Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

CHAP. XXI. Of an OEDEMA.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Oedema; and in English, Oedema, and, the White-swelling. 'Tis true, Hippocrates and other ancient Physicians, under the name of Oedema understood all other Turnors whatsoever; because it signifies an eminency, rising up, or swelling: but those of later times understand only one certain kind of swelling, which is the White-swelling here in∣tended.

II. Definition. Tumor est praeter Naturam, ab Humore seroso aut pituitoso ortum habens, albus, mollis, laxus, indolens, & caloris expers; prementi Digito cedens, & per congestionem frequentiùs, quàm per affluxum Humorum pro∣ductus. It is a Tumor besides Nature, arising from a serous or pituitous matter, white, soft, loose, without pain, and void of heat; yielding to the Fingers being prest, and oftner caused by conge∣stion, than fluxion, or a flux of Humors.

III. The Kinds. It is perfect, when it proceeds from Phlegm only: imperfect, when it pro∣ceeds from other Humors; as Blood, Choler, Melancholy; whence they are called Oedema Phlegmonoodes, Erysipelatoodes, Scirrhoodes.

IV. The Cause. It is caused from Phlegm alone sometimes, and sometimes from a mixtion of other Humors, as is mentioned in the Kinds. But Barbett thinks it to be produced from the ill disposition of the Lympha∣ducts.

V. Galen, ad Glauc. lib. 2. cap. 3. saith, that it is caused by a Pituitous matter; or else by the Spirits, when they are full of Vapors. But by that great Man's leave, tho' in the similar Parts there may be some kind of flatulent Spirit collected, which may tumify the Part; yet this Tumor is not properly Oedema, but rather 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, a Windy Tumor: of which hereafter.

VI. Sennertus says it proceeds from a serous Humor abounding in the Body, and descending upon the Part, and there abiding and sticking fast, as in a substance more cold than other parts of the Body.

VII. The Conjoined Cause is Phle••m contained in the Blood,

when it is so increased, that it irritates and stirs up the Expul∣sive Faculty: for Nature being then excited, protrudes the Matter out of the greater Ves∣sels into the less, and expels it from the more noble Parts to the weaker; till at length it is received and retained, by the most weak and infirm Part.

VIII. The Procatartick Cause is, an errour and default in San∣guification; producing such a like Humor, which must be found out from the Patient's Diet, Exercise, and way of Living.

IX. The Places. Altho' it may be excited in all parts of the Body whatsoever, yet it chiefly arises in the Hands, Knees, and Feet; as is manifest in such persons as are afflicted therewith; as in such as are Hydropical, Cache∣ctical, Phthisical, or Struma∣tick.

X. The Signs. It is known by being a Tumor soft and loose, so that if it be pressed down with the Finger, it easily gives way: for the moist Phlegm softens and loosens the Part; yet being thicker than the Lympha or other Humors, it sticks in the Part.

XI. It is altogether without pain, or any pulsation; for not dissolving perfectly the unity, it cannot be dolorous.

XII. It is also of a white, or whitish colour, because there is in it no preternatural heat, but only so much as is conformable to Na∣ture: or rather, there is a coldness of the Part, from its weakness, and nature of the Matter congested therein.

XIII. The Prognosticks. It is not suddenly generated, but grows by degrees, or by little and little: because the Humor is cold, thick, and sluggish; and there∣fore not fit for any speedy motion.

XIV. It often happens to old people, gross and phlegmatick. Bodies, and in Winter time; and to such who with gluttony and much drinking, continually debilitate the natural heat.

XV. It is a Disease, which in it self (without other accidents) is of no danger: nor is it great, or the cause thereof, of any dangerous consequence, nor has it usually any ill Symptoms joined therewith.

XVI. It is said to be dangerous, if it happens to such as have a Cachexy, Dropsy, Consumption, or Kings-evil: but then this danger comes not simply from the Oedema, but from those Dis∣eases which the Oedema fol∣lows: for which reason, you ought to distinguish whether it arises of it self, or follows upon some other Disease.

