thin and reasonable viscous Sanies doth flow. That affection which is called Favus is like to this; but it hath greater holes, which containe a matter like to honey. Trallianus lib. 1. c. 9. subscribeth to these in these words: Wee must know also that Cerion, (which is Favus in La∣tine) is a griefe like to Achor, yet differing in bignesse: for the holes out of the which the humor issueth, represent the honey-comb: wherefore by Ancients it was called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. The like hath Paulus Aegineta, lib. 3. c. 3.

* 1.427So that Achor differeth in three points from Favus: for first, in it the tumor is lesser: secondly, in it the holes are lesser: and thirdly, the holes in Favus are conspicuous; but in Achor not. Aetius lib. 6. c. 68. hath these words: Achor is seated in the skin of the head, and hath but small holes, out of which a thin and viscous Sanies doth flow. The griefe called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or Favus, is like to this, wherein there are large holes, out of which issueth a matter thick, like un∣to that which is contained in honey-combs: wherefore it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.* 1.428 As for Favus, or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greeke, Actuar. lib. 2. de dignose. morb. c. 5. thus describeth it: Small ulcers arise in the head thick, and red like little dugs, of the which, that which is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 hath but small holes, which sen∣deth out a clammie Sanies; but 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 or Favus hath greater holes, which containe an humor like to honey.

Out of these passages, which have beene alleaged out of these ancient and learned Authors, these descriptions of these two ulcers may be gathered:* 1.429 Achor is an ulcerous tu∣mor of the skin of the head, red and dug-like, having small holes,* 1.430 out of which issueth a thin and viscous Sanies. Favus is the like ulcer, yet wherein the holes are larger, containing

an humor in thicknesse resembling honey, from whence it hath its name.

* 1.431The primitive causes are in number two: corrupt nou∣rishment, and contagion: of the first I have discoursed here∣tofore, of the second there is no doubt to bee made: for it may be daily seene, that these griefes are communicate by contract and frequent conversation.

* 1.432The materiall cause is a sharp and fretting humor, vi∣scous in both these ulcers yet thinner in Achor, than it is in that which is called Favus. Galen and Aegineta in the places afore-cited, affirme it to be a salt and nitrous flegme. The Chymists affirme them to proceed from the salt of the vi∣triol of the lesser world, or man.

* 1.433The cause conjunct is the same humor impacted in the skin of the head.

The signes of these two are these: First,* 1.434 in both these tumors there is an itching, and a tumor. Secondly, holes appeare in both, but in Achor lesser, in Favus greater. And although Lice are often seene in both, yet it is proper for Favus to have scales.

* 1.435As for the Prognosticks, receive these.

I. Young persons are most subject to these griefes, and amongst these children most frequently: The causes of this may be two. First, because they may have received many im∣purities in the mothers womb, which when they are come to the light, the naturall heat increasing, they lat our to ex∣pell; or it may happen by reason of the corrupt milke of the Nurse, who useth an ill diet.

II. These ulcers, if they have continued long, and have much altered and corroded the skin, when they are cured, they leave behinde them baldnesse of the parts affected.

III. These griefes free children from the falling-sick∣nesse, according to Hippocrates, Lib. de sacro morbo, and Avicer. 1.3. c. de Epilepsia. For the humor which might cause this disease, is sent from the inner to the outer parts.

IV. If these griefes be hereditarie, they hardly can bee

cured: seeing this is true in all other maladies, how much more certaine, when to the humor a malignitie is joyned, as in these, as all must confesse.

* 1.436The meanes which are appoynted for the curation of these griefes, are of two sorts, Physicall and Chirurgicall.

The Physicall are three;* 1.437 A convenient order of Diet, Phlebotomie, and Purgation.

As for the Diet,* 1.438 that is most fit, which was set downe in the Lecture delivered concerning the curation of Leprosi∣tie: for by some this is accompted a particular Leprosie. All surfetting, strong and sweet wines, sharp, and salt, and fried meats are to be shunned; and such as afford a grosse and impure juyce, as hard Egges, Fishes living in muddie wa∣ters: Purselane, according to Avenzear, exceedingly fur∣thereth these griefes.

As for Phlebotomie,* 1.439 two indications may induce you to use this: First, a Plethora of the whole body: Secondly, much corrupt bloud settled in the vessels of the head. If there be a fulnes in the whole body, then it is fit to open the Medians of both the armes: it skilleth not much at which you begin: Let some daies passe between the opening of the one and the other: Let the strength, age, time of the yeare, and the like circumstances shew you, what quantitie of bloud is to be drawne. If much impure bloud bee conge∣sted in the head, open the Cephalica, the veines under the tongue, the Vena frontis, yea and the arteries of the tem∣ples; for they powerfully derive corrupt bloud and foule spirits from the head.

* 1.440As for Purgation: If this must be generall, then no me∣dicament is better than Confectio Hamech, or Hiera Diaco∣locynthides, with the syrup of Rose solutive with Agarick in Betonie, Eye-bright, Strawberrie, Cowslip, or water of the black Cherries. Receive this description as a patterne: ℞ Confect. Hamech, aut Hier. Diacolocynt. ʒiiij. Pulv. sancti ℈ij. Pulv. Holland. ℈j. Syrup. ros. solut. cum Agari∣co ℥j. Aq. praedict. ℥iij. Mise. ut fiat petio. If the partie af∣fect

pils, these or such like you shall finde verie effectuall: ℞ Pilul. aurear. & aggregat. an. ℈j. Trochiscor. alhand. pultorumgr. vij. spirit. Vitriol. gutt. 5. Formentur pilul. ʒj. quae de••ureatur. These purgative medicaments are to bee ministred once everie weeke, untill the pa••••••e be cured.

If you goe about particularly to purge the head,* 1.441 use Sternutatories made of white Hellebore, and the best and strongest Tobacco, with a little of the powder of the seeds of sweet Marjerome and Lavender; or use Gargarismes: This water drawne by a quill into the nostrils, which I will set downe, is verie effectuall: ℞ Pulv.Lap. magnet. amp; ca∣lamin. an. ʒij. Virid. aeris & Euphorb. an. gr. vj. Lap. haema∣tit. ʒj. Succini albi ʒss. Aq. major. ℥j. Misceantur. Let this medicament be kept in a glasse, and drawne into the nostrils everie morning, or everie other morning, as the patient is able to endure.

* 1.442The Chirurgicall meanes are the artificiall dressings of the ulcers with locall medicaments. To attaine to this, two things are to be noted: The first is, what medicaments are to be applyed: The second is, how they are to be applyed. As for the qualities of the medicaments, they ought to bee astringent and repelling: when I discoursed of tumors, I set downe an ample catalogue of them, whither I send you, because I hare idle repetitions.

* 1.443But seeing some magistrall compositions are required in the curation of these griefes, which often prove verie obsti∣nate and stubborne, I will not leave you unfurnished, but will deliver unto you some which are verie effectuall.* 1.444 The first is this of mine owne: ℞ Butyri recent.lb. ss. Axung. porc. ℥iiij. ol. Scorpion. ℥ij. Sulphur. vivi, Helleb. alb. & ni∣gri, Rad. Enul. pulveriz. an. ℥ss. Calcis viva ʒiij. Mercur. crudi ℥jss. Misc. ut fiat linimentum. The second is that of Gordonius, described by Rinodaus, Dispensator. medic. lib. 5. sect. 1. thus: ℞ Elleb. alb. & nigr. Sulphur. viv. Auripig. Litharg. Calc. viv. Alum. Gallar. Fulig. Ciner. Clavellat. an. ℥ss. Mercur. & virid. ar. an. ʒij. pulveriz. and pulv.

coq. in Succ. Borrag. Scabios, Fumar. Oxylap. & Aceti, an. ℥iij. ad Succorum consumpt. deind. addantur Ol. veter.lb. j. Piccis liquid. ℥ss. Cer. liquat. q. s. ut siat linimentum. I have made triall of it, and have found it effectuall. If you but consider the ingredients, you cannot but allow of it. The Author commendeth it in a scald head, all manner of scabs, and in Mulum mortuum it selfe.

* 1.445When you are to apply these unguents, which was the second point of the Chirurgicall meanes: First, you are to marke whether the roots of the haires be corrupt or no; for if the roots be corrupt, they must be pulled out: you shall know this by pulling out of a few, and observing the roots: for if the roots be thicker than ordinarie, & moyst, you may in be assured that they are corrupt: they are to be pulled out children, that you may the better apply your Topicks: In aged persons not onely to this end; but to open the skin al∣so, and to make it more perspirable, that the corrupt hu∣mors may be the more easily corrected and spent.

* 1.446The haires are readily pulled out, by application of an Emplaster of red wax newly made, drawne upon lether, and lying to the ulcers twelve houres. Secondly, above the un∣guents you are to apply Sparadrops made onely of wax, to save the unguents, and keepe them to the sores without much waste. Thirdly, you are to foment the sores with red wine, or Tanners woose, wherein Pomegranate flowers and rindes, Myrtill-berries, and Sumach, with red Rose-leaves dried, have beene infused in a pot set by the fire side, before you use the unguents.

* 1.447If children be offered to you to be cured, you must have a care that you use gentle medicaments to them, and that their caps bee so tied to their heads, that they cannot pull them off. For children receive these Topicks: the first shall be that of Minadous, in his Treatise De turpitudinibus, li. 2. c. 10. which he learned of a woman, who professed the cu∣rarion of these griefes:* 1.448 ℞ Sulphur. vivi. Litharg. Argent. pulverizat. an. ℥j. cum aceteros. teranturac levigentur, tuus

adde Terrae l••••••••ae pulv. ℥ss. Succi Plantag. & Limon. an. ℥j. Ol. Lentiscin. & Myrtini. an. ℥j. Misc. ut fiat linimentum. If the ulcers in children prove obstinate, use this of mine: ℞ Pomati, ungnent. Popul. & Vng. albi caphurat. an. ℥j. Ol. de vitell. ovorum ℥ss. Ol. Scorpion. ʒij. Mercur. crudi ℥ss. Misc. in unguentum. You may adde ʒjss. of Alome calcined and beat to powder, if you will have it stronger. These ul∣cers are to be dressed once in 24. houres, and towards the night: for then the medicaments will prove most effectu∣all. If these ulcers be verie moyst, and apt to bee enflamed, by the application of an unguent, then you are to use a me∣dicament made of the abstersive powders, which the Anci∣ents called Smegmata contempered with Oxymel simplex: such are the Ellebores, Sulphur vivum, S••aphesager, the Pu∣mick-stone, Cuttle-bones, the roots of Iris, and Aristolo∣chia rotunda, and Barley-meale: these being beat to pow∣der, and by the admixtion of Oxymel simplex brought to the consistence of a liquid Electuarie, must bee applyed to these ulcers, and above the medicament a cap of Ivie-leaves sowed together be set.

Having spoken sufficiently of the two kindes of moyst ulcers, which are found in the head, Achor and Favus, it is time that wee reason of the dry ulcer of the head, which properly is called Tinea.

* 1.449This is a crustie ulcer, fretting the skin like a Moth (from whence it hath its denomination) without any great store of moysture, corrupting the roots of the haire, and sending out of the skin a dry filth which stinketh: Videatur Hieron. Mercurial. c. 14. de morb. cutan. But Petrus Ioan. Faber, in his Chirurgia Spagyrica, thus describeth it, c. 15. de Ti∣nea: It is a peculiar phagedaenicall and cancerous ulcer of the head, caused of the salt of the Vitrioll of the body of man, which fretteth the skin, and produceth scales, sometimes white, and sometimes yellow. The materiall cause, and the manner of the generation of it, hee thus prosecuteth. The Vitrioll in the great would, while it is

calcined in the fire, it is coagulate into a masse; either white, if the calcination be but moderace; or yellow, if the fire bee increased. So in the little world (hee meaneth the body of man) the Vitrioll, when it is seperated from the Balsome of the body, it marcheth towards the skin of the head, which it corrodeth, and above it produceth a crustie and scaly substance. Thus he: and I protest verie probably.

* 1.450And if it bee true which Galen and Aegineta affirme of the materiall cause of Achor and Favus, that it is a sharp ni∣trous flegme, as hath beene said, it may verie probably bee affirmed, that the materiall cause of Tinea is Phlegma vi∣triolatum, Flegme endued with V••••rioll, yet grosser than that which is the cause of Achor and Favus.* 1.451 Avicen, Mer∣curialis, and the rigid Galenists affirme the melancholy hu∣mor to be the materiall cause, accompanied with some sharp humiditie, which pricking the expulsive facultie, moveth it to drive out the humor to the skin of the head, and so to cause this ulcer: but this opinion carrieth no shew of truth: for first, this griefe most commonly seizeth upon phlegma∣tick persons: secondly, it cannot be apprehended, how me∣lancholy, either by the admixtion of any humor, or by any degree of heat in the body of man, being of it selfe black, can produce such a coloured ulcer▪ to wit, white or yel∣lowish.

* 1.452The primitive causes are foure; Errors committed in the things not naturall, Hereditie, the corrupt Milk where∣with children are fed, and Contagion or Infection.

The signes are dry crustie scales most commonly white, sometimes yellowish, or of an ash-colour, or greenish, ne∣ver black altogether.

As for the presages: let this be the first.

I. This ulcer is hard to bee cured, because it is maligne and venomous.

II. Inveterate ulcers of this kinde are more maligne, and harder to be cured, than those which have but lately in∣vaded any person.

III. When they are cured, they often leave behinde them Alopecia, or Ophiasis.

IV. Sometimes they end into the Leprositie, and pedi∣cular or lowsie disease.

V. If in a Tinea the skin be hard, or of a shelly substance, and send out many scales, and the haire fall by reason of the corruption of the roots of them, it is of all others most hard to be cured.

VI. If this ulcer being once cured, returne, pronounce it to be of hard curation: for there must be some seed of this maligne malady firmely impressed in the braine.

* 1.453In the curation of this griefe, two indications offer themselves: The first is the removing of the causes; but seeing the causes are either primitive or conjunct: The pri∣mitive causes are removed, by rightly ordring those things which are called Res 〈◊〉〈◊〉 naturales: The cause conjunct is taken by purgation and phlebotomie. As for Phlebotomie and purgation, although that may suffice which I have deli∣vered in setting downe the healing of Tinea and Favus, yet let the insinuate this unto you, that it is expedient that once a quarter you open the Cephalica, two dayes before the full of the Moone, and that for purgation you call Mercu∣riall medicaments to aid, when Veget••••••s will not serve. Parrey is of the opinion,* 1.454 that the meanes which are used in curing of the French Pox, are effectuall in curing this griefe: Use these then, Mercurius sublimatus dulcis, Tur∣bith minerall, Mercurie precipitate dulcified, Mercurie coa∣gulate, and fixed by gold and silver.

* 1.455The second Indication is the curation of the ulcer it selfe by locall meanes.

* 1.456But before you goe about to apply any locall medica∣ments, observe these passages: First, that you meddle not with tender children, if they have a maligne Tinea, un∣till they bee able to abide sharp medicaments; for you shall vex both them and their parents, and so shall procure a dimission to your selves. The meane time you may use a li∣niment〈2 pages missing〉〈2 pages missing〉

espying things which might hurt the body,* 1.457 that we may prevent and shun them: yet the hearing excelleth it, for it is Disciplinae sensus, the Sense of learning, according to Ari∣stode, and the entertainer of faith: for faith is bred by hea∣ring, according to the Apostle. And as the sight furthe∣reth invention, so by die hearing, things invented are communicated to others. Besides, by hearing, the pertur∣bations of the minde, as anger, envie, wondering and such like, are most stirred up.

* 1.458The causes of the ulcers of the eares, are either antece∣dent, or conjunct.

The antecedent is either externall, or internall.

The externall causes are two;* 1.459 to wit, a blow, or a fall: for by reason of either of both these the parts may be con∣tused, and from hence quittor bred, which being stayed long within the cavities of the eare, and having the eare-wax, and other sharp excrements of the braine, mingled with it, may erode the parts.

The internall cause is a sharp humor sent from the braine to the cavity of the eare,* 1.460 which first of all causeth aposte∣mation.

As for the Prognosticks,* 1.461 let this be the first: These ulcers are not to be neglected; for if the curation be prolonged, deafenesse may ensue.

II. If greater plenty of matter issue out of the eare than the part of its owne selfe is likely to afford, then you may pronounce that the greatest part of it is sent from the braine ill affected.

III. If before matter issue out of the eare, the party feele pulsation, and great paine, you may pronounce that a Phlegmon hath invaded the part.

* 1.462These ulcers are either without any excrescence of flesh, or they have excrescence.

* 1.463In the curation of ulcers of the eares, it is requisite that ever before the application of any locall medicaments the head be purged by cephalicall pils.* 1.464 Receive a description of

those which are very effectual. ℞ pilul. aggregatar. & an. rear. an. ℈j. trochiscor. Alhandal. & diacrid. an. ℈ss. spirit. vitriol. q. s. ut formetur nassula. Ex hoc massa efformentur pi∣lul. iiij. deglutiat. duat hor. 5. Matur. sequente dio sumat toti∣dem. Exactis 4. horis à sumptione pilularum capiat•••• sculum sine pane, prandeat autem hora consueta.

* 1.465In the application of locall medicaments, these five points are to be observed, according to Petrus à Largelata Medi∣cus Bononiensis.* 1.466

• I. Let no sharp medicament be put into the eare before the body be well purged, lest we procure a fever, and cause an attraction of humors.
• II. Let all medicaments which are powred into the eares be neither too hot, nor too cold; for they being (for the greatest part) framed of spermatick parts, they can hardly endure any excesse in heat or cold.
• III. Let all the medicaments which are to be powred into the eare be of a liquid substance, that they may enter the deeper.
• IV. After the party is dressed, let him or her lie upon the sound eare, the ill affected eare being stopped with cotton or wooll for a good space of time.
• V. Let not fattie medicaments be either powred, or injected into the eare, for it is composed of spermatick parts, and such things will cause a sordid ulcer.

