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. II.

Of the Causes of Ʋlcers.

IN the third general concern∣ing Ulcers, is set down by me the causes of Ulcers. These are either antecedent or conjunct: The antecedent causes may be re∣duced to three; to wit, Cacochy∣mia or the evil habit of the Body; Contagium, or the communicati∣on or imparting of an infecting quality, Vapour or Humor, by the which an Ulcer is caused in any part; a venemous moisture, as in biting and stinging of Serpents; or lastly, the distemperature of the part it self.

As for Cacochymia, the specula∣tion of it belongs to the practice of Physick! yet in my Discourses of Tuniors I set down the signs of every Humor redounding as much as was requisite for any to know, who only meddles with the pra∣ctice of Chirurgery. While any of the three Humors (Blood being excepted) in the masse of Blood contained in the Veins is faulty, and peccant in quality, it is accounted the cause antecedent of an Ulcer. Sometimes these Humors are soli∣tary, sometimes they are associate together.

Contagium, or Infection, it is communicated sometimes by a rot∣ten and corroding Vapour; and so very often, if one visit often one having a Phthisis, such Vapours be∣ing mingled with the Air, infect the party who visits, especially if he draw too near to the diseased Party. So Ulcers of the Yard come from dealing with Women, whose Secret parts are touched with Venereal Ulcers: yea, the Itch it self, and scabbedness, is gotten by either lying with one troubled with it, or by sleeping in a Bed

where a scabbed person hath rest∣ed.

As for the distemperature of the Part, it may be procured either by Cold, as appears in Kibes; or by Heat, as we may see in a Gangrene, because the Blood flowing copious∣ly to the part pained, and not being concocted, it putrefies and erodes the part. Last of all, by biting or stinging, as of a mad Dog, or a venemous Serpent, a corruption of the Humors may be caused, the conjunct cause of an Ulcer: so that every Humor that is changed from its own natural temperature, whether it be by putrefaction, adu∣stion, or commixtion of any thing unnatural, may procure an Ulcer, in whatsoever part it seats it self.

But the followers of Hippocra∣tes and Galen, speak otherwise of these Humors than the Chymists do. The Galenisis make the three Humors of the masse of Blood; to wit, Choler, Phlegm, and Me∣lancholy, to be the causes both an∣tecedent and conjunct of all Ul∣cers, if they become contrary to Nature. So they will have Rheu∣matick Ulcers to be caused of salt Phlegm, Herpes exedens to be caused of aeruginous Choler; can∣cerous Ulcers of Bilis atra, which are the worst and most deplorable of all others.

The Chymists on the other part, affirm that the Discourse of Hu∣mors doth not manifest unto us the Essence, and proper Nature of any Disease. So Quercetan in his advice of curing the Gout, brings in the Stone, which he affirms not to be ingendred of the Galenical Humors. Petrus Severinus the Dane in his Idea Medici••ae Philosophicae, or Pourtraicture of the Philosophi∣cal Physick, wonders at the folly of those who make those phanta∣stical Humors Blood, Choler, Phlegm, and Melancholy the cau∣ses of Diseases; wherefore they out of Minerals, Salt, Sulphur, and Mercury, fetch the causes of all Griefs. Although Galen some∣times calls the Humors salt, ni∣trous, and aeruginous; yet the Chy∣mists have no reason to reject the ordinary names of Humors, and to call contumeliously dogmatical Physicians Humorists, and to de∣ny any Disease to proceed from the ordinary Humors of the Body becoming unnatural: For seeing that according to Galen 1. De loc. affect. c. 2. that is to be accounted the cause of a Grief, which being present, the Disease continueth, and which being removed, the Grief ceaseth; and seeing we perceive Diseases to be caused of vitious Humors abounding, and these be∣ing expelled, the Grief to vanish, I see no reason why these Humors may not be accounted the true causes of Griefs; and that it is a meer folly, and an affection of novelty, to Baptize these by names of Minerals far fetched; as to call that which in Fevers is cast up by vomit, rather Sulphur than Cho∣ler. Besides this, the Chymists are injurious to dogmatical Physicians, in labouring to perswade Men, that they by the name of a Humor, un∣derstand nothing else but a wate∣rish substance void of all other Fa∣culty; which should be the prin∣ciples of all Bodies, and the causes of all Diseases: whereas every ra∣tional Physician, by the term of a Humor, understands a liquid Bo∣dy

