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 ...

I. THEY are called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Gangraena; and in English, a Gangrene. II. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Syderatio, and Sideratio, also Sphacelus; in English, a Sphacelus, or Mortification.

II. Sennertus saith, that Gan∣grene and Sphacelus are neither Tumors nor Ʋlcers; neither will he have Sphacelus to be so much as a Disease, since it is the very mortification, or destruction of the Part. Yet with the favour of that Learned Man, tho' in re∣spect to the Part only, he will have it no Disease; yet in re∣spect to the whole Body, it is a very great one.

III. A Gangrene is a great and terrible Distemper, tending to a Mortification, which may be in∣duced without any Tumor at all: but yet because it most frequently follows Tumors, and chiefly Inflammations, we thought good to treat of it among Tumors; whereas others, (because that when a Part is Gangrenated, an Ulcer necessa∣rily follows thereon, and that after a Sphacelus, an Ulcer is left remaining) treat of them among Ulcers.

IV. Gangraena, is an imperfect Mortification of the Part by little and little, thro' violence of much in∣flamed Matter and Blood, which so stop the passages, as that the natural heat cannot have recourse thereto. If it come of Inflammation, the red Colour, Pain, Sense and Beating decays; waxing pale, livid, black and soft, yielding to the Fingers, without rising again.

V. Or, It is an imperfect corruption of the Part, tending unto a 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, necrosis; to wit, a mortification or deadness: to which if there are not speedy Remedies applied, it becomes Sphacelus, or Syderatio, wholly dead; losing all sense and life, and feeling nothing, tho' it is cut or burnt.

VI. The Differences. From what has been said it appears, that there is no difference between these Diseases, but in respect of degrees, or greatness. In a Gan∣grene there is not yet a perfect corruption of the part, or absolute mortification of the whole part; but only an inva∣sion of the softer and more tender parts, as the Skin, Flesh, and Muscles.

VII. Whereas in a Sphacelus, the whole part is wholly de∣prived of all sense and life, and is altogether dead; and there is a perfect, absolute, and intire corruption or mortification, not only of the softer parts afore∣named, but the very Bones themselves also are corrupted and spoiled.

VIII. But when a Sphacelus is inducing, the softer parts, as Skin, Flesh, and Muscles are first mortified; while the Veins, Arte∣ries, and Nerves may remain safe and sound: but if the Sphacelus continues to go on, and the putrid part is not speedily separated, the Arteries, Veins and Nerves will at length be invaded, and at last the Bone it self.

IX. The Causes. It is caused, 1. From external Cold, or Re∣pellers. 2. External Heat, Burners or Corrosives. 3. Defect of Nutri∣ment. 4. Stoppage of the Pores, (as in splinting and rowling Fractures,) whence comes suffo∣cation of the natural Heat. 5. Ma∣lign Humors. 6. The Scurvy, which by a peculiar property, sometimes causes a Mortifi∣cation.

X. Whatsoever destroys the native heat of the part, that same may also be accounted a cause of a Gangrene and Sphacelus. Now the native Heat is destroyed, when by its contrary it is either corrupted, or suffocated, or diffipated, or extinguished for want of Nourishment.

XI. It is destroyed by its con∣trary, either acting by a manifest quality, as Cold; or else by a hid∣den quality, as by Poison: it is suffocated, when the Transpira∣tion is hindred: it is dissipated, by a greater Heat: it is ex∣tinguished, if necessary Food and Sustenance is denied it.

XII. 1. From external Cold, as travelling in Frost and Snow, in the Northern Regions; where the extream parts, as Nose, Ears, Hands, Feet, &c. are dead with Cold, by reason of the extremity thereof.

XIII. 2. From Poison; as in a Carbuncle from internal mali∣gnity; or external, as from the bitings and stinging of poisonous creatures; as the Viper, Rattle-Snake, Slow-worm, &c. or the application of Septick Medica∣ments, which being not wisely and carefully applied, corrupt the Flesh; or from the afflux of malign and poisonous Humors.

XIV. 3. From Transpiration hindred; as in great Inflamma∣tions, where the part stands in need of perpetual ventilation and cooling; which if hindred, the native Heat is suffocated by the abundance of Vapors: and this is done many ways; as by ap∣plication of Emplastick Medica∣ments in moist places, too strict bandage and rowling of the Part, and in applying over∣cooling Medicaments in a Phle∣gmon or Erisipelas.