XVII. If it happens in the Feet or Knees, after long Dis∣eases, from Crudities collected by the Disease, or from a refrigeration, or other dangerous faults of the Liver, it is then dangerous, and may threaten death, from the Causes upon which it depends: but otherwise if no such acci∣dents be concurrent with it, there is no danger at all.

XVIII. If it degenerates into a Scirrhus, or by any accident comes to Apostemats, it will be

of very difficult cure, if not totally uncurable.

XIX. But yet tho' Oedema is a Disease, which of it self is without any danger, yet notwith∣standing it is of a long continuance; because it arises from a cold and clammy Matter, which cannot be overcome in a long time.

XX. Sometimes it terminates by a Resolution, unless it degene∣rates into a scirrhous Nodosity, or the like: for the much using of Digestives, many times makes the matter wax hard.

XXI. The Cure. Indications of Cure are threefold: 1. The removing the Procatartick Cause. 2. Removal of the Antecedent Cause. 3. Remo∣ving of the Conjoin'd Cause; which is done by Topicks, or External Applications.

XXII. As to the removing of the Procatartick Cause; let the Diet be such as does not generate or breed Flegm, but rather such as destroys it.

XXIII. Let his Bread be Wheat, and chiefly Bisket: his Meat, Flesh of good nourishment, and easy digestion, as roasted Mutton, Veal, Pullets, Rabbets: his Fish, such as swim in stoney and gravelly places: his Drink, Medicated Ale, with Wine sometimes.

XXIV. Let the Air he lives in, be drying and heating, use Exercise before Eating, to ••tir up the Native Heat; be merry and chearful, avoiding Melan∣c••oly as much as may be: diurnal Sleep is also to be avoided, also Blood letting, and such things as bind the Body, or over-much cool it, as Cheese, cold Fruits, as Cucumbers, Melons, &c.

XXV. The Antecedent Cause is removed by due Purgation, either upwards or downwards. If the Stomach is foul, give a Vomit of Tartar-emetick, à gr. ii. ad v. or vi. according to age and strength; or with Vinum eme∣ticum, or Vinum or Acetum scil∣liticum; repeating the Dose two or three times.

XXVI. Then purge with Dia∣jalapa, or Diagamba, or Our Family Pills, Pilulae Catharticae, Syrupus Catharticus, or Pul∣vis Corna••hini, or Tinctura pur∣gans: or you may often purge with an Infusion of Sena and Mechoacan, which is admirable: and then cut the tough Phlegm with Oxysaccharum, by often giving it in Infusio Catholica, or alone.

XXVII. Sudorificks are some∣times given with good success, be∣ing exhibited in the times be∣tween Purging.

XXVIII. A proper Diet ought also to be instituted, such as this of Barbett. ℞ Florentine-Orrice ℥i. Sena ʒvi. roots of Parsley, Sea-holly, A.℥ss. Rhubarb, Agarick trochiscated, A.ʒiii. Ci∣namon, seeds of Siler montanum, A. ʒii. Cloves ʒss. infuse them in old White-wine a quart: and take every morning ℥iv. or ℥v. for a Dose.

XXIX. Or this Electuary. ℞ Electuary of the juice of Roses ℥i. Jalap ʒi. Spirit of Salt ℈i. mix, and make an Electuary; of which let the

quantity of a Bean or Hazle-nut be taken every third or fourth day.

XXX. By the often use of one or other of these Medicines, he says he has many times cured an Oede∣ma; but withal rowling the Parts with Rowlers twelve or fifteen yards long; begining from be∣low upwards, allowing thereby no liberty for the Humor to descend. By this method the noble Parts are strengthned, the evil Humors evacuated, and the Parts affected in a few days restored.

XXXI. But in order to the Essential Cure, you must observe whether the Oedema follows any other Disease of the more noble parts: if so, the Intentions of Cure must first be directed to them; that the Disease upon which it depends may be taken away; otherwise the Oedema will never be cured.

