Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

II. Of an Empyema.

VII. The Signs. When the In∣flammation of the Lungs or Pleura, will not, upon Bleeding or other fit means, be removed, you may then judge a Collection of such Matter to come, within 12, 14, or 16 days.

VIII. The Patient finds a great heaviness in his Brest, without con∣siderable Pain; but if it be with Pain, it is commonly with a new Afflux of Humours, which they divert by Revul∣sion.

IX. There is a difficulty of Breathing, and in Motion the Pa∣tient finds a rumbling; and is sensible that the Matter changes place, and the side affected is hotter than the other.

X. He casts up, with violent Coughing, a purulent Matter, ha∣ving a continual Fever, or rather a Continent; (for such as I have seen afflicted with this Disease, had no remission of the heat:) The Appetite is depraved or weak, and he finds Anxiety or Pain at Heart.

XI. The Cause. It proceeds from a Fever, which many times putting the Blood and Humours into violent Motions, lodges them in the Lungs, Membranes of the Pleura, or Parts adjacent.

XII. The Differences. One is in the Lungs it self; another in the Membranes of the Pleura: Or, One arises from a Peripneumonia; another from the Pleurisie. One is from a Rupture of some pre∣ceding Apostem, as aforesaid. Another from a Vein opened, broken, or gnawn asunder; whence comes Blood, which issuing forth, is converted into Pus, forming it self a Cystis. A∣nother from an afflux of Rheum, or Humours, into the Thorax.

XIII. The Prognosticks. All Empyema's are dangerous, and Death is rather to be feared, than Life hoped for. But that, in a strong Person, and on the right side, and where the Pus is voided white, and without any great Pain or Coughing, it is the more hopeful.

XIV. So also, if, upon opening, the Sick has an Appetite to Meat, the Thirst goes away, and the Fever leaves the Sick the same Day, there is hopes; and con∣trariwise.

XV. Between the thirtieth and fortieth day, the Apostem common∣ly breaks; and if it be not spit forth in Forty Days, it com∣monly turns into a Consumption.

XVI. But, if upon opening, the Pus be of an ill Colour or Savor,

somewhat Bloody, or Water flows forth in great quantity, or it co∣lours the Probe red, the Sick, for the most part, dies. See the Third Edition of Our Syn∣opsis, Lib. 4. Cap. 22.

XVII. The Cure. If now the Humours collected connot be expell∣ed by Expectoration, nor by Ʋrine, or Medicines, we must then come to Manual Operation, which is performed according to this following Method.

XVIII. The way and manner of Opening the Brest, both in a Hy∣drops Pectoris, and an Empyema. The place of opening, is said, by some, to be between the third and fourth Rib; by others, be∣tween the fourth and fifth; and others say, between the fifth and sixth (reckoning upwards;) this last is thought safest; for if higher, the Pericardium may be hurt, if lower, the Midriff.

XIX. But as in other Tumors, so in this, the most raised place is most fit. So that if a Tumor ap∣pear on either side, make the Apertion four or five inches from the Sternon, and nearer to the lower, than the upper Rib, be∣cause under each Rib there lies an Intercostal, Vein, Artery, and Nerve.

XX. First, mark the place to be cut, with Ink; and charge the Sick to hold his Breath, as long as he can, mean season make an Oblique, but small, Orifice, in∣to which put a Pipe of Silver or Lead; at which suffer ℥iv. or v. to run out in a day.

XXI. If the Matter run not well, place the Sick on the wounded side, and make him Cough. If yet it will not come, by reason of its toughness, inject into the Cavity some abstersive, healing, and drying Medicine, as Decoctum Vulnerarium, Decoctum Fumaria compositum. See Pharm. Lond. Lib. 4. Cap. 14. Sect. 8, and 17. or Infusum seri Lactis Mesuae; let∣ting the Patient take inwardly, Decoctum Vulnerarium Mynsichti (at Sect. 30. of the aforecited place) of which he may drink often in a day, about two ounces at a time.

XXII. If the Sick be weak, and the inward parts corrupted, this Operation is more dangerous, other∣wise it has proved more effe∣ctual, than in the Paracentesis, for a Dropsie in the Belly. But before you do it, first try all o∣ther means, as Expectoration, Purging by Vomit, Stool and Urine, Sweating, &c. and if they fail, then make use of Chi∣rurgery.

XXIII. If the Matter runs not, by reason of its toughness, Bar∣bett advises to inject this: ℞ Goats Whey ℥xviij. Honey of Roses ℥iv. Juices of Celandine and Smal∣lage a. ʒvi. mix.

XXIV. Or this; ℞ Comfrey-roots ℥i. Roots of Sanicle ℥ss. Leaves of Agrimony, Betony, Bur∣net, Periwinkle a. Mss. the Cor∣dial-flowers P. ij. Seeds of Hype∣ricon, Carduus, Roman-Nettle a. ʒss. boil in Water and Honey q.s. to a pint and half, then strain out; with which Inject, letting him drink also a little of it twice or thrice a day.

XXV. Sometimes the collected Matter is contained in a Mem∣brane of its own, and by its rising,

manifests it self from without. This the Latins call Vomica Pul∣monis. In this case, you must not stay till the Membrane breaks of it self: For, by delay, the Matter flowing up and down, will be more difficulty got out of the Brest; but it ought pre∣sently to be opened, chusing no other place for the Apertion, but the most raised part of the Tumor.