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. XII. Of a FELON.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Panaritium, and Parony∣chia Arabum; in English, a Felon.

II. It is a Disease that seizes upon the Fingers end, and upon the ball of the Finger; being a small Tumor, hot, and by reason of the Nerves, exciting most vehe∣ment, and almost intolerable pains.

III. The Causes. It has its original from adust Blood, joined with a malign Humor, chiefly Melancholy; which Nature thrusts forth unto the Fingers ends, and there causes an Inflam∣mation.

IV. The Kinds. It is twofold. 1. One which is benign, and begins in the Flesh; which tho' it is painful, yet is less painful than the other. 2. The other, which is malign, and begins at the Bone, and seizes first upon the Peri∣ostion it self, whereby the pain is almost intolerable, and so comes gradually outwards: and this truly, in my opinion, is little different from that Dis∣ease which we call Spina Ven∣tosa; of which in its place.

V. The Signs. They are known by swelling, redness, and pain; appearing in the Fingers ends, chiefly on the ball of the Fin∣ger, and sometimes near the roots of the Nails; the pain is vehement and intense, by reason the near adjoining Ner∣vous parts are affected.

VI. The Patient can take no rest night nor day, (more espe∣cially if it is the latter kind) and the pain, by reason the Nerves are affected, is oftentimes extended thro' the whole Fin∣ger, yea many times thro' the whole Hand, and sometimes thro' the whole Arm.

VII. There is, for the most part, a continual Fever present; and if it be of the second kind, many times a disturbance of the spirit, faintings, swoonings, &c.

VIII. The Prognosticks. If the matter is benign, and not very sharp, the Symptoms are less ve∣hement, and more tolerable; but if malign, more grievous and vexatious.

IX. The first kind is without any great danger, because it is seldom accompanied with ma∣lignity, soon comes to ripe∣ness, with a kind of whiteness, which being opened with the Lancet, the matter is let out; and it heals almost of its own accord.

X. The latter kind is always malign, and causes vehement Sym∣ptoms; for which reason it is not without its dangers: sometimes it corrupts the Bone, Ligaments, and adjacent Nerves; so that the utmost Joint, to∣gether

with the Bone, apo∣stemates.

XI. Sometimes the whole Fin∣ger is corrupted, yea sometimes the whole Hand: and sometimes (as Barbett says) from the extre∣mity of the pain, the death of the Patient is caused.

XII. I remember when I was a Youth, I had one of this latter kind, upon the ball of my Fore∣finger of my left Hand: the pain was so vehement, that for five or six days, I had no ease night nor day; nor for the first three days did any thing appear, or any discolouring, but only the end of the Finger was a little swell'd: however with proper Applications, it was soon cured, without any detriment to me.

XIII. The Cure of the Benign Felon. Wiseman says, Repellents are commended in the beginning, but not with much astringency: but Sennertus says, that repel∣ling and astringent Medica∣ments are by no means to be applied; lest the Humor should be the more impacted into the Part, the Pain augmented, and the Nerves and Bone corrupted.

XIV. Yet as Defensatives up∣on the Parts adjacent, they may be imposed; such as these. ℞ Oil of Myrtles, juice of Night∣shade, Ana, and with fine Bole make a Cataplasm. Or, ℞ Barley and Bean flower, A. ℥i. Camphir ʒss. mucilage of Flea∣bane and Vinegar, A. q.s. mix, and over the Fire make a Cata∣plasm. ℞ Pouder of the green sort of Galls, and with Vinegar make a Cataplasm.

XV. Or: ℞ Mucilage of Flea∣bane-seeds, juice of Nightshade or Plantane, A. ℥i. Vinegar ℥ss. fine Bole q.s. mix, for a Cataplasm. Or: ℞ Mucilage of Fleabane∣seeds ℥ii. Vinegar ℥ss. fine Bole, q.s. mix them.