XXXII. The Conjoined Cause is next to be considered. By Fri∣ctions and hot Fomentations, warm the Part affected; or rub it well with Oil, mingled with Salt: or foment it with a Decoction of Wormwood in Wine, in which a little Salt of Wormwood, or of Tartar has been dis∣solved.

XXXIII. Or anoint with Un∣guentum Martiatum, or with Balsam de Chili, with which once I cured an Oedema; bathing the Part also with the Powers of Amber, and applying over a Resolutive Emplaster.

XXXIV. But in the beginning Repellers are to be mixed with Discussives, but so that the Dis∣cussives may exceed; afterwards use only Discussives or Resolu∣tives: as Ʋnguentum Adstringens mixed with equal parts of Ʋnguentum de Althaea, or Ʋng. Comitissae, or Ʋng. Rutaceum, or Ceratum de Ammoniaco, or Gera∣tum Galeni, mixt with a few flowers of Sulphur; or the Cataplasma Resolutivum Foresti, Diachylon simplex, &c.

XXXV. Or you may apply this, which is stronger. ℞ La∣bdanum ℥jss. Olibanum, Oil of Rue, A. ℥i. flowers of Sulphur ʒvi. Storax Calamita, Cow-dung, A. ℥ss. Alum, Nitre, Vine-ashes, A. ʒii. Turpentine, Pitch, A. q.s. mix, and make an Emplaster. Or, ℞ Cow-dung ℥iii. Pigeons-dung ʒii. mix, and fry them with Oil, and apply it.

XXXVI. ℞ Rose-vinegar ℥jss. Oils of Myrtles and Earth-worms, A. ℥i. fine Bole, Terra sigillata, A. ʒiv. Aloes ʒiii. Acacia, San∣guis draconis, Cyperus roots poudered, A. ʒii. Saffron ʒss. Wax q.s. mix, and make a Liniment.

XXXVII. Or this. ℞ Bean∣meal ℥ii. Vinegar ℥i. flowers of Sulphur, Vine-ashes, Sal-gem, A. ʒii. Oil of Nuts, Camphir, A. ʒi. Turpentine, Wax, A. q.s. mix, and make a Cerate.

XXXVIII. This Cataplasm is excellent. ℞ Roots of Althaea ℥iii. briony, Dwarf-elder, A. ℥ii. leaves of Sage, Rue, A. M. i. Savin, M ss. boil them in equal parts of Wine and Water: in the end add Wine-vinegar ℥iii. beat all well together; then add Bean∣meal ℥ijss. Leaven ℥jss. Cow-dung ℥i. Vine-ashes, common Salt,

A. ℥ss. Hogs-lard ℥ii. Oil of Camomil ℥iv. mix them.

XXXIX. Bandage (says Wise∣man) is of great help in this cure; so that we can do nothing consi∣derable without it. Those I espe∣cially commend to you, are, a laced Stocking, Trowze, Sleeve, Glove; because they sit most firmly, and may be worn with the greatest advantage, and least trouble or prejudice to the Health of the Patient; yet it requires consideration, and care how they be laced: for by unequal lacing, a Tumor may be raised; and by an equal over-hard lacing, the most fleshy Part may be emaciated.

XL. And Sennertus says, that in applying of Medicaments of any kind, whether Liniments, Ointments, or Emplasters, we must before-hand make the Part hot by Frictions and Fomenta∣tions; otherwise the Applica∣tions will scarcely effect the Cure, by reason of the cold∣ness of the Part.

XLI. The Frictions may be made with course hot linnen Cloths, the Fomentation with Decoction of Camomil, Feather-few, Hyssop, Origanum, Tansey, Wormwood, &c. in Wine: for by the Frictions and Fomen∣tations together, the Heat and Blood will be called into the Part, and the superfluous Humor will be scattered.

XLII. But if the Tamor will not resolve, but that it is neces∣sary to bring it to Suppuration, you may do it with the Cata∣plasm, at Sect. 38. afore∣going, adding thereto, pulp of roasted Onions, Basilicon the less, A. ℥iii.