mixed with Blood: which see∣ing it is a several body of its own kind, and is more compound than water, so it has far more excellent qualities than water: The Phy∣sicians their own selves have set the Alchymists at work, while talking of Humors, and the causes of Di∣seases, they so much talk of the first qualities, Heat, Cold, Moi∣sture, and Dryness. For although sundry Diseases are caused of Heat, Cold, Moisture, and Dryness, yet we shall find other qualities in the Humor, which may as well hurt the Body as these: For Hippocrates in his Book De prisca Medicina, or ancient Physick, affirms, not that which is hot, cold, moist, or soft, to be most powerful, but that which is bitter, salt, sweet, and sowre, unsavoury, and sharp, with some Sowerness; these and a thou∣sand such, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 being ex∣alted in their Faculties, he will have to be the causes of Diseases, and not the first qualities only: and from these the differences of sym∣ptomes in Fevers of this same kind do depend. These whilst they are exquisitely mixed in the Body are harmless, yet when one of these is severed from the rest, and is ex∣alted in its quality, it manifests it self, and annoys Man; so the corrosive Salt bewrays it self in Cancers and corrosive Ulcers. Nei∣ther is it to be thought absurd, that Minerals are in the Body of Man; for seeing Man is sed by Plents, and Beasts which seed also upon Plants; seeing also the Herbs have their Aliment from the ground, which is not alike in all places, but often is mingled with a salt Juyce, and other Mineral Spirits, which the Beasts and Herbs cannot per∣fectly convert into their own sub∣stance; one can hardly think that a Man can live upon these, and participate of no such thing. So we see what variety of Wines the diversity of Soils brings forth; and that in every Wine there is Tartar or Argol, which appears al∣so very often in podagrical Persons. In vomiting sundry times sub∣stance like to Leeks, green, and aeruginous, exceeding hot and sharp, are thrown up, which being received in Basons, die them with a bright aeruginous colour. See Histories in Schenkius Med. obser. lib. 3. ob. 63 in the Third Book of his Physical Observations, the 62 Ob∣servation. Michael Doringius lib. 1 De Medico & Medic••••a, in his First Book of the Physician and Physick reporteth, That a certain Lawyer made such Urine as did fret his Linings, as if it had been the Spirit of Vitriol; such Humors ap∣pear plainly in Scubbedness, fret∣ting Ulcers, but especially in a Cancer. Wherefore Bertinus: in his Third Book and Eleventh of his Physick, doth rashly and inconsi∣derately assirm, that not one whit of Mercury, Salt, or Sulphur, lies hid in the Body; for in the Itch, Scabbiness, some Catarrhs, Inslam∣mations of the Eyes, and fretting Ulcers, it may be perceived; but in Urine, which is also an excre∣mentitious Humor, the Salt may be separated and presented to the sight: yea, besides the Salt in Urine, another substance the cause of Diseases may be marked: for if you take a clear Urine and suf∣fer it to settle, a Matter like unto the powder of Brick, and some∣times

a white muddy substance will so cleave to the sides of the Chamber-pot or Urinal, that it can hardly be sometimes washed away: of such a Matter Tophi in gouty persons, and Stones in the Bladder are ingendred.

Whoever shall go about to re∣duce the causes of all Diseases to Blood, Choler, Melancholy, and Phlegm, shall wrap himself into a number of difficulties: I will desire him to yield me a reason, Why he calls salt Phlegm so, seeing Phlegm is said to be cold, but this hot? Why is Atra bilis comprehended under Melancholy, seeing it is ve∣ry hot, but this cold? Besides this, if any Physician go about to cure Diseases, procured either by Con∣tagion, or Poison, he without any great respect to the Humors, pre∣sently goes about to minister Alexi∣pharmica, as in the Plague, which is gotten by Contagion, to abate the force of it, and then he addres∣seth himself to the preparation and evacuation of the Humors. If Poy∣son be ministred to any one in Meat or Drink, which according to Cardan, commenting upon the 62 Aphor. of the 4. Sect. may be suspected, if he find griping in his Stomach, and if he Vomit and go to Stool, if within six hours the Skin become greenish or spotted, then Antidotes are ministred, and not such as respect Choler, Melancho∣ly, or Phlegm. Let the Humors then which are ingendred in the Body, retain the accustomed names; but if an external cause make them degenerate from their Nature, let these be distinguished from the ordinary, and have their denomina∣tion from that which altereth them. If Salt, Nitre, Alume, Vitriol, Ver∣digrease be mingled with any Hu∣mor, let it be called from the Mine∣ral mingled with it, salt, nitrous, aluminous, vitriolate or a••••ugi∣nous. And for this cause some late judicious Physicians writing of ma∣lign and pestilent Fevers, and con∣sidering their notable differences, have affirmed some to participate of the nature of Arsenick, some of Mercury, some of Hellebore, some of Opium, some of Leopards-bane, some of Hemlock; some to parti∣cipate of the poyson of a Viper, Scorpion, mad Dog and such like, noting the variety of Symptoms in sundry persons.

