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 ...

III. Salivation by Fumigation.

LXXVII. This is the third and last way of raising a Saliva∣tion, which is done by the Fumes of artificial Cinnabar, made into Troches, after this manner: ℞ Artificial Cinnabar ℥ j ss. Benjamin, Mastich, Myrrh, Olibanum, all in fine pouder, A. ℥ ss. Cortex Winteranus, Zedoary, in fine pouder, A. ʒ iij. Frankincense ℥ ss. Turpentine, enough to make them up into a mass for Troches; of which make fourty, for ten Fumi∣gations.

LXXVIII. Wiseman in his Chi∣rurgery, has these Troches: ℞ Cinnabar ℥ ij. crude Mercury ℥ j. Mastich, Frankincense, Gum of Juniper, A.℥ ss. Storax Cala∣mita, Benjamin, A. ʒ iij. make all into a subtil pouder, and with Turpentine q.s. make a mass for Troches, each weighing about ʒ iij. this quantity may serve for twenty Fumigations.

LXXIX. The way of using these Troches is thus: have an artificial Chair, or Cane-couch, made for the purpose, upon which put the Sick in some warm close

place; or a Tub for the purpose, made beneath of boards, and arched like a Tent; and covered all over with thick Blankets. Or, which is much better, let him go into Hartman's Sweat∣ing-Chair, in which let him sit, and receive the Fume from the Troches within, being thrown upon live coals.

LXXX. His Face must be out, as the nature of the place imports, that he may endure it the longer; and his Head so covered, that the Air come not at it; but towards the conclusion, the Head ought to receive some of the Fumes: and he is to endure it as long as he can without fainting.

LXXXI. Then wrapping warm Sheets about him, carry him to a fresh warm place, and place him in a warm bed, to sweat, for three or four hours, or more, as he can endure it.

LXXXII. These Fumes are to be used once every day, if the Sick be strong, but if weak, once every other day: and if he be faint, let him rest a day or two, till his Spirits are recruited, and then repeat the Fumigation again; till by the foreness of his mouth, and fluxing or spitting, you see reason to give over: he may also in this method of Fuming, eat oftner than other∣wise, and that good and nou∣rishing food; for too much abstinence in this case does hurt.

LXXXIII. If a particular part be chiefly affected, as an Arm or Leg, with vehement, Rheumatick pains, a malign Herpes, or cacoe∣thick Ʋlcer; you need only fume that Part alone (which is less troublesom and dan∣gerous to the Patient) by laying it in a proper posture, covering it over and close with Blankets, and then putting the Fumiga∣tion cast upon live coals, under it, &c.

LXXXIV. Hitherto of the usual Methods of Fuming; but length of time has brought the Art to a greater perfection: for now the Patient being drest in his Cloaths, (as if going abroad) is put in the morning into a close Room like a Closet, or some such thing; and the Fu∣migation being put upon live coals, in that little place, he receives it up his Mouth and Nostrils, for the space of about an hour, more or less, as he is able to bear it: which when over, he goes about his Cham∣ber or House, without any other Observation than this Caution, to beware of taking Cold.

LXXXV. This makes the Pa∣tient spit upon the spot, for an hour or better, and a little all the day after till the next morning; (but so as not to be perceived by strangers) and then it is repeated again in like manner for another hour; and thus continued for about thirty days, less or more, or till the Patient becomes perfectly well.

LXXXVI. This Method is with∣out any danger, and if the wea∣ther is warm, the Patient is permitted to go abroad: (for within an hour after the Fumi∣gation is over, the Salivation will be pretty well over also only a small kind of spitting continues all the day, and is

again revived the next day:) nor is any precise Diet to be observed by him in respect to his eating or drinking; salt and sowr things, and Pickles, being only forbidden him.

LXXXVII. By this Method, a Patient is as certainly cured as by any other; and I am sure, much easier, and with a great deal more of safety; and in my opinion, in a much shorter time. If any shall object the danger of the Fumes going up the Head, it is a vain Objection: for tho' it may be rationally enough an∣swered, yet daily Experience for thousands of times, has proved it safe and innocent: and doubtless there can be no Argument against Experience.

LXXXVIII. Since we have here shewn three several ways of Sa∣livating, as, 1. By Internals: 2. By Ʋnction: 3. By Fumiga∣tion; and it be demanded which of them is the best; we in few words answer, that by Fumi∣gation; next that by Internals, given by the Mouth; and in the last place we put that by Unction, as being the very worst way of all, and always attended with the more dan∣gerous Symptoms.

