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.

The THIRTEENTH BOOK. Of Ʋlcers, Fistulaes, and Haemorrhoides. (Book 13)

CHAP. I. Of the nature, causes and differences of Ulcers.

HAving already handled and treated of the nature, differences, causes,* 1.1 signs and cure of fresh and bloody wounds, reason and order seem to require that we now speak of Ulcers; taking our beginning from the ambiguity of the name. For according to Hippocrates, the name of Ulcer most generally taken may signifie all or any solution of Countinuity; In which sence it is read that all pain is an Ulcer. Generally, for a wound and Ulcer properly so called; as appears by his Book, de Ulceribus. Properly,* 1.2 as when he saith, it is a sign of death when an Ulcer is dryed up through an Atrophia, or defect of nourishment.* 1.3 We have here determined to speak of an Ulcer in this last and proper signifi∣cation. And according thereto we define an Ulcer to be the solution of Continuity in a soft part, and that not bloody, but sordid and unpure, flowing with quitture, Sanies or any such like corruption, associated with one or more affects against nature,* 1.4 which hinder the healing and agglutination thereof; or that we may give it you in fewer words according to Galens opi∣nion; An ulcer is a solution of Continuity, caused by Erosion. The causes of Ulcers are either internal or external.* 1.5 The internal are through the default of humours peccant in quality ra∣ther than in quantity, or else in both, and so making erosion in the skin and softer parts by their acrimony and malignity; now these things happen either by naughty and irregular diet, or by the ill disposition of the entrails, sending forth and emptying into the habit of the body this their ill disposure. The external causes are, the excess of cold seising upon any part,* 1.6 especially more remote from the fountain of heat, whence followes pain, whereunto succeeds an at∣traction of humors and spirits into the part, and the corruption of these so drawn thither by reason of the debility or extinction of the native heat in that part, whence lastly ulceration pro∣ceeds. In this number of external causes may be ranged, a stroak, contusion, the application of sharp and acrid medicins, as causticks, burns; as also impure contagion, as appears by the viru∣lent Ulcers acquired by the filthy copulation or too familiar conversation of such as have the French disease. How many and what the differences of Ulcers are, you may see here described in this following Scheme.

A Table of the differences of Ulcers.

• ...An Ulcer is an im∣pure solution of continuity in a soft part, flow∣ing with filth and matter or other corrupti∣tion, whereof there are two chief differen∣ces; for one
  • ...Is simple and solitary with∣out complica∣tion of any other affect a∣gainst nature, and this va∣ries in diffe∣rences, either
    • ...Proper, which are usually drawn from three things; to wit,
      • ...Figure, whence one Ulcer is called
        • ...Round or circular.
        • ...Sinuous, and variously spread.
        • ...Right or oblique.
        • ...Cornered as triangular.
      • ...Quantity, and that either according to their
        • ...Length; whence an Ulcer is long, short, indifferent.
        • ...Breadth; whence an Ulcer is broad, narrow, indifferent.
        • ...Profundity; whence an Ulcer is deep, superficiary, indifferent.
      • ...Equality or ine∣quality; which consists
        • ...In those differences of dimensions whereof we last treated, I say in length, breadth and profundity, wherein they are either alike or of the same manner, or else un∣like and so of a different manner.
    • ...Or common and acciden∣tal, and these drawn, either
      • ...From their time; whence an Ulcer is tearmed new, old, of short or long cure and curation.
      • ...From their appearance; whence one is called an appa∣rent Ulcer; another a hidden and occult Ulcer.
      • ...From their manner of generation; as if it be made by a heavy, bruising, cutting, pricking or corroding thing; whence a cut, torn and mixt Ulcer.
      • ...From their site; whence an Ulcer before, behinde, above, below, in the head, tail, or belly of a Muscle.

• ...
  • ...
    • ...
      • ...From that part it seises upon, whence an Ulcer in the flesh and skin, or feeding upon the gristles or bones, such as these of the nose, the palat of the mouth and ears.
      • ...From other common accidents; whence a Telephian Ulcer; that is, such an Ulcer as Telephus had. A Chironian, which needs the hand and art of Chiron. A Cankrous, which resembles a Cancer.
    • ...Is compound, and many and various wayes complica∣ted, as
      • ...With the cause whence an Ulcer
        • Is Cacochymick, C••tarrhoick or venenate, that is, which a Cacochymia or Repletion of ill humours, a Catarrh, or poison che∣rishes or feeds.
      • ...With the disease, as from
        • ...Distempers, whether sim∣ple or compound, whence an Ulcer is
          • ...Hot.
          • ...Cold.
          • ...Dry.
          • ...Moist.
          • ...Mixt.
        • ...Swelling or Tumor, whence a
          • ...Phlegmonous Ulcer.
          • ...Erisipelous Ulcer.
          • ...Oedematous Ulcer.
          • ...Scirrhous Ulcer.
          • ...Cancrous Ulcer.
        • Solution of continuity, or any other discom∣modity, whence a rough, callous, fistulous, cavernous, sinuous Ulcer, with luxation, fracture, &c.
      • ...With the Symptome, whence, a corroding, eating, painfull, sordid and virulent Ulcer.
      • ...With the cause and disease, Examples whereof may be taken from that we have formerly de∣livered.
      • ...With the cause and Symptom, Examples whereof may be taken from that we have formerly de∣livered.
      • ...With the disease and Symptom, Examples whereof may be taken from that we have formerly de∣livered.
      • ...With the cause, disease and Symptom. Examples whereof may be taken from that we have formerly de∣livered.

CHAP. II. Of the signs of Ulcers.

* 1.7THere are various signs of Ulcers according to their differences. For it is the sign of a putrid Ulcer, if it exhale a noysom, grievous, stinking and carion-like vapour, together with filthy matter. An eating Ulcer is known by the eating in, hollowness and wearing away of the part wherein it resides, together with the adjoyning parts. A sordid Ulcer may be known by the grosseness and viscidity of the excrements it sends forth, and by the loose and spongy softness, or the crusted inequality of the flesh which grows over it. A cavernous Ulcer, by the straitness of the orifice, and largeness and deepness of the windings within. A fistulous Ulcer, if to the last mentioned signs there accrew a callous hardness of the lips or sides of the Ulcer. A cankrous Ulcer is horrible to behold, with the lips turned black, hard and swoln; flowing with virulent and stinking corruption, and sometimes also with bloody matter, together with the swelling and lifting up of the adjacent veins.* 1.8 An untemperate, or as they term it, a distempered Ulcer, is such as is nourished by some great distemper, whether hot or cold, moist or dry, or compounded of these. An ill* 1.9 natured or malign Ulcer is known by the difficulty of curing and rebellious contumacy to remedies appointed according to Art and reason. We know a catarrhous Ulcer, if the matter which feeds it flow to it from some varices thereunto adjoyning; or dilated, swollen and broken veins, or from some entrail, or from the whole body being ill affected. An Apostumatous Ulcer is perceived by the presence of any tumor against nature, whose kind may be found out by sight and handling. Telephian Ulcers, are such as affected Tele∣phus; and Chironian (in whose cure Chiron excelled) are Ulcers which may be known by their magnitude, not much putrid, and consequently not sending forth any ill smell, not eating, not tormenting with pain; but having their lips swoln and hard, and therefore ill to be healed. For although they may be sometimes cicatrized, yet it being but slender may easily be broken, and the Ulcer renewed. They are almost like an ulcerated Cancer, but that they are accompanied with swelling in the adjacent parts; they are also worse than these which are termed Cacoethe, that is,* 1.10 ill natured, or malign; whence it is, that Fernelius thought they had a hidden cause of ma∣lignity, besides the common default of the humor, and that such as can scarce be driven away; such commonly are felt after the plague. Wherefore Galen thinks such to be malign as will not suppurate or yield any quitture.

CHAP. III. Of the Prognosticks of Ulcers.

THe bone must necessarily scale,* 1.11 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,* 1.12 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,* 1.13 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,* 1.14 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;* 1.15 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;* 1.16 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,* 1.17 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.

CHAP. IV. Of the generall cure of Ulcers.