The locall medicaments which are fit to be applied to ul∣cers of the eares, wherein there is no superfluous flesh, are these: Trochisci Andronii in aceto sambucino dissoluti: Haec autem est corum descriptie: ℞ ••••la••st. vitri••l. aristol. gallar. an. ʒij. alum. mirrh. sali•• Ammon. an ʒj. Excipiantur om∣nia melicrate & fiant trochisci. If you boile Crocus Martis in strong wine vineges, nutill both come to the consistence of a liniment, it is a good medicine. The Sanative syrup made of the vulnerarie plants, as, Selfe-heale, our Ladies-Mantle, Avens sanicle, Salamons-seale, Plantane, Horse-taile, Yarrow, Knotgrasse is very effectuall, not onely in ulcers of

the eares, but in all hollow ulcers in like manner, if Balau∣stia, Pomegranate-pils, Sumach, Mirtle-berries, and red Rose-leaves be added. These medicaments are sure, and such as you may trust into. In the winter time, if you boyle a sufficient quantity of dry Tabacco in strong Ale, and boyle the decoction strained, you shall have an effectuall me∣dicine, chiefly if the ulcer be foule, and have wormes, which you may conjecture by intolerable itching, which they will cause by their motion. If these ulcers afford great store of quittor, they must be dressed every foure and twen∣tieth houre; but if they yeeld but little matter, it will be sufficient to dresse them once in two dayes.

* 1.467If falleth out sometimes, that if ulcers in the eares conti∣nue long, that superfluous flesh doth so increase in them, that it filleth up all the cavities of the eare, and causeth deafenesse. This happened to a gentlewoman of the race of the Fittons in Chester, when I practised Phisick and Chi∣rugerie there.

* 1.468I thus cured her: First, I ministred unto her Cephalick∣pils.

This being done, I consumed the spungeous flesh by of∣ten application of the Fistula-powder, so that it did not not touch any part in the circumference. This powder I set downe in that Lecture, wherein was set downe the metho∣dicall cure of a Fistula.

Thirdly, I made in jection into the eare, made of two oun∣ces of white Wine, one dramme of Aegyptiacum, and halfe an ounce of Mel rosatum.

Last of all, I healed, and cicatrized it with my vulnerarie syrup dissolved in Plantane-water.

If such an accident come to your hands, proceed thus me∣thodically, and you shall undoubtedly bring to passe that which you shall goe about. So much I thought good to de∣liver unto you concerning the dignotion, and curation of ulcers of the eares, which often prove troublesome to the Patient and Chirurgeon, and loathsome to others, who ap∣proach

to the party grieved, by reason of the evill smell, which the ulcer sometimes sendeth forth.

* 1.469Now I will come to the ulcers of the eyes, which ought exquisitely to be handled, seeing the sense of sight, the in∣strument whereof is the eye, is so pleasing and necessary to all persons. Of all the ulcers of the eye, Fistula lachrymalis, or Aegylops, first doth offer it selfe, but seeing I amply dis∣coursed of it, when I delivered the doctrine of Fistula's, I will remit you to that Lecture.

* 1.470In this my discourse of the other ulcers of the eyes, I will first set downe the generall doctrine of them, and then de∣scend to the particular handling of each one of them.

In the generall doctrine, I will deliver three things: to wit, their causes; secondly, their prognosticks; and third∣ly, the indications of curing of them.

The causes, are either externall, or primitive, or inter∣nall.

The externall causes are two; to wit, a blow, or a contu∣sion by reason of a fall.

The internall causes are sharp and eroding humors.

[ I] As for the Prognosticks, let this be the first: Ulcers of the eyes in persons of an ill habit of body, seldome end without leaving some scar, or infirmity.

[ II] II. For this cause be wary what you promise, for boun∣tifull promise can hardly be called back, and the Patients, being for the most part carefull of the comelinesse of their parts, will undoubtedly expect the performance of them.

[ III] III. If children, or disordered persons, be presented to you to be cured of ulcers in the eyes, ever pronounce that the cure will prove difficult and hard.

The methodicall generall intentions of curing these griefes, are in number foure; Good order of diet, Phlebo∣tomie, Purgation, and the application of the Seton or Fon∣tanell for revulsion and derivation.

* 1.471Having dispatched the three points which the generall doctrine of ulcers doth containe, I am come to set downe

how each one of these ulcers in particular is to be cured.

As for the differences of them, they are either milde, or maligne. The milde are either of the Adnata, or Conjuncti∣va, or Cornea, or uvea. The ulcers of Conjunctiva most com∣monly proceed from Ophthalmia.

Of it then I will speak, beause it most frequently seizeth upon the eye:* 1.472〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek, but Lippitudo in Latine, according to Galen 4. de medicam. local. cap. 4. is an inflam∣mation of that tunicle of the eye which is called Adnata.

* 1.473There be two kindes of it: One properly so called, pro∣ceeding from inward causes.

The other proceeding from externall causes, which pro∣perly is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or Perturbatio.

Againe, Ophthalmia vera is either more milde, when on∣ly the Conjunctiva is inflamed or vehement, when as the eye-lid besides is red, turned up, and somewhat ulcerate.

* 1.474This griefe is thus bred, according to Cassius Medicus 66. probl. medic. When humors are impacted in the eye, they stop the passages, and keepe in the heat: the heat kept in, burneth when it cannot breathe thorow, and inflameth the humors; and these inflamed, cause Ophthalmia, and hinder the sight; for the Conjunctiva being inflamed, great pain and heat are felt in the eye. These draw humors into the eye: the humors attracted being dispersed thorow the eye, trou∣ble the humors and spirits; and these being troubled, of a ne∣cessity hinder the sight. The eyes are subject to these affe∣ctions, according to Arist. probl. 7. sect. ultim. & Alex. 1. probl. 35. because they are moist, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, very passable.

* 1.475All sorts of humors may cause a true Ophthalmia, but sundry wayes; for hot humors, as bloud and choler, of themselves cause great inflammations; but small inflamma∣tions may be caused of cold humors mixed with hot.

The primitive causes are the heat of the Sunne,* 1.476 paine of the head, a burning fever, dust, smoake, great cold binding the part, blowes upon the head, blustering winds, ebriety, venery, and according to Paulus, oyle. It bringeth an Oph∣thalmia,

because it cleaveth fast to the tunicles, and so stop∣peth the pores, and to the heat is kept in, and inflameth the eye.

* 1.477 Hippocrat. lib. de aer, aquis & locis, writeth, that they which inhabit the South, and hot regions, are easily assaul∣ted by such diseases, and easily cured: and by the contrary, that they who dwell in the Northerne parts are not so easi∣ly tainted with this griefe, but are more hardly cured: A∣vicen yeeldeth the reasons for this, saying, that they who dwell under a hot climate, have their heads full of vapours and humors, which being resolved by the hot aire, fall to the eyes, and being there stayed, cause an inflammation, which afterward is easily cured. First, because their bodies are more perspirable. Secondly, because they have still a loose belly. But in cold regions, although they have plen∣ty of humors in their heads, yet they are congealed, and doe not so promptly flow to the eyes; but if they come to the eyes, and be there impacted, they cannot so readily be dis∣cussed, by reason of the thicknesse of the skin, and constri∣ction of the pores. So inflammations of the eyes happen more frequently in the Summer to those who have their heads stuffed with vapors and humors, the heat colliquating them, and turning them to the eyes. In like manner in those diseases wherein there is an ebullition of the bloud, Oph∣thalmiae are forerunners, as in the small pox, measles, and sometimes the plague, hot and sharp vapours being carried up to the head.

* 1.478As for the signes of an Ophthalmia; they are generall, or particular.

The generall are these: according to Galen. 4. de medio. loc. 4. & lib. de totius morbi temporib. & Rhazes lib. 9. ad Almans. a swelling of the eie, a rednesse of it, paine somtimes pricking, sometimes corrosive, sometimes tensive, flowing of teares.

* 1.479The particular signes of a true Ophthalmia are these: a great tumor and paine, horrible heat, turning up of the eye∣lids, shew a great inflammation.

These accidents, in a more remisse degree, shew a milder Ophthalmia:* 1.480 if the humor proceed from the stomack, then the party will desire to vomit: if from the head, the head∣ach, vexeth: and seeing the humor may be sent both from the vessels within, and without the Cranium, if the veines of the forehead, and the rest of the face be full, if the arteries of the temples beat, and if the eye-lids be heavy, then the humor commeth from the vessels without the Cranium; but if none of these symptomes appeare, and yet the party often neezeth, and findeth itching in the nose, the humor or vapour is sent by vessels within the Cranium.

* 1.481Signes of the humors sent are these: If bloud be it, the eyes and face will be red, the veines will be full, the paine will be gravative, the matter that floweth will not be very sharp. If it be a vapour or flatuofity, there will be a finging in the eares, and a tensive paine. If it be pituitous bloud, the tumor will not be very red, but whitish, lesse heat and meane, great heavinesse of the eye and eye-lids; the eye-lids in the night time will be glued together.* 1.482

This happeneth for three causes: First, because in the day time the eye is still in motion, and suffereth not the hu∣mor to cleave to the eye-lids.

Secondly, because moisture is multiplied in the night time.

Thirdly, because the humor doth concoct in the night time, groweth thick, and so is more apt to cleave to the eye-lids, they then being immoveable. If choler be the cause, there will be but little rednesse mingled with yellow∣nesse, the humor which runneth from the eyes will be thin, the paine will be pinching. If flatuosity or a vapour, then none of these signes will appeare, yet the eye will be some∣what swelled, and a noise will be noted in the eares, and no humidity flow from it.

* 1.483As for the predictions: I. An inflammation comming of externall causes, is more easily cured than that which com∣meth of an inward.

II. When a continuall paine of the head is joyned with Ophthalmia, and coutinueth long, blindnesse most common∣ly ensueth.

III. If in an inflammation of the eye, the humor which floweth from it be thick, it will not long continue: for it betokeneth the benignity of the humor, and strength of nature.

IV. If a milde sever, or a lask,* 1.484 seize upon one troubled with Ophthalmia, it ceaseth within a short time, the humor being discussed by the first, and revelled by the second.

〈◊〉〈◊〉 If the tumor of the eye be great, the paine vehement, and the matter which floweth from the eye be copious and thin, the Ophthalmia is like to continue long; but short if signes contrary to these appeare. Thus much then concer∣ning the causes, signes, and prognosticks of an Ophthalmia vera shall suffice.

* 1.485Now it remaineth, that we speak a word or two of Ophthalmia spuria, a bastard Ophthalmia: This is caused onely by externall meanes, whereof we have spoken suffici∣ently before, when we set downe the primitive causes of Ophthalmia vera. And if the accidents, as inflammation, rednesse, and the like, be but moderate, it will easily cease, and without great difficulty, by removing the extrinsecall causes, and applying cooling waters, as Rose-water, or Plan∣tane-water, with Camphire.

* 1.486In the curation of Ophthalmia vera, some precepts are to be observed before the application of locall medicaments.

* 1.487I. The party must eat and drink sparingly, abstaine from venerie, and keep the body soluble.

II. Let the party be kept in a dark roome, and let the sleep be moderate; because immoderate sleep draweth va∣pours to the head.

III. Let the objects, which the party beholdeth, be greene, blew, or black.

IV. Let anger, serious cogitations, and motion bee shunned.

V. If the haire be too long and heavie, let be polled.

VI. Let the drink be small Beere, or Barley-water, wherein have beene boiled Fennell-seeds, Coriander-seeds, and eye-bright.

VII. Let meats salt, vaporours, sharp, and hard of di∣gestion be shunned.

VIII. If the party be strong, open first the Median, then the Cephalica, then the Vena frontis, and those behinde the eares, and in the temples, if the inflammation be great: if circumstances will not admit Phlebotomie, apply Ven∣toses to the shoulders, and thighes; and Fructions an•• ••••••∣gatures to the armes and legs.

IX. Purge according to the humor offending, as choler with Pilulae cochiae, or electuar. de succo ros. flegme with Diaturbith cum agarico, or Diaphanicum, or Diacartha∣mum.

X. If you use fomentations,* 1.488 these five things are to be observed:

• 1. That the body be cleane, otherwise the matter (be∣ing scattered by fomentation) will run to the eyes.
• 2. The matter must be discharged into the eye, and not in motion.
• 3. That it be used when the matter is thick, for it atte∣nuateth it.
• 4. That it be used in the declination of the griefe.
• 5. No astringent fomentations are to be used; for they wedge in the humor, and exasperate the griefe.

XI. To stay the fluxion, you are to apply a strong de∣fensive to the forehead and temples.

* 1.489XII. Opiaticall medicaments not well corrected, are not to be used; for if they be but weak, the may procure a little ease for the time, but the fluxion and pain will returne more fiercely: if they be strong, they may cause inevitable blindnesse, by hindering of the influence of the visive spirit.

* 1.490The locall medicaments must have three qualities; for they must be somewhat astringent, cooling, and anodine;

such are the water of the white of an egge, the mucilage of Fenugreek, and Quince-seeds drawne with Rose and Plan∣tane-water, with a little Saffron; Trochiset albi Rhasis sine opio (unlesse the paine be very great) dissolved in Violet, or Succorie, or Eye-bright-water. What I have spoken, I would have you to understand it of an ordinary Ophthol∣mia.

* 1.491If you perceive it to be venereall, or a symptome of the great Pox; then you must cure the griefe, and then the ac∣cident will cease: If after the using of these meanes, the ••••hthalmia prove rebellious, you must blister the neck.

* 1.492If this will not serve, you must apply the Seton, or make a Fontanell in the neck or arme; but the Seton is most effe∣ctuall: for first, by reason of the great paine which it brin∣geth, it maketh a stronger revulsion: Secondly, it dischar∣geth the humor more plentifully, it having two orifices, but the Fontanell onely one.

LECT. XXV. Of the rest of the ulcers of the eyes.

NOw order requireth, that I should set downe the do∣ctrine touching the ulcers of Cornea.

* 1.493These are either superficiall, or deep, corroding the sub∣stance of the Cornea.

[ I] The superficiall are foure, whereof the first is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which signifieth a troubling of the aire: and it is a very thin, and superficiary exulceration, of a bluish colour, resembling a dark aire, and possessing the greatest part of the black of the eye: the Latines call it Caligo, a mist in English.

[ II] The second is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, in Laine Nubocula, this is deeper than Achlis or Caligo, yet narrower, and whiter.

[ III] The third is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; it is an ulcer which groweth

about the circle Iris, possessing part of the white, and part of the black of the eye: without the▪ Iris it appeareth red, but within the Iris white.

[ IV] The fourth superficiary ulcer is called by Aetius〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 this is a superficiary ulcer also, which maketh the Cor∣nea rugged by erosion, and to be of an ash-colour, resem∣bling a lock of wooll, for the which cause it is called of Avi∣cen, the woolly ulcer.

* 1.494Of the deeper ulcers of Cornea there are three sorts:

The first is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; and it is an ulcer of the Cornea▪ hollow, narrow, without filth, like to a round p••••∣cture: in Latine it is called Fossula; [ 1] for 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek doth fignifie Fovea, a pit.

[ 2] The second is called in Greek 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and it differeth from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, in that it is wider, although not so deep.

[ 3] The third, of the deeper ulcers of the Cornea, is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 by Aetius; by Scribouius, Largus ustio; and by others inustio; and it is an impure, and crustie ulcer of Cornea, tho∣row which sometimes the humors of the eye come out, when it is made cleane, by cleansing medicaments applied.

These ulcers of the Cornea of the eye,* 1.495 whether they be superficiarie or deepe, are not to be slighted, but carefully to be dressed: but those especially which have deeply sei∣zed upon the substance of the membrane, lest they corrode thorow the whole membrane, and so the humors issuing out, the eye sink, and both deformity, and inevitable blindnesse ensue.

* 1.496For the materiall cause of these ulcers is a salt and nitrous humor, as Paulus Aegineta speaketh, Lib. 3. c. 22.

* 1.497It the Cornea be quite thorow corroded, then the uvea fal∣leth downe: this disease of uvea is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, uvea procidentia.

* 1.498Of this disease there are foure kindes:

[ I] If it fall out but very little, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉,caput musca, the head of a flie, and of Avicen, Formiculis, like the head of a pismire.

[ II] If it fall downe yet more, and equall a grape in bignesse, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, uvea, or uvatio.

[ III] If it fall downe yet further, and hang out like a little ap∣ple, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, m••lum, the apple-like rupture.

[ IV] But if the uvea fall downe and grow hard, brawnie, and flat, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, clavus, the naile-like rupture. All these foure kinds of the rupture of uvea for the most part are un∣curable:* 1.499 only the apple-like, and grape-like rupture, if the roots be small, and the party be of a good constitution, may be by binding cured, to takeaway and mitigate the defor∣mity of the eye. For if the sight be taken away before by these breaches of uvea, the deligations will not restore the sight, which must be intimate to the party before you goe about these operations, that he think not himselfe deluded, having hoped for the recovery of his sight, as the reward of his patience, in enduring the manuall operations.

