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. TƲMORS arising from BLOOD.

CHAP. I. Of TƲMORS in General.

I. A Tumor is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. also, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Tumor, plu. Tumores; also, Inflatio, pl. Inflationes; in English, a Swelling, and Swel∣lings.

II. 'Tis true, the ancient Greeks, as Hippocrates, call a Tumor 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Oidema, or Oedema; and this word with the more ancient Physicians signified in general, all, and every particular preternatural Tumor; as is observed by Ga∣len, in Prognost. 1. Text. 29. & in Comment. Aphoris. Lib. 4. Aphor. 34. & Lib. 5. Aphor. 65, 66.

III. But now with us, Oedema is taken for a particular Tumor, white, and painless; happening in the Joints, and more espe∣cially in the Knees; of which we shall speak in its proper place.

IV. A Tumor then is a re∣ceding of any Part from its natu∣ral state, by its augmentation in magnitude or quantity; thro' a diserasy, intemperies, or distem∣per of the Blood, Lympha, and other Humors.

V. This Disease is called by the Arabians, Bothor: but if a Tumor Apostemates, they call it Dubellet, and Dubellatum.

VI. We speak of Tumors pre∣ternatural only; for every swel∣ling or augmentation of a Part beyond its natural habit, is not to be reputed a preternatural Tumor: for as much as there is not the least hurt or detriment of any one Action, or any thing preternatural, or besides the intent of Nature; but only something that is not natural, but is above that which is according to Nature, as Galen testifies.

VII. And therefore where the magnitude of some one Part may be extended beyond its natural habit, but so, that its natural Operations are not impeded, and that there is no sense of Pain accompanying it; in this case, the Tumor or Swel∣ling is not preternatural, and so to be called a Disease, but rather a Symptom; as in Nurses Breasts distended with Milk,

and in a Woman with Child, near her time, &c. these things happening according to the laws and course of Nature.

VIII. From what has been said it appears, that a Tumor is a Disease of magnitude, augmented beyond Natures intention; and has its production from some∣thing which is preternatural adjoined to the Part affected; to which some Authors will have added, a Solution of Unity.

IX. The Differences. They arise, 1. From the containing cause, as Humors, Wind, or a solid Substance. Those which arise from Humors, have ob∣tained no particular appella∣tion, but are called by the general name of Tumors.

X. If they proceed from Wind shut up in any Part, and dis∣tending the same, they are called by the Greeks Emphysemata, and by the Latins Inflationes.

XI. If the cause is a solid substance, as Flesh, Skin, or some∣thing cartilaginous or bony; all these proceed from Humors, and are therefore referred to the first kind.

XII. 2. From changing of place: as when the solid Parts change their place and situation, slipping down upon some other Part, distending and elevating the same; of which kind are Hernia's or Ruptures, &c.

XIII. 3. From the quality of the conjoin'd Matter; as being hot or cold, moist or dry, soft or hard.

XIV. 4. From their Magnitude; some are great, and these are called by a simple and general name Tumors: some are small, and these are called Tubercula.

XV. 5. From their situation some are internal, some external, and these again are either more deep and profound, or more superfi∣cial.

XVI. 6. From their figure; some are round, others long; some broad, and flatter; others higher, and sharp-pointed.

XVII. But the main differences of Tumors are only two: the first arises from the variety of Causes, the other from the Part affected.

XVIII. The Kinds. 1. Some proceed from Blood: as, 1. Poly-sarkia. 2. An Abscess. 3. A Phlegmon. 4. A Bubo. 5. Ec∣chymosis. 6. A Carbuncle. 7. Pa∣rotis. 8. Phyma, or Phyge∣thlon. 9. Gangraena. 10. Par∣onychia, Panaritia. 11. Epiny∣ctis, or Furunculus. 12. Per∣niones. 13. Aneurisma. 14. Varix.

XIX. 2. Some proceed from Choler: as, 1. Erysipelas, or Rosa. 2. Herpes Miliaris. 3. Her∣pes Exedens. 4. Exanthemata, or the Small-pox.

XX. 3. Some proceed from Phlegm: as 1. Oedema. 2. A∣theorema, Meliceris, Steatoma, 3. Ganglion, or Lupia. 4. Gum∣ma, Nodi, and Tophi. 5. Fun∣gus. 6. Bronchocele. 7. Strumae, or Scrophulae.

XXI. 4. Some proceed from Wind: as 1. Emphysema, Tumor Ventosus. 2. Hernia Ventosa.

XXII. 5. Some proceed from Water: as 1. Hernia Aquosa. 2. Tumor Aquosus. 3. Hydrops. 4. Hydrocephalus.

XXIII. 6. Some proceed from Melancholy: as, 1. Polypus, or

Noli me tangere. 2. Scirrhus. 3. Cancer. 4. Spina Vento∣sa. 5. Elephantiasis Graecorum. 6. Elephantiasis Arabum.

XXIV. 7. Some proceed from the Solid Parts removing out of their proper places: as, 1. Her∣nia in the Cods and Navel, Epiplocele: and from the Bones also proceeds that which we call Exostosis; which is hand∣led in the Chapter of Gums, Nodes, and Tophs.

XXV. But many of these Tumors procceed not simply from one single Humor, but complexly, from a combination of several Humors meeting together; as, Phlegm, Choler, Melancholy, and Watery Humors: so that the conjunct Cause cannot properly be said to be any one single Humor, but Mat∣ter generated out of Humors conjoined; which is denomi∣nated from the principal Hu∣mor abounding: and in this sence the Kinds of Tumors but now enumerated, are to be understood.

XXVI. Galen, ad Glauc. lib. 2. cap. 7. says, that in Apostems has been found substances, like Stones, Sand, Shells, Wood, Mud, Slime, Filth of Baths, Dregs and Lees of Oil, with many other like sub∣stances.

XXVII. And in his Meth. Med. lib. 14. cap. 12. he far∣ther tells us, that in some Tumors there was found sub∣stances resembling Nails, Hair, Bones, Shells, and Stones.

XXVIII. Fallopius, and with him Sennertus, testifie, that Worms are frequently found in Tumors; and that the latter of them had seen them himself.

XXIX. The Causes. The Ex∣ternal Causes may be Blows, Falls, Straining beyond Strength, &c. The Containing Cause is some∣thing beyond, or besides Na∣tures intent, added unto a Part; which heightens, dis∣tends, and swells it up to a greater magnitude than ordi∣nary.

XXX. Tumors are caused ei∣ther by Congestion, or Fluxion.

XXXI. Congestion is the heap∣ing up of Matter contrary to Nature, being the Recrements of the third Concoction, of that Nutriment which is distributed for the nourishment of the Parts of the Body; or the Nutriment it self, not so perfectly digested as it ought to be.

XXXII. This Matter is ga∣thered together by little and little into the Part affected. Prima∣rily, by something amiss in the Part, as weakness of the Con∣coctive power of the Part, whereby it cannot digest the Nutriment sent to it, as it ought to do. Secondarily, from the weakness of the Expulsive faculty; the Recrements not being thrust forth as they should be, the Pores being closed thro' Cold, &c.

XXXIII. Congestion is caused many times also from evil and unwholesom Food, causing such an abundance of Recrements, that the Expulsive faculty can∣not cast them all forth; or being so thick, that Nature cannot easily expel them: and

this is daily manifest in such as are much troubled with Fu∣runculi, or Pushes.

XXXIV. Tumors therefore which proceed from Congestion, are more slow, long, and tedious in breeding, than those caused by fluxi∣on; for that these latter are with great pain, redness, and beat∣ing, and come suddenly to a height.

XXXV. Fluxion is the falling down of some Humor or Humors, to some certain part, either by At∣traction, Protrusion or Trans∣mission, offending it either in quantity or quality, or both.

XXXVI. Attraction, or as some will have it, Protrusion, primarily proceeds from Heat, either by over∣much motion, or the heat of the Sun, or Fire, or sharp Medicines taken inwardly, whereby when the parts are heated, they draw to themselves Humors; or the Humors being heated are rarifi∣ed, and so for want of room are protruded to the Parts.

XXXVII. Secondarily, from Pain, because Pain is said to ex∣cite Tumors by attracting Humors to the part grieved. Or rather, Nature attempting to relieve the part pained, protrudes an extraordinary supply of Blood and Spirits more than usual, so that thereby she over-loads and hurts the parts she endeavors to Succor.

XXXVIII. Then the grieved part growing hot from that abun∣dance of Blood and Spirits protru∣ded; the part is then said to at∣tract more, by reason of this adventitious Heat; and the Pain weakning the Member, if it at∣tracts not, yet it readily receives the Matter protruded without any resistance in the least.

XXIX. Transmission is a kind of Protrusion, but with the least force imaginable, whereby the Hu∣mors as it were slide down into the part affected; which if they be not digested or evacuated by Transpiration, but remaining and still increasing, they cause a Tumor.

XL. There is then a part from which the Humor is sent, and a part which receives it, and a part thro' which the Humor is trans∣mitted: The parts then trans∣mitting are excited by Heat, whether it be external or inter∣nal, and thereby the Faculty is provoked to expulsion, and sometimes the Humor by its own weight descends into a part, as Water in a Dropsy, falling into the Feet and Cods.

XLI. The Parts receiving, are such as by their weakness are dis∣posed to the Reception, which weakness is contracted either in their first Formation, or af∣terwards by some accidental Hurt; or so constituted by Na∣ture, for the more easy receiving the Recrements of other parts, as the Glandules in the Ears, Throat, Arm-holes, Groin, Skin, &c.

XLII. For Nature (to preserve the Human Frame from Diseases) has purposely ordained some weak and feeble Parts, that so the principal Parts oppressed or burthened with Humors, might empty into them whatever is superfluous and burthensom, and these are the Skin and

Glandulous Parts afore-menti∣oned.

XLIII. Thus the Brain trans∣mits the recrementitious Humors to the Glandules of the Ears; the Heart to the Arm-pits, the Liver to the Groins, &c.

XLIV. The Barts thro' which the Humors are transmitted are either hidden, as those in an Ascites, by which the Water falls into the Cavities of the Abdo∣men: Or Manifest, to wit, the Arteries and Veins, the recre∣ments of the Blood and Lympha, being as it were, spued forth from their Capillary ends or mouths, and by this way it is, that Tumors are mostly pro∣duced.

XLV. Out of what has been said, it appears, that the causes of Tumors are threefold, viz. Primitive, Antecedent and Con∣junct.

XLVI. The Primitive Causes are external, as Falls, Blows, &c. which move the Humors, also ex∣ternal Heat, Food taken too raw, or cold, or in excessive quantity.

XLVII. The Causes antecedent are internal, as Humors offending either in Quantity or Quality, Intemperature, Weakness, and Pain.

XLVIII. The conjunct cause, is the Matter gathered together in the place or part, by reason of the aforesaid Causes.

XLIX. The Signs. If the Tu∣mor proceeds from the falling down of any part, it is known by sight; if it does not, we may safely conclude, that it proceeds either from Congestion or the afflux of Humors.

L. If from Congestion, it is known by the Signs delivered at Sect. 34. aforegoing: And this is peculiar to them, that they take not up so much room in the part, as Pushes, Pimples, and the like.

LI. If the Tumor was generated by Fluxions, it will be known by the presence of the contrary Signs: And if there was not any fore∣going Pain or Heat in the af∣fected part, it shews the Afflux was by Transmission.

LII. And contrariwise, if Pain and Heat did precede, the Fluxi∣on is caused by attraction.

LIII. The beginning of the Tumor is when the Part is first perceived to be distend∣ed: The Increase or Growth is, when the part seems to be raised into an indifferent large Swel∣ling, with Symptoms corre∣sponding. The height or state of it is, when it ceases to be any farther augmented, and all the Symptoms are at their high∣est pitch: and the Declination is, when the Tumor and Symptoms are sensibly diminished.

LIV. The Prognosticks. In∣ward Tumors are always more dangerous than outward or exter∣nal; and they have more or less danger of Death, according to the excellency and use of the part.

LV. The greater the Tumor, the greater the Intemperies or Distem∣per accompanying it: The more malign and vitious the Humor, the more danger and difficulty in the Cure. And contrariwise,

LVI. Tumors arising from Wind, are more easily helped; for they are discussed or dissipated in

a manner of their own accord.

LVII. Tumors arising from Hu∣mors, if they vanish not of their own accord, are terminated either by, 1. Discussion. 2. Or by Sup∣puration. 3. Or by Corruption. 4. Or by Induration.

LVIII. If by Discussion or Re∣solution, the Member or Part grows lighter, i. e. loses of its weight and heaviness; and there is a ceasing of the painful beat∣ing, with which it was before troubled.

LIX. If it is by Suppuration, which is, when the Humor cau∣sing the Swelling, is converted into Pus, or a purulent Matter, there is then a pain and palpi∣tation in the part, with Heat in∣creasing: But when the Matter is concocted and ripened, then the Heat abates, the Pain asswa∣ges, and the Tumor becomes pointed, and eminently eleva∣ted, the Colour is white, and the place (if felt on) is soft, and the Matter seems to fluctu∣ate, and yield to the Touch.

LX. But if the Matter lyes deep, the maturation will not then be so easily discerned, by reason of the thickness of the part, as saith Hippocr. lib. 6. Aph. 41.

LXI. If it be by Corruption or Putrefaction, wherein the Consti∣tution, or Habit and radical Heat of the part affected, is corrupted and destroyed by the maligni∣ty of the Matter now nigh at hand, there is a blackness or li∣vid Colour upon the part af∣fected, and the violence of the Symptoms cease.

LXII. If it is by Induration, when the Tumor acquires an accidental and adventitious hardness, it is known by a di∣minution of the Tumor, but an increase of its hardness, the Swelling lessening unexpected∣ly, which diminution, if it comes from an internal Cause, is always evil, unless the matter retreating, goes off by some critical Evacuation.

LXIII. The Cure by Resolu∣tion is easiest and safest; and next to that is Suppuration: Induration is a very Evil Symptom, but Corruption worst of all. See the Third Edition of Our Synopsis Medicinae. Lib. 1. Cap. 49.

LXIV. The Cure. The Indi∣cation of Cure is taken from the conjoin'd Cause; for upon the removal thereof, the Tumor goes away.

LXV. If there is any intempe∣rature accompanying it, you must alter it, as if it is of Heat, you must cool, if of cold, you must heat; if of dryness, you must moisten: but if of moisture, you must dry; and this altera∣tion is made by the application of such things as have the op∣posite Properties in them.

LXVI. In removal of the con∣joined cause, see whether the Tu∣mor is perfect, or may yet receive any farther increase; if it is not as yet at height, but only approach∣ing thereto, then we must have respect unto the antecedent Cause, as also Causes procatar∣tick, which are with all possible care to be removed, and this is most considerable when the Tu∣mor proceeds from Fluxion, or an afflux of Humors.

LXVII. In those Tumors the

Fluxion is to be opposed, and as much as may be, totally removed; by evacuating the flowing Hu∣mor, either by Vomiting, or Purging, or Urine; as by the habit and constitution of the Body it is requisite.

LXVIII. If you Vomit, the Oxymel Scilliticum exceeds in its use; which ought to be used six or seven times: if Purging, the Sal Mirabile exceeds all other Remedies: if you pro∣voke Urine, Sal Nitre dissolved in Parsley or Hydropiper Water, and well sweetned with Sugar, is an incomparable Medicine.

LXiX. This being done, you ought to give things corroborative, to strengthen both the Part which breeds the Humor, and the Part which receives it: for which purpose, nothing exceeds our Theriaca Chymica, or our Lau∣danum Specificum, or, Dr. Gar∣dner's Laudanum Samech, which may be given in a a fit Dose, at night going to bed, and re∣peated as you see need requires.

LXX. The Fluxion also is op∣posed, 1. By Derivation, which is when the Humor is derived unto the opposite Parts: 2. By Interception, wherein the motion of the Humors in their passage is hindred; either by thickning them, or by repulsion.

LXXI. And since the Humor is said to flow partly by Attra∣ction, which is caused by Pain and Heat; it is requisite that this Pain be eased by Anodyns, and the Heat by Medicaments which refrigerate.

LXXII. The Humor is taken away out of the Part affected, either by translating it to some other Part; or by evacuating it out of the Body.

LXXIII. It is translated into some other Part either by Astrin∣gent Medicines, which drive back; or by Constringing Medi∣cines, which by Compression bring the Parts close together; or lastly, by Attractive Medicines, which draw the Humor unto other Parts, and is effected by Pain, Heat, and Emptiness.

LXXIV. But as for Repul∣sives, they only take place, where the matter is not as yet impacted or stuffed into the substance of the Part, but only flows to, in the greater and lesser Vessels of the same; or else without the Vessels, in the vacant spaces of the same; whose substance is neither so thick, nor yet so thin as to resist the force of Repulsives.

LXXV. But if the Matter be already so impacted into the Part, that it is scarce possible, nor yet safe to repel it; you must then strive by Suppuratives to bring it to maturation.

LXXVI. The Evacuation of the Peccant-matter is either insen∣sible, or sensible.

LXXVII. Insensible is by Dis∣cussion: and this is to be en∣deavoured when there is no great store of matter in the Tumor, and that it is not very thick; and the parts also about it not compact and hard, but rare, and porous.

LXXVIII. If the Matter to be discussed be any thing hard, it is first of all to be mollified by Emollients; that it may the

more easily be discussed thro' the Pores of the Skin.

LXXIX. Sensible Evacuation, is by opening the Tumor with the Knife; and this if the Matter contained in the Tumor is in great abundance, and withal thick, and if the Part lying above it is close and compact.

LXXX. If the Tumor is per∣fect, that is, come to its height or perfection, you must then treat it as an Apostem; and after the same manner it is to be opened, cleansed, and healed; as in Chap. 3. following, we shall teach.

CHAP. II. Of CORPƲLENCY.

I. IT it is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Corpulentia, Crassities; also Corpulentia nimia; in English, Corpulency; and too great Corpulency: because Au∣thors say, that if it is not exceeding, over and above, or too great, it is no Disease.

II. It is no Disease whilst the Functions of the whole Body are perfect and entire, but when it begins to hurt them, then it is accounted for a Disease: and it is a Disease of Magnitude, as Galen, lib. de different. Morb. cap. 9. affirms, because it is not natural, but is above that which is according to Nature.

III. Histories of exceeding cor∣pulent people are extant; and the same Galen, in the place cited relates, that one Nicomachus of Smyrna had his Body grew to so exceeding a bulk, that he could not move from one place to another.

IV. And Sennertus tells us of a Rope-makers Wife of Stras∣burgh, a City of Alsatia, who Anno 1613. and in the thirty-sixth year of her age weighed 480 pounds weight.

V. And he tells us of another, upon his own knowledge, who weighed more than 400 pounds weight, who notwithstanding ap∣peared in publick: but, says he, in such persons as these, there is not an equal augmentation of all the parts of the Body, as it is in such as grow, and naturally increase; but their Fat and Flesh only exceed in that vast proportion.

VI. These things seem not in∣credible; for I my self knew a young Lady not exceeding 18 years of age, so fat and fleshy, as scarcely to be able to go cross her own Chamber; and being weighed, exceeded 300 pounds weight.

VII. I know also a Man now living, so bulky, that he cannot go alone, but is carried in a

Running-chair out of one Chamber into another: and by some of his Family about him he is re∣ported to weigh more than 460 pounds weight; and truly his bulk bespeaks it.

VIII. The Causes. The Pro∣catartick Cause is, plentifully eating good and nourishing Food; and the person so eating being of a pure, untainted, and sound Body; having the Native-virtue generating Flesh very vigorous, strong, and active; and withal leading an idle life.

IX. The Antecedent Cause is, an over-great abundance of good Blood, made of nourishing Meats, abounding with a good Juice: for this cause it is, that Cor∣pulency is referred to Tumors proceeding from Blood: but there is this difference between them, that the conjoined cause of this Tumor is Fat and Flesh; whereas the conjoined cause of other Tumors arising from Blood, is Blood.

X. The conjoined cause there∣fore of this Tumor of the whole Body, is Flesh and Fat: some∣times the Flesh is most aug∣mented, sometimes the Fat; and sometimes they are both alike increased together.

XI. Fat we conclude to be generated of the fat and oily parts of the Blood, falling out of the Arteries into the membranous parts, and then digested by the innate faculty and virtue of the Membranes.

XII. And this happens most to such as are of a cold and moist habit of Body: and Galen also maintains, that all Bodies tend∣ing towards a cold and moist temperament, become fat.

XIII. The Signs. It is evident to the sight: but if it only produces a kind of deformity, it is then no more than a Symptom: but if it offends or hurts any Action, it is then to be accounted a Disease.

XIV. The Prognosticks. Avicen was of opinion, that such a great quantity of Fat with which such corpulent people are troubled, hin∣ders the Body in its motion, in walking and operating, and straitens the Veins with an ir∣regular and dangerous constri∣ction; from whence proceeds obstructions of the passages of the Spirits, by which they are suffocated or extinguished.

XV. But this danger of Suffoca∣tion more belongs to such as grow thus vehemently Corpulent in their younger years: for that they have their Veins and Arteries always small; and by reason of this ex∣cessive increase of Flesh and Fat compressing them, they are not permitted to grow larger.

XVI. Persons thus affected with such an extream bulk of Body, are also apt to fall into Apo∣plexies, Palsys, Palpitations, and Diarrhoea's, by reason of their very great Humidities; as also into Lethargies, Coma's, Faint∣ing and Swooning Fits, &c.

XVII. And whether Men or Women, they are apt to be Barren; the Male not being able to gene∣rate, nor the Female to produce an Embryo in the Womb, they having little or no Seed at all: the Seed being produced of Blood, of which they they have

a very small stock: and if some of them have an indifferent quantity of Seed, yet 'tis such as is thin and watery, and unfit for Generation.

XVIII. And if the Women con∣ceive, (for it is they that have the most Seed) yet it is very rarely; and when they do, they soon miscarry: nor are they able to nourish the Child in the Womb, because they have an exceeding weak Appetite, which affords not Nutriment enough.

XIX. This Disease is rarely cured, and when it is, the Cure comes but very slowly on, nor can it be done in a short time: for the Patient ought to be endued with much patience, self-denial, mortification, and prudence; without which things, the at∣tempt of the Cure will be wholly vain.

XX. The Cure. The great store of Flesh and Fat is to be removed; which is done by wasting and consuming what is already generated, and preventing it for the future to be increased: and this is effected, by taking care, that too great an abundance of Blood be not bred, by using things which heat, and exsiccate or dry, much.

XXI. In order to the perform∣ing of all this, there is a two∣fold Consideration: 1. That which has respect to the Diet and Government of the Patient. 2. That which has respect to the Medicaments exhibited.

XXII. 1. As to Diet. Much Fasting, and an extraordinary Abstinence from Food, is much commended in a word, a con∣tinual spare Diet is absolutely necessary, for it very much tends to the diminution of the Corpulency.

XXIII. The Diet also ought to be hard, as well as sparing: be∣cause hard fare, and Meats not of so easy digestion, breed not Blood in such an extraordinary quantity, as to conserve or continue, much less increase such a prodigious bulk of Flesh and Fat.

XXIV. Dry Bread is a good kind of Food for them; so also would Water, if the fear of a Dropsy did not attend it: how∣ever, the Patient may now and then drink a little Water, and sometimes Mild-beer, (because that is opening) and sometimes Wine very much diluted with Water.

XXV. All their Food and Drink ought to be such as may render the Belly slippery and soluble: for by that means, much of the Nutriment which would be con∣verted into Blood and Flesh, will be beforehand carried off.

XXVI. Let them accustom themselves to much and often Exercise every day; beginning with small Exercises first, and then increasing them by little and little, till they become great: avoiding by all means an idle and sedentary course of life.

XXVII. No exercise exceeds that of fast Walking, and Run∣ning; which may at first be but little, but ought every day to be increased gradatim, both as to the speed in running, and as to the time of exercising it: and

the course ought to be continued every day for some months, yea years, till the gross of the Body is brought down.

XXVIII. Next, Friction of the whole Body with hard or course Cloths, is of good use; because it opens the Pores, and causes a transpiration of much of the fatty Sweat or Humidities, which con∣spire to the increase of the ma∣gnitude of the Body: rubbing the Body presently after all over with some sweet Oil, which if you please may be perfumed.

XXIX. And withal, if they have conveniency, they ought to Sweat once a day, by a dry me∣thod of Sweating: the best for this purpose, is Sweating in Hartman's Chair, with rectified Spirits of Wine. By this course I cured a Man of a prodigious bulk in about three months time, or a little more; beyond mine, and all others expecta∣tion.

