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 ...

CHAP. X. Of PHYMA and PHYGETHLON.

I. THESE two kinds of Tumors, are really but one and the same Tumor, but so deno∣minated, as they proceed from different Causes: and therefore what the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. are called in Latin Phyma, and Phygethlon; also Tumor Glandularum; in English, a Swelling of the Glandules.

II. But they are thus distin∣guished: Phyma is a Tumor pro∣ceeding from Blood mixed with Phlegm, and is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and Phygethlon is a Tumor proceeding from Blood mixt with Choler, and is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

III. Phyma (says Wiseman, lib. 1. cap. 9.) is an Inflammation

affecting the Glandules under the Jaws, which are the conglobate Glandules; viz. neither the in∣ternal Salivary, which is Ranula; nor the external, which is Parotis.

IV. And this name Phyma is also given to the Tumor Phlegmo∣noodes, in and about the Anus; of which we shall speak anon.

V. The Cause. The principal Cause or Humor exciting Phyma, is Blood, but yet impure, being always mixed with Pituita, or Phlegm; for which cause Chil∣dren are most subject to them, more seldom Youths, and not often those of full Age; and the Inflammation is not so great and Intense.

VI. The Signs. It is known by its roundness and hardness, being much elevated, and little or no∣thing red, nor with much pain: but in time of Suppuration it is inflamed, and accompanied with pulsation, tension, &c. as in a Phlegmon, but sooner comes to Suppuration.

VII. About ten years since, my self had a famous Phyma under the right Jaw, as big as ones fist doubled, which much hindred my swallowing, and had almost cost me my life: it was a whole month before it came to maturation, and was accompanied with a Fever: James Wasse, one of our City-Chirurgeons, living in Clements-Lane, was the man who daily attended me, and did the Cure; he brought it to suppuration, then opened it with an Incision-knife, and in six weeks time saved me (through the goodness of God) out of the jaws of death.

VIII. Dr. Burwell, one of the Warwick-Iane Colledge, came several times to visit me in this Sickness, and prescribed Blood∣letting, and to carry off the mor∣bifick Cause by Purging: this he oftentimes (even as oft as he came) vehemently prest me to; but I refused it, not thinking that Practice according to the Principles of our Art; he often∣times also prest my Wife to the same, predicting otherwise my death.

IX. And told her, he should learn Experience by this Sickness of her Husbands; but he feared it would be with the loss of his life.

X. But agreeable to my Opi∣nion, was that of James Wasse the Chirurgeon; so that we took the contrary course, and by Su∣dorificks we assisted Nature in protruding the Morbifick-matter; and with alexipharmick Cor∣dials and Confortatives, we strengthned the Body, to sustain the shock, or encounter with the Disease.

XI. And externally moderate Suppuratives were applied; so that contrary to the Doctor's Pro∣gnostick, (whose counsel had I followed, I had certainly been a dead man;) I was signally preserved, and am yet in the land of the living, to give a report of the same to the World.

XII. Differences. Some, says Wiseman, have taken them for Strumae; but they differ from a Struma, which being contained

in a Cystis, does require to be eradicated by Escaroticks after Suppuration, and a discharge of the Matter: whereas these, after discharge of the Matter, are cured either of themselves, or by the ordinary intentions of Digestion, &c.

XIII. The Prognosticks. Sen∣nertus, lib. 5. part. 1. cap. 10. says it is altogether free from danger; and is likewise instantly augmented, and for the most part suppurated and healed, without the help of Medicine.

XIV. This may be true, where the Tumor is small, and is with∣out a Fever, and the Symptoms very gentle; but in such a case as mine was, the danger was very great; for the Tumor, even from its magnitude, had almost caused suffocation: and the rest of the Symptoms were so vehement, that my Life could never have been supported without the assistance of Medi∣cines.

XV. It is more easily cured in Children; more difficultly in Youths, and hardest of all in such as are of perfect Age.

XVI. The Cure. These admit not of Repercussives, but either of Resolution, or Suppuration, even from their first beginning: Wise∣man saith, all that ever he saw, terminated in Suppuration.

XVII. In the beginning he ap∣plies Diachylon cum Gummis, de Meliloto, &c. and in case of Pain, maturative Cataplasms; as in a Phlegmon.

XVIII. Tending to Suppuration, he drest it with Ung. Basilicon, and a Plaster; and being suppu∣rated, he opens it with a mild Caustick, or with an Incision-knife; and discharging the Mat∣ter, then dresses it with Leni∣tives, and after separation of the Eschar, incarnates by the common Sarcoticks, and the use of the Vitriol-stone; and lastly, heals, it up with Ʋnguentum de Lithargyro.

XIX. Sennertus is of opinion, that they ought to be suppurated with all possible speed; which Suppuratives ought (by reason of the coldness of the Part) to be the more strong and forcible.