* 1.500Seeing all ulcers of the eyes argue a cacochymicall body, for they are caused of sharp and corroding humors, the con∣stitution of the body must be altered, not suddenly, by labo∣ring to remove the whole cause at once; but 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and that is according to Galen. li. 9. meth. medend. when by little and little that is discharged which is faulty, that that which is good may succeed in its place. Wherefore you are to shun all strong catharticall meanes, lest they procure vomiting, which is very prejudiciall to weak eyes, such as are those which are ulcerate. The body having beene gently purged, nature very often doth correct the refidue of the humor, by turning that part which is benigne into nourishment, and expelling that which is superfluous, by stoole, urine, and sweat. Those twelve observations which I set downe in the deliverie of the curation of Ophthalmia vera, I commend unto you in the curing of the ulcers of the eyes also, which need not any repetition.

* 1.501To set downe all the locall medicaments, which are deli∣vered by the Ancients in curing ulcers of the eyes, were a fruitlesse labour.

Neverthelesse, I will furnish you with a few approved medicaments.* 1.502 Then in superficiall ulcers of Cornea, use These: I. ℞ su••xi tu••. fanicul. chelidon. ••uphragia an. ℥ij. vini albi poten••i•• ℥iij. sa••chat. cordi ʒiij. aloes, sarcocoll. an. ʒ••••. fellis capan. ʒij. Distill these, and use the water.

II. ℞ ••q. chelidon. & rutae an. ℥iss. aq. ros. ℥j. croci me∣tall. ʒj. fiat infusio.

III. ℞ succi saenicul. ruta an. ℥iij. mell. vptimi ℥ij. expo∣nantur soli inclusa vitro stricti orificii probe obturato per men∣sem tempore astive. Vtemdum ho•• medicamento abjectis foe∣civus.

IV. ℞ axung. porci aq. ros. ubluta ʒij. caphura ℈ss. turiae praepurar. gr. x. al••••s pulv. ℈j. sacchars candi gr. xvj. fiat col∣lyrium.

* 1.503In deepe ulcers of Cornea tunica use this of H••urni••••, which he bought at a deate rate, and which he hath set downe method. ad praxin, lib. 1. pag. 106. ℞ ••••laminar. ter. usti ac bis in vini aceto extincti ℈j. myrrhae, plumbi usti ac le∣ti an ℈ss. croci gr. v. opi•• gr. ij. aeris ust•• ℈ iiij. decocti fanu∣graeci ℥j. terantur omnia supor lapidom pictorum ac fiat colly∣rium. Having first made clean the eyes with a spunge dipped in the mucilage of Fenugreek and Linseed, dresse the ulce∣rate eyes twice in the forenoone, and so often in the after∣noone.

Collyrium de plumbo described by Rinodaeus, set downe by him in Dispensatorio medico lib. 5. cap. 11. de collyriis, is an effectuall medicament. ℞ plumb•• ust••, antimon. turiae lotae, ae∣ris usts, gumm•• Arabici, tragacanthi an. ℥j. opii ʒss. fiat ex omuib ut pulvis ex quo cum aqua resacea formentur trochises: dissolve one of them in Plantane and Purselane water, and dresse with this medicament the eye.* 1.504 When you are a dressing the ulcers of the eyes, minister once a week a pur∣ging medicament. If you use Pil••, minister (according to the advice of the Arabiane) Pilula alephanginae, or Pilula lucis majores & minores, or de agari••••, minister a dram made up into foure Pils, which are to be covered with silver

foile: or use this pill; ℞ Spcoier. hier. ℥ss. Diacridii ʒij. Trochiscor. Alhaxdal. ʒv. Cum Syrupo Augustano fiat massa. One pill of this composition weighing twenty graines, will purge sufficiently. If the partie cannot swallow pils, mini∣ster to him this potion: ℞ carieostin. & Electuar. lenitiv. an. ʒiij. Pulv. sancti ℈ij. Fulv. Holland. ℈j. Syrup. ros. solu∣tiv. cum Agarico ʒvj. aq. Beton. Faenicul. aut Euphrag. ℥iij. Misc. ut fiat poti••.

* 1.505To these medicaments both inward and outward, the, right use of those things which are called Non naturales must be joyned, or else the curation will be protracted and prolonged.

* 1.506The Aire then must bee temperate in its first qualities, as being neither too hot, nor too cold, too moyst, or too dry. It is not good to abide in the heat of the Sun, nor the beames of the Moone, or any open aire: the partie is to shun Southerne and northerne winds: for the Southerne wind, according to Hippocrates, troubleth the sight,* 1.507 cau∣seth hardnesse of hearing, an heavie head, dull senses, a lazie body, because it begetteth grosse spirits. And the Nor∣therne wind is verie sharp, and therefore it stingeth and pricketh the eyes: neither must the aire be too lightsome; for it scattereth the spirits.

The bread must be made of cleane wheat,* 1.508 well-leavened, and somewhat salted, wherein may bee put Fennill, Anise, and Coriander seeds: for unleavened bread is accompted hurtfull to the eyes.

As for flesh-meats these are good:* 1.509 Chicken, Capon, Hen, Partridge, Phesant, Pigeons. Larks, the Pie, the Swallow, and the Goose-flesh are accompted good for the sight.

As for fish, Trouts, Rochets, Pearches, and Pickerels,* 1.510 of fresh-water fish may for varietie of diet bee admitted: of salt-water fishes, Whiting-mops, and the Smelts are ac∣compted the best. Baked and fried meats, strong spices, as Pepper, Ginger, Mustard, and the roots of the Horse-rettish are not to be used. To meats minister this composition in

stead of salt: ℞ Euphragiae, Semin. Faenicul. an. ʒj. Cinamo∣mi & Macis, an. ℈j. Salis communis ℥j. fiat ex omnibus pul∣vis. All bulbous roots, as Onions and Garlick; and P••lses, as Pease and Beanes, are to bee rejected; as also moyst and ••••w fruits: Stewed Prunes, and Peares, or Quinces preser∣ved, are permitted after meat, to stay the ascending of va∣pors to the head, and the Marmalade of Quinces, with some Anise-seeds, Fennill-seeds, and Coriander-seeds Comfits.

As for drink,* 1.511 no liquor is more convenient than six shil∣lings Beere, neither too new, nor too stale, having had a bag of boulting-cloth hung in it, filled with Eye-bright, Fen∣nill-seeds, Betony, Rosemarie, sweet Marjerome and Sage.

If the partie hath beene accustomed to wine,* 1.512 let him use some small wine, not sharp or vaporous, wherewith some good spring-water must be mingled, and Borrage-flowers, and Burnet-leaves are to be put into the cup: and this will serve for two purposes: for the colour will comfort the eyes, and the herbs by their propertie will represse the va∣porousnesse of the wine. The lesse one doth drink the bet∣ter will the Patient be, and the sooner cured. A small kinde of Meath made after this manner will not be amisse: ℞ Aq. font.lb. xv. Mellis optimilb. j. Faenienl. Euphrag. an. man. j. Macis ʒj. Coq. adtertiae partis consumptionem semper spu∣mam auferendo,* 1.513 actandem colando. Immoderate sleepe fil∣leth the head full of vapors, and immoderate watching doth spend the spirits, coole the braine, and hinder the sight. It is good to goe to bed three or foure houres after supper, and to rise early, and to walk softly up and downe the chamber, to comb the head,* 1.514 pick the eares, and to emptie the excre∣ments. Much reading is not good, especially after meales, and weeping is verie hurtfull.

The body must still be kept soluble with lenitive clysters of Diacathol. the syrup of Althaea,* 1.515 and the oyle of Lilies dissolved in the ordinarie decoction appointed for clysters. Take this for a parterne: ℞ Diacathol. ℥jss. Syrupi de Al∣thea ℥ij. ol. Lil. albor. ℥ij. Decoct. communis pro clysterib.

℥viij. Misc. ut fiat clyster. If the partie will not admit a cly∣ster, then minister halfe an ounce of Electuar. lenitivum, in seven spoonfuls of broth made of a Chicken. After meales use this or the like digestive powder: ℞ Semin. Faenicul. & Coriand. Saccharo semel incrustatorum, an. ℥j. Cort. Citri, & Myrobalan. Kebul. condit. an. ʒiij. Euphrag. siccat. ʒij. Ma∣cis ʒj. Sacchari rosat. Tabellat. ʒjss. fiat ex omnibus pulvis. Dos. cochl. 1 à singulis pastibus.

Hitherto I have delivered unto you the differences of milde ulcers;* 1.516 now I will speake of the divers kindes of ma∣ligne ulcers of the eyes. These are either not contagious, or contagious. The not contagious are two; Noma, and Ʋlcera cancrosa. The contagious are three; Carbuncu∣losa, Venerca, Morbillosa. Of these in order I will discourse briefly.

Noma, or Ʋlcera depascentia are maligne ulcers,* 1.517 which sometimes begin at the corners of the eyes, sometimes at the white, and sometimes seize upon the hornie membrane. In corrupt bodies they fret exceedingly, and goe forward in such sort, that oftentimes they consume the parts adja∣cent, as the muscules and lids of the eye:* 1.518 from them flow∣eth a stinking slimie matter: the paine is grievous, and the diseased partie hath an accidentall fever.

This ulcer is dangerous,* 1.519 and seldome cured without de¦formitie and losse of the sight: wherefore my counsell is, that you fore-tell the danger, if such ulcers bee offered to you to be cured.

* 1.520Onely I will acquaint you with some locall meanes, ha∣ving spoken sufficiently of the generall intentions. Apply then to the ulcer the juyce of Plantane. Horse-taile, Knot-grasse, Night-shade, and Yarrow clarified with Honey, and the whites of Egges: Dresse these ulcers morning and eve∣ning, dropping a few drops into the affected eye, covering the eye with a cataplasme made of Ʋngn••••••••um ros••t 〈◊〉〈◊〉, the pulp of a Quince boyled, and some ••y••e of P••pp••es. If these ulcers prove verie maligne and corroding, you may

correct them by instilling some oyle of Vitriol, or Sulphur, mingled with Plantane-water, taking onely the fourth part of it. To asswage the paine use this cataplasme: ℞ Mala Cydonia numero 2. Sedi major. et Solani hortens. ana man. ij. coq. in s. q. Lact. muliebr. vacc. capr. aut asinae, adda∣tis Croci ℈j. ac fiat cataplasma.

* 1.521 Vlcus cancrosum, a cancerous ulcer followeth, which the Chymists pronounce to be caused of an Arsenicall salt, and it is like to be so: for in this ulcer, besides corrosion, there is a septick or putrefactive qualitie. It beginneth in the black of the eye.

* 1.522In it the black and white of the eye are reddish, lines seeme to be sent from the black to the temples: the Patient refuseth food, by reason of the exceeding great paine, a thin darkish and sharp humor floweth from it, and it is exasperate, by reason of the application of sharp medica∣ments.

You an onely promise a palliative cure of this maligne ulcer,* 1.523 by the application of anodine meanes, after you have used the generall indications before specified. Paulus Aegi∣net. lib. 3. c. 22. affirmeth it to bee an uncurable evill. Hee counselleth to feed the Patient with milk, panado's, and other meats of a good juyce, and of an easie concoction.

* 1.524Milde eye-salves are also to be applyed, as this: ℞ Muci∣lag. Semin. Cydon. et Palicur. Aq. ros. extract. ℥j. Trochisc. albor. Rhas. cum opio ʒj. fiat collyrium quod tepidum applice∣tur. Renovetur mane et vesperi. Desuper applicetur hoc ca∣taplsama. ℞ Pome cocta num. 3. Cassiae recent. extract. ℥ss. Croci ℈j. Lactis mulieb. ℥j. Albumen ovi unius: fiat cata∣plasma. So much then concerning the handling of maligne ulcers of the eyes,* 1.525 wherein there is no contagion.

Ulcers which are caused of contagious diseases follow, as the Small Pox, the French Pox, and the Plague: If you feare that the Small Pox are like to cause ulcers in the eyes, [ I] which you shall conjecture if there was an inflammation in the eyes,* 1.526 before any did appeare in the body; if the par∣tie

feele paine in the eyes, and cannot open the eye-lids, then are you to apply gentle fomentations to the eyes,* 1.527 as the brest-milk of a sound woman, having a little Saffron mingled with it; or the Mucilage of Fenugreeke, Lin-seed, and Quince-seeds, drawne with Rose-water, having some Saffron added to it. You shall not need to looke for any other medicaments in these ulcers.

* 1.528If the ulcers be venereall, caused of the great Pox: then with all expedition are you to goe about the curation of the maine griefe, lest blindnesse quickly ensue, and then to labour to cure the ulcers of the eyes, which are but onely symptomes of the disease. Rinod. in dispensat. med. lib. 5. c. 11. it setteth downe an excellent eye-salve for this purpose, ascribed to Lanfranck by the Neotericks, which hee could not finde in the works of Lanfranck (as hee confesseth) so that by all likelyhood it is a magistrall receit. The descrip∣tion of it is this: ℞ Vini albilb. j. aq. Plantag. & rosarum an. ℥iij. Auripigment. ʒij. Virid. ar. ʒj. Aloes, Myrrh. an. ℈ij. Terrantur ista subtilosmè, & fiat collyrium.

* 1.529I will adde a little of the ulcer of the eye, caused of a pestilentiall Carbo, or Anthrax, and so end. In this case, first there ariseth a small tumor in the eye, hot, hard, pain∣full, and contagious, caused of a thick, burned, and veno∣mous humor: It is hot, the unnaturall heat causing an ebul∣lition of the humor: It is hard, because the heat burneth the humor: It is contagious, by reason of the venomous humor which causeth it: when it yeeldeth matter it stin∣keth, by reason of the putrefaction of it.

* 1.530It is accompanied with watching, drought, internall heat, raving, and the urine is sometimes of a firie colour, sometimes thick and troubled.

* 1.531If these symptomes appeare, then are you first of all to minister such Antidotes as are fit for a pestilentiall fever, as Th••riaca Andromachi, Antid••••m de sangui••ibus, Electua∣rium de ovo, and such like, to tame the venenositie of the matter, and then to proceed to the curing of it. If you per∣ceive 〈2 pages missing〉〈2 pages missing〉

call the capitall instrument, the gibbous or arched part be∣ing blunt, and having a back; but the belly being as sharp a a razor: when you have compassed all the part united, ha∣ving turned the back of the instrument towards the eye lid, cunningly seperate the parts united, neither offending the eye-lid, nor any tunicle of the eye. But if either of these must bee touched, it is best that the eye lid suffer, than any tunicle: for it may more securely suffer the injurie. When this operation is performed, if you be not vigilant in kee∣ping the parts seperate asunder, they will easily unite againe. as Celsus noteth.

In setting downe the operation, Celsus calleth the instru∣ment Specillum:* 1.532 As for that instrument which goeth com∣monly amongst the Ancients, under the name of Specillum: It did absolutely represent your ordinarie Spathula's, being on the one end narrow and round, to serve for a probe, en∣ding in a round small button, to hinder it from offending, when you are to trie the depth of an ulcer, or wound, and on the other broad and flat, to spread your unguents: of the broadest end Galen speaketh, Method. 13. c. 5. where hee adviseth to besprinkle an ulcer with the powders, using lato Specilli mucrone, the broad end of the Specillum, or Spathula.

* 1.533One thing is to: be noted, that if (you feare that in put∣ting in of the instrument into the eye, to comprehend the parts united) you feare to hurt any part with the point, then it is requisite to arme it with a little wax, that it may bee like the end of a probe.

* 1.534To the parts thus seperated, apply a Collyrium made of Plantane-water, and Tochisci albi Rhasis sine opio: dissol∣ving in an ounce of the water, a dram of the Trochisces. Keepe the parts asunder with small dosils of lint put be∣tweene the parts disjoyned, laying upon the eye a couple of boulsters crosse-wayes, moystened with the afore-named medicament, and then rouling it up: Dresse the eye mor∣ning and evening, to hinder unition, and hasten the

cure, untill the incised parts be cicatrized, and no feare left of cleaving together againe of those parts, which by manu∣all operation were severed.

LECT. XXVI. Of Ozaena.

HAving set downe the ulcers which ordinarily possesse the eares and eyes, I must not let those passe which sometimes trouble the instruments of the other two senses, to wit, smelling and tasting, which are the nose and the mouth. Of all the ulcers of the nose, I will onely speake of Ozaena, omitting the rest; because they require no singular consideration: for the generall indications of curing of ul∣cers, will serve to lead any man to the curation of these.

* 1.535Ozaena hath its denomination from 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, which ac∣cording to Celsus, lib. 3. c. 11. is Foetor oris, the stinking of the breath.

* 1.536Of it Galen, de comp. medicam. sec. loc. lib. 3. c. 3. so discourseth: Polypodes are bred in the nostrils, which are tumors unnaturall: but Ozaenae are a kinde of ulcers, &c. First of all, I will speake of the Ozaenae, which are produ∣ced of the influxion of sharp, and putrid, or rotten humors. These humors, if they be onely sharp, they produce ulcers hard to bee cured; but not of a grievous smell: Out of Galen then you may gather, that Polypodes are onely tu∣mors in the nose, but Ozaenae are ulcers. Secondly,* 1.537 that there are two sorts of Ozaenae; the one is of these which erode, being caused of the influxion only of sharp humors, but stink not. The other is of these which smell grievously, and are caused not onely of sharp humors, as the former; but such also as have putrefaction annexed to the erosion. Actuar. lib. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉c. 10. so speaketh of this kinde of ul∣cer. Ozaena doth manifest it selfe by its verie name, which 〈2 pages missing〉〈2 pages missing〉

corrupt and evill juyce. Secondly, that he use great mode∣ration in the use of wholsome and convenient food.

* 1.538Fasting often in this case is verie requisite: First, be∣cause it drieth the habit of the body: Secondly, because it furthereth concoction: Thirdly, because by fasting those vapors are digested, which otherwayes would mount up to the head. And although in the beginning, while the body is fraughted with sharp humors, the sore may bee exaspera∣ted by fasting: yet after that the body is cleane, and dis∣charged of such humors, by frequent evacuations, you shall finde the commoditie of fasting: howsoever, the dinner must not be riotous, and the supper verie spare.