XXX. Galen, Method. Med. lib. 14. cap. 15. says, he perfectly cured a Man of about fourty years old, who was exceeding fat and gross, even to the admiration of all who beheld him. And this he did, by giving him an Anti∣dote made of Sal Theriacale, and the right Theriaca Andro∣machi made of Vipers; causing him to use an extenuating Diet after it, and to exercise himself with swift running.

XXXI. And he fitted and prepared him for this exercise of Running, by gentle Frictions with rough and hard Cloths made of new linnen, till the skin became red, and then anointed him with a digestive Oil, with which he also anointed him after his running.

XXXII. 2. As to Medicines, Bleeding is wholly forbidden; for it is manifest, that much and constant bleeding has made many grow to an extraordinary bulk of Body, who otherwise would have been lean and slender enough: and Hippocrates seems to be against Bleeding in fat persons, because (as they are of a cold habit of Body, so) they are more pro∣pense unto cold Distempers.

XXXIII. Authors advise to frequent Purgations with Aloes, and Aloetick Medicines: I com∣mend my Cathartick Laudanum, which may be taken every night to gr. x, or xij. and in some persons to xv, or xx. it is a noble Medicine, and works admirably the next day, and that without any griping, pain, illness, or making faint; and possibly may more waste the Body (almost after an insensible manner) than a thousand other Medicines, which purge more vehemently: and yet this is not to be despised, as to its purging neither.

XXXIV. Some advise to Aloes made up with Myrrh and Nitre, as a proper Remedy; because Sal Nitre in a great measure wasts the Body by Urine, at least hinders its farther increase.

XXXV. Oxymel of Squills constantly taken for some few months, is a famous thing; and will certainly bring the Body down in some few months, if the Patient can be but per∣swaded to the constant use of it.

XXXVI. Authors commend all hot and bitter things: as Worm∣wood, Southernwood, Rue, Pellitory of Pain, Sage, Tyme, Savory, Myrrh, Frankincense; and generally whatsoever things work by Urine, as Fennel, Smal∣lage, Parsley, Hydropiper, Asparagus, Onions, Winter-cherries, &c.

XXXVII. Sennertus commends this Pouder: ℞ Sal Nitre ʒ j. Alum ℈ij. Cortex Guajaci, Sar∣saparilla, Myrrh, Frankincense, A. ʒ ij. make all into a fine pou∣der; of which the Patient may take a dram morning and evening every day, for two months together.

XXXVIII. The Salt of Vipers is commended, but is a thing dear, and hard to be got: the Salt of Sheeps or Bullocks flesh will do as well.

XXXIX. For them that can∣not take Pills, I commend a con∣stant Purging with Our Tinctura Purgans, or Tinctura Cathartica; and sometimes for change, with Elixir Proprietatis: but more especially with Sal Mirabile, because that answers the In∣dication, both by Stool and Urine; and if constantly used, will do wonders of this kind.

XL. In the intermediate days of Purging, this following Pou∣der may be given: ℞ Sal Nitre, Winter-cherries, Cortex Guajaci, A. ℥ j. Myrrh, Cloves, Nutmegs, A. ℥ ss. Camphir, Gin∣ger, A. ʒ ij. white Pepper ʒ j. make each into a fine pouder, and mix them together. Dose, ʒ j. morning and evening, in Barley-water, or Decoction of Parsley-roots.

XLI. Lastly, for a constant Drink, (instead of Beer, Ale, Wine, Water, or other liquors) this following is most excellent; because it wasts not only the Nutritious-juices, but even the Flesh and Fat, to a Miracle.

XLII. ℞ Raspings of Guaja∣cum lbj. Cortex ejusdem, Sas∣safras rasped, A. lbss. Fennel-seed, Coriander-seed, A. ℥ iv. fair Water lbxxx. Salt of Tartar ℥ iv. mix, digest scalding-hot for twenty-four hours; then boil in a Diet-pot till a Gallon is con∣sumed: strain out, and sweeten it a little with double-refined Sugar: of this let the Patient drink constantly every day, as his ordinary Drink, and continue the use of it for 3, 4, 6, or 8 months; as the condition of the Sick, and continuance of the Distemper shall require.

APPENDIX. Of an ATROPHIA.

XLIII. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Atrophia, vel Consumptio Par∣tis, vel Partium; and in Eng∣lish, a Consumption, or Wasting of a Part or Parts.

XLIV. There are several kinds of Consumptions, as a Phthisis; a Marasmos or Tabes; a Hectick; and lastly, an Atrophia, Pining or Wasting; which is called in general, and Extenuation of the Body; viz. when the Body is not nourished so much as it

ought to be, but is diminished and lessened, by reason of the withholding of Nourishment from it; and this is called in general an Atrophy.

XLV. Now an Atrophy is two∣fold: 1. General, of which we have already treated in Our Syn∣opsis Medicinae, lib. 2. cap. 31. and lib. 6. cap. 18. 2. Parti∣cular; which is the Wasting or Pining away of some particular Part or Parts; as a Foot, Leg, Thigh, Arm, &c. of which we shall treat here, and the rather, because falling under none of the general Topicks or Titles of this Art, tho' a part of the Chirurgians duty: and not be∣ing willing to give it a place by it self, we chose to treat of it in this Chapter, by way of Appendix; as being the almost opposite of too great Corpulency.

XLVI. The Causes. The Causes of the particular Atrophy, (like that of the whole Body, which consists in some one particular Bowel, whose action is necessary for the Nutrition of the whole Body) is contained in some particular Vessel or Vessels, beloning unto that particular Part.

XLVII. Yet however the general Causes are the same as in an Ʋni∣versal Atrophy; viz. the weakness of the Nutritive-faculty of the Part, and defect of Nourishment.

XLVIII. The Faculty is hurt when the Part is over-cooled, and left destitute of its proper heat and warmth: for then the Part can neither attract any nutri∣ment, nor retain it, nor yet alter, or assimulate it.

XLIX. And a Part is said to be refrigerated, and its hea•• decayed, and to be made dull, or stupid, and unfit for action, from many Causes; as, coldness of the external Air, lying long in cold Water or Snow, or being laid upon a cold place; as also by long lying upon the Parts, (by which the Spirits contained in it are as it were suffocated) from over-much rest, in the Palsy; or from the straitness of the passages thro' which the Spirits flow.

L. The Nutriment fails chiefly by reason of the narrowness of the Passages, (or their being obstructed or stopt up thro' the congelation of some Humor in the same,) thro' which it ought to flow to the Part wanting it.

LI. And this arises mostly from External Causes, as, when the Arteries which carry the Blood unto the Part for its nourishment are compressed by the Bones, when they are loosened or out of joint: or from hard and strait band∣age; as many times happens in such as have long had an Issue; or from some Tumor nigh unto the Part; or from the brawniness or hardness of the Flesh; or lastly, from the Ves∣sels being cut asunder, which are to convey the Nutriment.

LII. The Signs. The Disease is known by Sight; and the very Causes may be fully known by the relation of the Patient: but because it may have dependance upon many of them, they are therefore all of them to be enquired into, that so the me∣thod of Cure may be the more rightly prosecuted.

LIII. The Prognosticks. From the Causes, we are to make our Judgments of the Cure: for if the Causes may be removed, there may be hope of Health and Restoration; if they can∣not be taken away, but will re∣main, the Disease will also remain.

LIV. The more recent it is, the more easily it is cured; and contra∣riwise, the more inveterate and old, the more hard and difficult.

LV. If the Nutriment only is consumed, there is more hopes; but if much of the substance of Flesh is already wasted, it will be the more difficult; and most of all when the Membranous parts are already exsiccated, and very much dried: for such an Atrophy is as impossible to be cured, as that which befalls the Body thro' old-age.

LVI. If the Native-heat be not so far weakned, but that it may be restored, the hopes of recovery is manifest: for that the Cause being removed, and the Heat restored, Nourishment will again be brought to the Part affected.

LVII. The Cure. A Part being extenuated or withered away, for want of the Nutriment being conveyed to it, and the languishing of the Heat of the Part; we must do our endeavour to restore the decayed Heat again, and to make an attraction of the Blood to the same.

LVIII. Heat is restored to the Part many ways: as by a gentle Friction, or moderate rubbing of the Member, moving of it up and down, and soaking it in warm Water.

LIX. Now this friction, moving, and soaking it in Water, ought to be so long (and no longer) con∣tinued, than to cause the Part to look somewhat red, and as it were a little swoln; but not so long till it is again asswaged and fallen.

LX. The Parts affected may also be soaked and bathed in Baths made of the following particulars, or some of them, which may be easiest gotten; as Aniseeds, An∣gelica, Avens, Asarabacca, Bay-leaves, Basil, Bawm, Bears-breech, Bishopsweed, Brook∣lime, Briony, Calamint, Camels-hair, Camomil, Caraway-seeds, Catmint, Cedar-tops, Celan∣dine, Centory, Chervil, Citron∣peels, Cicely, Coriander-seeds, Costmary, Costus, Cresses, Cu∣min, Dittander, Dittany, Ele∣campane-roots sliced, Fennel the herb and seed, Fenugreek, Fetherfew, Fir-tops, Galingal, Gaultree-leaves, Goats-rue, Gen∣tian, Grains of Paradise, Ground-pine, Hartwort, Hops, Hore∣hound, Hysop, Jack-by-the-hedge, Juniper-tops and berries, Larchtree-tops, Lavender, Limon-peels, Mallows, Marjoram, Masterwort, Mastich-herb, Maud∣lin, Melilot, Mint, Mustard, Myrtle-leaves, Navew, Orange-peels and leaves, Parsley, Pars∣nip-tops, Pellitory of the Wall, and of Spain, Peniroyal, Pepper bruised, Pimpernel, Pinetree-tops, Plowmans-spicknard, Po∣lymountain, Radish-tops, Ram∣pions, Rocket, Rosemary, Rue, Sage, Savin, Savory, Saxifrage, Scabious, Scruvigrass, Skirret-tops, Smallage, Sneezwort,

Solomons-seal, Soapwort, South∣ernwood, Spignel, Tobacco, Tansy, Tarragon, Tyme, Tor∣mentil, Turneps and their tops, Valerian, Vervain, Worm∣wood.

LXI. The bathing and fomenting being over, (which ought to be repeated every day, for some considerable time) you may anoint with this Oil: ℞ Oil-olive, or Neatsfoot-oil, ℥ xiv. Chymical Oils of Aniseed, Amber, Caraways, Juniper-berries, Ca∣momil, Rosemary, Sage, Savin, Sassafras, Lavender, sweet Mar∣joram, Turpentine, A. ℥ j. Oils of Oranges and Limons, A. ℥ iv. mix them; with which anoint the Part morning and evening.

LXII. Or you may make the former into an Ointment, by ad∣ding Sheeps-suet ℥ xij. Chymical Oil of Cumm ℥ vj. pouder of Castoreum ℥ viij. with which you may anoint, as before.

LXIII. Sennertus advises to this Ointment: ℞ Bdellium, Opoponax, A. ℥ j. dissolve in Wine, and strain: to which add Hogs-grease, Goose and Hens grease, A. ℥ j. old Oil-olive ℥iv. Turpen∣tine, Wax, A. ℥j. boil till the Wine is consumed, and then add Ma∣stich, Frankincense and Fenugreek, all in pouder, A. ℥ j. mix, and make an Ointment; with which daily, morning and evening, anoint the places affected.

LXIV. After well Anointing, for a week or more, you may apply the following Emplaster: ℞ Turpentine, Balsam-capivi, Gum-Elemi, Wax, Rosin, A. lbj. mix them upon the fire; then add there∣to Galbanum, Opopopanax, Sagape∣num, strained, A. ℥ iv. Tacama∣hacca ℥ iij. Frankincense, Ma∣stich, A. ℥ ij ss. Long-pepper, Ginger, Cardamoms, Grains of paradise, all in fine pouder; Nutmegs, Mace, Cloves, Zedoary, Galangal, Winters-Cinamon, Mu∣stard-seed, all in fine pouder also, A. ℥ ij. mix, and make an Emplaster; which apply, after it has been fomented with the following Fomentation.

LXV. The Fomentation. ℞ Spirit of Wine lbvj. Pepper, white, and long, Ginger, Zedoary, root of Pellitory of Spain, Mustard-seed, Grains of paradise, all in pouder, A. ℥ j. Bay-berries, Rocket-seed, berries of Spurge-olive, Juniper-berries, Winters-Cinamon, A. ℥ ss. Cloves, Nutmegs, A. ʒ ij. Mint, Marjoram, Rosemary, Sage, Tyme, all dried, A. ʒ vj. mix all these Pouders together, and grind them in a hot iron Mortar, with Salt of Tartar ℥ iv. then put all into the Spirit, which digest in a cold place for a week, and decant off the clear Tincture for use; with which foment the Part, before laying on of the Emplaster.

LXVI. After the application of the former things for four, five, or six day, the Ancients used Dro∣pacisms, or Pications. Now a Dropax or Pication, was a soft Ointment made of Pitch mixed with Oil; which they applied to the extenuated part blood-warm, keeping it on till it was cold, and then they removed it, and applied a fresh one; and this was often repeated, till at length the Part became red, and something swelled:

which done, they removed the Dropax, and anointed the Part with sweet Oil, or some fat body, and in the evening re∣peated the same as before: which course they continued so long, till the Member grew thicker, and more fleshy.

LXVII. If this Dropax or Pi∣cation would do nothing, they made then use of Percussion or Beating, smiting the wasted Part with Ferula's or Rods, till such time as it became swoln and red, and then immediately anointed it with some Oil, or fat Medi∣cament: but later Physicians make use instead thereof, of green stinging Nettles.

LXVIII. Some have been cured by anointing with this Oint∣ment: ℞ Oil-olive, Sheeps-suet, A. ℥ viij. Chymical Oils of Camomil, Juniper, Rosemary, Savin, Sassafras, and Spike, A. ℥ ij. Mustard-seed, roots of Pyrethrum in fine pouder, A. ℥ ij. white Pepper in pouder ℥ j. Cam∣phir, Ginger in pouder, A. ℥ ss. Turpentine q.s. mix them.

LXiX. Others have been cured by manifold Frictions, and then immediately anointing with this Mixture: ℞ Oils of Amber ℥ iv. Oils of Spike, Rose∣mary, and Sassafras, A. ℥ j. Oils of Aniseed, Juniper, Limons, and Turpentine, A. ℥ ss. mix them; with this the Patient was an∣ointed twice a day, rubbing it in for half an hour at a time; and being continued for twenty days or more, they became perfectly well.

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.

CHAP. IV. Of a SINUS in Tumors.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Sinus; and in English, the Hole of a Tumor or Apo∣stem.

II. The Description. Is it the hole or hollowness of a Tumor or Apostem, which being emptied of its Pus, is notwithstanding filled again; for which reason it is, that the sides of the said hollowness do not close, and grow together with the Flesh which is underneath it; but there is a certain cavity or hol∣lowness left remaining, very difficultly, if not-impossible, to be cemented.

III. Now the mouth and en∣trance into the Apostem and Ʋlcer, is generally strait and narrow; but within it is more profound or deep, enlarging it self into a proportional bredth.

IV. The Causes. They arise mostly from Apostems or suppurated Tumors, not soon enough opened, or not well cleansed.

V. For the Pus being longer kept in the Apostem than it ought to be, acquires a sharp or corroding quality; by which it makes many

winding and turning passages; to which there is an afflux of Humors from the adjacent parts, and many times from the whole Body: for which reason it is, that this Sinus, or Windings to and fro, is difficult to be filled up with Flesh, and healed.

VI. The Differences. They are manifold: 1. As to Magnitude; for some are greater, some lesser; some shallower, some deeper, some less capacious, others broader.

VII. 2. As to Figure; some are streight, others with many turnings and windings; some long and deep, others roundish, or globular.

VIII. 3. As to the situation, or way of Running: some run up∣wards, and so give better hopes of Cure; for that by its orifice the Pus may the more easily flow forth: some tend, or run down∣wards, so that the Pus cannot flow forth; for which reason, with the Syringotomos it may be opened on the lower part.

IX. The Prognosticks. If the Sinus is not speedily cured, it contracts a Callus, and degene∣rates into a Fistula; and will not then be cured, without much difficulty and danger.

X. The hopes of Cure are taken partly from the Sinus it self, as not being large, deep, winding, or depending: partly from the Part; as being in an upper part, not in a part depending: and partly from the Matter flowing forth; as being well digested, without much swelling, or any very sensible pain; being white in colour, and small in quantity.

XI. If the Pain is wholly vanisht, and the whole place is equal; not feeling with a hollow or yielding softness; it is a good Argument that the Sinus is already filled with Flesh.

XII. But if there is much pain, or any swelling or tumor, the matter flowing in great quantities, and as it were continually, of an evil colour, as green, blew, yellow, or blackish; and indi∣gested, or otherwise very putrid, and extreamly stinking; the hopes of Cure are very small.

XIII. The Cure. The Indica∣cations are taken from the Sym∣ptoms, which are chiefly two, Solution of Ʋnity, and Hollowness: and therefore there must be a Unition; which that it may be accomplished, the Hollowness must be filled with Flesh.

XIV. Now the Cavity cannot be filled with Flesh, except the temper of the Part is as it ought to be; and that the Sinus is free and clean from all its impurities and filth: we must labour there∣fore to remove the Distemper of the Member, if any be, and then that the Sinus be throughly cleansed.

XV. The former is done with Alteratives of a contrary temper; and Purging once or twice a week, with Pilulae Catharticae, Tinctura Purgans, Tinct. Cathartica, or Sal Mirabile, Pulvis Catharticus, or Pulvis Cornachini.

XVI. Then see to the Orifice of the Sinus, if it looks not down∣wards, cause it to look so, by opening the lower part thereof; that the filth may have a free passage forth; and such a like

Sinus, by applying Abstersives, is easily cured.

XVII. Now in this case, some∣times the whole Cavity must be laid open; sometimes an Ori∣fice must be opened only on the inferior part: but the opening the whole Sinus is most in use, because the Ulcer thereby may be the more easily cleansed and healed.

XVIII. Yet this is only when the Sinus is great, and the whole Part may be laid open without danger: otherwise we only open it in the bottom thereof; which done, it is throughly to be cleansed and dried, that no Pus be left remaining.

XIX. For if any of the filth be left behind, there are com∣monly Recidivations or Relap∣ses which follow it, or else it degenerates into into a Fistula: and tho' the parts may seem to be conglutinated, yet they stick not firmly together, but after∣wards separate again.

XX. Now to help on the re∣moval of the Pus, Pillows, or Bolsters and Swathbands are of great use, thereby straitly to com∣press the hollowness, from the higher part of the Sinus, to∣wards its Orifice.

XXI. This being said, we must come to consider of the Medica∣ments fit for this purpose; as 1. Bar∣ley-water, especially if mixed with a little Red-wine. 2. Mel∣icrate, or Water and Honey boil'd together. 3. Mulsum, or Wine and Honey boiled together; which both cleanses and cor∣roborates together.

XXII. To these things you may add, the White Potion, which is thus made: ℞ Strasburgh-Turpen∣tine ℥j. three yolks of Eggs, grind them together till they are well mixed, then add to them, Barley-water three quarts; with which wash the Sinus for some days.

XXIII. To these things we may add, Honey of Roses, Barley-meal, Bean-flower, Orobus-meal, meal of Lupins, Spirit of Wine, Alum-water, Oxymel, Unguentum Ae∣gyptiacum; which laft is the strongest of them, and to be used in the most filthy Ulcers.

XXIV. ℞ Honey of Roses strained ℥ ij. Barley-flower enough to give it a thick Body: or, ℞ Turpentine, Honey of Roses, A. ℥ j. juices of Wormwood and Smallage, A.℥ ss. boil them together; then add of Lupin, Bean, Barley flower, A. q.s. mix them well together.

XXV. Or, having for some days cleansed with the Mixture at Sect. 22. aforegoing, wash only with the following Mixture, with which sometimes the Cure is only and compleatly per∣formed. ℞ Well-water lbiv. Saccharum Saturni, Roch-alum, A. ʒ vj. white Vitriol ʒ iv. Spirit of Wine ℥ vj. mix them.

XXVI. But if the Sinus are manifold, or with many turnings and windings, or of an extraor∣dinary depth, so that it is alto∣gether impossible to open them wholly; nor that Unguents can possibly penetrate thro' the whole Cavity: in this case, liquid Abstersives must be used, which may (by the help of a Syringe) insinuate themselves into all parts of the Sinus.

XXVII. And sometimes, as

soon as the Medicine is cast in, the Orifice is to be stopt, (for some little time) that the Me∣dicament may remain there for a while; which may be best done with a short Syringe, if the Orifice is narrow, holding the Syringe in all the while, to pre∣vent the immediate flowing back.

XXVIII. ℞ Fair-water lbv. Honey ℥ iv. juices of Centory and Wormwood, A. ℥ ij. Aloes ℥ ss. dissolve by boiling, and strain.

XXIX. If it be very foul, ℞ Barley-water lbiv. Honey ℥ iij. Unguentum Aegyptiacum ℥ vj. mix them.

XXX. The Sinus being suffi∣ciently cleansed by the use of these things, or others of like nature, you must then come to the use of Sarcoticks, Incarnatives, or Flesh-breeders: for tho' Nature her self will generate Flesh, yet Art and Medicines many times assist her so, as to remove the recrements which hinder her in her operation; which since they are an impediment to her, are wholly to be taken away by means proper; so that the filth and impurities may be throughly taken away from the Ulcer, and the humidities dried up.

XXXI. Now Sarcoticks or Flesh-breeders, cannot be said properly or really to generate Flesh, for that is the work of Nature alone: but are so called from their being assistant to her, in removing (as was said before) the impediments, by their cleansing and drying qualities.

XXXII. Yet they ought not to be over-drying, but such as may agree with the natural temper of the Part: for as much as there is not the same degree or measure of driness in all Bodies, nor yet in all Members.

XXXIII. The more gentle Sar∣coticks are, Barley-meal, Bean-meal, Rosin, Frankincense: the stronger are, Orobus-meal, pou∣der of Orrice-roots, of Aristo∣lochia, Myrrh, Scammony, Aloes, Tutia, Pompholyx, &c. out of which you may make various Compositions.

XXXIV. A mild Sarcotick. ℞ Turpentine ℥ ij. Gum Elemi, Capivi, Frankincense, Mastich, Olibanum, Colophony, A. ℥ ss. Wax, Oil, A. q.s. mix, and make an Ointment.

XXXV. A strong Sarcotick. ℞ Round Birthwort-root, Orrice-root, Comfrey-root, all in pouder, A. ℥ ss. Mastich, Olibanum, Frank∣incense, Myrrh, Aloes, A. ʒ ij. Scammony ʒ j. Turpentine, Honey, A. q.s. mix them well together.

XXXVI. If it is Flesh of a harder kind which is to be gene∣rated, and in a Body more than ordinarily dry, and the Ʋlcer lyes open, then you may apply Topicks in a dry form, as Sarcotick Pouders, to strew on: as,

XXXVII. ℞ Frankincense, Mastich, Olibanum, Rosin, A. ℥ j. make all into a fine pouder. Or thus: ℞ Aloes, Frankincense, Mastich, Olibanum, Rosin, Sanguis Draconis, Sarcocol, A. ℥ j. make all into a pouder.

XXXVIII. This is better: ℞ Fine Scammony, and make it into a subtil pouder. Or this: ℞ Scammony, Myrrh, Olibanum,

A. ℥ j. make them into a fine pouder. Or this: ℞ Scammony in pouder ℥ iij. fine Aloes, Myrrh, A. ℥ j. Coloquintida in pouder, ℥ss. mix them.

XXXIX. This is a most ex∣cellent thing: ℞ Scammony in pouder, Mercurius dulcis levi∣gated, A. ℥j. Myrrh, Aloes, A. ℥ss. Coloquintida in pouder ʒ ij. mix them.

XL. But if the Sinus is not open, Sarcoticks of a liquid form are to be injected, after the manner of Cleansers; and the Orifice being kept close, they are to be kept in for a while.

XLI. For this purpose, red Port-wine, in which Myrrh, or Myrrh and Aloes has been dis∣solved, may be injected; or Wine, in which Scammon has been dis∣solved: or a Decoction of round Birthwort-roots in red Port-wine, in which you may dis∣solve Myrrh: also, a Deco∣ction of Comfrey-roots, Horse∣tail, red Roses, Myrrh, Frank∣incense, Aloes, &c. in red Port-wine, are admirable in this case.

