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. XXXII. Of the DROPSY.

I. THE general name in Greek, is 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Aqua intercus, (à facie aquea) ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Aqua, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 facies; in Latin, Hydrops; in English, the Dropsy.

II. The Kinds. It is threefold, 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ab 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 per, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 caro; 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ab 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in, sub∣ter, &c. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 album, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pi∣tuita; in Latin, Anasarca, Leu∣cophlegmatia: a Dropsy of the Flesh, or of the habit of the whole Body. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. ab 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 uter: in Latin, Ascites, Hydrops Abdominis; in English, a Dropsy of the Belly. 3. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Tumor ad Tympani similitudinem; in Latin, Tym∣panites; in English, the Tym∣pany, or, Windy Dropsy of the Belly; called by some, the Dry Dropsy.

I. Of ANASARCA, or, SARCITES.

III. Definition. This Disease is a praeternatural Collection of serous Lympha thro' all the fleshy parts, or habit of the whole Body. Or, it is a preternatural Tumor of the whole Body, caused by a Collection of waterish and serous Humors.

IV. The Causes. The Proca∣tartick Causes, are great Hemor∣rhages of what kind soever, irre∣gular living, idleness, much drinking, as well of strong Liquors, as of small; by which the Ferment left in the Stomach is washed away thro' that continual ex∣cess, or it is made more flaccid, and less fit for Concoction; whereby Crudities are increased, by which an evil Chymus is produced, of which a vitious Blood is generated, and a crude,

phlegmatick and serous habit of Body, whence comes Ob∣structions; and a Dropsy.

V. The Proximate or near Cause is the serous Lympha, which is also sometimes very sharp, which being much heaped up, does distend its tender Ves∣sels; and by too great disten∣tion does many times break them; whereby it is extrava∣sated, and falls every where upon the muscular Flesh, and interstices of the Muscles.

VI. The Antecedent Cause is an obstruction of the Glandules of the Lymphatick-vessels; where∣by the Lympha flows out too plentifully.

VII. The Signs. The whole Body, Face, Hands, Belly, Thighs, Legs, Feet, &c. being chill'd thro' the coldness of the serous or watery Humor is enervated, lan∣guish, and swell; and where-ever almost you press hard your Fingers, (more especially on the Legs) their print or im∣pression remains behind.

VIII. Respiration or breathing is always difficult, and with some trouble, but more espcially after eating; and the Patient is al∣ways thirsty and craving Drink; and tho' they drink never so much, yet they are never satisfied.

IX. Their Flesh is generally cold, or of a cold habit, soft, loose, pale and white; and many times they look as if they were dead; the Urine is thin and white, Stools many times very pale, with a weak and unequal Pulse.

X. The Prognosticks. In the beginning, and in Infants and Young people it is easily cured; and as easily returns again, if the Viscera be not strengthned, or a good Diet be not observed.

XI. But if the Patient is Scor∣butick, or of a Cachectical habit of Body, the Sick is with much difficulty restored to perfect Health: so also if it comes after a burning Fever, or an Ague of long standing.

XII. Celsus, lib. 2. cap. 8. says, that a Cough coming upon a Dropsy, takes away all hope of Cure: and Hippocrates, sect. 7. aph. 47. says, that if a Cough troubles an Hydropick person, he is in a desperate condition.

XIII. One troubled with an Anasarca, if there be a Fever withal, with little Ʋrine, and that thick, it foreshews Death. And if one be cured of a Dropsy, if it returns again, there will be but small hopes of Recovery: so also if they have Ulcers supervening. Hippocrates in Coa∣cis. Celsus, lib. 3. cap. 21.

XIV. The Cure. The Remote Cause must be removed, by insti∣tuting a good Diet, hot, drying, and strengthning; and forbearing things cold, moist, and watery. The Humor or Water super∣abounding, must be taken away by proper Catharticks, Diure∣ticks, and Sudorificks. And the Tone of the weakned Bowels must be restored and strengthned: but Bleeding must be avoided, as a thing most hurtful to all Hydropick per∣sons.

XV. The Humor or Water abounding is taken away, 1. With

the following simple Catharticks, Vinegar, Wine, and Oxymel of Squills, Cambogia, Elaterium, Jallap, Rosin of Jallap, Me∣choacan, Nitre, Syrup of Buck∣thorn-berries, and Sena in an Infusion in Wine.