* 1.18AN Ulcer is either simple or compound. A simple Ulcer, as an Ulcer, hath one and that a simple indication, that is, exsiccation; and that more than in a wound, by how much an Ulcer is moister than a Wound. There are many indications proposed for the cure of a compound Ulcer, in respect of which Galen would have us to keep this order, that we have the first regard of the most urgent, then of the cause, then of that, which unless it be taken away, the Ulcer cannot be healed. By giving you an example you may easily understand the meaning here∣of. Imagin on the ••••de of the Leg a little above the ancle, an Ulcer very painful, hollow, putrid, associated with the rottenness of the bone, circular, having hard and swoln Lips, and engirt with the inflammat••on and varices of the neighbouring parts. If you take this to cure, before you do any thing about the Ulcer, unlesse you be called upon by that which urges, as by vehemency of pain, you must first use general means by calling and advising with a Physitian. For in Galens opi∣nion,* 1.19 if the whole body require a preparation, then must that be done in the first place; for in some Ulcers p••rgation onl•• will be sufficient; in some, blood-letting; others are better by using both mea••s, which is as the cause of the Ulcer proceeds from a repletion or ilness of humors. Now by t e••e means having taken away the cause of the Ulcer, you must come to the particular cure thereo••, beg••nni••g with that which is most urgent. Wherefore you must first asswage the pain by applica•• o•• of things contrary to the cause thereof: as, if it proceed from a Phlegmonous distemper, whic h t lo••g possest, distended, and hardned the part, it must be eased by evacua∣tion. First, bat••ng •• wi h warm water, to mollifie and relax the skin, that so you may the more easily evacuate•• ••ec ••a e•• h••mors; then shall you draw away a portion of the matter cau••••g the swelling and pa n by scar fication, if the Patient shall be of sufficient courage, or else by ap∣plication of horse-le••c••es if ••e be more faint-hearted; and then you shall temper the heat there∣of by applying Unguentum refrigerans Galeni. To conclude, you shall attempt all things which we have formerly delivered (in our Treatise of Tumors) to take away the swelling thereof. When you have brought this to that pass you desire, yo•• shall come to those which are such, that it can∣not be taken away or healed without them, which shall be done by orderly helping the defects against nature which were co••jo••ned with the Ulcer, to wit, the rottenness of the bone, which you shall help by actual cauter es; and in the mean while you sha••l draw the Ulcer into another form, to wit, cornered, a••d ••ou shal•• cut away the callous har••ness, and help the rottenness; then must you proc••re the falling away of the Eschar, and then provide for the scaling of the bone by the mea••s formerly prescr be••; lastly the mundified Ulcer must be filled with flesh. For gene∣rating of flesh two causes must co c••rr,* 1.20 th•• efficient, and material; The efficient is, the good tem∣per both o•• the whole bo••y, as also of the Ulcerated part. For, this prevailing, there will be an attraction, digestion, opposition and assim••lation of the laudable j••••ce to the part affected; verily the laudable temper is preserved by like things, but the vicious is amended by cont••aries. The matter to be spent ••pon flesh is laudable ••loo••, which offends neither in quality, nor q••a••t••ty. In this rege••e••ation of the flesh there appear two kinds of excrements, the one more thin and hum••d called Sanies, the other more gross termed Sordes. Both of these for that they are contra∣ry to nature, do therefore hinder the regeneration of flesh, and therefore must be taken away by applying their contraries, as by things drying in the first degree, and more strongly or weakly detergent, accord••ng to the complexion of the part and the whole body, and the plenty and qua∣lity of the excrementitious humor, and the uncleanness of the Ulcer. For the part m••••t be pre∣served by the use of the like, but the Ulcer orecome by application of things contrary thereto. After that by natures endeavour and the Chirurgeons help the ulcer is replete with flesh, ••t must be cicatrized,* 1.21 that is, covered w••th a callous skin in stead of the true and native skin. It may be cicatrized by strewing of very drying powders having very little or no acrimony. Thus Alum and Vitriol being burnt and made into powder,* 1.22 and thinly strewed upon the part do quickly c••ca∣trize the former fleshy work. To this purpose also serve, the root of Aristolechia, Aloes, burnt Lead, Pomegranat pills burnt, Litharge, Tutia, and also plates of Lead besmeared with quick∣silver, whose efficacy for this purpose Chirurgeons sometimes find more certain and powerfull than any other remedies.

CHAP. V. Of a distempered Ulcer.

* 1.23BEfore we speak of a distempered ulcer, it is meet, lest that the Chirurgeon take one distem∣per for another, briefly to relate the signs of each. You may know that an ulcer is associa∣ted with a dry distemper by your sight, as if the ulcer be as it were wrinkled, if it send forth little or no moisture;* 1.24 also it is known by touch, if it feel rough and hard. You shall correct this distemper by humecting medicins, as fomenting it with warm water according to Galens opinion, or else with Hydnelaeum (i.) Oil and water mixt: but alwayes you must first purge, if the body shall abound with ill humors, or use Phlebotomie if the body be plethorick; otherwise you shall draw more humors into the part than it can bear. Now you shall so long foment it, untill the

flesh which is about it begin to look red, wax sort and moist, and the part it sel•• be a little ••o••. If you proceed further, you will resolve all the humor which you have drawn thither, and so your labour is in vaine. After the fomentation, apply such a remedy to the ulcerated part. ℞. crem••ris hordei ℥ij. fol. malvae in aq. coct. ℥j. pingued. perci ℥i ss. m••llis com. ℥ ss. misce in m••rtario, & fiat un∣guentum.

You shall know a moist distemper associates the ulcer by the plenty of the excrementitious hu∣mor, which the ulcer sends forth,* 1.25 by the spongy and fungous softnesse and growth of the flesh about it. You shall amend this by drying remedies, such as those are, which we term Sarcoticks, having alwaies regard to the plenty of the humor, the proper temper of the part, and other in∣dications formerly mentioned. Amongst other remedies Galen much commends Alum water,* 1.26 for it dries, clenses and corroborates the affected part. Also this ensuing fomentation may be apply∣ed to good purpose. ℞. rosar. rub. absinth. beton. tapsi barbati an. m. j. gallarum, nucum cupressi, an. ʒ j. aluminis r••chae ʒj. fiat decoctio in vino austero, instituatur fotus.* 1.27 Then let Empl. de cerussa or de minio be applyed to the ulcer. Also I have found by experience that the powder of burnt alum l ghtly strewed upon the ulcer is very effectual in this case. You shall know that an hot distemper associates the ulcer by the redness, or yellowness thereof, by the heat manifest to your touch, and the propriety of your pain. Then must you have recourse to refrigerating things, such as Ung. R••satum Mes. Refrigerans Gal. Populeon; stoops and clothes dipped in Plantain water, Night∣shade water, or Oxycrate. I have oft found by experience that scarification, or Leaches being ap∣plyed, did more conduce than any other remedie. For so the chafed blood, which by that means is apt to corrupt, is drawn away, and the part it self is also freed of that burden.

We know a cold distemp••r by the whitish or pale colour, by the touch of the Chirurgeon,* 1.28 and speech of the Patient complaining of the coldnesse of the ulcerated part. You shall correct this by applying and putting bottles filled with water about the part, or else swines bladders half-filled with the following decoction. ℞. origani, pulegii, chamaem. meliloti, an. m. j. absinth. majoranae, sal∣viae, rorismar. an. m. ss. fiat. decoctio in vino generoso, addendo aquae vitae quod sufficit. Also the Ulcer may be conveniently fomented with spunges dipped in the same decoction, and let there be ap∣plyed thereto Empl. Oxycroceum; emp. de meliloto; de Vigo cum mercurio, and sine mercurio. But if a mixt and compound distemper be joined to the Ulcer, the medicins must in like manner be mixt and composed. The residue of the Chirurgeons care and pains must be spent upon the proper and pe∣culiar cure of the Ulcer, as it is an Ulcer; which we said in the former Chapter was contained in detersion, regenerating flesh, and cicatrization thereof.

CHAP. VI. Of an Ulcer with pain.

THere oft-times so great pain accompanieth Ulcers, that it calls thereto the counsell of the Physitian. Wherefore if it proceed from any distemper, it shall be taken away by reme∣dies proper against that distemper, such as we mentioned in the former Chapter. But if it do not so cease, we must go on to Narcoticks. Such are cataplasms of the leaves of Mandrakes, Water lillies, Henbane, Nightshade, Hemlock, the seeds of Poppy and oils of the same;* 1.29 to which also may be added Opium, Populeon, and other things of like faculties. But if a malign acrimony and virulency of an humor corroding and eating the flesh lying under it and the lips about it, cause and make the pain, you shall neither asswage it by Anodynes, nor Narroticks; for by application of gentle medicins it will become worse and worse.* 1.30 Wherefore you must betake you to Cathae¦ret cks; For strong medicins are fittest for strong diseases. Wherefore let a Pledget dipped in strong and more then ordinarily powerful Aegyptiacum, or in a little oil of Vitriol, be applyed to the Ulcer; for these have power to tame this raging pain, and virulent humors. In the mean season let refrigerating things be put about the Ulcer; lest the vehemency of acrid medicins cause a defluxion.

CHAP. VII. Of Ulcers, with overgrowing or proudness of flesh.

ULcers have oft-times proud or overgrowing flesh in them,* 1.31 either by the negligence of the Chirurgeon, or fault of the Patient. Against this, drying and gently eating or con∣suming medicins must be applyed; such as are Galls, cortex thuris, Aloes, Tutia, Antimo∣ny, •• mpholix, Vitrioll, Lead, all of them burnt and washt if need require. Of these powders you may also make ointments with a little oil and wax; but if the proud flesh, as that which is hard and dense, yeeld not to these remedies, we must come to causticks, or else to iron, so to cut it off. For in Galens opinion, the taking away of proud flesh is no work of nature, (as the generating,* 1.32 restoring and agglutinating of the flesh is) but it is performed by medicins which dry vehemently, or else by the hand of the Chirurgeon; wherefore amongst the remedies fit for this operation, the powder of Mercury with some small quantity of burnt Alum, or burnt Vitriol alone, seem very effectual to me. Now for the hard and callous lips of the Ulcer, they must be mollified with medicins which have such a faculty, as with Calves, Goose, Capons or Ducks grease,* 1.33 the oils of

Lillies, sweet Almonds, Worms, Whelps, Oesipus, the mucilages of Marsh-mallows, Linseed, Fae∣nugreek seed, Gum Ammoniacum, Galbanum, Bdellium, of which being mixed may be made Em∣plaisters, unguents, and liniments: or you shall use Empl. Diachylon, or de Mucilaginibus, De Vi∣go cum mercurio. To conclude, after you have for some few dayes used such like remedies, you may apply to the Ulcer a plate of Lead, rubbed over with Quicksilver; for this is very effectual to smooth an Ulcer and depresse the lips: if you shall prevail nothing by this means, you must come to the causticks, by which if you still prevail nothing, for that the lips of the Ulcer are so callous that the causticks cannot pierce into them, you must cleave them with a gentle scarifi∣cation, or else cut them to the quick, so to make way, or as it were open a window, for the me∣dicin to enter in, according to Galen. Neither in the interim must you omit Hippocrates his ad∣vice,* 1.34 which is, that by the same operation we reduce the Ulcer, if round, into another figure, to wit, long or triangular.

CHAP. VIII. Of an Ulcer putrid and breeding Worms.

