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. XXVII. Of the KINGS-EVIL.

I. THIS Disease is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, vel, Pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Scro∣phula, Struma; and by some in the Plural only, Scrophulae, Strumae; I suppose, because oftentimes, many of these Tumors hang together: and in English, Scrophula, Struma, and the Kings-evil. The Greek and Latin Names are taken from Swine, because that kind of Beast is more frequently troubled with this Disease.

II. The Definition. Galen, Method. Med. lib. 14. cap. 11. defines, Strumae to be scirrhous Swellings, shut up in a peculiar Membrane.

III. Aetius, Tetrab. 4. Serm. 3. cap. 5. Strumae (dixit ille) sunt Carnes subcandidae, facile auge∣scentes, in Membrana contentae, & in summa Glandulae induratae, quae in Collo, sub Alis, & In∣guinibus oriuntur, ubi Glandulae Vasis substratae sunt, ut in aliis

quoque jam relatis Glandulis. Ali∣quando etiam, sed rarò tamen, ex Carne eorundem locorum fiunt; quae affinitate quadam ad Stru∣marum naturam vertitur, & Ma∣teriae accessione augetur. Viz. These Strumae (says he) are a kind of Flesh somewhat white, easily encreasing and growing, enveloped in a Tunicle or Cystis; and in a word, they are Glandules or Kernels hardned, which arise in the Neck, under the Arms, and in the Groins; where they are situated under the Vessels, even as in other parts related to the Glandules already mentioned. And some∣times likewise (but it is very rare) they are bred from the Flesh of the self-same places, which by a certain relation thereunto, is converted into the nature of Strumae, and does increase by an accession of matter.

IV. Barbett says that Strumae or Scrophulae, are preternatural Tumors of the Glandules of the Neck, contained in their own proper Cystis or Tunicle.

V. The Differences. The Tu∣mor or Tumors are sometimes in a Cystis, sometimes not; some∣times moveable, sometimes fixt; sometimes small, sometimes great; and sometimes but one, sometimes many; sometimes not ulcerated, sometimes ul∣cerated.

VI. The Places affected. They are generally the conglomerated Glandules of the Neck, called the Salival Glands: But that Struma which is not contained in a Cystis, (as that which is fixt for the most part is not) may happen to many other parts of the Body; as the Back and Back-bone, upper Lip, the Breast, Arms, Wrists, Hands, Fingers, Thighs, Legs, Ancles, Feet, &c. where it first appears, in an obscure, diffused Tumor; afterwards it breaks, and be∣comes ulcerated, and many times fistulous.

VII. To these you may add those Glands about the Ears called Parotides, or the Stenonian Pas∣sages, from Steno, their first discoverer. And it is to be noted, that the Salival-passages, pro∣ceed from the conglomerated Glandules of the Neck.

VIII. The Causes. Authors say, that they proceed from a Pituitous Humor, or from Phlegm mixt with Melancholy, by reason of the hardness, which for the most part goes along with the Tumor. Where∣upon it is, that such as are Phlegmatick-melancholy, who are gluttonous, and usually eat Meats cold and moist, and to drink cold Waters, or Snow-water, are more especially af∣flicted with Scrophula.

IX. And hence it is, that in several Regions, where the Inha∣bitants constantly drink crude, cold, and snowy Waters, (as gene∣rally in the Alps, &c. where this Disease is Endemical) they are all of them for the most part troubled and vexed with these Strumae.

X. Barbett says, that since the use of the Glandules of the whole Body, is certainly to percolate the Lympha; therefore of necessity the grosser Lympha (or the

Lympha vitiated) is the Cause of this Disease; from whence first of all proceeds their hard∣ness, and afterwards an in∣creasing and pertinacious Tumor.

XI. And so when any of this vitiated Lympha is shed abroad into other Parts, as the fleshy substance of the Body, the stru∣matick Tumor is then fixed, here and there, (tho' not in Glands) where-ever Nature finds a weak Part to protrude it to. And from hence it comes to pass, that in many Patients the whole habit of the Body is Strumatick also, and the Disease breaks forth in several places at once, making it rebellious, and very tedious to be cured; to the very great vexation, both of the Patient and Physician.