XV. 4. From an external pre∣ternatural Heat, which wasts the radical Moisture and native Heat.

XVI. 5. From defect of Nourish∣ment; viz. of Blood and Spirits flowing into the Part, which are wholly necessary and requisite for the cherishing the native Heat implanted therein: and this is caused many times also from too hard ligature, or by applying of Medicines over-astringent and cooling; by which the de∣scent of the Blood and Spirits is wholly hindred.

XVII. The Signs. In a Gangrene the part begins but to die, nor is the sense totally abolished; but the Skin is in a manner red, and without any vehement ill scent.

XVIII. In a Sphacelus (called also Necrosis and Syderatio) the Part looks first pallid, after livid, then black; the Flesh is spungy, with great stink; the sense, heat, and pulsation is vanisht, and the Parts are altogether dead.

XIX. A Gangrene proceeding from Cold, has great pricking; first 'tis red, then pale, then black.

XX. If from external Heat, or Stoppage of the Pores, the redness turns to a whiteness, pain and pulsation ceases, and Pustles appear, from whence issues a gleety Humor.

XXI. If from defect of Nutri∣ment, it for the most part seizeth on the Joints; the part waxes cold, without Pain, Inflamma∣tion, or Tumor.

XXII. If from Venemous Crea∣tures or Humors, there is Faint∣ing, great Pain, always a Fever, and oft-times a Phrensy; with a little Pustle, under which ap∣pears a black Spot, spreading it self over the whole Part.

XXIII. If from the Scurvy, it for the most part begins in the Toes, with blackish Spots or Lines; degenerating into a dry Crust, with numbness, and at length mortification.

XXIV. In a Gangrene which is yet but beginning, you may observe a variety of Signs and Symptoms; according as it has its original from divers and different Causes: but if at length Pustles arise, and the Part becomes pale and wan, then Pains also come on, and a Fever is excited.

XXV. If the Gangrene happens from too hard Ligature, then the Part swells, and greater Pustles arise, full of a thin Humor, not much unlike the Washings of raw Flesh.

XXVI. In a perfect Corruption, and absolute Sphacelus, the life and sense of the Part are wholly abolished; the Pulse is wholly lost, the Part, if cut or burnt, is insensible of pain; the Flesh feels cold, and becomes soft and

flaggy; which yet afterwards being throughly dried, becomes black, hard, and wholly dead, and yields a noisom stink, like that of a dead Carcass.

XXVII. The Prognosticks. Gangraena, if it be not presently helped, the Part straightways dieth, that is, degenerates into Sphacelus, as also the parts ad∣jacent; and so suddenly causeth the death of the whole Body.

XXVIII. But if the Sick be young, the Constitution good, and the Nerves and Muscles be unhurt, it is less dangerous.

XXIX. It is more dangerous, if it proceeds from the bitings of Venemous Creatures. It is also dangerous if in moist parts, or if the Humors continually flow to the Part, or be in the Cavi∣ties of the Body, viz. in the Mouth, Privy Parts, Bowels, or Fundament.

XXX. That which happens from the Scurvy, is seldom cured; in Hy∣dropick persons it is always mortal.

XXXI. A Sphacelus is yet much the more dangerous, for the Part can no more be restored again, but is immediately to be cut off from that which has life in it; and which being not done, the sound parts which lye next or near to it, will be infected, and the putrifaction will creep at length into the rest of the Body, from whence comes dan∣ger of present death: but be∣fore which there usually goes, Doatings, Watchings, Faintings, Swoonings, Convulsions, Belch∣ings, Sobbings, and cold Sweats breaking forth over the whole Body.

XXXII. The Cure. The In∣dications of Cure have respect, 1. To the Antecedent Cause. 2. To the Conjoined Cause. 3. To the Vital Powers.

XXXIII. In respect to the An∣tecedent Cause, which is first to be considered (if it is present in the Body) before we come to To∣picks. The Diet claims the precedency, which ought to be cooling and drying; especially when the Gangrene is accom∣panied with an afflux of Hu∣mors, and follows great Inflam∣mations: in other Cases, the Diet is to be varied according to the varity of the Causes.

