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. VIII. Of a CARBƲNCLE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Carbo & Carbunculus; and in English, a Carbuncle, or Burning-coal. Avicen calls it Pruna, & Ignis Persicus, the Persian-fire.

II. This Tumor is called by this name, because it is covered as it were, with a certain kind of Crusti∣ness, black like a Coal; and it is called Pruna, because the Flesh is black, and looks as if it were burnt with a Coal; and it is said to be a Fire, because the Part is pained as if it was burnt with Fire.

III. It is a Tumor proceeding from adust, thick, and inflamed Blood, degenerating into black Choler, and burning the Part. Or, it is a Pestilential Tumor in∣flamed, black, burning the place, and sometimes blistered, as if burnt with Fire, accompanied with great Inflammation and Pain, Vomiting, Trembling, sleep∣iness, cold Sweats, and Fevers.

IV. Some Authors would make a difference between Anthrax and Carbunculus, but there is none. The Cause, is from burnt Blood assuming the nature of Me∣lancholy, and so apt to corrupt.

V. There is sometimes but one great Pustle, sometimes many little ones, which being opened appear black, and inflamed round: the crust being removed, instead of Corruption or Matter, you will find spungy Flesh, the Part is very painful, with a Fever and Watching.

VI. The Description. It is a Tumor which has its original from a boiling and adust Blood, which corrupts the part, and arises in the outward parts of the Body; having a vehement pain joined therewith, invading the Patien with a Fever, and a manifestt swelling, black and hard.

VII. But Celsus, lib. 5. cap. 28. gives another kind of descri∣ption

of it, which seems to me to be a different species from the common. There is (says he) a certain redness, and thence comes forth, but not very far, certain Pushes or Pustules, black, and sometimes livid, in which there seems to be a rottenness, and be∣neath the colour is black; and the Body it self is more dry and hard than it ought to be. About the Tumor there is as it were a Crust, surrounded by an Inflam∣mation; the Skin cannot possibly be lift up, but is as it were fixed and fastned close to the Flesh underneath it; the Sick is extream sleepy, and sometimes there arises a kind of Horror, or Fever, or both: and the Disease proceeds, as out of certain roots, sometimes more hastily, sometimes more slowly: but above, when it first comes forth it looks of a whitish colour, and then immediately it becomes livid, with little Pushes or Pustules coming forth upon it: and if it chances to fall upon the Jaws, or parts near the Sto∣mach, it oftentimes causes Suf∣focation.

VIII. The Causes. Galen. de Tumoribus, lib. cap. 6. & ad Glauc. lib. 2. cap. 1. & Meth. Med. lib. 14. cap. 10. & lib. de Atra Bile, cap. 4. & 5. & de Differ. Febr. lib 2. cap. 19. saith the containing cause of a Car∣buncle, is a boiling thick Blood degenerating into the nature of black Choler, and having black Choler mixed with it, together with a conjoined malignity.

IX. But it rather proceeds from a malign and corrosive Salt, join'd with a poisonous Sulphur, which causes vehement sickness, great pain, burning and inflammation; by which Nature being grievous∣ly afflicted, she suddenly drives it forth from the interior to the exterior parts; and from the more noble members, to such as are less noble.

X. For this cause it is, that a Carbuncle is never produced by congestion or heaping up of Blood or Humors; but is always gene∣rated of a Defluxion, which is made all at once: nor is it produced of Melancholy, only as a Cancer, but of adust and burnt Blood, which degenerates into Melancholy, or has Melancholy mixed with it.

XI. The Procatartick Cause, is from an ill and unwholsom course of Diet, eating of Meats of a depraved and vitious juice, defiling the whole mass of Blood; and also from the external evil qualities of the Air; as being too hot and burning, corrupting the Humors; or malign and pestilential, depraving, infecting and poisoning the Blood and Juices at once, as is evidently seen in Pestilential times.

XII. The Differences. Some appear without Pustules, as the common Carbuncle, which is one uniform, round, hard, burning Tumor: and some with a Pu∣stule or Pustules, like such as are raised by burning with fire, which being broken, there lies underneath within, a crusty Ul∣cer; and of this kind is that which is described by Celsus, at Sect. 7. aforegoing.

XIII. They are also divided into Pestilential and Non-pestilential,

according as the Air is more or less malign and contagious; some in∣vading the Sick in a Pestilential constitution of the Air, others when no such Pestilential ma∣lignity is present.