XVI. With these Compounds: 1. Pilulae Catharticae, Family Pills, Pilulae Hydropicae Bontii, & Pilulae Lunares, (which are wonderful things) Pulvis Cor∣nachinii, Syrupus Catharticus, and Vinum Hydragogum Bar∣betti; which see, Dor. Med. lib. 2. cap. 12. sect. 7.

XVII. These Pills are also commended: ℞ Aloes, Cambogia, Nitre, ana; dissolve the Aloes and Cambogia in fair Water, or a strong Decoction of Colocynthis, and bring them to the body of a Pill, then add the Nitre in fine pouder. Dose, à gr. xvi. ad xx, xxv, or xxx. in the morning fasting.

XVIII. This Pouder is also good: ℞ Mercurius dulcis ℈i. Rosin of Jallap gr. vii. Elaterium gr. iii. mix, for a Dose, for a Man; a third part of it will serve for a Child; and one half of it for a Youth of 14 or 16 years old.

XIX. The next Course to be pursued, is that of Diureticks; for which purpose we commend Pellitory of the Wall, Salt of Tartar, Salt of Broom, or Broom-ashes, Pot-ashes, and all sorts of fixt Alcalious Salts; an Infusion of Mustard-seed in White or Rhenish Wine, the Pouder or Salt of Millepedes, &c.

XX. And in the intervals of Purging, whether by Stool or Ʋrine, the Patient ought often to Sweat, chiefly in a Bath of hot Water; in which hot and dry∣ing Herbs, as Southernwood, Wormwood, Camomil, Fether-few, Origanum, &c. Pot-ashes, flowers of Sulphur, &c. have been boiled.

XXI. If the Disease is vehe∣ment, and come to a head, this following Cataplasm is of ex∣traordinary use. ℞ Green Tobacco leaves (raised from Virginia seed) M. vi. cut, and then bruise them well in a Mortar, and make it up into the consistence of a Cataplasm, with pouder of Bay-berries; and apply it warm over the whole Belly of the Patient.

XXII. You may let it lye an hour, more or less, as you see occa∣sion, or that the Sick can bear it; and it may be renewed every other, or third day, if the Disease shall require it: it works strongly, and purges watery Humors, both upwards and downwards.

XXIII. If you cannot get green Tobacco, you may make use of dried Virginian; which being cut small, may be throughly moistned with White-wine: to it may be added some Mithridate or Honey, and a sufficient quantity of pouder of Bay-berries, to be beaten up into a Cataplasm, and to be applied warm, as before directed.

XXIV. And to facilitate the Cure, if the Legs swell much, or the lower parts, you may apply Vesicatories to the Calves, and let the Blisters run as long as you see convenient: for by this alone means, the Water has been drawn wholly out of the

Body; but you must be very cautions, and look after them very diligently, lest they should gangrene or mortify; which many times they are apt to do, thro' the great afflux of watery Humors.

XXV. But while this Purging, Diuretick, and Sudorifick Courses are pursuing, you must in the intervals of time strengthen the Bowels, and endeavour to re∣store their Tone; which you may do with the following things.

XXVI. ℞ Crocus Martis ape∣ritivus ℥i. Nutmegs in pouder ℥ss. Cloves in pouder ʒii. foecula of Aron roots ʒi. Camphir ʒss. mix them. Dose, ʒi. every night in the intervals of Purging, &c.

XXVII. We also commend Our Theriaca Londinensis, or rather Our Theriaca Chymica, which is a most admirable thing: so also Tinctura Martis cum Tar∣taro; which Preparation you may see in Our Doron Medicum, lib. 2. cap. 7. sect. 19.

XXVIII. And after the Dis∣ease seems to be cured, and per∣fectly gone, you must still for some time continue the use of these strengthners, either some of them, or all of them; using them in∣terchangeably, 'till the Viscera are absolutely restored, and con∣firmed in their healthful Tone; lest a relapse should follow, and thereupon, the death of the Patient.

XXIX. We are very short here, (tho' if truly considered, we have said a great deal:) but such as desire a more full and ample Discourse concerning the Cure of this Disease, may be pleased to see the third Edition of Our Synopsis Medicinae, lib. 6. cap. 4. sect. 1. ad 130. and sect. 163. ad 186. where they may re∣ceive abundant satisfaction. How∣ever, we thought good to say these things in this place; that we might not leave our young Artist, who may not have seen that Book, totally destitute.

