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 ...

The Signs of the Fluxing Kind.

XXV. To distinguish these in Name from the Phlyctaenae, or Ignis sylvestris, mentioned Lib. 2. cap. 25. we will henceforth call them 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, i. e. Phlyctaenae morbidae; because they shew forth a very corrupting and vehement Disease. And therefore in this Fluxing kind, tho' the Symptoms are nearly the same, yet they are much more corrupting and vehement: for it is this kind chiefly, which leaves pits, scars, or seams be∣hind it, by reason it corrupts or eats the place upon which the Humor lyes.

XXVI. The Fever in these, as also the sickness at Stomach, nauseousness, or inclination to vo∣mit, anxiety of Mind, and rest∣lesness of Body are much more vehement; and they come forth on the third day, or sooner, seldom later; and the sooner they are protruded, the more apt they are to Flux, or run together into one.

XXVII. But sometimes thro' the violence of other Symptoms, as vehement Sickness at Stomach, with Vomiting, or a Looseness or Flux, which accidentally happens

before the breaking forth of the Pox, and continues a day or two after, (which scarcely ever hap∣pens in the former kind:) or a Catarrh, or any great Hemor∣rhage; whether by the Nostrils, Urine, or Stool, the protrusion of the Pustules are retarded till the fourth or fifth day.

XXVIII. So that it appears, that the separation of the Mor∣bifick-matter, and febrile Ebul∣lition or Fermentation, are in the first three, four, or five days: But the real protrusion or coming forth thereof, is per∣fected by Nature in some suc∣ceeding time: in little Abscesses arising in the Skin, which, the Humor being serous, and more fluid, with the dissolution of a very sharp Salt, causes a fluxing of them one into an∣other.

XXIX. Many times, thro' the ill managing of the Sick, several bad Symptoms succeed; as Sleepi∣ness, Watchings, Phrensy, Light-headedness, or Dotage, falling down of the Pustules or Wheals; with sometimes little black Spots on the heads of them; or a depression in the middle, pur∣ple Spots being scattered almost every where between the Pu∣stules; together with spitting or pissing of Blood, or some other Hemorrhage; or a suppression of Urine, pain, restlesness, trem∣bling, &c. many of which Symptoms happen in the first six, or seven days of the Dis∣temper.

XXX. The Pustules come out sometimes after the manner of an Erysipelas, (but none but Fools and Ignorants will call it an Erysipelas; for where the Small-Pox is, that is Disease enough of it self, without the addition of any other:) and sometimes like the Measles, (yet 'tis no Mea∣sles) which may be distin∣guished by the differing signs of the Disease, and the time of breaking out.

XXXI. A kind of Catarrh, or Spitting, sometimes in persons of ripe age, begins at the time of breaking forth; sometimes two or three days after, spit∣ting at first a thin matter; which on the tenth or eleventh day grows more viscous or thick.

XXXII. And a Looseness or Flux in Children and the younger sort, is apt to seize also, before the breaking forth of the Pox, and many times continues a day or two after, which scarcely ever happens in the former Pustular kind: but this Loose∣ness seizes not so early, as the Catarrh or Spitting does Men.

XXXIII. Whil'st the Disease is in the increase, the Pustules rise not to any eminent height, but rather run together like red Blisters, in the Face; (so as many times to cover the whole Countenance) and many other Parts; which by reason of the fluidity of the Humor, swell sooner than the Pustular kind.

XXXIV. Afterwards, they seem to be like a white Bladder or Skin, and in the Face, are not much higher than the surface thereof; tho' the whole Face seems to be extreamly swelled:

those which are in the Hands and Feet are larger, and the farther or higher you go from the extremities of the Limbs, the lesser they are.

XXXV. The eighth, ninth, or tenth day sometimes, being past, the white Skin grows daily (but gradually) rougher and rougher, and of a brownish colour; and the pain in the Skin is more intense, till the Scabs fall off; which in this so vehement a Disease, seldom happens till after three Weeks are past.

XXXVI. The Symptoms do not immediately abate, after the coming forth of the Pustules, as they do in the Pustular sort; but the Fever, and the other Sym∣ptoms do continue also to vex the Sick for many days afterwards. And as in both kinds, the Fever is present from the be∣ginning to the time of pro∣trusion or eruption; so it continues to the time of full ripeness; after which it sensibly abates, and vanishes away of its own accord.