XXXIV. Then for taking away the Antecedent Cause, it is done either by Bleeding or Purging: con∣cerning which Barbett advises us to distinguish, that we may know when they are to be used with advantage or disadvantage, and ought to be according to the nature of the peccant Humor.

XXXV. But this is to be precautioned, That regard be had unto the Heart, that it be well; or otherwise to be defended against the malign Vapors and Humors proceeding from the putrifying part.

XXXVI. The chief things for this purpose among Simples, are roots of Angelica, Virginian-Snake-root, Contra-yerva, Ze∣doary, Lovage, Elecampane. Of Herbs; Angelica, Bawm, Borrage, Bugloss, Carduus, Rue, Scordium, Scabious, Swal∣lowort, Sage, Southernwood, Tyme, &c. Of Flowers; Saffron. Of Spices; Cloves, Nutmegs,

Mace, Pimento, Cinamon, Cor∣tex Winteranus, Ginger. Of Peels; Oranges, Limons, Citrons. Salts, of Carduus, Self-heal, Wormwood, Tartar, Pot-ashes. Of Animals; Cochenele, Vipers.

XXXVII. Among Compounds, these are chief; Treacle-water, Aqua Bezoartica Nostra, Our Tinctura Bezoartica, Diascordium, Mithridate, Venice-Treacle, Our New London-Treacle, Guttae Vitae mixt with four times its quantity of Syrup of Limons, Confectio Alkermes, Our Theria∣ca Chymica, which may serve instead of all the rest.

XXXVIII. The next thing is the Conjoin'd Cause, wherein are three Intentions of Cure. 1. Ei∣ther to prevent the Gangrene, when it seems to be inducing. 2. Or to hinder its spreading, and increasing. 3. To overcome it in the part, where it is present.

XXXIX. As to the first In∣tention of these, where the Gan∣grene is but coming on, Author's advise to Externals, as Leeches, Cupping with Scarification, (which some yet approve not so well of) and the application of such things as resist Putrifaction; as roots of Angelica, Birthwort. Herbs; as Wormwood, Car∣duus, Tobacco, Rue, Angelica, Germander, &c. Flowers; as Camomil, Melilot, Saffron, &c. Liquids; Lye, Brine, Urine, Camphorated Spirit of Wine, Powers of Amber and Turpen∣tine, Spiritus Ʋniversalis, which is instar omnium. Ointments, as Aegyptiacum, Fuscum Wurtzii, Mithridate, Our Theriaca Chy∣mica, &c.

XL. Now to know a Gangrene beginning, Wiseman, lib. 6. cap. 2. pag. 444. says, If the Tumor and Inflammation have been very great, and it changes colour suddenly, sinks down, the pain continuing, you may conclude a Gangrene is in∣ducing.

XLI. So also if there is a Wound or Abscess, if that Wound, &c. grow more painful, the Flesh loses its ruddiness, looks pale, and wi∣thered, and the Matter changes to be thin and gleety, you may then suspect its corrupting: in which case, it will be necessary that you scarify to the quick, and make it bleed freely. Now by the Patient's sensible feeling, and by the fresh trickling down of the Blood, you may judge of the Mortification.

XLII. But if the Gangrene has crept down, or seems to proceed from the bottom of the Wound, the Scarification ought to be made accordingly unto the fleshy parts: and if there be any Abscess or Apostem under the Muscles, or lips of the Wound or Ulcer, it is to be opened, and the Matter let out.

XLIII. Now in making such Scarifications, if you should hap to cut some Vessel, causing a flux of Blood, beware that you suf∣focate not the heat of the Part by thrusting in Dossils, whereby the mortification will be in∣creased; but stop the flux of Blood with some proper styptick Water, or Styptick-pouder, &c. Or you may use the Actual Cautery, whereby you will not

only stop the bleeding, but also hinder the progress of the Putrifaction: after which you may dress up the Wound, as we teach in the Cure of Burnings, &c.

XLIV. If in scarifying you prick or hurt a Nerve or Tendon, you will increase the Gangrene; so also if you burn them but in part with the actual Cautery, or sharp Medicines be applied on them, when newly hurt by Scari∣fication; for great Fluxions often arise from small disturbances of the Nerves and Tendons: when therefore they lye in your way, you had better cut them off, or burn them through, than hurt or prick them; after which the Ulcer will grow easy.