XII. And because Struma some∣times degenerates into Cancer, which is caused from a very sharp Humor or Lympha; Deckers does say, that the Humor or Lympha must have also an offending sharpness in it.

XIII. Others say, they are caused from gross and raw Juices, contained, 1. In the conglobate Glandules; which they receive from the Arterial Blood, con∣vert and perfect into Lympha, and from whence the Lympha∣tick Vessels do proceed; which convey it either into the Chyli∣ferous or Sanguiferous Vessels. 2. In the Conglomerate, which they receive from the Ve∣nal Blood; either the Lym∣pha again, or some other pecu∣liar Juices; where they ought yet be brought to a greater perfection, and are conveyed by other proper Ducts to the Parotides and Maxillary Glands, from which the Salival Ducts arise, which convey the Spittle into the Mouth.

XIV. Platerus will not have Phlegm and Melancholy alone to be sufficient for the generation of these Tumors; for that then they would not be of any long conti∣nuance, but would rather corrupt and apostemate, or turn into Pus: but that there is rather another Juice joined with them, nourish∣ing these parts; for Glandules are nourished with a thicker Juice than other fleshy parts: and therefore if this Juice is vitiated, or exceeds in quantity, it then generates this kind of Tumor.

XV. The Signs. The Tumor is sometimes roundish, sometimes longish, sometimes irregular, as to its form; sometimes single, some times complicated, and sometimes seated in a Glandule, and some∣times not; as when it happens on the Spina Dorsi, Lips, the Wrist, Hand, Finger, Ancle, &c.

XVI. It is for the most part void of pain, unless when it grows extraordinary big; and it is many times so hard, as not to yield to the impression of the Fingers.

XVII. They are known also by their slow growth; for they are not suddenly generated, or all at once, but by degrees; and where there are many Kernels, one after another. First of all, the Humor flows unto one Glan∣dule, in which is excited a Tumor, first soft and loose; and then there grows another, in like manner soft and loose.

XVIII. These Tumors are at length hardned; and many times they increase in number, till there hangs down from the place affected many Glandules, as it were so many branches: but this is chiefly to be understood, when it affects the Neck, and parts adjacent.

XIX. When it happens in the Joints and other parts, it is not contained in a Cystis, but is a broad diffused Tumor, without any considerable pain, 'till it grows very great; and mostly of the colour of the Skin, hard, and immoveable; which in process of time breaks, and becomes a foul Ulcer, or running Fistula; and many times fouls and rots the very Bone it self, after an extraordinary manner.

XX. The Prognosticks. These Tumors are always hard to be cured, and long in performing; especially if they be many, have been of long continuance, and are very great, and hard, or fixt.

XXI. By how much the more moveable they are, by so much the more easily cured; and when cured, they for the most part leave behind them great Scars.

XXII. If they grow very great, and painful withal, they are dangerous, and apt to become Cancerous; and if they stick to a Bone, they generally corrupt it, and hardly admit of cure: the like if they be fixt to any great Nerve or Vein, lye deep, or are hereditary: in all these cases, a Palliative Cure is the best.

XXIII. If in curing them by Section, you should divide the Recurrent Nerve, the Speech will certainly be lost, and many times Life withal.

XXIV. The Cure. The Indi∣cations of Cure are threefold: 1. To attenuate, attemperate, and evacuate the thick, acid, or vitious Lympha. 2. The Tumor is, if possible, to be discussed; otherwise, to be softned and ripened. 3. If it comes to Sup∣puration, it is at length to be taken away, either by Incision, or Escarotick Medicaments.

XXV. The first Indication is answered by Internals: First, such things as attenuate, incide, and evacuate the Morbifick-matter contained in the first Passages. I commend upon Experience Oxymel of Squills, which may be taken every other Morning; from one spoonful to two spoonfuls or more; in a glass of Wine and Water.