XLII. After all, it may be a question, whether the deeper and more extream parts of the Sinus are well cleansed and congluti∣nated? But this you may know by the Pus that flows out, if it is but small in quantity, well digested, and no pain is per∣ceived: but if after the fifth or seventh day, a crude and raw Humor shall come forth, it is a sign of no good healing, or conjoining the Parts; and that Flesh is not as yet bred therein.

XLIII. In this case, you must use Medicaments which more forcibly dry, yet without any biting; which may be conti∣nued till the Sinus is in a man∣ner filled up.

XLIV. Then some aggluti∣nating Medicament is to be ap∣plied, which may gently, and with∣out any acrimony, close together, and heal the tender Flesh which is generated and bred, con∣joining the divided parts.

XLV. After the Agglutinative has been applied, you may put upon it a new soft Spunge, dipt in generous Wine, or in Mulsum, or in a Decoction of Pomgranate-peels, Red-roses, and Myrrh, made in red Port-wine, and you may bind it round on; which binding let begin from the bottom of the Sinus, and so go forwards to the Orifice.

XLVI. And about the bottom, let the swathing be as hard and strait as may be, (but so, as not to cause pain,) and then slacken it by little and little, till you come to the very mouth of the Sinus it self; over which let the Medicament be laid after a loose manner.

XLVII. Nor must you too closely stop up the Orifice, but leave a place for the Pus to come forth; for which purpose, the Emplaster laid on may have a hole cut in the middle thereof.

XLVIII. This was the ancient way of curing a Sinus, and hollow Ʋlcers; but Arcaeus in his Book of Wounds, l. 2. c. 7. gives us ano∣ther more compendious course, discovered by himself in curing

Apostems newly opened; by which, on the third or fourth day at farthest, all the aforesaid cavity of Apostems might be perfectly cured.

XLIX. If the Apostem or Tu∣mor (says he) is great, let it be opened as well as may be; so wide, that ones Finger may go into the Orifice; that thereby all the Pus contained may flow forth, by a gentle compression of the place.

L. The Pus being evacuated, stop the mouth of the Sinus with a Tent, and lay over the Sinus a Bolster; which let lye with∣out stirring it, till the next day following.

LI. Then loosen the ligature, and let the hollow Ʋlcer be care∣fully purified or cleansed from all the Pus: (I suppose he intends, with abstersive Lotions or In∣jections) that nothing may be left remaining underneath.

LII. This done, let a small Pipe of lead be put into the Ori∣fice, reaching even to the cavity or hollowness; but by no means be forced any farther: upon which lay Emplastr. Basilicon, spred upon linnen Cloth; in the which the Pipe also may be contained, that it falls not forth; but always leaving a hole at the orifice of the leaden Pipe.

LIII. Then on either side of the Sinus let triangular Bolsters be laid, that all the hollow space may be filled up with them; leaving the orifice of the Sinus in which is the leaden Pipe or hollow Tent, free and open; not letting it be stopt up with the Bolsters, nor any ways ob∣structed by the ligature or bind∣ing; so that all the Pus con∣tamed may wholly run out.

LIV. Then let the place co∣vered with the Bolsters be rowled about with a Rowler; beginning from the bottom of the Sinus, and so going towards its Ori∣fice, thereby to force away the remaining pus or filth.

LV. Thus bound up, leave it till the day following, then loosen the Ligature, and search how much of the Cavity remains, by which you will know, whether the Bolsters did exactly press upon the hollowness.

LVI. For all these placs or hollownesses, which were com∣pressed by the Bolsters, will all of them be found conglutinated, and joined fast together; the which being manifest, the Bol∣sters are again to be bound on after the same manner as before, and so to continue till the next day.

LVII. But now if any Pus or Humor seems to be left in any place, this is to be prest forth (as before) with the Bolsters and Swathing; by which means the gaping or hollow places will coalesce, and be joined close together.

LVIII. Which as soon as you perceive, the Bolsters are to be removed, and you may lay upon the Ʋlcer a Plaster of Arcaeus his Leonine-composition, spred upon linnen Cloth; or some other Emplaster of like kind, as Dia∣palma, &c. every day wiping and cleansing it six or eight times.

LIX. Now here is to be noted,

1. That Arcaeus his Method is only in use in Apostems newly opened; but in an old Sinus, or where it may be callous, or fistulous, the former Way is much the better and safer.

LX. 2. That the Bolsters be sufficiently compressed with the Rowlers; both to press forth the Pus, and also to conjoin the disunited parts; other∣wise no healing can be expected.

LXI. 3. That there may not remain any reliques of the indi∣gested or putrid Matter thro' the Part; which if any be, will be known by the continuance of the Tumor, and redness of the colour; and therefore the due and thorow Cleansing must be endeavoured with all the speed that may be.

CHAP. V. Of an INFLAMMATION.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Phle∣gmone, and Inflammatio; in Eng∣lish, a Phlegmon, or Inflam∣mation.

II. The Description. It is a Tumor, rising gradually with pain, vehement heat, and redness, with a protrusion, and beating in the part; from a preternatural flux of Blood.

III. The Place. It is manifest chiefly in Fleshy parts, to wit, the Musculous, and sometimes in parts that are Membranous; as in a Pleurisie, in the Membrane which girts about and encom∣passes the Ribs; in a Phrensy, the Membranes of the Cerebrum; in an Ophthalmia, the Membranes and small Vessels of the Eye; oftentimes in the Glandulous parts, as in Bubo's, Parotis, &c. and in the Bowels also; as the Brain, Liver, Spleen, Womb, Reins, &c.

IV. The Causes. The Proca∣tartick Causes are Wounds, Fra∣ctures, Blows, Contusions, violent Exercise, Surfeiting, critical Eva∣cuations; or any thing which may cause a Solution of Unity in the Part, the Skin remaining whole.

V. The Antecedent-cause is Ob∣struction, and things breeding Ob∣struction, also the breeding much Blood; whence it comes to pass, that the Blood or Matter ob∣structed, not finding its way out, increases, and by a conti∣nual addition without circula∣tion, a Tumor is produced.

VI. The Conjoined-cause is Blood, if it is a pure Phlegmon; but as it may also arise from the mix∣ture of other Humors, as Lympha, Serum, Phlegm, Choler, or Melan∣choly, so it receives other Names; as if from Blood mixt with Choler, it is called Phelgmone Erysipelatoodes; if from a mix∣ture

of Phlegm, Oedematoodes; if from a mixture of Melan∣choly, Scirrhoodes.

VII. From this Blood, or Blood mixt mixt with Humors, arises a Ferment in the Part affected, with a hot Effervescency; causing many times a putrid Pus or Matter.

VIII. Galen saith, it is caused from a hot fluxion of Blood, which when it has seized upon, and seated it self in some Musculous part, at first the greater Veins and Arteries are filled up, and dis∣tended; and after them the lesser: and so it is carried on, and continued, till it arives at the Capillaries, or least Vessels.

IX. In these, when the matter of the Fluxion is forcibly impacted, and cannot be any longer contained in the Vessels, it is then extrava∣sated, or transmitted unto the outward parts; partly by Anastomosis, thro' their own Mouths; and partly by Dia∣pedesis, or percolation or sweat∣ing of it out thro' the Tunicles; and partly by Diaeresis, or break∣ing of the Vessels; whereby the void spaces that are betwixt are filled full with the Flu∣xion.

X. For since the Arteries and Veins run along unto every par∣ticular Part; so long as the Blood flows in a due measure, and is contained within those its receptacles, by circulation, no Inflammation or Phlegmon can be at all: but then it hap∣pens only when the Blood is in an over-abundant manner, and all on a sudden is emptied and poured forth by the said Vessels into the substance of the Flesh.

XI. This is evident in an Ophthalmia: for in the Tunicle Adnata, replenished with innume∣rable of these Capillary-vessels, whilst the Eye is free from dis∣temper, they are so very small, that they are hardly to be di∣scerned by the most piercing Eye: but as soon as the Eye is in∣flamed, and those Vessels pre∣ternaturally replenished with Blood, then they notoriously shew themselves, and become very conspicuous.

XII. And in like manner it is most agreeable to Reason, and even Truth it self, that it should be the same in all other Inflam∣mations whatsoever, and in what part soever.

XIII. But yet there will be no Phlegmon or Inflammation, tho' the lesser and Capillary-arteries are even filled up with Blood; until that at length by and thro' them the Blood is impacted into the remaining parts, or substance of the Flesh.

XIV. And this is done, when that the Blood being emptied thro' those Capillary-arteries into the substance of the Flesh, it cannot flow again or circulate thro' the ends or mouths of the Capillary-veins, by reason of some thick or viscous Matter obstructing them.

XV. The Differences. The chief Differences of an Inflammation, are taken; 1. From the Variety of the conjoined Gause. 2. From the various Qualities of the Blood, which stirs up, and makes the Inflammation.

XVI. The Kinds And so a

Phlegmon is said to be, 1. True, as that which springs from Blood alone. 2. Spurious, which comes from Blood mixt with other Humors.

XVII. The Spurious is three∣fold, viz. Erysipelatoodes, Oede∣matoodes, and Scirrhoodes; as we have already discoursed at Sect. 6. aforegoing.

XVIII. As for the Blood, as it is more acrimonious and sharp, so it makes the Tumor more sharp and painful, and contrariwise: now this is no change of its substance, but of its qualities; for if the Blood changes its substance, it excites not any kind of Blood-tumor at all, but the Tumor is denommated from some other Humor.

XIX. The Signs. They are ma∣nifold; as, 1. Tumor and dis∣tension: for the great quantity of Blood does not only fill the Arteries, but even the whole substance of the Part; all of it is distended or stretched out, but chiefly the Skin.

XX. 2. A very great and intense Heat, from whence the Tumor has its name and denomination; which is caused from the over-great afflux of hot Blood detained in the Part; and an obstruction of the Pores of the Skin, that the hot Exhalations or Vapors can∣not sufficiently perspire, nor the heat be cooled as it ought to be; together with putrifa∣ction of the Blood and Humors.

XXI. 3. A vehement Pain: for where there is a vehement Heat, or hot Distemper, and a solution of Ʋnity, (as there must be in all Tumors) together with a distention of Parts, there must also be a great Pain: now this Pain is various, and much dif∣ferent; as distending or stretch∣ing, pulling or twingeing, pres∣sing and burthening; accord∣ing to the quality of the Parts affected.

XXII. 4. Resisting the Touch: for tho' the inflamed Part is not hard of its own nature, yet being so much filled with Blood, and distended thereby; it must necessarily resist the Touch (in some measure) and appear as it were hard to the feeling.

XXIII. 5. Redness of the Part: for the Blood imparts this colour thereto; there being nothing in Mans body which assumes a redness of colour, but the Blood primarily, then the Flesh.

XXIV. 6. A Pulse, or beating Pain in the Part: there is per∣ceived a beating of the Arteries of the inflamed Part, which when the Part was well, was not per∣ceived: but this happens not to all places, but only to such of them as have some notable Arteries, and other parts which are endued with an exquisite sense; and when the Inflam∣mation is grown to a consi∣derable bigness; as says Galen, de Loc. affect. lib. 6. cap. 7. viz. when the Inflammation tends towards Suppuration.

XXV. The Prognosticks. A Phlegmon, if small, does often resolve; (which is known by abating of the Symptoms, and growing less) but if great, and the matter is thick, and deep in the Flesh, it does often suppurate.

XXVI. If the Inflammation vanishes, and the Tumor suddenly strikes inward, with a Fever, or other evil accidents, it is dan∣gerous.

XXVII. If it neither resolves, returns back, nor comes to Sup∣puration, it grows into a scir∣rhous hardness.

XXVIII. If it falls in the Fleshy parts, it is said to end in fourteen days; if on the Ten∣dons and Ligaments, in about forty days.

XXIX. An Inflammation ex∣ternal, often frees the internal parts from many Diseases, and is healthful; except it is very great and malign; for then you may fear a Gangrene, or some other danger.

XXX. That is dangerous which seizes on the Eyes, Jaws, Ʋvula, great Vessels, Penis, or Joints.

XXXI. In a Young person, and in Summer-time, 'tis sooner cured than in Elder persons, or in Winter-time, or cold weather; and sooner in a lean, than a fat Body.

XXXII. The end is good, when Nature overcomes the matter which breeds the Inflammation, which happens, when the Tumor is either resolved by insensible perspiration by Discussives, and is the best kind of curing it: or when it is suppurated, and turned into Pus, or purulent Matter.

XXXIII. The end or event may be said to be evil, when Nature does not overcome the Morbifick-matter; which is, when (if the Tumor is external) it suddenly vanishes, or strikes inward; or when the natural heat being overcome and extinguished, it becomes a Gangrene: so that if it is not presently cut off, death must ensue.

XXXIV. The end or event is not good, when upon Resolution, or Discussion, the thinner parts are removed, leaving the thicker behind; by which the Tumor becomes hard, and degenerates into a Scirrhus.

XXXV. Now if the matter is not very thick, nor deep, or shut up under a hard and deep Skin, the Body not very corrupt, and nature strong; then a Reso∣lution by an insensible Perspi∣ration may be expected.

XXXVI. But if the matter is much in quantity, and thick, lying deeper than usual, and under a thick Skin; a Suppuration is to be expected.

XXXVII. If the Tumor dimi∣nishes without application of Re∣percussives or Repulsives, it will retreat inwards.

XXXVIII. If the heat, pain, red colour, and pulsation of the Tumor ceases without manifest cause, the Tumor still remain∣ing, the approach of a Gangrene may be presaged.

XXXIX. If over-strong Dis∣cussives be applied in the beginning, where the matter is very viscous, and hard withal, the natural heat being strong and vigo∣rous, the thicker parts will be scattered and dispers'd, and leave the thicker behind, which will degenerate into a Scirrhus.

XL. The Times of an Inflam∣mation. It is necessary to know the Times of a Tumor, in re∣lation to the Cure; lest we run

our selves into an errour, whilst we apply improper, or contrary Medicaments.

XLI. Now then Inflammations, as all other Diseases, have four Times, or Crises; viz. the Be∣ginning, the Increase, the State, and the Declination.

XLII. The Beginning is, when the Part begins to swell and be distended, when as yet no Action is hurt or hindred. The Increase is, when the tumor, pain, stretching, and heat are increased.

XLIII. The State or Height is, when the tumor, distention, heat, pain, and all other Sym∣ptoms are most vehement, and in the height of their extremity. And the Declination is, when the Morbifick matter is diminished, the pain and heat, together with the other Symptoms, are become more remiss and gentle: or otherwise, when the Tumor is come to ripeness, being con∣verted into Pus, or purulent Matter.

XLIV. But as to these Times or Crises, they are sometimes shorter, sometimes longer; and sometimes a Phlegmon is sooner, and sometimes later terminated: for Galen, in Aphoris. lib. 6. Aph. 49. saith, that which is of a thinner substance, is sooner digested than that which is thick or tough, which requires a longer time; and that which is thick and viscous, will have yet a more larger time.

XLV. The Cure. The Indica∣tions of the Cure of this Disease, depend chiefly upon the Times of the Disease; for each Time or Crise has it own proper Indi∣cation.

XLVI. The beginning. The chief Indication here is taken from the Antecedent and Conjoined Causes, by removing the one, and repelling the other: now the Antecedent Cause is Obstruction, and an increase of Blood: the Con∣joined Cause is Blood it self, as we have before declared: and they ought to be removed in the very same order, in which they follow one another.

LXVI. The Obstruction is re∣moved by Aperients or Openers, and such Catharticks as have power to call back the Humors, or divert the Fluxion: of the first kind are the Spiritus Salis Armoniaci, Spirits of Blood, and Urine, and the Spiritus Ni∣tratus, which is a famous thing.

XLVIII. Of the second kind are Our Family-Pills, our Pilulae Catharticae, Tinctura Purgans, & Cathartica; an Infusion of Sena, and Rhubarb, and not inferior to any of them is the true Sal Mirabile.

XLIX. If the Body is repleat, and the Stomach foul, first Vomit once or twice, with Sal Vitrioli; or rather with the Tartarum Emeticum, or Oxymel Scilliticum; and then Purge with some of the former things: because sharp Blood, or Blood mixt with sharp Humors, cause the Fluxion.

L. Then again you may exhi∣bit the aperient Alteratives before named; which may be given in Syrupus Antifebriticus, and sometimes in Syrupus de Me∣conio; a little to cool the

Blood, and thicken the Humors.

LI. The Conjoined Cause, which is the blood in the Tumor, is resisted by application of Reper∣cussives or Repellers: and this is in a manner the only Time in which repulsion ought to be used.

LII. But that it might the more safely be done, Sennertus advises to Venesection, that the great store of the abounding Blood may be diminished, and be drawn back from the aggrieved place; and (says he) it is not to be omitted, if the strength of the Patient will permit it to be done: for that in this case, hardly can any Remedies be applied with safety, without the diminution of the Blood by this means, be first attempted.

LIII. For if Repellers be applied to drive back, the Body still con∣tinuing so full of Blood, it is much to be feared, lest the matte should not be received by the other Parts, and that thereupon it should endeavour to flow to some other particular Part, and possibly the more noble.

LIV. The Blood also is dimi∣nished by hindering its breeding, which is done, by a very sparing Diet, and eating such Food as affords not much nourishment: for which reason strong Ale and Wine is to be forborn, and Meats of a rich juice; and if the Sick (by long custom of using it) cannot forbear Wine; let it be very much diluted with Water: avoiding also all hot, sweet, fat, spicy, and astringent things.

LV. His Drink, if possible, should be Barley-water, or a middling sort of Drink, aculeated, with Spirit of Sulphur, or Sal Nitratum, or Vitriolatum; a•…•…'d his Food Watergruel, or Barley 〈◊〉〈◊〉 broth, with juice of Limons.

LVI. After Revulsion or Bleed∣ing, (which ought only to be done in the very first rise of the Distemper, and only when there is a great plenty of Blood, and a more than usual Fluxion, or rushing thereof to the Part af∣fected) Repulsion is next to be pursued, which is performed, by the application of Repercussive Medicaments.

LVII. Repercussives or Re∣pellers are of two sorts or kinds: one cold and moist, or Waterish; the other cold and dry, or Earthy; having also a thickness of parts, and an Astringent power: for which reason they act with a double force, 1. By their Cold∣ness: 2. By their Astringency.

LVIII. Cold and moist Repellers, are the more mild and gentle, and have power only to drive back the thin Humors, which are small in quantity, and seated in the superficies; and are pro∣sitably applied when heat and pain afflict the Part, and the Vessels are small and strait.

LIX. For they do not only oppose and resist the influx of the Humors, but also allay the heat; and by relaxation do something mitigate and asswage the pain.

LX. Of this kind are Housleek, Wall-peniwort, Lettice, Purslane, Endive, Suecory, Henbane, Night-shade, juice of Gourds, Water-leatils, Fleawort, Mandrake, Water-lilies, Arach, Violets; and all other things which are cold,

and endued with a Watery Humor.

LXI. However, among these there are several degrees, some having a less, some a greater efficacy: for Wall-peniwort and Fleawort repercuss less forcibly than Mandrake, Nightshade, Henbane, Housleek, Lettice, or Purslane.

LXII. Cold and dry Repellers, which are astringent, are proper in other cases; and chiefly if the Fluxion proceeds from a de∣bility of the Part, and that the pain is not very vehement.

LXIII. For they strengthen the Part receiving, that so it may refuse the Humors flowing into it, and drive back that which has already flown in: they are good also to be applied where the Vessels, thro' which the Blood flows are wide and large.

LXIV. Of this kind are, flowers and heads of Roses, leaves and unripe fruit of the Bramble and Mulberry, Vine-leaves and unripe fruit, Raison or Grape stones, red Sanders, unripe fruits of Medlars and Services, wild Pears, Quinces, leaves and berries of the Myrtle, roots of Bistort and Tormentil, Pomgranate flowers and peels, Frankincense, Acacia, pulp of Slows, unripe and ripe, fine Bole, Terra Sigillata, Dragons blood, dried blood of Man or Beast, leaves and nuts of the Cyprus-tree, Oak-leaves, unripe Galls, Acorn-cup, Ceruss, Li∣tharge, Saccharum Saturni, Alum, white Vitriol, salt of Vitriol, lapis Haematitis, pouder of dried Toads, &c.

LXV. Out of these, several Mixtures may be made, as the circumstances of the Disease shall require: for of the Plants, the raw Leaves, &c. may be ap∣plied, or Spunges may be dipt in the juice of the same; or a Cataplasm of the whole sub∣stance; or Spunges dipt in a Decoction of them in Water, or red Port-wine.

LXVI. Some apply Cloths or Spunges dipt in Frog-spawn-water, in which Myrrh is dissolved: or a Lixivium of Quicklime, boiled with Wax and Oil of Roses: or the whites of Eggs beaten with Rose-water and Vinegar, and mixt with fine Bole, or lapis Haematitis; or a Cataplasm made with Ʋnguentum Populeon mixed with Bole-armoniack; or Milk, Bread, and Litharge, with a little Terra sigillata.

LXVII. Galen dipt a Spunge in Oxycrate, and applied it; and for the same purpose, Oil-Omphacine and of Roses, Oil of Myrtles, Ointment of Roses, the Ceratum Santalinum, Vin∣egar, Red-wine, juice of Plan∣tane, the Cataplasma Rabricii, Anacolema Schroderi, and Cata∣plasma contra Cruorem, are all of them said to be of good use: the last three see in Our Pharm, Lond. lib. 5. cap. 7. sect. 7, 13, and 14.

LXVIII. A Cataplasm of Barley-meal, boiled with Vinegar and juice of Plantane, i•• commended; so also a Cataplasm of Barley-meal, pouder of Pomgranate-peels and Sumach, with Hous∣leek and Red-wine, boiled to∣together. This Cataplasm, saith

Galen, ad Glauc. lib. 2. cap. 2. is absolutely the best in such like Disaffections: for that it drives back what flows in, drys up what is already in, and fortifies the Parts adjacent.

LXiX. ℞ Housleek ℥vj. Barley-meal ℥ v. Pomgranate-rinds, Su∣mach, both in pouder, A. ℥ ij. pulp of Sloes ℥ j. boil all in red Port∣wine, or Vinegar, for a Cataplasm.

LXX. ℞ Plantan, Lettice, Purslain, Nightshade, Red-roses, A. M. j. Water and Vinegar, A. q.s. boil them, and by addition of Barley-meal make a Cataplasm.

LXXI. ℞ Juices of Housleek, Plantan and Poppy, A. ℥ iij. Vin∣egar ℥ j. Oil-omphacine ℥ j ss. Barley-flower, enough to make it into a Pultess by boiling.

LXXII. ℞ Pouder of Pomgra∣nate-peels, Sumach, red Sanders, A. ℥ j. fine Bole ℥ iv. Barley-flower ℥ vj. juice of Housleek ℥ viij. boil, and make a Cataplasm: to which add Oil-omphacine, or Oil of Myrtles q.s. mix them.

LXXIII. This is stronger. ℞ fine Bole, Sanguis Draconis, Salt of Vitriol, A. ℥ j. Saccharum Saturni, Comfrey-roots in pouder, A. ℥ ss. mix them with the white of an Egg beaten up with Rose-water, and make a Cataplasm.

LXXIV. To these things are added Interceptives, which some call Defensatives; but they are the same with Repercussives or Re∣pellers, and differ only in respect to the place to which they are applied: the former being ap∣plied to the place affected, but these unto the parts and ways by which the Humor flows unto the affected Part; that they may intercept its passage, and stop up the way against it.

LXXV. These are generally ap∣plied to Parts having little or no Flesh, and where the Vessels most appear, as in the Joints, and just above the Joints: So in a Phle∣gmon in the Hand, they are applied to the Wrist; if be∣twixt the Wrist and Elbow, to the Elbow; if in the Shoulder, to the highest part thereof; if in the Foot, above the Ancle-bone; if in the Leg, above the Knee.

LXXVI. The common Defen∣sative is thus made: ℞ Fine Bole, Sanguis Draconis, Terra sigillata, all the Sanders, A. ℥ j. Oil-omphacin and Oil of Myrtles, A. q.s. Vinegar of Roses ℥ j. mix them, and boil till the Vinegar is consumed.

LXXVII. In this Prescript, the Oils are disapproved of, because they mollify, and if they lye long on, are apt to heat: and therefore it is better to mix the said Pou∣ders only with Oxycrate; and where you would have them act more forcibly, with the white of an Egg mixt with Oxycrate; for so they will stick the faster, and make a greater constriction.