LXXXIX. For if we consider the way the Mercury has to make, when used by Ʋnction, that it must pass thro' the Skin, then thro' the Fat, if any be, and Musculous Flesh, thro' which it has a long passage; (where by the way it is sometimes lodged, and sometimes meets with the Bones, corrupting and rot∣ting them; causing many times nocturnal Pains, with many other Aches and disorders,) and at length ascends up into the Sto∣mach, Head, and Brain; whence the Serosities of the Parts, and Acidities of the Humors preci∣pitate it down again into the Salivatick Glands and Ducts: I say, when a man considers, that this is the way it must make, to perform the work of Salivation, with the accidents and dangers attending it, it would make even a bold Man tremble to attempt it.

XC. As to the Internal way of raising the Salivation, (tho' it is much better than that by Ʋnction, yet) some Objections lye against it: for unless it be made with Mercurius dulcis, (which is too weak a Preparation for a confirmed Pox) it generally makes the Patient extremely sick, even almost to death; frequently excites violent Vo∣mitings, Faintings, and cold Sweats: and sometimes the Sa∣livation either rises not at all, or if it does, it is many times so faintly as to do no good: and unless the Artist be very skilful in his business, by en∣deavouring to raise it to its due height, he many times suffo∣cates his Patient; or otherwise by a too much opening the mouths of the Vessels, causes a violent flux of Blood; to the great hazard, at least detriment of the Patient.

XCI. From what has been said it is manifest, that the Way by Fumigation is truly the best; and in that way, the method of Fuming by the Mouth, with the

Clothes on, because this is free from all the Symptoms, Dan∣gers, and Miscarriages of the other Methods; tho' we do not by this forbid them others, but do allow that sometimes, upon some occasions and acci∣dents, they may well enough be made use of, if done by a skil∣ful Hand.

XCII. But which way soever you pursue, whether by Internals, Ʋnction, or Fumigation, you may know when the Salivation is in beginning, by the working of the Pulse, vexation of Mind and Body, diminution or entire loss of Appetite, heat of the Mouth, swelling and soreness of the Gums and Lips, thickness of the Tongue, blisters in the Cheeks, stinking of the Breath, white∣ness of the Palate, pain of the Teeth, and indisposedness to sleep.

XCIII. When by these signs, you find the Salivation to approach, you must forbear giving any more Doses by the mouth, if you use that way; or Ʋnction, if you have used that, or Fumigations, if that; and all sort of Mercurials, lest some evil accident, as vehement corrosion of the Vessels, by which much Blood runs out of them for some days, or Suffocation should ensue, which many times happens when Mercury is used in too great a quantity.

XCIV. But if the Salivation comes regularly on, it will be manifest by a continual kind of stream, or running down of a clear Flegm or Saliva, as it were in a long thread, which at first runs but gently, but gradually en∣creases for 8 or 9 days, till it comes to the height, which in persons of a moist and gross ha∣bit of Body, may come to four, five, or six Pints in a day and night, and to others in a less proportion.

XCV. But it ought to be brought on with care and caution, and by a gradual ascension in the use of the Medicaments, first seeing the ultimate of what the last Dose or Quantity will do, before you venture upon the next, lest by too frequent administrations, you raise the Salivation to a degree not to be commanded, and so suffocate the Patient.

XCVI. In the beginning of the Operation, there is sometimes ve∣hement pains of the Belly, causing a Flux downwards. These if they be very violent and difficult to endure, you may ease by ex∣hibiting an Anodyn Clyster. ℞ White Posset drink or broth of Pearled Barley lbj. Powers of Aniseeds ʒ iij. Tincturae Opij gut. 30. mix, and give it warm.

XCVII. If the Mouth be much Ʋlcerated, you ought to wash it daily with warm Water or Da∣mask Rose-water, mixed with a little Wine; I know some ad∣vise to a mixture of Milk and Water; but Water and Wine are much better, by reason of the abstersive Quality of the Wine: 'Tis true, it will make the Patients mouth smart a little, but its good effects will make it to be born withal, notwith∣standing that little inconveni∣ency.

XCVIII. While the Spitting lasts, cold is carefully to be avoid∣ed;

and before taking of any thing inwardly down the Throat, the Mouth ought to be well washt two or three several times with fair warm Water, that the adhering sharp, corrosive and poysonous Humor may be washt off, the Mouth kept clean, and the in∣crease of the Ulcers hindred.

