The workes of that famous chirurgion Ambrose Parey translated out of Latin and compared with the French. by Tho: Johnson. Whereunto are added three tractates our of Adrianus Spigelius of the veines, arteries, & nerves, with large figures. Also a table of the bookes and chapters.

CHAP. X. The cure of an ulcerated Phlegmon.

BUt it often happens that the humor is so impact in the part, that it cannot be repressed,* 1.1 and so gross, that it cannot be discussed; which we may know by the greatness of the heat and swelling, by the bitterness of the pricking pain, the feaver, and pulsation, and hea∣viness.

Wherefore laying aside all hope of discussing, we must come to the Suppuratives.* 1.2 For which purpose Galen foments the swollen part with water, or Oyl being warm, or with both of them; and then applies this following Cataplasm.

℞ farinae tric. vel micae panis ℥ iiij. ol. com. ℥ i••j, aquae com. quantum sufficit, fiat cataplasma; Or,* 1.3 ℞ rad. lili. r. alb. & alth••ae, an. ℥ iij, fol malvae p. rietar. & senecionis ana m. i, coquantur in hydromelite, p••ssmur trajectis adde farin. sem. lim ℥ ij, axungiae su••llae, ol. liliorum an ℥ ss, fiat cataplasma: Or, ℞ mal∣va, ••ismalv. violar. an. m. i, caricarum ping. n. x. passul. ℥ ij, coquantur in aq. com. tusis, & trajectis, adde nullis com. ℥ ij, ung. basilicon. & butyri recent. ana ℥ i, fiat cataplasma. You may profitably use for the same purpose Empl. Diachylon magnum, or Basilicon. Or, ℞ Empl. Diachyl. Mag. ℥ iij, ung. basilicon. ℥ i, ol. liliorum ℥ ss. Of these mixed together make a medicine for the foresaid use.

When the heat, pain, feaver, and other accidents shall remit, when the tumor hath a sharp head,* 1.4 when by the pressing of your finger you find the humor to flow, as it were, to and fro, then you may know that it is ripe.

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

For this usually happens, especially then, when the matter is venerate, or malign, or when the swelling is near a joynt, or at the fundament, or such like hot and moist places.

For by the decree of Hippocrates we should anticipate the maturation of such tumors by opening.* 1.5

They may be opened with an Incision-Knife, or Caustick, and that either actual, or potential. For if the Patient shall be heartless and less confident, so that he either cannot, or will not indure any Instrument, you must make way for the matter by a Potential cautery. You may also do the business by another slight, as thus:

Thrust the point of a sharp Knife, or Lancet, through a brass Counter that it may stand fast in the midst thereof; then cover it diligently with some Emplaister, or Cataplasm, that neither the Patient nor standers by perceive the deceit: then laying on the Plaister, as if that you would make a passage for the matter by that means; but when you have fitted the point to the part, where it is fit to open the tumor, so guide the Counter with your fingers, that you may presently make an impression into the tumor, sufficient for excluding the matter. I have here expressed three deli∣neations of such Instruments; that you may use these, either bigger, lesser, or indifferent, as occa∣sion shall serve.

[illustration]

Counters with the points of Knives or Launcess put though them,

• A, shews the Counter or piece of Silver.
• B. shews the point of the Lancet.

But there are seven things which must be diligently considered in opening all sorts of Impo∣stumes. The first is that you put your knife to that part of the Abscess which is the softer, & yields to the impression of your fingers, and where it rises into a head, or point. The second is, that you make choice of that place for dissection which is the lowest, that so the contained impurity may the more readily flow out, and not stay in the passage. The third is, that it be made according to the wrincles of the skin, and the right fibers of the Muscles lying next under the skin. The fourth is, that you turn your knife from the larger Vessels and Nerves worth speaking of. The fifth is, that the matter contained in them be not evacuated too abundantly at once in great Abscesses, lest thereby the strength be dejected,* 1.6 the spirits being much wasted together with the unprofitable humor. The sixth is, that the affected part be handled as gently as you can. The seventh is, that after the opening when the matter is evacuated, the Abscess be cleansed, filled with flesh and last∣ly, consolidated and cicatrized. But seeing that commonly after such Sections some part of the Tumor remains, all the contained humor being not wholly suppurated, the Chirurgeon may per∣ceive that this is an implicite affect, that is, a Tumor and Ulcer. But the Cure thereof must be so, that you take away the Tumor before the Ulcer; for the Ulcer cannot be healed before the part

[illustration]

Other Instruments for opening Abscesses.

• Rings in which little Knives lye hid, fit for to open Ab∣scesses.
• The Delineation of a Trunk or hollow Instrument go∣ing with Spring.
• A, shews the thicker pipe.
• B, shews another which enters and is fastened in the other by a serue.
• C, the point of the Instrument locking out.
• D, the spring which forces the Instrument.

be restored to its nature. Therefore the Suppuratives formerly prescribed must be used, and the Ulcer must be dressed for two or three dayes with this following Medicine.

℞ Vitellum unius ovi, terebinth. Venetae, & ol. Rosar. an, ℥ ss, fiat medicamentum.* 1.7 Then you must seek to cleanse it by this following Medicine.

℞ Mellis rosar. ℥ i, Syrupi rosar. & tereb. Venet. an. ℥ i ss, far. hordei ℥ ij, fiat medicamentum ad u∣sum. For this very purpose there is a singular Detersive made of Appium, or Smallage, of which this is the description.

℞ Succi appii, plantag. beton. an. ℥ i, Mellis commun. ℥ v, terebint. Venet. ℥ iiij, farin. Hordei & Orobi, an. ʒ ij, pulveris Aloes, rad. Ireos florent. myrrhae, an. ʒ i, coquatur mel cum succis, quibus con∣sumptis addantur farinae, & pulveres, & misceantur omnia ad formam unguenti. But if you would cleanse it more powerfully, you may use Unguentum Apostolorum, or Unguentum Aureum and Ae∣gyptiacum mixed according to the scope you conceive in your minds; when the Ulcer shall seem sufficiently cleansed, it shall be filled with flesh, and cicatrized after the manner we shall declare in the proper treatise of the cure of Ulcers.

Notes

• * 1.1

  The signs of a Phlegmon turning to an Abscess.
• * 1.2

  Lib. 2 Glan. Cap. 7.
• * 1.3

  Suppurative medicines.
• * 1.4

  The signs of pus, or matter,
• * 1.5

  Hip. lib. de Fi∣stula.
• * 1.6

  What the cure must be after the opening of the av••••••••s.
• * 1.7

  Detersive Me∣dicines. Ʋnguentum de Appio.