XIV. The Signs. It arises for the most part from a small Pustle or Swelling, and sometimes from one of the greater Pustules break∣ing forth; or from many small ones like Millet-seed, lying very thick together; which when broken, a crusty Ulcer appears, like that made by a red-hot Iron.

XV. But before these Pustules break forth, there is a kind of itching felt in the part, near which one or more of these Pustules come forth: yet sometimes the Carbuncles comes forth without any such Pustule; a crusty Ul∣cer being excited, sometimes blackish, and sometimes of an ash-colour: in a very little time after which, it becomes like to a Bubo, and then it obtains a round sharp form, with vehe∣ment heat, and burning pain.

XVI. This heat and burning is more particularly exasperated at night, and it is so vehement, that the Sick can scarcely endure it without rubbing of the place af∣fected; from which rubbing, there arise many of the afore∣named Pustules.

XVII. The Flesh round about them grows hot, which when the Disease comes to the height, has a vehement burning heat: and the colour it obtains is sometimes blacker than that of an Erysipelas, or a Phlegmon; as if black was mixed together wtih red.

XVIII. The Sick has also a Fe∣ver, (from the burning Heat) which afflicts these more than those which are affected with a Phlegmon or an Erysipelas: they have also a nauseousness, a vomiting, de∣jection of Appetite, a trembling, panting and beating of the Heart, dotage or delirium, with frequent faintings and swoonings: all which Symptoms are so much the more vehe∣ment, by how much the Matter or Cause is more malignant.

XIX. Now tho' all Carbuneles are malign, yet all are not pesti∣lential, or have an adventitious malignity more than what is na∣tive to them: those which are Pestilential, are known, 1. From the Pestilential constitution of the Air; for it is scarcely pos∣sible for a Carbuncle to arise at such a time, and not be Pestilential.

XX. 2. From the Signs and Symptoms which appear, being more frequent, and more vehe∣ment, than in a Carbuncle which is not pestilent.

XXI. 3. From the Fever, which always appears of the nature of the Plague or Pesti∣lence; which tho' outwardly it seems sometimes not so violent, as in a Carbuncle which is not Pestilential, yet it burns more inwardly, and is much more dangerous.

XXII. 4. The fresh colour of the Face is changed, the Tongue becomes black and dry, the De∣jections liquid and cholerick, the Appetite prostrated, with nauseousness, and vomiting of most offensive and malign Humors;

difficulty of Breathing, stinking Breath, vehement Sweating, sometimes hot, and sometimes cold Sweats, with Sleepiness, and sometimes Watchings, De∣lirium, Fainting and Swoon∣ing, &c.

XXIII. The Prognosticks. If black, it is often mortal; so also if it vanish, or happen in the Emun∣ctories, or near to principal mem∣bers, or about the Stomach or Jaws, (where it generally choaketh:) but if it be little, appear first red, and afterwards yellowish, with Pustles, it is the less dangerous: for from a very little Pustle, it suddenly gets to an extraordinary greatness.

XXIV. By how much the blacker it is, by so much the worse it is; for it is produced by the most corrupt Blood: and the next to this, is the wan and yel∣lowish.

XXV. And those are the most mortal, which beginning once to wax red, do presently vanish again; for then the matter is trans∣lated to the more inward and noble parts, which generally kills the Sick.

XXVI. Where there is but one Carbuncle, it is less dangerous, than where there are many; for in this last case, it shews the vast quantity of the malign matter.

XXVII. In a Pestilential Car∣buncle, consider whether it comes forth before the Fever appears, or after: if before, it shews that Nature is strong, and able to expel the poison, before the Fever can suprize the Heart; but if after the Fever, the contrary; for that the Heart is seized with the pestilential Ve∣nom, which from thence dif∣fuseth it self into all parts of the Body.

XXVIII. The Place is next to be considered. It is always evil and pernicious, if it happens in the Emunctories, or near to any of the more noble and principal parts: but herein the strength of the Sick is to be observed; for one weak and languishing may soon be overcome, even by a small Disease; whereas one vi∣gorous and strong, may over∣come a Disease which is very strong and powerful.

XXIX. The Cure. The Indi∣cations of Cure have respect to the Antecedent cause, to the Con∣joined cause, and to the Symptom.

