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. XXIV. Of GƲMMS, NODES, TOPHS.

I. THESE kinds of Diseases are called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Tumor gummosus, nodosus, tophaceus, & callosus; in English, a Gumm, Node, Toph, or Callous Tumor.

II. The Differences. There is some difference as well in the natures of these Tumors, as in their names: and tho' they may all happen to one and the same person, and at the same time, yet always in different parts of the Body, and from different causes.

III. A Gumm, called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Tumor gummosus; is a Tumor happening in the brawny parts of the Body, or in the substance of the Flesh; and this is for the most part softish, and of a much softer substance, than either a Node, or a Toph.

IV. A Node, called, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Tumor nodosus; is a knotty hard kind of Tumor; and commonly affects the Nerves, or Nervous parts.

V. A Toph, called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Tumor callosus; also, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Tumor tophaceus, a hard, stoney-like Tumor, is an Exostosis, or bone-like substance, growing out upon a Bone, or a stoney Concretion growing in the joints.

VI. The Places. A Gumm happens many times upon the brawney part of the Arm, as be∣twixt the Wrist and the Elbow, and between the Elbow and the Shoulder: also upon the fleshy parts of the Buttocks, Thighs, and Leggs, and many times upon the hairy part of the Head, and Forehead, and seve∣ral other parts, as Wrists, Ancles, &c.

VII. A Node is always an Affection of the Nerves, or Ner∣vous parts, following many times upon Convulsions, or after severe Cramps; and sometimes in those places where the Lympha∣tick Vessels run.

VIII. A Toph is always found upon the Bones, or in a Boney place; being a hard Callus, or bone-like substance; and is seated generally under the Periostion, upon the Shins, &c. and some∣times in other parts, as the Joints, in the Gout, where it is stoney.

IX. The Causes. A Gumm, for the most part, arises from the Venereal Disease; which causes a fugitive, malign, pitui∣tous Humor to fly up and down the Body; till it meets with a plentiful Viscosity, sufficiently able to stop it in its career, and then hold it fixt in the Part where it so appears.

X. A Node, is caused for the most part by a contraction of the

Nerves in Spasmatick-paroxysms; or thro'a rupture of some of the Lymphatick-vessels, in the Pox; and other Diseases: where that Juice being sharp, and making its way, and not being able to get thro' the Skin, it hardens into a Matter, much like to a Knot in a Nerve, or some Cartilaginous substance.

XI. A Toph arises from many causes, as sometimes from breaking of the Bones, the Bone-making Faculty and Juice, being too powerful and luxuriant; but mostly from a sharp and malign Humor, in the French-pox; which touching the Bone, seizes upon it, where making its seat, it grows hard and great, extending the Periostion; or from a Li∣thontriptick Juice; which be∣ing scattered up and down the Body, Nature for her relief sends to the Joints, and there hardens it into the substance of Chalk-stones.

XII. The Signs. These are all known by sight, and from what has been said in their Differences, places they seize on, and the variety of causes which produce them. Gumms are known by a broad large swelling in the Flesh, making the very place somewhat harder, and somewhat higher than the adjacent Flesh; sometimes of the colour of the Skin, and sometimes of a kind of red∣dish hue, especially if any sort of pain attends them; which being nipt with your Fingers, as hard as you may do any other fleshy substance of the Part, puts the Patient to ten times as much more pain.

XIII. A Node is hard in feel∣ing, much like to a hard, nervous, or cartilaginous substance, some∣times as large as a small Hazle∣nut, sometimes as big as a large Nutmeg; sometimes bigger, sometimes less, generally pain∣ful, and sometimes not easy to be felt by the Fingers in places nervous, or where the Nerves and Lymphatick-vessels pass.