XXXVII. During the extream heat of the Fever, the Sick seems to be as it were in a Furnace or Oven; and it is generally accom∣panied with great Thirstiness, and sometimes a Hoarseness; and a Cough many times seizes them as they drink, making the Drink to come forth thro' the Nose.

XXXVIII. You must note also, that the nearer the Pustules or Bladders are to ripening, the more brown they grow, and indeed so much the more dangerous they are: but the yellower they are, the less they flux or run toge∣ther, and the more quickly go away.

XXXIX. Presently after the Scabs or Skin are come off in the Face, it is spread over with a kind of mealy or white Scales or Scurf, of a very eroding nature, which many times causes pits, scars, or seams; and tho' then the swelling of the Face should decline, yet it goes not wholly away, till some days after.

XL. The Prognosticks. If the Sick is so violently thirsty, that nothing can quench it, grows hoarse, is extream sleepy, or le∣thargick, and his Catarrh or Spitting ceases; without any apparent swelling of the Face and Hands, beginning, and con∣tinuing till the Pustules are fully come out, conclude Death is at hand.

XLI. The greater, and more in number the Pustules, chiefly in the Face, the greater the danger: the lesser and fewer, provided the Sick has no heart-sick, fainting, or swooning Fits, the less danger: and if they be of a violet-colour, green, or livid, or black, they are dangerous, and for the most part mortal: so also if they strike in again.

XLII. The Fever increasing after their being full come out, difficulty of Breathing, unquench∣able Thirst, Looseness, Bloody-flux, bleeding at Nose, or otherwise; and black or blew Spots, with black or livid Urine, are all signs of Death.

XLIII. A suppression of all Evacuations in the state of the Sickness, a Frenzy, or Lethargy

after the eleventh or fourteenth day, great quantity of Ʋrine, the Fever not abating; plentiful Sweats, not diminishing the Dis∣ease; a violent Flux in the beginning of the Disease, and continuing; the eruptions small, and of an evil colour, where the putrifaction is great, if they fall back again, tho' not quite in, (whereby the malign Morbifick-matter retires to the more noble parts,) all these are signs of Death.

XLIV. If they be slow in coming out, or they be hard, or vastly great in number, or if they touch one another; or the Sick breathes not freely, or the Fever abates not after their breaking forth; or if there is violent Vomitings, Sickness at Heart, Fainting, or Swooning; or there be Frenzy, Delirium, Raving, or Dotage, or Convulsions with raving, trem∣bling of the Hands and Tongue, or Heart-burning, or Hiccough, great loathing of Food, many and violent Excretions in the beginning and increase of the Disease. These Symptoms, I say, tho' they are not always mortal, yet they are very evil, and exceeding dangerous.

XLV. The Pulse like that in perfect health, is dangerous, for Nature out of weakness concocts not the Humors: and then tho' the Sick seems freed from his Fever, yet he grows worse and worse, and draws towards death.

XLVI. If they come easily out, and easily, or soon ripen; if there is Sneezing (provided the Lungs are sound) or a suppression of all Evacuations, in the beginning and augmentation of the Disease, or Deafness in the state of the Disease; or the Urine is with signs of Concoction, or the Symptoms be not great, or there are Critical Sweats, or other Critical Evacuations, in the state and declination, wherein the Sick is better after them: these, I say, are all Signs of good Health, and Recovery.

XLVII. However, whil'st the Disease is in its beginning and increase, it will be prudence to suspend judgment; for it will be dubious and uncertain, till about the end of the state or declina∣tion. And if you would give a more exact and perfect judg∣ment, you ought diligently to study and learn Our Prognosticks, which we have largely and clearly delivered, in the Third Edition of Our Synopsis Medicinae Lib. 1. from Chap. 46. to Chap. 66.

