Chirurgorum comes, or, The whole practice of chirurgery begun by the learned Dr. Read ; continued and completed by a Member of the College of physicians in London.

CHAP. IV.

Of curing of a Tumor come to Suppuration.

HAving shewed the Method how Tumors are to be dis∣cussed: now order requireth that the means be set down, how a Tu∣mor is to be handled, if it tend to Suppuration, or Maturation, which by our usual term is called Aposte∣mation. And we are inforced thus to go to work: First, if the Hu∣mor be too plentiful; for then the natural Heat cannot well rule it, and so it must be seconded by fo∣reign and external Heat, which working upon superfluous Humidi∣ty, causeth Putrefaction according to the Philosopher. Secondly, when it is crude; for then we must labour to concoct it with Medica∣ments, which are peptica or co∣quentia. Thirdly, when the Mat∣ter is hard, and then we must use emollient Medicaments. The Me∣dicaments which procure Quittour, they are temperately hot and moist: and these help natural Heat, that it may the more easily elaborate the Matter, and make it fit for expul∣sion, and this we call Concoction. Emollient Topicks are used to soften any Matter indurated, and such are dry in the first degree, and hot in the first, and in the beginning of the second. But it is to be noted that there is a difference between Tension and Hardness, and Relax∣ation and Softness: a part stretched will yield to the Finger pressing it, if it be hard it will not; and where there is any Tension, relaxing Me∣dicaments are to be applied, which attenuate and open the Pores, and therefore they must more discuss than dry, and so be drying in the first Degree, and hot in the second. A part indurated must have emol∣lient means applied to it: whereof

we will speak, when we come to discourse of a Scirrhus. In the Cure of Apostems, we are to do two things: First, we are to prepare the Matter; and make it fit for expulsion: Secondly, we are to evacuate it when it is prepared. To accomplish the preparation of the Matter, first, we are to remove Ac∣cidents: Secondly, to procure the maturation of the Matter. The Accidents are these, Pain, Tension of the Part, Hardness and Heat. As for the asswaging of Pain; nar∣cotical or stupefactive Medica∣ments have no place here: For first, they extinguish the natural Heat of the Part; which is the principal efficient cause of Cocti∣on: Secondly, by thickning of the Matter, they make it more rebel∣lious; wherefore we are to use Anodyne Medicaments, whereof we have spoken already: you shall do well to apply a Cataplasm of White Bread Crums, let the Apo∣stem be dressed with this, or such a Medicament Morning and Even∣ing.

If the part be stretched, use re∣laxing Topicks, such are those which are temperately hot, not drying much, and of subtil parts, as White Hore-hound, Archangel red and white, Mullen, Dill, Cha∣momil, Fenugreek, Mercury, Me∣lilot, Turneps, the leaves of Marsh∣mallow, the Flour of Barley, Beans and Vetches; of these you may frame to your purpose such a Ca∣taplasm; Take of Chamomil-flow∣ers beat to Powder ij. pugils, of Barly, Bean, and Flour of Vetches, of each ij. ounces, of Marsh-mallow Leaves and Flowers pounded a handful: boil these in Beef or Mut∣ton Broth strained, and the Fat taken away, until they come to the consistence of a Poultess: Then add to it the oyl of Dill, Chamo∣mil and Rapeseed, of each one ounce: dress the Apostem with this or the like, Morning and Evening.

If hardness hinder, use those things which are emollient, as all manner of Fats, the Dregs of Oyl, all sorts of Mallows, Colts-foot, Bugloss and Burrage, Quinceseed, Milk, the White Lilie, Linseed, Figs, Raisins, the Marrow of Beasts, Oyl of Sweet Almonds, Marsh∣violets, Ammoniacum, Bdellium: of some of these you may frame a Cataplasm after this manner: Take of Linseed Meal or Powder iiij ℥. of Marsh-mallow Roots, and White∣lilie Roots boiled in Water, and well bruised, of each ij ℥. of Violet Loaves and Flowers, and Colts-foot Leaves, of each an handful; boil these in new Milk, until they come to the consistence of a Cataplasm; unto the which add of Ammonia∣cum dissolved in Muscadine, of the pulp of Figs and Raisins of each j ounce, and so make up your Ca∣taplasm.