XXVI. Afterwards it may be taken a spoonful at a time, every morning; for 14 or 16 mornings, in like manner.

XXVII. Afterwards you may purge twice a Week, with Our Family Pills, Pilulae Catharticae, Pilulae Mirabiles, Tinctura Pur∣gans, or some such like thing.

XXVIII. In the intervals of Purging, give something that is specifick against the Disease, and may attemperate the acid Hu∣mor, by absorbing it; which is done by Alcalies, chiefly such as are volatil.

XXIX. Of this kind, the Spi∣rits of Sal Armoniack, of Harts-horn, of Cows-horn, Ox-horn, Ox and Horse-hoofs, of Beef, &c. are said to be chief, whether inward∣ly used, or outwardly applied,

given in a convenient Vehicle.

XXX. A famous thing is Salt of Hog-lice: they that cannot get the Salt, may take the Pouder of them; being first washed clean, then drowned in Wine, and dried in an Oven, 'till they will reduce to pouder. Dose, à gr. x. ad xxv. in any proper Liquor, for forty or sixty days.

XXXI. These following Inter∣nals, have also the property of consuming Scrophula's, and in∣ducing their healing, if ulcerated: viz. Roots of Swallowort, round Birthwort, Briony, Jallap, Me∣choacan, Sowbread, Dropwort, Pilewort, Figwort, Devilsbit, Orrice-root, Squill, Vervain, flowers of Broom, of Privet, Crabs burnt, Eggshels burnt, Sal Gem, Sponges burnt, ashes of a Lizard, &c.

XXXII. Johannes Prevotius commends the Electuary of green Lizards, as a great Secret, and certain Remedy for the cure of the Kings-evil. Dose, to Children ʒii. to Men or Women ℥ss. ʒvi. or ℥i. at most, continuing it for thirty or forty days: anointing also outwardly with the Oil of Lizards. See their Preparations in Our Doron Me∣dicum, lib. 3. cap. 2. sect. 9. Hercules de Saxonia commends those things also, as most ex∣cellent.

XXXIII. In like manner the pouder or ashes of Spunges and Sea-crabs may be given; by mixing them with Honey, and making them into an Electuary, as you do the pouder of Li∣zards.

XXXIV. As for the Diet or Food, it ought to be such as is prescribed usually in the Cure of an Oedema and Scirrhus, which may consume the cold phlegmatick Humor, and alter the habit of the Body: Purging also with proper Phlegmagogues, such as are the aforementioned things: or a Diet-drink made of Sena, Rhubarb, Mechoacan, Horse-radish roots, and Scurvigrass.

XXXV. Avoid Bleeding, as the most pernicious thing; (it is the advice of Barbett, and other great Men) but sometimes, in the intervals of Purging, the Patient may sweat, by the ex∣hibition of volatil Alcalies; which is a good expedient in this Cure: so also the dulcified Spirit of Nitre.

XXXVI. Pouder of Vipers, given ad ʒi. is a famous thing; so also the Salt of Vipers, given ad gr. x. or the Powers of Vi∣pers given ad gut. xxx. in any convenient Vehicle.

XXXVII. And for their con∣stant drink, let it be Decoctum Ulmi; in a gallon of which let five hundred Hog-lice be bruised and boiled; than which, there is no greater Specifick in the World, I have proved it several times: For by the constant taking of this Liquor, the quality of the whole mass of Blood and Lym∣pha comes to be perfectly altered, and the scrophulous habit of Body to be throughly changed, so that the Patient mends upon it to a wonder: it may be drank as common Drink, mixed with a little White-wine. See the Prepa∣ration thereof in Our Pharm.

Bateana, lib. 1. cap. 16. sect. 29. And see more of this Cure, in Our Synopsis Medicinae, (the Third Edition) lib. 6. cap. 15.