XLVIII. The Cure. The Indi∣cations of Cure are fourfold, and have respect, 1. To the Nature or Essence of the Disease; which is to drive from the Centre to the Circumference. 2. To the Cause; which is the Morbifick-matter to be protruded, or thrust forth thro' the Pores of the Skin. 3. To the Symptoms; so as to secure the first Indica∣tion, and in the due time to abate them. 4. To the Vital Indication; which has respect to the strength or weakness of the Sick: all which we shall pursue (thro' God's assistance) in the following Discourse, and in their due Order.

XLIX. But before we enter

upon the true Method of Curing, we think it necessary to reflect upon the present Mode of Pra∣ctice, now managed by some per∣sons, who are thought to be Men of great Names, but lesser Skill; as it has relation to Bleeding, Purging, and Blistering; where∣in we hope to deliver our Mind, with a kind of Demon∣stration: especially being con∣sidered with respect to the un∣erring Principles of Our Art.

L. I know I cannot do this, without meriting the Malice and Envy of some particular Men; but the truth of it is, it is of such as are my profest Enemies, and such as have determined, and publickly declared my Ruine and Destruction; who have already by all unjust methods at Law persecuted me, and still con∣tinue to do the same. But on my part, I oppose them not for malice or envy sake, nor with any respect to the Evil they have done me; for I freely forgive them all: but only for the sake of Truth, which I desire to bring to light, for the benefit of Mankind in general.

LI. I cannot think without terror, of the Death of Her late Majesty, when I consider with what Methods She was managed. I must confess, I would not hazard a Negro, (whose Life I may value but at 20 l.) under those pernicious courses of Bleeding; but infinitely less, that of so good, and so great Queen: a Life so valuable, that nothing can be put in the balance against it: since other courses may be pursued, with a thousand times less danger.

LII. But what shall I say in this case? 'tis the eternal fate of the Great, to fall under such ill circumstances, and under such Fatal Mens hands: and for this, we have the Authority of the Poet; as you have it in Mr. Gould's admirable Poem up-Sn the Memory of Her late oacred Majesty, QUEEN MARY, in the following Lines or Words.

Ye Sons of Aesculapius, boast no more, That you the Weak to Health and Strength restore: Vain is your Learning, and your Art a Cheat; At least, 'tis ever Fatal to the Great. All you can do, is but [hap-hazard] Guess, And a whole Colledge has the worst Success. For like a two-edg'd Sword, you both ways slay;

I add this Line.

By want of Skill, and sometimes by foul Play.

Who under you escape, had yet no doubt, Sooner recover'd to their Health without. You are your selves an Epidemick Ill: For one you let escape, you thousands kill. To Plagues and Pestilential Blasts a-kin; Their Poisons reign without, but yours within.

From you, 'tis weakness to expect Relief; Both Atheists in your Practice and Belief. From GOD, can Favour on your Work be shown, When you so boldly argue there is none? Those that would live, must your Prescriptions shun:

I add:

Who Sacrifices to your Net 's undone. Under this just Reproof, you justly stand; Y' are evil Omens to our mourning Land. Night-birds, and Birds of Prey, foreboding ill; Who ne're approach, but with design to Kill. Where th' Carcass is, like Vultures you resort; And if you come, Death makes the Dire Report. We call to Witness our Indulgent QUEEN, Who, we believe, had liv'd, had you not been. We cannot help Our Faith; Believe we must: And We believe She 'd liv'd, had some been just. Your Prescripts are but formal Acts of Fate; Who scapes your Hands, you think does dye too late. Death's Harbingers you are; you go before. And to its splendid Entry ope the Door. Abandon them, my Soul! and fly, my Heart! And let me dye by Nature, not Their Art.

LIII. Haec autem obiter. Now to the purpose in hand. First, as to Bleeding: it is my Opi∣nion, that it is against all the Indicationes Curativae; and this we shall endeavour to prove or demonstrate to the Under∣standing, from the following Arguments.

LIV. Either there are Princi∣ples in Our Art, upon which we build, and by which we ought to be guided, or there are none. If Our Art consists of Principles, we ought either to Act by, and ac∣cording to them, or not: if we ought, then all the Indications or Methods of Cure in every Disease, are to be squared according to those Principles; and he that Acts not according to those Precepts, shews him∣self to be a Cheat, Ignorant, or something worse. But if we ought not to walk by them, then it is manifest, that the Art it self is precarious and vain; and they are all Fools, who make it their Business to study and break their Brains about an Art, whose Principles have no Worth or Usefulness in them.