The second Physicall meane is Phlebotomie:* 1.539 If the bo∣dy bee plethorick: First, open the Cephalica of the right arme in the Spring and Summer; but of the left, in the Har∣vest and Winter: Then three or foure dayes afterward open the veines under the tongue, which will serve for deriva∣tion of the humor, as the former did for revulsion of the same.

* 1.540This must much further the curation: For first, Phle∣botomie impaireth the quantitie of the humors contai∣ned in the masse of the bloud: Secondly, it maketh way for the receiving of better bloud into the vessels, which of a necessitie must ensue after the appointing of a conveni∣ent diet, and exquisite purging of the body, which imme∣diately after Phlebotomie is to be performed.

The third Physicall meane appointed for the curation of an Ozaena,* 1.541 was said to be purging of the body by cathar∣ticall medicaments: for vomitive medicaments are not so convenient as the catharticall, in the diseases of the head, unlesse the stomack bee foule, and pestered with raw and corrupt humors, which require a long time for concoction: Vomitions (as is confessed by all Practisers) send up vapors to the head.

* 1.542These purging medicaments are of two sorts: for they are either vegetable, or minerall.

* 1.543As for the vegetable medicaments, they must bee of the strongest, which are appointed for disburdening of the head of ill humors: such are Agarick, Turpetum, Coloquint, Scammonie, the black Ellebore. But seeing the purgative simples are seldome ministred alone, I will shew unto you what compounded medicaments are fittest to bee used in this case. The compounded purgative medicaments are ei∣ther Pils or Potions.

As for the Pils:* 1.544 If the humors be mixed then use E••∣tractum Panchimagogic•••• of Paracalsus, or the Pilula e••∣tracta R••u••••••; of them minister halfe a dram for a dose: Let the Patient use this medicament twice a weeke. If cho∣le•• and flegme corrupted be the materiall cause of the ulcer, then minister the pils called Sine quibus esse no••••. If thick and gorsse humors be the cause, ministe 1 Pilula a••••••a, & coc∣tia. It corrupt flegme be the cause, minister Pilulo de A∣garito. Of these pils minister one dram for a dose: let the number of the pils bee according to the swallowing of the Patient.

If the Patients bee hard to be moved to the stoole, you may acuate, and make the pils more effectuall, by adding to everie dose of the pils some graines of the Trochisces of A••••andal, and three graines of Dacrydium.

If the partie cannot swallow pils,* 1.545 then you are to mini∣ster potions. The Electuaries most fit for this purpose, are Diacatholicum, Caricosti••••m, Diaph••••••icum, Elect••ar••um de succo rosarum, Confectio Hamech, Diac••••rhamum. Of these Electuaries, and convenient syrups, and distilled wa∣ters, or decoctions, you may make potions fitting the con∣stitutions of the parties grieved.

For one of a cholerick constitution minister such a po∣tion: ℞ Caricos••i••. & El••••tu••••. de s••••c•• res. an. ʒiij. Sy∣rup. de C••••bor. cum 〈◊〉〈◊〉 ℥j. aq. Endivia ℥iij. Misc. ne fiat potio.

If the partie be of a phleg•••••••••• constitution, minister this potion: ℞ Diaph••••. & Di〈7 letters〉〈7 letters〉, an. ʒiij. Syrupi

ros. solut. cum Agarico ℥j. aq. Beton. ℥iij. Misc. ut fiat potio.

If the diseased person be of a melancholy temperature, then minister this potion: ℞ Confect. Hamech ʒiiij. Dia∣cartham. ʒiij. Syrupi Augustani ℥j. aquae Fumariae ℥iij. Misc. ut fiat potio.

Thus you may purge the body with vegetable medica∣ments, if the body of the diseased partie be weake, or if you feare the use of minerals. But let me insinuate so much un∣to you, that the minerall medicaments, if they be well pre∣pared, are most effectuall, and if they be ministred by a skil∣full Practiser, howsoever they are sleighted and despised by those, who glorie of the denomination of Galenists, a∣mongst whom some may bee found, whose skill is inferior to the envie of an understanding man.

* 1.546The minerall medicaments are more subtill and piercing than the vegetables, and sooner alter the complexion of the partie unto whom they are ministred. These medi∣caments are most commonly taken from Antimonie and Mercurie.

The Antimonie which purgeth most by stoole is excel∣lent.* 1.547 The Sulphur of Antimony drawne by Art from the recrements of the Regulus is good; as also the Regulus it selfe calcined and fixed with Sal-peter, and brought to a white powder. The glasse of it, and Crocus metallorum, are not so convenient and secure, because they procure strong vomitions.

There bee divers preparations of Mercurie which are verie effectuall;* 1.548 as Mercurie precipitate, with Aqua fortis, the oyle of Vitrioll, or Sulphur, with Gold or Silver, or precipitate alone, without the addition of any thing. There is none of any note amongst you, who is not able by one preparation or another of Mercurie, to procure salivation.

These Mercuriall medicaments are effectuall, as well in an Ozaena which is a primarie disease, or of it selfe, as in

that which is a symptome of the French Pox. You have heard what diet is most convenient, and what internall me∣dicaments are most effectuall in curing of an Ozaena: The last point which I propounded unto my selfe to attaine to the curation of this ulcer, was the right use of the exter∣nall medicaments.

* 1.549These are in number two; to wit, the locall medica∣ments, and the actuall cauterie.

As for the locall medicaments, they are either waters, or decoctions, or unguents: But before you apply any medi∣caments to mundifie, incarnate, or cicatrize, you must labour to remove the crustie substance,* 1.550 which doth fix it selfe in the fore-part of the Ethmoides, or Os Cribriforme: and that for two causes: First, because the braine is hindred from discharging of the residue of the maligne humor, which causeth the ulcer, and so the curation is protracted: Se∣condly, because the medicaments cannot touch the affected parts, and so no alteration can be procured.

For the removing of the crustie substance, I commend unto you two medicaments:

The first is this: ℞ Ol. A mygdalarum dulcium ℥j. Sper∣mat. Ceti ʒij. exquisitè misceantur:

The second is this: ℞ Axung. Vrsi ℥j. Pinguedin. Taxi ℥ss. ol. Semin. lin. ʒiij. Mise.

* 1.551You must thus dresse the Patient: Turne his face up∣ward, and let his head be bent backwards, then morning and evening with three feathers tied together, drop still some of these medicaments warmed in a Sawcer, into the nose, and let the partie grieved stil draw in his breath, untill hee feele the taste of them in his mouth.

When you have perceived that the crust is soft, morning and evening let him snuffe up into his nostrils some of this sternutatorie powder: ℞ Ellebor. albi, Nigilla, Tabacc. an. ℈j. Rorismar. Salv. an. ℈ij. Moschi gr. ij. fiat pulvis subtilis. Let him snuffe a little up into his nose everie mor∣ning, after you have moystened the crust with some of the

medicaments set downe before. When part of the crustie substance is falne out, dresse it still after this same manner, untill all the crust is spent:* 1.552 then proceed to the application of the medicaments named by name.

Use these waters.

* 1.553First, the preheminence shall bee given to Aqua alumini•• magistralis of Fallopius allayed with Plantane, or white Rose-water.

The second shall bee this: ℞ Aq. Plantag. Card. Bene∣dict. Caras. nigror. & fragor. an. ℥iii. Spirit. Vitriol. ℈i. Misc.

The third shall be this: ℞ Aq. aurifabror. & gemmar. quer∣cus an. ℥iiij. Alum. ʒij. Exquisitè misceantur & depurentur.

The fourth shall be this: ℞ Aq. Alum. & Plantagin. an. ℥iiii. Mercur. dulcis ʒii. Digerantur in cinerib. calidis per her. 2.

* 1.554As for Decoctions, I commend unto you these:

I. ℞ Flor. ros. rub. pug. ii. Balanstior. ʒss. rad. Tormen∣till. ʒi. fol. Plantag. Polygon. & Vinca pervinc. an. pug. 1. Boile these in six ounces of spring-water, untill the halfe be consumed; straine then the three ounces remaining, and dissolve in them one ounce of Melrosatum.

II. ℞ Rhois Coriar.lb. ss. Alumin. ʒii. coq. ista ac cla∣rificextur albumine ovi unius, ac colentur. Colaturae adde mel∣lis rosat. Syrup. Myrtill. & deros. rub. sicc. an. ℥i. I will not trouble you with great varietie, as I might out of the mo∣numents of the Ancients; seeing these will suffice, or else none.

* 1.555The waters and decoctions you must inject by a fyringe warm, to make your topicks answerable to the ayre, which is drawn by the nostrils in the first qualities, to wit, moyst and hot: moyst, I say, actu, but potentia, drying; seeing ul∣cers require such medicaments: seeing both waters and de∣coctions being applyed, do quickly evaporate, and leave the part affected dry, and thirsting for other topicks.

* 1.556The unguents shall offer themselves; I will not super∣erogate

in this point, but will only deliver unto you such as shall bee effectuall; and what is deficient in number, shall be supplyed by efficacy. Receive this as the first, out of Da∣niel Sennert. med. pract. lib. 1. part. 3. sect. 4. c. 1. ℞ plumb. usti, lithargyr. an. ℈i. ceruss. bol. Armen. balaust. an. ℈ ss. ol. ros. myrtin. an. ʒ ss. cerae alb. ℈i. Ducantur ista in mor∣tario plumbco, donec acquirant unguenti confistentiam. The second shall be this: ℞ unguent. de tutia, & unguent. albi caphurati, an. ℥i. ol. myrtill. et cydon. an. ʒii. Mercur. dulcis ʒ i. ss. pulverizati. Misceantur. These ulcers are to be dres∣sed twice a day, morning and evening.

* 1.557Cancerous ulcers also seaze upon this part. This griefe hastened the end of that famous Mathematician, Mr. Ha∣riot, with whom I was acquainted but a short time before his death; whom at one time, together with Mr. Hughes, who wrote of the Globes, Mr. Warner, and Mr. Turperley, the Noble Earle of Northumberland, the favourer of all good learning, and Mecaenas of learned men, maintained while he was in the Tower, for their worth and various li∣terature. But seeing those documents, which I delivered for the curation of cancers already, may suffice, I will only set down the description of an effectuall water in this griefe, which is this:* 1.558 ℞ spermat. ranar. et limacum, an.lbii. gem∣mar. quercus, et hederae terrest. an. ℥ iiii. Extilletur aqua è stillatorio communi, unde prolici solet aquarosacea in recipi∣ens, cui immissae sint caphurae calcinatae ʒ ii. Inject this water into the nose, and lay to the sores either double clouts, or lint moystned in this water, as you shall think most fit, morning and evening.

* 1.559It resteth only now that I speak a little of the applicati∣on on of the actuall cautery, which was sayd to bee the second externall meane in the curing of an Ozaena: this meane is only used when the sore is rebellious to powerfull ordinary meanes; which hapneth either by reason of malignity, or too much, or superfluous humidity:* 1.560 for according to Hip∣pocrates

aphor. lib. 1. aphor. 6. Against extreme griefes, ex∣treme remedies are best.

* 1.561The actuall cautery is applyed for two purposes:

First, to cause an eschar by impressing of it upon the ul∣cer.

Secondly, it is used only to dry the ulcer, by often apply∣ing of it, still desisting before the party feele any paine, by reason of extreme heat.

* 1.562If you meane to procure an eschar, both the ends of the pipe by the which the cautery is carried, must be open; but if you intend desiccation, the end which you apply to the ulcer, must be shut.

If you have procured an eschar, the fall of it is to be procured as I did shew in removing of the crust: this being done, proceed in curing of the ulcer as hath been taught.

If only you have caused desiccation by iteration of the application of the actuall cautery, the manner of curing is not to be altered.

LECT. XXVII. Of the ulcers of the mouth.

NOw am I to discourse of such ulcers as befall the in∣strument of taste, which is the mouth.

* 1.563It beginneth at the lips, and reacheth to the beginning of the wind-pipe, and the Gula, or mouth of the stomack.

* 1.564It hath foure uses: I. It serveth for breathing, it sending fresh aire unto the lungs, and discharging fuliginous vapors sent from the heart by the Arteria venosa.

II. It receiveth the food, and having prepared it by the chewing of the teeth, and the mandible, it sendeth it to the stomack there to be chylified.

III. It serveth for speaking: the externall and internall parts of it serving for the framing of the voyce.

IV. It serveth for the discharging of the excrements of the braine, by spitting out of the excrements of the lungs by expectoration, and of the excrements of the stomack by vomiting.

Seeing then the uses of it are so manifold and necessary, it behoveth me to discover such diseases (belonging to our purpose) as deprive us of one or more of these commodities which it affordeth to us. But seeing some of the parts of it are externall, as the lips; and some internall, as the teeth, gums, roofe, the tongue, the almonds, the uvula: I will onely meddle with the ulcers of the lips, roofe, tongue, almonds, uvula, and the ulcers of it beyond the uvula, as onely being proper to my intention.

* 1.565I will begin first with the ulcers of the lips: how hurtfull the ulcers of the lips are, you may gather from the commo∣dities, which they (being sound) afford to man.

* 1.566The lips afford a sixfold commodity to the life of man:

• I. They serve for the convenience of eating and drink∣ing, for they keepe in the meat untill it be chewed.
• II. They beautifie the face if they be well fashioned.
• III. They keep in the spittle of the mouth.
• IV. They keep the teeth and gums from externall in∣juries.
• V. They serve for the framing of the speech.
• VI. They serve for kissing, the earnest penny of lust.

And although the benefits which doe redound unto us by the lips, being well affected, may be hindered by sundry meanes: yet I will touch onely but two sorts of solution of unity befalling to the lips, as proper to the subject which I have in hand, which are the chaps of the lips, and the ulcers of the same.

* 1.567 Fissura labiorum, or the chaps of the lips, proceed from a salt, sharp, & drying humor, which causeth these narrow, but

long small ulcers,* 1.568 which are hot and painfull, chiefly when the party speaketh, eateth, or laugheth.

These chaps,* 1.569 although they may without any great diffi∣culty be cured in persons of a laudable constitution, yet in cacochymicall bodies they will give you somewhat to doe: in so much that the Patient will wonder and fret, that such toyes and trifles cannot more speedily be cured; for so they terme such griefes, considering not the quality, but quanti∣ty of the griefe.

* 1.570For the curation of these, I will commend unto you two medicaments of my owne, which I familiarly use: The first is this: ℞ cer. flav. ℥ij. ol. ros. mell. & axung. porc. in aq. ros. lot. an. ʒiij. litharg. argenti, myrrhae, zinzib. pulv. an. ʒj. fiat linimentum s. a. First, moisten the part with the parties owne spittle, and then anoint the part affected with the li∣niment: it is effectuall, not onely in chaps of the lips, but in other chinks of Fissurae in what part of the body soever they be; and it cureth speedily.

The second is a Pomatum, the description wherof is this: ℞ Pomae numero 3. quibus infige cariophyll. ℥ss. styrat. cala∣mit. ʒiij. benzoini ʒij. labdan. ʒiss. calam. aromat. cinamom. an. ʒj. axung. porc. lib. ij. aq. lavendul. & ros. an. ℥iiij. Moschi, civetae an. gr. iss. Indantur ista vasi terreo satis am∣plo, ac calore B. N. evaporentur aquae, & colatur pomatum, quod in vase puro servetur. You may conjecture the efficacie of this medicament by the ingredients.

* 1.571As for the ulcers of the lips, they are either milde, or ma∣ligne.

* 1.572As for the milde ulcers, this ointment described by R••••o∣daus, Antidot. lib. 5. sect. 1. cap. 11. which he calleth Vn∣guentum de minio, or Vnguentum rubrum caphuratum, is ve∣ry effectuall: compos. haec est: ℞ minii triti ℥iij. lithar. argent. ℥ij. cerussae ℥iss. tut. ʒiij. caphur. ʒij. ol. ros. lib. j. cer. albi, ℥iij. fia••ung. ut ••rsprascribit. This unguent is effectuall a∣gainst even old and inveterate ulcers, in what part soever of the body they be.

* 1.573If you perceive an ulcer of the lip to be maligne or can∣cerous, which you may conjecture if the colour be livid, or blackish, if the brims be hard, if the heat and paine exceed the quantity of the ulcer, and if it yeeld a sanious and ill smelling quittor; then are you to looke about, and to espy which are the most powerfull medicaments.

When I discoursed of a Cancer, a Nome, and a Phagedae∣nicall ulcer, I delivered unto you choise of locall medica∣ments: for such ulcers, if they happen to invade the lips, at this time I will onely deliver unto you a description of a di∣stilled water, and of a magistrall unguent.

The water is thus to be made: ℞ fol. plantag. solani hor∣tens. veronic. sempervivi major. & minor. an. man. iij. albu∣mina ovorum conquassata num••ro xij. alumin. contus. lib. ss. caphur. ʒiss. Extuletur aq. calore balnei: fomentetur cancr••∣su••••, aut malignum••lc•••• hac aqua, quae & facici ruborem tol∣lit. The description of the unguent is this: ℞ plumbi ʒiij. fundatur in crucibulo, eique addatur Mercur. ʒiss. postquam refrixit man. in pulverem vertatur massa, cui adde unguenti de tutia ʒvj. terebinthin. ʒij. terebinthin. ʒj. ol. myrtil. ʒiss. fiat unguen∣tum quod ulceri post fotū applicetur. Deligetur ulcus singulis diebus quoties opus est. If you find the ulcer to be rebellious, and not to yeeld to these very convenient and effectuall meanes, then are you to apply such medicaments as I have set downe for the curation of Nome, Phagedaena, and Can∣cer, when I discoursed of them, whither I remit you, to shun tedious and fruitlesse repetition.