XXXVIII. If yet the Disease is so rebellious, that none of the afore-prescribed Methods will do, you must then come to the last Remedy, which is Salivation; which is to be done with a great deal of care and gentleness, with proper inward Mercurials: And this I have done several times with happy success; but this way succeeds best, when it is in any other part but the Neck and Throat; if it be in these, it may be done, but it must be with much caution; lest by the too great afflux of Humors, the Patient should be suffocated.

XXXIX. The second Indica∣tion is answered by the applica∣tion of Externals, which are of three kinds: 1. Discussives and Resolutives, where there is hope of Resolving. 2. Suppuratives or Maturatives, where there is no hopes of Resolution. 3. Pal∣liatives where it is indurated, so that its degeneration into Scirrhus or Cancer is feared.

XL. If they be loose, small, and not very hard, there is hopes of Resolution; in which case a simple Ointment made of Pile∣wort roots is an excellent thing: much more if an half part of Our Hercules be mixt with it.

XLI. Or anoint with this Liniment of Barbett: ℞ Oils of Myrtles and Bays A. ℥i. Ʋng. of Martiaton ℥ i. Quick-silver extinct with flowers of Sulphur ʒvi. mix, and make an Ointment, with which anoint twice a day: if the Tumors are not consumed with this, they will at least be diminished.

XLII. Balsam of Sulphur is a good thing to anoint withal; so also Ointment made of Tobacco, green or dry: if it is made of green Tobacco, it ought to be such as is raised with us from Virginia Seed: and it is so much the better, if it is mixed with white Precipitate ʒii. native Cinnabar ʒi. to one ounce of the Ointment.

XLIII. This of Poterius is a singular good thing: ℞ Green Tobacco leaves M. vi. fresh Butter lbii. Venice Turpentine ℥iv. mix, and insolate eight days; strain out by pressing; to the expressed matter add Wax, Gum Ammonia∣cum, Galbanum, A. ℥ii. which mix; and being almost cold, add crude Antimony, Cinnabar artifi∣cial, both in fine pouder, A.℥ss. Myrrh, Frankincense, A. ʒii. (I add pouder of Tobacco leaves ℥i.) mix again, and make an Ointment.

XLIV. ℞ Oil of Bricks, com∣monly called Oleum Philosopho∣rum ℥vi. Oils of Juniper and Turpentine, A. ℥ i. Spirit of Nitre ℥iii. mix them, and there∣with anoint. Balsamum mirabile is excellent to anoint with in this case: so also to bathe the Part affected with Spiritus mi∣rabilis.

XLV. Or you may anoint with Ung. Cosmetic. or ad Scabiem, or Mercuriale; and apply over the Tumors Ceratum de Galbano, è Gummi Elemi, vel Ceratum ad Tophos; or Our Diachylon cum Gummis; or Our Emplast.

ad Strumam, vel Mercuriale; all which see in Our Pharmaco∣poeia Chirurgica, in Lib. 1. cap. 74 sect. 5. 8. 9. cap. 76. sect. 3. 4. 9. and cap. 77. sect. 3. 8. and 10. aforegoing.

XLVI. Barbett commends this Emplaster: ℞ Ammoniacum, Bdellium, Galbanum, A.℥ss. Bay-berries, Cummin, Pellitory of Spain, Stavesacre, A. ʒvi. Pi∣geons dung ʒi. Goats dung ʒiii. Hogs-grease ℥jss. Oil of Camomil ℥i. Wax, Pitch, A. q.s. mix, and make an Emplaster.

XLVII. Cinnabar ℥i. is good to be added to it: and if the Tumor is painful, you may also add to it Opium ʒvi. or ℥i. be∣cause it has not only the virtue of easing pain, but also of Discussing and Resolving.

XLVIII. This following Em∣plaster is also good. ℞ Empl. è Cicuta cum Ammoniaco ℥ii. pure Gum Elemi ℥ss. flowers of Antimony, Mummy, A. ℥ ss. red Precipitate ʒv. flowers of Sal Armoniack ʒiii. Juniperine Bal∣sam of Sulphur q.s. mix, and make a soft Emplaster; which spread upon Leather, and apply to the Part affected, renewing it once every two days.

