Oedema, and so of the rest; always naming the tumor, from that which is predominant in it.
Therefore we must observe that all differences of such tumors arise from that, either because the bloud causing it offends only in quantity; which if it do, it causes that tumor which is pro∣perly called a Phlegmon; if in quality, it makes a Phlegmonous tumor, because the matter there∣of is much departed from the goodness of bloud.
But bloud is said to offend in quantity, either by admixture of some other matter, as Phlegm, Choler, or Melancholy, from whence proceeds Oedematous, Erysipelous, and Scirrhous Phlegmons; or by corruption of its proper substance from whence Carbuncles, and all kinds of Gangrenes; or by concretion, and when Nature is disappointed of its attempted and hoped for suppuration, either by default of the Air, or Patient, or by the error of the Physitian; and hence oft-times hap∣pen Atherema's, Steatoma's, and Melicerides. Although these things be set down by the Ancients, of the simple and similar matter of the true Phlegmon; yet you must know; that in truth there is no Impostume, whose matter exquisitely shews the Nature of one, and that simple humor, without all admixture of any other matter; for all humors are mixed together with the bloud, yet from the plenty of bloud predominating, they are called Sanguine, as if they were of bloud alone.
Wherefore if any tumors resemble the nature of one simple humor, truly they are not of any natural humor, but from some humor which is corrupt, vitiated and offending in quality; for so bloud by adustion degenerates into Choler and Melancholy.
Therefore a true Phlegmon is defined by Galen; A tumor against Nature, of laudable bloud, flowing into any part in too great a quantity.
This tumor though most commonly it be in the flesh, yet sometimes it happens in the Bones, as Hippocrates and Galen witness.
A Phlegmon is made and generated thus: when bloud flows into any part, in too great a quan∣tity; first the greater veins and arteries of the part affected are filled, then the middle, and lastly, the smallest and capillary; so from those thus distended, the bloud sweats out of the pores and small passages like dew, and with this the void spaces which are between the similar parts are first filled, and then with the same bloud all the adjacent parts are filled, but especially the flesh, as that which is most fit to receive defluxions, by reason of the spongious rarity of its substance; but then the nerves, tendons, membranes, and ligaments, are likewise stuffed full; whereupon a Tumor must necessarily follow, by reason of the repletion which exceeds the bounds of Nature; and from hence also are Tension and Resistance; and pain also happens at the same time, both by reason of the tension and preternatural heat.
And there is a manifest pulsation in the part, specially whilst it suppurates, because the veins, ar∣teries, and nerves, are much, being they are not only heated within by the influx of the fervid humor, but pressed without by the adjacent parts. Therefore seeing the pain comes to all the fore∣said parts because they are too immoderately heated and pressed, the arteries, which are in the perpetual motion of their systole & diastole, whilst they are dilated, strike upon the other inflamed parts, whereupon proceeds that beating pain.
Hereunto add; The Arteries, then filled with more copious and hot bloud, have greater need to seek refrigeration by drawing in the encompassing Air; wherefore they must as of necessity, have a conflict with the neighbouring parts which are swollen and pained. Therefore from hence is that pulsation in a Phlegmon which is defined by Galen, An agitation of the arteries, painful and sensible to the Patient himself; for otherwise as long as we are in health, we do not perceive the pulsation of the arteries.
Wherefore these two causes of pulsation, or a pulsifick pain in a phlegmon, are worthy to be observed, that is, the heat and abundance of bloud, contained in the vessels and arteries (which more frequently than their wont incite the arteries to motion, that is, to their systole and diastole) and the compression and straitning of the said arteries, by reason of the repletion and distention of the adjacent partts, by whose occasion the parts afflicted and beaten by the trembling and fre∣quent pulsation of arteries are in pain.
Hence they commonly say, that in the part affected with a Phlegmon, they feel, as it were, the sense or stroke of a Mallet, or Hammer smiting upon it. But also, besides this pulsation of the ar∣teries, there is, as it were, another pulsation with itching from the humors whilst they putrefie, and suppurate, by the permixtion, motion, and agitation of vapours, thereupon arising.
The cause of heat in a Phlegmon is bloud, which whilst it flows more plentifully into the part, is, as it were, trodden or thrust down, and causes obstruction, from whence necessarily follows a prohibition of transpiration, and putrefaction of the bloud, by reason of the preternatural heat. But the Phlegmon looks red by reason of the bloud contained it, because the humor predominant in the part shines through the skin.