LV. But if the Art is built upon no Principles, but that all that is done in it, is only Opinion, Chance, and Hap-hazard; then the Art it self (as it is called) is no Art, but a meer Cheat, and Delusion; the Profession thereof all Trick, and Designing: and the Practice thereof tho' under the most specious title of Doctor or Collegiate) nothing but Vil∣lany, Impudence, and Quacking.

LVI. But we presume, the Pro∣fessors thereof will readily grant us, that the Art is built upon Principles, that those Principles are rational, and the Indications of Cure raised from them, reasonable, and necessary to be followed. And that he that acts not by those Principles, acts precariously and dangerously, as to the Patient; and his Practice, as to himself, is meer Confidence and Quack∣ery.

LVII. If this is granted, we will then consider the Indicatio∣nes Curativae, in this particular Disease, as built upon those Prin∣ciples: and they are four, as you may see in the third Edi∣tion of Our Synopsis Medicinae, Lib. 1. Cap. 75, 76, 77, 78, 79, and 80. and so are taken, 1. From the Nature or Essence of the Disease. 2. From the Causes. 3. From the Sym∣ptoms. 4. From the strength or weakness of the Sick, which is called the Vital Indication, all which we shall consider di∣stinctly, with reference to Bleeding, &c.

LVIII. The Essence and Nature of this Disease is, to protrude or thrust forth the Morbifick-matter, from the Centre to the Circum∣ference. And therefore, what∣ever Methods are taken contrary to this Indication, must be extreamly prejudicial to the Sick, if not destructive and fatal.

LIX. Now Bleeding (tho' many rash and ignorant persons use it in this Age, in the Cure of this Distemper) is diametrically oppo∣site to this Indication: For all Physicians account Bleeding a Revulsive Remedy, which calls from the Circumference to the Center: and if so, then the Morbifick-matter, which ought to be thrust forth, is imme∣diately drawn into the Blood by the Veins, (for they will be filled again) and so by Circu∣lation conveyed to the Heart.

LX. From whence we con∣clude, that unless the Disease is very gentle, the Morbifick-matter but little in quantity, and the Patient very strong, and natu∣rally of a good habit of Body; if this Remedy be used, the Sick must patiently submit to his Fate; for Death stands at the door: as we have in some hundreds of Patients particu∣larly observed.

LXI. The second Indication arises from the Cause, which is the Morbifick-matter to be thrust forth; that we may hinder the augmentation thereof for the future, which Nature now endeavours to diminish by cast∣ing forth.

LXII. But Bleeding is opposite to this Indication: for the evil Matter now in part protruded, thro' the Fermentation of the Blood and other Juices, being by this means drawn into the Blood again; the whole Mass thereby becomes in a very short time putrified, and all the Juices of the Body converted into the very Matter or Cause of the Disease.

LXIII. This augmented or mul∣tiplied Putrifaction being thus joined again with the Blood, which Nature had been for a long

time before separating, by Cir∣culation with the Blood comes to the Heart and smites it, empoisons the noble Parts, stagnates the bloody Juice, and suffocates the vital Flame.

LXIV. The third Indication of Cure, has respect to the Symptoms. Where the Symptoms are more extream, and shew more danger than the Disease, the Intention of Cure is to be directed to remove, or alleviate them. But where the Disease is more vehement, that is first to be considered, because upon the remedying of that, the Symptoms of their own accord cease or vanish.

LXV. So in this Disease, the Fever is one of the Symptoms, which tho' never so strong and intense, is never so dangerous as the malign matter to be protruded: and is therefore here to be neglected; and not only for that Reason, but for another more powerful, viz. because it is assistant in expelling the Morbifick-matter.

LXVI. The diminution then of the febritick Heat is to be avoided, yea it ought to be kept up to the height; otherwise the pro∣trusion will be weak and imper∣fect, and in general proves fatal to the Sick. 'Tis a great error indeed, to cause an abatement of the Fever; for 'tis the strength and height of the Fever, which saves the Life of the Patient.