XCIX. For otherwise every time any thing is drunk or taken down, part of the poysonous Re∣crements hanging about the Mouth, Tongue and Throat, will also be swallowed, whereby the Patient will be reinfected with his own Poyson, which often times causes tortions and gripings of the Bowels: and truly, the want of this course of daily washing the Mouth, is the cause of the repeating of Salivation after Sa∣livation; and that after seve∣ral Salivations, tho' never so well performed; they have proved ineffectual as to a perfect Cure; and that the Patient has been forced to go thro' two or three several Salivations, and some more; when one perform∣ed with this care, would have served the turn, and possibly done better too.

C. As to the time the Flux ought to continue, it is not exactly to be determined; in some it will finish of its own accord in 12 or 14 days, (counting the beginning of the Flux when the Sick spits between a Pint and a Quart in 24 hours) in some in 20 days, and in others in 30 days, be∣yond which it ought not to be continued, unless it be very small and inconsiderable.

CI. For if you drain some Bodies too much, consuming and exhaust∣ing the Radical Moisture it self, which is the Root of Nourish∣ment, and Foundation of Life, you will dry up the Brain by little and little, and so infallibly induce an incurable Atrophy upon the whole Body, making Death to close up the Act. You ought therefore as well to preserve what is natu∣ral to the Body, as to destroy what is inimical: and there∣fore you must observe how much the Body is dryed, how much of the Strength is spent, and all o∣ther circumstances and acci∣dents, which may give you time∣ly notice to stop the Salivation (after a sufficient continuance) to prevent any future danger.

CII. If therefore you would stop the Salivation when it rises too high, or continues too long, some Authors advise to repress it with Catharticks; others with salt of Tartar mixt with Broth, or ordinary Liquid Purges, as a Tincture or Infusion of Sena, &c.

CIII. But if you would do it certainly and effectually, give this mixture: ℞ Flowers of Sulphur, or Sulphur Vive in fine Pouder ʒ ij ss. Honey, or extract of Juni∣per-berries, q.s. mix, and make a mass for five Doses, to be given morning and evening: and if the Salivation is vehement, you may give a Dose or two of Lau∣danum, for that immediately thickens the Humor thro' the whole Body, so that it cannot flow to the Salivatick Glands, nor supply them, after which you may give a gentle Purge.

CIV. To heal the Ʋlcers which happen in the Mouth and Throat,

often gargle with fair warm Water in which a few Drops of Spirit of Sulphur or Vitriol are put; Or with this Gargarism, ℞ Fair water lbij. S.V. ℥ iij. Mel Rosarum ℥ jss. mix for a Gargle: Or this, ℞ Fair Wa∣ter lbij. Red Port Wine lbss. Honey of Mulberries ℥ j ss. mix them.

CV. If there is a Flux of Blood at Mouth, ℞ Fair Water ℥ jv. Red Port Wine ℥ ij. Tinctura Mi∣rabilis ℥ j. mix them. Or give this: ℞ Catechu ʒ ss. Flowers of Sulphur ℈ j. Honey of Roses, q.s. mix and make a Bolus, which often repeat. Or, ℞ An infusion of Red Roses in Water ℥ jv. and make it pleasantly acid with Spi∣rit of Sulphur; it will be astrin∣gent enough to repel the Blood.

CVI. If there is a Diarrhaea or Bloody Flux, give one small Pill of Our Specifick Laudanum, at night going to bed; or instead thereof, this mixture, ℞ Red Port Wine ℥ vj. Tincturae Mirabilis ʒ jv. Guttae Vitae, or Liquid Laudanum gut. xxx. mix for a Dose to be given at night going to bed, to be repeated every night so long as the Flux lasts.

CVII. If after the Salivation is over, there is in Women, yet an overflowing of the Womb, with a kind of purulent Humor, it will be necessary for her to receive up her Womb, the Fume of some of the Iroches mentioned Sect. 77. aforegoing; or else to inject into the Womb with a Womb-Syringe this Water. ℞ Fair Water lbij. White Vitriol, Roch Alum, Saccharum Saturni A. ʒ iij. mix and dissolve, and inject therewith three or four times a day, blood-warm.

CVIII. If the Sick is accompa∣nied with much Weakness and Fainting Fits, either in the time of the Salivation, or after it is finisht, you may give them two or three spoonfuls or more, of Our Aqua Bezoartica, or Spiri∣tus Cordialis, or strong Cinnamon Water, (if in the Salivation,) mixt with as much choice Cana∣ry, or else (if out of the Saliva∣tion) alone by it self; Or a glass of generous Wine, which will relieve the suffocated Spi∣rits, fortify the Heart, and do much good in all fainting and swooning Fits.

