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. XXIII. Of a WEN.

I. THIS Tumor is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Ganglium, Lu∣pia; and in English, a Wen.

II. What the Ancients meant by Ganglion, is hard to be

determined, nor yet have we any any Disease common with us, that agrees with those Signs and Sym∣ptoms declared by Sennertus; but our more late or modern Authors, under the names of Ganglion or Lupia, intend that Tumor called by the Vulgar a WEN.

III. A Wen is a preternatural Tumor, proceeding sometimes from Phlegm, and sometimes from Phlegm mixed with Blood and other Humors; sometimes hard, sometimes soft, but most com∣monly round, and of a fleshy substance.

IV. The Places. It generally happens in those places which have little Flesh, being dry and ner∣vous: as the Forehead, Eye∣brows, Back-bone, Joints of the Toes, &c.

V. The Kinds. They are two∣fold: 1. Those which are contained in a Cystis, or Bag as it were. 2. Such as are without a Cystis, and seem to be one continued lump of Flesh with the adjoining Flesh of the Body.

VI. The Causes. The Proca∣tartick Causes are, heavy and dull blows, falls from high places, overstraining of any Part, or, any other violence; whereby the mouths of the Capillary Arte∣ries may be made too open, or the mouths of the Capillary Veins may be obstructed, so as to hinder the due Circulation of the Blood.

VII. For those Arteries (which are appointed to carry the Nou∣rishment to the Muscles) yielding or casting out their bloody Juice, and it not being received in again by the mouths of the Capillary Veins; whereby the Blood joined with Lympha, becomes extravasated, Nature forms it into a new body, and makes such a preternatural Tumor as we call a Wen.

VIII. The Antecedent Cause is sometimes Lympha alone, some∣times Lympha join'd with Serum: and sometimes join'd with Blood if it proceeds chiefly from a lymphatick, serous, or pituitous matter, it is generally included in its proper Cystis; otherwise, if from Blood, not so, but is one continued piece of Flesh with that of the Body.

IX. The Conjoined Cause is for the most part a fleshy sub∣stance, contained in its proper Cystis, or not contained; having its own particular Veins and Arteries, by which it is nou∣rished, and made daily to in∣crease, and grows sometimes to a very great magnitude.

X. The Signs. If it is not con∣tained in a Cystis, it sticks more firmly to the Part, and is as it were immoveable; as those upon the joints of the Toes, &c. but if it is contained in a Cystis, then it is more moveable with your Fingers, up and down.

XI. It is a Tumor arising from a very small beginning, and grows in a round or globular form by little and little, sometimes to a very great magnitude: some grow as big as a Nutmeg, and never any bigger, some as big as Wal∣nuts, some as big as large Eggs; others again to a vast bigness, even to the greatness

of a large Melon or Pom∣pion.

XII. In some they cease growing after a year or two, in others they grow for the space of six or seven years together: some of them easily yield to the touch, others with more difficulty; being mostly of a fleshy sub∣stance, and generally without pain.

XIII. The colour is many times white, or of the colour of the Skin, especiall where Lympha or Phlegm is the principal cause: if much Blood is conjoyn'd, it is red∣dish; if Choler be joyned there∣with, the colour is yellowish, and the Tumor a little painful; but if Melancholy, it is livid, and very hard to feel to.

XIV. As the Tumor increases, the Vessels, as Veins and Arteries, grow big also; so that they appear sometimes under the Skin, as thick as ones Thumb.

XV. The Prognosticks. This Tumor is not in it self malign; but by evil Applications it may easily be made so: however, the best of Remedies seldom answer expectation.

XVI. If it is great, and of long continuance, it will never come to Resolution: if evil Medicines be applied, it oftentimes dege∣nerates into Cancer: but this is chiefly to be understood of such as are contained in no proper Cystis.

XVII. If it is about a Joint, there is scarcely any cure for it: for in that case, cutting will be very dangerous.

XVIII. The Cure. While it is in beginning, you may hinder its encrease, as Paraeus says, (lib. 7. cap. 20.) by somewhat a strong and frequent rubbing with your Fingers: for so (says he) their Cystis or Bag, together with the Skin will wax thin, and the con∣tained Matter grow hot, and be attenuated and resolved.

XIX. But if this nothing pre∣vails, (we speak of that contained in a Cystis) you must press upon it hard with your whole Hand, or a hard piece of Wood, as heavy as you can, till the Cystis is broken; and then apply and bind strongly unto it a plate of Lead besmeared with Quicksilver: Paraeus says, he has many times found by experience, that it has a wonderful force, to re∣solve and waste the subject Humor.

XX. But if the Wen is in such a place, where you can make no strong impression; as in the Face, Breast, Stomach, Throat, or Belly; then this resolving Emplaster may be applied. ℞ Gum Ammoniacum, Bdellium, Galbanum, A. ℥iii. dissolve them in Vinegar, and strain thro' a Sieve: then add Oils of Lillies and Bays, A. ℥i. pouders of Orrice-root, Sal Armoniack, Sulphur vive, and Roman Vitriol, A. ʒss. Aqua Vitae ℥ss. mix, and make an Emplaster.

XXI. But whilst this is doing, it will be good to prescribe uni∣versal Purgers; and then to take the Tincture of Salt of Tartar for many days together.