XXX. In respect to the Ante∣cedent cause, a fit Diet must be prescribed, and such things as alter and correct the heat and evil quality of the Blood. Sudori∣ficks are first to be given; as Spirit of Sal Armoniack, Harts-horn, Man's Scull, Our Theriaca Londinensis, specifick and volatil Laudanum, &c.

XXXI. This dore, the fervour of the Blood is to be allayed with Syrupus Antefebriticus, Sal Ni∣tre, Sal Mirabile, and other like things, which easily enter into the mass of Blood, and cool, alter, and correct it.

XXXII. Some Authors advise Bleeding, but you ought to be cau∣tious therein, lest you draw the ma∣lignity inwards to the Heart, and so destroy the Patient: since Bleed∣ing is generally acknowledged to be a Revulsive Remedy: and

therefore in this Disease it is scarcely to be admitted, for that the Natural and Vital Powers are deiected by the Dis∣ease; and having entred the Lists therewith, are now in the conflict, and not to be inter∣rupted, without eminent peril to the Sick.

XXXIII. Authors also advise to Purging; but in this you ought to be careful, lest thereby the Humor which Nature strives to thrust forth to the external parts, be drawn to the internal: and there∣fore, if it may at all be done, it may be more safe in a Car∣buncle not pestilential, than in one that is pestilential.

XXXIV. But if there is any considerable Fever joined there∣with, the crudity of the matter, and the malignity, forbid Purging: and indeed there is scarcely a Carbuncle to be seen, in which there is not something of ma∣lignity: and therefore the malign matter is rather to be protruded to the external parts by Alexipharmicks, than drawn inwards by Bleeding, and Drenching or Purging, as the usual way of some is.

XXXV. The Matter being sufficiently thrust forth by Sudori∣ficks, which in some measure allay the servency of the Blood, it is then to be altered, and cooled by other things which resist Malignity, as Sal Nitre, Sal Prunellae, Sal Vitriolatum, Sal Tartari Sulphuratum, juices of Wood-sorrel, Oranges, Limons, Citrons, Pomgranates, either simple, or in Syrup; or Syrup of Vinegar, or Vinegar medi∣cated with proper Alexiphar∣micks, as Angelica, Bawm, Sca∣bious, Carduus, Rue, &c. which may be given in all that the Sick drinks. Thus far as to the Antecedent cause, we now come to the Conjoined.

XXXVI. The Conjoined cause, which has respect to the Tumor it self, is not removed, as it is in other Inflammations, nor are Repercussives to be used or applied; but the malign and poisonous Humor is rather by Attractives, to be drawn from the more inward, to the more outward parts.

XXXVII. And therefore Au∣thors advise, that the Part af∣fected be forthwith scarified, and that with Lancings deep enough; that so the corrupt, malign, and poisonous Blood may be fully drawn forth; for that other∣wise, unless it be immediately drawn forth from the Part affected, it corrupts the Parts next adjoining.

XXXVIII. And being scari∣fied, you may apply Cupping-glasses, that the Blood may be the more effectually drawn out; after which the Part is presently to be cleansed, and well washed with warm salt Water, or warm Wa∣ter in which Nitre has been dissolved, that the Blood may not clod or coagulate in the Part.

XXXIX. And if the corrupt Blood seems not fully enough drawn forth, Scarification is again to be repeated. Where note, that the place being scarified, you are not to apply digestive, or suppurative Medi∣cines

to promote the Pus or purulent Matter, (because in this kind of Tumor, they increase the putrifaction and rottenness; and a Carbuncle in putrifying always creeps, and spreads farther and farther, to the endangering of a Mortifi∣cation;) but rather those things which are dying, and such as resist putrifaction.

XL. Of this kind is Morsus Diaboli, bruised green, and laid on, and boiled in Wine and drunk. Also a Cataplasm made of Orobus meal, pouder of Myrrh, and Oxymel; to which some add Ʋnguentum Aegyptiacum. Or, make a Cataplasm of green Sca∣bious bruised, yolk of an Egg, Barley flower, and a little Salt: which things are to be laid on the Carbuncle it self.

XLI. If the Humor flows into the Part with great Violence, then Attractives are not safe to be administred; lest the matter flowing in too great abundance, should make the pain the more vehement, thereby augmenting the Fever, causing Watch∣ings, and dejecting the natural Strength.

XLII. In this case such things as moderately repress and drive back, with a digestive quality, are to be used: as, ℞ Plantane, meal of Lentils, brown Bread, A. boil them in equal parts of Water and Wine, to a Cataplasm; and apply it, not upon the very Carbuncle it self, but only near it round about, some three fingers breadth distant from it.

