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. XXVI. Of BRONCHOCELE, RANULA, TONSILLAE.

I. THE first of these Tumors is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. à 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Aspera Arteria; & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Hernia: in Latin, Bronchocele, Hernia gut∣turis: and in English, a Tumor of the Neck, or Throat

II. The second of these Tumors is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Ranula; and in English, a Tumor or Apostem under the Tongue.

III. The third is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Tonsillae, & Morbus Glandula∣rum; and in English, the Tumor

or Swelling of the Almonds of the Ears.

IV. The Signs. A Bronchocele is known by a great Tumor on the Neck, either on the sides, or on the Throat, or both; mostly con∣tained in a Cystis, and of the colour of the Skin; large gene∣rally, but more flat than high; in which the quantity of the Flesh seems to be increased; and it is mostly without pain; not very hard or soft.

V. Ranula is known by a soft Tumor or Swelling under the Tongue, of the colour of the Skin, much about the bigness of a Pigeons Egg, hard and round; and when painful, of a reddish colour: the Tongue being turned up, it thrusts its self forth. It is an impediment both to speaking and swal∣lowing: it is mostly included in a thick Cystis, and when sup∣purated, the matter looks of a whitish colour.

VI. Morbus Glandularum, or Swelling of the Almonds, is known by sight, being increased in magni∣tude; and when very large, filling almost the whole passage of the Throat: it is an impediment to speaking, and taking any thing down the Throat; and without much pain, except in the time of swallowing; which proves very troublesom to the Patient.

VII. It is a soft fleshy Tumor, of a round or oval figure, re∣taining the natural colour of the Skin, and of a dull sense; so that the body thereof may be pierced with a Knife or Bod∣kin, without causing pain, or drawing Blood.

VIII. The Causes. A Bron∣chocele is said to arise from preternatural Phlegm, and an acid Lympha joined with Wind; contained for the most part in a Cystis, lying between the Skin and Aspera Arteria: but some∣times it is without a Cystis, possessing the Muscular-flesh.

IX. Ranula is caused by a Pituitous-matter, arising from congestion of Humors in the infe∣rior Salival Gland; causing a soft Swelling, and possessing those Salivals under the Tongue; which in its progress fills up the space between the Jaws, and makes a Tumor externally un∣der the Chin.

X. Tonsillae are caused by con∣gestion of Humors gradually, with∣out pain; and therefore are seldom taken notice of, 'till by their growth they bring several inconveniencies with them; as, Catarrh, Cough, difficulty of Swallowing, wherein, in drink∣ing, the drink many times runs out at the Nose.

XI. They arise from a cold and pituitous Lympha, and differ from the common Swellings of the Almonds, as Tumors made by congestion, do those made by fluxion: the latter being of sudden growth, and terminating as soon: whereas the Tumor we here intend, may have been many years a growing, in∣creasing and decreasing with the Moon, as all Tumors caused by congestion in the Glands do.

XII. The Kinds or Species. Authors account all these Tumors as a Species of Struma, or the Kings-evil; and therefore will

have them to proceed mostly from the same Causes.

XIII. The Prognosticks. Bron∣chocele is of difficult cure, and dangerous; whether contained in a Cystis, or not; if it waxes very great, and grows hard, pressing upon the Aspera Arte∣ria, it may endanger Suffoca∣tion: that without a Cystis, which will not be discussed, many times becomes incurable.

XIV. That in a Cystis, is many times to be removed by Excision: that without a Cystis, whil'st recent, is in the possi∣bility of being resolved, taking away withal the internal Cause.

XV. Ranula, is a Tumor not dangerous as to Life; but more troublesom, as impeding several of the Operations of Nature: yet it is of difficult cure, and very troublesom to the best Artist, putting him many times to the trouble of Excision.

XVI. Tumor Tonsillarum, if it is small, the trouble is but little; several people having them from their Infancy with∣out much inconvenience.

XVII. If the Tumor is great, there may be great danger of Suffocation; nor will they easily discuss, sometimes never: when they will not discuss, they may be cut off, without any danger or difficulty.

The Cure of BRONCHOCELE.

XVIII. Ʋniversals must be premised, as in the cure of Strumae; purging the Body with our Family Pills, Pilulae Catharticae, Pulvis Cornachinii, Tinctura pur∣gans, or an Infusion of Sena and Rhubarb.