XLIII. The Abscess being sup∣purated, let it be opened either with a Caustick, or the Knife; and let it be throughly cleansed with juice of Wormwood and honey of Roses, mixt with Turpentine and Frankincense; fill the hollowness with Ʋn∣guentum Basilicon, or Nicotianae, and at length heal it up ac∣cording to Art: but it com∣monly proves a long time, be∣fore the Cure is perfected.

XLIV. If it should degenerate into a Scirrhus, you must use only Emollients: and for this pur∣pose, we use Vinegar, in which Lapis Pyrites or Fire-stone, or a piece of a Mill-stone heated red-hot has been quenched: afterwards anointing the Part with old Oil, in which roots of wild Cucumbers and Althaea, have been boiled.

XLV. Or this. ℞ Mucilage of Althaea roots, Linseed and Fe∣nugreek, Goose grease, Veal marrow, pouder of Orrice root, pouder of Hermodacts, Camomil flowers, A. ℥ii. liquid Storax, Myrrh, Frank∣incense, Oil of Camomil, A. ʒx. Wax, q.s. mix, and make an Emplaster.

XLVI. Scultetus has this Ob∣servation. With the noble Lime-water, says he, made use of for some days, I have discussed obstinate Oedematous Tumors. ℞ A piece of Quicklime, the quantity of a Walnut, put it into boiling Water till it is dissolved; which done, stir them toge∣ther, and let them settle: de∣cant off the clear Water, and

dip into it a new Spunge, which press out, and apply hot to the Part; it being first an∣ointed with Oil of sweet Al∣monds, or Hogs-grease.

XLVII. The same practice (says he) is to be given to a Spunge dipt into Posca or Oxycrate, viz. Vinegar and Water mixt to∣gether; being applied in the beginning or augmentation of the Disease. Scult. observ. 72.

XLVIII. In an Oedema Phle∣gmonoodes, which is somewhat like an Erysipelas, and for the most part invades the Limbs, being very troublesom, nothing is found better than this: ℞ Lye of Vine-ashes lbi. Sal-nitre ʒjss. common Salt, Wine-vinegar, A. ℥i. mix them. After general Remedies, dip double linnen Cloths in this lukewarm, and apply, binding them on with Rowlers: it wonderfully drinks in, discusses, and in three or four days at most, helps dan∣gerous Oedema's, threatning Mortification. Scultet. observ. 98.

XLIX. Munick, Chirurg. lib. 1. cap. 6. sect. 14. commends this, from great Experience. ℞ Re∣ctified S.V. Wine-vinegar, A. ℥vii. common Salt ℥ss. mix, and dissolve: this Liquor apply with double Cloths dipt in it hot, with strict ligature (rowling it from below upwards) but not too much compressing the Parts.

L. About three years since, I had a Maid-servant in cure, who having an obstruction of her Terms, had forthwith an Oedema in her Knee; it was very large: I first well purged her with my Family Pills three or four times; and gave her Tinctura Martis to provoke her Terms, which was effectually done: after which, (making her keep her Bed, for about seven or eight Weeks) I gave her every night my Guttae Vitae, beginning at fifty drops, and increasing the Dose gra∣dually, till it came to an hun∣dred; which she continued the taking of, the whole time of the Cure.

LI. And outwardly, after Fri∣ctions, I bathed it well with my Spiritus Anodynus, (which is a Tincture of Opium, &c. in Spirit of Wine:) and after, anointed it with Balsam de Chili, ap∣plying over it a Plaster of Mi∣thridate. This course was con∣stantly repeated, morning and evening; and in about 8 weeks time she was perfectly well.

LII. Where an Oedema is very obstinate, whether it breaks, or breaks not, there is nothing equal to a gentle Salivation; which being skilfully and careful∣ly performed, does the Cure to a wonder; for that it causes an effectual revulsion of the Humor to another Part.