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. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Tumor Cysticus; in English, the Cystick Tumor, or, Tumor contained in a Bag.

II. The Kinds. It is three∣fold, according to the threefold Matter contained in the Cystis, or Bag: viz. 1. When it is like unto Frumety, called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Pultis genere; in Latin, Athe∣roma. 2. When it is like unto Honey, called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; à 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Mel, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Cera; in Latin, Meliceris. 3. When it is like unto Suet, called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, à 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Sebum seu Sevum; in Latin, Steatoma, Tumor sevosus.

III. They are all of them also called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Choeratodes; because they have some resem∣blance to that swine-like Disease the Scrophula; when contained in a Cystis or Bag.

IV. The Definition. Atheroma is a preternatural Tumor, con∣tained in a proper Cystis; caused from a Humor or Matter like to Frumety or Paste, made of boiled Barley or Wheat; of the colour of the Skin, without pain, hot easily yielding to the Fingers; nor when removed, suddenly swelling out again.

V. Sometimes in an Athero∣ma, there is mixt with the pultis∣like Matter, hard substances, and stony bodies; sometimes a sulphur-like substance, somtimes small Bones, matted Hair, and the like.

VI. Meliceris is a preternatu∣ral Tumor, contained in its own proper Cystis, proceeding from a honey-like Matter, of a white colour, painless, round, and easily yielding to the Fingers; which being removed, present∣ly returns again to its first figure.

VII. The Tumor in this, is greater than the former, its figure is rounder and higher, and the Humor thereof thinner.

VIII. Steatoma is a preter∣natural Tumor, contained in its proper Cystis, caused from a matter like to Suet, and of the same colour, and soft: it arises from a small beginning, in∣creases gradually and leisurely, difficultly yields to the Fingers; which being removed, it re∣turns again to its former magnitude.

IX. The Differences. How they differ one from another, the Signs aforegoing shew: but (says Bar∣bett) if the Matter of any of these Tumors is gathered together about the Joints, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ganglion: if about the Glandules of the Neck, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Choeratodes, Glan∣dula, Scrophula, or Struma: if

in the Arms or Legs, Tuberculum; if from the Pox, Tophus, or Gumma. So that in the main, it seems, that he makes them but as a species of the Kings-Evil.

X. But if they happen in the Head, they are called, 1. Talpa, which is referred to Atheroma. 2. Testudo, or Topinaria, which is referred to Meliceris. 3. Natta, which is referred to Steatoma, growing forth especially on the Back.

XI. The Causes. The Antece∣dent Cause is Phlegm; in the one more, in the other less; receding from its natural constitution: and sometimes (tho' seldom) it is mixt with Melancholy.

XII. Platerus is of pinion, that these Tumors are not gene∣rated from excrementitious Hu∣mors, or Phlegm; (for that it would be obnoxious to putrid∣ness) but from an alimentary Juice: viz. such as is by Nature provided for the nou∣rishment of the Part.

XIII. For (says he) if the Humor is thicker than is neces∣sary for nourishment, then a fleshy substance or Excrescence is bred: but if the Humor is extraordinary thick, then it becomes a Scir∣rhus: but if the Humor is thinner, then it suddenly ends in an Apostem, in which dif∣ferent matter is generated, ac∣cording to the difference and variety of the Juice mixt with other Humors) which has bred this Tumor; which yet comes not to suppuration in like manner, as other Apostems bred from Blood; nor yet is it turn'd into Pus, but into an∣other kind of Substance, con∣tained in a proper Cystis.

XIV. All these sorts of Tumors have their cause from a very inconsiderable beginning; and they are tedious, and increase but by little and little; being in∣cluded in their own peculiar Tunicle.

XV. The Signs. Atheroma yields when it is touched, as if it were a certain loose body, and returns back slowly: but what it has within, (as also Meliceris and Steatoma) is only to be guessed at by conjecture: so true it is, that it cannot be certainly known, till it is cast forth; as Celsus says, lib. 7. cap. 6.

XVI. Meliceris is rounder in figure, more extended; and when pressed down, it suddenly yields and gives place to the touch; and upon removal of the Fin∣gers, as soon returns back again.

XVII. Steatoma is harder than the other, and resisteth upon the touch, having the bottom there∣of more solid: but tho' it is hard, yet it differs from Stru∣mae, because it is nothing so hard as Strumae, nor has it an inequality like it.

XVIII. The Tumors called Talpa, Testudo, and Natta, are easily known, 1. From the Place, because they almost always hap∣pen in the Head. 2. From their Form and Substance; being soft Tumors, at least not very hard, and shut up in their own pro∣per Cystis.

XIX. TALPA (from its

creeping like a Mole) runs under the Skin and Flesh, and seems to feed upon the Cranium or Skull; the matter whereof is more gross and thick than in Testudo, and so may be referred to Atheroma.