XVI. To the Affect it self you may apply the Worms that are found in the middle of the Teazle∣heads, being found alive; because they alleviate the pain, and sometimes discuss the Tumor: but because they are not always to be had, we must have re∣course to other Remedies; as ℞ Green Tobacco, and bind the leaf on the Part: if that cannot be had, moisten dried Tobacco-leaves in Wine, and apply them. Or, ℞ Unguentum Nicotianae ℥i. Rosin in pouder ℥ss. mix, and apply.

XVII. But if it tends to Sup∣puration, ℞ Mucilage of Flea∣bane-seeds, meals of Linseed and Fenugreek, A. ℥ss. yolk of one Egg, Hens or Goose grease ℥ii. Saffron ʒss. pouder of Rosin or Tobacco-leaves q.s. mix them. Or: ℞ Ʋnguentum Nicotianae ℥i. yolk of one Egg, meal of Lin∣seed, Tobacco in pouder, A. ℥ss. Rosin poudred, q.s. mix them.

XVIII. When the Tumor is maturated, the Apostem is imme∣diately to be opened, and the Pus to be taken forth; then the Ulcer is to be cleansed with Abstersives, incarnated, and healed.

XIX. For which purpose, Seanertus commends this: ℞ Aloes ʒiii. Myrrh, Frankincense, Sarcocol, A. ʒi. Honey of Roses ʒii. Turpentine ℥ss. mix them.

This I commend by Experience. ℞ Ointment of Tobacco ℥i. Honey of Roses ℥ss. Tobacco in fine pou∣der, Rosin in pouder, Myrrh, A. mix them, and apply.

XX. A Child was pained with a small red Swelling about the inside and root of the Nail of one of its Fingers, Ceratum Galeni was applied to it; the second day it shined, or was like a Blister, it was opened with a Needle, a thin yellow matter was discharged, and by dressing twice with Ʋng. Basilicon, it was cured. Wiseman.

XXI. A Gentleman had a very large one upon the ball of his Thumb, like a great Blister; it was let out with a Lancet, and cured with Ʋnguentum Tutiae. Wiseman.

XXII. Another under the fore∣part of the Nail and Finger was very painful, but was suppurated by Lenients; the matter was let out, part of the Nail cut off, and it was cured in few days. Wiseman.

XXIII. A Woman had one of these in the end of her Finger, with vehement Pain, Fever, Fainting, Swooning, Nauseousness, Vomiting, and other Symptoms. The Finger was fomented with Milk, in which flowers of Ca∣momil and Melilot, and seeds of Fenugreek and Quinces were boiled: then the superficies of the Skin were shaved off, under which small red Spots appeared; these were opened with a Knife, and a drop or two of red Water came forth; after which linnen Cloths dipt in Aqua Vitae, in which Venice-Treacle was dissolved, was ap∣plied; by which means the Pain was taken away: and by this only Remedy, the very next day the Finger was healed. Guilielm. Fabricius, Cent. 1. Observat. 97.

XXIV. Another Woman, by reason of a Paronychia, could neither sleep nor rest for three days: the Skin was shaved off, under which, in the very tip of the Finger, a small Spot about the bigness of a great Pins head was found, in which was about one drop of an ichorous Humor: it was opened, and Cotton dipt in Aqua Vitae, mixt with Venice-Treacle, was dissolved, was applied; and about the whole Hand and Wrist a double linnen Cloth, dipt in Vinegar mixt with a little Water, was wrap∣ped; the pain immediately ceased, and the next day the Finger was cured. Guil. Fabric.

XXV. But that Author ad∣vises (by reason the Skin in that part is of a great thickness) to make the Incision forthwith, in the very beginning; because other∣wise, by the afflux of Humors, a Tumor and Inflammation will be excited; and so the Flesh lying underneath, yea even the Bones themselves, will be in danger of being eaten through.

XXVI. The Cure of a ma∣lign Felon. These ought imme∣diately to be laid open, pene∣trating to the Bone: for if you wait the time of Suppuration, the Bone, Flesh and Nerves will infallibly be corrupted: for ma∣ny times, (before there is any

outward appearance in the Flesh) it rots the Bones, Liga∣ments and Membranes; so that there is scarcely any remedy but Amputation, chiefly if there is any danger of running farther, or infecting the parts adjacent.