* 1.35WOunds are divers times bred in ulcers, whence they are called Wormy ulcers; the cause hereof is the too great excrementitious humidity prepared to putrefie by unnatural and immoderate heat. Which happens, either for that the ulcer is neglected, or else by reason of the distemper and depraved humors of all the body, or the affected part; or else for that the excrementitious humor collected in the ulcer, hath not open and free passage forth; as it happens to the ulcers of the ears, nose, fundament, neck of the womb, and lastly, to all sinuous and cuniculous ulcers. Yet it doth not necessarily follow that all putrid ulcers must have worms in them; as you may perceive by the definition of a putrid ulcer which we gave you before. For the cure of such ulcers after generall means, the worms must first be taken forth, then the excre∣mentitious humor must be drawn away, whence they take their original. Therefore you shall foment the ulcer with the ensuing decoction, which is of force to kill them; for, if any labour to take forth all that are quick, he will be much deceived; for they oft times do so tenaciously ad∣here to the ulcerated part, that you cannot pluck them away without much force and pain. ℞. absinth. centaur. majoris, marrubii, an. M.j. fiat decoctio ad lb. ss. in qua dissolve aloes ℥ ss. unguenti Ae∣gyptiaci ℥ j.* 1.36 Let the ulcer be fomented and washed with this medicin, and let pledgets dipped herein be put into the ulcer; or else, if the ulcer be cuniculous or full of windings, make injec∣tion therewith which may go into all parts thereof.

* 1.37Achigenes much commends this following medicin. ℞. Cerusae, polii montani, an. ℥ ss. picis nava∣lis liquidae quantum sufficit, misce in mortario pro linimento. If the putrefaction be such that these medicins will not suffice for the amendment thereof, you must come to more powerful, or to cau∣teries also, or hot Irons, or to Section; yet you must still begin with the more gentle, such as this of Galen's description. ℞. cerae, ℥ij. cerusae ℥ j. olei ros. ℥ij. salis ammon. ℥ ss. squam aeris ʒij. thur∣alum. arug. malicor. calcis vivae, an. ʒ j. fiat emplastrum. Or lb. terebinth. lotae ℥ij. cerae albae ℥ ss. lique∣fiant simul addendo sublimati, ʒ ss. salis torrefacti, & vitrioli calcinati, an. ℥ j. fiat mundificativum. Or you must use our Aegyptiacum alone, which hath Sublimate entring into the composition thereof; but in the interim the circuit of the Ulcer must be defended with refrigerating and defensative things for fear of pain.

CHAP. IX. Of a sordid Ulcer.

A Sordid Ulcer after the cure of the body in general, shall be healed with detergent medi∣cins; the indication being drawn from the gross and tough excrement, which with the excrementitious sanies, as it were besieging, and blocking up the ulcerated parts, wea∣kens and as it were duls the force of medicins though powerful,* 1.38 which causeth us to begin the cure with fomentations and lotions, as thus. ℞. Lixivii com. lb. j. absinth. marrub. apii, centaur. utrius∣que, hypericonis, an. M. ss. coquantur, colaturae, quae sufficiat, adde mellis rosati ℥j. unguenti Egyptiaci ℥ ss. fiat fotus. Then use the following detersive medicin: R. succi apii, & plantag. an. ℥ij. mellis com. ℥ j. terebinth. ℥ i ss. pul. Ireos Florent. & aloes an. ℥ss. fiat medicamentum. The Chirurgeon must well consider, at how many dressings he shall be able to wash away the grosse sordes, or filth stick∣ing close to the Ulcer, and dry up the excrementitious sanies. For oft times these things may be done at one dressing; but in others who have more quick sense or feeling, not so soon. But when the Ulcer is freed of such gross Sordes or filth, you must forbear to use more acrid things for fear of pain, defluxion, inflammation, and erosion, whereby the Ulcer would become more hollow. Wherefore then we shall be content to apply remedies which dry and cleanse without acrimony that we may so help natures endeavours in generating flesh.* 1.39 Such remedies are, the powders of Aloes, Mastich, Myrrh, Orris, Litharge, Antimony, roots of Gentian, Barly flower, and the like, which being strewed upon the Ulcer, you shall cover it with Lint, and put over that a plate of Lead, rubbed over with quicksilver; and you shall put on these detersives and desiccatives more or less strong, as you shall find it requisite and necessary. For the too plentiful use of drying and

detersive things, doth in time hollow the Ulcers,* 1.40 whereby it comes to pass that in short time in like sort, a greater quantity of Sanies flowes from the Ulcer, the proper substance of the flesh being dissolved by the force or acrimony of detersive medicins; as also the proper alimentary humor, which flowed to the part, being in like sort defiled: which thing beguiles the unskilfull Chirurgeon. For by how much he sees the Ulcer flow more plentifully with Sanies, he endeavours by so much the more to exhaust and dry up with more acrid medicins these humidities, as if they were excrementitious:* 1.41 But Galen hath long agoe admonished us to take heed hereof, setting forth a History of a certain Emperick who dressing a sordid Ul∣cer with a green, acrid and eating medicin, dissolved the flesh; and so consequently made the Ulcer more hollow, and caused more pain and defluxion; whereby it hapned, that con∣tinually adding more acrid medicins, he continually (by his ignorance and unskilfulness) increa∣sed the colliquation of the flesh, the largeness of the ulcer and excrementitious humidity: Where∣fore we must take special care whether the sordid Ulcer growes each day worse, by its proper fault, and the impurity of the whole body besides, or else by the colliquation of the flesh, and corruption of the benign and alimentary humor sent thither for the nutrition of the part, by the too frequent and unskilfull use of too acrid a medicin. You may conjecture this by the increase of the pain without reason, and by the heat and redness of the lips of the Ulcer. Therefore you must principally have regard to this; that you give each of your Patients his fit measure;* 1.42 that is, a convenient and agreeable medicin to each of their strengths, taking indication from the strength, distemper, and consistence of the whole body and affected part; for there is a great deal of difference whether you apply a medecin to a plow-man or labourer, or to an Eunuch and woman; or whether to the leg or eyes: For these medecins which to a dense and hard body and part are only detergent and drying, the same are to delicate and tender bodies and parts cathae∣retick and eating, by colliquation of the flesh, and corruption of the nourishment, making an in∣crease of Sordes or filth; on the contrary, those things which do laudably and sufficiently cleanse the flesh in a soft body, and dry up the Sanies, these same things applyed to a hard body, encrease the Sordes and Sanies by suffering them to breed, neither are they of sufficient power to wash away the tenacious impurity of a dense body. Wherefore the skilfull Chirurgeon will see when he must betake himself from too strongly cleansing and eating medicins, to these which are more milde.

CHAP. X. Of a virulent, eating and malign Ulcer, which is tearmed Cacoethes, and of a Chironian Ulcer.

VIrulent and eating Ulcers differ not, unless in magis and minus,* 1.43 for we tearm it a virulent Ulcer, which sends forth a virulent sanies, which is properly called Virus. This Virus, or virulency, when it becomes more malign, gnawes and feeds upon the parts which lie under, and are adjoyning to the Ulcer, and makes an eating Ulcer. Such Ulcers are by Galen cal∣led Dysepulotica, that is, difficultly to be cicatrized; for, saith he,* 1.44 it happens that the Ulcer is Dysepulotick, either for that the part affected may be vitiated, either in the habit or temper thereof, so that it may corrupt the humor which flowes thither; such an Ulcer is by a particular name tearmed Cacoethes; or for that by reason of the evil quality of the blood flowing thither and eating the part, the part affected being too moist cannot heal up. He further adds,* 1.45 that a Chi∣ronian Ulcer is far more malign than these Ulcers, which are termed Cacoethe. For the cure; by reason that all these Ulcers have a large extent, for some are more malign and ill to be cicatrized than other some, it is also necessary to have divers medicins ready and at hand, distinct both in their faculties and the degrees thereof, so that it is no marvail if they oft fail of their purpose, who with the same medicin dress (and think they shall heal) all malign Ulcers. This following medicin described by Asolepiades, is much commended by Galen. ℞. squammae aeris, aeruginis, rasae, an.* 1.46 ℥j. cerae lb. ss. resinae laricis ℥ j ss. quae liquari possunt aridis affundantur, and make an emplaster to be laid only upon the Ulcer; for you must lay a defensative about the Ulcer, for fear of inflamma∣tion. But Galen saith, that the following Epulotick of Primion excells the rest, as that which to desperate Ulcers (which many have taken in hand and left as uncurable,) was of certain and ap∣proved use. ℞. soreos ℥iij. aluminis scissilis; calcis vinae, an. ℥ij. thuris gallarum, an. ℥ iiij. cerae. lb. j.* 1.47 & ℥iij. sevi vitulini lb. j. & ℥vij. olei veteris quantum sufficit, fiat emplastrum.

CHAP. XI. An Advertisement to the young Chirurgeon, touching the distance of times wherein malign Ulcers are to be dressed.

TO shew the use of Asclepiades his medicins, described in the former Chapter,* 1.48 and con∣vince the error of these Chirurgeons, who think they do well for their Patients, if they twice or thrice on a day dress malign ulcers; I have here thought good to digress a little from my purpose, and to interpose Galens authority. Rightly (saith Galen) hath Ascle∣piades added these words to the formerly described medicine: And loose this after three

dayes, and foment the Ulcer, and fasten the same emplaster being washed, and apply it again; for unless the medicin adhere long to the skin, it will do no good. Which thing notwithstanding many Physitians have been ignorant of; thinking, if they wiped away the sanies from the Ulcer thrice on a day, they should do better than those who did the same but twice a day. But those who dress it but once a day, are reproved by the Patients, as negligent. But they are much mista∣ken; for you must remember, as we have delivered in most of our writings, that the qualities of all neighbouring bodies do mutually actuate and affect each other in some degree, although the one thereof be much more powerfull; for by this reason in space of time they become somewhat alike, though they otherwise differ much: But when the quality of the medicin shall be like the species to the body to be cured, there follows the better success. Wherefore he which moved by these reasons, first appointed to use the emplaister formerly applyed, is wor∣thy of commendations; and we ought to follow him much the rather, seeing that which he found out by reason, is approved by experience. Neither did he unadvisedly command, to fo∣ment the wound every third day, that is, every dressing; for, seeing it is a powerfull medicin, therefore it stands in need of mitigation. Thus much Galen, whose opinion grounded on reason, he can again confirm with another reason.* 1.49 It is already sufficiently known, that medicins can do nothing in us unless by the force of the native heat, which stirs up the faculty of the medicin to operation. But in Ulcers which are absolutely malign, the native heat of the affected part is very languid, being broken and debilitated by the presence of the preternatural heat; so that it stands in need of a great space of time to actuate the vertue and faculty of the medicin. Wherefore, if in that time, when as the native heat hath much moved and stirred up the faculty of the medicin, the Ulcer be loosed or opened, and that emplaister cast away which was laid upon the part, and a fresh one laid in stead thereof; the heat implanted in the part, is either dissipated by the contact of the air, or is weakned and driven in; and that endeavour which was made by the emplaister was to no purpose, being as it were stopped in the midst of the course: But a new emplaister being laid on, the heat of the part must undergo a new labour, so to stir up the faculty to bring it to act.