If immoderate heat trouble you, apply things cooling: but let them be cold either in the second de∣gree, or beginning of the third, for the Reasons yielded against Narcoticks, when I spake of Pain; such are umbilicus Veneris, or Na∣vel Woort, Prick-madam, Sen∣green, Barly meal, Endive, the pulp of the Pumpion, Sea-tong Lettico, Ducks-meat, the Water Lilie, the Water Archer, Plantain, Garden Night-shade: of these Herbs with Barly meal boiled in fair Spring

Water make a Poultess, and to eve∣ry pound of the Poultess, add ij ℥. of populeum unguentum, and ℥ j ss of unguentum rosatum Mesuis.

You may demand of me, how long the Application of these Topicks, prescribed for the re∣moving of Accidents, is to be con∣tinued?

I answer, until the Accident be almost gone, with the which you encountrred, and then you may proceed to assist Nature, by in∣creasing natural Heat by ripening Medicines, which was the second intention of curing Apostems set down by me: Now those Medica∣ments which help Nature, ought first to stop the Pores reasonably, only suffering the sharp Vapors to breath out, and to detain those which are mild and somewhat thick, which are the secondary cause of Coction. In this respect then they ought to be viscous and tough in substance, which are tem∣perate Oyls, and Mucilages, which by Galen are called Empla∣stica; secondly, they ought to be familiar to Nature, and so tempe∣rately hot and moist. One thing is to be noted, that hotter Sim∣ples are to be chosen, according to the temperature of the part, if the Tumor seem somewhat cold: wherefore if the Tumor seem hot, only Maturatives in the first De∣gree are to be used, and those of the second Degree to be shunned: But if the Matter be somewhat cold, then you are to use Matura∣tives of the second, yet always mingling with them some of the first Degree. And the Reason is this, because the Medicaments of the se∣cond Degree dry too much; where∣fore those of the first Degree are to be added, in the which there is much moisture, which is requisite to Coction and producing of Quit∣tor. These Medicaments are call∣ed Concoquentia, and Pus moventia, and Suppurantia: such ought to be hot and moist, as the Body of a temperate Man is, and so they ought neither to dry or moisten, or to heat or cool immoderately, but only to preserve and increase the Natural Heat; for a Suppurative Medicament ought to answer the Constitution of him unto whom it is applied.

Of these Suppurative Medica∣ments there be two Ranks; In the first, are Mans-grease, which as∣swageth Pain, also Ducks-grease, Geose-grease, Hens-grease, Oyl of sweet Almonds, sweet sallet Oyl, Mallows, sweet Butter, Figs, Fenu∣greek, Lily-roots, Linseed, Wheat∣flour; a Cataplasm made of Wheat∣flour, Water and Oyl, an Emplaster made of yellow Wax, and Oyl called Cerelaeum, Violet-leaves and flowers, Saffron; For an Exam∣ple, I will set down the description of a Suppurative. Cataplasm com∣pounded of some of these of the first Rank: Take of Milk a pint, in the which boil of Wheat-flour a quarter of a pound, of Violet∣leaves, and Mallow-leaves stamped, of each a handful, of Lily-roots, and Figs boiled in Water, until they be soft, of each two ounces; when they are come to the con∣sistence of a Poultess, add of Saf∣fron beat to powder a dram, of the Oyl of Linseed, sweet Almonds, Lilies, and Mans-greese, of each one ounce, and so make up your Me∣dicament, If the Tumor be im∣moderately

hot, mingle always with your Suppuratives those things which are cold and moist in the first Degree, as Violet-leaves, Lettuce, the pulp of Pompions, Grownsil, Succory, Dandelion, and such like. If on a sudden you be called, and be required to dress a Tumor tending to Suppuration, you may have re∣course to the Apothecaries shop, and with these things dress it. First, beat some Oyl of Violets and fair Spring-water together, taking two spoonfuls of Oyl, and one of Water, with the which embrocate the Tumor; then apply a Pledget moistened in this, upon the part which is like to break, or be opened: and above the Pledget, Diachylon simplex if the Tumor be hot, or Diachylon cum gummi if it be but a little exceed∣ing the ordinary temperament.

Suppuratives of the second De∣gree are these; Terebinthina, Am∣moniacum, Galbanum, Sagapenum, Gummi elemi, Pix navalis, Bur∣gundie Pitch, Saffron, Leaven, Fenugreek, Onyons and Garlick rosted under the Embers, old But∣ter, Oyl of Chamomil, and Dill, old Hens-grease, Badgers-grease, and Bears and Dogs-grease, Wheat∣flour, Flour of Linseed. In the Shops there are Emplastrum de mucilaginibus, Dialthaea cum gum∣mi, Diachylon cum gummi, Diachy∣lon magnum.