XLV. The second Intention of Cure is, to hinder the Gangrene from spreading, or creeping farther into the sound parts. Those parts are to be defended with Flow∣ers of Sal Armoniack, or Spirit of Sal Armoniack, or Spirit of Urine mixt with Spirit of Wine, whereby the Humors are kept from flowing, and also by applying the red Defensive Emplaster, or Vigo's Cerat, or this following.

XLVI. Take fine Bole ℥ ss. Galls, Cypress-nuts, Pomgranate∣peels, all in fine pouder, A. ʒiij. Barley-flower ℥vi. Oxymel sim∣plex, q.s. mix, and make a Cataplasm. Or: ℞ Fine Bole, Terra sigillata, A. ℥ ss. burnt Harts-horn ʒi. Camphir ℈i. Rose∣vinegar ℥i. Oil of Myrtles ℥iii. white of one Egg: mix, and make a Liniment.

XLVII. Sennertus advises, always to endeavour to hinder the sound Parts from receiving the Putrifaction; which is done by guarding and defending them with the afore-named Medica∣ments; or by these following, in which Scordium is put, for that it powerfully resists Pu∣trifaction.

XLVIII. ℞ Fine Bole ℥i. Ter∣ra sigillata ℥ss. Harts-horn burnt ʒi. Camphir ʒss. Wax ʒvi. Oil of Roses ℥iv. juice of Scordium ℥i. white of one Egg; mix, and make a Liniment. Or: ℞ Terra Le∣mnia ℥i. Vinegar of Scordium q.s. mix them.

XLIX. The third Intention of Cure, is the overcoming of the Gangrene in the part where it is present. And this is done by scarifying of the place affected, and cleansing it of the clotted Blood, by washing it with Brine; or a strong Lixivium of Wood-ashes, Tincture of Myrrh, or Spiritus Ʋniver∣salis, &c.

L. And that the Putrifaction may go no farther, some anoint or touch it round with Butter of Antimony, or Oleum Narcoticum, in which an eighth part of Mercurius sub∣limatus is dissolved; digesting them together 'till the Oil looks red, which not only perfectly cleanses all fetid Ulcerations, but also separates the gangrened parts from the living; removing the putrifaction, and yet not touching the sound.

LI. Then fill up the Scarifica∣tion with Trochisci Musae mixt with Precipitate, or in Dossils dipt in Oil of Cloves or Turpen∣tine

actually hot; Ung. Aegyptia∣cum is good here also, with the addition of Nitre, flowers of Sal Armoniack, Camphir, Mi∣thridate, Venice-Treacle, &c.

LII. But the usual Fomenta∣tion is a Lixivium made of Pot∣ashes, wherein the tops of Worm∣wood, Southernwood, Centory the less, Carduus ben. Scor∣dium, Swallowort, roots of round Birthwort and Gentian have been boiled; to which a quantity of Spirit of Wine is to be added.

LIII. Aqua Calcis, with a So∣lution of Sublimate in it, is of good use for this purpose; so also Aqua Lapidis Medicamentosi, the Powers of Amber, Powers of Turpentine, or Spiritus Univer∣salis, to foment withal. Cata∣plasms also made of the meals or flower of Barley, Beans, Lupins, Lentils, Pease, and Mithridate, boiled in a Lixivium of Pot∣ashes, with a little Oxymel added, are approved.

LIV. Then as to the Dressings, you are to consider well in the application of the Medicament, that in the destroying of one Gan∣grene, you do not excite another; which will easily be done, by the too long use of sharp Medicines: for which reason, when you feel the Ulcer warm, and find it to cease gleeting, desist their use, and dress it with warm Digestives, as Ʋn∣guentum Basilicum, with Oil of Turpentine, hot.

LV. And after Digestion, cleanse it with Detersives or Mundifica∣tives, as that ex Apio, or such other like, that the slough may the more speedily and easily be cast off.

LVI. Lastly, after Digestion, and sufficient cleansing, you must compleat the Cure by Sarcoticks and Epuloticks; as in Lib. 5. of the Cure of Ulcers following, we shall particularly teach.