* 1.50For all medicins are, what they are in faculty. Equal to this is their error, who by too oft re∣newing their emplaisters on the same day, do too powerfully cleanse; for so they do not only take away the excrementitious humors, both sordes and sanies, but also the alimentary juice; to wit, the Rob, Cambium, and Gluten, which are the next matter for procreating of laudable flesh. Wherefore, it is not good to dress Ulcers so often in one day, and to loose them to apply new emplaisters, unless some grievous symptom (as pain) force us to do it, which requires to be asswa∣ged and mitigated by the often changing and renewing of Anodyne medicins.

CHAP. XII. How to binde up Ulcers.

* 1.51FOr the binding up of Ulcers, you must alwayes begin your bandage at the Ulcer. Now the Rowler must be so large, that it may not only cover and comprehend the Ulcer, but also some portion of the adjacent parts above and below; and let it press the Ulcer with that moderation, that it may only press out the excrementitious humors. For so the Ulcer will be∣come dry, and consequently more neer to healing, as it is observed by Hippocrates. Let this be the measure of your binding, that it be neither too strait, for hence would ensue pain and defluxion; nor too lax, for such is of no use. You may moisten your boulsters and Rollers in Oxycrate, or in red and astringent Wine, especially in Summer; when you have bound it up; the part must be kept quiet: For according to Hippocrates, those who have an Ulcer in the leg, ought neither to stand nor sit, but to lye on a bed. Wherefore, when the legs are ulcerated, the arms must be exercised, by handling,* 1.52 lifting up and casting down of divers things. But on the contrary, if the arms be ulcera∣ted, the legs must be exercised with walking, or frictions from above downwards, if the Patient cannot endure to walk. So the humors and spirits which with more violence and greater plenty run down to the part affected, may be drawn back and diverted.

CHAP. XIII. Of the cure of particular Ulcers, and first of those of the Eyes.

* 1.53FOr that (in Galens opinion) the divers indications in curing diseases are drawn from the condition of the part, to wit, the temper, complexion, site, figure, use, dull or quick sense; Therefore having briefly handled the general cure both of simple and compound, and implicit Ulcers, I think it fit to treat of them now as they are distinguished by the parts, begin∣ning with these of the eyes. These according to Celsus, are sometimes caused by pustules, or a sharp defluxion which frets or eats in sunder the coats thereof, or else by a stroak.

* 1.54Paulus sets down these differences of the Ulcers of the eyes; If (saith he) a small, little and hol∣low Ulcer be upon the horny-coat, it is by the Greeks tearmed Botryon; but if it be broader and less deep, it is termed Caeloma; about the circle of the Iris or Rainbow, it is called Argemon. If it be crusty and sordid, it is termed Epicauma. These in general require the same cure as the former, that

is, to be mundified, incarnated, dryed and cicatrized; but the part affected indicates more gen∣tle medicins. Wherefore having purged the Patient and taken some blood both from his arm,* 1.55 as also from his veins and temporall Arteries, and bathed him if it be needful, to divert the defluxi∣on, you shall to his shoulders apply cupping-glasses with scarification; or else bread newly drawn out of the oven, and sprinkled with aqua vitae; or some good wine shall be applyed to the original of the spinall marrow.* 1.56 But you shall apply to the forehead and temples an astringent emplaister made of emplastrum contra rupturam, ung. Cemmitissae, and resiccativum rubrum mixed together. But this ensuing Collyrium described by Celsus and approved by Hollerius, shall be dropped into the eye. ℞ aeris usti, cadmiae ustae & lotae, an. ℥j. ex aqua fingatur collyrium quod liquore ovi dislolvatur. But in the mean time you must diligently observe whether you put the eye to any great pain. Wherefore now and then by putting anodyne medicins thereto, it will be good to comfort it. Also you may make collyria of the decoction of Plantain, faenugreek, wormwood, with a little quantity of Sugar-candy, tutia, gum tragacanth, myrrh and vitrioll dissolved therein. When the ulcer is mundified,* 1.57 the following sarcotick will be of good use. ℞. sarcocollae in lacte muliebri nutritae, ʒiij. pul. diaire∣os simplicis, gum. arabici, tragacanth. an. ʒ ss. mucilaginis faenugraeci quantum sufficit ut inde fiat colly∣rium. But you must note, that for moist ulcers, powders are more convenient than Collyria. When the ulcer is plained or filled with its proper flesh, it may be cicatrized with the following collyrium.* 1.58 ℞. tutiae; cadmiae ut decet praeparatae, cerusae, antimonii, olibani, an. ʒ ss. myrrhae, sarcecollae, sanguinis Draconis, aloes, opii, an, ℈ ss. cum aqua plantaginis fiat collyrium; or the powder only may be conveni∣ently strewed thereon.

Celsus hath noted that the cicatrizing of the eyes is incident to two dangers; that is, lest they be too hollow, or else too thick. If too hollow, they must be filled by the following remedy;* 1.59 ℞ Papaveris lachrymae, ʒ ss. sagapeni, opopanacis, an. ʒ ss. aeruginis ʒj. cumini ʒ iij. piperis ʒ ij. cadmiae lotae & cerusae, an. ʒiss. cum aqua pluviali fiat collyrium. But if the scars be thick or gross, the fol∣lowing remedy will extenuate them. ℞ cinamom. acaciae, an. ʒ ss. cadmiae elotae, croci, myrrhae, papaveris lachrymae, gum. arabici, an. ʒ j. piperis albi, thuris, an. ℥iss. aeris combusti, ʒ iij. cum aqua pluviali fiat collyrium. But if the scar be upon the cornea or horny coat, so that it cover the pupilla or sight,* 1.60 the sight will be intercepted by the denseness of the membrane. Here you must also observe, that the scars that are on the Cornea are white, but these on the Adnata are red, because this is spread over with more little veins than that.

CHAP. XIV. Of the Ozaena and Ulcers of the Nose.

THe Ozoena is a deep and stinking ulcer in the inside of the nose,* 1.61 sending forth many crusty and stinking excrements: Celsus saith that such ulcers can scarsly be healed. It is caused (as Galen saith) by the distillation of acrid and putrid humors from the head into the nostrils about the mammillary processes. For the cure, the Patient must eat sparingly, and his meat must neither be sharp nor strong; the humor being prepared must be purged; the head dryed and strengthened, that so it may neither admit the excrementitious humors, nor send them down; then must we come to the part affected with the ulcer. The ulcer must be dryed with a repelling medicine; such as is the juice of Pomegranats boiled to the half in a brass vessel; the powder of Calamint, Cresses, white Hellebore, the juice of Cresses with Alum and other things which you may read in Celsus. Galen out of Archigenos wishes, to draw up into the nostrils the juice of Calamint, or that the Calamint it self being dryed, and made into powder, may be blown with a quill into the nose. Others use this following powder. ℞ ros. rub. mint. calam. arom. rad.* 1.62 angelicae, gentian. macis, cariop. an. ʒ ss. camph. ambrae, an. gr. iiij. mosch. gr. vj. fiat pulvis subtilissimus. Manardus writes, that the Urine of an Asse, though a nasty medicine, is an excellent remedy in this affect. But if the inveterate and contumacious evil do not yield to these remedies, then you must have recourse to Coperas, Verdigreece, sal ammoniacum, and Alum with Vinegar. It divers times happens, that the ulcer spreading on, comes to take hold of the Ossa ethmoidaea or sive-like bones; in which case, you must not forcibly pluck them out, but refer the whole business to nature, and expect when they shall come away of themselves, making in the mean while injections into the nostrils, of aqua vitae, wherein Cephalick powders have been steeped for the greater drying.

CHAP. XV. Of the Ulcers of the Mouth.

OF this tribe are the Aphthae, ulcers familiar to little children, according to Hippocrates.* 1.63 They oft-times begin in the gums, and by the palat of the mouth creep into the uvula, throtle, and over all the mouth, as Ceisus saith. Galen makes two kinds of Aphthaes; the one of easie cure, such as that which usually troubles children by reason of the acrimony of the nurses milk; the other is malign by reason of an afflux of an evil humor (that is, venenate and malign) into the mouth. For the cure, it shall be good to abstain from all acrid thngs,* 1.64 and if it be a sucking childe, it will not be amiss to temper the nurses milk with refrigerating meats, bathing

the whole body, and fomenting the dugs with warm water; for all the members in children are most tender, and as it were mucous, and their mouths are unaccustomed to meats and drinks. For topick medecins, you must make choice of such, which may quickly and readily work the effect; for here the condition of the affected part is such that they cannot long remain and adhere thereto. Therefore if the ulcer be malign, it must be lightly touched with aqua fortis, which hath been used in separating metals, and which besides is tempered with six parts of com∣mon water. You may for the same purpose use the oyls of Vitriol, Sulphur, Antimony, Mercury water and the like. Aetius wishes you to touch and correct such ulcers with a lock of wooll dip∣ped in scalding oil, and so fastned to the end of a probe, untill they wax white and become smooth or plain: For so their eating and spreading force will at length be bridled, and laudable flesh grow up in place of that which is eaten. After such burning, it will be good to wash the mouth with the following gargarism, which also of it self alone will serve to cure Aphthaes, which are not malign. ℞ hordei integri p. j. plantag. ceterach. pilosellae, agrimoniae, an. M. j. fiat decoctio ad lb j. in qua dissolve mellis rosati ℥j. diamoron. ℥ss. fiat gargarisma. You may also make other gargles, of Pomegranate pills,* 1.65 Baulastines, Sumach, Berberies, red Roses being boyled, and dissolving in the strained liquor Diamoron and Dianucum, with a little Alum: For Galen writes, that simple ulcers of the mouth are healed with things which dry with moderation;* 1.66 now Diamoron and Dianucum are such. But others stand in need of strong medecins, with such like. If the palat be seised upon, we must use the more diligence and care;* 1.67 for there is danger, lest (being the part is hot and moist) the bone (which lies under which is rare and humide) may be corrupted by the contagion, and fall away; and the voice or speech be spoiled. If the ulcer be pocky, omitting the common remedies of ulcers, you must speedily betake your self to the proper antidote of that disease, to wit, quick-silver. Fistulous ulcers often take hold on the Gums, whence the root of the next tooth becomes rotten; and so far, that the acrimony of the Sanies oft-times makes its self a passage forth on the outside under the chin; which thing puts many into a false conceit of the scrophula or Kings-evil, and consequently of an uncurable disease. In such a case Aetius, and Celsus counsel is, to take out the rotten tooth,* 1.68 for so the Fistula will be taken away, the Gum pressing and thrusting its self into the place of the tooth; which was taken forth; and so the cause nourishing the putrefaction being taken away, (that is, the tooth) the rest of the cure will be more easie. The ulcers of the tongue may be cured by the same remedies by which the rest of the mouth; yet those which breed on the side thereof endure very long, and you must look whether or no there be not some sharp tooth over against it, which will not suffer the ulcer in that place to heal; which if there be, then must you take it away with a file.

