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. III. Of ABSCESSES, or APOSTEMS.

I. THIS kind of Tumor is called in Arabick, Du∣bellet, and Aldubellet; in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and in Latin, Abscessus, pl. Abscessus; Tumor est qui suppuratur: in English an Apostem, pl. Apostems; a Swelling full of ripe matter.

II. The Description. It is a Tumor arising from corruption and putrifaction, chiefly in the end of a Disease; and in or near the Glandules, as behind the Ears, in the Neck, under the Arm-holes, or in the Groins, being repleat with a preternatural Humor, most commonly in its own Mem∣brane, yet sometimes not; if it proceeds from concussion, or other external hurt: whence follows inflammation of the Part, a Fever, and then a ge∣neration of Corruption, whence comes an Abscess.

III. But some Tumors are de∣nominated from their times; for whilst unripe, they are Tumors of that particular kind; but coming to suppuration, they many times lose their first appellation,

and are called Apostems, of which kind are Phlegmon's suppurated; and indeed any Tumor when it is maturated, is called by some an Apostem: whence it is ordinary to say, when a Tumor is ripe for Apertion, it is Apostemated.

IV. If therefore the matter which causes the Phlegmon or Inflammation is not dissipated in∣sensibly: Nature, which can never be idle, converts it in process of time, (especially if assisted with warm Medicaments, or any Blood be mixed with the pro∣truded Matter) into a certain rotten substance called Pus; which when it is wholly sepa∣rated from the Parts containing, and gotten together into the Part affected, is properly called an Abscess, or Apostem.

V. The Differences. They are taken, 1. From their Times. Some are maturated more speedily, as those which proceed from Blood, and are in a fleshy-part.

VI. Some are maturated more slowly, as those Tumors which are bred out of other Humors; and are seated near the Joints, and in Nervous parts, or parts which are weak, or have in them but little native Heat.

VII. 2. From the Matter. And this is various, according to the Humor it is generated of: out of good Blood is generated a Pus, less offensive; but out of other Humors is bred a sharp, putrid, green, yellow, or ill-coloured stinking Matter.

VIII. Sometimes this matter resembles Gruel, Honey, Suet, Wine-lees, Oil-lees; and some∣times it is like Honey and Snivel mixt together, or the substance of rotten Eggs; and that of so ill a savor, and so stinking, as not to be endured, &c.

IX. And sometimes living Worms, and other like Animals are found in them; for the Humors of the Body may pos∣sibly be wholly converted into Worms, and such like substances, in great variety.

X. 3. From the Tumor it self: for the matter in the hollowness of the Part, is either without a Membrane; or else is contained in a peculiar Cystis or Mem∣brane of its own.

XI. Yet some Authors are of opinion, that those Tumors alone, which proceed from Inflammation and Pain, and had within them a sharp corroding Humor, and not contained in any peculiar Skin or Tunicle, could properly be called Apostems.

XII. The Causes. Tho' they may proceed from other Tumors maturated, and so the remote and antecedent Causes in those cases are thence to be derived; yet they are also many times caused from external injuries; as falls, blows, bruises, &c. wherein Blood being extravasated by the external force, it is thro' the help of Nature, and the heat of the Part putrified, and so there arises an Apostem.

XIII. An Example of this kind, we have in Guiliel. Fabricius, Cent. 1. Obs. 63. A young Man 27. years old had a great Fall, and by the hilt of his Sword was hurt under the short Ribs and left Kidney, having also

his Loins much bruised: after some days, he felt a pain in the left part of his Loins, which by degrees became exceedingly sharp and intolerable: upon which followed loss of Sleep and Appetite, with some small kind of Fever; but the Part affected was not black and blew, or any way discoloured, or in the least swoln, but appeared as in perfect health.