XXVII. Guido, and Vigo, call it a cruel, vehement, and mortal Disease; and they report to have seen some so vehe∣mently tormented therewith, as to die thereof: But this I pre∣sume is, according as the Cure is managed, by falling into ignorant and unskilful Hands.

XXVIII. Vigo advises to apply the actual Cautery, because it has an admirable virtue in cor∣recting of Malignity and Poison, which offend the Bone and Nerves, and eases the vehement pain; then to cleanse it with Ʋng. Aegyptiacum, mixed with Aqua Vitae, or a little Aposto∣lorum.

XXIX. Wiseman proposes an immediate Incision to the Bone; then letting it bleed a while, he dresses it with a Pledget of Ʋnguentum Basilicon, over which he lays Emplast. e Bolo; and in a day or two after, according as the Patient is easy, takes off the Dressings; and continues with fresh applica∣tion, till it is cured.

XXX. If it is rebellious, and on the second day after taking off the Dressings, he finds the Wound open and undigested, he dresses it with a Dossel dipt in red Pre∣cipitate, with Emplaster and Bandage: the third day after he dresses it again, at what time the Slough does mostly come off with the Dossel.

XXXI. Then he dresses it with a less Dossel spread with Basilicon and Precipitate, with a Pledget of Ʋng. Diapompholigos, and an Emplaster over it, whereby it digests, and in six or seven days after is commonly healed.

XXXII. Now the reason why it sometimes heals not by agglu∣tination with the first or second dressing, is from the acrimonious Ichor, which offends at the bottom of the Wound, and many times pierces deeper: which shews indeed the neces∣sity of timely laying open Tumors of this kind; unless you find they go away by discussion, which is very rarely to be seen.

XXXIII. If the Tumor has been ill handled, by application of Suppuratives, till the Putrifaction within has rotted the Ligaments and Periostion, corrupted the Bone, and extended the Apostem to the second or third Joint. In this case, lay open the Apostem by Incision from the Fingers∣end downwards, even the whole length of the Abscess; then dress it with red Precipitate, applying Dossels over it, spread with a Digestive, to keep the lips of the Wound distended.

XXXIV. And with snips of Empl. Diapalma, rowl it up, leaving way for the Matter to discharge: over which put a moderate Bandage, to press out the Matter in the Part, and restrain the influx; the better to reduce the Finger to its former shape.

XXXV. The third day dress it again, and if you find the Ʋlcer sordid, and overgrown with proud Flesh, rub it with the Vitriol∣stone, and fill the Ulcer again with red Precipitate, dressing it up, as before: By which me∣thod, deterging the Ulcer, let it be incarnated with Sarco∣ticks, and the Cure finished with Epuloticks, and proper Bandage.

XXXVI. The Vitriol-stone is of great use in these Ʋlcers, which so abound with luxurious or proud Flesh, among the Tendons; for by it, the corrupt Flesh is dried up, without offending the Nerves, Tendons, or other sound parts: and the Ulcer may be deterged, according as it is touched more or less; and the Bone it self, where it is bare or carious, may be dried by it, and disposed to moulder off.

XXXVII. And where the Hy∣persarcosis is great, by sprinkling it with Precipitate, the Ulcer is the more speedily freed from its Putrifaction.

XXXVIII. Where the Ʋlcer seems to be rebellious, with a kind of malignant Humor attending, whereby the Cure succeds not, but is like to be very tedious and unsuccessful, by the increase of the putrifaction, and rotting of the Bone; the best Remedy in this case, is the cutting off the Finger in the next joint beyond the Putrifaction; or otherwise in the middle of the joint, with a Chezil, as Mr. Wiseman pra∣ctised.

XXXIX. Then to dress up the Stump with Pulv. Galeni cum albumine Ovi, rowling it on, and the second day after to dress it with Turpentine mixt with the yolk of an Egg, whereby it be∣comes digested; after which it is to be incarnated with com∣mon Sarcoticks, and cicatrized with Ʋng. Desiccativum rubrum, and Pledgets dipt in Aqua Calcis.