* 1.574To the ulcers of the lips, the ulcers of the Palatum, the roofe of the mouth must be annexed: It is rawted, that the aire being repercussed, the voyce should be the sharper: it is wrinkled and rough where it covereth the bone,* 1.575 that it might the more firmely cleave to it, and the better stay the meat whilest it is in chewing.

* 1.576Now seeing all the internall parts of the month are in∣ducd with the sense of tasting, but chiefly the membrane

which covereth the tongue,* 1.577 and have the exquisite sense of feeling, by reason of the nervous fibres, whereof they have great store, you are to have a care that your locall ap∣plications be not distastfull and loathsome, seeing the parts will abhorre them. If then the wrinkled skin, which cove∣reth the Os palati, be ulcerate: first, touch it with Aqua Fallopii, allaied with Plantane-water, if it be foule; or with this: ℞ aq. plantag. card. bonedict. & spermat. ranar. an. ℥iij. melius ros. ℥ij. ol. sulphur. aut vitriol. ℈j. Misc. Having touched the ulcer with either of these waters war∣med sufficiently, apply this medicament: ℞ syrup. è ros. rub. siccat. è baccis myrts, & de succo granatorum an. ℥j. ol. vitriol. ℈ss. Misc. Seeing the part is moist, and will not admit any deligation, you are to dresse it the more often. If you perceive the Os palati to be bare, then mingle some of this powder following, mingled with these syrups: ℞ far. hord. rad. irid symphyti, tormentill. an. ℥ss. mastiches, boracis, sarco∣coll. an. ℥ss. fiat ex omnib us pulvis. If the rough skin unite, as I have often seene, then have you obtained your desire.

* 1.578If a small peece of the Os palati fall out, using these incar∣native using these incar∣native meanes, and keeping the brims of the ulcer raw, you may bring them together; but if a large peece of the bone come away, there is no hope of unition. In this case, you are to cause the party to weare a plate of silver to supply the defect of the bone, that his speech bewray not the losse of it.

The third internall part of the mouth, which useth to be ulcerate,* 1.579 is the tongue. The tongues of Angels are not able to expresse what benefits doe redound unto man by the right ordering of the tongue, and what harmes and incon∣veniences againe, when we give it free reines to lash out. The frequent exhortations set downe in the holy Scripture to the first, and dehortations from the second, may make us wary in our discourses & conferences. It is that part of the body by the which God is chiefly glorified; by it we praise

and magnifie him, as godlesse persons blaspheme him with it we confesse our sins, by the which we provoked him to anger; and againe, we powre out our prayers with the tongue to obtaine remission for them.

* 1.580The tongue affordeth foure benefits to the body. I. It is the instrument of tasting, by the benefit of the membrane wherewith it is covered.

II. It uttereth the speech, by the which we communi∣cate our wants to others, and implore aid in time of di∣stresse.

III. It helpeth chewing, by gathering of the meat toge∣ther, and tossing it to and fro, it turneth also the meat downe to the stomack.

IV. It serveth for licking. To omit that in our infancie we could not suck without it: so we see, that if the fraenum of it come too neere to the tip of it, the sucking is hindred, and it must be cut. The children who have this infirmity, are said to be tongue tied. The flesh of it is spungeous,* 1.581 that it might receive the qualities of the sapors, and the more accurately judge of them.

If the sores of this part be but ordinary and milde, this medicament will serve if it be often washed with it: ℞ hord. mundat. ℥iij. rad alth. ℥ij. liquirit. ℥iss. Bulliant ista in lib. vj. aq. font. ad mediat ac coletur decoctum, cui admisce syrup. viol. tussil••g. & scabiosae an ℥jss. ac serva in mundo vase ad usum.

* 1.582It falleth out sometimes, that sores in this member prove maligne and very fretting, causing one of those ulcers which are called, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 as it happened to the late Lord Mayor of London, Ralph Freeman. Hee lacked neither Physitians nor Physicke, yet old age, weaknesse, and the malignitie of the sore hindred the procuring of his health, which his Physitians and Chirurgeans aimed at and wished for. The ulcer was so corrosive, that it fretted asunder the veines and arteries of the tongue, on that side

which it possessed, and caused a great flux of blood, which exceedingly weakned him, for that present causing a strong syncope, so that afterward nature could not recol∣lect her selfe. When such griefes befall great personages, their case is worse than that of the poorest in the like infir∣mities, because Physitians and Chirurgians are not per∣mitted to use the like libertie in the application of medica∣ments to the one, as to the other. If the like case fall out hereafter at any time, I advise you so to use medicaments borrowed of the vegetables, as that you contemne not the minerals: What hurt I pray you can come from the use of Merc. dulcis, and Merc. praecipitat with gold: None I assure you: for these medicaments are familiar to nature, and are true balsams for maligne sores.

[Quest.] But you may aske what was the reason that these medi∣caments were not used?

[Answer.] I answer, because there was no mention made of these medicaments at the first, and it was too late to minister them at the last, nature being surprised; for this only would have made the medicaments odious, and the Physitian, (who should have advised this course) obnoxious to calum∣nie and reproach.

* 1.583Now time admonisheth mee to come to the ulcers of the Uvula, or gargarion.

* 1.584If they be milde and ordinarie, the former medicaments set downe for the curation of the tongue will suffice.

* 1.585But if it be a fretting ulcer, first you are to admonish the patient of some accidents, which may ensue: and those are two in number.

The first is,* 1.586 that if the Uvula bee wholly fretted away, the party shall hardly be able to speak clearely and distinct∣ly. Howbeit both Bauhinus in his Theatr. anatomicum, and Guillelmus Fabricius Hildanus cent. 2. observ. 21. doe affirme that in some they observed it to have beene lost, not leaving any defect in their speech.

The second accident is, the danger of pthisis, or cough of the lungs, for this is to be feared, seeing the member which did hinder the roushing in of the cold ayre into the lungs, and put back from the breast humors distilling from the head, is wholly taken away. Having acquainted the pa∣tient with prognosticks, proceed to the curation.

* 1.587This is performed either by the application of conveni∣ent medicaments, or else by cutting it away.

* 1.588As for the medicaments, use first this gargarisme: ℞ fol. plantag. veronic. et sigill. Salom. an. man. 1. scord. orig. centaur. minor. an. man. ss. Bulliant ista in lib. 2. aq. font. ad consumpt. lib. 1. & coletur decoctam, in quo dissolve oxymellis simplicis ℥iij. Then touch the sore morning and evening with this liniment: ℞ ung. Aegypt. ℥ss. alum. pulv. ʒss. mell. ros. ℥ss. Misc. applicetur mane & vesperi.

If it proceed from a veneriall cause, use this topick twice a day: ℞ aq. card. benedict. & plantag. an. ℥ vi. aq. fort. ʒi. Misc. you may also use the blue water, which you may buy for three-pence a pinte after the silver is separate, after so∣lution, and hath no other mettall in it, but a little of Ʋenus. If these meanes will not prevaile, then you must wholly cut it away.

But according to Valescus de Taranta,* 1.589 you must ob∣serve these five things before you goe about this operation.

• 1. You must purge the bodie well.
• 2. No humor must be in flowing to the part.
• 3. You must not attempt this operation as long as there is hope that other medicaments will prevaile.
• 4. Goe not about this operation, unlesse it bee small a∣bout the root, for if it be thick, and red, or blue, such a flux of blood may ensue, as will strangle the partie, and cause fainting.
• 5. Marke how much of a necessitie must be cut off, for a little remaining will both further the speech, and repell the cold ayre from the lungs. If after the cutting of it off, a

• flux of blood ensue, either apply astring or else cauterize it with the Uvula spoone made hot.

* 1.590If the Tonsillae or almonds be ulcerate by reason of the influxion of sharp humors, which your eyes can discerne, the tongue being pressed downe by your spathula, carry in mind these prognosticks.

* 1.591I. If the ulcers be without a fever, they are the more safe.

II. If these ulcers happen in the summer, they sooner spred.

III. If these almonds become scirrhous they are hardly or never cured.

IV. These ulcers as all other ulcers of the mouth, require stronger desiccatives than the ulcers of the externall parts; First, to hinder them from spreading. Secondly, because they are still kept moist with the spittle.

For the curation of these ulcers, I will deliver unto you two locall medicaments: The first is the decoction of the root of the devils bit to be used in steed of a gargarisme. The second is a liniment to bee applyed after gargarization tryed by Seanertus, and set downe medicin. pract. li. 2. c. 22. ℞ centaur. minor. rad. irid. stercor. canini. an ℥ cum melle de∣spumato fiat electuarium. As for the facultie of a white dogs turd read Galen. li. 10. de simpl. med. facult, c. de sterc••re canino.

* 1.592If the throat beyond the Uvula be ulcerated, use this wa∣ter instead of a gargarisme as a certaine experiment. ℞ aq. plantag. li. 1. ros. rub. flor. arantior. an. ℥ j. pulv. Mer. subli. ʒij. digerantur in arena per horā quadrantem ac coletur aqua,* 1.593 quae in vase vitreo servetur ad usam. If by reason of these ulcers the partie cannot swallow any solid meat, minister to the patient mercurius duleis for foure mornings together, and you shall perceive a wonderfull effect. Give it in new milke.

Lect. XXVIII. Of the ulcers of the lungs.

SEeing the lungs very often become ulcerate, a solution of unitie in the substance of them, or an apertion of the vessels of them which are the branches of vena arteri∣osa, and arteria venosa, being caused by a wound: I must not let such ulcers to slip untouched.

* 1.594The causes of ulcers of the lungs after a wound inflicted may be assigned two: to wit, a solution of unitie in the sub∣stance, and vessels of the lungs, and the effusion of blood into the h••llownesse of the breast, you shall discerne the lungs to be wounded,

* 1.595I. First, if frothie blood issue out of the wound, and mouth by coughing, which shew some of the vessels to bee wounded, and opened.

II. Secondly, difficultie of breathing troubleth the party wounded.

III. Thirdly, the paine of the sides is grievous, which he felt not before.

IV. Fourthly, it is more easie for the patient to lie upon the wounded, than the whole side: So that often hee can speak readily so lying, but being turned upon his sound side. he can but with paine and difficultie speake.

* 1.596You shall perceive and gather blood to have beene pou∣red out into the capacitie of the breast by these signes.

I. First, if a heavie weight seeme to presse downe the midriffe.

II. Secondly if the partie breath with great difficultie.

III. Thirdly, if the fever increase.

IV. Fourthly, if the wounded partie void blood at the mouth.

V. Fifthly, if the breath of the partie stinke after a while, for that betokeneth the blood to bee turned into quittour.

VI. Sixtly, the wounded person can onely lie upon the back.

VII. Seventhly, the partie hath a desire to vomit, and striveth to rise, from whence ensueth fainting; for noy∣some vapours arising from the clotted blood turned into quittour assault the heart, and weaken it exceedingly, and dissolve the facultie of the stomack.

* 1.597After that the wound is inflicted, and that you have dres∣sed it so long a time as you have required in former times for healing of a penetrating wound of the breast, (which will be shorter in the summer, than in the winter: for heat helpeth digestion) you may feare than a fistula at the least, or a putrid ulcer of the lungs will ensue: chiefly if a thinne sanies, and not a laudable quittour doe flow out, farre in quantitie exceeding the bignesse of the wound.

* 1.598Why in wounds of the lungs, so much quittour every day is sent out these are the causes.

I. The vicinitie and neerenesse of the heart, which be∣ing the welspring of the vitall blood, [ I] doth send too much of it to the part affected: And when as it cannot make use of all of it by reason of weaknesse, it turning the remainder by its naturall heat into quittour, dischargeth it by the ori∣fice of the wound.

[ II] II. Because the sound parts send unto the diseased blood and spirits without meane or measure.

[ III] III. Because the lungs draw more nourishment to themselves by their motion, heat, and paine, than they are able to digest.

[ IV] IV. Because the ulcer like a devouring wolfe by its ma∣lignitie and filth, presently corrupteth the blood sent for nourishment unto the lungs, turning the greatest part into quittour, and defrauding the part affected of mainte∣nance: from whence ensueth the extenuation of the whole bodie.

* 1.599Now that you may the better foresee and foretell to the patients the events of such ulcers, I would have you to mark these prognosticks which I shall deliver unto you.

1. All ulcers of the lungs are hardly, or with great diffi∣cultie cured, and that for foure causes.

1. Because the musculs of the breast, lungs and heart, are in perpetuall motion: now motion hindereth consolidati∣on, as all by experience know.

2. Because the lungs are onely environed by the Pleura, the skin inwardly investing the ribs, which is endued but by small store of blood, and being a spermatick part, to wit, a membrane, is not easily united; and that onely by the second intention.

3. Because locall meanes cannot be kept to these ulcers, by rowling, bowlstering, and emplastering, as they may to the ulcers of the externall parts.

4. Because the orifice of the ulcer is not most commonly in a depending part; but either parallel, or higher than the ulcer. How hard a matter it is for quittour to ascend, I leave it to your consideration.

5. If the partie pine not away, if hee expectorate easily, if he fleepe reasonable well, if he digest his meat, if his stools be orderly, if the quittour bee indifferent good, you may conceive some hope of the cure.

6. But if the diseased parties breath smell ill, if he con∣sume, if the quittour which floweth from the ulcer stink, if he hath a grievous cough, and difficultie of breathing, if a lingring putrid fever troubling him chiefly toward night, and hindering his sleep, follow him, if his appetite decay, and the concoction of the aliments be empaired; if a rotten peece of the liver, or of the branches of the wind be throwen out at the mouth, if he have a whistling voice as if he spake thorow a cane, his case is desperate.

7. If his haire fall, which happeneth by reason of the want, and corruption of the nourishment: if the nailes

grow crooked, the flesh of the tops of the fingers being spent, if the cheekes grow to bee of a leady colour; but when after meat they seem ruddy, vapours mounting thi∣ther, if the feet begin to swell, the naturall heat being spent, if lice multiply by reason of the corruption of the hu∣mours, you may pronounce, that a diarrhea or humorall flux ensuing, the party shall depart.

VIII. Although some have lived many yeeres who have had an ulcer of the lungs,* 1.600 as Avicen reporteth, that he saw a woman who lived twenty three yeeres, or thereabout, with an ulcer of the lungs. And as Matth. de Gradil. in 9. Rhas. c. 54. affirmeth, that he saw a woman who still was busied about the fire, who lived twenty eight yeeres; yet bee not you too forward to take in hand such persons as have ulcerate lungs: for the curation is uncertaine, and that for foure causes.

* 1.601I. By reason of symptomes which ensue, as are a lingring fever, and consumption of the body.

II. Because the quittour which is contained in the spongious substance of the lungs, cannot be voyded by ex∣pectoration without coughing; which doth much trouble the lungs, and exasperate the griefe.

III. Because the medicaments which are ministred to cure these ulcers, cannot come to the lungs in their full force.

IV. Because the fever and consumption of the body re∣quire those things which are moystning, but the ulcer those things which mundifie, and dry.

If it chance that by Art and good luck you cure an ulcer of the lungs, charge the party that hee walk circumspectly in the course of the residue of his life; for many times when the ulcer hath seemed to have been cured, yet the cicatrix being removed by the ill carriage of the patient, the ulcer hath gotten footing, and been the cause of un∣timely death, as Galen witnesseth, 4. de loc. affect. c. 5.

* 1.602When you go about to cure such ulcers, you are to pro∣pose three indications curative to your selve.

The first is, the appointing of a convenient diet.

The second is, the ministring of fit pectorall decocti∣ons.

The third is, the artificiall dressing of the ulcer.

* 1.603As for the diet: the party having an ulcer of the lungs, must eat meat of an easie concoction, because nature is much weakned; of good juyce, lest putrifaction bee encreased; and lastly, of much nourishment, because the body in this griefe is most commonly much extenuate: only I will briefly touch some kindes of food which are endued with these qualities.

The first that offereth it selfe is Milk,* 1.604 for it nourisheth the body, it affordeth matter to blood, it correcteth the a∣crimony of corrupt humors; with the wheyiest part it mun∣difieth the ulcer, with the cruddy part it consolidateth, and with the buttery part it moystneth, and stayeth the desicca∣tion of the body. Womans milk is most familiar: By the sucking of a womans breast I saw a Welch Gentlewoman called Mrs. Price, recovered of a P••hisis, who could not turne her selfe in her bed, by reason of weaknesse, and could not take any other food. Asses milk is thinner and more wheyish, and so more apt to mundifie. Goats and Cowes milk obtain a meane between these two.

But lest it corrupt in the stomack, you are to dissolve some sugar or hony in it.

You are to minister it only when the stomack is empty, and no other meat is to bee taken before it bee digested; o∣therwise it will crud, become sowre, and be corrupted.

So much of it is to be given, as the stomack of the party can well digest: wherefore first prescribe the lesser quantity, and ascend to a greater.

Abstaine from appointing of it, If the party be feverish, have the headach, and be troubled with flatuosity.

* 1.605Snailes and Crabbes are much commended in this griefe; neverthelesse, seeing they are of a thick, terrestriall, and sli∣my substance, and afford a corrupt and excrementitious juyce, it may be doubted whether they be good or no: to omit that they are of hard digestion; the broth of them boyled in milk, and sweetned with sugar, and mingled with other brothes, may be good; for so the nourishment will be the more solid.

* 1.606As for pectorall decoctions, I will not trouble you with any great variety of them; only I will set down a few; but the paucity shall be recompenced with the efficacy.