XLIX. This also is of singu∣lar efficacy. ℞ Red Precipitate q.v. Quick-silver as much as it will absorbe, or suck up by grind∣ing in an iron or glass Mortar: put this Mixture into a thin Cloth, and strain from it all the Quick-silver which would not unite: to this Mixture put de∣purated juice of Nightshade, q.s. insolate for some days; decant the juice, and repeat it three times: this done, mix of this Pouder ℥i. with Oil-olive, Sheeps-suet, A. ℥ss. first melted together, and almost cold, and make an Ointment: it resolves much, and eases pain.

L. But where a Resolution can∣not be accomplished, and the Tumor is great, and manifestly contained in a Cystis, and free from any great Vessels, the best way is by Section; making an incision thro' the Skin, and separating it from the Cystis, then cutting it off by the root, as we have taught in the former Chapters.

LI. If this cannot be com∣modiously done, you must then endeavour a Suppuration; and this is most commonly per∣formed in a Phlegmonoodes, with this Cataplasm: ℞ Onions, heads of Garlick, A. N^o ii. bake them in an Oven, 'till soft, old Leven ℥ii. Mucilage of Althea and Lilly roots, Mithridate, A.℥i. pouders of Fenugreek and Linseed, Hens and Pigeons dung, A. ℥ss. Figs roasted, N^o vi. Oil-olive ℥jss. Oil of Juniper ℥i. Saffron ʒii. mix, and make a Cataplasm.

LII. Wiseman says, that to hasten the Suppuration, it is com∣mon to pinch them hard; and some say, to thrust a Thorn into them, to inflame them, thereby to hasten their ripening: you must endeavour a perfect con∣coction; for if you open them, while any part of the Gland is hard it will increase, or put you upon a necessity of eradicating it, or else to leave the Cure imperfect.

LIII. Being perfectly ripe, the

way of opening the Tumor, is mostly by Incision, because it makes the least Scar: but if the Struma is large; the way by Caustick may be better, because it makes a large Orifice, and with less pain assures a Cure.

LIV. The Matter being dis∣charged, you may cleanse with the Mundificative ex succo Apii, Basilicon, red Precipitate, and the Vitriol-stone; and afterwards incarnate and cicatrize, as in other Abscesses or Apostems.

LV. In old and hard Struma's which admit not of a compleat Suppuration, but break out into small holes, which growing bigger and bigger, become so many painful Ʋlcers, spreading one into another, the body of the Gland remaining hard, without hopes of maturation; these you may dress two or three days with a Pledget of Ʋnguent. Basilicon, which will qualify the heat, and moderate the Ulceration, and then by interchangably applying Dis∣cutients or Lenients, you may happily waste the whole Gland, the Patient taking the mean while specifick Internals.

LVI. In some Strumae ulcera∣ted about the Chops, I have seen (says Wiseman) a Fungus thrust forth, so that with my Spatula thrust under them, I have thrust them quite out, and healed the Ʋlcer in few days: in others, where they are incapable of being so soon thrown out, I cut off the protuberant part, and consumed the remaining Basis with Escaroticks.

LVII. When therefore the Stru∣mae are large, or lye deep, and near considerable Vessels, Extirpa∣tion by Causticks and Escaroticks is the best way. 'Tis true, it requires more time, but 'tis sure, and the only way Patients generally admit of; for the very notion of cutting with a Knife, frights them.

LVIII. In order then to this work, the Patient ought frequently to purge, and constantly to take some antistrumatick Diet, &c. otherwise new Tumors will arise whil'st the old ones are eradi∣cating.

LIX. Then such Escaroticks are to be chosen, as may penetrate deep into the Gland, and do the work with the least pain: But indeed all Medicaments fit for this work are very painful, yet the strongest Causticks are most pro∣per to begin with, so they be kept within their bounds.