CIX. As to the Diet which the Sick is to submit to, during the course of the Salivation, We now come to speak. If the Body is hot, dry, thin, and lean, you must forbear all Nutriments of a heating Quality, and withal nou∣rish somewhat more than ordi∣narily: Give him plentifully of broth made of Beef, a Leg of Veal, or a Pullet, making it a little savory, adding to it Sor∣rel, Lettice, Purslain, or Succo∣ry, and let him drink of it of∣ten: Or you may give him Gelly made of Veal, also Gelly made of Harts-horn, and Barly Broth, made with Milk like to Cream, and a little sweetned with dou∣ble refined Sugar; Or Posset-drink made White, and a little sweetned with fine Sugar: let him take hourly in the day∣time, and every third or fourth hour in the night, of some of these things, which he likes best; and if he be faint for want of

Food, you may give him a couple of New-laid Eggs poached, eve∣ry day at Noon, or only when need requires.

CX. But if the Body is fat, fleshy, strong, cold and moist, or flegmatick, you may give him the former things, but without Sorrel, Lettice, Purslain or Suc∣cory, and not so often, nor in so large Quantities, but only just enough to keep the Saliva∣tion up, and the Patient alive; and once in two or three days you may give him a New-laid Egg or two, poached, for the Support of his Spirits: Also Water Gruel is of good use in this case, boiled with Sage, Time, Fennel and Savory.

CXI. Sometimes instead of Sa∣livating, the Mercury Praecipitates downwards, and the Malignity is carryed off by Stool; but this hinders not the Mercury from penetrating into all the parts, and is much better than when it terminates in Sweating. This is caused from the abound∣ing of Alcalious Salt, which meeting with the Mercu∣ry, stops its motion, and forces it downwards. In this case the Physitian ought to as∣sist Nature, by repeating proper Purges and Diureticks.

CXII. Sometimes also, it ope∣rates chiefly by Ʋrine, and this is better than that by Stool, and next to that of Salivation, espe∣cially if it continues long, and is large enough. This happens in such Bodies where acid Salts and alcalious Salts are nearly e∣qual: for Acids taken inward∣ly become Diuretick, carrying off Flegm and Serosities by U∣rine, but joining with the Mer∣cury, they may be sublimed, or carried upwards with Heat; whereby they loose that Pro∣perty, unless encountred with an equality or sufficient Power of an Alcalious Salt, for then being dissolved in the Serum, by the power of the Alcali the Mercury is precipitated down∣wards, and by the Vertue of the Acid, it is conducted to the Reins, and so the Impurities are carried off and expelled by Urine.

CXIII. But if the Mercury per∣forms a compleat Salivation, which is its most ordinary operation; it is, because that the Venereal Salts fermenting like Leven, dis∣solve in the Blood and Lympha, and so spread themselves into all parts of the Body, rendring by this means all the Humors sharp and acid; and the Mer∣cury meeting with these acid Humidities, charges it self with them, from whence it comes to pass, That the Mercury by its Volatile Property, thro' the na∣tive heat of the Body, ascend∣ing upwards, carries all the ma∣lignity of the Humors with it, to the Salivatick Glands, and so causes the Salivation.

CXIV. And it seems that Na∣ture acts her part in this work of her own accord, because this moti∣on is not only from below upwards, but it is generally equal, moderate and continual. Now all the acid, malign and impure Humors as∣cending with the Mercury, they make it corrosive (like corrosive Praecipitate dissolved in A.F. or

Spirit of Nitre) and ascending up with Heat, they increase their corrosive property, (making a kind of Sublimate) which seiz∣ing upon the parts about the Mouth and Throat exulcerates them, and sometimes penetrates them so exceedingly, that many times the Vessels are corroded and opened, whence comes a flux of Blood, lasting sometimes for several days, till the fluid matter becomes less corrosive, thro' the diminution of the A∣cids.