I. ℞ rad▪ enul. ℥ ij. scob. guaiacilb. ss hyssopi, marrhub. albi, an. man. ij. polypod. liquirit. an. ℥ i ss ficuum incisar. passul. major. exacinat. an. ℥ iij. Infundantur infundenda per noctem in aqu. font. fervent.lb xviij. deinde additis reliquis coq. ad consumpt.lb vi. ac coletur decoctum, quod clarificetur additis sacchari & mellis an. ℥ ij. croci ʒ i. atque iterum cole∣tur: utatur aeger hoc decocto loco consueti potus.

II. ℞ rad. chin. ℥ iiij. symphiti, tormentill. irid. an. ℥ i. capill. vener. tussilag. scabios. marrhub. albi. hyssopi, an. man. i. flor. viol. borag. buglos. an. pug. i. flor. herbae paralays. pug. ij. flor. alth. pug. i ss. caricar. ping. ℥ iij. liquirit. ℥ ij. semin. co∣riand. anis. an. ʒ vi. Infundantur ista ut superiora in pari quantitate aquae, ac decoq. ad consumpt.lb vi. ac coletur deco∣tium, quo utendum loco consueti potus.

Every morning the patient is to take halfe a pinte of ei∣ther of these decoctions warm, and to eat a lozenge of saccharum rosatum tabellatum, or two drammes of the con∣serve of red roses, being a twelve-moneth old.

* 1.607Now I am come to the artificiall dressing of ulcers of the breast.

The medicaments which are fittest for dressing, are In∣jections by a large syringe.

As for the simples whereof the injections are made,* 1.608 they must not bee of bitter things, as Wormwood, the lesser

Centory, or Carduusbenedictus; for as judicious and dili∣gent Ambros. Paraeus noteth, Chirurg. lib. 9. c. 31. these bitter things being injected, are first drawn in by the spon∣gious substance of the lungs, and from thence are sent by the trachea arteria, to the throat; where such a bitternesse is felt, that it causeth a desire to vomit; so that they rather hurt than profit.

These injections are either abstersive or consolidative.

* 1.609Of abstersive injections I will set down a few, as a pat∣tern, by the which you may make others.

I. ℞ marrub. alb. hyssopi, scabios. an. man. ss. c••qu. inlb iij. aqu. font. ad medietat. consumptionem, ac coletur de∣coctum; quod postea clarificetur addit. mell.lb ss. atque ite∣rum coletur.

II. ℞ aqu. hord.lb i. mellis ros. ℥ ij. sacchari rubri ℥ iij. Mise. bubiant 3 aut 4 ebullionibus ut injectio clarificetur, quae postea coletur.

If you perceive that the ulcer is sordid, and affordeth much matter, you may adde either of ungnentum Aegypti∣acum, or the oyle of Sulphur, or Vitrioll, so much as you shall finde fit to cleanse the ulcer.

When you perceive that the ulcer is sufficiently mundi∣fied; which you may gather, if laudable quittour flow,* 1.610 and in no great quantity; then hasten to consolidate the ulcer: I will in this case furnish you also with effectuall topicks, and but a few: the first shall be this:

℞ decoct. pectoral. ℥ iiij. syrupi è ros. rub. sicc. ℥ i ss. fiat injectio.* 1.611

II. ℞ hed. terrest. flor. & fol. symphit. sanicul. plantag. polygon. millefol. vinc. pervinc. Equiseti, hyper. eupat. beton. valerian. an. man. ij. limaces numero 40. cancros fluviatil. numero 10. Addita aqu. pluviali: instituatur distillatio in alembico, ut extilletur aqua. ℞ aqu. hujuslb ss. syrup. myr∣till. & è ros. rub. siccat. an. ℥ i. ss. syrupi granat. ℥ i. Misc. ut fiat injectio.

* 1.612These injections must bee warmed when they are to bee used. Into the orifice which is in the breast somewhat must be put to keep it open: this then is to be performed either by a tent, or a pipe made either of gold or silver.

The materials of the tents are three;* 1.613 lint, fine tow, and a sponge. Lint is altogether unapt, for it is apt to fall a∣sunder after that it is made up into a tent: if therefore a p••cce of it part and rest upon the diaphragma, it must pu∣trify there, and send noysome sents unto the heart, which cannot but bring faintings, and at the last shorten the life.

Good tow then is better than it, because it cleaveth fast together; but the spunge is best of all, because it doth not only cohere firmly, but draweth also strongly the quittour, and doth imbibe it.

It is good so to forme the tents, that the outer end being broader than the inner, it may bee stayed from slipping in: it is not amisse to halter them with thred for this same pur∣pose.

* 1.614A pipe is best of all; it must be of thicknesse proportio∣nate to the orifice, having two stayes to hinder the slipping in of it into the cavity of the breast; and sundry holes some∣what large about the end, to give way to the quittour. It must also be somewhat arched, lest the lungs butting against it, should suffer any hurt. The outer hollownesse of it is to be stopped with a sponge dipped in aqua vitae and wine min∣gled together, and warmed, and wrung. Above the tents and the pipe apply emplastrum de minio, or diachalcithes.

If the ulcer runne much, it must bee dressed twice a day; but if it runne little, once dressing will serve.

You may demand of me,* 1.615 when the tents and pipe are to be left?

I answer, when the ulcer yeeldeth but a small deale of quittour,* 1.616 and that good; and seemeth to bee almost dry: for siccum est sano proximum, that which is dry commeth

neere to that which is whole.

If you keepe the orifice of the breast too long open, it will fistulate.

* 1.617It falleth out many times, that in ulcers of the breast, the diseased person groweth leane. In this case you are to per∣mit the party to drink some Almond milk made of chicken broth, wherein have been boyled Pompion, Cucumber, and Muskmelon seeds, with Mallow roots, Cowslip flow∣ers, Succory flowers, and Marigold flowers, between meales, and in the night time after two a clock; or mini∣ster a dramme and a halfe of this powder which I will set down, every morning and evening, in six ounces of one of the pectorall decoctions, which I described in the begin∣ning of this Lecture.

The description of the powder is this: ℞ semin. papav. albi ʒ i ss. gu••••••••i tragac••••th. far. ••robi an. ʒ ij ss. semin. alth. portul. cucum. melon. pepon. pla••tag. hyoscyam. alb. an. ʒ iij. coral. rub. praparat. perla••. pr••parat. succini albi praeparat. an. ʒ i ss. liquirit. ʒ iiij. sacchari r••sat. tab••llat. ad pondus ••mnium: fiat pulvis.

If these courses being used faithfully, do not prevaile, acquaint the diseased parties friends with the dangerous estate wherein he is; for no other medicaments are like to prevaile.

Lect. XXIX. Of the ulers of the backe, the abdomen, and joynts.

NOw I am, according to my promise, to deliver the last Lecture appointed for this yeere, and withall to shut up this Treatise of Vlcers; that when I shall ascend to this place againe, I may begin to handle a new subject, which will bee of wounds. And although one might rest contented with that which hath been already delivered concerning ulcers; yet that none may justly say, that any thing absolutely necessary, hath been omitted, and to fur∣ther the practice of those which are not so well versed in the curing of all particular ulcers, I will briefly set down some notes concerning the ulcers of the back, the abdomen, or lower belly, and of the joynts.

* 1.618 Vlcera dorsi, or ulcers of the back, most commonly fall out after 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or cedematous phlegmons, wherein morbi acuti ex decidentia end.

Now that you may the better understand what I meane, I must digresse a little, and briefly shew you what diseases are termed morbi acuti, and how many kindes of them there are.

* 1.619 Morbi acuti, or sharp diseases, are properly called such as with great expedition, force, and danger, go on to their status and extremity of the symptomes, as may be gathered out of Galen 2. aphor. 19. & 23.

Now there be three kindes of these morbi acuti, or sharp diseases; for they are either peracuti, very sharp, or acuti simpliciter, simply sharp, or acuti ex decidentia, or sharp diseases ending into other griefes.

Peracuti end at the furthest the seventh day, and they are of two sorts, exquisitè peracuti or perperacuti, or exqui∣sitely very sharp, which end the fourth day, and non exquisi∣tè peracuti, which are not exquisitely very sharp, which continue till the seventh day.

Now the simpliciter acmi in like manner are of two kinds: for they are either exactly so, and end for the most part the fourteenth day, or not exactly so, which may conti∣nue till the twentieth day. You may, and (I make no doubt) doe see examples of these in burning and pestilentiall fevers almost every week. Last of all are acuti〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ex decedentia, which may bee prolonged to the fortieth day: Diseases which continue longer than fortie dayes are called morbi chronici, or di••ur••i, long or lingring diseases. Some of these chronicall diseases may end in sixtie, some in eigh∣tie, some in an hundred, some in two hundred dayes: some may continue a whole yeere, some seven yeeres, some twice seven yeeres.

I saw a Scottishman whose surname was Iohnson,* 1.620 a sadler by profession, who followed the Court in Queene Eliza∣beths reigne, who was troubled twelve yeeres with a quar∣tan ague without intermission: neither can I affirme that it left him during his life time.

I being in the Ile of Shepey in Minster street curing one Clover an aged man,* 1.621 whom I dismembred, there was a girle brought to mee, of seven yeares of age, which for the space of six yeeres was grievously tormented with an exquisite quartan. The lifes of these personages may be well termed living deaths. Some of these lingring diseases againe con∣tinue in boyes untill the fourteenth yeere of their age, and in maids untill their courses flow: as the falling sick∣nesse.

* 1.622Now to come to apostemes of the back, which leave ulcers after they are brought to suppuration and opened; They are for the most part criticall translations of humors,

sent in morbis acutis ex decidentia, sharp diseases which continue untill the fortieth day, or on chronicall diseases the continuance of which is uncertaine, sent from the inner either noble or ministeriall parts from within outward, the Physitians say this to be done, per diadosin: whereas if noxious humors be turned from without inward, as in pe∣stilentiall and veneriall buboes, they affirme this to be done per metastasin.

* 1.623Criticall ending of griefs, are either performed by ex∣cretion or translation of the griefe.

By excretion nature doth expell the peccant matter sun∣dry wayes, [ I] as by vomit, siege, sweating, bleeding at the nose, the flowing of the menstruous course, and the apertion of the hemorrhoidicall veines, as you may observe everie day in termination and ending of sharp fevers.

II. In translation, the peccant matter is not altogether discharged out of the bodie; [ II] but it sent from the part affe∣cted unto another part by provident nature.

But seeing the humor may be sent from the outward parts to the inward, and from the inner parts to the outward, this last translation is most secure; for if this first be done in maligne and contagious diseases, as in the Pox and Plague, all understanding practisers pronounce either death, or protraction of the cure.

When therefore these apostemes appeare either in the back, or one of the great joynts, which afterward degene∣rate into ulcers, the motion of the matter by nature is lau∣dable doing it by translation, seeing she cannot by excre∣tion, partly by reason of the weaknesse of the principall parts, or by the plenty, or hard concoction of the hu∣mor.

But this is the miserie, that the friends or kinsfolks of such a diseased person thinke him or her to bee altogether safe and secure, when they see them eased by the transla∣tion of the humor, and therefore to spare charges call not

for skilfull Physitians, and Chirurgeans, by whose skill and diligence the motion of nature might be furthered. And so it falleth out many times, partly by reason of the thicknesse of the skin, as in the back, or by reason of the thicknesse of the skin, & compactnesse of the membranes as in the joynts, that the vertebrae of the back are corrupted, & the cartil∣lage, and tendons of the joynts before remedie is sought for.

But that you may meet with these hide bound patients, and keepe your selves from incurring danger or discredit, marke these prognosticks which I will deliver unto you.

* 1.6241. If after inquisition you find that a tumor in the back continued a long time before it did break of it selfe, or was opened, suspect the ulcer to bee of hard curation: for it is likely that the vertebrae of the back are foule.

2. If the vertebrae bee foule, which you may easily find out, by your finger or probe, the case is desperate: wherefore take heed that you promise not curation.

3. If in ulcers of the back you see the parties body day by day to become more and more extenuate, advertise the parties friends of the danger: for it is an evident argument that the principall parts are weakned, and cannot wholly discharge the humor which offendeth.

* 1.6254. Ulcers in the upper part of the Spina dorsi are more easily cured, than those in the loynes: Because the abdomen or lower belly sendeth out more superfluities than the tho∣rax or the breast, which is the middle cavitie. Secondly, because they are neerer to the heart, the sunne of the lit∣tle world, who by his heat it able to consume much super∣fluous humiditie.

I think it will not bee unpleasant to you to heare mee confirme that which I have delivered unto you in my last prognostick,* 1.626 by true relation of the events which befell mee when I practised in Wales in the like griefes: seeing exam∣ples leave a deeper impression in the mind, than precepts, and leade best to the curation of externall griefes.

In Denbigh towne there was one Richard Pryce an Ha∣berdasher, sonne to Iohn Pryce, who kept the principall Inne of the towne, who after hee had beene troubled with a chronicall diseases, felt in his back a little below the shoul∣ders blades, a tumor still increasing in the outward parts, as he was eased in the inward, untill at the last it grew to the bignesse of a penny loafe. I having beene called unto it by opening of the Aposteme, & using methodicall indications, cured the Patient. This man (as I heare) having given over his trade, still keepeth the Inne which his father did.

In this same Towne about the same time, a lustie young man, whose sirname was Owin, whose father was a retainer to Sir Iohn Salisburie, had the like tumor in the Vertebrae of the loines, after a lingring griefe: I having been entrea∣ted by the truly worshipfull, Sir Iohn Salisburie, (who had not an ordinarie skill in the knowledge of the plants, and in performing chirurgicall cures) tooke a view of the young Gentle-man. After mature deliberation, I told Sir Iohn and the young mans friends, that there was much quittor in the tumor, which must be discharged; and that the event of the curation would be uncertaine, if the matter were let out, for the reasons above specified. At the entreatie of Sir Iohn Salisburie & the young mans parents & friends, I ope∣ned the Aposteme which was in the Vertebrae of the loines: And although no meanes were omitted, which seemed unto us effectuall, for the recoverie of the young mans health, and that the Vertebrae of the loines were not foule; yet hee fell into a Marasmus, or extenuation of the body, being other∣wayes a proper and valiant young Gentle-man; and so en∣ded his life before age called for his dissolution, to the great griefe of his parents, having no other sonne but him, and the commiseration of the worthy Knight. I have delivered unto you my observations in this griefe, whereof I hope you will make good use: you having occcasion ministred to be warie, by the examples of others, which is no meane benefit.

* 1.627How I performed the curation of the first Patients, now I will declare unto you: First, I purged his body with a gen∣tle medicament: It was this; ℞ Electuar. lenitiv. ʒiiij. E∣lectuar. de succo ros. ʒij. Syrup. ros. solutivi cum Agarico ℥j. aq. Cichor. ℥iij. Misc. ut fiat p••tio. Secondly, I applyed the Lapis infernalis to the depending part of the tumor: Thirdly, I opened the Aposteme, making but a small orifice thorow the eschar. Fourthly, everie day I dressed the sore, still suffering a little of the quittor to flow out, untill all was discharged. Fifthly, I used a mundifying injection, un∣till I perceived the sore to bee cleane, not stinking, and to afford both laudable, and small store of laudable quittor. Sixthly, I used a consolidative injection, and boulsters somewhat thick, to compresse the sore.

* 1.628The mundifying injection was this: ℞ Vini albilb. j. mel∣lis rosati ℥iij. Ʋngi••en••. Aegyptiaci ℥ ss. ••isc. ut fiat inje∣cti•• usurpand•• calid••. The consolidative injection was this: ℞ aq. Plantag. ℥iiij. Syrupi ••yr••i••i & è ros. rub. sie∣cat. a••. ℥ ss. Trachisc. albor. Rhos. sine ••pio ʒij. Misc. ut fiat injectio applicanda item calida: All such injections must be warmed; for cold, as Hippocrates witnesseth, is hurtfull to the Spinalis medulla. The Emplaster which I used was Diachylon cum gummis. By these meanes I cured the partie in three weekes space.

* 1.629Now the ulcers of the Abdomen, or of the lower belly, doe offer themselves onely to bee but compendiously tou∣ched. Seeing there are three parts of it, Regio epigastrica, ••••••ilicalis, and hypogastrica, the upper, the umbilicall, and lower region: I am to shew unto you what parts in these regions most commonly suffer ulceration.

* 1.630I saw the stomack of one Mistresse F••r••e, together with the muscules perforate by the erosion of a sharp humor, in the Howlt, a towne distant from Chester five miles: the meat, drinke, and chylus came thorow the perforation: the ulcer also smelled strongly. I being unwilling to deale with

her, prescribed some locall meanes, which wrought but small effect; for she died of a Marasmus, or extenuation of the body, within a short time: the ulcer hindering the chy∣lification of the aliment, and so defrauding the body of nourishment. My opinion was then, and now is, that ul∣cers penetrating into the cavitie of the stomack are mortall, although wounds of this kinde bee sometimes cured: for in the second there is but a bare solution of continuitie; but in the former there is a solution of continuitie, having an∣nexed to it the sharpnes & malignitie of the matter. Here in London,* 1.631 in the Inne a little above Fleet-conduit, one Richard, who wa Tapster of the Inne, had for a long time a great paine in the right side of the epigastricall region of the Abdomen: in progresse of time there appeared a great hard tumor, causing a sharp fever: at last the Phlegmon brea∣king of it selfe, sent out great store of quittor. I then being lodged within the signe of the Naked Boy, a little below the Conduit, and being of his familiar acquaintance, was sent for, finding him in a strong fever, and having difficultie of breathing, the tumor of the liver hindring the free mo∣tion of the Septum transversum, the instrument of naturall respiration, I pronounced his griefe to be mortall, and so it fell out: for although no rationall meanes were omitted, fit to have recovered the partie, if the griefe had beene cu∣rable, yet the partie died. It were but a fruitlesse labour to set downe the medicaments which were used, seeing they prevailed not.