LVII. The Vital Indication. This is not always requisite to be considered here, where there is a sufficient strength of Body, where there is no malignity, where the discrasy of the Blood is little, and the Humors of the Body not much depraved: But in a Patient weak, the disease or temper of the Air malignant, the Blood vitiated, and the Juices cor∣rupted, this last Indication will necessarily have place.

LVIII. From what has been said it appears, that the Diet must be composed of, 1. Strength∣ners and Restoratives. 2. An∣tidotes against Poison and Ma∣lignity. 3. Restorers of the Blood to its due Crasis. 4. De∣purators of the Humors, or Juices of the Body: to which add a due quantity of proper Traumaticks.

LIX. A Diet-Drink. ℞ Scor∣zonera roots, Parsley roots, A. lbj. Galangal, Angelica roots, Sca∣bious, Scordium, Bawm, Mint, A. ℥viii. Snakeroot, Contra∣yerva, Winter's Cinamon, A. ℥ii. Bloodwort, Sorrel, A. lbj. Self∣heal, Winters Green, Ladies Mantle, Saracens Consound, Bugle, Hypericon, Speedwell, A. ℥iv. fair Water 4 gall. boil to one half, then add Coriander and Dill seed bruised, A. ℥ii. Limon and Citron peels, A. ℥jss. Cubebs, Cloves,

Ginger, A. ℥ss. boil again a quar∣ter of an hour, then strain out, and bottle it up for use. Dose, half a pint in the morning fasting, half a pint at 11 be∣fore noon, and half a pint at 6 at night.

LX. A Medicated Ale, for the same purpose. ℞ Take Fennel and Parsley roots, Angelica roots, A.℥xii. Contra-yerva, Snake∣root, Winters Cinamon bruised, A. ℥iii. Rhubarb, Galangal, A.℥ii. Agrimony, Bawm, Mint, Parsley, Scabious, Scordium, Bloodwort, A. M. iv. Bugle, Fluellin, Ladies∣mantle, Saracens Consound, Self∣heal, Vervain, Yarrow, A. M. vi. Aniseeds, Coriander-seeds, Dill-seeds, Fennel-seeds, Pimento, all bruised, A.℥jss. Orange, Limon, and Citron peels, A. ℥i. put all into a Bag with a Stone in it, which put into 4 gallons of new Ale, and let them work up together: after three days, let the Sick drink of it, three quarters of a pint, plus-minus, morning and evening, and oftner, if they so please.

LXI. In this latter case, if the Patient is of a gross Body, and full of Humors, it may not be inconvenient to put in a fit quan∣tity of purging Ingredients, by which the morbifick Cause may in a great measure be carried off. To the former quantity of Ingredients, you may add Sena ℥viii. Mechoacan thin sliced, or bruised ℥iv. Carthamus-seeds ℥ii. but in thin and weak Bodies, these Ingredients must be for∣born. Hitherto of the General Cure; the Particular Cure, as it arises from Particular Causes, now follows.

LXII. A Gangrene from Ex∣ternal Cold. If it arises from vehement Cold, as in Denmark, Norway, and Swedeland; and it is only beginning, and not per∣fectly induced; known by its not being black, but being yet red with pain: then bring the Patient toward the Fire, but not too near, that by degrees the heat may be again restored to the Part.

LXIII. And for this purpose, let the Part be plunged in cold frozen Water, or strongly rub it with Snow, or Cold, for some considerable time; and inwardly give the Patient Mithridate, Venice-Treacle, or Our Theriaca Chymica in Sherry-wine, or in Canary: Or, Our Powers of Rosemary, Anise, or Angelica in a glass of Sack: Or you may give our Aqua Bezoartica, or Spiritus Cordialis ℥ii. by them∣selves.

LXIV. When the cold and pain remit, embrocate the Part with Oil of Dill or Camomil, mixed with ⅓ of Oil of Juniper∣berries, or Oil of Aniseeds or Amber: Or with a Decoction of Turneps, mixt with Powers of Turpentine.

LXV. Afterwards you may foment with S.V. in which Spirit of Sal Armon. or Flowers of Sal Armon. are dissolved; or with Powers of Amber and Juniper, Oils of Turpentine and Spike, or the like; laying over the Part a Cataplasm of Mithri∣date, mixt with a little Oil of Amber.