LX. Of these there are several kinds: as, 1. Soap-lees, boiled up to a Stone; but this will spread, in spight of all Defensa∣tives. 2. The Causticks made of Arsenick, Sublimate, and Vi∣triol; which spread also. 3. Calx viva, boiled up with Lixivium Saponis; which spreads least of all.

LXI. Simple Escaroticks are, 1. The Caustick-stone. 2. Corro∣sive Sublimate. 3. Arsenick. 4. Au∣ripigment. 5. Ʋnslaked Lime. 6. Oils of Vitriol and Sulphur. 7. Butter of Antimony, &c.

LXII. Simple Cathereticks are, 1. All sorts of Vitriol. 2. Ver∣digrise. 3. Squamae Aeris. 4. Chal∣citis. 5. Misy. 6. Sory. 7. Burnt Alum. 8. Arcanum Coralinum. 9. Red Precipitate.

LXIII. Of these Compounds are made: as, 1. Trochisci de Minio Vigonis, made of Corro∣sive Sublimate, Minium, and Leven. 2. This of John Arden, more Escarotick. ℞ Corrosive Sublimate ʒiv. Ceruse, Starch, A. ʒiijss. Arsenick in fine pouder ʒjss. juice of Asphodel ʒx. best Vinegar ʒv. mix, and boil to the con∣sumption of the humidity; then pouder it, and incorporate it with Auripigment calcin'd ʒjvss. Leven ʒxvi. mix, and with a lit∣tle Rose-water, make Troches. 3. Pulvis sine pari. It is made of corrosive Sublimate, Auri∣pigment, Quicklime, ana. 4. Tur∣bith-mineral alone. 5. Red Pre∣cipitate alone. 6. Red Precipi∣tate mixt with burnt Alum. 7. The Vitriol-stone.

LXIV. The gentlest of those Preparations with Corrosive Sub∣limate, are too painful to be applied in tender Bodies, and scarcely to be endured in the strongest, tho' taken off in four or six hours after: for that the Salts having penetrated, the pain will continue vehement for a long time after; many times affecting the neighbouring parts with Tumors and great Inflam∣mation, and sometimes affecting the Head with terrible pains, as also Palpitations of the Heart, Faintings, &c.

LXV. The Cathereticks most commonly used, are Turbith-mineral, red Precipitate, and burnt Alum, which are indeed the mildest, and therefore of a more slow operation, but may serve ordinarily, and in tender Bodies.

LXVI. The Method of applying them is this. 1. It is best to chuse that Caustick which will spread least; which you are to spread long, in proportion to the Tumor, reaching from the lowest part thereof upwards; because in consuming it, the Scrophula will sink downwards; and defend the sides with Pla∣sters, that it do not spread.

LXVII. 2. The lips being once divided, they give way, and as the Escarotick, penetrates into the body of the Gland, the sides will fall in, and be eradicated out of the aperture, tho' very small; which the less it is, the less Scar will remain from the Cicatrice, and the sooner it will be cured.

LXVIII. 3. The Escar being made, divide it the whole length, and with a Caustick-stone, rub into it, 'till it has penetrated into the body of the Gland; the which it will the sooner do, if you press into the same place with a Stick dipt into Oil of Vitriol, or Butter of Antimony.

LXiX. 4. This done, dress it up with Ung. Basilicon, mixt with a little Linseed-oil; embrocating the Parts adjacent with Oil of Roses mixt with Vinegar, and over all lay Empl. è Bolo: being thus drest, it is painful; but it lasts not above half an hour.

LXX. 5. The third day after dress it again; and if the Escar in the middle is dried hard, dress it with Lenients: but if it feels soft, rub it again interchangably with the Caustick-stone, and Oil of Vitriol, or Butter of Antimony, thrusting them every

way into the body of the Gland; but taking heed, that the lips of the Ulcer may not be en∣larged thereby.