This historie I thought good to set downe, that you may imagine what the event is like to be, if you be called to the like griefe.

* 1.632If falleth out sometime, that superfluous flesh groweth above the navell, if it be slackly bound, and be left some∣what long, which doth become ulcerate: This I saw once in Tavestock, a towne in the West Countrey, in Devon∣shire, in a childe of Master Moones, a Draper of that towne.

I having beene called to the cure, first bound off the navell by a strong ligature, afterwards I cured it by the application of Vnguentum de cerussa.

* 1.633In the groine after a Phlemone of it opened, oftentimes an ulcer is left penetrating thorow the oblique and trans∣vers muscules of the Abdomen: If you perceive such an ulcer, pronounce it to be not of easie curation, chiefly if it fall out to be after a venereall Bubo: For first, there is mor∣bus cum causa, a griefe having the cause annexed: Secondly, it corrupteth the Fibres of the muscules: Thirdly, it cor∣rupteth sometimes the Vertebrae of the loines, in which case all medicaments are fruitlesse, because the griefe is mortall: This happened to a young woman,* 1.634 who dwelt with the Lady Lucie, whom Master Napkin dressed, and opened after her death. Both M. Doctor Gifford and I were called to view the sore sundrie times; and although means were used for her recoverie, yet they did not prevaile; so that shee died of a Marasmus, the body becomming ex∣tremely extenuate; although she seemed to bee of a firme and thick habit of body, when the tumor first appeared. If any such tumors come to your hands, after they are brought to maturation, use the generall meanes prescribed for the curation of Lues venerea, lest the like event happen to you.

* 1.635I will touch briefly the curation of ulcers of the joynts, which differeth but verie little from the curation of ulcers in other parts, saving that they require medicaments of more desiccation without any sharpnesse, and more power∣full anodine cataplasmes for asswaging of paine; which is an inseparable accident of ulcers, seizing upon these parts.

* 1.636Apply then to the sore Desiccativum rubeum, and anoynt the brims with this liniment: ℞ Ʋnguent. popul. & albi Caphuratian. ℥j. Ol. Cydonit. & Papaverin. an. ℥ ss. Misc. ac fiat liniment. ex arte. Before you apply your medica∣ments,

foment the part with a fomentation made of Su∣mach, Pomegranate pils and flowers, red Roses dryed, and Myrtle-berries infused in astringent red wine, being put in∣to a long and narrow galley pot, and set in a warm place, or in a posnet having in it boyling water.

In curing of these ulcers often purging is required, to stay the flowing of sharp humors; but seeing everie purga∣tive medicament is not of like efficacie, I will set downe one as a patterne, after the which you may frame others: ℞ Caricostin. & Elect. de succo ros. an. ʒiij. Syrup. ros. solut. cum Agaric. ℥j. aq. Cichor. ℥iij. Misc. ut fiat potio: You may either detract from the quantitie of the purging Ele∣ctuaries, or adde to them what you shall think fit, after you have diligently considered the strength of the partie: with this I will end the Lectures for this present, and finish the Tractation of Ulcers. When God shall permit mee to ascend againe into this seat, I will begin the Lectures of wounds.

FINIS.

Notes

• * 1.1

  The differen∣ces of the solu∣tion of unity.
• * 1.2

  Quest.
• * 1.3

  Answ.
• * 1.4

  The scope.
• * 1.5

  Point.
• * 1.6

  Quest.
• * 1.7

  Answ.
• * 1.8

  Point.
• * 1.9

  De caus morb. cap. ult.
• * 1.10

  The descrip∣tion.
• * 1.11

  Point.
• * 1.12

  Or lastly the distemperature of the part it selfe.
• * 1.13

  The opinion of dogmaticall Physicians concerning hu∣mors.
• * 1.14

  The opinion of Chymists.
• * 1.15

  That the ordi∣nary humors of the body are causes of disea∣ses.
• * 1.16

  What a Humor is.
• * 1.17

  The first quali∣ties are not the only causes of diseases.
• * 1.18

  Minerals are in the body of man.
• * 1.19

  The ordinary humors are not the causes of all diseases.
• * 1.20

  Of the super∣fluous melan∣choly Humor.
• * 1.21

  That the spleene draw∣eth superfluous melancholy.
• * 1.22

  The qualities of the waterish Humor of the spleene.
• * 1.23

  Object.
• * 1.24

  Answ.
• * 1.25

  IV. Point.
• * 1.26

  Differences of uncers.
• * 1.27

  I. From their na∣ture
• * 1.28

  Differences of a compound ulcer.
• * 1.29

  II. From the parts
• * 1.30

  V. The signes of ulcers.
• * 1.31

  Signes of the lungs ulcerated
• * 1.32

  Riolan. Chiru••. sect. 2.
• * 1.33

  The causes conjunct of wounds and ulcers.
• * 1.34

  Object.
• * 1.35

  Sol.
• * 1.36

  VI. Point.
• * 1.37

  The presages.
• * 1.38

  Signes of a corrupt bone.
• * 1.39

  Foure times of ulcers.
• * 1.40

  The qualities of laudable qu••ttour.
• * 1.41

  The meanes of curing of ul∣cers.
• * 1.42

  Causes antece∣dent.
• * 1.43

  The cause con∣junct.
• * 1.44

  The use of sup∣purative me∣dicaments.
• * 1.45

  In what ulcers Digestives are unfit.
• * 1.46

  The uses of re∣pelling medi∣cines.
• * 1.47

  The mixtion of medicaments when profita∣ble.
• * 1.48

  Mundificatives
• * 1.49

  How fluxion is stayed Revulsion.
• * 1.50

  How revulsion is to be procu∣red.
• * 1.51

  Repulsion.
• * 1.52

  Defensives.
• * 1.53

  To know good medicaments.
• * 1.54

  Albucasis.
• * 1.55

  Things which make ulcers long in curing.
• * 1.56

  Quest.
• * 1.57

  Answ.
• * 1.58

  Conditions to be observed in applying of Desiccatives.
• * 1.59

  What a Cica∣trix is.
• * 1.60

  The qualities of Epuloticall medicaments
• * 1.61

  The differen∣ces of epuloti∣call medica∣ments.
• * 1.62

  Galen. lib. 3. meth. c. 3.
• * 1.63

  Indications of curing an hol∣low ulcer.
• * 1.64

  Secundum. Gal. comm. ult lib. Prognost. 10.
• * 1.65

  Excrements in ulcers.
• * 1.66

  After Mundisi∣cation, Incar∣nation
• * 1.67

  Two causes of the sleshingen 〈◊〉〈◊〉.
• * 1.68

  The Indicati∣ons of curing a simple ulcer.
• * 1.69

  Diet.
• * 1.70

  Quietnesse.
• * 1.71

  Prognosticks.
• * 1.72

  Digesting, Mundifying, Incarnating.
• * 1.73

  Cicatrization.
• * 1.74

  How the Cica∣trix is procu∣red.
• * 1.75

  Epuloticall medicaments.
• * 1.76

  What a com∣pound ulcer is.
• * 1.77

  The differen∣ces of com∣pound ulcers.
• * 1.78

  Diseases com∣plicate with ulcers.
• * 1.79

  Authors to bee followed in cu∣ring the French-pox.
• * 1.80

  Of the causes annexed.
• * 1.81

  How causes in flowing are to be met withall.
• * 1.82

  How humours flowing are re∣moved. Gal. 4. me∣thod. 2.
• * 1.83

  Galen. 2. de dif∣fer. feb. 11. & 12. method. 3, 4, 5.
• * 1.84

  Gal. 4. meth. 2. & 13. meth. 13.
• * 1.85

  The distempe∣rature of the part.
• * 1.86

  An observa∣tion.
• * 1.87

  Quest.
• * 1.88

  Answ.
• * 1.89

  The curation of a moyst di∣stemperature.
• * 1.90

  The curation of n hot di∣stemperature.
• * 1.91

  The curation of a cold di∣stemperature.
• * 1.92

  Of an ulcer witlrasymp∣rome.
• * 1.93

  Of paine.
• * 1.94

  How it is cea∣sed.
• * 1.95

  Narcoticall medicaments.
• * 1.96

  Indications of ••uring a plaine compound ulcer.
• * 1.97

  A sinewous ulcer. Sinus.
• * 1.98

  The causes of it.
• * 1.99

  Their figures.
• * 1.100

  The differen∣ces of sinuous ulcers.
• * 1.101

  The manner of curing caver∣nous ulcers without ope∣ning.
• * 1.102

  Locall medica∣ments.
• * 1.103

  The manner of dressing.
• * 1.104

  Signes of ag∣glutination.
• * 1.105

  Why such an ulcer is not to bee dressed often.
• * 1.106

  The manner of curing of these ulcers by ope∣ning.
• * 1.107

  In what cases you are to use these meanes.
• * 1.108

  When the ul∣cer is to bee opened onely in the depen∣ding part.
• * 1.109

  When the cau∣stick is to bee used.
• * 1.110

  The manner of applying cau∣sticks.
• * 1.111

  when Incision is to be used.
• * 1.112

  Internall medi∣caments.
• * 1.113

  The definition.
• * 1.114

  The cause materiall.
• * 1.115

  The signes.
• * 1.116

  The differen∣ces.
• * 1.117

  The signes of the differen∣ces.
• * 1.118

  An H••storie.
• * 1.119

  Indications of curing.
• * 1.120

  Two kindes of curation.
• * 1.121

  The meanes to cure Fistula's.
• * 1.122

  Dieteticall meanes.
• * 1.123

  Pharmaceuti∣call meanes.
• * 1.124

  Purgatives.
• * 1.125

  1. Consolida∣tives.
• * 1.126

  2. Compound consolidatives.
• * 1.127

  Chirurgicall meanes to cure a Fistula.
• * 1.128

  How to dilate a Fistula.
• * 1.129

  Incision when it is to be used.
• * 1.130

  The use of the spunge.
• * 1.131

  The second Chirurgicall attention.
• * 1.132

  The matteriall cause of a Cal∣lus.
• * 1.133

  Why the ori∣fice first con∣tracteth a Cal∣lus.
• * 1.134

  To know wher the passage hath also a Callus.
• * 1.135

  How the callo∣sity is to be re∣moved by me∣dicaments.
• * 1.136

  3. Intention.
• * 1.137

  4. Intention.
• * 1.138

  The descripti∣on of the con∣solidative Sy∣rup.
• * 1.139

  The use of it.
• * 1.140

  5. Intention.
• * 1.141

  Because it doth happen in the place from whence teares flow.
• * 1.142

  The signes.
• * 1.143

  The Progno. sticks.
• * 1.144

  The diversities of these Fistu∣la's.
• * 1.145

  The curation.
• * 1.146

  The manner of dilatation.
• * 1.147

  Observation.
• * 1.148

  Why solid me∣dicaments are better than liquid.
• * 1.149

  Mundification.
• * 1.150

  Consolidation.
• * 1.151

  Cicatrization. How an Aegi∣lops, with cari∣ositie of the bone, is to be cured.
• * 1.152

  My manner of curing Aegi∣logs.
• * 1.153

  When the bone of the nose is to be pierced.
• * 1.154

  How it happe∣neth.
• * 1.155

  The differen∣ces.
• * 1.156

  The Progno∣sticks.
• * 1.157

  2. Prognostick.
• * 1.158

  The curation.
• * 1.159

  The diet.
• * 1.160

  Pectorall de∣coctions.
• * 1.161

  The Simples of them.
• * 1.162

  My owne.
• * 1.163

  The reason of the quantity of the decoction to be taken.
• * 1.164

  Things which hinder the cure
• * 1.165

  The manner of incision.
• * 1.166

  The region of the brest fittest 〈◊〉〈◊〉 incision.
• * 1.167

  The place.
• * 1.168

  The manner of section.
• * 1.169

  What is to bee done if a Ma∣rasmus or He∣ctick fever be complicate with a Fistula of the brest.
• * 1.170