XLIII. If Scarification do not, or the Carbuncle will not yield to these Remedies, you must come to Burning, and that immediately with all possible speed; for the least delay may bring the Sick into extream danger, yea even of death it self.

XLIV. Some use Potential Cau∣teries, as anointing the top of it with the Butter of Antimony; but the Actual Cautery is ac∣counted more safe, for that, by the heat and driness of the fire, does after a peculiar man∣ner resist Putrifaction, and pre∣serves the sound parts, from being infected with the putrid∣ness: it also draws from the very bottom and depth, all the malign, poisonoes, and corrupt matter.

XLV. Now in this case, this terrible Remedy, is not so painful as may be imagined, for the Pa∣tient is many times not very sen∣sible of it, for that the Flesh is mostly dead; and therefore the use of it must be so long conti∣nued, 'till in all the parts there∣of there be a sense of pain.

XLVI. This done, you must with all possible speed that may be, even in the space of twenty four hours, remove the Eschar or Crust, for that to delay it is dangerous: for which purpose, Authors advise to use Hogs or Goose grease, and such other like things: but these will not do, but rather increase the pu∣tridness.

XLVII. For this purpose, Guilielmus Fabricius commends this Ointment: ℞ Meal of Orobus, roots of Birthwort, of Florentine-Orrice, of the lesser Vernal Gentian, all in fine pouder,

A. ℥ss. Venice Treacle ʒii. Honey of Roses q.s. mix, and make an Ointment, which apply.

XLVIII. Horatius Augenius commends this. ℞ Vitriol in fine pouder, Hogs Lard, A. ʒii. choice Honey ℥ss. mix them, and apply for the same purpose. Some anoint with Ʋnguentum Aegy∣ptiacum.

XLIX. Paul Barbett com∣mends this following, which is much better. ℞ Venicle Trea∣cle, white Vitriol in fine pouder, A. ℥i. Honey of Roses ℥jss. Leaven, Turpentine, fresh Butter, A. ℥ii. Soot ℥ijss. black Soap ℥iii. Mu∣stard-seed, Saffron, A. ℥ss. yolks of Eggs N^o iii. mix, and make a Cataplasm.

L. The Eschar being removed, the Ʋlcer must be cleansed with Unguentum Fuscum Wurtzii, Aegyptiacum, and Honey of Roses, &c. often changing the External application: but be∣ware of Suppuratives, for the Humors are easily corrupted of themselves.

LI. Aetius writes, that wild Rue made into a Cataplasm with Honey and Raisons of the Sun, does quickly separate the Crust; and therefore such Medicines as resist Malignity, as Mithri∣date, Theriaca Andromachi, Our Theriaca Chymica, &c. are very proper to be mixed herewith.

LII. Others commend this. ℞ Rue M.i. Leaven, Figs, A. ℥i. Myrrh ℥ss. Pepper, Cloves in pouder, A. ʒi. Salt ʒii. mix, and make a Cataplasm, which apply morning and evening: it is said to separate the corrupt part or flesh, from the good and sound, in about two days time.

LIII. If it is a Pestilential Carbuncle, you must use Antidotes both internally and externally; among which are Our New Lon∣don Treacle, and Our Theriaca Chymica, which are chief.

LIV. And for taking off the Eschar, you may use some of the former things; chiefly the Cataplasm of Barbett, or the Oil of Mercury, or Joel's Cata∣plasm of Radishes beaten with Rose-vinegar. Or this: ℞ Scabious, roots of Comfrey, and Radishes, yolks of Eggs, common Salt, A. ℥ii. Squills, Onions roasted, Leaven, Soot, A. ℥i. Honey, Turpentine, A. q.s, mix, and make a Cataplasm; which spread up∣on Cloth or Leather, and lay it on hot, shifting it almost every hour.

LV. If you see the Crust be∣comes round, and a circular red∣ness appears, it is a good sign of health and recovery, and that Nature has now separated the corrupt parts from the sound: and when the Crust is wholly taken away, the Ulcer is to be cleansed with the things di∣rected at Sect. 50. aforegoing; or with Honey of Roses, and juice of Smallage.

LVI. After the Cleansing, it is to be filled up with Flesh, by apply∣ing Sarcoticks; the lips of the Ulcer are to be joined together, and at length Cicatrized with Epuloticks.