XIV. In this condition he was tampered with by a certain DOCTOR, as a Nephritick, but all in vain, for the Doctor was mistaken; for it was a hidden Apostem in the Muscle Psooa. At length he sent for Griffonius, a learned Physician and Chirur∣gian, who presently discovered the whole grief, and the danger impending, from the Matter being shut up in those inward or deep parts: it now possessed his whole Loins; he therefore applied powerful Attractives, to draw all the Matter into some one place, where the principal Vessels were but few, and the Instruments of Motion might be least hurt: then he opened it on the left side, nigh to the fourth Vertebra, with a red-hot Razor, making the Wound as deep and as long as ones finger, from the end thereof to the hollow of the hand; out of which there flowed a great quantity of putrid and stinking Matter; which he afterwards cured according to Art.

XV. Sometimes they are caused from Fevers; where, by the fer∣mentation of the Febritick-heat, the Morbifick-matter is critically protruded into some particular Part, where Nature can best dispose thereof.

XVI. An Example of this kind we have from the same Fabricius, in the place cited, which happened also in the Muscle Psooa; where he tells us, that a certain Matron took her bed, with extream and acute pains about her Loins; having a Burning-fever, accom∣panied with Swooning-sits and difficulty of Making-water.

XVII. By the Signs, Symptoms, and kinds of the Pain, it ap∣peared to be a hidden Apostem; for outwardly nothing appeared, nor could any thing be discerned by the touch; and by the place, that it could be no where but under the Psooa-Muscle. She was told the extream danger, and that it would be with hazard of her life, unless it was opened; she gave consent, and it was opened with a Razor, on one side of the Spina Dorsi, thro' the Skin, and exterior Muscles, even to the Psooa; and there came forth a quantity of stink∣ing Pus, or Matter: after which, by abstersive and cleansing Me∣dicaments for some time ap∣plied, she became perfectly well.

XVIII. Sometimes also it is caused by Witchcraft; as when Hairs, Bones, Wood, Nails, Pins, Needles, Coals, Cockle-shells, or any thing of a like nature, is found; into which it is not possible for Humors to be na∣turally changed: in such cases, Artists ascribe the cause to Sor∣cery and Witcheraft.

XIX. The Signs. In a Phle∣gmon, it is easily seen when the

Humor causing the Tumor is changed into Pus,and in other Tumors also there are peculiar Signs: for till the Matter is changed into Pus, the Heat, Pain, Tumor, and other Sym∣toms are heightned, not dimi∣nished, as they are when it is ripe; as Hippocrates, Sect. 2. Aph. 47. affirms.

XX. When the Maturation approaches, the Apostem begins to be sharp-pointed, the Pus seeking its passage forth, and so the more lifting up the Skin: then also there is an abatement of the Fever and Heat, the Swelling round about a little diminishes, and the extension and hardness is something remitted, and the Patient has some ease, and is a little lightsom.

XXI. Then also, coming to perfect ripeness, if the place is pressed down with the fingers, there is a softness, and a kind of float∣ing of the Matter underneath, which is sensibly perceived in the Part.

XXII. Yet, that you mistake not, this is to be understood, where the matter is thin, and lies high; but if the Matter is thick, or lies deep, as under the Psooa-Muscle: (in which Muscle Apostems seldom appear out∣wardly, as by the two afore∣going Examples is manifest) there is no fluctuation at all to be perceived, and many times neither tumor nor discolouring, as Hippocrates maintains, Lib. 6. Aph. 41.

XXIII. The Prognosticks. An Apostem is generally Critical, or upon the end of a Disease: if it increases, and the Sick grows better, health is a coming.

XXIV. If it strikes inward, or falls down; or otherwise, if it yet increases, and the Sick grows worse, let him prepare for death, for it is near at hand.

XXV. Apostems lying hid, (as those in the great Muscle Psooa) are much more dangerous, than those which are apparent and outward; and by how much the more outwardly they lye, by so much the less danger.