XIX. Give also Clysters every other day, to make a more ef∣fectual Revulsion of the Humors from the Part affected. ℞ Broth, or Posset-drink lbi. Tincture of Colocynthis ℥jss. brown Sugar ℥iv. mix, for a Clyster.

XX. And in the intervals of Purging, give this following Pou∣der. ℞ Aethiops mineralis, Be∣zoar mineralis, native Cinnabar, A.ʒvi. Myrrh, Orrice root, Ze∣doary, A. ʒiv. Alum burnt, Bwax, Ens Veneris, Scammony, A. ʒii. Cloves, Long-pepper, Spicknard, A.ʒi. make all into a fine pouder, and mix them; to which add treble refined Sugar ℥v. Dose, ʒii. every Morning, when Purging is intermitted.

XXI. Outwardly apply over the Tumor a Plate of Lead, besmeared with Quick-silver; or, Empl. de Ranis, with treble Mercury; or, our Emplast. Mercuriale, Em∣plast. Diasulphuris Rulandi; or, Ceratum è Gummi Elemi, Ce∣ratum Spermatis Ceti, Ceratum ad Tophos, Emplast. Diachylon cum Gummis; or, Emplast. ad Strumam, which is inferior to no other: see them in Our Pharm. aforegoing.

XXII. These things, whil'st recent, may prevail: but if they do nothing, there is no other Re∣medy (as to Internals) but Sa∣livation; which yet let be care∣fully performed, for fear of Suffocation. If none of these things do, you must remove it by Section. See the following Example.

XXIII. A Maid thirty years old, strong of Body, had one of these Tumors on the left side of her Neck, reaching from her Ear to the Aspera Arteria, and stretching over it upwards to the other side of the Neck; it was soft, and seemed to be full of Matter, but was without in∣flammation.

XXIV. A puncture was made into the body of it, which dis∣charged a stinking Serum, much like Horse-piss; the Tumor then sunk, and felt unequally hard, and it was drest up with a Pledget of Ʋng. Basilicon, and Empl. Diachalciteos.

XXV. The next day, taking off the dressings, the swelling was lank; a Caustick therefore was applied the length of two inches, about three fingers-bredth from the Ear: the Escar was opened, and a foul matter discharged; after which it was drest up with Dossels dipt in red Precipi∣tate, with Lenients over the Escar; and from that time, the falling off of the slough was hastned.

XXVI. After the separation of it, another sort of matter was protruded, not much unlike that of an Atheroma and Meliceris mixed together: with the Probe-Scissers it was laid open towards the Aspera Arteria, and with the Fingers several Vesiculae were pulled out, some con∣taining a foul Serum, others a gritty substance: also gobbets of Flesh came away, with which the basis of the Abscess seemed to be laid.

XXVII. Being thus cleansed, it was filled up with Dossels dipt in Precipitate, and the lips were kept open: this method of dressing was repeated every other day, and the strumous Excrescences were rubbed with the Vitriol-stone: the sinus contracted narrower within, but the Tumor being strumous, it would not heal whil'st any hollowness re∣mained, but filled up with that sort of Flesh, and raised a Tumor.

XXVIII. Whereupon a Caustick was applied, upon its upper part towards the Ear, and it was divided with a pair of Scissers, and the Sinus fill'd with red Pre∣cipitate, dressing the lips with Digestives. After the Escar was separated, the strumous flesh was eradicated with the Vitriol-stone and Precipitate, and cicatriz'd from the Ear downwards; but with some difficulty, the Basis proving false more than once, in one part or other.

XXIX. Some of this strumous Flesh rising among the Vessels, and uniting over them, made Sinus's so deep, that it was diffi∣cult to divide those, without danger of the Vessels: But no Cure being to be expected whil'st this remained, a Ligature was passed with a small Probe under the Fungus; and by deligation, and application of Precipitate, the Fungus was consumed, so that that the deepest Sinus was laid open.

XXX. This done, by applica∣tion of Epuloticks, a Cicatrice was induced upon them; and thus the Abscess was healed well near to the Aspera Arteria: after

which, the other side was laid open, and by the same method, the matter was eradicated, and the Tumor cured, as the other before. Wiseman, lib. 4. cap. 4. Observ. 10.

XXXI. If the Tumor is con∣tained in a Cystis, whereby neither External applications, as Resolvers, nor yet Salivation will prevail, you must attempt the Cure by Section.