XX. For tho' possibly some may be resolved or scattered by Discus∣sives; as Southernwood, Parietary, Fetherfew, Tansy, Marsh-mallow roots, Ammoniacum, &c. yet this happens but very seldom; and therefore it is the safest course artificially to open it, unless it break of its own accord; lest the long detaining of the matter matter should bring danger.

XXI. This Suppurative is commended. ℞ Althea roots, meals of Beans and Lupins, Lea∣ven, A. ℥i. choice Figs, Onions roasted, A. ℥ii. Balsam Capivii ʒvi. Oil of white Lillies, q.s. mix, and make a Cataplasm.

XXII. Or this. ℞ Balsam de Chili, or Peru, Turpentine, Honey, A. ℥i. Onions roasted, Mithridate, A. ʒvi. Ammoniacum ℥ss. Oil of white Lillies, q.s. mix them.

XXIII. If it is Pestilential or Malign, as was that of mine, you ought to provoke Sweat with Our volatil Laudanum, giving two or three grains every night.

XXIV. And every morning

fasting, half a spoonful or a spoon∣ful of my Tinctura Pestilentialis, in a glass of Sack, or some other proper Vehicle.

XXV. Tinctura Pestilentialis Nostra. ℞ Tincture of Salt of Tartar, or Philosophick Spirit of Wine lbii. Jamaica Pepper ℥ii. Virginia Snake-root, Contra-yerva, Cortex Winteranus, Cinamon, Bay-berries, Camphir, A.℥i. Gen∣tian, Cubebs, Zedoary, A. ʒvi. Cloves, Mace, Nutmegs, Opium, A. ʒii. Ginger Cochinele, Saffron, A. ʒi. mix, digest, and make a strong Tincture; which decant, filter, and keep for use.

XXVI. This Tincture strengthens the Stomach and Heart, fortifies the Archeus and Digestive Fa∣culty, causes Appetite, expels Wind, comforts and warms the Bowels, provokes Sweat, and is good against all malign Diseases, and such as proceed from Cold: it is an Arcanum against the Plague or Pestilence, and all pestilential and malign Fevers, Measles, Small-pox, &c. Dose, à ʒii. ad iv. or vj. in some proper Vehicle.

XXVII. And sometimes-in the day time, I took forty or fifty drops of my compound Tincture of Coral, in a little Wine also: by these things the morbifick mat∣ter and malignity were expel'd, partly in the Phyma, or Tumor, and partly in a continual breathing Sweat: nor was I out of a sweating condition, little or much, for near a whole month, both night and day.

XXVIII. By these things the Heart and Spirits were also kept up; and tho' an extream weak∣ness had universally seized me, yet I plainly perceived that Na∣ture got ground against the Disease.

XXIX. To maturate the Apo∣stem, this Cataplasm was ap∣plied. ℞ White Lilly roots, pulp of Figs, A. ℥iv. boil them in Milk to an absolute softness; then add crumbs of White-bread, q.s. boil again, and add Oil of white Lillies ℥ii. Mithridate ℥iv. Saf∣fron in pouder ℥ss. mix them well for use.

XXX. This was applied twice a day, as hot as it could well be endured; and in about three weeks time it came to ripeness: at what time the Chirurgeon opened it with an Incision-knife, out of which, near half a pint of green-coloured matter came away at several times.

XXXI. Then, the Abscess being cleansed, it was healed up in about three weeks following: after which I took two or three very gentle Purges, and became per∣fectly well: and this was the whole course I pursued in that Cure. See more here of Our Pa∣rateremata, or Select Physical and Chirurgical Observations, lib. 3. cap. 2. sect. 29.

De PHYMATE juxta ANƲM.

XXXII. It happens often in the lower part of the Intestinum rectum, where the Musculi Ani are inserted; and is many times the original of Fistula in Ano, they for the most part arising from these Abscesses; whether they break within and ulcerate there, or the matter descends lower,

and raises a Tumor without the verge of the Anus.

XXXIII. The Prognosticks. Those Phymata, which in the Anus produce the most dangerous Fistulae; the matter of which piercing thro' the Tunicles into the neighbouring Muscles, are seldom discovered, 'till they have made their way more outward among the Muscles of the Buttocks; and tho' they be discovered sooner, yet the Cure is most difficult.

XXXIV. If it appears out∣wardly, upon the verge of the Anus, tho' it is of much easier cure, yet if it be ill managed, the de∣fluxion of the Humor is continued; and the Sinus grows callous, and requires the same method of Cure which Fistula in Ano do; of which we shall hereafter speak in Lib. 5. following.

XXXV. The Cure. To pre∣vent the danger that may ensue by these Phymata, you must timely lay open the external Phyma by Causticks, that the Pus may have its free discharge; for if you open it by Incision, it must then be kept open by a Tent, which cannot easily be kept in.

XXXVI. And whether the Matter be stopt in by that, or the Tent slide out, and so the Ori∣fice close up, it is much alike inconvenient, and prolongs the Cure.