XXVI. The sooner an Apostem comes to maturity, the sooner and easier it is to be cured; the more hard the matter, the more tedious and difficult the Cure. The rest of the Prognosticks see in the Third Edition of Our Synopsis Medicinae, lib. 1. cap. 49. sect. 9, ad 24.

XXVII. The Cure. Whilst the Abscess or Apostem is in the way of maturation, you must cherish the heat of the Part, by Medica∣ments that concoct, and increase Pus, and ease the present in∣tense Pain.

XXVIII. Such things are called Chalastica, and Anodyna, for for that they take from the part all sense of pain: and of this kind are Milk, Butter, Oil, Hogs-grease, Capons-grease, Ʋng. Di∣althaeae, Emplast. Diachyl. simplex.

XXIX. What things hasten Sup∣puration, we shall shew at large in Chap. 5, and 6. following: such are these, for hoc Tumors; Oil mingled with Water, and simple without mixture; Wheat-Hower, and Bread of the same; Fats of a Calf, of a Hog, of a Hen, of a Goose; Pitch, Rosin,

Wax mixed with Oil; Ʋng. Te∣trapharmacum, made up of Wax, Rosin, Pitch, and Fat, &c. the Mucilages of Lin-seed, Fenu∣greek-seed, Mallows, Marsh∣mallows. Or this Cataplasm:

XXX. ℞ Pouder of Althaea∣roots, Mallow-leaves, A. ℥ j. Wheat-flower ℥ j ss. seeds of Line and Fenugreek, A. ℥ ss. Saf∣fron ʒ ss. boil them in Milk or Decoction of dried Figs; to which add Hogs-grease, Unguent. Dial∣thaeae, A. ℥ j. mix, and make a Cataplasm.

XXXI. But if the Tumor be cold, you must use hotter things; such are Turpentine, Gums of the Fir-tree, Larch-tree, and Pine-tree; dried Figs, Rai∣sins, Lin-seed, Fenugreek-seed, rosted Onions, Leven, Oils of Camomil and white Lillies, old Hens fat, old Butter, Bdellium, Galbanum, Ammoniacum, Em∣plaster of Melilot, and Diachy∣son magnum.

XXXII. Or this Cataplasm: ℞ of the former Cataplasm ℥ vj. Leaven ʒ vj. Camomil ʒ ij. old Hens fat, Oil of Camomil, A. ℥j ss. mix for a Cataplasm. If you add white Lilly roots, Onions, Tur∣pentine, A. ℥ j. it will be yet stronger.

XXXIII. When the Apostem is come to full ripeness, it is then to be evacuated and cast forth of the Body: which is done either by Discussion, (which is very seldom and rare;) or, by open∣ing of it; (which is much the better way) be it done either of its own accord, or by Art.

XXXIV. Now to know when an Apostem is fit for opening, you must have respect to the signs of its maturation; which are, an abatement of the intense Pain and Inflammation: as we have shewn more at large in Sect. 20, 21, and 22, aforegoing.

XXXV. The Abscess being now found by the Signs to be fit for Apertion, you must perform it as we have taught, Lib. 1. Cap. 18. of this Work, where the Operation is expressed at large. If the opening is by Instrument, it is done with the Knife either red-hot, or else cold: but we now very seldom make use of the hot Iron, and then never but in cold Tumors; and that also, only when the Apostem is in those Parts which have many, or else large Veins and Arteries; that so the Flux of Blood, or Haemorrhage, may the better be prevented.

XXXVI. Now if upon opening of the Apostem, great pain should ensue, or a flux of Blood, or a swooning; in this case, the Se∣ction must be performed with the greatest speed and care that may be.

XXXVII. If an Haemorrhage be feared, you must have in a readiness, these things which stop the flux of Blood; as Frank∣incense, Aloes, white of an Egg, fine Bole, Sanguis Draconis, Pom∣granate rinds and flowers, burnt Alum, Caput. mort. of Vitriol, and several others, which both Our Doron, and our Pharm. Lond. are able to furnish you with.