XXXII. Make an Apertion in a right line, observing the fibres of the Muscles, which being on the Neck, must be long-ways; taking heed that you hurt no Artery, Vein, or Nerve; (rather than to hurt any of those Vessels, you had better cut the fibres cross:) If the Tumor is great, you must make a double incision cross∣wise, taking heed as aforesaid, of the Vessels: then with your Fingers remove the Bag, which seldom or never sticks very fast to the Skin; and cutting off the little Artery by which it is fed, take heed, that not the least particle of the Bag may remain, lest it grow again; after which, heal it up as another Ulcer.

The Cure of RANULA.

XXXIII. First let Ʋniversals be premised; cleanse the Stomach and Ʋpper-region by proper Eme∣ticks; then give Ʋniversal Cath∣articks, which repeat five or six times: afterwards keep the Body soluble, and perfectly cleanse the Bowels with the Clyster in Sect. 19. aforegoing, repeating it as oft as you see occasion.

XXXIV. To the external part of the Tumor apply Discussives, or Resolutives; such as are ap∣plied in a Struma, where there is hopes of doing the Cure by Resolution; of which kind are Emplastrum Diasulphuris Rulandi, Our Diachylon cum Gummis, Ceratum è Gummi Elemi, Cera∣tum de Spermate Ceti, Ceratum ad Tophos, Emplast. ad Strumam, or Our Emplast. Mercuriale.

XXXV. And the Topicks to apply to, or to wash the Tumor under the Tongue, are also Discussives; the chief among which are all man∣ner of Salts, and hot Aroma∣ticks; either in substance, or decocted in some proper Liquors, and so to be held in the Mouth.

XXXVI. Barbett commends the following Pouder, by which he says they are often cured. ℞ Pepper, Ginger, A.ʒi. roots of Florentine-Orrice, Hermodacts, Calamint, Origanum, A. ʒss. Ma∣stich ℈ i. make of all a Pouder.

XXXVII. These may be boiled in Wine, to wash with and hold under the Tongue; or mixt with Oxymel, to besmear the Part with; or it may be strewed dry, or rubbed upon the Tumor, and oft repeated in the day-time: for by the heat it creates in the Part, the Tumor seems to be discuss'd.

XXXVIII. But if these things will not do, you must open the Tumor by help of an Actual Cau∣tery, in one or more places; that the Humor may come forth, and afterwards dress it with Honey of Roses. But Barbett rather

approves of Incision with a Lancet, or Incision-knife.

XXXIX. An Observation. A Woman thirty five years old had a large Ranula between her Jaws, under her Tongue, reaching to her Fore-teeth, making a great swelling under her Chin, which was troublesom to her, and caus'd a croaking in her speech.

XL. She had before passed under a course of Physick unsuc∣cessfully: the matter was proposed to be let out by an Actual Cautery, but she refused; whereupon it was opened by Incision on each side near the Tongue; and out of it came two Blood-porrengers full of an albuginous matter, upon which the Tumor sunk.

XLI. Search was made with a Probe, and it was found that the matter had not only made a deep cavity downward••, but all the inner part of the Tongue was ren∣dred hollow: it was then drest with Syrupus de Rosis ficcis: and Empl. ad Herniam, mixed with a third part of Empl. Caesaris was applied externally under the Chin; deterging it after∣wards with Mel Aegyptiacum, dissolved in Decoction of Sage, Betony, Smallage, &c. and then it was incarned and cicatrized.

XLII. Some time after the Tumor rose again as formerly; whereupon it was opened with the Actual Cautery, on both sides of the Ranula; by which the matter was again discharged, and the Tu∣mor sunk. During the time of the Cure, she was purged, and put into an Antistrumatical Course, and so at last was cured. Wiseman, lib. 4. cap. 8. Obs. 1.

XLIII. A young Fellow had also a painful Ranula under his Tongue; incision was made into it, according to its length, and there came forth a Stone bigger than that of an Olive: it was after∣wards drest with Syrupus de Rosis siccis, and thereby in a few days cured. Wiseman.

The Cure of TONSILLAE.

XLIV. Preparation is to be made for the Cure, by Ʋniversal Purgation, Clysters, &c. and Derivation by Vesicatories, Cupping, Issues, &c. especially if there is Inflammation, and the Tumor is caused by Flu∣xion.

XLV. But if they are made by Congestion, the speedy and only way of cure is by Extirpation; either by Excision, at once cutting them off; or else by application of the Actual or Potential Cautery; among the latter of which, Butter of Antimony is accounted the chief.