Now I will set down a com∣pound Medicament, framed of these Simples: Take of the Roots of white Lilies, of the Roots of Marsh-mallow, of Onyons boiled and bruised, with the Liquor of each iiij ℥. of Leaven ij ℥. of Lin∣seed-meal j ℥. and a half, of Saf∣fron beat to powder a dram, of Ammoniacum and Galbanum dis∣solved in Muscadine, and the pulp of Figs, of each j ℥. of Oyl of Chamomil and Lilies, so much as will make a Cataplasm of a good con∣sistence.

In Strumes, and Bubo's venereal, use this: take of Diachylon cum gummi, and Emplastrum de muci∣laginibus, of each j ℥. of Garlick and Onyons rosted under the Em∣bers of each ℥ ij. of Dialthaea cum gummi, Mans-grease, and Bears∣grease of each ℥ j. make a Medi∣cument. One thing I would have you to note, that Suppuratives of this Degree are fittest for all con∣tagious Tumors, and that to all such, Onyons and Garlick rosted, and mingled with other Medica∣ments, are to be applied, for being thus prepared, they lose their sharp∣ness, attract, and become familiar to the Natural Heat.

How Apostems are to be opened.

Hitherto you have heard, how that Tumors that cannot be dis∣cussed are brought to suppuration: Now I am to deliver unto you, how the Matter, which is suppurated, is to be discharged. This is done by opening the part: Now some things are to be considered before the Action, some in the Action, and some after the Action. Be∣fore we go about to open an Apo∣stem, 1. We must be certain whe∣ther it be ripe enough; 2. We must resolve how to open it.

The signs of Maturation, are; I. The Tumor, by contracting it self, seemeth less than it was in the state; for while the Natural

Heat concocts the Matter, Vapors are raised by the heat, and so the part is distended; but when the Matter is concocted, the Elevati∣on of Vapors ceases, and the Tu∣mor falls somewhat. II. The Tumor draws it self to a point, or prominence; because when Nature overcomes the Matter, it draws it together, and draws it to the skin. III. Hardness and tension are much abated; for Maturation being procured, many Vapors are discussed, which before stretched, and made the skin hard. IV. By pressing the Matter with the Fin∣ger, we find a fluctuation or coming and going of it: but we must be circumspect when a Tu∣mor in a great Joynt is offered un∣to us, as in the Knee; for if we press lateral parts of it, a certain un∣dation will appear. V. The party feeleth much ease in the part; part∣ly, because some of the sharp Va∣pors are resolved; partly, because the Matter concocted doth make the parts more loose. VI. The vehement Heat ceaseth; for the Humor being come to Maturation, the unnatural Heat abateth, and the natural Heat resteth. VII. If the part inflamed hath changed the co∣lour, and of red is become white, and chiefly in the pointed place. VIII. The Scarf skin becometh shriveled, and ruffled; and this is a good sign, for it sheweth that unna∣tural Heat hath left it.

The second thing which we said was to be resolved upon, was the In∣struments with the which the A∣postems are to be opened. They are three; I. The Lancet or Inci∣sion-knife, of the which there be divers forms set down by the Anci∣ents: of the which we will speak, when we come to discourse of par∣ticular Operations for the which they are required. II. Is the Cau∣stick or Pyrotical Medicament. III. The Actual Cautery, which we will leave willingly to Horse∣leeches, unless we be destitute of other means, and when we are to make a Fontanel, or to stay a great Flux of Blood, or to dry a Carious Bone, or to correct a Cancerous part after that it is extirpate.

As for the Steel Instruments, we are to use them. First, if Apostems be in the Face, to avoid the filthi∣ness of the Scar, after the Curati∣on. Secondly, in small Tumors: for so they will be the sooner whole.

As for Caustick Medicaments, we use two sorts of them: the first is made of the strongest Sope-lees, boiled to the consistence of a soft Stone. The second is made of the like Lee, and unslaked Lime, boil∣ed to the form of a firm unguent. The first is best in Tumors which possess the convex part. The second is most convenient, if they be in parts concave or hollow.