  What a Maras∣mus is.
• * 1.171

  Lib. 12. cap. 4.
• * 1.172

  The degrees of Marasmus.
• * 1.173

  Signes of it in fieri.
• * 1.174

  The curation of this degree.
• * 1.175

  The signes of a Marasmus consummate.
• * 1.176

  2. Differences of a Marasmus.
• * 1.177

  The differen∣ces of a Maras∣mus caused of cold.
• * 1.178

  What a Hectick fever is.
• * 1.179

  The degrees of a Hectick.
• * 1.180

  What 〈◊〉〈◊〉 to b•• done in 〈◊〉〈◊〉 suma•• co••∣sumpti••••.
• * 1.181

  The uses of the discourse of a Marasmus, and a Hectick fever.
• * 1.182

  Remedice a∣gainst a Maras∣mus.
• * 1.183

  Remedies a∣gainst a He∣ctick fever.
• * 1.184

  Locall applica∣tions.
• * 1.185

  The differen∣ces of Fistula's of the belly.
• * 1.186

  A historie.
• * 1.187

  The cure.
• * 1.188

  The removing of the Callus.
• * 1.189

  The mundifi∣cation.
• * 1.190

  A historie.
• * 1.191

  Of the Fistula an••.
• * 1.192

  Signes of a Fi∣stula piercing the gut.
• * 1.193

  Presages.
• * 1.194

  The curation.
• * 1.195

  The curing of Fistula's not passing to the gut.
• * 1.196

  The cure of a Fistula pier∣cing the gu••.
• * 1.197

  The manner: of binding.
• * 1.198

  The manner of searching.
• * 1.199

  The presage.
• * 1.200

  Object.
• * 1.201

  Answ.
• * 1.202

  The topicall meanes.
• * 1.203

  Anodine meanes.
• * 1.204

  How the Callus is removed.
• * 1.205

  What a ma∣ligne ulcer is.
• * 1.206

  How the ali∣ment of the part is corrup∣ted.
• * 1.207

  Differences of ••••••lig•••••• ulcers.
• * 1.208

  〈…〉〈…〉
• * 1.209

  ••o••a.
• * 1.210

  The signes
• * 1.211

  The Proguo∣sticks.
• * 1.212

  The causes of ulcers accor∣ding to the Spagyricks.
• * 1.213

  The curation of Herpes exedens.
• * 1.214

  1. Intention purging of the body.
• * 1.215

  The d••••••¦tion of a dec••∣ction purga∣tive.
• * 1.216

  ••. Intention
• * 1.217

  The ••••••••••ing di••••••ents of the 〈◊〉〈◊〉
• * 1.218

  The Topicall meanes of the moderne Chi∣rurgeons.
• * 1.219

  How the cavity in such ulcers is filled up.
• * 1.220

  cap. 8.
• * 1.221

  How 〈◊〉〈◊〉 ul∣cers are skin∣ned.
• * 1.222

  The Etymon of the name.
• * 1.223

  The significa∣tions of it.
• * 1.224

  The descrip∣ion of it.
• * 1.225

  The mater•••• cause of it.
• * 1.226

  The signes.
• * 1.227

  〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉
• * 1.228

  The Etymon,
• * 1.229

  The 〈…〉〈…〉
• * 1.230

  〈◊〉〈◊〉 and ••••lephian ul∣ce••;
• * 1.231

  Chiron.
• * 1.232

  Telephus.
• * 1.233

  Presages.
• * 1.234

  The intentions of curing.
• * 1.235

  Dict.
• * 1.236

  Internall me∣dicaments.
• * 1.237

  Apud Rinedaeum de hieris cap. 4.
• * 1.238

  Nomae verende∣rum.
• * 1.239

  The applica∣tion of Topi∣call meanes.
• * 1.240

  How long you are to use these medicaments.
• * 1.241

  In admoni∣tion.
• * 1.242

  The descripti∣on of a cance∣rous tumor.
• * 1.243

  The cause of the name.
• * 1.244

  The differen∣ces of atra bilis.
• * 1.245

  The efficient causes.
• * 1.246

  The cause of a Cancer not ul∣cerate and ul∣cerate.
• * 1.247

  Why a Cancer is not bred of naturall me∣lancholy.
• * 1.248

  The materiall cause of a Can∣cer.
• * 1.249

  That a Cancer can hardly bee without paine.
• * 1.250

  The signes of a Cancer.
• * 1.251

  What parts a Cancer may possesse.
• * 1.252

  Why it doth possesse the brest.
• * 1.253

  Why the ma∣trix.
• * 1.254

  Prognosticks.
• * 1.255

  The explica∣tion of Hippo∣crates.
• * 1.256

  The curation of a cancerous tumor.
• * 1.257

  How often the Cancer is to be dressed.
• * 1.258

  Of a cancerous ulcer.
• * 1.259

  The signes.
• * 1.260

  The differen∣ces.
• * 1.261

  A Note.
• * 1.262

  The Progno∣sticks.
• * 1.263

  The curation.
• * 1.264

  Locall meanes.
• * 1.265

  How the juyce of herbs is to be kept.
• * 1.266

  De ulcerib. c. 12.
• * 1.267

  The use of cor∣rosives.
• * 1.268

  The curation of a Noli me tangere.
• * 1.269

  For a Cancer in the matrix or anus.
• * 1.270

  Medicaments in the shops.
• * 1.271

  Empyricall meanes.
• * 1.272

  How we shall know a Cancer to be exstir∣pate.
• * 1.273

  The cause of Cancers accor∣ding to Chy∣mists.
• * 1.274

  The manner how to cure Cancers accor∣ding to Alchy∣mists.
• * 1.275

  Their Topicks.
• * 1.276

  The names of it.
• * 1.277

  The divers kindes of le∣prosity.
• * 1.278

  The difference between itch∣ing, scabbines, and the Greeke leprosie.
• * 1.279

  The signes.
• * 1.280

  The causes.
• * 1.281

  The efficient.
• * 1.282

  The materiall cause.
• * 1.283

  The presages,
• * 1.284

  The materiall cause and dif∣ferences of the Leprosie.
• * 1.285

  The signes of the Leprosie beginning.
• * 1.286

  Nat. hist. l. 26. cap. 1.
• * 1.287

  The signes of the Leprosie confirmed.
• * 1.288

  De occult. nat. mirac. l. 2. c. 52.
• * 1.289

  The meanes of curing.
• * 1.290

  The diet.
• * 1.291

  Consult. 66.
• * 1.292

  Isagog. c. 12.
• * 1.293

  Chirurgicall meanes.
• * 1.294

  Baths.
• * 1.295

  Liniments.
• * 1.296

  Oyle of Ad∣ders.
• * 1.297

  The nature of cathaereticall medicaments.
• * 1.298

  Vnguentum Aegyptiacum.
• * 1.299

  Vnguentum Apostolorum.
• * 1.300

  How hard and stubborne proud flesh is to be abated.
• * 1.301

  〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉
• * 1.302

  Why caustick medicaments are painfull.
• * 1.303

  Lapis infernalis.
• * 1.304

  The white Caustick.
• * 1.305

  Mercurie sub∣limate.
• * 1.306

  Turbith mine∣rall unwashed.
• * 1.307

  Of the nature of Septicall medicaments.
• * 1.308

  Septick Medi∣caments.
• * 1.309

  Septick Vege∣tables.
• * 1.310

  Whether su∣perfluous flesh may not be ta∣ken away by instruments.
• * 1.311

  When instru∣ments are not to be used.
• * 1.312

  De ulcerib. c. 18
• * 1.313

  Ibid.
• * 1.314

  The causes of the corruption of the bones.
• * 1.315

  1. Externall.
• * 1.316

  2. The inter∣nall.
• * 1.317

  The signes of the corruption of the bones.
• * 1.318

  1. Sensuall.
• * 1.319

  2. Intellectuall.
• * 1.320

  Aphor. 45. sect. 6. Prognoses. 1.
• * 1.321

  How the ••tio∣•••• o•• a bone 〈…〉〈…〉 is to be cured.
• * 1.322

  How the bone is to bee laid bare.
• * 1.323

  〈◊〉〈◊〉 By incision.
• * 1.324

  2. By exesion.
• * 1.325

  Where poten∣tiall cauteries are not to be used.
• * 1.326

  3. Dilatation.
• * 1.327

  When this is convenient.
• * 1.328

  How the bone is to be scaled.
• * 1.329

  1. Desquama∣torie medica∣ments.
• * 1.330

  Degrees of de∣squamatorie medicaments.
• * 1.331

  De ulcerib. c. 22.
• * 1.332

  The scaling of the bones by instruments.
• * 1.333

  the signe of the cariositie removed.
• * 1.334

  Lib. 8. c. 2. What mallet best.
• * 1.335

  How ulcers of the head, wher∣in both the ta∣bles are cari∣ous ought to be handled.
• * 1.336

  How bones corrupt are to be scaled by the actuall cau∣••••••••.
• * 1.337

  When it is to be applyed.
• * 1.338

  Where it is to be applied.
• * 1.339

  3. How the bone is to be dressed after cauterization.
• * 1.340

  Where the a∣ctuall cauterie is not to bee used.
• * 1.341

  〈◊〉〈◊〉 An ulcer ha∣ving the co∣lour of the part altered.
• * 1.342

  I. The red co∣lour.
• * 1.343

  The efficient causes of it.
• * 1.344

  The materiall cause.
• * 1.345

  How bloud may offend.
• * 1.346

  The curation.
• * 1.347

  The diet.
• * 1.348

  The season of the yeare.
• * 1.349

  Of the gar∣ments. Rowlers.
• * 1.350

  Rowling.
• * 1.351

  Venerie. Violent mo∣tion. Suppression of solemne eva∣cuations.
• * 1.352

  How the men∣struall courses are to be pro∣cured.
• * 1.353

  How the He∣morthodes are to be opened.
• * 1.354

  How the mate∣riall cause i•• to be dealt with∣all.
• * 1.355

  Of the livid colour. Its causes.
• * 1.356

  How lividitie from black bloud is to be cured.
• * 1.357

  How lividitie from cold is to be cured.
• * 1.358

  Of a black co∣lour
• * 1.359

  How this acci∣dent is to be removed.
• * 1.360

  Of Varices.
• * 1.361

  Its names.
• * 1.362

  The descrip∣tion.
• * 1.363

  Its causes.
• * 1.364

  The materiall.
• * 1.365

  Aristotles opi∣nion.
• * 1.366

  Galen and Hip∣pocrates his opinion.
• * 1.367

  The antece∣dent causes.
• * 1.368

  The primitive causes.
• * 1.369

  The presages.
• * 1.370

  The curation.
• * 1.371

  The diet.
• * 1.372

  Phlebotomie.
• * 1.373

  Purgation.
• * 1.374

  The chirurgi∣call curation.
• * 1.375

  Vstion.
• * 1.376

  Excision.
• * 1.377

  Excision.
• * 1.378

  The Auchors way of curing.
• * 1.379

  How the wormes are called.
• * 1.380

  Their genera∣tion.
• * 1.381

  The materiall cause.
• * 1.382

  The efficient.
• * 1.383

  The signes.
• * 1.384

  Against the use of instruments.
• * 1.385

  Against the use of the actuall cautery.
• * 1.386

  The curation.
• * 1.387

  The medica∣ments.
• * 1.388

  From a mani∣fest quality.
• * 1.389

  Pellamountain.
• * 1.390

  Medicaments killing wormes from a hidden quality. 〈◊〉〈◊〉 Minerals.
• * 1.391

  Cap. 93.
• * 1.392

  Aqua alu••••••in•••• magistralis.
• * 1.393

  The use of it.
• * 1.394

  Vegetables.
• * 1.395

  Of wormes in the belly.
• * 1.396

  Their names.
• * 1.397

  Their efficient cause.
• * 1.398

  The materiall cause.
• * 1.399

  ••he differen∣ces swormes.
• * 1.400

  〈◊〉〈◊〉. Ordinary.
• * 1.401

  Taenia,
• * 1.402

  The signes. Of round ••••••mes.
• * 1.403

  Of Ascarides.
• * 1.404

  Of Tania.
• * 1.405

  The predicti∣ous.
• * 1.406

  The curation.
• * 1.407

  Medicaments that kill wormes.
• * 1.408

  Act. 12.
• * 1.409

  Iose••h••••a•••••• lib. 18. cap. 13.
• * 1.410

  A lowsie ulcer.
• * 1.411

  The efficient muse.
• * 1.412

  The differen∣ces of the lice.
• * 1.413

  The ordinary.
• * 1.414

  Crab-lice.
• * 1.415

  Syrones.
• * 1.416

  The Prognosticks.
• * 1.417

  The curation.
• * 1.418

  Phlebotomie.
• * 1.419

  Purgation.
• * 1.420

  Locall medica∣ments.
• * 1.421

  Lib. 3. c. 3.
• * 1.422

  Differences of ulcers of the head.
• * 1.423

  The nature of these griefes and names.
• * 1.424

  The materiall causes. The divers kindes of sharp humors.
• * 1.425

  The Chymists opinion con∣cerning the material cause.
• * 1.426

  Achor, what it is.
• * 1.427

  The differen∣ces betweene Achor and Fa∣vus.
• * 1.428

  Favus, what it is.
• * 1.429

  Achor.
• * 1.430

  Favus.
• * 1.431

  The primitive causes.
• * 1.432

  The materiall cause.
• * 1.433

  The conjunct cause.
• * 1.434

  Signes.
• * 1.435

  The presages.
• * 1.436

  The Indicati∣on. of curing.
• * 1.437

  1. Physicall.
• * 1.438

  Dieteticall.
• * 1.439

  Phlebotomie.
• * 1.440

  Purgation. Generall.
• * 1.441

  Particular.
• * 1.442

  Chirurgicall meanes.
• * 1.443

  How persons of ripe age are to be dressed.
• * 1.444

  Compound unguents.
• * 1.445

  The artificiall dressing. The pulling out of the haire.
• * 1.446

  Pulling out of the haires.
• * 1.447

  How children are to be hand∣led.
• * 1.448

  Of the Ma∣stickt ee.
• * 1.449

  Of Tinea.
• * 1.450

  The materiall cause.
• * 1.451

  Cap. de Tinea.
• * 1.452

  Primitive causes.
• * 1.453

  The curation.
• * 1.454

  Lib. 16. c. 2. de Tinea.
• * 1.455

  The applica∣tion of the Fo∣picks.
• * 1.456

  Things to be noted before the application of lo••••ll medi∣caments.
• * 1.457

  The excellen∣cie of the hearing.
• * 1.458

  The causes.
• * 1.459

  Externall.
• * 1.460

  Internall.
• * 1.461

  ••••ciages.
• * 1.462

  The differen∣ces.
• * 1.463

  The curation.
• * 1.464

  Purgation.
• * 1.465

  Application of locall meanes.
• * 1.466

  〈◊〉〈◊〉. 5. tract. 9. c. 9
• * 1.467

  The curation of the ulcer of the eare with excrescence of flesh.
• * 1.468

  An experiment of the Authors.
• * 1.469

  Of ulcers of the eyes.
• * 1.470

  Three points of the generall doctrine.
• * 1.471

  The manner of curing these three ulcers in particular.
• * 1.472

  Ophthalmia what it is.
• * 1.473

  The differen∣ces of it.
• * 1.474

  How it is bred.
• * 1.475

  The causes of Ophthalmia ve∣ra conjunct.
• * 1.476

  Primitive.
• * 1.477

  Why in hot re∣gions the inha∣bitāts are more frequently troubled with these inflam∣mations.
• * 1.478

  The generall signes of a true Ophthalmia.
• * 1.479

  The particu∣lar.
• * 1.480

  Signes of the parts sending.
• * 1.481

  Signes of the humors sent.
• * 1.482

  Why in an Ophthalmia the eyes cleave to∣gether in the night time.
• * 1.483

  The predicti∣ons.
• * 1.484

  6. Aph. 17.
• * 1.485

  Ophthalmia spu∣ria, what it is.
• * 1.486

  The curation of Ophthalmia vera.
• * 1.487

  Precepts be∣fore the appli∣cation of To∣picks.
• * 1.488

  Fomentation.
• * 1.489

  Opiaticall me∣dicaments.
• * 1.490

  The locall me∣dicaments.
• * 1.491

  The venereall Ophthalmia.
• * 1.492

  The use of the Seton.
• * 1.493

  Superficiarie ulcers of Cor∣nea.
• * 1.494

  The three kindes of dee∣per ulcers of Cornea.
• * 1.495

  Prognosticks.
• * 1.496

  The materiall cause of these ulcers.
• * 1.497

  The falling downe of uvea.
• * 1.498

  Foure kindes of it.
• * 1.499

  Predictions.
• * 1.500

  The alteration of the body.
• * 1.501

  Locall medica∣ments.
• * 1.502

  To superficiall ulcers of Cor∣nea.
• * 1.503

  For deepe ul∣cers.
• * 1.504

  Purging of the body.
• * 1.505

  The ordinati∣on of the things not na∣turall.
• * 1.506

  The Aire.
• * 1.507

  aphor. sect 3.
• * 1.508

  Bread.
• * 1.509

  Flesh.
• * 1.510

  Fish.
• * 1.511

  Drinke.
• * 1.512

  Wine.
• * 1.513

  Sleeping and watching.
• * 1.514

  Exercises.
• * 1.515

  Solublenesse.
• * 1.516

  Of maligne ulcers of the eyes.
• * 1.517

  Noma.
• * 1.518

  Signes.
• * 1.519

  Prognosticks.
• * 1.520

  The locall me∣dicaments.
• * 1.521

  A cancerous ulcer.
• * 1.522

  The signes.
• * 1.523

  Prediction.
• * 1.524

  Locall meanes.
• * 1.525

  Maligne ulcers proceeding of contagious dis∣eases.
• * 1.526

  Of ulcers cau∣sed of the Small Pox.
• * 1.527

  Topicks.
• * 1.528

  Venereall ul∣cers.
• * 1.529

  Of the ulcer caused of a pe∣stilentiall Carbo.
• * 1.530

  The symp∣tomes.
• * 1.531

  The curing of it.
• * 1.532

  Specillum.
• * 1.533

  A note.
• * 1.534

  The locall me∣dicaments.
• * 1.535

  The Etymon.
• * 1.536

  What it is.
• * 1.537

  The differen∣ces of Ozaenae.
• * 1.538

  How fasting is profitable.
• * 1.539

  Phlebotomie.
• * 1.540

  The commodi∣ties of it.
• * 1.541

  Purgation.
• * 1.542

  Their kindes.
• * 1.543

  The vegetable purgatives.
• * 1.544

  Pils.
• * 1.545

  Potions.
• * 1.546

  Minerall me∣dicaments.
• * 1.547

  Antimonie.
• * 1.548

  Mercurie.
• * 1.549

  The externall medicaments.
• * 1.550

  How the crustie substance is to be removed.
• * 1.551

  The manner of the applying of these medi∣caments.
• * 1.552

  The medica∣ment, to be applyed.
• * 1.553

  I. Waters.
• * 1.554

  ••I. Decocti∣ons.
• * 1.555

  The manner of using of wa∣ters and deco∣ctions.
• * 1.556

  The unguents.
• * 1.557

  Cancerous ulcers.
• * 1.558

  A water fo•••• cancer in the nose.
• * 1.559

  The applica∣tion of the actuall cau∣terie.
• * 1.560

  When it is to be applyed.
• * 1.561

  The uses of it.
• * 1.562

  The pipes.
• * 1.563

  The limits of the mouth.
• * 1.564

  The uses of it.
• * 1.565

  Of the ulcers of the lips.
• * 1.566

  The commodi∣ties of the lips.
• * 1.567

  The chaps of the lips.
• * 1.568

  Their cause materiall.
• * 1.569

  ••••••••ictions.
• * 1.570

  The curation of these.
• * 1.571

  Vlcers of the lips.
• * 1.572

  For the milde.
• * 1.573

  For the ma∣ligne.
• * 1.574

  The ulcers of the Palatum.
• * 1.575

  Its figure.
• * 1.576

  The instru∣ment of ta∣sting.
• * 1.577

  The instru∣ment of fee∣ling.
• * 1.578

  What is to be done when Os palati falleth out.
• * 1.579

  Of the go∣vernment of the tongue.
• * 1.580

  The uses of it.
• * 1.581

  How mild sores of the tongue are cu∣red.
• * 1.582

  Of maligne ulcers of the tongue.
• * 1.583

  Of ulcers of the Vvula.
• * 1.584

  Of mild ones.
• * 1.585

  Of fretting ulcers.
• * 1.586

  Prognosticks.
• * 1.587

  The curation.
• * 1.588

  1 By medica∣ments.
• * 1.589

  Lib. 3. cap. 3.
• * 1.590

  Vlcers of the almonds.
• * 1.591

  The Progno∣sticks.
• * 1.592

  Vlcers of the throat.
• * 1.593

  The curation.
• * 1.594

  The cause of the ulcers of the lungs after a wound.
• * 1.595

  Signes of the lungs wounded.
• * 1.596

  Signes of blood poured out into the capa∣citie of the breast.
• * 1.597

  Whether after a wound of the lungs an ulcer will ensue.
• * 1.598

  Why wounds of the lungs send out much quittour.
• * 1.599

  The progno∣sticks.
• * 1.600

  Lib. 3. sen. 10. tract. 5. c. 18.
• * 1.601

  Why the cura∣tion of the ul∣cers of the lungs is un∣certain.
• * 1.602

  The indicati∣ons of curing.
• * 1.603

  The di••••▪
• * 1.604

  Milk.
• * 1.605

  Snailes, Crabs.
• * 1.606

  Pectorall de∣coctions.
• * 1.607

  The artificiall dressing.
• * 1.608

  Injections.
• * 1.609

  Abste••s•••••• inject••••••.
• * 1.610

  The consolida∣tion.
• * 1.611

  Consolidative medicament••.
• * 1.612

  The manner of dressing.
• * 1.613

  Tents.
• * 1.614

  The use of a pipe.
• * 1.615

  Quest.
• * 1.616

  Answ.
• * 1.617

  What course is to bee taken if the body grow leane.
• * 1.618

  Vlcers of the back.
• * 1.619

  Which are to be accompted sharp diseases. Three kindes.
• * 1.620

  Histor. 1.
• * 1.621

  II.
• * 1.622

  Apostemes and ulcers of the back.
• * 1.623

  Criticall en∣ding of griefs.
• * 1.624

  The progno∣sticks of the ulcers of the back.
• * 1.625

  Why ulcers in the upper part of the Spina are of easier cura∣tion, than those of the lower.
• * 1.626

  Histories.
• * 1.627

  How the Ha∣berdasher was cured.
• * 1.628

  The descripti∣on of the inje∣ctions.
• * 1.629

  Of the ulcers of the Abdo∣men.
• * 1.630

  1. Of an ulcer penetrating of the stomack.
• * 1.631

  2. Of an ulcer of the liver.
• * 1.632

  Of an ulcer of the navell.
• * 1.633

  A penetrating ulcer of the groine.
• * 1.634

  An Historie.
• * 1.635

  Of ulcers of the joynts.
• * 1.636

  The Topicks.