LXXVIII. As for Example: ℞ Fine Bole, Sanguis Draconis, Sumach, flowers and peels of Pom∣granates, Red-roses, Myrtle∣berries, red Sanders, all in fine Pouder, A. ℥ j. Catechu, Jesuits∣bark, Opium, Salt of Vitriol, Saccharum Saturni, all in pouder, A. ℥ss. with whites of Eggs beaten with Vinegar, A. q.s. mix, and make a Cataplasm.

LXXIX. It remains now, that we enquire when these Medicines, even Repellers of any kind, are to be used, or whether to be used at all, or no: if they are to be used, they are only to be used in the beginning of the In∣flammation, before the Blood and Humors are impacted into the Part; but there are some cases, in which they may not be used at all.

LXXX. As first, if the Humor is malign, venene, or pestilential, wherein if Nature protrudes the Morbisick-matter outwards, we ought not to drive it back again to the internal parts; lest re∣treating to the more noble parts, it should increase the Disease, cause suffocation, or smite the Vitals.

LXXXI. Secondly, nor are they to be applied at any time, when Nature acting of her own accord, produces the Phlegmon critically, thereby ending some other Dis∣ease: for Nature in this case is no ways to be hindred in her operation.

LXXXII. Thirdly, nor are they to be applied to such Parts, which Nature has ordained to receive the recrements or superfluities of the more noble Parts; as the Glandules behind the Ears, in the Throat, Armpits, and Groins: for if Repercussives should be applied to these, it may be feared that the matter may again recur to the more noble parte, from whence Nature sent it for their relief.

LXXXIII. Fourthly, nor may they to be applied to other places, which too nearly neighbour upon the more noble parts; for fear, lest the matter being driven back, should invade those noble parts, and so cause a greater mischief.

LXXXIV. Fifthly, nor are they to be applied when the Phlegmon is too profound, or over-deep; for then their virtue will not reach to the matter, nor will they prevent the farther afflux: for by the repelling Medicine the exterior parts will be con∣tracted, and the Humors driven out of them inwards, and it may be obtruded even upon the place it self affected.

LXXXV. The encrease of the Phlegmon: and this is the time in which the Physician strives to perform the Cure by insen∣sible perspiration, or discussion: in this case Repellers may be applied, yet not alone, but mixed with Digestives or Discussives, that by the heat, the Humors or Matter may be somewhat atte∣nuated, and converted into Vapors.

LXXXVI. Now how Repercus∣sives are to be mixt with Di∣gestives, we are instructed by Galen, de Comp. Med. secund. Loc. lib. 6. cap. 1. As in the begin∣ning (saith he) Repercussives are useful; so in the encrease, even to the end, those Medicines which consist of a repelling virtue, and a digestive faculty, will be re∣quisite to discuss and scatter.

LXXXVII. But (says he) A∣stringents ought to have the pre∣cedency in the beginning of the Encrease; that is, ought to exceed the Digestives; in the middle of the encrease they ought to be equal;

and towards the latter end of the encrease, the Digestives ought to exceed the Repercussives; but at the end of the Encrease, then Digestives are alone to be used.

LXXXVIII. If therefore the Phlegmon admits not of cure by the first Intention, viz. by repel∣ling the afflux of the Blood and Humors, we must attempt it by the second Intention; which is to be done when it is in its augmentation or encrease, by a mixt Remedy, as we even now hinted at Sect. 85, 86, and 87. just aforegoing.

LXXXIX. This manner of Eva∣cuation of the Morbifick-matter, per 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, id est, insensibiliter, or by insensible transpiration, is performed by such Medicaments as the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. which being considered as Externals, we construe them to be dige∣stive, discussive, and resolving Medicines.

XC. Now Discussion or Reso∣lution, is only an evacuation of the Humor by insensible Transpiration: and therefore the Matter to be discussed ought to be thin and fluxil, and the Skin thin and poroas.

XCI. For if it is clammy, viscous and thick, and the Skin thick, and its pores closed and condensed; or the matter is in a place very deep, whereby it cannot find a ready way, or new passage forth, it will not easily be cured by Resolution.

XCII. Now since all Discussives are hot in quality, they are not as we said before, to be applied in the beginning of the encrease of the Phlegmon; but rather Re∣percussives, either alone, or mixt with Discussives.

XCIII. Nor can the Humor be resolved, attenuated, and con∣verted into Vapors, but only by heat: but as hot Medicaments are of various qualities: as some to Ra∣rifie, or open the mouths of Ves∣sels; some to Incide, or cut tough Humors; some to Attract, or draw them, and others to Cau∣terize, or burn: so also some are Diaphoretick or Discussive, and differ from all the former, having in them this singular and peculiar faculty, to thin them, and convert them into Vapors.

XCIV. The Internals are called Sudorificks, or Sweating Medi∣cines; and they are given to help forward the Operation of the external Diaphoreticks or Dis∣cussives; as Spirit of Sal Ar∣moniack, of Blood, or of Harts-horn, given in a Glass of Rhe∣nish-Wine or Sack, &c.

XCV. The Externals are two∣fold: some weaker, or milder; and same stronger.

XCVI. The milder are, Camo∣mil, Melilot, roots of Althaea, of white Lilies, and of Foenu∣greek; meals of Lupins, of Oro∣bus, and of Cicers, leavened Bread, Goose-grease, old Oil, Elder-tree flowers.

XCVII. The stronger are, Dill, Origanum, Tyme, Penyroyal, Fennel, Fetherfew, Hyssop, Mint, Angelica, Calamint, Horehound, Rue, Sage, seeds of Anise, Cara∣ways, Cumin, and Fennel, Orrice-roots: Gums; Ammoniacum,

Bdellium, Galbanum, Opopanax, Sagapenum, and Tacamahacca; Bears, Hens, and Ducks grease; Oils of Bays, Nard, and Rue; Ʋnguentum Arragon, Martiatum, Oxycroceum, Cataplasma de Fer∣mento, Resolutivum Foresti, & Rondeletii, Leven, and the Dung of Beasts.

XCVIII. But the strongest of all are, Soap in small quantity mixt with Hogs-lard, Nitre, Borax, Sulphur, Lime, &c.

XCIX. Out of the aforenamed materials, others more compound may be made: as ℞ Barley-meal ℥ iv. Linseed ℥ ij. Camomil-flowers in pouder ℥ j. Vinegar q.s. boil them together, and then add Oil of Camomil ℥ j ss. Oil of Aniseeds ʒ ij. mix, and make a Cataplasm, to be applied in the augmentation.

C. Or thus: ℞ Mallows, Pel∣litory of the Wall, Plantan, A. M. j. Oxycrate q.s. boil them: then beat them in a Mortar to a mash, and add Barley-flower ℥ ij. Fenugreek-seed ℥ j ss. Oil of Ca∣momil ℥ j ss. Oil of Fennel-seed ʒ iij. mix, and make a Cata∣plasm.

CI. Where note, 1. The milder sort are to be made use of, when the matter is in a place not very deep; and when the Body it self, and part affected is more soft and pliant.

CII. 2. That the stronger sort are used where the Inflammation is greater, and the Matter deep; as also where the Body and Part are more hard and condensed. Yet these are to be used with cau∣tion, lest they should discuss and resolve the thinner parts, leaving the thicker behind; making the Tumor become hard and incurable.

CIII. But this danger may be prevented, if with such things as forcibly discuss, you likewise mix such things as moisten and mollify: and that the Discussives be not very sharp or biting, lest they thereby augment the pain, and increase the fluxion.

CIV. The height or state of the Phlegmon. When it is manifest that the Phlegmon is not yet ended, neither by repercussion nor by discussion, but is come to the height or perfection, you must then endeavour to com∣pleat the work by Digestives and Anodyns.

CV. These following are approved Digestives: as, roots of white Lilies, Marsh-mallows, Onions roasted, leaves of Marsh-mallows, Mallows, Sorrel, Wood-sorrel, Camomil-flowers, Saffron, Figs, Raisons, Currans, Dates, Ammo∣niacum, Bdellium, Galbanum, Opoponax, Sagapenum, Taca∣mahacca, Tar, Turpentine, Gum Elemi, Copayba; Ducks, Geese, Hens, and Hogs grease, Oil of Lilies, Ʋnguentum Dialthaeae, Ba∣silicon greater and lesser, Em∣plastrum Diachylon, simple, & cum Gummis, Mithridate, Venice-Treacle, Our Theriaca Chymica, Hens and Pidgeons dung.

CVI. Out of these things several Compositions may be made: as, ℞ Flowers of Melilot and Ca∣momil, Mallow-leaves, A. M. j. Red-roses, Elder-flowers, A. M j.ss. boil them in sharp wine; then add meal of Fenugreek ℥ ss. Oil∣olive q.s. to which add of Spike

ʒ iij. mix, and make a Cataplasm.

CVII. ℞ White-lily-roots, Hens-dung, A. ℥ j. flowers of Camomil and Melilot, A. M. j. Red-roses M. ij. boil all in Water q.s. then add Barley and Fenugreek meal, A. ℥ j. ss. Saffron ℥ ss. Oil-olive q.s. mix, and make a Cataplasm; adding at last Oil of Spike ʒ ij. A stronger sort of Discussive is that of Paulus Aegineta, lib. 4. cap. 18. which perfectly dis∣cusses and scatters such Apo∣stems as are not concocted. ℞ Pouder of the stone Pyrites, Gum Ammoniacum strained, A. ℥ j ss. Bean-meal ʒvj. mix them up with Turpentine, which spread upon Leather, letting it lye on till it falls off of its own accord.

CVIII. ℞ Turneps roasted in the embers ℥ iij. roots of white Lilies and Althaea, A. ℥j. Saffron in pouder ʒ j. beat all together; and then add Basilicon, Ducks and Goose grease, A.℥ ss. Honey, meals of Linseed and Beans, A. ℥jss. yolks of Eggs, q.s. mix, and make a Cataplasm. This is not inferior to that of Paulus Aegi∣neta: ℞ Gum Ammoniacum strained ℥ ij. Galbanum ℥ ss. Li∣tharge ℥ iij. Old-oil, q.s. mix, and make a Liniment.

CIX. Now the height or state of a Phlegmon is known by the Symptoms; as the tension, pain, heat, redness, and symptoma∣tick Fever, being at height, and so remaining, neither increasing nor decreasing; the Veins of the adjacent parts also conti∣nuing in the same fulness and dilatation.

CX. In this case, the Digestives and Anodyns aforementioned may be made use of, and applied; and whatever other things may contribute to that end.

CXI. The declination of the Phlegmon. This is performed by Digestives or Discussives of the stronger kind, many of which we have enumerated at Sect. 97. aforegoing: but if the matter is grosser and thicker than ordi∣nary, that Digestives alone can∣not satisfie expectation; the matter is then to be made more fit for discussion and perspira∣tion; by inwardly giving gentle Sudorificks, and outwardly ap∣plying Medicins more mollifying.

CXII. In this case, we must not only abstain from such things as over-heat and dry, (since they wast only the thinner parts of the matter;) but we must also apply the greater Emollients, which moderately heat, and moisten withal.

CXIII. As Bears, Brocks, Goose, Hens, and Hogs grease, Sheeps-suet mixt with two thirds of Oil-olive, Neatsfoot-oil, roots of Althaea and white Lilies, Mallows, Linseed, Fenugreek-seed, Ammo∣niacum, Bdellium, Galbanum, Sagapenum, Tacamahacca, and such like.

CXIV. And these things are to be applied, when the matter is thicker than ordinary; and as we elsewhere shew, when we speak of Emollients or Mol∣lifiers.

CXV. This Composition is approved. ℞ Roots of Althaea ℥ j. leaves of Mallows, Origanum, flowers of Camomil, of Melilot, A. M. j. Elder-flowers M. ss. Fenu∣greek and Linseed, Dill-seed,

A. ʒ iij. Water q.s. boil, and make a Fomentation, to be applied with a Spunge.

CXVI. Or, ℞ Pouder of the flowers of Camomil and Melilot, of Bay-berries, A. ℥ ss. pouder of Dill-seed ℥ ij. meals of Beans, Fenugreek and Linseed, A. ℥ j. Oils of Dill and Camomil, A. q.s. mix, and make a Cataplasm.

CXVII. Thus have we shewn you all the Ways and Methods used by the most learned Artists, for the cure of a Phlegmon by Reper∣cussion or Discussion; but if thereby you cannot attain the end, you must then come to Scarification, or to the opening of the Part.

CXVIII. Now Scarification is of use while there is yet hope of Discussion, or that the Tumor will be brought to a cure without Sup∣puration: But the Opening of the Part is of use when all hopes of Resolution is past, and that it is manifest, that the Cure can only be performed by the means of Suppuration.

CXIX. Concerning Scarifica∣tion, Galen, Art. Parvae, cap. 95. saith, You shall more especially evacuate, both by the useful help of Scarification, and by the help of Medicines which have a fa∣culty in them to dissolve; in case you find any thing to be contained in the intervening middle spaces.

CXX. And, de Tumor. cap. 2. It is (says he) found expedient by Physicians in the case aforesaid, not only to discuss by heating Medicines; but also sensibly to evacuate some part of the Blood it self, by scarifying the Skin.

CXXI. But before this is done, we ought to be sure that the Matter is not yet turned into Pus, or is suppurated; for if it is so, or there is any hopes of Suppura∣tion, Scarification would be wholly vain, nor can it have any place at all.

CXXII. But if the Matter is not changed into Pus, nor yet any hopes thereof; and withal, that there is no likelihood that it should be wholly discussed by Topicks, then Cupping-glasses with Scarification must be ap∣plied.

CXXIII. For this is an ef∣fectual means, for the evacuation of the Matter, of what kind soever, which sticks and lies deep; and which seems to be in a ready way to degenerate into a Scir∣rhus.

CXXIV. But it is not to be used in the beginning of a Phle∣gmon, but after the Body is suf∣ficiently evacuated, and the Tu∣mor come to the height; that there may be no farther cause to fear that a new fluxion should be excited.

CXXV. It is also to be used only to those Parts, which in other cases may be thought fit to suffer this Operation, lest a greater evil should ensue. But after all, the best way is to do the Cure by Discussion of the Matter only, (if it may be) without Scarifi∣cation, to prevent as much as possible, the very fears of evil accidents to ensue.

CXXVI. The Cure of a Phle∣gmon, degenerating into an Apostem. Now when there is no hopes that the Phlegmon will be per∣fectly cured by any of the preceding Methods; but that

by the Signs present, it will come to Suppuration; (as from the vehement heat, and grievous pain, which increases every day more and more, with manifest pulsation or beating, and an evident extension of the Part increasing) then we must en∣deavour by all ways and means, the concoction or suppuration of the matter, or its conver∣sion into Pus.

CXXVII. And it is necessary, that the Tumor be suppurated be∣fore it is opened; for otherwise you will draw forth nothing, and rather add to the Disease, than cure it: for concoction and sup∣puration of the Matter, makes a kind of separation of the cor∣rupt Humors from those which are good, whereby they are the more easily evacuated.

CXXVIII. And this gathering together of the Pus, (being changed into an equal, smooth, and whitish Matter) into some one particular place, is calledby the Greeks 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and by the Latins, Abscessus; as in the pro∣per places we have shewed.

CXXIX. This Concoction of the Humor is Natures work alone, and the Physician only is an As∣sistant to her: for the native Heat it is which digests the Humors, and brings them to the perfection of laudable matter; and this is only when the Heat is vigorous or strong, and then it is equal, smooth, and white, and not very stinking: the con∣trary it is, if the Heat is weak.

CXXX. The Physician there∣fore when he finds the Heat languid, or weak, endeavours to cherish, preferve, and increase it (in the inflamed Parts) by proper Applications, for the easy and effectually generating of the said Pus, or laudable quittor.

CXXXI. This innate Heat is conserved and augmented, 1. By stopping it from breathing forth, and that it may not be dissipated by the ambient Air. 2. By appli∣cation of Medicaments hot and moist; which having a refem∣blance to the native Heat, may cherish and augment it.

CXXXII. And these are such as we call Emplasticks, having a certain clamminess in them; which may so sill the Pores of the Skin, as to prevent the going forth, and evaporation of the native Heat.

CXXXIII. For which reason it is, that things of an abstersive quality, and things which forcibly heat, (as Cataplasms of Bean-meal, Lupins, Chiches, Fenu∣greek, &c. seeing they let the Vapors exhale and vent them∣selves outwardly, may indeed be said to dry; but little or no∣thing farther Maturation: of which kind are these following.

CXXXIV. ℞ Roots of Althaea ℥ iij. leaves of Mallows and Bearsbreech, A. M. j. boil them in Water till they are soft; then add Turpentine ℥ ij. Hogs-lard q.s. mix, and apply them.

CXXXV. Or thus: ℞ Roots of Althaea and white Lilys, A. ℥ ij. leaves of Mallows and herb Mer∣cury, A. M. j. fat Figs cut in bits ℥ iij. boil all together to soft∣ness; then add Balsam Capivi, Gum Elemi, Turpentine, A. ℥ j. Wheat-meal ℥ ij. Linseed ℥j. But∣ter,

q.s. mix, and make a Cataplasm.

CXXXVI. Or, ℞ Althaea-roots, Onions, White-lilys, A. ℥ ij. Wheat-meal, Lin-seed, A.℥ j. Tur∣pentine ℥ss. Saffron ℈j. Hens-fat, Oil of Camomil, A. q.s. mix.

CXXXVII. Or, ℞ Onions roasted in the embers ℥ iij. roots of Althaea, White-lilys, A. ℥ j. Leaven ℥ ss. Saffron ℈ j. beat all together; then add Hens-dung, Basilicon, Ducks and Goose grease, A. ℥ ss. Honey, yolks of Eggs, meal of Lin-seed, A. ℥ j ss. mix, and make a Cataplasm.

CXXXVIII. Now here is to be noted, that if the Tumor seem cold, the hotter Simples are to be chosen, according to the tem∣perature of the Part: if it is hot, Maturatives only of the first degree, avoiding those of the second, which are only to be used where the Heat is less.

CXXXIX. And to accomplish this Maturation, Accidents are first to be removed: as 1. Pain; and this is removed by Anodyns only: Narcoticks or Stupefactives have no room here, lest they extinguish the natural heat of the Part, which is the principal efficient Cause of Coction, and thicken the Matter, making it the more rebellious. A Cata∣plasm of White-bread and Milk, with a little Saffron in it, is good here.

CXL. 2. Tension, or vehement stretching forth; and this is done by Relaxers which are temperate∣ly hot, of subtil parts, and not much drying: as Archangel, white Horehound, Mullein, Dill, Ca∣momil, Mercury, Melilot, Marsh∣mallows, Fenugreek, Turneps, meals of Barley, Beans, and Vetches.

CXLI. ℞ Camomil-flowers in pouder ℥ss. flower of Barley, Beans, and Vetches, A. ℥ ij. leaves and flowers of Althaea beaten M. j. Mutton-broth q.s. boil to the consistency of a Pultise, and add Oil of Camomil and Rape-seed, A. ℥ j.

CXLII. 3. Hardness. And here Emollients, and all manner of Salts and Oils are of use: as Mallows of all sorts, herb Mer∣cury, Coltsfoot, Borrage, Bu∣gloss, Spinage, Quince-seed, Cream, White-lilys, Figgs, Raisons, Marrow of beasts, Oil-olive, Oil of Almonds, Ammo∣niacum, Bdellium, &c.

CXLIII. ℞ Linseed-meal ℥ iv. roots of Althaea and White-lilys, boiled in Water and bruised, A.℥ij. herb Mercury, Mallow-leaves, A. M. j. Milk q.s. boil to the con∣sistency of a Cataplasm; to which add Ammoniacum strained, pulp of Figs and Raisons, A. ℥ j. mix them.

CXLIV. 4. Extream Heat. Here things moderately cooling must be used, (but not extream coolers, lest you induce a Gangrene) as Barley meal or flower, En∣dive, Succory, Navelwort, pulp of Melons, Lettice, Water-lilys, Plantan, Garden-nightshade: of these, or some of them, a Cataplasm may be made with Barley-flower and Fair-water; boiling them to a consistency, and adding to it a little Ʋnguen∣tum Populeon, or Rosatum, &c.

CXLV. Now come we to Sup∣puratives, which the Greeks call

〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and the Latins, Sup∣purativa; which are of two kinds, 1. Mild and gentle, as Mans grease, (which is Anodyn) Grease of Bears, Ducks, Geese, Hens; Oils of Olive, Almonds, and Rape-seed, Sweet-butter, Mal∣lows, Althaea, Violets, Lilly-roots, Figs, Linseed, Fenugreek∣seed, Wheat-flower, Saffron.

CXLVI. Example, of a Sup∣purative Cataplasm. ℞ Milk a pint, in which boil Mallow-leaves and herb Mercury, A. M. j. cut and bruised; Figs, Lily-roots, A. ℥ij. (both boiled in Water till they are soft) Wheat-flower ℥ iv. boil to the consistency of a Pul∣tise; to which add Saffron in pouder ʒ j. Linseed-oil, Oil of Sweet-almonds A. ℥ ij. with which mix Oil of Anise, or Fennel-seed ʒ ij. and make a Cata∣plasm.

CXLVII. If the Tumor is very hot, the Oil of Anise or Fennel-seed is to be left out; upon an exigence this has been found good, ℞ Milk ℥ viij. Wheat-flower ℥ iij. yolks of three Eggs, Oil-olive ℥ j ss. mix, and boil to a consistency. Also an Emplaster made of Oil, Wax, and a little Turpentine, is of good use; so also Diachylon simplex, if the Tumor is hot.

CXLVIII. 2. The stronger Sup∣puratives, which are, Ammonia∣cum, Balsam Capivi, Gum Elemi, Galbanum, Sagapenum, Tacama∣hacca, Turpentine, Tar, Ship∣pitch, Burgundy-pitch, Leven, Onions, Garlick, and Leeks roasted in the embers, Hens and Pidgeons dung, Badgers and Dogs grease; Oils of Camomil, Dill, Anise, and Fennel seeds; Saffron, &c. Diachylon cum Gummis.

CXLIX. An Example, framed out of these things, (which are chiefly to be applied to venene, or pestilential Fevers.) ℞ Roots of Althaea and white Lilies, Onions boiled and bruised, A. ℥ iij. Le∣ven ℥ ij. Linseed-meal ℥ j ss. Saffron ʒ j. Ammoniacum and Gal∣banum strained, pulp of Figs, A. ℥ j. Oil of Aniseeds ʒ iij. mixed with Oil-olive q.s. mix, and make a Pultiss of a good consistency. And to this add those others, described in Sect. 134, 135, 136, 137. aforegoing, and Sect. 190, 191, 192, 193. following.

CL. These things are to be ap∣plied till the Apostem is perfectly ripe; which then, if the Skin is thin and tender, breaks of its self: but if thick and tough, it is to be opened by Instrument; as we have taught at large, Lib. 1. Cap. 18. aforegoing.

CLI. Now before we come to this Manual-operation, we must be sure that the Apostem is perfectly suppurated; and this we shall know by its proper Signs, which are as follows.

CLII. 1. The Swelling contracts it self a little, and seems less than it was in the State: for whilst Nature with the help of Medi∣cines concocts the Matter, it is somewhat rarified, and some part of it is discust thro' the Pores of the Skin.

CLIII. 2. The Tumor does as it were draw it to a point, a pro∣minence: for when Nature over∣comes the Matter, it draws it together, and also to the Skin.

CLIV. 3. The Cuticula becomes a little shriveled, which is a good Sign; for it signifies that the preternatural Heat has left it.

CLV. 4. The vehement Heat also vanishes: for the Phlegmon being suppurated, the unnatural Heat goes away, leaving behind in the Part, only the natural Heat.

CLVI. 5. The Hardness and Tension will be much abated: for the Suppuration being pro∣duced by Discussion, many Vapors will be exhaled, which before stretched out the Skin, and made it hard.

CLVII. 6. The Colour also of the Part is changed, and from red, it is become white; more especially in the more elevated or pointed place.

CLVIII. 7. By pressing of the Matter, or place of the Tumor, you will find a fluctuation; which will be perceived by pressing it with two Fingers, a little distance asunder, one Finger at a time; by which pressing with one Fin∣ger, it will feel to fluctuate under the other, with a certain softness of the Part: but in this case we must be wary, for in some places a fluctuation will be felt, whilst they are sound, as in the Knee, or other great Joints: whereas also on the contrary, if the Matter is thick, and lyes deep, tho' it be ripe, yet no fluctuation will be felt.