CHAP. XVI. Of the Ulcers of the Ears.

ULcers are bred in the auditory passage both by an external cause, as a stroak, or fall; as also by an internal, as an abscess there generated. They oft-times flow with much matter not there generated,* 1.69 for such ulcers are usually but small, and besides in a spermatick part; but for that the brain doth that way disburden its self.

For the cure, the chief regard must be had of the antecedent cause, which feeds the ulcer, and it must be diverted by purging medecins,* 1.70 Masticatories, and Errhines. This is the form of a Masti∣catory. ℞. Mastich. ʒj. staphisagr. & pyreth. an. ℈j. cinam. & caryoph. an. ʒ ss. fiant Masticatoria, utatur mane & vesperi.* 1.71 But this is the form of an Errhin. ℞ succi betonic. mercurial. & melissa, an. ℥ ss.* 1.72 vini alli ℥j. misce & frequenter naribus attrahatur. For topick medicins, we must shun all fatty and oily things, as Galen set down in Method. medendi, where he finds fault with a certain follower of Thessalus, who by using Tetrapharmacum, made the ulcer in the ear grow each day more filthy than other, which Galen healed with the Trochisces of Andronius dissolved in Vinegar, whose composure is as followeth. ℞ baulast. ʒij. alumin. ʒj. atrament. sutor. ʒij. myrrhae ʒj. thur. aristol••ch. gallarum, an. ʒij. salis Ammon. ʒj. excipiantur omnia melicrato, & fiant tr••chisci. Galen in the same place witnesseth, that

[illustration]

The figure of a Pyoulcus, or Matter-drawer.

he hath healed inve∣terate ulcers and of two years old of this kind,* 1.73 with the scales of Iron made into pow∣der, and then boiled in sharp Vinegar untill it acquired the consistence of Honey: Moreover an Oxes gall dissolved in strong Vinegar, and dropped in warm, amends and dryes up the putrefaction wherewith these ulcers flow. Also the scales of Iron made into powder, boyled in sharp Vinegar, dryed and strewed upon them. But if the straitness of the passages should not give leave to the matter contained in the windings of the ears to pass forth,* 1.74 then must it be drawn out with an Instrument thereupon called a Pyoulcus, or matter-drawer, whereof this is the figure.

CHAP. XVII. Of the Ulcers of the Wind-pipe, Weazon, Stomach and Guts.

THese parts are ulcerated either by an external cause, as an acrid medicine,* 1.75 or poyson swal∣lowed down; or by an internal cause, as a malign fretting humor, which may equal the force of poyson generated in the body, and restrained in these parts.* 1.76 If the pain be en∣creased by swallowing or breathing, it is the sign of an Ulcer in the Weazon, or windpipe joining thereto. But the pain is most sensibly felt when as that which is swallowed is either four or acrid, or the air breathed in, is more hot or cold than ordinary: But if the cause of pain lye fastned in the stomach, more grievous symptoms urge; for sometimes they swound, have a nauseous disposition and vomiting, convulsions, gnawings, and pain almost intolerable, and the coldness of the extream parts; all which when present at once, few scape unless such as are young, and have very strong bodies. The same affect may befall the whole stomach, but because both for the bitterness of pain, and greatness of danger, that Ulcer is far more grievous which takes hold of the mouth of the Ventricle, honoured by the Ancients with the name of the Heart; therefore Physitians do not make so great a reckoning of that which happens in the lower part of the stomach. Now we know that the Guts are ulcerated, if Pus,* 1.77 or much purulent matter come forth by stool; if blood come that way with much griping; for by the Pus staying and as it were gathered together in that place, there is as it were a certain continual Tenesmus, or desire to goe to stool. Now all such Ulcers are cured by meats and drinks,* 1.78 rather than by medicins, according to Galen: Therefore you must make choice of all such meats and drinks as are gentle, and have a lenitive faculty, shunning acrid things; for Tutia, Lytharge, Ceruse, Ver∣digreece and the like, have no place here, as they have in other Ulcers: But when as the Ulcer shall be in the Gullet or Weazon, you must have a care that such things may have some viscidity or toughness, and be swallowed by little and little, and at divers times; otherwise they will not much avail, because they cannot make any stay, in these common wayes of breath and meat; therefore they presently slip down and flow away;* 1.79 wherefore all such things shall be used in form of an Eglegma, to be taken lying on the back, and swallowed down by little and little, open∣ing the muscles of the throat, lest the medicin passing down suddainly, and in great quantity, cause a Cough, a thing exceeding hurtfull to these kindes of Ulcers. When they must be cleansed, you shall have crude honey, which hath a singular faculty above all other detergent things, in these kinde of Ulcers: But when they can conveniently swallow, you shall mix Gum Tragaganth dissolved in some astringent decoction. In Ulcers of the stomach,* 1.80 all acrid things (as I have for∣merly advised) must be shunned; as those which may cause pain, inflammation and vomit, and be∣sides, hinder the digestion of the meat: Therefore let them frequently use a ptisan, and sugred gellyes wherein Gum Tragaganth, and bole Armeniack have been put, the decoction of Prunes; Dates, Figs, Raisons, Honey, Cowes-milk boyled with the yolks of eggs, and a little common honey. When they are to be agglutinated, it will be convenient to make use of austere, astrin∣gent and agglutinative things, which want all acrimony, and ungratefull taste, such as are Hypo∣cistis, Pomegranate flowers and pills, terra sigillata, sumach, acacia, a decoction of Quinces, the Lentisk wood, the tops of Vines, of brambles, myrtles, made in astringent Wine,* 1.81 unless there be fear of inflammation: Their drink shall be Hydromel water with Sugar, syrup of Violets and Jujubes. Honey mixed with other medicins is a very fitting remedy for Ulcers of the guts and other parts more remote from the stomach; for if you shall use astringent medicins alone of themselves, they will stick to the stomach; neither will they carry their strength any further; but honey mixed with them, besides that it distributes them to the rest of the body, and helps them forwards to the affected parts, also cleanses the Ulcers themselves. Here also Asses milk may with good success be used instead of Goats or Cowes milk: The use of a vulnerary potion is also commendable, if so be that it be made of such hearbs and simples, as by a certain tacit familiarity have respect to the parts affected:* 1.82 But the Ulcers of the Guts have this difference amongst themselves, that if the greater Guts be affected, you may heal them with a Clyster and injections, made also sharp to correct the putrefaction; such as are those which are made of Barly water, or wine with Aegyptiacum. But if the small guts be ulcerated, they must be rather healed by potions and other things taken at the mouth;* 1.83 for that (as Galen saith) these things which are put up into the body by the Fundament, do not commonly ascend to the small or slen∣der guts, but such as are taken at the mouth cannot come unless with the loss of their faculty, so far as the great guts.

CHAP. XVIII. Of the Ulcers of the Kidneyes and Bladder.

ULcers are caused in the Kidneys and Bladder, either by the use of acrid meats, drinks,* 1.84 or me∣dicins, as Cantharides; or else by the collection of an acrid humor, bred in that place, sent or faln thither; or else by the rupture of some vessel, or an abscess broken and degenerated into an Ulcer, as it sometimes comes to pass. They are discerned by their site,* 1.85 for the pain and heaviness

of Ulcers of the Reins comes to the Loins, and the Pus or matter is evacuated well and throughly mixed with the Urine.

* 1.86Neither doth the Pus which flows from the reins stink so ill, as that which is cast forth of the bladder; the reason is, for that the bladder being a bloodless, fleshless and membranous part, hath not such power to resist putrefaction. That Pus which flowes from the Kidneyes, never flowes without water; and although by long keeping in an Urinall, it at length subsides or falls to the bottom, and may be seen separated; yet when it is first made, you may see it perfectly mixed with the Urine; but that Pus which flows from the bladder is oft-times made alone without Urine; and usually it comes to pass that the Pus, or matter which flowes from the ulcerated Kidneyes hath in it certain caruncles, or as it were hairs, according to the rule of Hippocrates. Those who in a thick Urine have little caruncles, and as it were hairs come forth together there∣with, they come from their Kidneyes; but on the contrary, those who have certain bran-like scales come from them in a thick Urine, their bladder is scabby or troubled with a scabby Ulcer.

