The practice of physick in seventeen several books wherein is plainly set forth the nature, cause, differences, and several sorts of signs : together with the cure of all diseases in the body of man / by Nicholas Culpeper ... Abdiah Cole ... and William Rowland ; being chiefly a translation of the works of that learned and renowned doctor, Lazarus Riverius ...

Chap. 5. Of the Scirrhus of the Liver.

THe Scirrhus of the Liver, is a hard Tumor without pain, bred of a thick Humor, fastened and hardened upon the Liver.

This Scirrhus is Two-fold; either it is Exquisite, or Perfect; or Imperfect. That which is a perfect Scirrhus, is laid down in the Definition propounded, which is without Pain or Sence.

That which is not exquisite or perfect, hath some kind of pain, and comes from a Matter less hardened; in a word, it is a Scirrhus beginning, and not confirmed: but that which is exquisite is confirmed, so that they only differ in Degrees.

A Scirrhus breeds in the Liver two waies; either from Defluxion, or Congestion of a thick and glutinous Humor upon the part; or from Inflamation, which dissolveth the thin Humors, and lea∣veth the thick.

The Matter of the former, is Flegm or Melancholly, either sent from other parts, or bred in the substance of the Liver by an evil Concoction. For the producing of this Humor, evil diet is a main cause, if it be of thick, cold, and viscous, or clammy Nourishment; as also a Flegmatick or Melanchol∣lick Constitution, and a Natural straightness of the Liver. From whence Galen saith, 13. Meth. That a Scirrhus easily breedeth in the Liver, Spleen, and Reins: In the Liver, because the Passages are narrow, and it is nourished with thick blood in the Spleen, because it receiveth the thick blood: and lastly, in the Reins, because they are nourished with thick blood.

The Causes of the latter Scirrhus, which followeth other Humors, is the immoderate use of dis∣cussing Medicines, or of Repercussives, which by cooling and binding, do thicken the Matter, and keep it from dissolving. Besides, the Matter of the Disease, which is properly cold and thick, and will not be dissolved; or the weakness of the part, which cannot help the breathing forth of the Hu∣mors. And lastly, a cooling and thickening Diet.

The signs of a Scirrhus in the Liver are, a hardness in the right Hypochondrion, and that more than in an Obstruction, next a heaviness in that part, especially when there is violent breathing, no Feaver, nor pain, by which it is distinguished from an Inflamation, or there is but little pain, as when the Schirrus is not exquisite or perfect: There is less repose upon the left side, because the Liver being hard and heavy, doth then lie upon the Stomach, and burden it: the color of the Face is pale, and and greenish, because when the Liver is Schirrus, there is no good Blood produced by it: The whoI Body also, is fallen away, because there is neither Sanguification, nor distribution of Nourishment as it ought to be.

The Prognostick of this Disease is given by Galen, 2. ad Glaucum, cap. 4. in these words: An insensible Scirrus is incurable, but that which is a little sensible is curable, though with much diffi∣culty. Also Galen, cap. 5. of the same Book, saith, We have cured a Schirrus of the Liver often in the beginning of it; but when it hath been of long continuance, neither could I, nor any other that I ever heard of, cure it.

An old inveterate Scirrhus turns to a Dropsie incurable, of which some die sooner than others, if they have a loosness of the Belly therewith of long continuance.

A Scirrhus which followeth the Jaundice, or causeth the same, is dangerous. Whence Hippocra∣tes, Aph. 42. Sect. 6. saith, that if the Liver grow hard in them who have the Jaundice, it is an evil sign.

The Cure of a Scirrhus, is first by the taking away of the Antecedent Cause, by the Apozem which is prescribed in the Obstruction of the Liver. To which you may add other Medicines proper to o∣pen Obstructions.

Afterwards you must discuss the hard Matter with mollifying and opening things. For this end the Steel Pills above mentioned, are excellent, especially if you add thereto, Bdellium, Ammonia∣cum, and Sagapenum.

But if the hardness be very great, you must give these Pills following, many daies together.

Take of Gum Ammoniacum dissolved in Vinegar, and strained, and again made thick, two drams: Bdellium, and Storax, of each four scruples: mix them. Take one dram every other day.

And in the daies between, let him use the Opiate, or strengthening and opening Lozenges prescri∣bed in the Cure of Obstructions.

These following Pills have a wonderful Vertue to soften a Scirrhus, and dissolve it.

Take of the best Aloes, and Gum Ammoniack dissolved in Vinegar, strained, and again made thick, of each half an ounce: Mercurius dulcis two drams: Diagridium one dram: With Oxy∣mel

of Squils make a Mass of Pills; of which let him take half a dram four hours before Dinner, for twenty or thirty daies together.

Zacutus Lusitanus, Obs. 41. Lib. 1. Praxis Admir. reports that there was a strong Scirrhus cured by the use of Conserve of Horehound forty daies together.

Some Practitioners commend the use of Turpentine thus prepared:

Take of Turpentine washed with white Wine one ounce and an half: Sugar half an ounce: Give one dram every day, or every other day, for it is an opening Medicine that provoketh Ʋrine, and looseneth the Belly.

All the time of Cure, let the Patient take white Wine, or thin Claret steeled, for his ordinary Drink.

Also the other Preparations of Steel before mentioned, are very good.

Outwardly you must apply Fomentations, Oyntments, and Plaisters, thus made:

Take of Marsh-mallow Roots, Briony and Lilly Roots, of each one ounce: Mallows, Viole•••• Pellitory of the Wall, Wormwood, and Agrimony, of each one handful: Linseed, Foenugreek and Dill seed, of each half a dram: Chamomel, Melilot, and Rose flowers, of each one pugil: boyl them in three parts of Water, and one of white Wine, or in Water and Vinegar. With the strai∣ning, let the Region of the Liver be fomented every morning and evening.

If the Scirrhus be very great, add to the Decoction, Flowerdeluce, wild Cucumers, and Dwarf-Elder Roots, and make the Decoction in Tripe Broth, and white Wine.

Take of Oyl of Lillies, Chamomel, Melilot and sweet Almonds, of each one ounce: Oyl of Ro∣ses and Wormwood, of each half an ounce: Gum Ammoniack dissolved in Vinegar three drams: Wax two drams: make a Liniment, with which anoint the part aforesaid, after the Fomentation.

If you desire a stronger Liniment,

Take of the Juyce of Briony and wild Cucumer, of each two ounces: the Oyl of Capars and Tamarisk, of each three ounces: white Wine one ounce: boyl them till the Juyce and the Wine be consumed, then add two drams of Wormwood in pouder, Gum Ammoniack dissolved in Vinegar half an ounce: with a little Wax make a Liniment.

Take of the Emplaister de Mucilaginibus one ounce: Melilot half an ounce: Gum Ammoni∣ack melted in the Juyce of Wormwood three drams: soften them with a little Oyl of Wormwood 〈◊〉〈◊〉 Lillies, and make a Plaister to be laid on after the Liniment.

The Leaves of Henbane boyled in Vinegar are good to be outwardly applied to the part, made •••• to the form of a Cataplasm or Pultiss, with Oyl of bitter Almonds.

To these you may add Baths made of softening and digesting things, and of strengtheners, such as we prescribed for Fomentations; and let the Patient use them by turns.

And finally, Make an Issue in the right Leg, that part of the Matter offending may be that way drawn forth.