CLIX. 8. Lastly, the Patient feels much ease in the Part, com∣pared to what it was in its height; because many of the sharp Vapors are resolved, and the concocted Matter is contracted into less room.

CLX. Having now found that the Apostem is fit to be opened, we are next to consider, how it is to be opened, and with what Instruments: nor is it at all to be delayed; for if the Pus is too long kept in, it destroys the temper of the Part, cor∣rupts those which are adjacent to it; and so either makes an intricate and winding Sinus, or else degenerates into a Fi∣stula; which principally hap∣pens when the matter is sharp and malign, or when the In∣flammation is in the Joints or Arms, &c.

CLXI. As for the waiting for Natures breaking of it, we are allowed, so to do only when the Tumor is not exceeding great, and is more especially in the outward most part of the Flesh and Skin, and a Skin that is very thick; otherwise it is not safe to expect a spontaneous or voluntary opening.

CLXII. The way and manner of opening the Apostem, or the Instru∣ments by which it is done: 1. With the Lancet or Incision-knife: and they are of use where the work is desired to be speedily done; also in small Tumors, which will be suddenly whole; and lastly, if the Apo∣stem is in the Face, or any other visible place, to avoid the deformity of a Scar.

CXLIII. 2. With a Caustick, which is commonly the vulgar Lapis Infernalis, or the silver one. The former is made either with the strongest Soap-lees, alone,

boiled to a soft Stone; which is best in Tumors in the convex Parts: or with the same Lees and unslaked Lime, boiled to the form of a soft Ointment: and this is most convenient in Parts concave or hollow.

CLXIV. The Caustick or Pyro∣tical Medicaments are of use in five cases: 1. When the Tumor ought to be kept long open: as in all contagious Apostems of the Plague, Pox, Kings-evil, &c. for where the Caustick is ap∣plied, there is always loss of substance, and many times the Orifice is roundish or Oval, which of all other figures, are longest in curing.

CLXV. 2. They are many times applied where the Patient is fear∣ful: tho' in truth the Incision-knife it self is much less pain∣ful, and much sooner done.

CLXVI. 3. When Apostems are large; for with them we make as large an Orifice as we please, and as large as the magnitude of the Apostem requires; by which means we shall not need to Tent, or enlarge it.

CLXVII. 4. They are also of greatest Service, where a Flux of Blood may be feared: for by their burning the Part, the Flux is prevented.

CLXVIII. 5. When the Apostem is deep, as in the Back, and other like places; for thereby the Matter will have a readier way for Evacuation.

CLXIX. To the two former ways at Sect. 162 and 163 above, Authors add a third way, which is the Actual Cautery, or Red-hot-iron: but this is not of any ordinary use, except to stop a Flux of Blood, (which we do with easier Remedies) dry a Carious Bone, or correct a Can∣cerous Part, being first cut off.

CLXX. As to the very act of opening the Tumor, these five things are to be considered; 1. That it be done where the Skin is thinnest, for so less pain will be caused; and in the most depending part, that the Matter may more easily flow out.

CLXXI. 2. That the nature of the Part be considered; so as to avoid Arteries and Veins, for fear of an Hemorrhage: as also Nerves, Tendons, and Mem∣branes, because of their exqui∣site sense.

CLXXII. 3. The largeness of the Incision, must be in proportion to the Part and Tumor: for if it is too little, then the Matter (if it is thick and grumous) will not easily flow out without pressing; which is apt to pro∣duce a Callosity, and make the Sinus a Fistula.

CLXXIII. 4. That if the Skin is only to be divided, then the Apertion is to be made streight a but if a Muscle also must be cut, then the Incision must be made according to the ductus of the Fibres.

CLXXIV. 5. That you consider the quantity of the Matter, which is to be evacuated at one time: for in great Apostems which are near the Joints, Back, Abdomen, or any principal Part, the Mat∣ter is to be taken away gra∣dually; because therewith many Spirits are spent and lost, whence comes Fainting, and

sometimes Swooning, and Death it self.

CLXXV. As for the Accidents which may happen upon opening, they are three: 1. Fainting; which is helpt by giving a spoonful or two our Aqua Be∣zoartica, or Spiritus Cordialis, inwardly, either alone, or mixt with a glass of Alicant, or other styptick Wine; or a little sup of choise Cinnamon-water.

CLXXVI. 2. Pain; if it is much, let the Part be embro∣cated with this: ℞ Oleum Re∣frigerans ℥ ij. Red-wine ℥ j. mix them together by shaking: but be careful that it touches not the edges of the Apertion, if it was made by Incision, lest it causes spungy or proud Flesh to grow.

CLXXVII. 3. An Hemorrhage, which is to be stopt by applying a Pouder: as, ℞ Aloes, Frank∣incense, Olibanum, fine Bole, A. ℥ j. Ashes of an old Hat ℥ ss. Sac∣charum Saturni, Salt extracted out of the Caput Mort. of Vi∣triol, A. ʒ. iij. mix, and make a Pouder: which lay upon Dos∣sels or Pledgets dipt in whites of Eggs, &c. and apply.

CLXXVIII. The manner of Applying the Potential Cautery. You must be sure before-hand, that the Tumor is perfectly maturated; which that you may not fail of, let some one of the following Compositions be applied.

CLXXIX. ℞ Althaea-roots, White-lily-roots, both bruised soft; Garlick, Onions roasted under the embers, Figs boiled soft, meal of Fenuereek, Leven, A. ℥ j. beat all into a pulp; to which add, Oil of Aniseeds ʒiij. ss. Hogs∣grease, q.s. mix them.

CLXXX. ℞ Roots of Althaea, Onions, Garlick, Leeks, all boiled soft, A. ℥ ij. meal of Fenugreek ℥ viij. Oil of Spike ʒ vj. Hogs∣lard q.s. mix them, and apply.

CLXXXI. ℞ Sharp-leven, Doves-dung, roasted Onions and Garlick, A. ℥j. Black-soap, Hogs∣lard, A. q.s. mix, and make a Cataplasm: this is much stronger than the former.

CLXXXII. Emplastrum Dia∣chylon mixed with Mustard-seed, pulp of Figs, and Salt, performs the same thing with the former.

CLXXXIII. This done, so that you are sure it is come to its persect ripeness, you must then come to the application of the Caustick Medicament, thus: Take a Cloth spread over with Ʋnguen∣tum Diacylon, or some other sticking Emplaster, in the midst whereof cut a small hole; lay this upon the Apostem close to the Skin, that it may stick: let the hole be somewhat nar∣rower and less, than you intend the Cautery, and upon every place where you would have it opened.

CLXXXIV. This done, take one of the Causticks mentioned in Sect. 163 aforegoing: or the Lapis Infernalis, in Lib. 1. cap. 64. sect. 7. aforegoing, which being some∣thing moistned with Spittle, apply it upon the Skin, at the hole of the Emplaster; and then lay on another Emplaster over that, upon the former Plaster.

CLXXXV. After three or four hours, remove the Caustick with

the Emplaster, and you will find the Part appear black, soft, and without any sense of feeling: this Eschar is made to fall off, by well anointing it either with Fresh-butter, Hogs-lard, Palm-oil, or some proper Digestive, which is better: but the only, and more excellent way is, to open it with the Incision-knife, for that the Patient will feel nothing of the Operation; and this is the safer and better way.

CLXXXVI. If the hole is not wide enough, it may be very easily enlarged, by putting into it a piece of prepared Spunge, or Puff-ball, an Elder-pith, or dry Gentian-root, or dry Rape-root; for that these things being filled full with humidity, will be then dilated, and so thereby enlarge and make wider the hole.

CLXXXVII. The Spunge is thus prepared. Take Spunge, and soak it well in the white of an Egg well beaten together, then squeeze it close together in a Press, and dry it leisurely in the shade: a bit, or small Tent of this, when dried, is to be taken and put into the hole of the Apostem.

CLXXXVIII. The Apostem being opened (by which of the ways it matters not) the Pus or purulent Matter is to be evacuated; but yet not wholly, or all at once, but by degrees; some of it at one time, and some of it at another; more especially if the Patient is weak.

CLXXXIX. For if it is great, and has much Pus within it, the evacuating of it altogether would not only be a great loss of Spirits, but might also be apt to cause Faintiness and Swooning; as we have before declared, at Sect. 184. afore∣going.

CXC. When the Pus is evacua∣ted, if there is pain, or any reliques of the Matter not suppurated shall appear in the circumference, or that the Pus is not well and per∣fectly suppurated; then the pain is to be eased with some Ano∣dyn; and some digestive Medi∣cament is to be applied, for the more speedy concocting of the remaining unripened Matter.

CXCI. As, Oil of Almonds mixt with yolks of Eggs; which both ease the pain, and digests the remaining Humor. Or this: ℞ Strasburgh-Turpentine ℥ j. yolk of one large Egg, grind them well together in a Mortar; then add Frankincense, Olibanum, Mastich in pouder, A.ʒi. Oil of Olives ℥ ss. Oil of Aniseeds ℈j. mix them well together: Diachylon cum Gummis is also very profitable in this case.

CXCII. The manner of Dressing, after opening. 1. If it was done by Incision, you must put into the Orifice, if it be small, a little Tent; or if it is large, Dossels with Pledgets, fortified with some Astringent pouder; as fine Bole, Frankincense and Flower, mixt with glair of Eggs; and then over all a Plaster of Diachylon, and so to bind it up, letting it to remain so for the space of 24 hours.

CXCIII. 2. If it was opened by Cautery or Caustick, as we have shewed from Sect. 194, to 198. you may apply your Dossels fortified

with Basilicon; over which you are to lay an Emplaster, (which is thus to be drest once or twice a day, as you see need requires, till you see the Eschar falls) and bind it up as aforesaid, but not with too hard a bandage.

CXCIV. If in the mean season spungy or proud flesh should grow up, it is to be removed with Ca∣theretick Medicaments; as red Precipitate, either alone, or sometimes mixed with Basilicon, in gentle Bodies; or mixt with a third part of burnt Alum, in more hardy Bodies.

CXCV. ℞ Ung. Basilicon ℥j. red Precipitate washed ʒ j. mix them well together, Again: ℞ Red Precipitate ʒ ij. burnt Alum ʒ j. mix, and grind them upon a Porphyry together; to which add Ung. Basilicon ℥ ij. mix them well into a body.

CXCVI. The next thing is, throughly to cleanse the Apostem, (without which, Flesh can nei∣ther breed, nor Agglutination be made) which you may do with this: ℞ Strasburgh-Turpentine, Gum Elemi, Balsam Copayba, A. ℥ ss. Mel Rosarum ℥ j. yolk of one Egg; mix, and give them a walm over the fire; then add Saffron in pouder ʒ j. and a little Barley-flower.

CXCVII. But if there is need of better Cleansing, ℞ Honey, Barley-flower, A. ℥ j. juice of Smallage ℥ ss. Saffron in pouder ʒ ss. mix them: and if the Cleansing ought to be more forcible, Ʋn∣guentum Aegyptiacum q.s. may be added.

CXCVIII. This following is good: ℞ Juice of the lesser Centory, of Smallage, A. ℥j. Honey ℥ iij. boil them together; then add flower of Barley and Orobus, A. ℥ j. take them off the fire, and mix with them Turpentine, Gum Elemi, A. ℥ ss. pouder of Flo∣rentine-Orrice ʒ iij. You may also use those other things which we have prescribed in the Cha∣pters of the Cure of an Apostem and Sinus, Cap. 3. and 4. afore∣going.

CXCIX. The Apostem being thus throughly cleansed, the next things to be applied are Sarcoticks or Incarnatives, viz. Flesh-breeders, that the Ulcer or Sinus may be filled with flesh: a Catalogue of which you may see in Our Doron Medicum, lib. 1. cap. 10. sect. 18. and in some of the following Chapters of this Book.

CC. And out of those singular things, you may make these fol∣lowing Compounds: ℞ Frank∣incense, Mastich, Olibanum, Rosin, A. ℥ j. Honey of Roses, Oil-olive, A. q.s. mix them. Or thus: ℞ Bugle, Comfrey, Sanicle, A. M.j. bruise them, and boil in Wine: squeeze forth the juice, and add to it Frankincense, Mastich, and Olibanum, A. ℥ ij. Honey, Tur∣pentine, A. q.s. boil to the con∣sumption of the Juice, and make an Ointment.

CCI. This is inferior to none: ℞ Fine Aloes, Bdellium, Myrrh, Sarcocol, Honey, A. ℥ j. Wine q.s. mix, and boil them to a due thickness. For a Wash none ex∣ceeds this: ℞ Fair Well-water lbij. Saccharum Saturni, Salt of Vitriol, or pure white Vitriol, Roch-alum, A. ℥ ss. or ʒ vj.

Spirit of Wine ℥ iv. mix, and dissolve: wash with it twice or thrice a day; it performs all the intentions of Cure, and heals to a miracle.

CCII. Lastly, the Ʋlcer being filled with flesh, we must then come to the use of Epuloticks or Cica∣trizers; a Catalogue of which you may see in our Doron Medi∣cum, lib. 1. cap. 10. sect. 20. to which you are referred: and of this kind are Emplastrum Al∣bum, or Diapalma, now called Diachalciteos, Emplastrum de Minio, without Soap; Ceratum Nigrum, Oxylaeum, and Refrige∣rans; with other things of like kind.

CCIII. Hitherto of a true and pure Phlegmon; it remains that we speak something of the bastard or mixt Phlegmon: which, as we told you at Sect. 6. afore∣going, was principally three∣fold, viz. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Phlegmone Erysipela∣toodes; where Choler is mixt with the Blood: 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Phlegmone Oidematoodes; where Phlegm is mixt with the Blood: and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Phlegmone Scirrhoodes, where Melancholy is mixt with the Blood.

CCIV. The Cure of these differs not much from that of the simple or pure Phlegmon; save, that in an Erysipelatoodes, things more cooling and moistning, are to be mixed; in an Oedematoodes, things more heating; and in a Schirroodes, things more warm∣ing and emollient.

CCV. If the Phlegmon, thro' carelesnss, or unskilful application, should become a Gangrene, you must pursue the Cure thereof, as we teach in the Chapter of Gangrene following, Chap. 11. mean season, if you fear any such thing, foment or bathe the Part affected with Our Powers of Amber, or with Spirit of Wine, mixed with Spirit of Sal Armoniack, and apply things healing and drawing.

CCVI. An Example of a Phle∣gmon, out of Hildanus, Cent. 3. Obs. 100. A young Man (says he) had a Phlegmon in his Foot, and being called to him, he found the Foot swelled, and full of pain, which reached to his Hips; the Patient was in a continual Burning-fever, restless, delirious, and fainting away sometimes.

CCVII. He prescribed him a spare Diet, and purged him with this Potion: ℞ Electuary of the juice of Roses, Diaturbith with Rhubarb ʒ ss. Syrup of Roses solutive ℥ j. Decoction of Agri∣mony, Speedwell, roots of the sharp-pointed Dock, inner bark of the black Alder-root, and Ani∣seed, q.s. mix, and make a Draught; which wrought gently: the evening of the same day, two hours after Supper, he gave him Laudanum gr. vj. which caused him to rest well that night.

CCVIII. The next day he took away ten ounces of Blood from the Arm of the side affected, being plethorick and strong: upon which his Fever, Pain, and Inflam∣mation much abated: then he anointed his Hip, Knee, and all

thereabouts, which were free from the Inflammation with this Liniment. ℞ Oil of Roses ℥ ij. Oil of Earth-worms, Mans-fat, A. ʒ ij. mix them. And because Galen says, fat things are not to be applied to the Part affected, he applied this: ℞ Seeds of Quinces, Fenugreek, Althaea, A. ʒ ij. pouder of Roses ʒ ss. Water q.s. boil to the rhickness of a Cataplasm: afterwards add the yolk of an Egg with the white. This was applied, and renewed as oft••as need required.

CCIX. Opon this, the pain was •…•…sed, and the place of ma∣turation appeared; to which he applied Emplastrum Basilicon and the prescribed Emplaster, all over the Foot: the sole, because it was very callous, he fo∣mented well with hot Milk, boiled with Fenugreek-seeds, Mallows, and Violet-leaves, and then pared away with a Razor the thick Skin: thus in a short time the Apostem broke in the sole of his Foot, after which he soon recovered. We have been the larger upon this Cure of a Phlegmon, because, being well understood, it seems to lay the groundwork or foundation of the Cure of all other Tumors, of what kind soever.

CHAP. VI. Of a BƲBO.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Bubo, Inflamma∣tio vel Tumor Glandularum; and in English, a Bubo, or Swel∣ling in the Armpits or Groins.

II. It is a Tumor and Inflam∣mation of the Glandules, chiefly the Kernels of the Armpits, or Groins; painful, hard, and red.

III. But Galen ad Glauc. lib. 2. cap. 1. defines it to be, an Inflammation in the Glandules of the Groins. For they being by Nature ordained as the Sinks of the superfluous Humors from the principal parts, if those Humors, and with them the Blood shall happen to be thrust forth together, and as it were by heaps, into them, an In∣flammation is forthwith excited: and this happens most-an-end in the Groins, and sometimes in the Armpits: if it be behind the Ears, it is called a Parotis.

IV. A Bubo is either Critical, or Symptomatical; the Critical is safe and healthful, and they are such as follow the declining of any Sickness, as Fevers, &c. The Symptomatical are either Ve∣nereal or Pestilential, and these shew from whence they pro∣ceed.

V. If a Bubo is little, and not painful, but easily brought to ma∣turation, it is called Phyma; where it is mixt with Choler, it is called Phygethlon; if it be in the Armpits, it is named Panus;

behind the Ears, Parotis; if con∣tracted from impure Coition, it is called Venereal.

VI. The Signs in general are, pain, redness, heat, pulsation, ten∣sion, and sometimes a Fever.

VII. That is to say, that in the Groins or Armholes there is a tumor or swelling, with redness of colour, hardness, resisting the touch, intense pain, accompanied for the most part with a gentle Fever.

VIII. And this is manifest, if the Bubo happens to be by Crisis; for then a Fever, or some other disease went before; which upon the appearing of the Bubo is abated, and the Signs of a good and hopeful Crisis preceded; the which if they be absent, the Bubo then is to be accounted for Symptomatical.

IX. And then if no signs appear of the Plague or Pestilence, or of Morbus Gallicus, it is a simple Bubo, and not malign and con∣tagious: but if the signs of the Plague are present, then it is malignant and contagious.

X. And if the Patient is in∣fected with the French Disease, it is then to be accounted Ma∣lign and Venereal, and to pro∣ceed from a Venereal Defile∣ment.

XI. The Causes. All Bubo's whatsoever have their Original from a preternatural protrusion of Blood (conjoined always with some vitious and corrupt Humor) into the Glandules of the Groins and Armholes, excited from the Fer∣ment of the said evil Humor; whereby Nature is stirred up to such a kind of excretion, or rather expulsion.

XII. But from hence the strength of the principal parts is to be observed; for that they are able to expel and thrust forth what∣soever is offensive and hurtful to them, unto these ignoble parts, and other the like Emun∣ctories.

XIII. Fabricius ab Aquapen∣dente will have some Bubo's to be from Blood only, excited at the instant time of the Crisis: but this seems not to me to be true, for certainly some evil Humor is always conjoined with the Blood. Yet this we say, that a Bubo does sometimes follow upon another Disease, and is excited by the Crisis, whether perfect or imperfect; and some∣times without any other Dis∣ease preceding it.

XIV. Yet in this last case, where no other Disease precedes it, (whereby it cannot properly be said to arise from a Crisis,) it is Na∣tures work to make an expul∣sion of the vitious Humors, and is a healthful protrusion.

XV. The Prognosticks. A Bubo (if not malign) being in the extream parts, soon suppurates, and is not dangerous; if it ripens slowly, it may turn to a Fistula.

XVI. A Malign Bubo, is for the most part a sign of sudden Death, though all outward signs may appear well.

XVII. A Venereal is only of difficult cure, especially if the folly of the Physician has been to use bleeding and repelling Medicines; whereby Nature has been diver∣ted from her work, and the ma∣lignity turned inward, which should have come outward.

XVIII. Bubo's arising under the Armholes come soonest to suppura∣tion, because they proceed from hotter Blood; as being nearer the greater Vessels, and the Heart, the Fountain of life and heat; which in this case for Suppura∣tion is alogether necessary.

XIX. Those which come in the Groins, are excited by a Blood less hot; and being likewise in a place more remote from the Heart, and but moderately hot, they are longer before they come to maturation: but those coming behind the Ears, proceed from a colder kind of matter; and as the place is also colder, so their suppuration is the slowest of all.

XX. The Cure. In a Bubo, (not Venereal or Pestilent) the Cure is to concede with Natures Operations; for the Matter is by no means to be driven back in∣to the internal parts, if there is any hope of its coming to ripeness, or may possibly be discussed.

XXI. If the Bubo is by Crisis, and that perfect, the Sick will the presently be freed from the danger of his Disease; and if there be signs of a good Crisis, nothing is to be disturbed, but the matter must be left to Na∣ture; and means must be used either to discuss, if possible; or speedily to bring it to sup∣puration.

XXII. In the case of Discus∣sion, excellent is the Balsamum Sulphuris to anoint with, applying over it Emplastrum Diasulphuris, or Emplastrum Hystericum, &c. See Our Pharmacopoeia's, &c.

XXIII. But if it will not be dissolved, then apply this Oint∣ment: ℞ Yolks of Eggs N^o ii. Balsam Capivii ℥i. Oil of Camomil ℥ss. Saffron ʒii. White-bread q.s. mix, and apply it, repeating it often: and being ripe, it may be opened by touching it with Butter of Antimony, &c.

XXIV. In these cases, Sudo∣rificks are good to be given in∣wardly, because they drive out∣wards: but Bleeding is extremely ill, so also Repercussives or Re∣pellers; because they drive back that into the inward parts, which Nature did drive or thrust forth for her relief.

XXV. Scarification with Cup∣ping, is not to be used in malignant Tumors; nor are Leeches to be applied, unless they are very much inflamed.

XXVI. If the Pain is violent, it ought to be eased with Anodyns; as this Liniment: ℞ Balsam Capivii, Balsam de Chili, A. ℥ss. Oil of Ben, Sheeps-suet, A. ℥jss. Bean-meal, q.s. mix them.

XXVII. Or you may apply this Cataplasm: ℞ Mallow-leaves M. i. Meal of Althea-roots and Fenugreek-seeds, A. ℥ii. Barley-meal ℥ i. Ducks-grease, Oil of Dill, A. ℥ss. boil all in Milk, to the consisteney of a Cataplasm.

XXVIII. But if the Bubo is Critical, and the Crisis is imper∣fect, the Humor is farther to be attracted into the part affected, by the application of Cupping-glasses, or by Medicines made of Leven, Black-soap, old Hogs-grease, Pine-tree-rosin, Dia∣chylon cum Gummis, and the like.

XXIX. If the Bubo is not Cri∣tical, and that no other Disease preceded it, yet is not Natures motion to be disturbed in the least: but if with the Blood, many vitious Humors be heaped up also, gentle purging may then be necessary; but yet so gentle, as not to molest Nature in her Operations.

XXX. In this case the Sal Mirabile is most to be commended, because it takes away the great abundance of evil Humors, without disturbance, or lessning of the Pro∣tuberance, by that act of Purging: and it may be given from ʒv. to ʒvi. or ℥i. at a time, dis∣solved in Broth or Posset-drink.

XXXI. The other part of the Cure is to be performed like as in other Inflammations, of which we have treated at large in the afore∣going Chapter: yet this is to be observed, that because the Glan∣dules (especially of the Groin) are colder than other places, the Discussives or Digestives ap∣plied, are to be of the strongest sort.

XXXII. Some advise to a Ca∣taplasm made of flower of Barley and Lupins, mixt with Honey.

XXXIII. Or this: ℞ Roots of Althea, of white Lillies, of wild Cucumers, A. ℥i. leaves of Par∣sley, Smallage and Pellitory of the Wall, A. ℥i. boil in Wine q.s. to softness, and beat them to a pulp, which pass through a Sieve: to which add meal of Lupins ℥ii. Oatmeal ℥i. pouder of Orrice root ℥ss. Oil of Camomil q.s. mix, and make a Cataplasm.

XXXIV. But Ceratum de Ammoniaco Forresti, or Ceratum de Galbano crocatum, or Em∣plast. Diasulphuris, are inferior to no other thing; which see in Our Pharm. Londinensis.