LXVI. And in those Northern Countries, they give them burnt

or mull'd Wine, with pouder of Cina∣mon, Cloves, Nutmegs, and Ginger, and the like Spices. Or this Deco∣ction: ℞ Rue M. ss. Swallow∣wort, Angelica, A. M.j. Scordium M. jss. Pepper bruised ʒi. boil in White-wine, and strain: to a pint of which add of Our Spiritus Cordialis ℥iii. And the Patient being in bed, make him to sweat with the Warming-stone, or application of glass Bottles filled with hot Water.

LXVII. But if the Part is al∣ready gangrened, known by its being blackish, and stiff with cold; you must then immediately scarify the Part, and foment it with the former hot Medicaments, and continue the use of the former things, as we have be∣fore declared.

LXVIII. A Gangrene from too much Heat. Let the Diet be cooling, and the hot Humors (being qualified) evacuated with proper Catharticks, if the Dis∣ease takes its original from an internal Canse.

LXiX. Then let the Part affected be scarified, and wash with Dia∣clysma frigidum; to a pint and half of which you may put Vin∣egar half a pint, Salt an ounce and half: or you may wash with this: ℞ Fair Water ℥xiii. Vin∣egar, juices of Sorrel and Scor∣dium, A.℥viii. juice of Germander ℥iv. Salt ℥jss. Lupins ℥ss. mix, and boil to the consumption of a third, and use it hot.

LXX. Or you may use the Spiritus Universalis, to ℥iv. of which you may put juices of Scor∣dium and Germander, Spirit of Wine, A. ℥iii. after which apply Ʋng. Aegyptiacum, or Fuscum Wurtzii, &c. but proceed not to an actual Cautery, unless necessity force it.

LXXI. A Gangrene from Tran∣spiration hindred, as in too hard Ligature, application of Empla∣stick Medicaments in a Phle∣gmon, &c. The Binding is then forthwith to be removed, or the Emplastick-body taken a∣way; and Scarification being made, you must wash the Part with Spiritus Ʋniversalis, Spirit of Wine camphorated, Powers of Amber or Turpentine; or some other of the former di∣rected Medicines.

LXXII. And then you must apply Medicaments discussive, and non-putrifactive: and the Blood and Humors flowing over-much into the Part, are to be emptied out of the whole Body by Bleeding, Cupping, with Scari∣fication, Derivation, Purging, and other fit Remedies.

LXXIII. And round about the part affected, Defensatives are to be applied, as directed at Sect. 45. &c. aforegoing. But as to the Gangrene it self, the Scarifications ought to be many, and deep enough, that great plenty of Blood may be eva∣cuated: but yet their greatness and depth ought to have respect to the greatness of the Affect it self; according as it is more or less nigh unto putridness and a Sphacelus.

LXXIV. After Scarification, as directed, you may use the Me∣dicaments at Sect. 71. aforegoing; or this following Wash, which is much commended: ℞ Strong

Lye and sharp Whitewine-vinegar, A. lbii. Scordium, Wormwood, Lupins bruised, A. M. j. roots of Flowerdeluce, round Birthwort, Swallowort, A. ℥ss. boil to the consumption of one third part; then strain, and add fine Aloes, Myrrh in fine pouder, A. ℥ss. boil again a little, and lastly add Honey of Roses ℥i. S.V. ℥ iii. mix them.

LXXV. The Part being washed with the former, then apply Ung. Aegyptiacum, for that it is reputed to be the most excellent Remedy to remove Putridness, and to separate the dead and putrid Parts from the living and sound. But this Ointment is not to be applied alone; but there∣upon a Cataplasm is to be imposed, which resolves, drys, and hinders Putrifaction. Take Mithridate ℥iv. Myrrh ℥ii. round Birthwort in fine pouder ℥iss. Cam∣phir in pouder ℥ss. Honey of Squills q.s. mix, and make a Cataplasm.