These Pyrotical Medicaments are most fit to be used in five Cases: I. If we intend to keep the Tumor long open, as is requisite in all conta∣gious Tumors, in the Plague, and Pox: for where the Caustick is ap∣plied, there is always loss of sub∣stance, and by it we make the O∣rifice round, which of all other Figures most slowly is cured. II. In large Apostems Causticks are fit∣test; for by them, making as large an Orifice as we will, we shall spare tenting and enlarging of it; besides, the stretched parts will the

sooner be contracted. III. They are to be used in deep Apostema∣tions, such as happen in the Belly and Back, for so the Matter shall have a readier way for Evacuation. IV. They are best, when a Flux of Blood may be expected. V. We apply them, when we will gratifie timorous persons.

When we are come to open the part, then these things are to be observed: I. The Nature of the Part: this teacheth us, to shun Veins and Arteries by reason of He∣morrhage; and Nerves, Tendons and Membranes by reason of the pain which ensueth. II. If the Skin only be to be divided, then the Apertion is to be made strait; but if a Muscle also be to be incided, it must be done according to the Fi∣bres of it. III. Apertion must be made in the depending part, because the Matter will be more readily so drawn out. IV. It must be done where the part is thinnest, for so less pain is caused. V. The Apertion must be proportionate; for if it be too little, then the Matter, especi∣ally if it be thick or grumous, can∣not be well drawn without expres∣sion, which maketh way for Callo∣sity and Fistulation. If it be too large; First, the Scar will be the more ugly; Secondly, the parts subjacent will be made more apt to be altered, by receiving the im∣pression of the cold air. VI. We are to know how much Matter is to be evacuated at one time: In great Tumors, and those which are in the Joynts, great moderati∣on is to be used; for with the Mat∣ter many Spirits breath out, and so are spent: from whence extenua∣tion of the Body, yea, and Death sometimes ensueth. The Chirur∣geon who is to do this, ought to be resolute, chearful in counte∣nance and speech, and no ways scrupulous: otherwise he shall make the Patient dismayed, and fearful, which doth much weaken and abate the courage of the Patient.

Things to be observed after the opening of an Apostem, are these: First, the removing of Accidents which most commonly fall out. Secondly, the manner of dressing. The Accidents are most commonly three, Fainting, chiefly if the par∣ties be Children or Women, but above these, Effeminate Men. Se∣condly, Pain. Thirdly, a Flux of Blood.

As for Fainting, we may labour to prevent it by giving the Patient a Caudle, Aleberry, or some sty∣ptick Wine with a Toast, as Alegant and Tent; or if it be like to ensue, we may give them some Cordial Water with Sugar, as Cinamon Water, Treacle Water, or Aqua coelestis. If pain ensue, let the part be embrocated with Oyl of Roses, and the third part of Wine beaten together: yet the Oyl is not to touch the brims, if Apertion hath been made by Incision, lest it cause Spungeous Flesh to grow. As for staying of Blood, I will set down the fittest, and most effectual means to perform this, when I shall come to discourse of Wounds, for in them it doth most commonly fall out.

As concerning the manner of dressing after opening: If this hath been done by Incision, either a Tent, if it be small, or Dosels with Pledgets armed with some restrin∣gent Powder, as Bole, Frankin∣cense,

and Flour tempered with the Whites of Eggs, if it be large, are to be used: and so it is to remain for the space of four and twenty hours. If the Caustick be applied, then Dialthaea simplex, or sweet Butter melted in a Saucer, are fit to be used until the Eschare fall; then the Cavity is to be Incarnate: If in the mean time Spungeous Flesh ap∣pear, it is to be removed with Ca∣theretical Medicaments, as Mercury precipitate alone in gentle Bodies, or mingled with Alume, taking the third part of this in harder Bodies: yea, you shall be enforced some∣times to use Pulvis sine pari, and other Fistula Powders with some Medicaments which cool and as∣swage pain, as Ʋnguentum Po∣puleum, and Rosatum Mesuis: take my word, Basilicum and Aureum are not so fit.

Last of all it is to be sealed up with Epulotical Medicaments, as Diapalma, Emplastrum de minio, Ʋnguentum comitissae, and Desicca∣tivum rubeum. If a Tumor end into an Induration, it must be cured as a Scirrhus, whereof I will speak in its proper place. If it end in the Corruption of the Part, the way of Dressing this shall be set down in my Discourses of Gangraena and Sphacelus. If a Tumor cease, be∣cause the Matter removeth from one place to another, as when Pleuritis endeth in Empyema, neither doth this belong to this place.