LXXI. 6. Thus proceeding, most of the Struma will be wasted, before the first Escar in the cir∣cumference will fall off: after which you may consume the re∣mainder with red Precipitate, and keep it open by Dossels of Lint, letting the lips grow nar∣rower in the mean time; and so heal it with a Cicatrice, as another Sore. Wiseman.

LXXII. This is the Method for very large Strumae, the lesser will not admit of this Way; to such you may apply the strongest Catheretick Pouders, as you see cause. But if they affect the Muscles, Nerves, Tendons, Li∣gaments, Joints, &c. they require more caution in their extirpation.

LXXIII. The Cure of the Evil which is without a Cystis, af∣flicting the Muscles, Tendons, and Joints. The gumminess upon the Muscles and Tendons require Emollients and Discussives, and differs not much in Cure from that of a Scirrhus.

LXXIV. The Evil affecting the Joints increases gradually, and rises by congestion: it is twofold; 1. That which rises Externally, upon the Tendons, between them and the Skin, or them and the Bone. 2. That which rises Internally, within the Bone it self, which we shall consider in the Chapter of Spina Ventosa.

LXXV. The first of these arises for the most part from an Humor overmoistening the Tendons and Ligaments; which very much relaxes them, and produces a weakness and uneasiness in the Joint, raising a Tumor exter∣nally; which in process of time corrodes and rots the Mem∣branes and Bones, thro' its acidity.

LXXVI. First purge with Mer∣curials and Antimonials, and keep the Patient to an Antistra∣matick Diet, to alter the habit of the Body; and apply to the Tumor Emplasters of an astrin∣gent and dry quality, as Empl. de Minio, è Bolo, &c. with moderate Bandage; and let the Member be placed in such a position, as may prevent the falling down of the Humor.

LXXVII. Afterwards strengthen the Joint by Fomentations, and Emplasters of a discussive and astringent faculty: but if yet the Tumor grows greater, and will not discuss by any appli∣cation, it is to be feared, that the Bones are hurt.

LXXVIII. Now since these kinds of Swellings are for the most part caused by an Hypersarcosis within, they are not to be opened, without some assurance of a rottenness of the Bone: for otherwise upon opening, it will only yield a G••eet, and the Hypersarcosis will be protruded in a Fungus.

LXXIX. If also in some par∣ticular place Suppuration does appear, and upon opening, a matter much like whites of Eggs does come forth, you may conclude the Bone is corrupted, (especial∣ly in the Hand or Foot) and the longer the opening is delayed,

the more rotten the Bones will be.

LXXX. In this case, discharge the matter, making the vent large, according as the Vessels will per∣mit; and proceed in the Cure, as in an Ulcer with rottenness of the Bone, and keep the member in such a position, that the Joint may not be contracted.

LXXXI. If much proud Flesh shall grow up in the Ʋlcer, it will hazard the rotting of the Bone underneath; and if the Bone is once carious, it is not then the work of Nature, but of Art: for 'till the Hypersarcosis is re∣moved, the Bone will never exfoliate, but the Evil will still increase, and the Bones rot in pieces, one Apostemation coming upon another; so that the Patient will consume, and dye miserably.

LXXXII. In this case, the proud Flesh must be removed by such things as the Patient can bear; as Precipitate, either alone, or mixt with Basilicon, or burnt Alum, as the occasion may require: then way being made to the Bones, they are to be made bare, and such as are loose are to be taken out, the others you must dispose to exfoliate.

LXXXIII. Then cleanse the Ʋlcer well by Detersives; for which purpose nothing seems better than Ung. Nicotianae, and che∣rish the native Heat by discus∣sive, and drying Fomentations; and by Compresses (pressed out of Lime-water, or the Water of the Griffin) and convenient Bandage, endeavour to restore the Part to its natural form and magnitude.

LXXXIV. If it becomes of a scirrhous hardness, or seems to degenerate into Cancer by reason of pain, then nothing is to be attempted more than a pallia∣tive Cure. ℞ Ceratum de Gal∣bano lbi. Pulvis Mercurii coagulati ℥vi. Oil-olive q.s. mix, and make a soft Emplaster.