CXV. Tho the Directions we have here given, are almost infal∣lible for curing this Disease, and do scarcely fail one of a hundred, if exactly observed, yet many times dreadful Accidents happen, which no man could foresee, and many times are impossible to be remedi∣ed; as in dry, thin and lean Bo∣dies, of a sudden there is a flux of the Bowels, with almost in∣sufferable Gripings, which soon leaves a constipation behind, which causes an inflamation of the Bowels, Brest, Throat and Mouth, with a difficulty of swal∣lowing and breathing, which produces a Fever, with intole∣rable heat and burning, whence comes oftentimes Deafness, Blindness and Palsies, and many times Frensies, Swoonings, Ap∣poplexies, and Death it self.

CXVI. So also in a fat, cold, moist, and flegmatick Constitution, as sudden Alterations happen, the Mercury thro' its violent ascen∣sion, carries with it so great a confluence of Humors, that not only most of the afore-enume∣rated Accidents may happen, but many times a very great swelling of the Throat, Tongue, and Cheeks, and oftentimes of the whole Face, with hardness, cancrous eating Ulcers, loosness of the Teeth, and an immoderate flux of Blood, which causes ei∣ther present Suffocation, or o∣therwise the Ulcers spreading, and growing black and stinking, they at length gangrene, and so cause Death.

CXVII. The Causes of these things are often unknown, and therefore difficult to be avoided; in some there are inward Dispo∣sitions and Qualities, not pos∣sible to be understood, and so without the possibility of being taken away; in others the Ca∣cochymia of Body is so great, that it cannot any ways be cor∣rected, or overcome; besides the true causes of many mens Death is wholly unknown, nor can the set time be avoided; for which reasons it is, that the success of this Operation is not always so happy as one would desire, and such accidents hap∣pen, which as they could not be fore-seen, so might not rea∣sonably be expected, and there∣fore not in the power of the most Skilful to prevent.

CXVIII. It remains now, that we prescribe the conclusive Diet, or that which is to be taken after the Salivation is over, which is to be continued for at least thir∣ty days; of which we shall give you one only Praescript, which is this that follows, and is chiefly for a cold, moist, and flegmatick constitution.

CXIX. The conclusive Diet

Drink. ℞ Antimony in fine Pou∣der, and tyed up in a Rag ℥ xxiv. Burdock Roots thin sliced ℥ xxxij. Mealy Sarsaparilla slit, Liquorice bruised, Lignum Guajacum, rasped Pot-ashes, A. ℥ xvj. Cortex Gua∣jaci, Winters Cinnamon bruised, A. ℥ viij. Water six Gallons; mix and infuse all night in a scalding heat; the next day boil till six Quarts are consumed in a proper Diet-Pot: then add Currans, Raisons of the Sun stoned, Figs slit, A.℥ xvj. Zedoary ℥ x. Anise-seed, Carraway-seed, Coriander-seed, Fennel-seed, A. ℥ iv. boil well again for half an hour, or better, and then strain out, with∣out pressing; bottle it up, putting into each Bottle a Clove slit in two: Of this drink three Pints a day, viz. morning, noon, and night, gently sweating upon it every night.

CXX. The remaining ingredi∣ents, except the Figs, Raisons, and Currans, which are to be cast away, you may take again, and add to them fresh Figs, Raisons and Currans, A. ℥ xvj. Aniseeds, Coriander, Carraways, and Fennel-seeds, A. ℥ ij. Water lbxx. and boil again half an hour or better, then strain out and bottle it up as before; this is the second decoction, and for ordinary Drinking: The An∣timony keep and preserve, for it will serve 40 times if there be occasion.

CXXI. But if it is in a thin, hot, dry, cholerick and consum∣ptive habit of Body, you must take but one half of the Lig∣num Guajacum, and wholly leave out the Cortex, Winters Cinna∣mon, and Zedoary, and then make it up with the remaining Ingredients, in all respects as the former, both as to the first and second Decoctions.

CXXII. Lastly, That all parts may be sufficiently cleansed, and that no Seeds of the Dis∣ease, nor Recrements of Hu∣mours may be left in the Bo∣wels, or other Passages, purge first before you take the De∣coction, at least twice, and af∣terwards whilst you take the Decoction, once every fifth day, with this infusion of Sena. ℞ Choise Sena ʒ ij. green Liquo∣rice bruised ʒ jss. Salt of Tartar ʒ ss. Fair Water ℥ jx. mix and infuse two hours close covered, then give it a Walm or two, and Strain out for one Dose. See more of this Cure at large in the Third Edition of Our Synopsis Medicinae, in the Elements of Physick, Lib. 1. Cap. 71. Sect. 44. ad Sect. 63. and Lib. 6. Cap. 6. where you will receive abun∣dant Satisfaction.