LXVII. 'Tis that violent Heat, which is the effectual Cause of a compleat protrusion of the Mat∣ter into the surface of the Skin: and not only so, but 'tis also the cause of a more speedy expulsion, and bringing the Disease to a much more speedy, healthful end.

LXVIII. For the more languid that Heat, the more danger; and if the Fever goes either quite away, orconsiderably abates, 'tis a thou∣sand to one but the Sick dies suddenly, or in a little time becomes past all hopes of reco∣very.

LXiX. But if the Heat be conserved, and the Fever let alone, you will see in a short time, by the plentiful eruption of the Pustules, (if there is a plenty of the Morbid-matter) that the danger of Death will quickly be over, to the great ease, comfort, and satisfaction of the Sick.

LXX. And that after Nature has made a sufficient protrusion, the Fever it self (for want of fuel) will presently vanish of its own accord, without the help of any Medicine: and this is that which in the space of thirty-three Years Practice, I have, I believe, above a thousand times observed.

LXXI. It is objected, That by the violence and continua∣tion of the Fever, the Small-pox may come forth too plentifully; or much more than otherwise they would do; to the great prejudice, and greater danger of the Sick. We readily answer, 1. That they cannot come too plenti∣fully out; for all the Morbid-matter, which Nature has pre∣pared, and separated from the Blood and other Humors, ought to be expelled. 2. That there

is no danger to the Sick, simply by their coming forth plenti∣fully: but directly on the con∣trary, the danger is, if they do not come fully forth, as they ought to do.

LXXII. If there is not a plenty of Matter to be expelled, they cannot come plentifully forth: but if there is a plenty of that Matter, it ought to be all expell'd, otherwise several in∣conveniences will unavoidably ensue.

LXXIII. If the Body is weak, and the Constitution very faulty, as Cachectical, Scorbutical, &c. the not coming compleatly forth, for the most part, hazards the Patient's Life. But if the Sick is of a strong habit and consti∣tion of Body, whereby Nature is so able to contend with the Disease, as to vanquish the dan∣gers of Death; then some evil Symptoms, as running Sores and Ulcers, Scabs, Itch, Biles, &c. are apt to seize upon the Patient; in some presently; and in others, in some little time afterwards.

LXXIV. Or else some other pernicious and ill-natured Disease is apt to seize and afflict them; as the Scurvy, Leprosy, Kings-Evil, Consumption, &c. which by reason of the remaining universal defilement of the Body, will not be easily ma∣stered or overcome; without much trouble, and long and tedious courses of Physick.

LXXV. It is also to be ob∣served, that the greatness of the Fever, is in proportion to the prepared and separated Morbid-matter now ready for expulsion: if it is little in quantity, the Fever is never great; and some∣times, where the Pustules are very few, as here and there one) scarcely to be discerned; so that the Patient goes up and down the House, as if nothing ailed them. But where it is much in quantity, the Fever is great, and always in proportion to the Matter to be expelled, as it were by Natures designa∣tion.

LXXVI. 'Tis also observa∣ble, that more Matter than Nature has prepared and separated, will not be protruded, do what you will, neither by the height, nor continuance of the Fever, use of Sudorificks, or any other means whatsoever. And therefore, what Matter the has separated for expulsion, ought not to be pre∣vented, by abating the Sym∣ptoms thro' Bleeding, lest other greater evils do ensue, as we have before declared.

LXXVII. The last Indication of Cure, is the Vital Indication, respecting the strength or weakness of the Sick, against which Bleed∣ing is diametrically opposed. For take away the Blood, in which the Vital potency resides, and you manifestly weaken the Sick more and more, and diminish the Spirits, which ought to oppose, or encounter the Dis∣ease.

LXXVIII. For Nature thro' Bleeding, being weakned, (not only by being robb'd of her de∣fence, but by introducing an Enemy, who universaily defiles her Oeco∣nomy, and quenches the Vital

Flame) there is immediately an universal weakness spread over the whole Humane Frame, and the contest of Nature with the Disease ceases, by Natures being overcome. This Truth is so evident, that we cannot but speak it with grief, when we do but think of that late precious Life, which by that means, we faithfully believe, was lost.