XXXV. If it yields not to Dis∣cussives, you must suppurate with very strong Attractives, such are roots of Aron, Birthwort, Brio∣ny, Cresses, Cantharides, Castor, Dittany, Ranunculus, Pellitory of Spain, Nettles, Galbanum, Euphorbium, Succinum, Sulphur, Leaven, Quick-lime, black Soap, Garlick, Figs, Onions, Mustard, Ox-gall, Pidgeons dung, Goats dung, Niter, Diachylon, Oxycro∣ceum, Mithridate, Venice Trea∣cle.

XXXVI. In this case, the Cataplasma Laxativa Schroderi is good, so also that Pro Adultis, as also the Dropax Confortans.

XXXVII. Or this: Take roots of Pellitory of Spain, Mustard, A. ℥ss. Salt ʒvi. Treacle of Androma∣chus ℥i. Onions, Pidgeons dung, A. ℥ii. Figs N^o xii. Leaven ℥jss. dissolved in Vinegar, enough to make it into a Cataplasm.

XXXVIII. Some take a Chick, Pidgeon, or Frog, divide it in the midst, and apply it warm to the part; others apply the Anus of a Hen or Pidgeon, the feathers being pulled off: but it is best forthwith in the beginning to apply a Vesicatory thereto, the next morning to open the Bli∣ster, and then to apply the Attractives.

XXXIX. The Bubo being sup∣purated, let it be forthwith opened, and that rather by Incision, than by Cautery: keep it open till the Tumor is wholly dissolved, and the Ulcer cleansed; then

heal it after the manner of other Ulcers.

XL. In a Pestilential Bubo, neither Bleeding nor Purging is to be used: Sudorificks and Refri∣geratives are good; outwardly, you must apply strong Attra∣ctives in the beginning.

XLI. The same is to be observed in a Venereal Bubo, (so long as there is any hope of curing it by external Remedies) lest the malign matter which Na∣ture has thrust forth, should re∣gurgitate, and so cause the Pox.

XLII. The Suppuration is to be endeavoured by all means; and then forthwith, although not perfectly ripe, to be opened: if it be tough, Cupping-glasses should be applied.

XLIII. If the whole mass of Blood is infected, you must manage the Cure then, as in the Cure of the Pox. In this case, our Quint∣essence of Guajacum and Sassa∣fras, drunk in good Beer or fra∣grant Wine, is excellent.

CHAP. VII. Of a CONTƲSION.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Effusio, Suffu∣sio, Sugillatio, Contusio; and in English, a Bruise, or Bruising.

II. It is the pouring forth of Blood or Humors, into the next adjacent spaces, thro' the Veins or Arteries; either by 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, anastomosis; or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, diapedesis; or by 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, diai∣resis, the skin remaining whole; which for the most part comes to pass, either by the vehement pressure of some heavy weight, falls, blows, stoning, or the like. Gal. de Fract. lib. 2. com. 16.

III. The Kinds. Galen. lib. de Tumor. cap. 10. & de Simp. Med. Fac. lib. 10. cap. 9. makes two kinds of Contusions; 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ecchymoma; which is the general name; and is when the Contusion is of a middle colour between red and black, to wit, of a livid or leaden co∣lour; and this the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Pelidna, Lividness.

IV. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Melasma, which is Blackness; and this is most familiar unto old persons, as oft as their Veins are bruised; as the other, to wit, Pelidna is familiar to Children, and such as are young.

V. But Paulus Aegineta, lib. 4. cap. 30. makes three kinds, ac∣cording the diversity of the parts affected; of which, the two first have relation to the Eyes, the last to the Nails of Fingers or Toes: these indeed are particular kinds as they have relation to those particular parts, but can by no means be accounted of, as in a general relation to the whole Body.

VI. The first is that which we

call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, hypopia; but by Hippocrates 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, hyp∣ophthalmia, i. e. subocularia, blewness under the Eyes. This second is 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, hypospha∣gma, called by some suggillatio, an Effusion of Blood into the Adnata, or Cornea-Tunicle of the Eye. The third 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, hyponychos, the Bruising of the Nails.

VII. The Signs. A Bruise is easily known from the preceding external Cause, the Colour it self, and the Swelling, if there is any which are evidently seen: the Physician may also understand it from the relation of the Patient.

VIII. Sometimes the hurt part is not elevated into a Tumor, the Blood only insinuating it self into the spaces of the parts, making the Skin of a red, yel∣low, livid, or leaden colour.

IX. And sometimes the Contu∣sion, by reason of its greatness, and the pouring forth of abundance of Blood and Humors under the Skin, and into the substance of the Flesh and Muscles, is lifted up into a Tumor; with which there is sometimes (according to the nature of the part) Pain, and sometimes Inflammation, and perhaps at length a Gangren may be excited.

X. The Prognosticks. A Con∣tusion is generally without danger, (if the principal parts be not hurt) and the Blood, whil'st it is thin and not coagulated, may easily be dissipated or discussed.

XI. But if it is long deteined in the part, and the Contusion is great and considerable, and near some principal part, it may prove of dangerous consequence; for the corruption of the part af∣fected may be feared, with other mischief to the whole Body.

XII. For the Blood being coagu∣lated, and not insensibly discussed, or turned into Pus, (which is ab∣solutely necessary, where the Contu∣sion is great:) Putrifaction and a Gangren are at length in∣duced, which many times costs the Patient his Life.

XIII. If also the part affected loses its colour of wanness, livid∣ness, or greenness; and becomes very much distended, hard, pain∣ful, and inflamed; great danger is threatned, and a Gangren or Sphacelation is at hand.

XIV. The Cure. If the Con∣tusion is great, care is to be taken in the beginning, to prevent the afflux of Blood to the place, lest an Inflammation should be ex∣cited.

XV. To perform this, some Au∣thors prescribe Venesection; but this intravasates none of the Blood that is already out. However, Defensatives and Repercussives are to be applied near to, and about the part affected; to pre∣vent, as much as may be, the influx of Blood into the same.

XVI. And of this kind are Alum, Bole-Armoniack, Catechu, Terra sigillata, Sanguis draconis, Poppies, roots of Hounds-tongue, Henbane, Hemlock, juice of Hem∣lock, Roses, Myrtles, Cypress∣nuts, Opium, Camphir, Galls, Pomgranate-flowers, roots of the lesser Consound, Saccharum Sa∣turni,

Housleeek, Nightshade, Orpin, Nitre, &c. out of which Compounds may be made.

XVII. ℞ Bole ℥iv. Vinegar q.s. mix, and boil them; then add Balaustians, Red-roses in fine pouder, root of Consound in pouder, A. ℥ss. Oil of Myrtles q.s. mix, and make a Cataplasm.

XVIII. Or: ℞ Terra sigilla∣ta, Chalk, A. ℥ii. Vinegar q.s. mix and boil; then add pouder of Pomgranate-peels, Nut-galls in pouder, A. ʒvi. Sanguis draconis ʒii. Nitre ʒjss. Saccharum Sa∣turni ʒi. Oil-omphacine q.s. mix, and make a Cataplasm.

XIX. Or: ℞ Whites of Eggs ℥ii. Rose-water ℥i. Saccharum Sa∣turni ʒi. shake or beat them well together, and with Towe, apply them to the place affected.

XX. Or: ℞ Whites of Eggs ʒii. Rose-water ℥i. beat them well together, then add Oil of Myrtles ℥jss. fine Bole ℥i. Caput Mort. of Vitriol, Dragons-blood, A. ℥ss. Vinegar q.s. mix, and make a Cataplasm.

XXI. But this is to be observed, that you are not to apply many moist and clammy Medicaments; lest the extravasated Blood be putrified, from whence ma∣ny dangerous Symptoms may ensue.

XXII. If the Contusion is from some vehement cause, as a fall from some high place, crushing of a Cart, &c. whereby the Blood is poured forth in some extraor∣dinary manner; and that not only the external part may be hurt and bruised; the Blood will then be apt to coagulate or clot together; thereby inducing many evil Symptoms, extreamly dangerous, as Inflammations, violent (even the worst of all) Fevers, and very oft Death it self.

XXIII. When therefore there is the least fear that the Blood is extravasated, and faln into the more inward parts, and that it cannot be dissipated by external Medicaments; you must then endeavour to hinder its coagu∣lation; and if it be begun, that it may be dissolved, and that with all possible speed it may be carried off by Stool, Urine, or Sweating.

XXIV. For when once the Blood and Humors become putrid, the Disease will not be so easily cured; and sometimes not at all with∣out extraordinary and specifick Remedies, and great care, pains, and industry, and ap∣plication.

XXV. For this purpose, Phy∣sicians commend these following Simples; Winter-cherries, Pelli∣tory of the Wall, Fumitory, Hype∣ricon, Scabious, juice of Citrons, or Limons, Carduus benedictus, Vinegar, Chervil, Parsley, Hydro∣piper-water, Madder, Rhapontick, Rhubarb, Terra sigillata, fine Bole, Sperma Ceti, Crabs Eyes, Mummy, Volatil Sal-Armoniack, Salt of Harts-horn, Spirit of of Sal-Armoniack, and Spirit of Harts-horn.

XXVI. Sperma Ceti is given à ʒi. ad ʒii. dissolved in Vinegar, or Parsley, or Hydropiper-water.

XXVII. ℞ Hydropiper-water ℥iijss. Parsley-water ℥ii. Vinegar, or juice of Limons ℥ss. mix for a Dose.

XXVIII. ℞ Hydropiper-water ℥iv. Spirit of Harts-horn ʒj. mix for a Dose. Or: ℞ Parsley-water (in which Onions have been infused) ℥iv. Spirit of Sal-Armoniack ʒi. mix for a Dose.

XXIX. Or: ℞ Of Our Aqua Bezoartica, or Spiritus Cordialis ℥i. Hydropiper-water ℥iv. Spirit of Harts-horn ʒi. mix for a Dose. These things may be given upon the spot.

XXX. Then at night you may give of Our specifick Laudanum, à gr. ii. ad iii. or iv. drinking after it a little mull'd Sack. The next night, that the Body may be a little opened, you must give a Dose of Our Cathar∣tick Laudanum; so will the Patient have a gentle Stool (without pain, or griping) the next day in the afternoon.

XXXI. Some give this. ℞ Rhubarb ℥ii. Terra sigillata, Crabs-eyes, Ox-blood dried, Sper∣ma Ceti, A.ʒi. Nutmegs ℈i. mix, and make a Pouder. Dose, ʒi. or ℈iv. at a time, in Milk-water, or Hyodropiper-water.

XXXII. Or this. ℞ Rhu∣barb ʒiii. fine Bole, Goats blood prepared, Crabs eyes, Sperma Ceti, Mummy, Comfrey roots, round Birthwort root, Nutmegs, A. ʒi. make a Pouder. Dose, ℈iv. in Syrup of Limons: after these Examples you may make a thou∣sand other Mixtures.

XXXIII. Some give Balsams inwardly; the chief of which are Lucatella's Balsam, as also Balsam de Chili, Capivii, Peru, Tolu, &c.

XXXIV. This following is commended by some Practisers. ℞ Angelica, Bawm, Bugle, Be∣tony, Cinquefoil, Fennel, Ground-Ivy, Hyssop, Ladies-mantle, Parsly, Peniroyal, Sanicle, Sage, South∣ernwood, Smallage, Tormentil, Yarrow, A. M. i. fresh new made Butter lbiv. being gathered green, shred them, and boil them in the Butter till they are crisp, adding Wine lbi. then press forth the Li∣quor, and add again the same quantity of Ingredients, boiling as before, and pressing out: to the pressed Liquor add Strasburgh-Turpentine, Balsam Capivii, Bal∣sam of Tolu, Sperma Ceti, A. lbss. mix, and make a Balsam. Dose, ℥i. in Syrup of Vinegar or Li∣mons, and outwardly you may also anoint with the same.

XXXV. For Liquors, Mum that is choice, and Spruce-beer, are much commended; drinking some one of them, half a pint at a time, blood-warm, morning, noon, and night.

XXXVI. As for Topicks, at the beginning Astringents are to be mixt with Discussives, that the bruised Tunicles of the Vessels out of which the Blood is poured, may be strengthned and bound up; lest new mat∣ter flows thither thro' the pain.

XXXVII. For if Discussives be only used, they will by their heat be apt to drive more Blood into the contused Part, before the contused Vessels can be possibly restored to their natural state.

XXXVIII. For this purpose therefore the Skin of a Lamb or Sheep new taken off, is many times applied, before it is cold, sprinkled with a Pouder made of Myrtle-berries, Bay-berries, fine Bole,

Catechu, and Salt: and this is chiefly for external Contusions, made by beating, whipping, and the like.

XXXIX. And where it cannot be got, a white drest Sheepskin may be got to lay over the place; it being first drest with this: ℞ Balsam of Peru and Chili, A. ℥iii. pouder of Myrtle-berries, Bay-berries, Catechu, A. ʒvi. Salt finely ground ℥ss. mix them.

XL. And the next day you may dress the place with Balsam de Chili or Peru, or Lucatella's Balsam, or with some of those mixed with Ʋnguentum Nico∣tianae; because these things pre∣vent the flux of new matter, hinder putrifaction, and also sufficiently discuss.

XLI. If the Contusion is par∣ticular, and external, (the Skin not being broken) foment it with the Spiritus Ʋniversalis blood-warm; or with that Spirit, in which Camomil, Fennel, Fe∣therfew, Southernwood, Tansey and Wormwood have been five or six hours beforehand infused.

XLII. Then bathe it with Powers of Amber, and after that apply Balsam de Chili or Peru, and so bind it up. Some commend the root of Solomons-seal new gather'd, applied in form of a Cataplasm; or if in Winter, and dry, to be made into a Ca∣taplasm with Wine; which is said in one nights time to do the Cure, and cause the native heat to return to the Part con∣tused.

XLIII. Over the place also you may apply Clothes dipt in the following Liquor. ℞ Spiritus Universalis ℥xx. one Bulls Gall, Catechu ℥iv. in pouder, roots of Aron ℥jss. of Solomons-seal ℥iv. cut all small, digest six or eight hours, then apply it with the Clothes.

XLIV. But if by the use of all these things the Cure succeeds not, nor the matter is discust, you must then apply Cupping-glasses, and for the most part, with Scarification; because these extract whatever is contained in the Part, tho' the matter lies deep, and by the means of Scarification some of the Blood is also drawn forth.

XLV. If all these things avail nothing, but that signs of Suppu∣ration appear, as the swelling up a little of the place, a beating pain, a redness beginning to appear round about, with a softness to the touch; then you must promote the Suppuration by such things as we have declared in the Cure of a Phlegmon or Inflammation.

XLVI. The Suppuration being accomplished, the Apostem must be opened and cleansed, as we have before taught; and then the Ulcer is to be filled up with Flesh, and at length cicatrized, as is usual.

XLVII. But in this case, Sup∣puration must be used with cau∣tion; viz. that they be not of the stronger sort, but such only as are gentle and mild; lest a ca∣coethick, sordid, or putrid Ulcer be induced.

XLVIII. And therefore when we perceive the Contusion degenerates into an Apostem, we rarely wait for a present Suppuration; lest

the pus or purulent matter, being too long kept in the place af∣fected, should excite vehement Pains, malign Fevers, and a great Putrifaction; so as to cor∣rupt the adjacent Parts, Muscles, Nerves, Ligaments, and Bones, and cause cacoethick and putrid Ulcers, Fistula's, &c.

L. You must then never apply emollient and suppurating Cata∣plasms and Emplasters; because they, by reason of their moisture, are apt to induce putridness, and other evil Symptoms.

LI. In this case, Authors ad∣vise us, that the Apostem excited by coagulated or congealed Blood, be forthwith opened with an Incision-knife; and then a Tent put into the Wound, dipt in Ʋnguentum Aegytiacum; defen∣ding the whole part affected, and laying over it some proper Emplaster, which may preserve the native Heat, and kept it from putrifaction: and this is more especially to be observed if the Contusion is in the Belly, Hypochonders, Sides, or Back.

LII. For then the third, fourth, or fifth day, you must observe, whe∣ther there are any signs of an Apo∣stem (as swelling, with pain in∣creasing, pulsation, uneasiness, not enduring it to be touched, and a redness in the circumference:) for where-ever they appear, (tho' no lividness, blewness, yellow∣ness or blackness appear in the external parts) they demonstrate that purulent matter is gene∣rated, and an Apostem produced.

LIII. Ʋpon which, the place is speedily to be opened, that the Pus may be brought forth, lest it retires unto the more inward parts; making (as it were) Coney-boroughs, and eating asunder the Nerves, Ligaments, Muscles, and Vessels, thereby causing either speedy death, or some lingring Disease.

LIV. Then the Wound is to be ordered, as before directed; and during the whole course of the Cure, Vulnerary or Traumatick Potions are daily to be given.

LV. But if the hurt is great, or some error has been committed in the managing of the Cure, so that the place begins to look black or blew, and that by reason of the suffocation of the native Heat, a Gangrene and Mortifica∣tion is feared; you must then immediately scarifie the part, and apply Cupping-glasses, that so the putrid Blood may be evacuated.

LVI. This done, the part is to be fomented with Powers of Am∣ber, or Spirit of Wine, mixed with a little Spirit of Sal Armoniack, or with the Spiritus Ʋniversalis; or with the Liquor at sect. 43. aforegoing.

LVII. Or you may use warm. Vinegar, or the Decoction made of roots of Radishes, of Aron, of Solomons-seal, of Virginia Snake∣root, and Winters Cinamon, in Wine, or their Infusion in Spiri∣tus Ʋnversalis: for that these things dissolve and draw forth the clotted Blood from the very bottom of the Affect.

LVIII. After which you may apply Diachylon Simplex, or cum Gummis; or for want there∣of, any other drawing Emplaster.

LIX. Or this Cataplasm: ℞

Camomil, Smallage, Southernwood, Tansy, A. M. ss. juice of Aron or Musterwort q.s. mix, and make a Cataplasm; adding a little Spirit of Wine.

LX. If the Contusion is in the Muscles, chiefly those about the Ribs, the Flesh generally swells a little, with a kind of purulent Matter; which being pressed down, sends forth a kind of flatulent Air, with a little noise, leaving for a time the print of the fingers after it; which if it be about the Costae or Ribs, endangers a putrifaction or mortification, with a separation of the Flesh from the Bones.

LXI. In this case the Remedy must be speedy, by applying things which cleanse and restore the na∣tural Heat; after which it must be strongly drawn together, and firmly bound up, with Emplast. Diachylon, made up with a little pouder of Myrrh, or some other like Digestive.

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.

CHAP. IX. Of a TƲMOR behind the EAR.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, quod sit juxta Aures; in Latin, Parotis; and in English, a Bubo, or Tumor behind the Ear; and by Hippocrates these kinds of Tumors are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Eparmata.

II. A Parotis is a Bubo or Inflammation of the Glandules near unto the Ears, viz. some∣times behind, sometimes besides, and sometimes under the Ears; for which reason it is said in the Definition, to be near to the Ears.

III. The Signs. It is known from the Place affected, from a violent beating, pain, redness, and swelling, for the most part be∣hind the Ears, and extending to the Jaws and Temples.

IV. And it generally appears with Heat, and a Fever; some∣times with Frensy, Convulsions, Swoonings, coldness of the Ex∣tream parts, with dejectedness of Spirit.

V. The Kinds. It is either Critical or Malign; and the Ma∣lign is either Pestilential, or Venereal.

VI. Now whether it is Critical or Symptomatical, the time of the Disease, and the signs of the Crisis, whether present or ab∣sent, will sufficiently mani∣fest.

VII. If it is only transmitted from the Head, there went before a vehement pain of the Head; the which, upon the breaking forth of the Parotis, either wholly vanishes, or is very much diminished.

VIII. The Causes. Blood is said to be the principal and conjoin'd cause of this Tumor, but it is seldom or never pure, but with a mixture of other Humors; as Choler, Flegm, Lympha, or Melancholy; and sometimes they are con∣joined with malign or pestilen∣lential Miasmata; from whence it is that they are also malign and pestilential.

IX. For Nature being provoked and stirred up by the vitious and depraved Humors, protrudes unto the External parts those defile∣ments with the Blood: and they are sent to the Part affected, either from the whole Body, or from the Brain.

X. It is also caused sometimes by Poison, which at any time may happen to be drunk, or taken into the Body; wherein if Nature be strong enough, (and the Poison ascends up into the Head) she sometimes protrudes it to the Glandules of the Ears.

XI. The Differences. The prin∣cipal Differences arise, 1. From the Matter: viz. according to the Humor with which the Blood is conjoined, whether simple, malign, or pestilential. 2. From the manner of their Beginning or

Generation; in regard that some of them may have their origi∣nal without a Fever, as Celsus, l. 6. c. 16. says, the Patient being in good health, Nature protru∣ding those Humors to such a particular Part, for the general good of the whole Body; and some may be with a Fever, acute or chronick; either be∣nign, malign, or pestilential.

XII. The Prognosticks. It is longer before it come to ripeness than other Bubo's: the Critical are healthful, the Pestilential dangerous, and for the most part a sign of sudden death.

XIII. The Venereal are not mortal, yet difficult to be cured; more especially if they be made worse by Bleeding, Purging, or Blistring.

XIV. The Cure. It is needful to consider in the Cure of the Parotides, whether they be Criti∣cal or Symptomatical, and of what kind of Humor they are bred: if they be Critical, thereby ter∣minating a Disease, or at least diminishing of it, then the whole work is to be committed to Nature, as Hippocrates advises, lib. 1. aph. 20. and nothing else is to be done, but only those things which ease Pain are to be laid thereupon, and the which may at one and the same time help forward the Suppuration.

XV. But let the Parotis be what it will, whether Critical or Symptomatical, great or little, benign or malign, be it what it will, this is to be noted, that no Repercussives, Repellers or Drivers-back, have place in any measure, lest that the matter be driven from the exterior to the interior, and from the more ignoble, to the more noble Parts.

XVI. If the Tumor hastens not fast-enough it self to come forth, but that Nature is weak, you ought to apply the gentler sort of Attractives; such are the Oils of Camomil, Flowerdeluce, Dill, Melilot, &c. not using the stronger, but with caution, lest the pain should be increased.

XVII. If Nature inclines to Resolution, you must assist her with Discussives; but if to Suppura∣ration, (which is much better) than with Medicines which con∣coct, digest and maturate; all which we have proposed in the Cure of Phlegmon and Bubo.

XVIII. The Apostem being sup∣purated, it must be opened, (as we in its proper place do teach,) and to be cured after the manner of other Ulcers.

XIX. If it be Symptomatical, and Nature be weak; or there be an over-great abundance of the Antecedent Cause, it is to be les∣sened by Evacuation: for where such plenty of vicious Humors are, it is not to be feared that Nature hereby may be averted from; and hindred in her work of Expulsion; but rather to expect, that being eased of some part of her burthen, she will the more easily afterwards expel what remains, and ought to be emptied forth.

XX. But yet, if notwith∣standing this Evacuation, whether Emetick, Cathartick, Sudorisick, or Ptarmick, Nature cannot sufficiently expel, then the

Expulsion is to be forwarded by Cupping-glasses with Scari∣fication, and other Attractives.

XXI. And hence it is, that either a Discussion, or (which is better, and most practised) a Suppu∣ration is to be procured, by those Medicines which we have pro∣posed in the Cure of Phlegmon and Bubo, aforecited.

XXII. But here you must ob∣serve the condition of the Tumor; for if it be more than ordinary cold and thick, you must use the hotter and stronger Discussives; and if there be any cause to fear that the matter may be hardned, you must make use also of Emollients.

XXIII. The Matter being soft∣ned and maturated, if it so tends, let the Apostem be opened, and cured; as we advise in lib. 1. cap. 18. & cap. 3. sect. 3 5. ad 47. of this Book, aforegoing.

XXIV. Now you must not expect that the Tumor should break of its own accord, nor are you to wait till then; lest the Pus being long retained, produce many sad and dangerous Symptoms; and (as Guilielmus Fabricius, Cent. 2. Observ. 39. well notes) seeks another passage, whereby it may cost the Patients their lives.

XXV. A young Maiden (saith he) was afflicted with a Parotis, which tho' she was not so much amiss or ill, as to take her bed; being all the while also free from any Fever, and came well out, so that on the 14 day the Apostem was as big as ones fist: yet because it was not timely opened, she was sud∣denly surprized with a Fever, Vomitings, Heart-qualms, and Swooning-fits, with Watchings, and want of rest, as also a ve∣hement pain in her Back and Reins: and tho' it broke of its own accord, yet in regard it was too long before it broke, little or no Pus at all came forth; it seeking a passage downwards, and at last it cost the Patient her life.