* 1.87For the cure; it is expedient that the belly be soluble either by nature or Art, and the use of mollifying Clysters. And it is good to vomit sometimes, so to draw back the humors by whose conflux into the affected part the ulcer might be fed and made more sordid and filthy.* 1.88 You must beware of strong purgations, lest the humors being moved and too much agitated, the matter fit to nourish the Ulcer may fall down upon the kidnies or bladder. The ensuing potion is very ef∣fectual to mund••fie those kind of Ulcers.* 1.89 ℞. Hordei integri, M. ij. glycerrhizae ras. & contus. ℥ss. rad. •••• ••sa & petr••s••l. an. ʒvj. fiat decoctio ad lb. j. in colaturâ dissolve mellis dispum. ℥ij. Let him take every morning the quantity of four ounces. Gordonius exceedingly commends the following Tro∣chisces.* 1.90 ℞. quatuer sem. frig. maj. mundatorum, sem. papaveris albi, sem. malvae, portul. cydon. baccarum myrti, tragac. mi••. gum. arab. nucum pinearum mund. pistach. glycerrhizae mund. mucilaginis sem. psi••ii, amygd. du••c. hordei mund. an. ʒij. bol. armeni. sang. drac. spodii, rosarum, myrrhae, an. ℥ ss. excipiantur hydromelite, & fingantur trechisci singu••i ponderis ʒij. Let him take one thereof in the morning dissolved in Barley-water or Goats-milk. Galen bids to mix honey and diuretick things with me∣dicines made for the Ulcers of the reins and bladder, for that they gently move urine, and are as vehicles to carry the medicines to the part affected. Ulcers of the bladder are either in the bottom thereof,* 1.91 or at the neck and urinary passage. If they be in the bottom, the pain is almost continual; if in the neck, the pain then pricks, and is most terrible when they make water and presently after. The Ulcer which is in the bottom sends forth certain scaly or skinny excre∣ments together with the urine; but that which is in the neck, causes almost a continual Tentigo. Those which are in the bottom are for the most part incurable,* 1.92 both by reason of the bloodless and nervous nature of the part, as also for that the ulcer is continually chased and troubled by the acrimony of the urine, so that it can hardly be cicatrized. For even after making of water some reliques of the urine alwayes remain in the bottom of the bladder, which could not therefore pass forth together with the rest of the urine, for that for the passing forth of the urine, the bladder being distended before, falls and is complicated in its self. Ulcers of the bladder are healed with the same medicins as those of the reins are; but these not only taken by the mouth, but also injected by the urinary passage. These injections may be made of Gordonius his Tro∣chisces formerly prescribed, being dissolved in some convenient liquor; but because Ulcers of the bladder cause greater and more sharp pain than those of the Kidnies; therefore the Chirur∣geon must be more diligent in using Anodynes. For this purpose, I have often by experience found, that the oil of henbane made by expression, gives certain help. He shall do the same with Cataplasms and Liniments applyed to the parts about the Pecten and all the lower belly and peri∣naeum,* 1.93 as also by casting in of Clysters. If that they stink, it will not be amiss to make injection of a little Aegyptiacum dissolved in wine, plantain, or rose-water. For I have often used this reme∣dy in such a case with very prosperous success.

CHAP. XIX. Of the Ulcers of the Womb.

* 1.94ULcers are bred in the womb, either by the conflux of an acrid, or biting humour, fretting the coats thereof, or by a tumour against nature degenerating into an abscess, or by a difficult and hard labour; they are known by pain at the perinaeum, and the efflux of Pus and Sanies by the privity.* 1.95 All of them in the opinion of Avicen, are either putrid, when as the S••nies breaking forth is of a stinking smell, and in colour resembles the water wherin flesh hath been washed;* 1.96 or else sordid, when as they flow with many virulent and crude humours; or else are eating or spreading Ulcers, when as they cast forth black Sanies, and have p••lsation joyned with much pain. Besides they differ amongst themselves in site, for either they possess the neck and are known by the sight, by putting in a speculum, or else are in the bottom, and are manifested by the condition of the more liquid and serous excrements, and the site of the pain.* 1.97 They are cured with the same remedies wherewith the Ulcers of the mouth, to wit, with aqua fortis, the oil of Vitriol and Antimony, and other things made somewhat more milde, and corrected with that moderation, that the ulcerated parts of the Womb may be safely touched with them; it is requisite that the remedies which are applyed to the ulcers of the womb, do in a moment that which is expected of them, for they cannot long adhere or stick in the

womb, as neither to the mouth. Galen saith,* 1.98 that very drying medicins are exceeding fit for ulcers of the womb, that so the putrefaction may be hindred or restrained, whereto this part as being hot and moist is very subject; besides that the whole body, unto this part, as unto a sink, sends down its excrements. If an ulcer take hold of the bottom of the womb, it shall be cleansed, and the part also strengthened, by making this following injection. ℞. hordei integri p. ij. guajaci ℥j.* 1.99 rad. Ireos. ℥ss. absinth. plant. centaur. utriusque, an. M. j. fiat decoct. in aqua fabrorum ad lb ij. in quibus dissolve mellis rosati, & syrupi de absinthio, an. ℥iij. fiat injectio. For amending the stinking smell, I have often had certain experience of this ensuing remedy. ℞. vini rab. lb.j. unguent. aegyptiaci ℥ij. bulliant. parum. Thus the putrefaction may be corrected,* 1.100 and the painfull maliciousness of the humor aba∣ted. Ulcers when they are cleansed, must presently be cicatrized; that may be done with Alum water, the water of Plantain wherein a little Vitriol or Alum have been dissoved. Lastly, if reme∣dies nothing availing, the ulcer turn into a cancer, it must be dressed with anodynes and remedies proper for a Cancer, which you may finde set down in the proper treatise of Cancers. The cure of Ulcers of the fundament was to be joined to the cure of these of the womb; but I have thought good to referre it to the treatise of Fistulaes, as I do the cure of these of the urinary passage to the Treatise of the Lues Venerea.

CHAP. XX. Of the Varices, and their cure by cutting.

A Varix is the dilatation of a vein, some whiles of one and that a simple branch,* 1.101 other whiles of many. Every varix is either straight or crooked, and as it were infolded into certain windings within its self. Many parts are subject to Varices, as the temples, the region of the belly under the navil, the testicles, womb, fundament, but principally the thighs and legs. The matter of them is usually melancholy blood,* 1.102 for Varices often grow in men of a melancholy temper, and which usually feed on gross meats, or such as breed gross and melancholy humours. Also women with childe are commonly troubled with them, by reason of the heaping together of their suppressed menstrual evacuation.* 1.103 The precedent causes are a vehement concussion of the body, leaping, running, a painfull journey on foot, a fall, the carrying of a heavy burden, torture or racking. This kinde of disease gives manifest signs thereof by the largeness, thickness,* 1.104 swelling and colour of the veins. It is best not to meddle with such as are inveterate;* 1.105 for of such being cured there is to be feared a reflux of the melancholly blood to the noble parts, whence there may be imminent danger of malign Ulcers, a Cancer, madness or suffocation. When as many Va∣rices and diversly implicit are in the legs, they often swell with congealed and dryed blood, and cause pain, which is increased by going and compression.* 1.106 Such like varices are to be opened by di∣viding the vein with a Lancet, and then the blood must be pressed out, and evacuated by pressing it upwards and downwards; which I have oft-times done, and that with happy success to the Patients, whom I have made to rest for some few dayes, and have applyed convenient medicins. A varix is often cut in the inside of the leg a little below the knee, in which place commonly the originall thereof is seen. He which goes about to intercept a varix downwards from the first originall and as it were fountain thereof, makes the cure far more difficult. For hence it is divided as it were into many rivulets, all which the Chirurgeon is forced to follow.

A varix is therefore cut or taken away so,* 1.107 to intercept the passage of the blood and humours mixed together therewith, flowing to an ulcer seated beneath; or else lest that by the too great quantity of blood, the vessel should be broken, and death be occasioned by a haemorrhagie pro∣ceeding from thence. Now this is the manner of cutting it. Let the Patient lye upon his back on a Bench or table, then make a Ligature upon the leg in two places the distance of some four fingers each from other, wherein the excision may be made, for so the vein will swell up and come more in sight; and besides you may also mark it with ink; then taking the skin up between your fingers, cut it long-wayes according as you have marked it; then free the bared vein from the adjacent bo∣dies, and put thereunder a blunt-pointed needle (lest you prick the vein) thred with a long double thred, and so bind it fast; and then let it be opened with a Lancet in the middle under the ligature, just as you open a vein, and draw as much therehence as shall be fit: Then straight make a ligature in the lower part of the forementioned vein, and then cut away as much of the said vein as is con∣venient between the ligatures, and so let the ends thereof withdraw themselves into the flesh above and below; let these ligatures alone untill such time as they fall away of themselves. The opera∣tion being performed, let an astringent medicine be applyed to the wound and the neighbouring parts; neither must you stir the wound any more for the space of three dayes. Then do all other things as are fit to be done to other such affects.

CHAP. XXI. Of Fistulaes.

A Fistula is a sinuous, white, narrow, callous, and not seldom unperceivable Ulcer:* 1.108 It took its denomination from the similitude of a reeden (Fistula) that is, a pipe, like whose hollow∣ness it is. A Fistula is bred in sundry parts of the body, and commonly followes upon abscesses or Ulcers not well cured.