XIV. A Toph or Exostosis is known from the Place, which is generally upon some naked Bone; as the Shins, Jaw-bones, &c. From its Form, it being broad in its Basis, and lifted up higher than the rest of the Flesh: and from its Sub∣stance; it being very hard, like to a bone, and not yielding to the Fingers: its Colour is the na∣tural colour of the Skin, and is very full of pain, chiefly in the night time, and when warm in bed; whence come those which are called Nocturnal Pains; this kind of Tumor generally following upon, and being one of the Symptoms of the Pox: Stones in the Joints, are known by Sight.

XV. The Prognosticks. These are all of difficult cure, and only to be removed, by curing the Dis∣eases which cause them. Gumms proceeding from the Pox, are easier of cure, than either Nodes or Tophs, because they are removed by resolution with Externals only; and sometimes by Internals only, by such things as take away the Disease which causes them.

XVI. Nodes are of very difficult Cure; and tho' many times, at length they are cured by Reso∣lution,

yet they also many times, remain during the whole course of the Patient's life.

XVII. Tophs are the hardest of all to cure, where they are of a stoney hardness; as those of the Joints in the Gout, which are said to be incurable.

XVIII. And Exostoses upon the Shins and other places, admit of no other cure, but laying open the Part, and scaling the Bone, or Excision; which is a work of time, labour, difficulty, and hazard; together with removing the original Cause, viz. the Pox it self.

XIX. The Cure of Gumms. These, as they arise from the Pox, so the internal Remedies must be such as cure that Disease; the chief of which are, the Princes Pouder, Precipitate per se, white Precipitate, Turpethum Mine∣rale, Arcanum Corallinum, Aurum Vitae, &c.

XX. Outwardly you may apply this: ℞ Juice of Night∣shade, Oil of Lillies, Vipers fat, A.ʒiv. boil to the consumption of the Juice; then add, artificial Cinnabar ʒiv. Opium, Castile-soap, A. ʒii. Sublimate in fine pouder ʒiss. Labdanum, Wax, A. q.s. mix, and make an Emplaster.

XXI. Or anoint with this Liniment. ℞ Distilled Oils of Turpentine, Euphorbium, Amber, and Guajacum, A. ʒii. crude Opium ʒiv. Quick-silver killed with spittle ʒi. mix, and make an Ointment or Liniment.

XXII. Or you may apply Em∣plastrum de Ranis, with double or treble quantity of Mercury, or Emplastrum Mercuriale, de∣scribed in lib. 1. cap. 77. afore∣going, which is inferior to no other Medicament.

XXIII. I have also many times cured Gumms, by bathing the place affected two three times a day with this Water. ℞ Sub∣limate corrosive in fine pouder ʒi. boiling Water ℥x. mix, and dissolve.

XXIV. A Child seven years old, had a Gummy-swelling en∣compassing the Muscle Mastoides, on the right side of her Neck, also the Fingers of her right Hand were affected with the like Swel∣lings. The Gumms upon the Neck and Fingers were embro∣cated with Ʋng. Magistrale ad Strumas and Empl. ad Tophos, applied over all: during which Applications, the Child was frequently purged with Calo∣melanos and Diagredium; and drank a Decoction of Sarsa, Burdock-roots, Scrophularia the greater, flowers of Sage, Betony, and Rosemary, &c. But the Cure not succeeding with these, there was given her a few grains of Theriaca Metallorum, by which she Salivated; during which the Gummy-tumors resolved, and several Ulcerations she had, dried up. But to confirm the Cure, she took Sudorificks, and purged frequently. Wiseman.

XXV. A Woman thirty years of age, had a Gumma on the Muscle Mastoides, (whether from the Pox, or Kings-evil, is doubtful,) she took Calomelanos, ad ℈i. and repeated it as oft as was thought cenvenient, with a Decoction of Sarsa; by which course, some Ʋlcers in her Throat were also healed. The Gumma

lessened, her Chaps being now already sore by the Calomela∣nos, two Doses of Turbith were given her; beginning with gr. 7. and so higher, by which a Salivation was raised, which resolved the Gumma; after which she was purged, and with a drying Diet she was cured. Wiseman.