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.

CHAP. XI. Of GANGRENE and SPHACELƲS.

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.

Of a SPHACELUS.

C. When the whole Mem∣ber is corrupted, or become per∣fectly dead, it is then sphacelated, as is before declared, and then it is no way to be cured, but by cutting off: the way of doing which, whether in the dead or living part, we have fully and plainly declared and taught, in Lib. 1. Cap. 32. aforegoing.

CI. Yet if you please, with what is there said, you may take the following Notes. Celsus, lib. 7. cap. 33. advises to make the Section between the sound Flesh and the dead, and rather to take away some of the sound, than to leave any of the dead Flesh remaining: but this our mo∣dern Physicians disapprove of, because of the accidents and dangers which follow, viz. im∣moderate profusion of Blood, vehement pain, fainting, swoon∣ing, &c.

CII. Fallopius advises to make the Section in the dead part alone, and cuts with a Razor into the dead Flesh, (even to the Bone) and then takes it off with a Saw; after with red-hot Irons he burns the Flesh and greater Vessels, even to the causing of pain.

CIII. The Putridness is some∣times apt to creep farther; but you will see when it ceases to increase, because it will divide it self from the sound part of its own accord, and be sepa∣rated by Nature, upon the

applying fit and proper Medi∣caments.

CIV. But if you see the Putrid∣ness creeps forward by great steps, and that Nature of her own accord begins not to separate the sound from the corrupt; you may not then make the Section in the corrupted part, without present danger: and the reason is, that sometimes the Putrid∣ness creeps farther underneath near the Bone, than it appears to do upon the Skin and outward parts.

CV. If in this case you make the Section in the mortified part, the interiour Putridness will al∣ways creep farther, deeper, and broader, and so hasten the death of the Patient; or else you must reiterate the Section, and so put the Patient to a second torture.

CVI. But then in amputating in the sound Part, the sense of pain may very much be moderated by tying the Ligatures very strait, thereby intercepting the passage of the Animal Spirits for a time; and so the Instrument being sharp, the Cutting will be quite finished, before the Patient shall peceive what is doing.

CVII. And tho' the Section is made in the dead part, yet all manner of pain is not then pre∣vented; for when the Saw comes to cut asunder the Bone with the Periostium, there will be excited very acute and sharp pains; and if to avoid them, the am∣putation is made in the Part where the said Membrane is dead, and the Bone is corrupted, it is to be feared, so great a putridness will be left re∣maining in the Vessels and Muscles, (which are very apt to receive the putrifaction) that it is scarcely possible to be extinguished, tho' with the actual Cautery it self.

CVIII. Nor do these Cauteries destroy the whole Putridness with∣out much pain; of which there ought many to be applied, in removing or destroying the whole substance that is morti∣fied; which if so effectually applied, they by their vehe∣ment heat melt the Fat and Humors; thereby exciting ex∣traordinary pain, and so con∣sume the Flesh, that a great part of the Bone sticks forth naked and bare; so that of∣tentimes it requires a new Section.

CIX. If then you make the Amputation in the sound part, the Muscles and Vessels being drawn strongly upwards towards the sound part, the Member below is to be very straitly tied down with Ligatures; by which binding, 1. The very great flux of Blood will be prevented: 2. The sense of the Part, by restraining the Animal Spirits, will be somewhat dulled: 3. The Mu∣scles thus drawn upwards, (when the Section is ended, and the Ligature loosened) will again devolve downwards, and the better cover the extream and naked parts of the Bone.

CX. And if it should chance that there should be a greater flux of Blood than ordinary, yet it may prove for the addvantage of

the Patient; for thereby the Blood in the Vessels, which possibly may have received some putridness, may be evacuated, whereby the danger of the putridness re∣turning, or creeping farther, will be prevented; and then when you think fit, you may stop it, by the application of Styptick Waters, Pouders, and the like.

CXI. A Styptick Pouder. ℞ Roman Vitriol calcin'd to whiteness in the Sun ℥iv. Saccharum Saturni ℥ii. Roch-alum in fine pouder ℥i. Blood dried and reduced to pouder ʒvi. mix, and make a pouder, for the present stanch∣ing of Blood.

CXII. This is yet much better. ℞ Caput mortuum of Vitriol, calcine it in an open Fire to a purple blackness; then with fair Water elicit the Salt, filter the Solution, and abstract to driness, and keep the Salt for use. Where note, that some after this, calcine the Salt again with a red-hot Iron. This is wonderfully sty∣ptick, and stanches Blood with∣out any caustick or burning quality.

CXIII. As to the place of Se∣ction; if it is in the Feet, and the Sphacelus has got above the Ancles, the Leg is best to be cut off a little below the Knee; for it will be more commodious to the Patient, and he may the better wear a wooden Leg. The Amputation is not best to be made always very near to the dead part; because when the Sphacelus is just by the Ancle, the remaining part of the Leg will be troublesom to the Sick, and much impede his motion: but in these cases you must do as the Patient will have it.

CXIV. But in the Arm, as little as may be is to be taken away; and the Amputation is to be made as near the spha∣celated Part, as is convenient for the health of the Patient.

CV. If the Sphacelus is in the Fingers or Toes, the Section will be best to be made in the very Joint: for in the Joint (if the Disaffection will admit) the Amputation will be made with the least danger, and with the least pain.

CXVI. For the Nerves and Tendons, as soon as they are cut asunder, immediately contract themselves upwards, and are covered with Flesh; nor does any Convulsion follow there∣upon.

CXVII. From what has been said it appears, That the practice of the Ancients, in stopping vehement fluxes of Blood in Amputation, was always by the actual Cau∣tery, or Burning: But this way Paraeus very much inveighs against, because of the ex∣ceeding barbarity and cruelty thereof.

CXVIII. For that it causes, 1. Extraordinary Pain. 2. Dan∣gerous Symptoms may happen to the Nerves and nervous Parts. 3. Very much of the sound Flesh is consumed, whereupon the Bones are left bare, and the Flesh, together with the Ci∣catrice, is either not at all brought over the end of the naked Bone; or if be, it is

with much difficulty, and length of time.

CXIX. He therefore by the Crows-bill lays hold of the Ves∣sels, draws them together, and binds them up with a Ligature, tying them very straight, or closes them with a Cautery, and so loosens the Bandage; after which he applies some such-like Pouder, as that in Lib. 1. Cap. 32. Sect. 14. upon Towe dipt in the whites of Eggs, for the stanching of Blood.

CXX. I must confess, with∣out any such Ligature or Cau∣tery, the Blood may be stanched with the application of the said Pouder, or with Crepitus Lupi, so much used by the Chirur∣geons, being applied and laid upon the mouths of the Vessels which so vehemently bleed: but more effectually with the Styptick Pouders above descri∣bed at Sect. 111. and 112. afore∣going.

CXXI. The Wound being thus drest and bound up, it is to be placed in a direct middle posture or figure, upon Pillows stuffed with Down, or Hares-hair, Wheat∣meal, or the like.

CXXII. And this Method is so long to be used, till there is no cause of farther fear of an He∣morrhage; and then Digestives are to be applied, 'till you see the Wound become purulent: then these things being laid aside, you are to make use of Cleansers, such as are described Lib. 1. cap. 32. sect. 23. aforegoing.

CXXIII. In the mean season, you must endeavour to draw the lips of the Wound together, that the Flesh may cover the Bones; which Paraeus does by sewing together the lips of the Wound in the form of the Letter X, or crosswise: but the Dry Su∣ture seems to me to be much more convenient.

CXXIV. Thus: ℞ Mastich, Sanguis draconis, fine Bole, Sar∣cocol, white Starch, A. ℥ss. mix them (being in fine pouder) with the white of an Egg: with this make Plasters of linnen Cloth, of a convenient bigness, by throughly moistning it therein: which let be applied unto the extremities of the Wound on both sides, crosswise; and so let them stick 'till they become dry, and cleave fast to the Skin; which then with a Needle and Thread you may sew, and draw them together, as you see ne∣cessary and convenient.

CXXV. Lastly, if you have used the actual Cautery, you must endeavour that the ends of the Bones which have been hurt by the red-hot Iron, or Air, may fall off. For which purpose, some burn them again with a red-hot Iron, taking great heed to avoid the Flesh: others make use of Em∣plastr. de Betonica, or of a Ca∣tagmatick, or Fracture-medica∣ments; others of other things: by which means the corrupted part of the Bone will fall off in about thirty or forty days.

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.

CHAP. XIII. Of a PƲSH, or BILE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, (〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. quo∣niam noctu generatur, ut Galenus & Celsus docent; vel magis, non quod noctu oboriatur, sed quoniam noctu vehementiùs ho∣minem excruciet, ut Paulus Aegi∣neta & Aetius existimant;) in Latin, Furunculus, & Epiny∣ctis; in English, a Push, or Bile.

II. The Kinds. It is twofold: 1. Furunculus, the great Push or Bile. 2. Epinyctis, the little Push. The first is a Tumor about the bigness of a large Pigeons Egg, the latter about the bigness of a large Horse-Bean.

III. And of the Furunculi, some are mild and gentle, seizing only upon the Skin; others are malign, which descend deeper, and are mischievous and dangerous, not to be cured without great dif∣ficulty, its roots being deeply fixed: they are also sometimes Sporadick, and sometimes Epi∣demick, which if they happen in a Plague-time, are not with∣out sufficient danger.

IV. The Differences are, 1. In magnitude; the Furunculus being greater, the Epinyctis being lesser. 2. In the greatness of the affect; the first being more painful, troublesom, tedious and diffi∣cult to cure than the latter. 3. In the time of breaking out; which as Galen says, the Epini∣ctys does in the night: but in this, I think those Ancients are mistaken, for it breaks out as the Furunculus does, at any time; but it seems to be most troublesom in the night, where∣as the other seems to be night and day alike.

V. The Signs. Celsus, lib. 5. Cap. 28. says that Furunculus is a Tumor a little acuminated or sharp-pointed, with Inflammation and Pain; and then especially, when it is perfectly converted into Pus.

VI. It is indeed a small In∣flammation in the beginning, a Pustule growing bigger and bigger by degrees, seldom exceeding the bigness of a large Pigeons Egg, with a certain kind of pain, and redness of colour; when it is come to its full bigness, and withal tending to a point; which happens about the ninth or tenth day, at farthest.

VII. If it is Epidemical and Pe∣stilential, it is then black and green, and there is present a malign Fever, with other evil Symptoms: but it differs from a Carbuncle in this, that altho' it proceeds from thick and vitious Blood, yet the matter of a Carbuncle is more adust or burnt: also a Furunculus will admit of Sup∣puration, whereas a Carbuncle will not.

VIII. Tho' many times there is but a single Furunculus breaks forth at a time; yet sometimes many of them break forth, in various parts, together.

IX. The Epinyctis, says Aegin. l. 4. c. 9. & Aet. tetr. 4. serm. 2. c. 61. is a small Pustule, breaking forth of its own accord, somewhat reddish; which being broken, there comes forth a bloody filth and matter, not greatly excrutiating the Patient in the day∣time, but giving a pain more than ordinary in the night, and sometimes many of them break forth (in diffe∣rent places) together.

X. Pliny, l. 20. c. 6. says they are pale and wan Pustles, which disquiet much in the night-time: but Celsus, l. 1. c. 28. has given the most ab∣solute description of them. Viz.

XI. Pessima Pustula est quae 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Epinyctis, vocatur. Ea colore vel sublivida, vel sub∣nigra, vel alba esse consuevit: circa hanc autem vehemens Inflam∣matio est, & cùm adaperta est, reperitur intùs exulceratio mucosa: Color est Humori suo similis: Dolor ex ea supra magnitudinem ejus est, neque ea saba major est. Atque h••c quoque oritur in eminentibus partibus, & fer•• noctu. Ʋnde

nomen quoque à Graecis ei Epi∣nyctis impositum est. Viz. This Pustule which is called Epinyctis, is the very worst of all the kinds: its Color is usually pale and wan, or blackish, or else white: there is also conjoined with it a great Inflammation, and within, it contains a pu∣rulent and filthy matter: the Colour is much like to the Humor of which it is generated: the Pain which it gives, much exceeds its magnitude, not being bigger than a (large) Horse∣bean. It also arises in the emi∣nent or principal Parts, and most commonly in the Night; for which cause this name, Epi∣nyctis, is imposed upon it by the Greeks.

XII. The Causes. Galen. de Comp. Med. lib. 5. says Furunculus has its original from thick and vitious Blood, but not so burnt and corrupted as in a Carbun∣cle; which Nature severing from the rest, expels and drives forth, as offensive and useless, unto the superficies of the Body.

XIII. The cause of Epinyctis is Blood, corrupted with a salt and serous Humor mixed with Flegm, and sometimes with Choler or Melancholy; for which reason it is that the colour is not al∣ways one and the same: and by reason of the pituitous Hu∣mor mixed in the Tumor, it is, when suppurated and opened, found abounding with a puru∣lent and filthy Matter.

XIV. Some are of Opinion, that the cause of these Tumors is the same with that of the Car∣buncle, save that here is no mali∣gnity present: but for my part, I judge the contrary, unless it be in a Plague-time, and then I think the case is much altered.

XV. The Procatartick Causes of all these Tumors, is an evil course of Diet and Living, breed∣ing an evil and scorbutick habit of the Body: the Antecedent Causes, are the evil Humors produced by that ill way of Living; which being impregna∣ted with an acid and sharp Salt, causes them to ferment with the Blood, and so break forth: and the Conjoin'd Cause, is the Blood thrust forth with the Matter fermenting.

XVI. The Prognosticks. Hip∣pocrat. Epidem. lib. 6. sect. 1. says, these Tubercles which bunch forth externally, and are sharp-pointed, equally maturate, and are not hard, or divided as it were into two parts, but have their tendency downwards, are the more hopeful.

XVII. And Celsus, lib. 5. cap. 28. says, that in a Furun∣culus, Bile, or great Push there is little or no danger, tho' nothing is done for the cure thereof, be∣cause it suppurates of its own accord, and so breaks forth. It is the Pain that accompanies it, which induces the application of Medicines, for the more speedy ease of the Patient.

XVIII. Epinyctis, or the small Push, is yet less dangerous, and rather denotes the strength of the Expulsive Faculty; but it is troublesom, by reason of the Pain it causes, and the restlesness which it brings with it in the night-time.

XIX. The Cure of Furunculus, or a Bile. You must first endeavour Suppuration by external applica∣tion, with the same things as in a Phlegmon; as Raisons of the Sun, Figs bruised, and laid upon the Part, Diachylum, white Lilly roots, roots and leaves of Althea, Mallows, herb Mercury, and all Emollient Gums.

XX. Or you may apply Em∣plastr. Diachylon cum Gum∣mi, de Meliloto, de Muci∣laginibus, Tripharmacum, de Minio cum Sapone, or proper Cataplasms.

XXI. Or, ℞ Meal of Linseed, roots of Althea in pouder, A. ℥ss. fat Figs N^o iv. Raisons of the Sun stoned ℥i. Water q.s. boil them together to a Cataplasm, adding at the end Goose or Capons grease, or fresh Butter, q.s.

XXII. If the Pain is vehe∣ment, apply this: ℞ Mucilage of the seeds of Fleawort, Althea, Linseed, A. ℥ii. Barley meal or flower ℥ijss. Oil of Lillies, Ca∣pons grease, A. ℥jss. Saffron ʒss. yolk of one Egg: mix, and make a Cataplasm.

XXIII. When the Tumor is maturated, it is to be opened (unless it breaks of its own ac∣cord:) and then it is to be cleansed with this: ℞ Juice of Smallage, Turpentine, A. ℥i. yolk of one Egg, Barley-meal, Fr•…•…k∣incense, A.ʒiii. Rosin in pouder ʒiss. Honey of Roses q.s. mix, and make a Liniment.

XXIV. And over all apply this Cerat: ℞ Sheeps suet, Calves suet, A. ℥iii. Turpentine ℥jss. Oil-olive ℥i. Wax q.s. mix, and make a Cerecloth: after all, evacuate the Humor with pro∣per Catharticks and Antiscor∣buticks.

XXV. The Cure of Epinyctis. The Tumor is to brought to suppu∣ration, as in the former; then breaking, or being opened, they are to be cleansed with Abster∣sives, and washed with some proper Styptick Water to dry them up: or you may apply a Mixture made of equal parts of Sulphur vive and Litharge, mixt with Wine.

XXVI. If they be very painful, Anodyns are of good use; as a Cataplasm of Mithridate and pouder of Bay-berries, after which they may be healed up, with Ʋnguentum Tutiae, or some such like thing.

XXVII. Lastly, let the Pa∣tient keep from all things, sharp, acid, and salt; and purge out the vitious Humor, by proper Antiscorbutick Catharticks.

CHAP. XIV. Of CHILBLAINS or KIBES.

I. THIS Disease is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, i. e. Hyeme;

in Latin, Pernio, plu. Pernio∣nes; Fen English, Chilblains, Bloody-falls, or Kibes.

II. It is a peculiar kind of Tumor or Inflammation, which arises chiefly in Winter-time, upon the Heels, Toes and Fingers, with other parts of the Hands and Feet: But Wiseman will have them only to be called Kibes, which happen upon the Feet and Toes; Sennertus saith that he once saw a Nobleman, which had such a kind of Disease on the very tip of his Nose.

III. The Causes. This Inflam∣mation arises from the Winters cold; weakning those parts, by the entrance of cold Atoms, and the drawing Blood and Pain into the Part.

IV. The Signs. There is a swelling in the Part, with redness, and an extream itching, so that the Patient cannot forbear scratch∣ing or rubbing of them; some∣times to the breaking of the Skin, and then they exul∣cerate.

V. These Tumors many times go away of their own accord in Summer-time, and then again about the beginning of Winter return again, with the old swelling, redness, itching, &c.

VI. The Prognosticks. There is no danger in this Disease; yet notwithstanding if they be not speedily cured, they commonly prove tedious, and of long continuance, and often return again for many years.

VII. If the Tumor grows very great, and meets with many heats and colds, it commonly breaks and exulcerates; and then the Tumors which were before cal∣led Chilblains or Bloody-falls, lose that name, and get the appellation of Kibes.

VIII. The Cure. It is to be considered, 1. As Chilblains, be∣fore they are broken. 2. As Kibes, after they are broken and exulcerated.

IX. The Cure before they are broken, is, as Sennertus advises, to rub the Parts affected with Snow, or dip them into frozen Water, or Snow-water, or Water full of Ice: others advise to put the Part into a warm Decoction of frozen Turneps: or when the itching and heat is over, to dip them into a pail of cold Water almost frozen. The De∣coction of Lupins is an approved thing.

X. Some have been cured by fomenting the Part with Milk blood-warm, wherein Bay-berries, Camomil, Fennel, Origanum, Pe∣niroyal, Rosemary, Rue, Savory, Southernwood, &c. have been boiled: others by holding them to the flame of a Candle, (in the fit of the itching) and to burn them as it were therewith: others bathe them with S.V. or rather with Beef-brine.

XI. Or you may make Com∣pounds, after this manner. ℞ White Port-wine sbi. Alum ℥i. boil, and bathe the••with. Ointment of Roses with Oil of Turpentine, to anoint withal, is an approved thing. Or after Bathing, you may anoint with Honey, with which pouder of Sulphur vive has been mixt.

XII. ℞ Oil of Bays ℥ii. Ho∣ney ℥i. Turpentine ℥ss. mix them.

Or, ℞ Oil of Mace, fresh Butter, Turpentine, A. ℥i. mix them. Or, ℞ Oil of Wax, Oil of Roses, Honey, Olibanum, A. ℥i. mix, them.

XIII. The Cure, after they are broken and exulcerated. Let the Ulcer be cleansed with the Li∣niment in Chap. 13. Sect. 23. aforegoing: Or, ℞ Frank∣incense, Roch-alum, both in fine pouder, A. ℥i. mix them, adding thereto a little Wine; laying over Emplastr. Catholicon, or some other good Vulnerary.

XIV. An Ointment made of the ashes of River-crabs mixt with Honey and Oil of Roses, is approved; pouder of Aloes also to strew upon them, is an ex∣cellent thing; and if very foul, Ʋng. Basilicon mixed with red Precipitate, is to be applied. But in my opinion, nothing exceeds the pouder of Scam∣mony, strewed on dry.

XV. For that cleanses, purifies, and incarnates. If the Bone is foul, I have known it to scale it, and make it white, remove all the impediments and acci∣dent which may befal the Cure, cleanse, repress proud Flesh, and yet incarnate and heal: so that there is scarcely a better singular thing for this purpose, or for the cleansing of any foul Ulcer in the World.

XVI. Then over the Pouder lay this Emplaster of Barbett, which is admirable. ℞ Frank∣incense ʒii. Litharge, Myrrh; A. ʒjss. red Lead ʒi. Galls, round Birthworth-roots, both in pouder, A. ʒss. Camphir ℈i. Mer∣cury sublimate gr.•• vi. Sheeps or Rams suet, Rosin, A. q.s. mix, and make an Emplaster, adding a little Oil-olive.

XVII. And afterwards wash the Sore with Saccharum Saturni dissolved in Spirit of Wine, or some other proper Liquor, to cause a speedy healing.

XVIII. Lastly, if the Ʋlcers prove rebellious, they are to be cured after the common me∣thod, as we shall teach in Lib. 5. following.

CHAP. XV. Of an ANEƲRYSM.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Aneu∣rysma; and in English, an Aneu∣rysm, or Rupture of an Artery: it is so called, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, i. e. supra dilatare, to dilate, or widen above: but mo∣dern Physicians have found from Practice and Observation, that it is more than a dilatation of an Artery, viz. more than a rupture of the inner Coat, and dilatation of the outward Coat; and that it is (as Wiseman has well obser∣ved) a downright rupture thro' both the Arterial Coats.

II. Definition. This Disease is therefore an eruption of Blood out of the Artery, by a rupture of both the Coats of the same, and filling the spaces of the Muscles adjacent thereto, with Arterial Blood. For as the aforenamed Author says, it is not probable that a force big enough to burst the inner Tunicle of an Ar∣tery, which is so very tough and firm, should leave the exterior whole, which is much softer and weaker, leisurely to be extended by the Blood.

III. Barbett also defines an Aneurysm to be a Tumor besides Nature from a rupture of an Ar∣tery; continually beating, easily yielding to the Fingers, and as suddenly returning.

IV. The Kinds. An Aneurysm is either great, or small. The great can never be but with the rupture of both the Coats of the Artery, whereby the Blood insinuates it self into the interstices of the Muscles: the small may be (according to Barbett) from an erosion of the internal Tunicle, the ex∣ternal being only extended: but if the Tumor is of the bigness of ones Fist, 'tis impos∣sible but that the external must be broken too.

V. The Place. Sennertus says, an Aneurysm may happen in every part of the Body, but more fre∣quently in the Throat, where it produces a Bronchocele: it happens likewise in the Head, nigh unto the places of the Arte∣ries, and in all other parts of the Body also where the Arteries may be wounded; as also in letting Blood in the Arm, &c. when an unexpert Artist in attempting to open a Vein, does withal either prick, or cut asunder the Artery lying un∣derneath it. Aegineta, lib. 4. cap. 53.

VI. The Causes. All Arteries (except such as are disperst thro' the Brain and upper parts) consist of a double Tunicle: and therefore what things soever contribute to the rupture of those Tunicles, are the cause of this Disease; and these causes are either Internal or Ex∣ternal.

VII. The Internal cause is ei∣ther from some corrosive Humor or Salt corroding the Tunicles; and that is either innate in the Blood, which eats thro' some parts of the Vessels thinner than ordinary; or being highly fermented by other Causes, causes an unexpected Rupture: or extern to the Vessels, which fixing upon some particular Part, may at length meet with an Artery, and gnaw that asun∣der also; as in a Cancer, is often seen.

VIII. The Internal Cause, if it is in the Blood it self, is from an Impetus arising either from the violent motion of the Blood; which being greater than the Artery can sustain, does force its way thro' the sides of the Ves∣sel, making a rupture in it; whereby the Blood filling the interstices of the neighbouring Muscles, it incrassates the Membranes, and forms its self a Cystis.

IX. Or it may be from the too

great quantity of Blood in that Part, being more than the Vessel can contain; which opens mostly in the Nose, Lungs, or in the Brain, (there causing an Apo∣plexy:) or in the Stomach, Guts, Reins, Anus, &c.