XLVI. Wiseman says, that the way by Potential Cautery is, by working with a Caustick-stone, and other Escaroticks, fixt in such an Instrument as may serve to eat into them, without offend∣ing the neighbouring sound Parts; and so to make way into the body of the Gland, consu∣ming it within; and at length the exterior parts of it will fall in pieces, and so the whole will be eradicated.

XLVII. Such a like Tumor in

those places, I once saw Dr. Tho∣mas Gardner, chief Chirurgeon to the King's Houshold, (and now attending his Majesty's Person in his Camp in Flanders) open, with a great deal of dexterity, at Sir John Roberts his House in Bromley by Bow, by touching it with Butyrum Antimonii twice; and then cutting it with an Incision-knife, the Tumor yielded near a quarter of a pint of matter, presently wasted away, and became healed in a very short time after.

XLVIII. The way by Excision, is by making a ligature about the Basis of them; and then cut∣ting or snipping them off with a pair of crooked Probe-scissers.

XLIX. In doing this, consider how they are radicated: if they be rooted deep in the Throat like a Crista, if in cutting them out, you only cut the part you tied, and cut the ligature at the same time, the matter or sub∣stance may fall down into the Throat, and so hazard choaking.

L. Whil'st therefore you hold the ligature with one hand, with the other hand you must pass the Scissers down as close by the Basis of it, as you can, so as by one snip, you may cut it clear off.

LI. But for fear of failing, 'twill be necessary to have another ligature fitted in an Instrument for this purpose, and the Patient's Head to be held steady; that in case you fail in the first attempt, and it fall into the Throat, you may readily re∣turn it, and tye it at the same time, which is easy enough to do.

LII. The Excision being made, the bleeding may soon be stopt with Oxycrate; and you may cica∣trize it in a few days time, by touching it with the Vitriol and Alum Stones.

LIII. Observations. A Man, twenty five years old, long subject to defluxions from overgrown Ton∣sils, had taken much Physick unsuccessfully; so that no other way of Cure appeared, but by Excision. The right Tonsil was very large, and a ligature was made upon it, with design to cut it off at that instant: but for fear of a great flux of Blood, it was deferred to the next morning; at which time it was shrunk, and much lessened.

LIV. Then hold being taken of the Ligature with one hand, and with the other passing the Probe-Scissers close by the root of it, at one snip, it was cut off, and brought away with the Ligature, it scarcely bleeding a drop: the remaining Basis was rubbed with the Vitriol-stone, and after∣wards he gargled with Barley-water sweetned with Syrupus de Rosis siccis, and in four or five days time it was cicatrized; and the Man recovered a better degree of health. Wiseman.

LV. A Girl twelve years old was often troubled with Catarrhs, and difficulty in swallowing, thro' a great Tumor in the right Tonsil; Excision was advised. A liga∣ture was made upon it, and at the same time it was cut off: afterwards, by rubbing it with the Vitriol-stone, it was cica∣trized in a few days. Wiseman.

LVI. A Woman, twenty six years old, subject to Catarrhs, from the preternatural growth of the Amygdalae, was also cured by Excision: a Ligature was made upon the one, and it was cut off, washing her Mouth after with Oxycrate: then a Ligature was passed upon the other, and it was also cut off; after which she gargled and washt her Mouth: afterwards the Basis of them was rubbed with a Vitriol-stone. Wiseman, lib. 4. cap. 7. Ob∣serv. 2, 3, 4.

An Appendix, concerning cutting off the UVULA.

LVII. If there is an elongation of the Uvula, thro' a great afflux of the Saliva, it oftentimes happens, that it touches upon the root of the Tongue, or upon the Epiglottis; causing a frequent, and almost continual hauking, whereby in process of time a vexatious Catarrh is produced.

LVIII. Such was the case of a Maid-servant, her Uvula hung dangling upon the root of her Tongue, not swelled, nor inflamed. Supposing that to be the cause of her Distemper, the lower part of it was taken hold of with the Forceps, and then im∣mediately it was cut shorter with a pair of Scissers; it bled not a spoonful, and afterwards cicatrized of it self, without application of any Medicine: and so she was freed from her Catarrh.

LIX. Such another was cut off in one of the King's Servants at Hampton-Court; as also some others, who were so affected, and thereby they were freed from their Catarrhs, when all other Remedies failed. Wiseman.