XXXVIII. To prevent Fainting and Swooning, especially in Chil∣dren, Women, and fearful persons,

you ought to have in a readiness Spiritus Angelicae magis compo∣situs, Aqua Bezoarica, or Spiritus Cordialis, or that of Matthiolus; letting the Sick smell to Oil of Rosemary, or Spike, or Sa∣vin, which is better than either; or in desperate cases, to Spirit of Sal Armoniack.

XXXIX. And likewise that the Section may be rightly per∣formed, the Chirurgian ought to know the condition of the Part; the situation of the Veins, Arte∣ries, and Nerves; as likewise the nature of the Muscles: with∣out the exact knowledge of which, many irregularities, enor∣mities and errors may be com∣mitted, even to the hazard of the Patients life.

XL. For the Veins and Arte∣ries being cut, a violent Haemor∣rhage may follow; the Nerves being cut, either intolerable Pain may arise, or the Member may altogether be deprived of Sense, or both; and the Muscles being cut, the Part may be wholly deprived of its motion.

XLI. Moreoever, regard ought to be had to the Fibres of the Muscles, that Section may be done according to their conduct, and not overthwartly, or cross to them; and that some con∣sideration be had to the great∣ness of the Section.

XLII. If it be too little, the Pus cannot come forth without compression of the Part; which may both excite pain, and beget a brawniness, thereby hazarding a Fistula: if it be too great, there may be either an unsightly Scar, or the ambient Air may get too much in, and alter the Part.

XLIII. To make the Incision, Sennertus admits of either the Razor or Incision-knife; or a Knife myrtle-shaped, edged on both sides, with which the Ita∣lians and French open Veins; or with the Lancet; or lastly, with the Syringotomos, an In∣strument crooked, and of only use in the Incision of an in∣ternal or concavous body.

XLIV. The Incision being made, if there be but little Pus, you may gently press the part, that it may the better flow forth: but if there be much, you ought to evacuate leisurely, and by little at a time; lest if all should be let out together, the Spirits should be too much wasted, and swooning follow.

XLV. After Incision, and emptyng, of the Pus; the first day you may strew on the dust of Frankincense: on the second day, lay on some kind of Digestive; that if any thing remain not perfectly sup∣purated, it may be compleated.

XLVI. And if any kind of nastiness does occur, let it wiped away; and then cleansed with this: ℞ Turpentine ℥ j. Honey of Roses ℥ ss. Barley-meal, q.s. mix them, and apply it.

XLVII. If the Ʋlcer require yet more forcible cleansing, you must use stronger Abstersives; as, Ʋnguentum Apostolorum, Aegy∣ptiacum, &c. and at length Sarcoticks, or Medicines breeding Flesh are prudently to be apply∣ed to the consummation of the Cure, as in the Chapt. following we shall discourse more at large.

XLVIII. If an Apostem leys

deep, so as that it is concealed in many places; or if it is not opened in due time, but that delays are made, whereby it is kept too long; the Humor or Matter is then for the most part translated to some other place, and sometimes to the more noble Parts which cannot be, but with manifest danger to the Sick.

XLIX. Of this kind, Guiliel. Fabricius, Centur. 1. Observ. 81. gives us a remarkable Example, of a Child three menths old, which had an Apostem near to his right shoulder. The Parents (says he) would admit of no Incision, and by degrees the Tumor much abated; at length it was opened, but a very small quantity of matter issued forth, and in a short time it sunk wholly away: but the Humor gradually gliding downwards into the Abdomen and Genitals, it destroyed the native heat; upon which followed a Gan∣grene, and in a few days more, a Sphacelus; so that in a short time after the Child died.

L. From what has been said it appears then, that delays of opening Apostems, are not to be permitted, in any Part; much more if they be in Parts, where the Matter is easily translated to those we call the more noble; and that sometimes it is better to open them a little too soon, than a little too late; the for∣mer being an error, at most, on the right hand.