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CHAP. III. Of the Prognosticks of Ulcers.
THe bone must necessarily scale,* 1.1 and hollow scars be left by malign Ulcers of a years con∣tinuance or longer, and rebellious to medicins fitly applyed. The bone must scale by rea∣son of the continual efflux, and wearing by the acrimony of the humor, which looses the composure and glue by which the parts thereof are joined together. But the scars must become hollow, for that the bone (whence all the flesh takes its first original) or some portion thereof, be∣ing taken from under the flesh, as the foundation thereof, so much of the bulk of the flesh must ne∣cessarily sink down, as the magnitude of the portion of the wasted bone comes unto.
You may know that death is at hand, when the Ulcers that arise in or before diseases,* 1.2 are sud∣dainly either livid or dryed, or pale and withered. For such driness sheweth the defect of nature, which is not able to send the familiar and accustomed nutriment to the part ulcerated. But the livid or pale colour is not only an argument of the overabundance of choler and melancholy, but also of the extinction of the native heat. In Ulcers where tumors appear, the patients suffer no convulsions, neither are frantick; for the tumor being in the habit of the body possessed with an Ulcer, argues that the nervous parts and their original are free from the noxious humors. But these tumors suddainly vanishing and without manifest cause, as without application of a discussing medicin, or bleeding, those who have them on their backs have convulsions and distensions, for that the spine of the back is almost wholly nervous; but such as have them on their fore parts, be∣come either frantick, or have a sharp pain of their side, or pleurisie, or else a dysentery if the tu∣mors be reddish; for, the forepart of the body is replenished and overspread with many and large vessells, into whose passages the morbifick matter being translated, is presently carryed to those parts which are the seats of such diseases. Soft and loose tumors in Ulcers are good,* 1.3 for they shew a mildness and gentleness of the humors: but crude and hard swellings are naught; for all digestion in some measure resembles elixation. Ulcers which are smooth and shining are ill, for they shew that there resides an humor malign by its acrimony, which frets asunder the roots of the hairs, and depraves the natural construction of the pores of the skin; whence it is,* 1.4 that such as are troubled with Quartain agues, the Leprosie, or Lues venerea, have their hair fall off. A livid flesh is ill in Ulcers which cause a rottenness or corruption of the bones lying under the flesh; for it is an argument of the dying heat and corruption of the bone, whence the flesh hath its original and integrity.
Those Ulcers which happen by occasion of any disease, as a Dropsie, are hard to be cured;* 1.5 as also those whereinto a varix or swoln vessell continually casts in matter; which a present distemper foments; which have swoln, hard and callous lips; and such as are circular or round. An Hyper∣sarcosis, or fleshy excrescence usually happens to Ulcers not diligently mundified; and if they possess the arms or Legs, they cause a Phlegmon or some other tumor in the groins, chiefly if the body be full of ill humors, as Avicen hath noted. For these parts by reason of their rarity and weakness are fit and subject to defluxions. Albucrasis writes that for nine causes Ulcers are diffi∣cultly replenished with flesh and cicatrized. The first, for want of blood, in a bloodlesse body;* 1.6 the second, by reason of ill humors and the impurity of the blood; the third, by the unfit applica∣tion of unconvenient medicins; the fourth, by reason of the sordidness of the Ulcer; the fifth, by the putrefaction of the soft and carion-like flesh encompassing the Ulcer; the sixth, when they take their original from a common cause which every where rages with fury, such as are those which are left by the pestilence; the seventh, by reason of the callous hardness of the lips of the Ulcer. The eighth, when the heavens and air are of such condition as ministers fuell to the con∣tinuance of the Ulcer, as at Sarogoza in Aragon; the ninth, when the bones which lye under it are wasted by rottenness. An Ulcer that casts forth white, smooth, equall quitture,* 1.7 and little or no stinking, is easily healed; for it argues the victory of the native heat, and the integrity of the solid parts. We term that smooth quitture which is absolutely concocted, neither yeelds any as∣perity to the touch, whereby we might suspect that as yet any portion of the humor remains crude; we call that equall, wherein you can note no diversity of parts; and white, not that which is perfectly so, but that which is of an ash colour, as Galen observes. But it is ill, if when the cure is indifferently forward, a flux of blood suddainly break forth in those Ulcers which beat strongly by reason of the great inflammation adjoyned therewith. For, as Hippocrates observes, an effusi∣on of blood happening upon a strong pulsation in Ulcers is evill; for the blood breaking out of an Artery cannot be stayed but by force and also this blood is so furious by reason of the heat and inflammation the nourishers of this Ulcer, that it breaks its receptacles, and hence ensues the ex∣tinction of the native heat, whence the defect of suppuration and a Gangrene ensues. Now for that there flowes two sorts of excrements from malign Ulcers, the more thin is tearmed Ichor or sani••s, but the more grosse is named sordes; that is virulent and flowes from pricked nerves, and the periostea when they are evill affected; but the other usually flowes from the Ulcers of the joints, and it is the worser if it be black, reddish, ash-coloured, if muddy or unequall like wine Lees, if it stink. Sanies is like the water wherein flesh hath been washed; it argues the preterna∣tural heat of the part; but when it is pale coloured, it is said to shew the extinction of the heat.