XX. TESTUDO, is a great Tumor in the Head, soft, or not very hard, of a broad form, much like the manner of a Tortoise; growing forth at first in form and fashion of a Chesnut, after∣wards like an Egg, containing a soft kind of matter, in a Cystis; for which reason it is referred to Meliceris, which sticks so fast in the Scull, that it vitiates it, and causes rottenness.

XXI. NATTA, is a Tumor great and soft, without any pain or colour, growing on the head, back, shoulders, and somtimes other parts, hanging by a small, slender root; yet sometimes it increases to the weight of some pounds, and in bigness, to the quantity of a large Melon: the Matter con∣tained, seems to be fleshy, but indeed it is no Flesh, but like unto Fat, and therefore is re∣ferred to Steatoma.

XXII. These three last Tumors have the same Cause, which the three former Tumors have; but in this lyes the difference, that in these there is a greater quan∣tity of Matter; for which reason, their magnitude or bulk is much greater.

XXIII. The Prognosticks. Atheroma, Meliceris, and Stea∣toma carry no danger in them; yet they are generally of long continuance, and without any great hurt, continued and neg∣lected.

XXIV. Sometimes they Aposte∣mate of their own accord; but if so, they are not of so diffi∣cult cure as Scrophulae, or a Scirrhus.

XXV. If they be elevated, and exposed to motion, they are easily cured; but if they lye deep, and not exposed to the touch, with much more difficulty.

XXVI. In cutting them out, much care is required, because of the danger of great fluxes of Blood; or the cutting or pricking of some Nerve. Many Chirur∣geons for want of skill, in cutting away these Tumors, many times cut away the Nerves that lye under them.

XXVII. These Tumors (says Barbett) are scarcely ever cured, but by Manual Operation. If the Vesicle is broken, or not all taken out, there remains a Fistula, or foul Ulcer; whose cure will be both difficult and tedious.

XXVIII. Talpa, Testudo, or Natta, being in the Head are dangerous, by reason of their nearness to the Scull; for that they corrode the Scull, and corrupt it, chiefly about the Suture.

XXIX. If they are without any corruption of the Scull, they are the more easily and safely cured: but if there is present a great corruption of the Scull, it is much better to let the Tumor alone, than to cure it.

XXX. As in Atheroma, Meli∣ceris, and Steatoma, so in Talpa, Testudo, and Natta, there is no

perfect recovery to be hoped for; unless the whole Cystis, together with the Humor contained in it be taken forth; for if any thing is left behind, a new Tumor of like kind will arise again.

XXXI. The Cure. Tho' Athe∣roma, Meliceris, and Steatoma, differ in their names, yet they have almost but one way of curing. Universals are to be premised, and the whole Body is to be purged from the vitious or or offending Humor, both by Vomit and Stool.

XXXII. Afterwards the con∣joined Matter, which is the cause of the Tumor; and the Cystis it self is to be taken away, if need requires.

XXXIII. Barbett says they are sometimes, but very rarely removed by Resolvents: Senner∣tus says, that Atheroma is cured by Discussives and Suppura∣tives; and for the most part, has no need at all of Section.

XXXIV. Barbett cured some with Balsam of Peru; some with Empl. Oxycroceum; some with this following: ℞ Labdanum ℥i. red Myrrh ʒiii. Camphir ʒi. mix, and make a Plaster.

XXXV. Another. ℞ Gum Ammoniacum, Sagapenum, A.℥ss. flowers of Sulphur ʒiii. Oil of Amber ʒi. Euphorbium, and roots of Pellitory, A. ʒss. mix, and make a Plaster.

XXXVI. This of Sennertus is good. ℞ Labdanum, Bdel∣lium, Galbanum, Ammoniacum, Propolis, Turpentine, A. q.s. mix, and make an Emplaster. Un∣slaked Lime also (he says) mixed with Grease or Oil, is very useful, and of singular benefit.

XXXVII. Or this: ℞ Ship-Pitch ℥i. Gum Ammoniacum, Sulphur, A. ℥ss. mix them. Or this: ℞ Roots of Sowbread, Hogs-lard, A. q.s. to which add a little Sulphur, and make a Cataplasm.

XXXVIII. If these Tumors tend to suppuration, which is very rare, you must assist Nature with Maturatives: and if they break, and the Matter discharge out of the Tunicle, then you must use Corrosives, for other Medi∣cines will be too weak.

XXXIX. Cathereticks for this purpose, are roots of white and black Hellebor, burnt Galls, burnt Date-stones, Verdigrise, burnt Alum, Quicklime, Mercury-sublimate, Vitriol, Spirit of Salt, Oil or Butter of Anti∣mony, Liquor of Tartar, red Precipitate, Oak-ashes, Vine-ashes, Ʋng. Aegyptiacum, Ʋng. Fuscum Wurtzii. Some use Ar∣senick and Orpiment, but with great danger in some places, as near the Nerves and nervous Parts; but to the Skin and fleshy Excrescencies, they may be better applied.