LXXIX. From what has been said, it is manifest, that Bleeding in this Disease, is a very inimi∣cal course to the Patient, let the Practisers thereof say what they can for themselves: and if they alledge Experience against us, we will bring Experience against Experience; and justify by the universal Management of this Disease thro' the whole King∣dom, yea almost thro' the whole World, That above a thousand does well without it, to one that does well with it.

LXXX. And generally speaking, every one that is born into the World, and now alive, who in their order or course, have had this Disease, and have overcome it without Bleeding, ought to be opposed to the novel Practices of these times: for that thro' the whole Kingdom, yea thro' the whole Universe, there is not one to a thousand, that are let Blood in it; yea I am of opi∣nion, that there is scarcely one of ten thousand in the whole, that is; and yet gene∣rally, they live and do well.

LXXXI. Whereas, let us but examine amongst those that are let Blood, and we shall find by sad experience, that scarcely ten live in an hundred. Take an equal number on both sides, suppose a thousand which may have this Disease, and are not let Blood; we find, that by the help of a good Nurse, and care∣ful looking after, that at least nine hundred and fifty, do well; which is compleat nineteen in twenty.

LXXXII. Whereas in a thou∣sand that have this Disease, and are let Blood, at least nine hun∣dred and fifty of them dye; which is again full nineteen out of twenty. And this my own Eyes are Witnesses of: I knew ten in one Family, all which had the Small-pox at the same time almost, one after another; six Children, a Wife, and two Brothers; they were all let Blood, in order to the Cure, and were all lost: the Master of the House fell sick after∣wards of the same, and refused that course, by reason of the ill success of the other nine; and lived and did well. Now what can be said to such an Example as this?

LXXXIII. But to give Our Adversaries all the advantage that can be, suppose among those that are let Blood, the one half of them should live, yet the odds of living are on our side, who are against Bleeding. And to justify our selves in this Opinion, we will consider the whole Body of our own Nation, which you see at this day is full of People; and yet, that tho' the greatest part of them have past past this Disease, (take the whole Kingdom throughout)

not one in ten thousand of them (I mean, of them that are living) have been let Blood in this case. Which is a mighty and weighty Consideration, and worthy to be taken notice of.

LXXXIV. As for my own part, in my time of Practising, I am very confident I have had at least a thousand Patients sick of this Disease, not one of which I ever let Blood, or caus'd it be done, and yet they all liv'd and did well; nor had I ever (I bless God for it) a Patient sick there∣of under my hands, which died.

LXXXV. And yet I freely con∣fess, that the Disease is sometimes so malign and deleterious, that no Methods whatsoever can save; and therefore where I see mortal Symptoms, I always forbear med∣ling: and truly it is a great and good piece of knowledge in our Art, to be so well skill'd in the Prognostick part thereof, as to foresee the danger of the Sick; which being well under∣stood, gives the true Physician a great reputation; by avoiding the Infamy, which otherwise might attend him.

LXXXVI. If it be enquired, Whether Blood may not be taken away before their coming forth; we answer, No. In any Patient of mine, were I sure the Small-Pox would succeed, I should al∣ways forbid it: and my Reason is, because it would make the protrusion of the Pustules very languid and weak; whereby, if it did not hazard the Patient's life, yet this evil might fol∣low, that by reason thro' weak∣ness of the Expulsive Faculty, there might not be a full ex∣pulsion of the Morbifick-matter, the remaining part thereof would lay the foundation of some other more pernicious Dis∣ease; as the Measles, Leprosy, Kings-evil, Apostems, Consum∣ptions, &c.

LXXXVII. When any of the Blood-suckers Patients dye, the Pustules seem to fall in again, grow flat and dead, or to dent in in the middle; and sometimes to turn purple, livid, or black; with many livid, or purple spots in the interspaces. Then to excuse themselves, they say it was a dangerous and malign Disease, and complicated with an Ery∣sipelas, Purples, Spotted-fever, or the like; by reason of which Complication, 'twas impossible for the Sick to escape death, what course soever had been taken.