LXXXV. Or this. ℞ Empla∣strum album ℥iv. Sacchar. Saturni, Opium, (dissolved in Water, and inspissated to the thickness of new Honey) A. ℥i. shining Soot ℥jss. volatil Sal Armoniack ʒvi. soften with Oil of Nightshade, q.s. and make an Emplaster.

LXXXVI. Or, ℞ Emplast. de Galbano lbss. Empl. Mercuriale lbi. mix them, and apply. Or, ℞ Sheep-suet ℥ii. Oil-olive ℥ivss. melt, and mix; to which add Oils of Juniper-berries, Fennel-seed, Anniseed, and Amber, A.ʒi. volatil Sal Armoniack ℥iii. Sac∣charum Saturni ℥jss. Opium ex∣tracted ℥i. white Precipitate, native Cinnabar, A.ʒvi. mix them, and anoint therewith.

OBSERVATIONS.

LXXXVII. A Girl ten years old, had hard Kings-evil Swellings on three of her Fingers: she was cured by the Smoak of Vinegar poured upon red-hot Flints, morning and evening for a Month together. Riverius, Ob∣servat. communicat.

LXXXVIII. A Maiden, four∣teen years old, was much troubled from her Infancy with Ʋlcers in her Ears and Fingers, Lips much swelled, darting Pains, Scurvy, with Glandules of Neck and Ears

exulcerated, and the rest scirrhous, and so swelled, that she could scarce move her Neck. She drank the Decoction of Guajacum, with cutting and opening Medi∣cines, four times a day, with eight drops of Spirit of Sal Armoniack in it: and once a week she took this Pouder. ℞ Jalap ʒss. Tartar vitriolated gr.v. Oil of Fennel gut.ii. make a pouder, for a Dose; which gave her three or four Stools. And outwardly there was applied Emplast. de Ranis cum Mercurio, softned with Oil of Rue and Soot; but the Glandules being exulcerated, Ʋng. Basilicon was first applied, and after that, Balsamum Sulphuris Rulandi; with which in about three months she was cured. Deckers.

LXXXIX. A Gentlewoman was three years troubled with a hard painful Tumor in her Neck, to which was applied this. ℞ Em∣plast. de Ranis cum Mercurio ℥ss. fine Galbanum ʒii. Saccharum Saturni, volatil Sal Arm. A.ʒss. soften with Oil of Rue, q.s. and make the consistency of a Plaster. By the application of this the Pain and Swelling va∣nished away. Deckers.

XC. A young Lady cholerick and lean, had many scrophulous Tumors, and being afflicted with a continual Hectick-fever died: her Body being opened, there was found above a thousand Glan∣dules upon her, little and great, from the Jaws to the Os Pubis; which were within of the same colour with those in her Neck, viz. yellow; Medicines were wa∣rily apply'd, yet with no suc∣cess. Barbett.

XCI. A Youth twelve years old had a Struma under his right Jaw, of an oval figure. Inci∣sion was made into the Skin, according to its length; then se∣parating it, a Ligature was fast∣ned under it, and so it was cut out, leaving the Ligature to digest off. It was drest with a Digestive made of Turpen∣tine, and Emplast. è Bolo: after Digestion, it was deterged, in∣carned, and cicatrized. Wise∣man.

XCII. A Woman twenty eight years old, had a large Struma on the left side of her Neck, of an oval figure, and moveable under the Skin: an Incision was made the full length of it, and the Skin being every where sepa∣rated from it, it was pulled out, and a Ligature was tied about the Vessels under it, and then cut off: it was drest with a Dossel spread with the Di∣gestive of Turpentine, dipt in Pulvis Galeni, with Pledgets of the same Digestive over it, and a Restrictive Plaster over all, with good Bandage; and after Digestion, it was incarned and healed. Wiseman.