LXXVI. Or, after Scarifica∣tion, you may wash with this Water: ℞ Vitriol ℥i. Oak buds or tops M. i. Frankincense ℥ss. Camphir ʒii. Ʋrine lbijss. mix, boil to the consumption of a third, and strain out for use: and after washing, apply the fol∣lowing of Guilielmus Fabricius, (which is to be applied when the corruption is more than ordi∣nary. ℞ Verdegrise, Honey, A. ℥iii. Decoction of Wormwood and Scordium lbi. Vinegar of Squills lbss. juices of Rue and Germander, A. ℥ii. Alum, Sal Armoniack, A. ℥ss. mix, and boil to a good thickness; then add Venice Treacle, Mithridate, A. ℥ss. Camphir ʒi. mix them, and apply.

LXXVII. A Gangrene from Poison, or the afflux of malign Humors. If the Poison is from without, as the biting of a Rattle∣snake, &c. then such things as do strongly attract the Poison, dry it up, and destroy it, are to be made use of; for which purpose, nothing seems better than the application of the actual Cautery; giving inwardly cooling, cordial, and sudorifick Medicaments.

LXXVIII. The Part affected being either burnt or scarified, then such things as resist Putridness, and prevent the Necrosis or Spha∣celation, are to be used, viz. the strongest Attractives, and such as resist malignity and putridness, as Wormwood, Rue, Dittany, Angelica, Swallowort, Scordium, Radish-roots, seeds of Cresses, Garlick, and Oni∣ons roasted in Embers, Lea∣ven, &c.

LXXIX. The Gangrene being mastred, the Ʋlcer is to be cleansed with juice of Smallage and Honey of Roses, to which Spirit of Wine may be added, and with other things proper to the same intention; and Defensatives are also at first to be applied round about, that the Poison may not spread it self any farther into the interior and more noble parts, nor yet spread broader into any of the adjacent places.

LXXX. But if the Poison proceeds from within, Defensa∣tives are not to be used, but the malignity is only to be sent forth

into the external parts: 1. By Alexipharmick and Sudorifick Medicaments. 2. To be drawn forth by Scarification and Attractives, Cupping-glasses, Leeches, &c. and in this case, Barbett saith, that he had seen Bleeding and Purging oftner to do hurt, than good.

LXXXI. If the Gangrene is from the afflux of malign Humors, or a malignant Quality, a cooling and drying Diet is to be ordered, with Sauces made of the juices of Oranges, Limons, Citrons, and Pomgranates: the depraved and malign Humors are to be eva∣cuated by Purging Medica∣ments, and sometimes by Bleed∣ing, if need requires it, or the nature of the Sick will bear it: and the malign Matter is by Topicks, as Burning, Scarifi∣cation, Attractives, &c. to be drawn forth.

LXXXII. And inwardly the Malignity is to be expelled and protruded to the External parts, with such like things as we usually give in malign Fevers, viz. Medicaments made of Citrons, Limons, Angelica, Borrage, Bugloss, Bawm, Carduus bened. Dittany, Scordium, Sorrel, Swallowort, Mithridate, Our Theriaca Chymica, &c. endea∣vouring a powerful Sweating, the malignity may be driven outwards, &c.

LXXXIII. A Gangrene from an Atrophia, or want of Nourish∣ment. In this case, advise to Meats hot and moist, and easy of digestion, which generate much, and good Blood: and outwardly the Body is by all means to be moistned, by rub∣bing and anointing it with sweet Oil, Oil of sweet Almonds, Oil of Ben, and pure Neats-foot Oil; avoiding all things which exsiccate and dry the Body.

LXXXIV. Here is no place for Defensatives, but the Part already affected with the Gan∣grene is to be drawn with vehe∣ment Attractives, that it may be supplied with Nutriment; and it is gently to be rubbed and chafed, with application of Cupping-glasses without Sca∣rification.

LXXXV. But if there is al∣ready a present Putridness, you must apply things which do alike both attract and resist Putrifa∣ction; such as are, Salt-brine mixed with juice of Scordium, Tar mixed with meal of Lupins or Orobus, Myrrh mixed with Mithridate and Cress seeds, Spiritus Ʋniversalis, campho∣rated S.V.

LXXXVI. And if the Gangrene has already proceeded on, you must proceed to Scarification, and the Lotions afore-mentioned, dres∣sing it afterwards with Ʋnguen∣tum Aegyptiacum, with other things afore-named.