XL. This Ointment is also of good use. ℞ Dulcified Vitriol ʒi. Verdigrise ℈i. Ung. Aegy∣ptiacum ℥ss. mix, and make an Ointment. Others commend red Precipitate mixt with Honey, or Honey of Roses.

XLI. But if the Tumor open; not of its own accord, then you must come to Section; that so the Cystis (whether it contains a

butter-like, a honey-like, or suet-like substance) may be taken forth, and cut away.

XLII. The Skin is not to be cut transversly, or overthwart; but streight forward, or a little ob∣liquely, like to the form of a Myrtle-leaf; then the Cystis, or Membrane containing the Hu∣mor, is to be freed from the Skin, and the Part lying under it: after which it is to be wholly cut off at its root, with one singular cut.

XLIII. Now in this Operation great care is to be taken, that the Cystis be not hurt; for so the Humor that is contained there∣in, flowing forth, will hinder the Operation; and be a means that some of it, or some of the Humor may be left behind; which if it should so chance, is to be consumed by Cathere∣ticks: for if any part of the Tunicle is left remaining, the Tumor will again return.

XLIV. If these Tumors are in the Head, (the Cystis being taken forth) the Pericranium must be cut, and the Scull shaved, lest there be any remainder which may generate the Tumor afresh.

XLV. If the Patient will not admit of Section, the Skin is to be opened with a Caustick, and the Cystis being taken forth, the Ulcer is to be consolida∣ted, cutting away the Skin, whatsoever of it is superfluous.

XLVI. An Observation. A Child three years old had an Atheroma, a large soft Swelling without inflammation: the Bone being suspected to be carious, a Caustick was applied, which gave vent to a matter not unlike Butter, and by search with a Probe, the Cranium was felt bare. It was drest with Lenients, and after separation of the Escar, the Cranium was bare, as broad as a shilling: it was drest up with Linimentum Arcaei hot, and the lips of the Ulcer with Ʋng. Basilicon mag. The second day, it was fomented with Decoction of the tops of Hypericon, Ori∣ganum, Betony, red Roses and Balaustians in Wine and Water: the Bone was drest with Dossils of Lint, prest out of S.V. and the lips were drest with Ʋng. Diapompholigos, touching them sometimes with a Vitriol or Alum Stone. By this means the Bone incarned, united with the lips of the Ulcer, and cica∣trized from the edges round; during which some small pieces of Bones cast off, and the Ulcer easily healed. Wiseman.

XLVII. Another. A Coach∣man had a troublesom Meliceris on his right Shoulder, which after preparing and purging the Body, there was applied the Cerate Dia∣sinapios to it, thus made. ℞ Old Oil ℥xi. Sal Gem, Litharge of Gold, Ceruse, A. ℥iv. Mustard∣seed poudred ℥ii. Galbanum, Opo∣panax, A. ℥ss. Wax, Turpentine, A. ʒii. Vinegar q.s. mix, and make a soft Cerate. The effect of this Cerate against a Meli∣ceris, I lately experienced in another person; who by my advice apply'd it to a Meliceris in the right Knee, as big as a Goose-egg, which it totally discussed in a months time, with all those other Humors,

which were gathered to the Part in the beginning, thro' the neglect of general Reme∣dies. Scultetus.

XLVIII. If any of these kinds of Tumors hang like Figs by a slender stalk, they are not to be cut out by opening the Skin, but they are to be cut off by the roots: or in timorous people, you may bind it about its roots with a Thread, drawing it harder and harder every day, to stupify it; which is there to be left, till the Tumor falls off: but where the Patient has courage enough, 'tis best to be cut away with a sharp Knife.

XLIX. If it bleeds much, (after cutting off) you must either stop it with a Styptick, or lightly burn it with a red-hot Iron; and when the Escar is fallen, you must heal it as a common Ulcer: this way the Ulcer is but small, and equal, and the Cure soon done.

L. Some of these Atheromata, which lye upon the Parts with a large Basis, are of very dif∣ferent magnitudes: some are as big as a small Nut, some as big as a Walnut, others as big as an Egg; but the great ones are as big as a large Melon or Pompion: and I once saw one, upon the Back of a Gentle∣woman, as big, nearly, as an half-bushel.

LI. Now these great ones, by reason of many Veins and Arte∣ries, cannot be taken forth, but are wholly to be cut off at once, after the manner as a Cancer is cut off: taking it away by the very roots; after which, to stop the flux of Blood, it must be drest up with Stypticks, Digestives, Sarcoticks, and Epu∣loticks.

LII. Scultetus, instead of taking hold of it, as you do of a Cancer in cutting it off, has a large pair of Pincers made on purpose, with which he takes hold of the whole Apostem, as far as the roots of it, and so proceeds to the amputation, or cutting off: those which are of the lesser sort, are cut forth by opening the Skin, and separating it, and not otherwise.

LIII. In this latter case, you must be very careful that you hurt not the Cystis, especially in an Atheroma, and a Meliceris: but in Steatoma, the tallowy substance being more solid, it will hardly run forth, so that there is less danger in hurting the Bag.