One doubt remains concerning the Melancholick Humor, whether it be only thin and waterish, as Reusnerus affirms in his Book of the Scurvy, Exercit. 4. out of sundry places of Hippocrates, who calleth Melancholy 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, as in his Book De morbis, and in his first Book De morbis Mulierum; or whether it be thick and earthy, according to the vulgar and received Opinion. Be∣fore this doubt be solved, some Pro∣positions are to be premised. 1. In the Chyle there are two substan∣ces, one liquid and thin, the other thick and terrestrial, which can no more nourish than Ashes. 2. Na∣ture mingles these which are not sent away by Stool, with part of the aqueous and superfluous Hu∣midity, caused of Drink and liquid Meats. So in a Lie the Salt and some adust Parts are so mingled, that they are not discerned before separation. I say then, that this thick and feculent Humor temper∣ed with much moisture, is to be accounted the superfluous melan∣cholick

cholick Humor, and that it is at∣tracted by the Spleen. For First, Seeing this feculent Humor is alto∣gether unapt to nourish, it must be separated from the Chyle, which cannot be performed by any other part besides the Spleen. Secondly, the Spleen is of a darker Red co∣lour than the Liver is, which pro∣ceeds from the thick, feculent, and terrestrial Humor, which it imbi∣beth. Thirdly, Hippocrates de aere, aq. & loc. affirms, that such per∣sons as dwell in Fenny places, are subject to passions of the Spleen. The cause is, because the waters are not pure but muddy. Fourth∣ly, if the Spleen did draw only thin and waterish Humors, it could not be so subject to obstructions as it is. The feculent Humor mixed with much Humidity, is the cause of sundry Diseases, the thin parts sometimes ascend to the upper parts, the gross to the lower parts, as we see in the Scurvy, wherein the Gums are ulcerated, and the Legs tumefy. The Spleen being spongy, draws much Humidity to it, wherefore splenetick persons ought to drink sparingly; for if they bib too much, the natural heat of the part is easily oppressed, and so they become Hydropick. The waterish Humor of the Spleen is not insipid, but sharp and biting, and copious: so we see those who are troubled with Quartanes, about the end of each Fit to sweat plen∣tifully; and those who are oppres∣sed with Melancholy, to spit much. In the thick, feculent, and terre∣strial blackish Matter, sometimes there is no excess of the Spleen: in qualities sometimes there is, and those are two: Acerbitas, an astrin∣gent sharpness, such as appeareth is green unripe Fruits; and Acidit••, sowreness: from these qualities in∣tended and exalted, atra bilis beco∣meth so corrosive. So much I thought good to set down of Me∣lancholy, to clear the doubts which are moved about it, and to shew one use of the Spleen.

To return then to the carbonary Cure of unlearned Alchymists, they object thus, The rational Physici∣ans affirm the Body to be nou∣rished by the four Humors, How can they then be causes of the Di∣seases?

It is strange that any Man should wilfully shut the eye of the Mind (Understanding I mean) that they may not see Truth, seeing Man, as Aristotle in the very first words of the Book of his Metaphysicks affirms, naturally covets knowledg, and our first Parents to their own and our loss, are witnesses. No dogmatical Physician ever affirmed any disease to be caused of any Humor of the Body, as long as it continues in its own natural estate; but then to stir up Griefs, when it is separate from the rest, when it putresies, when forraign substances and qualities are added, which make it of a familiar Humor a professed enemy to Health, consist∣ing of the natural constitution of the Body, a result of the laudable commixtion of the four Humors natural. I have insisted somewhat long in the setting down of the causes of Ulcers, because he (who∣soever he be) that goes about to cure Ulcers without the know∣ledge of the Causes, is like one, who being blind-folded, is set to thrash a Cock.