LXXXVII. A Gangrene pro∣ceeding from the Scurvy. This is not common, yet Authors have taken notice of it; as Sennertus, Barbett, &c. This most usually begins in the Extream parts, as of the Leg or Foot, with black and purple Spots; after which there appears a crusty and gangrenous Ulcer, drys, so as it yields neither the thinner Matter, which we call Sanies,

nor the thicker, which we call Pus.

LXXXVIII. Then one or other of the Toes begins to dye, af∣ter which red lines and purple spots appear upon the juncture of the Foot, according to the length of the Part.

LXXXIX. This Gangrene dif∣fers from the common, very much; for that arises from Causes mani∣fest; and there always runs forth from the mortified or sphacelated Part, a thin stinking Humor, the Member is soft and putrid, and yields a filthy stink, like that of a dead Carcass, creeping far in a short time, and quickly kills the person that has it: where∣as the Scorbutick Gangrene in∣vades without any manifest cause, creeps but very slowly, and kills not the Sick 'till after a long time: the Part is dry, so that no moisture flows from it; and when the corrupt Part is taken away by Instrument; the Flesh seems to be of a dark or blackish red, and remains dead the next day also, without any perceivable stink which may offend.

XC. And as soon as ever the Disease has seized upon one Foot all over, it then presently after, (without any evident cause) begins to appear in the same manner, with Spots of a red purple colour on the other Leg and Foot, and not long after, one or other of the Toes of that Foot becomes wan and livid, and in a very little time it is found to be perfectly dead: at length the Sick is taken with an Apoplexy or Epilepsy, upon the first fit whereof they dye.

XCI. Sometimes again this Dis∣ease is induced suddenly, viz. when the peccant Humor is thro' terror, fear, anger, wrath, or other like causes, disturbed and protruded (as it were in a mo∣ment) unto the Toes, after the same manner as an Erysipelas is wont to arise, causing the Part so affected presently to dye; from which cause this kind of Gangrene is called by some Syderatio, Blasting; or as the Vulgar phrase it, Planet-struck.

XCII. This Disease seizes most usually on the Tendons, causing almost intollerable pains, afflicting the Patient night and day: and because it seizes the Ten∣dons, which do not so soon and easily putrify as the Flesh; therefore it is that it creeps on so slowly, being sometimes one whole months space in creeping over one whole Joynt, before it seizes upon another; notwith∣standing that within the Foot, almost all the Tendons are al∣ready infected.

XCIII. It is seldom or never cured, because this malign acid Humor has insinuated it self very deep into the Tendons, that it cannot easily be taken away: so that it many times continues three, four, and sometimes six months before that it klils the Patient.

XCIV. As to the Cure, the Internals must be highly Antiscor∣butick, mixt with Antidotes which have power to absorb the acid Humor, and destroy the mali∣gnity; which are to be given

both medicinally and dieteti∣cally, as the Physician shall direct.

XCV. Order cordial Medica∣ments, giving after Sudorificks; which let be followed close with strong Tinctures, Elixirs, or Potestates of Scordium, Rue, Dittany, Scurvigrass, Cresses, Swallowort, Our New London-Treacle and volatil Laudanum are good things, as also Our Theriaca Chymica.

XCVI. Outwardly foment the affected Parts with this. ℞ Gua∣jacum rasped, Sassafras rasped, Fennel-seed, A. ℥i. roots of An∣gelica, Celandine, Cress-seeds, A. ʒvi. Scurvigrass, Watercresses, A. M. j. S.V. lbj. infuse a night, then distill in B.M. to driness.

XCVII. Or you may anoint with this. ℞ Oil of Earth∣worms, of Bays, of Rue, A. ʒii. Castor ʒi. Spirit of Wine ʒiii. mix, and make a Liniment; and apply over, Emplastrum de Gal∣bano crocatum Mynsichti, Empl. Polychrestum, ad Strumam, vel Arthriticum.

XCVIII. If these things do not, you must apply Cupping-glasses, Scarify, &c. then wash with Brine in which flowers of Sal Armoniack are dissolved; or with Spiritus Ʋniversalis, mixt with camphorated S.V. and after apply Ʋng. Aegyptiacum, and over it some resolving and drying Cataplasm.

XCIX. If yet there be no amendment, you must come to Cauteries; either Potential, as Butter of Antimony, red Pre∣cipitate, &c. or Actual: af∣ter which you must remove the Escar in due time, lest new Putrifaction grow under it.