LXXXVIII. To which we an∣swer, That this is only a blind for their Ignorance, and an Ex∣cuse for their cursed Male-practice: for many (if not most) of those miserable Patients might have lived, if they had not fallen into those Blood-suckers hands: and it is for the most part Bleeding, (where the Sick dyes upon it) which is the cause of such-like Spots appearing.

LXXXIX. But as for a Com∣plication of the above-named Dis∣eases in the Small-pox, we never once knew it, in the thousand cases we have seen, nor do we believe it possible to be: it is the nature of the Disease, not to admit them. The Small-Pox is Disease enough of it

self, we need not add others to it, to make it worse.

XC. As for an Erysipelas, the Small-pox it self is so like it, in its first approaches and coming out, that it is not every one that can distinguish between them. But however, the Small pox cannot in any wise admit of an Ery∣sipelas to be joined with them; their natures are as different, as are the methods of their cure.

XCI. And when purple or livid Spots appear, upon the falling down of the Pustules, or death of the Patient, they no more demon∣strate a purple or spotted Fever, than they do the Dropsy or Gout. 'Tis the property of the Dis∣ease, when Nature is upon the yielding part, or is already over∣come, to send forth those Sym∣ptomata, as Tokens of her ensuing Fate.

XCII. These things being said, we shall now address our self to the Cure; wherein we shall do our endeavour to explicate it, according to the best Methods of Practice; and what I my self have found admirably successful in all my undertakings, where∣ever I have been concern'd in the Cure of this Disease.

XCIII. First, Purging we for∣bid, as dangerous; (almost for the same reasons as we do Bleed∣ing) lest it should induce a Flux of the Bowels, whereby their plentiful eruption might pos∣sibly be hindred: 'tis better of the two, to keep the Body Costive, than to admit of any thing which may hazard a Flux of the Belly.

XCIV. But upon the Patient's first falling ill, if the Body is Cacochymick, or has a fulness of Humors, or the Stomach is foul, or a Vomiting be present; you may safely enough give some proper Antimonial Emetick, as Vinum Benedictum, Tartar eme∣tick, and the like; because it at once empties the Stomach of abundance of filth, adhering to its Tunicles, and gives upon the spot, a wonderful relief to Nature.

XCV. But in the progress of this Cure, I think a good, honest and careful Nurse is most to be relied on; I am sure, much more than on the Blood-sucking Doctors, and No-Doctors of these times; under whose hands, the greatest part of those who fall into them, miscarry.

XCVI. If extream Thirst af∣flicts the Patient, it may be allay'd by small Beer, in which Saffron has been infused, and made pleasantly sharp with Spiritus Nitratus: or with this, ℞ Fair Water three quarts, burnt Harts-horn ℥ii. boil till a quart is consumed: towards the end of boiling put in a crust of Bread; then strain, and sweeten with treble-resined Sugar ℥ii. or better, adding also the juice of one Limon: of which give the Sick, as need requires.

XCVII. Give this every night going to bed. ℞ Our Tinctura Opii, or Guttae Vitae, or liquid Laudanum, a gut. vi. ad xvi. Spiritus nitratùs gut. xx. Milk-water, or the former Decoction of Harts-horn ℥iii. mix for a Dose. But be sure to regulate the

Dose of the Opiate, according to the age and strength of the Sick. If it is a young Child, gut. iii. or iv. may be Dose enough, and you may sweeten it with a little white Sugar.

XCVIII. And every Morning give this. ℞ Bezoar-mineral gr.xii. Bezoar-stone, Cochinel, A. gr. vi. Salt of Amber gr. iv. mix for a Dose, if it is a Man. But if it is a Child, it will serve for two Doses.

XCIX. If the Tongue and Throat are clammy, rough, hot, and dry, inject the following Gar∣garism with a Syringe. ℞ Of the former Decoction of Harts-horn ℥viii. Honey of Roses ℥jss. Tin∣cture of Saffron and Cochinele ʒiii. dulcified Spirit of Nitre gut. xxx. mix them.

C. If the Pustules seem to strike in, fall flat, or sink in the middle, let the Composition at Sect. 98. above, be repeated every six hours. Or this Mixture. ℞ Milk-water ℥viii. choice Cana∣ry ℥i. Spiritus cordialis ʒss. Tincture of Saffron and Cochinel ʒii. Spirit of Sal Armoniack, or Spirit of Harts-horn ʒijss. mix them, for four little Draughts.