XXXVIII. If the Phymata are internal, they are soon, and easily cured; if, being timely discovered, they are opened by Incision.

XXXVIII. A Child four years old was much pained in Ano, four or five days, the Tumor appeared externally, and lay juxta Anum, as big as a Pheasants Egg, per∣fectly suppurated: I applied the milder Caustick on the decli∣ning part with Plaster and Bandage: the next morning I took off the dressings, and found the matter discharged thro' the Eschar, which was as I had design'd it, the bredth of a two-pence: I dressed it with a Pledget of Towe spread with Ʋng. Basilicon cum Oleo Rosarum; by this method the matter dis∣charged freely, without dis∣turbance in going to stool, and it was cured by the Maids dressing, I not visiting there. Wisenian.

XXXIX. One thirty years old, of a sanguine Body, was taken with a pain in Ano; I made a search with my finger dipt in Oil, but found nothing: after three or four days, the pain increasing, I made another search, and felt a swel∣ling on that part lying next to the neck of the Bladder: I took a crooked Incision-knife, and defending the edge of it, almost to the point, with a piece of Plaster, conveyed it in by my finger to the swelling, and made incision into the Tumor, which presently discharged a spoonful or two of matter: from that time he complained no more of pain; I cast in a little Oil of Hypericon warm, and dressing him no more, he was perfectly cured. Wiseman.

XL. I was sent for to one extreamly pained in Ano; viewing the Podex, I saw no external disturbance, I then anointed my

finger with a little Butter; and in passing it up in Ano, felt a Tumor, which I opened, as in the former Observation: the Patient desired to ease himself, and he did so, and discharged only a quantity of Matter well con∣cocted; from which time he complained of no more pain, and was cured in a day or two, by the benefit of Nature: nor did I cast in any Injections, lest they should get into the Ab∣scess, and make it sinuous. Wiseman.

Of PHYGETHLON.

XLI. Phygethlon, is a Tumor affecting the glandulous parts under the Jaws, and is called Panus; being an Inflammation, wherein Blood is mixed with Choler.

XLII. But Celsus, lib. 5. cap. 28. calls it Panis; from the similitude of its figure, being broad and flat, like a Loaf.

XLIII. The Cause. It is from a hot and fervent Blood, mixt with sharp Choler, as Galen, ad Glauc. lib. 2. cap. 1. affirms; and comes mostly after Fevers, a Fever being in some measure the cause thereof: or after some vehement pain of some other Part, chiefly the vehe∣ment pains of the Belly.

XLIV. The Signs. It is known by tumor, hardness, heat, dis∣tension, and greater pain, than probably a Tumor of that magni∣tude might cause.

XLV. There is oftentimes also a Fever, accompanying or preceding it; or some other vehement pain of the Belly, or some other part, as the Head, &c.

XLVI. And sometimes (it lying deeper than ordinary) none of the aforesaid outward signs at Sect. 44. are perceived, but only some certain prickings inwardly; and this, as it is long before it comes to maturation, so it is not fit to be converted into Pus.

XLVII. The Prognosticks. If it arises from any Ʋlcer, pain, stroak, blow, or any other exter∣nal cause, it is wholly void of danger.

XLVIII. That which follows upon Fevers (as in pestilential and contagious times) or proceeds from Swellings, either under the Armholes, or in the Neck, is the most dangerous, as Pau∣lus Aegineta saith, lib. 4. cap. 22.

XLIX. Celsus, lib. 5. cap. 28. saith, if it becomes not more hard than ordinary all of a sudden; and which, though it grows not red, yet notwithstanding is of a changed colour; it is of the safer kind, and has little danger in it.

L. The Cure. If it comes from Ʋlcer, pain, contusion, blow, or any other Procatartick cause, then its increase (as in other Inflam∣mations) is to be hindred by Coolers and Repellers.

LI. But if it is in Fevers, or is otherwise excited from some internal abounding of Humors, then Repercussives have no place, but only Discussives and Resolu∣tives; and if the Tumor is very hard, Emollients may be mixed with them; as Althea, Mallows, Arach, Chickweed, Parietary,

Figs, Ammoniacum, Galba∣num, &c.

LII. If the Matter be discus∣sed, then you must endeavour to suppurate it, by application of Maturatives; after which, it it is to be opened by Incision, unless it breaks forth of its own accord, and then to be cured as an ordinary Apostem.

LIII. An Observation from Wiseman. A little Girl was brought to him, as supposing she had the Evil, who had a flat, hard, round Tumor, lying under her Chin and part of the right Jaw, down towards her Throat; it was of a yellowish red colour, not much unlike an Erysipelas, but with∣out Vesication: he caused a Cataplasm made of white Lilly roots, &c. to be applied, by which it was suppurated in three or four days, and dis∣charged a well-digested matter, during which the hardness was resolved, and was cured in seven days, by the only use of that Cataplasm.