XXVI. The Cure of Nodes. These are more difficult to be cured th••n the former, and can only be ••ielped by curing the Disease which causes them.

XXVII. If they proceed from Convulsions of the Nerves, or Spasmodick Paroxysms, give in∣wardly this: ℞ Powers of Rosemary, Lavender, Sage, Li∣mons, Anise, and Amber, A. ℥i. mix them. Dose, one spoonful, in a glass of Ale or Wine, mor∣ning and evening.

XXVIII. And outwardly, bathe with the same Mixture, or with Oil of Amber, or with this. ℞ Pure, sweet, golden-coloured Palm-oil ℥i. Spirit of Nitre, Oil of Amber A. ʒii. mix them well, and anoint there∣with daily, two or three times a day.

XXIX. Sennertus commends natural Sulphurous Baths; as also Emplast. Diasulphuris Rulandi, which he says is here very useful, and of singular benefit. However, nothing in the World seems to out-do the force of the Spiritus Mirabilis, bathing with it twice or thrice a day.

XXX. But if they proceed from a Venereal or Pocky Cause, nothing can absolve the Cure, but inwardly to give Mercurials, to cause a compleat Salivation; as we have taught in lib. 2. cap. 38. of this present Work.

XXXI. And outwardly to anoint the Node with Ung. Mer∣curiale, Cosmeticum, vel ad Sca∣biem; and to apply over it Cera∣tum ad Tophos, Emplastrum de Ranis; with treble quantity of Mercury; or the Emplaster de∣scribed at Sect. 20. aforegoing:

XXXII. Or, which is better, our Empl. Mercuriale, in our Phar∣macopoeia Chirurgica, described Lib. 1. cap. 77. sect. 8. afore∣going. If these things do not, the Affect is incurable.

XXXIII. Some have attempted to remove them by Chirurgical Operation; but by reason of the Parts in which they happen, which are mostly Nervous, it cannot be done without great danger, and much pain; besides rendring the Part deformed, and many times useless, as to its natural operations.

XXXIV. The Cure of Tophs. These, as they always proceed from a Venereal Cause, so their cure must be attempted only by a radi∣cal cure of the Pox; which can be done but by a through-salivation: wherein you are to consider the age, sex, strength, and habit or constitution of the Body; and accordingly to ex∣cite it, by such things as may be most agreeable.

XXXV. Then you must come to Topicks, which give us but little hopes; without laying open the Part to the Bone, and taking away the Exostosis, (or it may be only a foulness of the Bone) by proper Medi∣caments,

or Manual Opera∣tion.

XXXVI. Scultetus, Obser. 65. had a Man who complained of a Venereal Toph on the left Leg, which would neither yield to a Sudorifick course, nor the-Cerate in Sect. 39. following. He there∣fore laid open the Shin-bone (which was foul) with a Cau∣stick; and shaved it away to the sound part, with the Scraping-Irons: which done, he applied a Drying-pouder to the Bone, and with dry Lint, Incarnatives, and Epuloticks he healed it up as an ordinary Wound, and so perfectly cured the Man.

XXXVII. Now here is to be noted, that no Fat, or Oily Me∣dicines are to be used to the Bone, except they are extream drying: or such Oils and Balsams as are made by Distillation, and so have lost all Unctiousness.

XXXVIII. It is also observa∣ble, that sometimes the virulency of this Disease is such, that it penetrates and corrupts the Shin-bone to the Marrow; in which case, the use of the Rasp or Scraping-iron is not sufficient; but besides them, Trepans, and red-hot Irons or Cauteries, are necessary to the rooting up, and consuming the remaining foulness, which will not be separated by the Tinctura Ex∣folians, or sprinkling upon it the pouder of Euphorbium.