CI. Or this. ℞ Our Theriaca Chymica, Electuarium Antepesti∣lentiale, A. ℥ss. mix them. Dose, à gr. xvi. ad ʒi. to be repeated every six hours, till the Pustules begin to arise again: or either of the particulars may be given alone in the same Dose.

CII. If upon the eleventh, twelfch, or other succeeding days the Fever goes not off; but that the Sick is unquiet, uneasy, and restless, and that death seems to be at the door, give the Pulvis Antifebriticus, à ʒss. ad ℈ii. or ʒi. in the Harts-horn-Decoction. Or this: ℞ Aqua Elementaria ℥vi. Spiritus Cordia∣lis ℥i. Spirit of Harts-horn ʒi. mix for a Draught.

CIII. If a vehement Flux is present, give à gr. ½ ad ii. of a simple Extract of Opium, mixt with, or dissolved in Tinctuce of Catechu; to be repeated every Night, so long as need requires, and given in the Harts-horn-Decoction.

CIV. When the Pustules are fully come out, and begin to grow yellow, the purulent matter may be let out, by pricking them with a Needle, or the point of a Lan∣cet, or cutting off their heads; after which, you may anoint them with a Feather, with the following Mixture. ℞ Sheeps-suet ℥ii. Oil of Ben ℥jss. Sperma Ceti ℥i. mix, and make an Ointment; with which anoint, 'till the Pustules are fully dried up.

CV. This is commended. ℞ Oil of Ben ℥iijss. pure white Sperma Ceti ℥i. juice of Limons ℥ss. in which let be dissolved Saccharum Saturni ʒii. mix, and make a Liniment; with which anoint twice a day.

CVI. The Scabs being fallen off, there is wont to succeed a notable Scurf, which in many eats even into the Skin: to prevent which, and to clear it of the Scurf, you must daily, two or three times a day, or as oft as you see occasion, wash with Aqua Tartarisata blood-warm; or rather with Lac Virginale,

than which I think nothing is better.

CVII. If in the beginning of the Disease, there happens to be either spitting or pissing of Blood, or a Bloody-flux, you must ne∣cessarily give Our Tinctura Mi∣rabilis, à ℥ss. ad ℥i. mixt with some convenient Vehicle. Or this Pouder: ℞ Catechu in pouder ℈i. Crocus Martis astrin∣gens ℈ss. Opium in pouder gr. i. mix for a Dose; to be repeated as oft as need requires.

CVIII. If the Disease is vehe∣ment, the Fever great and in∣tense, and the Pustules break forth generally over the whole Body, in very great numbers, or run every where into a flux; the Sick ought to keep their Bed, be carefully tended and lookt after; and, as much as may be, avoid taking Cold, for that is as much as the Life is worth; and their Food may be boil'd Barley, Barley-broth, or rather boil'd Rice, and Rice-broth, Ponada, &c. drink∣ing also the Harts-horn Drink before described, Canary-whey, which comforts the Spirits; white Posset-drink made with Ale, and sweetned with double-refined Sugar.

CIX. Lastly, at the End of the Disease purge the Body well; either with Sal mirabile, Our Family Pills, Pilulae Cathar∣ticae, Tinctura purgans, Tinctura Cathartica, Syrupus Catharticus, an Infusion of Sena and Rhu∣barb, or some other proper Purge, agreeable with the habit and constitution of the Body; which let be repeated at least three or four times. The want of doing this, (which carries off all the remainders or re∣liques of the Distemper) has been the cause of Scurvy, Gout, Consumptions, Apoplexies, Apostems, foul Ulcers, Botches, Biles, Scabs, Leprosy, and Kings-evil, breaking out after∣wards, and seizing upon the Patient

CX. Some, when the Pustules rise not as they ought to do, or when they find them to fall down again, apply Vesicatories, or Blistering-Emplasters: but they only put the Patient to a very great deal of pain and tor∣ture, without doing any gene∣ral good, or any good at all: for as much as they draw but only from particular Parts, and Parts adjucent to the Applica∣tion, and so leave the Sick worse than they found him.