* 1.109A Callous is a certain fleshy substance, white, solid, or dense and hard, dry and without pain, generated by heaping up of dryed excrementitious phlegme, or else adust melancholy encom∣passing the circuit of the Ulcer, and substituting it self into the place of laudable flesh. The Sinus or cavity of a Fistula is sometimes dry, and other while drops with continual moisture: sometimes the dropping of the matter sodainly ceases, and the orifice thereof is shut up, that so it may de∣ceive both the Chirurgeon and the Patient with a false shew of an absolute cure; for within a while after it will open again, and run as formerly it did. Some Fistulaes are bred by the cor∣ruption of a bone, others of a nerve, others of membranes, and others of other parts of the body. Some run straight in, others and that the greater part, have turnings and windings; some have one, others have more orifices and windings; some are at the joints, others penetrate into some capacity of the body, as into the chest, belly, guts, womb, bladder; some are easily, others diffi∣cultly cured,* 1.110 and some wholly uncurable. There are divers signs of Fistulaes, according to the va∣riety of the parts they possess; for if that which you touch with the end of your probe make re∣sistance, and resound, then you may know that it is come to the bone; and then if the end of the probe slip up and down as on a smooth and polite superficies, it is a sign that the bone is yet sound; but if it stop and stay in any place as in a rough way,* 1.111 then know that the bone is eaten, rough and perished; sometimes the bone lies bare, and then you need not use the probe. Besides also it is a sign that the bone is affected, if there be a purulent efflux of an unctuous or oily matter, not much unlike that marrow wherewith the bone is nourished. For every excrement shewes the condition of the nourishment of the part whence it is sent; in a Fistula which penetrates to a nerve, the Patient is troubled with a pricking pain, especially when you come to search with a Probe espe∣cially if the matter which slowes down be more acrid: Oft-times if it be cold, the member is stu∣pified, the motion being weakened; besides also the matter which flowes from thence is more subtle, and somewhat like unto that which flowes from the bones, yet not oily nor fat, but sanious and viscous, resembling the condition of the alimentary humour of the nerves. The same usually ap∣pears and happens in Fistulaes which penetrate to the Tendons and those membranes which involve the muscles. If the Fistula be within the flesh, the matter flowing thence is more thick and plenti∣full, smooth, white, and equal. If it descend into the veins or arteries, the same happens as in those of the nerves; but that there is no such great pain in searching with your Probe, nor no offence or impediment in the use of any member: yet if the matter of the fistulous Ulcer be so acrid, as that it corrode the vessels,* 1.112 blood will flow forth; and that more thick if it be from a vein, but more subtle and with some murmuring if from an artery. Old Fistulaes, and such as have run for many years, if suddainly shut up, cause death, especially in an ancient and weak body.

CHAP. XXII. Of the cure of Fistulaes.

* 1.113FOr the cure; in the first place it will be expedient to search the Fistula; and that either with a wax size, a probe of lead, gold or silver, to finde out the depth and windings or corners thereof. But if the Fistula be hollowed with two or more orifices, and those cuniculous so that you cannot possibly and certainly search or find them all our with your probe; then must you cast an injection into some one of these holes, and so observe the places where it comes forth, for so you may learn how many, and how deep or superficiary cavities there be; then by making in∣cisions you must lay open and cut away the callous parts. You must make incisions with an incision knife or razour, or else apply actual or potential cauteries; for nature cannot, unless the callous substance be first taken away, restore or generate flesh, or agglutinate the distant bodies: For hard things cannot grow together, unless by the interposition of glue, such as is laudable blood; but a cal∣lous body on all sides possessing the surface of the ulcerated flesh, hinders the flowing of the blood out of the capillary veins, for the restoring of the lost substance, and uniting of the disjointed parts. If you at any time make caustick injections into the Fistula,* 1.114 you must presently stop the orifice thereof, that so they may have time to work the effect, for which they are intended. Which thing we may conjecture by the tumor of the part, the digesture of the flowing matter, and its lesser quantity. Then you must hasten the falling away of the Eschar, and then the Ulcer must be dressed like other Ulcers.* 1.115 But oft-times the Callous which possesses the sinuous cavity of a Fistula, over∣come by the power of acrid and escarcotick medicins, comes whole forth, and falls out like a pipe, and so leaves a pure Ulcer underneath it. Which I observed in a certain Gentleman, when I had washed with strong Aegyptiacum divers times a fistulous Ulcer in his thigh, shot through with a bullet; then presently by putting in my Balsam formerly described, he grew well in a short time. Fistulaes which are neer great vessels, Nerves or principal intrails, must not be medled with un∣less with great caution.* 1.116 When a Fistula proceeds by the fault of a corrupt bone, it is to be consi∣dered whether that fault in your bone be superficiary, or deeper in, or whether it is wholly rot∣ten and perished: For if the default be superficiary, it may easily be taken away with a desquamma∣tory Trepan; but if it penetrate even to the marrow, it must be taken forth with cutting mullets, first having made way with a Terebellum. But if the bone be quite rotten and perished, it must be wholly taken away, which may be fitly done, in the joints of the fingers, the radius of the Cubit and Leg; but no such thing may be attempted in the socket of the Huckle-bone, the head of the Thigh-bone, or any of the Rack-bones when they are mortified, neither in those Fistulaes, which

are of their own nature uncurable; but you shall think you have discharged your duty and done sufficiently for the Patient, if you leave it with a prognostick.* 1.117 Of this nature are Fistulaes which penetrate even to the bowels, which come into the parts orespread with large vessels or Nerves, which happen to effeminate and tender persons, who had rather dye by much, then to suffer the pain and torment of the operation. Like caution must be used, when by the cutting of a Fistula there is fear of greater danger, as of convulsion, if the disease be in a nervous part.* 1.118 In these and the like cases, the Chirurgeon shall not set upon the perfect cure of the disease, but shall think it better to prevent, by all means possible, that the disease by fresh supplies become no worse, which may be done, if he prevent the falling down of any new defluxion into the part; if by an artificial diet he have a care that excrementitious humors be not too plentifully generated in the body; or so order it, that being generated, they may be evacuated at certain times, or else diver∣ted from the more noble to the base parts. But in the mean space it shall be requisite to wast the faulty flesh, which growes up more then is fitting in the Ulcer, and to cleanse the sordes or filth, with medicins which may do it without biting or acrimony and putrefaction.

CHAP. XXIII. Of the Fistulaes in the Fundament.

FIstulaes in the Fundament are bred of the same causes as other kindes of Fistulaes are;* 1.119 to wit, of a wound or abscess not well cured, or of a haemorrhoid which is suppurated. Such as are occult,* 1.120 may be known by dropping down of the sanious and purulent humor by the Fundament, and the pain of the adjacent parts. But such as are manifest, by the help of your probe you may finde whither they goe, and how far they reach. For this purpose the Chirurgeon shall put his finger into the Fundament of the Patient, and then put a Leaden probe into the orifice of the Fistula; which if it come to the finger without interposition of any medium, it is a sign it pene∣trates into the capacity of the Gut. Besides also, then there flowes not only by the Fundament, but also by the orifice which the malign humor hath opened by its acrimony, much matter, some∣whiles sanious, and oft-times also breeding Worms. Fistulaes may be judged cuniculous, and run∣ning into many turnings and windings, if the probe do not enter far in, and yet notwithstanding more matter flowes therehence then reason requires should proceed from so small an Ulcer.* 1.121 You may in the orifices of all Fistulaes, perceive a certain callous wart, which the common Chirurge∣ons tearm a Hens arse. Many symptomes accompany Fistulaes which are in the Fundament, as a Tenesmus, strangury and falling down of the Fundament.* 1.122 If the Fistula must be cured by manual operation, let the Patient lye so upon his back, that lifting up his legs, his thighs may press his belly; then let the Chirurgeon, having his nail pared, put his finger besmeared with some oint∣ment into the Patients Fundament; then let him thrust in at the orifice of the Fistula, a thick Lea∣den Needle, drawing after it a thread consisting of thread and horse-hairs woven together, and then with his finger taking hold thereof, and somewhat crooking it, draw it forth at the Funda∣ment, together with the end of the Thread: Then let him knit the two ends of the thread with a draw or loose-knot, that so he may straiten them at his pleasure. But before you binde them, you shall draw the thread somewhat roughly towards you, as though you meant to saw the flesh therein contained, that you may by this means cut the Fistula without any fear of an Haemorrhage, or flux of blood. It sometimes happens, that such Fistulaes penetrate not into the Gut; so that the finger by interposition of some callous body, cannot meet with the needle or probe. Then it is convenient to put in a hollow Iron or Silver Probe, so through the cavity thereof to thrust a sharp pointed needle, and that by pricking and cutting may destroy the Callus; which thing you cannot perform with the formerly described Leaden Probe, which hath a blunt point, unless with great pain.

[illustration]

The description of a hollow silver Probe, to be used with a needle, as also a Leaden Probe.

• A. Shews the Needle.
• B. The hollow Probe.
• C. The Nee∣dle with the Probe.
• D. The lea∣den Needle drawing a thread af∣ter it.

The Callus being wasted, the Fistula shall be bound as we formerly mentioned. That which is superficiary needs no binding, only it must be cut with a crooked scalprum, and the Callus being consumed, the rest of the cure must be performed after the manner of other Ulcers. But you must note, that if any parcel of the Callous body remain untoucht by the medicin or Instrument, the Fistula reviving again, will cause a relapse.

CHAP. XXIV. Of Haemorrhoides.

* 1.123HAemorrhoides, as the word is usually taken, are tumors at the extremities of the veins en∣compassing the Fundament, caused by the defluxion of an humor commonly melan∣cholick,* 1.124 and representing a certain kind of Varices. Some of these run at an hole being opened, which sometimes in space of time contracts a Callus; others only swell, and cast forth no moisture; some are manifest; others lye only hid within. Those which run, common∣ly cast forth blood mixed with yellowish serous moisture, which stimulates the blood to break forth, and by its acrimony opens the mouths of the veins. But such as do not run, are either like blisters, such as happen in burns, and by practitioners are usually called vesicales, and are caused by the defluxion of a phlegmatick and serous humor; or else represent a Grape, whence they are called Uvales, generated by the afflux of blood, laudable in quality, but overabundant in quantity; or else they express the manner of a disease, whence they are termed morales, proceeding from the suppression of melancholick blood; or else they represent Warts, whence they are stiled Verrucales, enjoying the same material cause of the generation as the morales do. This affect is cause of many accidents in men;* 1.125 for the perpetual efflux of blood extinguisheth the vivid and lively colour of the face, calls on a Dropsie, overthrows the strength of the whole body. The flux of Haemorrhoides is commonly every moneth, sometimes only four times in a year. Great pain, inflammation, an Abscesse which may at length end in a Fistula, unless it be resisted by convenient remedies, do oft-times fore-run the evacuation of the Haemorrhoides. But if the Haemorrhoides flow in a moderate quantity, if the Patients brook it well, they ought not to be stayed, for that they free the Patients from the fear of eminent evils, as melancholy, leprosie,* 1.126 strangury, and the like. Besides, if they be stopped without a cause, they by their reflux into the Lungs cause their inflammation, or else break the vessels thereof; and by flowing to the Liver, cause a dropsie by the suffocation of the native heat; they cause a Dropsie and universal leanness on the contrary, if they flow immoderately, by refrigerating the Liver by loss of too much blood; wherefore when as they flow too immoderately, they must be stayed with a pledget of Hares-down dipped in the ensuing medicin.* 1.127 ℞ pul. aloes, thuris, baulast. sang. draconis, an. ℥ ss. incorporentur simul cum ovi albumine, fiat medicamentum ad usum. When they are stretched out and swoln without bleeding, it is convenient to beat an Onion roasted in the embers with an Oxes gall; and apply this medicin to the swoln places, and renew it every five hours.* 1.128 This kind of remedy is very prevalent for internal Haemorrhoides; but such as are manifest, may be opened with Horse-leaches, or a Lancet. The juice or mass of the hearb called commonly Dead-nettle or Arch-angel, applyed to the swoln Haemorrhoides, opens them, and makes the congealed blood flow there-hence. The Fungus and Thymus, being diseases about the Fundament, are cured by the same remedy. If acrimony, heat and pain, do too cruelly afflict the Patient, you must make him enter into a bath, and presently after apply to the Ulcers (if any such be) this following remedy. ℞ Olei ros. ℥ iiij. cerusae ℥ i. Litharg. ℥ ss. cerae novae, ʒ vj. opii ℈ j. fiat unguent. secundum artem. Or else, ℞ thuris, myrrhae, croci, an. ʒ j. opii ℈ j. fiat unguentum cum oleo rosarum & mucilagine sem. psillii, addendo vitellum unius ovi. You may easily prosecute the residue of the cure according to the general rules of Art.