XXXIX. If the Nocturnal Pains are recent, and the Toph but young, it is many times cured by anointing with Ung. Mercu∣riale, or Cosmeticum, or ad Scabiem, and applying over Empl. Mercuriale; or this of Sculte∣tus: ℞ Diachylon with Gumms, Cerate Oxylaeum, Citrinum, A. ℥i. Quick-silver (killed with fasting-spittle) ℥ss. Oil of Gua∣jacum ʒ i. pouder of Indian To∣bacco ʒss. mix, and make a Pla∣ster.

XL. But if these things do not, so that the Pains remain, and the Tumor is not discussed, it is a certain sign that the Bone under the Gumm or Toph is corrupted: and therefore it is necessary to make incision upon the Toph long-ways, upon the Shin-bone, with an Incision-knife; and then the Bone being uncovered, to rasp or scrape it away with the Scraping-iron, where it is corrupted.

XLI. The Bone being made bare, this Pouder to cleanse it, is good. ℞ Euphorbium ʒi. Sar∣cocol, Mummy, A. ʒss. make each into a pouder, and mix them. Barbett.

XLII. But if the corruption of the Bone is so great, that it can∣not be removed by Medicaments, then you must come to Manual peration, as afore declared; scraping the Bone only, if the corruption is small; but per∣forating it, if it is great; or rather using the Actual Cautery: for without these you will not be able to make a perfect Cure.

XLIII. The Padua Chirurgeons do it thus. The first day they cut the Toph with an Incision-knife, upon the length of the Shin-bone, to the Bone it self: then they dilate the Wound, with Tow wet in Glair of Eggs, and they bind up the Leg with convenient

Ligature, to repress any afflux of Humors

XLIV. The second day, they remove the Dressing, opening the Wound artificially; and then having well defended the sound parts about it, that they may not be hurt, they fill it with a Caustick, and after that cover it with a Plaster, reaching all over it, but not going round the Leg, and bind it up again, according to Art.

XLV. The third day, the Em∣plaster and Caustick are removed, and then they apply things to make the Escar fall off; which being taken away, they scrape away the rottenness, 'till the Bone appears sound: and lastly, with drying Pouders they cover the bone with Flesh.

XLVI. Where note, that they first cut the Toph, that the Cau∣stick may the sooner come to act; yet incision is not always first necessary; for we now gene∣rally apply the Caustick first upon the whole Skin, and then open it with an Incision-knife to the quick; wherein, if the Caustick has not had its full effect, we sometimes apply it again a second time, and that with good success; as was done to a late Patient of mine, with all the advantage imaginable.

XLVII. A Man having a Toph upon the shin of his right Leg, from a Venereal cause, (of which he had been lately cured (was first purged, and prescribed a De∣coction of Sarsa, &c. also Anti∣monium Diaphoreticum, and Em∣brocations and Emplasters were applied to resolve the Toph: but after six weeks course, it remained almost as painful as before.

XLVIII. Ʋpon which considera∣tion, it was concluded to lay it bare; it was done with the white Caustick: after, the Escar was divided to the Bone, and at the next dressing, raised the Escar off; then the Toph was scraped with a Rasp, and dressed dry, as is usual in Ulcers with Caries.

XLIX. The Lips of the Ʋlcer were digested with Unguentum Basilicon applied warm: after∣wards the Bone was incarned, and the Ulcer was cured in the space of two months; but not with∣out great trouble to the Chir∣urgeon, and much pain to the Patient. Wiseman, lib. 7. cap. 4. observ. 53.

L. If in the Operation of this Cure, proud Flesh should arise upon the Lips, or in the middle of the Ʋlcer, it may be taken away by strewing upon it red Precipitate dry, and laying over it Pledgets spread with Basilicon mixt with Precipitate, or on which Preci∣pitate is strewed, &c. and at length, after due cleansing, the Ulcer is speedily healed, by washing it with some styptick Liquor, and applying de Minio, or some other drying Empla∣ster.