XXII. And whilst the Tumor is small, strive to resolve it, by often anointing it with Balsam of Sulphur; and applying Empl.

Hystericum, or de Galbano croca∣tum, which is accounted one of the greatest Resolvers; or Ce∣ratum de Ammoniaco Foresti, (which see in Our Pharmacop. Lond. lib. 5. cap. 5. sect. 4. and cap. 6. sect. 61. or the Empl. de Ranis, with double or treble Mercury, which is inferiour to none of them.

XXIII. Oribasius made use of this. ℞ Ammoniacum, Galba∣num strained, old Oil, Rosin, Ce∣ruse, A. ℥i. Wax ℥iv. mix them, and apply it.

XXIV. But indeed in the be∣ginning, such things as repell and astringe are to be applied; rowling the Part upon them gently. ℞ Pomgranate-peels, Bistort-root, A. ʒi. rust of Iron, burnt Lead, Quick-silver killed. A. ʒii. fine Bole, Blood-stone, A. ʒjss. Turpen∣tine, Wax, A. q.s. mix, and make an Emplaster.

XXV. Some commend Sorrel-leaves roasted under the Embers and applied, being mixed with Oak-ashes in form of a Pultise: others apply Suppuratives, then open it, and cure it as an∣other Ulcer.

XXVI. Some use an Actual Cautery; because by it, its en∣crease may be staid for a long time; and sometimes it wholly removes the Tumor.

XXVII. Where the neck or root of it is small (or so small as a Thread may be applied) cast a strong Thread, or small Pack∣thread about its neck twice, and tye it with a double knot; drawing it straiter and straiter every day, 'till it is deprived of its colour, feeling, and life; which will be in eight or ten days time.

XXVIII. Then with a crooked Knife you may easily take it off, without any great pain, or flux of Blood: but this ought to be done in a cold and moist habit of Body, or one of a Phlegma∣tick constitution; but in San∣guine or Cholerick habits, it will so afflict, that it will scarce∣ly be endured: however, you ought to anoint with some anodyn or cooling Ointment, and use perswasions to the Pa∣tient to bear it.

XXIX. Some use Potential Cauteries, as this: ℞ Ʋnslak'd Lime, Goose-grease, Turpentine, A. ℥i. Ammoniacum strained ℥ss. mix them, and apply it.

XXX. Others, (if they will not resolve) gently and carefully anoint it, or rather touch it with Oil or Butter of Antimony, round about the roots thereof: and then with a sharp Instrument (all things being fit) cut it off according to Art; presently washing the place with Ablution of Saccharum Saturni warm, or applying some other Styptick, and then healing it up, as an∣other Ulcer.

XXXI. But if you design to take it away by Section, (which is to be done, when the Wen is grown to so great a mass, that it cannot be cured by other means, but yet withal where there is no danger by reason of its too great magnitude, too close adhesion to the adjacent Parts, or too near to the greater Arteries and Veins, for in all these cases, it will

be better to let section alone:) the manner is thus:

XXXII. Make a small inci∣sion in the Skin, even unto the Cystis, in which the Matter of the Tumor is included; thro' which a Probe of the thickness of a Finger, round at the end, but hollow in the middle, is to be conveyed in, between the Skin and the Cystis, and to be drawn about even to the root of the Wen: and then after this, upon the Skin, an Incision is to be made large enough, in form of the Letter X, or crosswise; after which, presently draw off the Skin from the Cystis, corner∣wise, towards its root, with your Fingers wrapt about with a linnen Cloth, or separate it with an Incision-knife; after which, cut off the Wen by the root.

XXXIII. If there arises any Hemorrhage from the larger Ves∣sels, (which are as it were its roots) upon their being cut, it is to be stopt with the Royal, or some other proper Styptick: after which it is to be well bound up, a portion of the Skin with which it was covered being first cut off, and only so much left as is enough to cover the Part; after which, let it be cured as some other green Wound.

XXXIV. If any of the sub∣stance of the Tumor should be left behind, it must either be cut again, or else consumed with caustick Medicaments.

XXXV. Paraeus says, he took away a Wen which hanged at a man's Neck, as big'as a man's Head, which weighed eight pounds: and he says, that being called on a time to open the Body of a great Lady, he found in one of her Breasts a Stone, as big as a Hen-egg, hard and compact like a Pebble; taken by the Physicians and Chirur∣geons whilst she was living, for a Cancer; because it was very painful to her, when pressed upon.

XXXVI. The Cure of a Wen not contained in a Cystis. Whilest it is young, and in its beginning, you must apply Discus∣sives or Resolutives, and such things as make supple, as are Emollients: Natural Baths of Sulphur are good in this; also Empl. Diasulphuris Rulandi, which dissolves much.

XXXVII. But you must beware how you apply Suppuratives, lest you create an incurable Ʋlcer; at least such a one as will be very difficult to heal, or may prove phagedenick, whereby the nervous parts near about the Joints may be corrupted.

XXXVIII. In a Tumor there∣fore of this kind, your best way will be, to be contented with a Palliative Cure, and such things as may keep it from growing bigger, or degenerating into Can∣cer; of which kind are Ʋng. Diapompholigos, a Plate of Lead besmeared with Quicksilver, Emplastrum de Ranis, with triple quantity of Mercury, &c.