The End of the Thirteenth Book.

Notes

• * 1.1

  The divers ac∣ceptions of an Ulcer. Sent. 34. sect. 3. lib. de fract.
• * 1.2

  Sect. 1. prog.
• * 1.3

  What an Ulcer properly is.
• * 1.4

  Lib. de constit. Artis cap. 6.
• * 1.5

  The internal causes.
• * 1.6

  The external causes.
• * 1.7

  The signs of a putrid Ulcer
• * 1.8

  Gal. cap. 5. lib. 4. Meth.
• * 1.9

  Ulcus Cacoc∣ches.
• * 1.10

  Com. ad aphor. 22. sect. 5.
• * 1.11

  Aph. 45. sect. 6.
• * 1.12

  Hip. progn. lib. 1 cap. 8. Aph. 65. sect. 5.
• * 1.13

  Aph. 97. sect. 5.
• * 1.14

  Aph. 4. sect. 6.
• * 1.15

  Hip. Lib. de ult. Gal. cap. 2. & 5 lib. Meth. 4.
• * 1.16

  For what cau∣ses Ulcers are hard to heal.
• * 1.17

  What pus or matter is smooth is equall•• and white. Ad sement. 32. sect. 2. de fract. Aph. 21. sect. 7. Two sorts of excrements flow from a malign Ulcer.
• * 1.18

  The curing of a simple Ulcer consists in ex∣siccation. Gal 7 Meth. cap. 12.
• * 1.19

  Gal. lib. 4. de comp. med. se∣cund. gen.
• * 1.20

  The things conducing to the generating of flesh.
• * 1.21

  What a Scar is
• * 1.22

  Things causing cicatrization.
• * 1.23

  Signs of a dis∣tempered ulcer.
• * 1.24

  Remedies for a dry distem••e∣red ulcer.
• * 1.25

  Signs of too moist an ulcer.
• * 1.26

  Gal. lib. 1. simp. cap. 7.
• * 1.27

  Signs of a hot distempered ulcer.
• * 1.28

  Signs of a cold distempered ulcer.
• * 1.29

  The matter of Narroitick ca∣taplasms.
• * 1.30

  Cathaereticks have power to asswage pain.
• * 1.31

  Things wa∣sting superflu∣ous flesh.
• * 1.32

  Lib. 3. Meth. cap. 6.
• * 1.33

  For the callous lips of Ulcers.
• * 1.34

  Lib. 4. Meth. cap. 2.
• * 1.35

  The cause of worms bree∣ding in Ul∣cers.
• * 1.36

  A fomentation to kill the worms.
• * 1.37

  Gal. 4. comp. med.
• * 1.38

  A detergent lotion.
• * 1.39

  Detergent me∣dicins without acrimony.
• * 1.40

  A caution very observable in use of deter∣gent things.
• * 1.41

  A distinction to be observed concerning the impurity of Ulcers.
• * 1.42

  Diligent regard must be had of the patients bo∣dies, and the affected part.
• * 1.43

  How virulent and eating Ul∣cers differ.
• * 1.44

  Gal. lib. 4. de comp. med sec. genera.
• * 1.45

  How a Chiro∣nian Ulcer dif∣fers from an eating, see be∣fore, Cap. 2.
• * 1.46

  Gal lib. 4. see Gen. Cap. 5.
• * 1.47

  Gal. lib. 4. de comp. med. see Gen. Cap. 6.
• * 1.48

  Gal. lib. 4. de comp. med. see Gen. Cap. 5.
• * 1.49

  Galens reason further explai∣ned.
• * 1.50

  Medicins are only such in faculty.
• * 1.51

  The beginning of your binding must be at the Ulcer. Hip. lib. de ult.
• * 1.52

  Revulsion into contrary parts.
• * 1.53

  4. M••••h.
• * 1.54

  Lib. 6. cap. 6. Lib. 3. Botryon Caeloma. Argemon. Epi∣cauma.
• * 1.55

  The cure.
• * 1.56

  A Collyrium to cleanse the ul∣cers of the eyes.
• * 1.57

  A sarcotick Collyrium.
• * 1.58

  An epulotick Collyrium. Lib. 6. cap 6.
• * 1.59

  A Collyrium for hollow scars.
• * 1.60

  The scars of the Horny coat are white, and these of the Adapta red.
• * 1.61

  Lib 6. cap. 8. Gal lib. 3. de Comp. med. se∣cund. locos cap. 3. The cure.
• * 1.62

  Lib. 20. epist. ••. An injection when the Ozae∣na shall come to the Ossa Ethmoidaea.
• * 1.63

  Aph. 24. sect. 3. Celsus lib. 6. cap. 11. Gal. com. ad 3. lib. epidem.
• * 1.64

  The cure.
• * 1.65

  A gargarism for the Aphthae.
• * 1.66

  Lib. 6. M••th. Cap. 10.
• * 1.67

  Ulcers of the palat must be quickly and carefully dres∣sed.
• * 1.68

  Aetius Lib. 6. cap. 3. Celsus lib. 6. cap. 13.
• * 1.69

  Their causes.
• * 1.70

  The cuure.
• * 1.71

  A masticatory.
• * 1.72

  An Errhin. The compositi∣on of Andronius his trochisces.
• * 1.73

  Scales of Iron.
• * 1.74

  Of the Pyoul∣cos Galen makes mention 2 ad Glauconem.
• * 1.75

  The Causes.
• * 1.76

  Signs.
• * 1.77

  Gal. lib. 5. de loc. affect. cap. 5.
• * 1.78

  Lib. 4. & 5. Method. The cure.
• * 1.79

  How to take medicins for Ulcers of the throat.
• * 1.80

  Why acrid things must be shunned in these Ulcers.
• * 1.81

  How powerfull Honey is to cure such kind of Ulcers.
• * 1.82

  Aegyptiacum good for the Ulcers of the greater guts.
• * 1.83

  Lib. 5. meth.
• * 1.84

  Causes.
• * 1.85

  Signs.
• * 1.86

  Hip. Aphor. 81. sect. 4. Aphor. 76. sect. 4. Aphor. 77. sect. 4.
• * 1.87

  The cure.
• * 1.88

  Why we must shun strong purges.
• * 1.89

  Things to cleanse these Ulcers.
• * 1.90

  Trochisces for the ulcers of th•• kidnies and bladder. 4. Method.
• * 1.91

  Signs to know what part of the bladder is ulcerated.
• * 1.92

  Why Ulcers in the bottom of the bladder are uncurable.
• * 1.93

  Aegyptiacum for the ulcers of the bladder.
• * 1.94

  The causes.
• * 1.95

  Lib. 3. sect. 12. tract. 2. cap. 5.
• * 1.96

  Signs.
• * 1.97

  The cure.
• * 1.98

  Why strongly drying things are good for Ulcers of the womb.
• * 1.99

  An injection for an Ulcer in the bottom of the wombe.
• * 1.100

  An injection hindering pu∣trefaction.
• * 1.101

  What a Varix is, and what be the differences thereof.
• * 1.102

  The matter.
• * 1.103

  The causes.
• * 1.104

  Signs.
• * 1.105

  The cure.
• * 1.106

  The cutting of Varices.
• * 1.107

  For what in∣tention a Varix must be cut. Paulus cap. 82. lib. 6. The manner how to cut it.
• * 1.108

  What a Fistu∣la is.
• * 1.109

  What a Callous is. The differences of Fistulaes.
• * 1.110

  The signs.
• * 1.111

  The sign that the bone is bare from the con∣dition of the matter which is cast forth. Aetius tetr. 4. sect. 2. cap. 55.
• * 1.112

  Old Fistulaes if closed prove mortall.
• * 1.113

  How to finde out the wind∣ings & cavities of Fistulaes.
• * 1.114

  Caustick in∣jections.
• * 1.115

  Celsus lib. 5.
• * 1.116

  Remedies for a Fistula proceed∣ing from a cor∣rupt bone.
• * 1.117

  The cure of what Fistulaes may be at∣tempted, and which may not.
• * 1.118

  A palliative cure of a Fistu∣la.
• * 1.119

  The causes.
• * 1.120

  Signs.
• * 1.121

  Symptomes.
• * 1.122

  The art of binding and cutting a Fistu∣la of the Fun∣dament.
• * 1.123

  What they are.
• * 1.124

  Their differen∣ces.
• * 1.125

  Symptomes.
• * 1.126

  Sent. 37. sect. 6. epid.
• * 1.127

  A remedy for the immoderate flowing of the Haemorrhoides.
• * 1.128

  For supprest Haemorrhoides.