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. III. The signes of Impostumes or Tumors in general.

* 1.1BEfore we undertake the cure of Tumors, it is expedient to know their kinds and differences, which knowledge must be drawn from their proper signs, the same way, as in other dis∣eases. But because the proper and principal signs of tumors are drawn from the essence of the part they possess, we must first know the parts, and then consider what their essence and com∣position are.

We are taught both by skill in Anatomy, and the observation of the depraved function, especi∣ally when the affected part is one of those which lie hid in the Body; for we know whether or no, the external parts are affected with a Tumor against Nature, by comparing that with his na∣tural, which is contrary. For comparing the sound part with the diseased, we shall easily judge whether it be swollen, or no.

But because it it not sufficient for a Chirurgeon only to know these general signs (which are known even to the vulgar) he must attentively observe such as are more proper and neer. And these are drawn from the difference of the matter and humors, of which the tumors consist.

* 1.2For this, Galen teaches, That all differences of Tumors arise from the nature and condition of the matter which flows down and generates the tumor; also they are known by such accidents as happen to them, as colour, heat, hardness, softness, pain, tension, resistance.

Wherefore pain, heat, redness, and tension, indicate a sanguine humor; coldness, softness, and no great pain, phlegm; tension, hardness, the livid colour of the part, and a pricking pain by fits, melancholy; and yellowish and pale colour, biting pain without hardness of the part, cho∣ler.

And besides, Impostumes have their periods and exacerbations following the nature and moti∣on of the humors of which they are generated. Wherefore by the motion and fits it will be no dif∣ficult matter to know the kind of the humor; for as in the Spring, so in the morning the blood is in motion; as in the Summer, so in the midst of the day, choler; as in Autumn, so in the even∣ing, Melancholy; as in Winter, so in the night the exacerbation of phlegm are most predomi∣nant. For Hip••••crates and Galen teach, that the year hath circuits of diseases, so that the same pro∣portion of the excess and motion of humors, which is in the four seasons of the year, is also in the four quarters of each day.

Impostumes which are curable have four times: their beginning, encrease, state, and declinati∣on; and we must alter our medicines, according to the variety of these times. We know the be∣ginning by the first swelling of the part; The encrease, when the swelling, pain, and other acci∣dents do manifestly encrease, and enlarge themselves; the state, when the foresaid symptoms in∣crease no more, but each of them, because at their height, remain in their state immoveable, unless the very matter of the tumor degenerate,* 1.3 and change it self into another kind of humor; The declination, when the swelling, pain, feaver, restlesness, are lessened. And from hence the Chi∣rurgeon may presage what the end of the tumor may be; for tumors are commonly terminated four manner of wayes, if so be, that the motion of the humors causing them be not intercepted, or they without some manifest cause, do flow back into the body.

Therefore first they are terminated by insensible transpiration, or resolution; secondly, by suppuration when the matter is digested and ripened; thirdly, by induration, when it degene∣rates

into a Scirrhus, the thinner part of the humor being dissolved; the fourth, which is the worst of all, by a corruption and Gangrene of the part, which is, when overcome with violence, or the abundance or quality of the humor, or both, it comes to that distemper, that it loses its pro∣per action.

It is best to terminate a tumor by resolution; and the worst by corruption; suppuration and induration are between both, although that is far better than this.* 1.4 The signs by which the Chi∣rurgeons may presage that an Impostume may be terminated by resolving, are, the remission or slacking of the swelling, pain, pulsation, tension, heat, and all other accidents, and the unaccu∣stomed liveliness and itching of the part; and hot Impostumes are commonly thus terminated, be∣cause the hot humor is easily resolved, by reason of its subtilty.

Signs of suppuration are the intension or encrease of pain, heat, swelling, pulsation,* 1.5 and the Feaver: for according to Hippocrates, Pain and the Feaver are greater when the matter is suppu∣rating, than when it is suppurated.

The Chirurgeon must be very attentive to know and observe when suppuration is made; for the purulent matter oft-times lies hid (as Hippocrates saith) by reason of the thickness of the part lying above, or over it.

The signs of an Impostume degenerating into a Scirrhous hardness,* 1.6 are the diminution of the tumor, and hardness remaining in the part. The causes of the hardness not going away with the swelling, are the weakness of nature, the grosness and toughness of the humor, and unskilfulness of the Chirurgeon, who by too long using resolving things hath occasioned, that the more subtil part of the humor being dissolved, the rest of the grosser nature like earthy dregs remains con∣cret in the part. For so Potters vessels dryed in the Sun grow hard. But the unskilful Chirur∣geon may occasion a Scirrhous hardness by another means, as by condensating the skin, and in∣crassating the humors, by too much use of repercussives.* 1.7 But you may perceive an Impostume to degenerate into a Gangrene thus, if the accidents of heat, redness, pulsation and tension shall be more intense, than they are wont to be in suppuration, if the pain presently cease without any manifest cause; if the part wax lived or black; and lastly, if it stink.

But we shall treat of this more at large when we come to treat of the Gangrene and Sphacelus.* 1.8 A sodain diminution of the tumor, and that without manifest cause, is a sign of the matter fallen back, and turned into the body again, which may be occasioned by the immoderate use of refri∣gerating things. And sometimes much flatulency mixed with the matter, although there be no fault in those things which were applyed.

Feavers and many other malign Symptoms; as Swoundings and Convulsion, by translation of the matter to the noble parts, follow this flowing back of the humor into the body.

Notes

• * 1.1

  The principal signs of tu∣mors are drawn from the essence of the part.
• * 1.2

  Lib. 2. ad Gl••uc. & 13. ••n••••ed. The proper signs of a san∣guin tumor, of a phlegma∣tick, of a me∣lancholick, of a cholerick. The knowledg of tumors by their motion and exacerba∣tion. Lib. 2. Ep. ••••m.
• * 1.3

  The beginning of an impo∣stume. The encrease. The state.
• * 1.4

  The signs of a tumor to be terminated by resolution.
• * 1.5

  The signs of suppuration.
• * 1.6

  The signs and causes of a tu∣mor termina∣ted in a Scir∣rhus.
• * 1.7

  The signs of a Gangrene at hand.
• * 1.8

  Of disappea∣rance of a tu∣mor, and the signs thereof.