X. Or from some violent mo∣tion of the Body, or vehement passion; by which the Blood is forcibly driven from the Heart, towards some peculiar Artery: which being intercepted by some violent contraction of the Muscles, thro' which it must pass, it of necessity breaks the Vessel; as in violent Vomitings, and other vehement Strainings. Aneurysms are often made in the Neck, Arms, Legs, Belly, Thighs, &c.

XI. The External Causes are Wounds or Punctures, made by Incision-knife, Lancet, or Weapon; cutting, bruising, or any other thing which may break and divide the Coats of the Arte∣ries.

XII. The Signs. It is known by a Tumor gradually increasing, and of the same colour of the Skin: if it is small, there will a continual pulsation be felt in it, and it easily yields to the Fingers: But if great, and it rises suddenly, and is white and soft from its first appearance, there will no pul∣sation be felt, nor any return of the Blood, if compressed with the Hand: yet you may conclude it to be an Aneu∣rysm, there being no Hu∣mor, but the Blood only, which can so suddenly make such a Tumor.

XIII. The often increase and decrease of the Tumor, is a sign of an Aneurysm, the diminution being the return of the Blood into the Artery, whence it as often comes out again; but this is in a small Aneurysm: the contrary is found in a great, where, as Barbett observes, there is a noise heard, as of boiling Water: and this hissing noise is not only to be perceived when it is pressed down by the Fingers, but also at any other time, upon putting the Ear close thereto; which is thought to proceed from the motion of the Vital Spirit, thro' strait and narrow places.

XIV. If it is from the pricking of a Lancet, the manner of the springing out of the Blood will shew it; and if it does not bleed, yet a Tumor immediately thrusts up under your Finger, with pulsation, the Blood forcing its way into the inter∣stices of the Muscles, tho' not quite to the Skin: but the Tumor will be more compact or scatter'd, as there was care taken at first to restrain it within compass.

XV. In some of these there is redness and inflammation, by reason of the expansion of the Parts beyond their capacity, or from the putrifaction of the Blood: in which latter case, a Fever and Fainting for the most part accompany it.

XVI. The Differences. They are taken, 1. From the Magni∣tude, great or little; possessing the whole Member, or a part only. 2. From its Situation; as being

superficial, near the Skin; or deep in the Muscles. 3. From its shape; it either keeping the shape of the Part, which is when the orifice in the Artery is small; or losing that form, when the eruption is so sud∣den and great, as it cannot be kept within bounds: or when it is by an unskilful Artist, managed with Lenitives and Discussives, being mistaken for some other Tumor, whereby the Membranes are more relaxed, and made to give way.

XVII. The Prognosticks. All-Aneurysms are very difficult of cure: Barbett says, not at all, if great, without taking off the Member: Sennertus says, those which are recent, and less, will admit of cure; the greater no ways, but by Amputation or Section; because the Blood will not be driven back by Astrin∣gents, nor the Artery admit of consolidation.

XVIII. If the Tumor is opened, it brings the Patient into extream hazard of death; and remarkable Instances there are of such as have died under the hand of the Artist, at the time of opening; because of the extream profusion of Blood, and great wasting of the Vital Spirits.

XIX. However, not being opened, Sennertus says the Tumor has no great danger in it, but life may be lengthened out for a long time; and he knew a Woman who had an Aneurysm as big as a Walnut, in the inward bending of the Arm, (thro' the unskilfulness of the Artist, who in opening of a Vein, cut the Artery also) for the space of above thirty years, injoying her health all that time: and there∣fore concludes, that it is better to bear with some inconve∣nience, than to run the hazard of a dangerous Cure.

XX. Barbett says, it is for the most part a long Disease, yet he has sometimes seen it kill, without any other accidental cause, in the space of two years: but this, I prefume, is intended of large Aneurysms.

XXI. Wiseman says, those which are large, and arise from Arteries deep in the Muscles, to which application cannot be made, are incurable: but if it is in a Part capable of Bandage, and application of Medica∣ments, the Cure is feasible; or it may be palliated, to the ease of the Patient.

XXII. The Cure of a small Aneurysm. So soon as ever it is perceived, let Astringents and Repellers be imposed upon the place affected, to repel and qua∣lify the Blood, and close up the hole of the Artery: for which purpose, Emplastrum ad Herniam, either the common, or of Our Prescription, are of exceeding good use.

XXIII. Sennertus commends a thin plate of Lead to be hard bound on, which does repel, thicken, and close the loosened Artery, and keep the Blood within its Channels: or you may ma∣ster it (as Wiseman says) with Escaroticks, or the Actual Cautery.

XXIV. The Medicaments pro∣per in its first appearance, if it

arises from an Internal Cause, are such as are good to restrain its motion, and agglutinate the Ves∣sels; as fine Bole, Terra sigillata, Gypsum, Aloes, Catechu, Opium in pouder, Frankincense, Dra∣gons-blood, Blood dried, Ox∣liver poudred, fine Wheat-flower, Sal Vitrioli, Saccharum Saturni; juices of Plantane, Mouse-ear, Shepherds-purse, dead Nettles, Periwinkle, Yar∣row, and the like. Compounds may be made of the Pouders of the former, with Juices of the latter; or mixt with Vin∣egar and the whites of Eggs.

XXV. Other things also may be prepared of the roots of Com∣frey, Mastich, Pomgranate peels and flowers, Acacia, Hypocistis, unripe Sloes dried and reduced to pouder, unripe Bramble∣berries in pouder, Myrtle-berries, Nutgalls, Loadstone, Lapis Haema∣tis, Crocus Martis astringens, &c.

XXVI. But if it is in a place incapable of Bandage, you must content your self with the ap∣plication of Emplastrum Caesaris, Catagmaticum, Album, or some such like.

XXVII. If it is near the Trachea Arteria, the Patient may wear a Plate of Gold or beaten Lead upon it, covered with Sars∣net, or some such like.

XXVIII. If it lies where you may take it up, the Cure is then best performed by dividing it: the manner of the Section is thus: The Tumor or outward Skin being opened, the Artery that is to be cut, must be intercepted by binding it about with two Bands, and then it must be dissected between the two Bandages; which Bandages are not to be loosed, till Nature has covered the Wound with Flesh, and the danger of an Hemorrhage is over.

XXIX. But as this is an Operation so cruel, that few or none will submit to it, so has it likewise much of danger in it, nor has the Sick always cure by it: for upon loosning the Bandage, either an Hemorrhage may be feared, or else a new Aneurysma may be caused.

XXX. If it is only a small Aneurysm, wherein the inner Coat is only broken, the outward di∣lated or extended, the manner of the Operation out of Paulus Aegi∣neta, lib. 6. cap. 37. is thus: Let a streight Section be made long-ways, then part the lips of the Skin far asunder by little Hooks, so that the Artery may be made bare, severing it from the Membranes by Instru∣ments fit for this purpose: then after the transmission of a Needle under it, tye it with double Threads; and with a Lancet or Incision-knife, prick the middle of the Artery, that what is contained therein may be evacuated; after which ap∣ply Suppuratives, till at length the tyes of the Threads fall off.

XXXI. But if there is the rupture of both Coats of the Ar∣tery, let the Skin be divided, and the Artery tied both above and below; and cut out the middle with the Tumor, not loosing the Ligatures, till the Wound is perfectly cured,

and there is no fear of an Hemorrhage.

XXXII. Immediately after opening of it, the Hemorrhage of the Part ought to be stopt with Astringent Pouders, and Sty∣pticks, either Pouders or Waters; such as we have prescribed in cap. 11. sect. 111, 112. aforegoing; or the Royal Styptick, over which a Compress is to be put. This Method of curing by Se∣ction, is so cruel that few will endure it, besides the hazard and danger that is in it: Wise∣man says, you ought well to be advised, before you attempt the Cure by opening it.

XXXIII. If it is caused by Putrifaction of the Blood, and it burst forth suddenly upon you, the Life of the Patient will be in danger: then you must be quick in application of Restrictives, Astringents, or Stypticks, and good Bandage: after which you have time to consider what to do against the next Dres∣sing or Eruption; for if it breaks not out again of it self, you are not to open it; and for the future, you must en∣deavour the Cure by the Me∣thod that hereafter will follow.

XXXIV. In great Aneurysms, Sennertus says, the more secure and safe course is only to bind hard, and press together the Tumor with Medicaments (Compress) and Bands, that it may no farther augment. But Barbett says, that by reason the Ope∣ration at Sect. 30. and 32. above is dangerous, painful, and trou∣blesom, and many times of little benefit; it is better, to preserve Life, to amputate or cut off the Member.

XXXV. If the Aneurysm is caused by a Puncture in Blood∣letting, you may permit it to bleed freely; but if it bleeds not well, immediately loosen the Bandage, and apply a Compress with Styptick Pouders, or dipt in the Royal Styptick Liquor: or for want of them, in Oxy∣crate.

XXXVI. Let it be held firmly upon the Apertion by a Servant, whil'st the Artist makes Revul∣sion by opening a Vein in the other Arm, by a long evacua∣tion, to fainting, if requisite.

XXXVII. Mean season apply Astrictive or Styptick Pouders to the Arterial Wound, with good Restrictive Emplasters over it; defending the upper part of the Arm, by application of Cloths wrung out of Oxycrate: then with a Rowler with two heads, rowl it two or three times upon the wounded Part; and (the Arm being bowed the while) rowl the Arm upwards, and turning the Rowler about the Neck, return it again backward to the Part affected, fastning it on the outside of the Arm; and make the Expulsive-bandage from the Hand upwards.

XXXVIII. This Rowling and Bandage ought so to be done, as to be for the ease of the Patient; let him then be put into his Bed, and his Hand placed upon his Brest; and give him cordial and cooling Juleps, Opiates, &c. to quiet and allay in some measure the motion of the Blood.

XXXIX. The Bandage being thus well made, open it not hastily, because many times the first dres∣sing secures the Patient. The great mischief in this Cure proceeds from Ignorance, in binding up the Arm carelesly; upon which the Patient the next day complaining, he em∣brocates and foments the Tu∣mor; thereby making way for the Blood to empty it self into the interstices of the Muscles, causing a Tumor of the whole Arm.

XL. In this case, Wiseman says a laced Sleeve and Glove may be of great use. If this Method fails, the Cure is to be performed by the Directions before delivered.

CHAP. XVI. Of VARIX.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, by Aristotle, hist. Animal. lib. 3. cap. 11. and Plutarch, in vita Caii, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. but by Galen, meth. Med. lib. 10. cap. ult. out of whom Paulus Aegineta, lib. 6. cap. 82. and Aetius, Tetr. 4. Serm. 2. cap. 48. have it, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Venae dila∣tatio; in Latin, Varix; in English also Varix; and the Dilatation or Widening of a Vein.

II. The Signs. Varices are easily known, let them happen in what part of the Body soever; by their turgency, their crooked figure, and azure or blew colour; which is more or less evident, as the Veins lye superficial, or more deep.

III. The Veins are much larger swoln, blacker than formerly, soft, easily yielding to the Fingers, and as soon returning again.

IV. In a Hernia varicosa, there is an unequal knotted Tumor in the Vein leading to the Testicle, with relaxation of the same Testicle; and if the Testicles are filled with Wind, the Vein is also distended, and painful.

V. The Places. They may hap∣pen in divers parts of the Body, but most frequently in the Thighs, Legs, Testicles, (which Tumor is specially called Kir∣socele) and Fundament, in the Hemorrhoidial Veins.

VI. They often happen also in the lower parts of Womens Bel∣lies, under the Navel, (caused in them many times from hard labour:) and sometimes in the Temples, as Paulus in the place mentioned, testifies.

VII. The Causes. Galen, de Atra bile lib. cap. 4. says, They are generated from great store of melancholy Blood, which Nature oftentimes transmits unto those Veins which are in the Thighs; by which being distended and dilated, they are rendred va∣ricose, or swoln up, and the

Skin that touches them, becomes in process of time of a black colour.

VIII. But if the Blood is not adust, or mixt with Melancholy, then the colour of those Veins being dilated, will scarcely ever be of that black hue, as in the former case is declared; nor indeed does good Blood, tho' never so plentiful, scarcely ever produce Varices, without it be thick, which by its weight tends down∣wards upon the Thighs.

IX. Hippocrates, in Coacis Praenot. versus finem, says, Va∣rices happen not till ripeness of age; for that a thick and me∣lancholy Blood is not generated sooner in the Body: and in∣deed they often happen to Men of a Melancholy temper, Women with Child, and such like.

X. The more remote Causes, are all those things which produce and breed melancholy Blood; especially a distempered Spleen, which helps towards the gene∣ration of these Varices.

X. Wiseman says they proceed from the Restagnation of gross Blood; which being transmitted into the Veins, either by reason of the depending of the Part, or from some other pressure upon the Vessel; or else by its own grossness, proves unapt for Circulation.

XII. So that instead of con∣tinuing its current proportionably to the other Parts, it stops in the place, and as it were coagulates or thickens; and by degrees in∣creases it self by the accession of the like particles of the succeeding Blood; and thereby dilates the Vessels into a capacity large enough to receive it: but this thickning of the Blood in a Varix, is not so much as to stop the passage wholly up; for the current always forces its thinner parts by the sides of the Coagulum, and so increases the dilatation.

XIII. This Affect most com∣monly happens in Cutaneous Ves∣sels, where the Veins have little or no assistance from Muscular Flesh; which by a continual pressure forces the Blood for∣ward, and permits it not to stagnate.

XIV. Another Cause may be, from the weakness of the Vessels, either natural or accidental; in which the valves of the Varicose Veins are so feeble, that they cannot sufficiently support the Blood in its ascent; but falling down again upon the sides of the Vessels, its weight proves too much, or rather an over∣match, for its circular mo∣tion.

XV. The Veins prove varicose many times, in Women with Child, from that exceeding thickness of the Blood; occasioned from its being robbed of its nutritious Serum; and sent partly to nou∣rish the Foetus in the Womb.

XVI. The Veins are also varl∣cose in Cancers, either from the coagulation of the Serum, or gru∣mousness of the Blood some where in its passage; by something pressing upon the Part, or some compression made by the matter of the Tumor; by which it happens, that the current

of the Vein beyond it is stopt, and so is forced to swell.

XVII. In a Woman with Child, if the burthen lyes vehemently, or presses much upon the Ramus Illiacus, on either side of the Body, it makes the Thigh and Leg on all that side va∣ricous.

XVIII. The external Causes are, from too strait Gartering, which may cause Varices in the Leg: so the weight of the Te∣sticles, or pressure of a Bolster-Truss in a Rupture may render them varicose.

XIX. Riding much on horse∣back does the like; because of the pressure made upon the in∣side of the Thigh by the Sad∣dle, more especially if riding with long Stirrups.

XX. They may also proceed from Blows, overmuch strainings, as in the Bellies of Women who have hard travel in Child-bearing, long and tedious Foot-journeys, extream hard Labour, and the like; where the continual standing puts the Muscles up∣on contraction; whereby they press upon the upper Branches of the Thigh-Veins, and so straiten them, and hinder the free ascent of the Blood.

XXI. The Prognosticks. Va∣rices are not dangerous in them∣selves; for they rather free the Patient from imminent and dan∣gerous Diseases; especially such as proceed from Melancholy.

XXII. Hippocrates, lib. 6. aph. 21. says, Insani si Varices vel Haemorrhoides supervene∣rint, Insaniae fit solutio: i. e. If Varices or the Hemorrhoids happen to such as are Mad, they are thereby freed from their Madness. Moreover, the whole Body is by them throughly purged from all the flatulent Blood.

XXIII. Galen, de Venae se∣ctione, adversus Erasistratum, cap. 6. & libri de Atra Bile cap. 4. says, that Madness, Pleurisies, Pain of the Reins, Hemorrhoids, Coughing, Spit∣ting of Blood, Apoplexies, Cachexies, Dropsies, and other Diseases may arise from their being unreasonably taken away.

XXIV. And if they break, and flow intemperately, they may also cause Cachexies, Dropsies, Con∣sumptions, and other the like Diseases: and Sennertus says they are sometimes changed into the Elephantia Arabum, which is a cancerous Tumor of the Feet.

XXV. The Cure. These Vari∣ces ought not to be cured, unless they be very great, and that the Veins and Skin by reason of their extension are so exte∣nuated, as to endanger a Ru∣pture; whereby a great profu∣sion of Blood, and Death it self may ensue.

XXVI. Nor are they to be cured, unless they be inflamed, or extreamly painful, or if there is present some great and mali∣gnant Ʋlcer; lest they being removed, some more vehement mischief should ensue; since those things only may be said to cure, that wholly frees the Patient, not causing or gene∣rating Diseases more dangerous than the former.

XXVII. But if there is a ne∣cessity of curing them, the Cure must be begun with Purging and Bleeding; not once or twice, but often to be repeated, letting forth some of the Blood in the Varix: and whatsoever is amiss in the Liver and Spleen, or other Viscera, is to be corrected and amended, by altering, strengthning, astringent, and exsiccative Medicaments.

XXVIII. If the Varix is small and inconsiderale, Aquapendens orders it to be cured by Astringents: as, ℞ Gum Tra∣gacanth, dissolve it in Astringent Wine, or in juice of unripe Grapes, or of unripe Bramble-berries; to which add fine Bole, Mastich, Sanguis Draconis, Catechu, Ana, all in fine pouder; so much till the Tragacanth becomes as thick as Wax; so that in the palm of the Hand it may be reduced into the shape and form of a Wax-Candle: and sometimes also he used Hypocistis, for the same purpose.

XXIX. These Medicaments he applied, according to the length of the Varix, binding it down with a part of a Reed tied fast thereupon, with a narrow Band∣age; and over all, a Hose, or Buskin, made of a Dogs skin, which he put about, and fastned it about the Thighs, by lacing it on.

XXX. Hippocrates, in his Book of Ʋlcers, teaches us how to make an Evacuation of the Blood, that is already flown in. The Vein (says he) is not to be cut with any great and wide gash, lest thereby a great Ulcer should be caused; but the Varix is again and again to be pricked, whensoever it shall be fit; by which means, the Blood already flown in will be evacuated. And this you must do by little and little, not all at once, but as it were by degrees, till the Vein does even fall down and sink; upon which then it will be good to apply such Astringents, as we have mentioned before (at Sect. 28.) with good and strong Bandage.

XXXI. Aquapendens approves not much of the Chirurgick way of Cure, whether it be by Section or Burning; but thinks the Work is better to be done by inter∣ception of the Blood, with Astrin∣gent Medicines and strong Band∣age: and of this opinion is Mr. Wiseman. However, be∣cause we are willing that young Artists should know the Way of doing these things, we will give the Method of the Ope∣ration, from Paulus Aegineta, Corneiius Celsus, and Avicenna.

XXXII. From Paulus Aegi∣neta, lib. 2. cap. 82. Tye a String (says he) about the upper part of the Thigh, and cause the Diseased to walk, that the Varix may fill; then mark it with Ink, according to the situa∣tion, the length of three Fin∣gers, or more.

XXXIII. 2. After lay the Patient on his back, with his Thighs extended; and with an∣other String bind the part above the Knee; so will the Varix be filled, or lifted up a considerable height.

XXXIV. 3. And with an

Incision-knife, in the place marked, cut, but only no deeper than thro' the Skin, by no means dividing the Vein: distend the lips of the Section or Skin, with a little Hook; excoriating or flaying off the Membranes with a crooked Incision-knife, sò that the Vein may be laid naked and bare.

XXXV. 4. Then loosen the Thigh-bands, and by a little Hook, elevate the Varix; under which put a crooked or bowed Needle, drawing with it a double Thread, cutting in two the bow.

XXXVI. 5. This done, divide the Vein in the midst with a Venesectory-incision-knife, and eva∣cuate or let forth the Blood, as much as is needful; and by squeezing it out with your Fingers, if occasion requires it.

XXXVII. 6. After this, with one of the Threads tye close toge∣ther the upper part of the Vessel; and the Thigh being extended streight out, with your hands press forth the Blood which is in the Thigh: then with the other Thread tye close together the nether part of the Vessel or Vein.

XXXVIII. 7. This done, you may now either cut off and take quite away, that part of the Vein which lyes between the Ligatures; or otherwise let it remain, till at length, with the Threads it falls out of its own accord.

XXXIX. 8. The Operation being over, put in drying Lini∣ments, or styptick Pouders, and over, a long spleen-like Empla∣ster, after it has been throughly washt in Wine or Oxycrate, or with some styptick Liquor: then bind it down close, and cure it according to Art.

XL. From Cornelius Celsus, lib. 1. cap. 31. where he shews the Operation by Cutting, much as is before declared; and also by Burning with a red-hot Iron, in this manner.

XLI. Si recta est, si quamvis transversa, tamen simplex, si mo∣dica est, meliùs aduritur. Ad∣urendi ratio haec est. Cutis super∣inciditur; tum patefacta Vena, tenui, & retuso, Ferramento can∣dente modicè premitur; vitaturque, ne Plagae ipsius orae adurantur, quas reducere hamulis facile est. Id, interpositis ferè quaternis di∣gitis per totum Varicem fit, & tum superimponitur Medicamen∣tum, quo adusta sanantur. Viz. If the Vein is streight, or tho' it may be transverse, provided it is single; or if not very great, it is better to be cured by Burning. The manner of of which Burning is this. The Skin is first to be opened by incision, then the Vein being laid bare, it is moderately to be pressed down or burnt with a small and blunt Cauterzing-Iron made red-hot; and great care is to be taken, so to shun the lips of the Wound it self, that they be not burnt; which to reduce again with small Hooks, will be easily done. This may be performed by in∣terposing four or five fingers in a row, thro' the whole Varix, and then applying such a Medi∣cine, by which the parts burnt may be healed.

XLII. But, says he, if the Veins or Varices are crooked, and are as it were implicated into certain orbs or bunches: so that many of them are as it were involved and folded one within another; it is then more con∣venient to take them forth by Section, as is before de∣clared.

XLIII. Avicen, lib. 3. Fen. 17. Tr. 1. cap. 18. advises to cut the Skin, till the Varix appears; and this is indeed to be done long-ways, and not either obliquely or trans∣versly; then you must extract all the Blood that is in it, and cleanse it, by cutting it in length. Again, sometimes it is to be drawn forth with a Needle, and so to be cut: and sometimes the taking it forth with a Cautery, is better than the cutting it forth.

XLIV. Wiseman, l. 1. c. 14. says, If you proceed by Section, that you must divide the Skin, and separate the Teguments, and having raised the varicous Vein; you are to pass a Ligature above, and another beneath it, making a deligation of them; then slit the Vein, cast out the gross Blood, and afterwards digest and heal it, as you do in an Aneurysm.

XLV. Fabricius Hildanus, Cent. 4. Obs. 85. has this History. An extraordinary strong Man had in his left Leg a malign and inveterate great Ulcer, to∣gether with a Varix of a vast magnitude, equal in thickness to the brawny part of the Arm above the Wrist, and nearly a span long.

XLVI. It began in the very Ham, and descending towards the Foot, it made a ring, and two circumvolutions: whenever he lift up his Leg any thing high, the Blood presently fell back; and putting it down again, it immediately descended.

XLVII. He instituted a fit course of Diet, several times purged him, bled him in the Arm of the same side; and placing the Patient on a Bench, in the very Ham, he gently separated the Skin from the Vein it self.

XLVIII. Then with a Thread twice doubled, and put into the eye of a crooked Needle, he wound it about the upper part of the Varix, and in like manner in the lower part of the same: then he caused his Leg to be taken off the bench, and set upon the ground; that the Blood ac∣cording to its custom might flow downwards: after which he tied the Thread hard, and made fast the knots at both ends of the Varix, both upper and lower.

XLIX. After, with an Incision-knife, he made an Incision almost in the upper part of the Varix; that the Blood contained there∣in, as in a long and little Bag, might flow forth.

L. But the flux of Blood proving to be greater, than what was proportionable to the Tumor; he exactly viewed the place, and found a blind passage in the lower part of the Ligature, which entred into the Varix, from which the Blood flowed.

LI. This, because it could not

be tied with a Thread, he first applied to the entrance thereof, the Escarotick Ʋnguent; and af∣ter that, he put on in great abundance his own Astringent Pouder, with the white of an Egg for stanching the Blood.

LII. All these things he bound fast 〈◊〉〈◊〉, with a Swathband throughly moistned in Oxycrate, which he left till the following day: after which he healed the Wound after the usual manner of a Vulnerary Cure, and in a short time the Man became perfectly well and sound.

LIII. But after all, the Pallia∣tive Cure, with Aquapendens, Sennertus, Wiseman, and others, is rather to be embraced, than this of Section.