II. Of an ASCITES.

XXX. Definition. An Asci∣tes is a preternatural Tumor of the Belly, caused by a Collection of Watery Humors into the capa∣city of the Abdomen.

XXXI. The Causes. The Pro∣catartick Causes are the same with the former. The Antecedent Cause is the weakning of the Blood, or a discrasy, whereby it cannot convey its Serum to the Reins: so that the sanguiferous Vessels swelling, they are not able to receive their continual and daily proportions of Lym∣pha; from which cause, the Lymphaducts being overcharged, are extended, and swell; and at length where they are most tumified, and weakest, break.

XXXII. This breach of the Lymphaducts, if it happens in the internal Parts, as the Viscera, they let fall their Juices, (now depauperated, altered, and changed, thro' their stagnation) into the cavity of the Abdomen; which at beginning is but small, but being continual (tho' gra∣dual) at length comes to pro∣duce a mighty Tumor of the Belly; from whence, the Cods,

Thighs, Legs, and Feet, many times are caused to swell, thro' the dispersion of the same Humor.

XXXIII. The conjoined Cause is a serous Lympha, but in a recent Ascites it seems to be wholly Lymphatick; in an inveterate Ascites, it is most like to Serum, with a thicker part like Curds, or some such like thing; as Barbett in a dissection after death observed.

XXXIV. A Woman fifty years old died of an Ascites, she was opened by Barbett, the famous Franciscus Sylvius, and Ver∣schagen being by, they found, 1. A thin and fluid Lympha: 2. Then a Matter, which was congealed: 3. That which was thicker, or like the Matter of an Apostem. From this and several other like Examples, Bar∣bett was of opinion, that this thicker part of the Matter re∣maining in the Belly, after Tapping, is the cause of many a Patient's death.

XXXV. And that if the Pa∣tient would sooner yield to ••e tapp'd, they might, with much greater probability, recover: whereas being grown invete∣rate, it is for the most part mortal.

XXXVI. The Signs. There is a manifest Tumor or Swelling of the whole Belly, and when it grows great, it is very heavy with the Water: and there is a sound of Water rumbling, as it were falling or squashing, when the Sick turns from one side to the other.

XXXVII. The Thighs, Legs, and Feet many times swell; and generally there is a tumor of the Scrotum, which by degrees, grows many times as big as a Man's head.

XXXVIII. There is an internal Fever, very great Thirst, a dry Cough, and at length a difficulty of Breathing; whereby the Patient cares not for stirring or moving up and down, but rather de∣lights in sloth and idleness.

XXXIX. There is also an Exte∣nuation, or kind of Consumption of the upper parts of the Body; and the Urine is very little, and thick, and sometimes of a red∣dish colour.

XL. The Prognosticks. This is the most difficult of all Dropsies to cure; yet while it is recent, and newly begun, may be at∣tempted by Purging: but if it is inveterate, then Purging rather adds to it, and in∣creases it.

XLI. Hippocrates, Sect. 7. Aph. 55. Those who have their Liver fill'd with Water, if (says he) it falls upon the Caul (that is, into the cavity of the Abdo∣men) it fills the Belly with Water, and then the Patient dies.

XLII. If it has been of long continuance, there is great dan∣ger of the Bowels being corrupted or putrified; and then, (tho' the Sick admits of being Tapt) no∣thing but Death can put a period to the Disease.

XLIII. But if Tapping be at∣tempted while the Disease is recent, and the Patient has strength and courage, the Operation may be very successful; and many times the Patient returns to perfect

health again, and that in a short time.

XLIV. The Cure. The Diet in this ought to be as in the former, with observation of all other things relating to the seven Non-naturals: and while the Disease is recent, Purging may be made use of for some time, with such things as restore and strengthen the Tone of the Parts in the intervals of Purging; as Opiates, and all sorts of hot and dry Antiscorbuticks, which abound with a volatil Salt.

XLV. But if after some trials by Purging and Diureticks, you find no benefit; but that the Dis∣ease does get ground of the Pa∣tient; it is then totally to be forborn, and the sooner the better, to make way for a more effectual Remedy; since delays in this case always breed danger.

XLVI. How the Paracentesis or Opening is to be made for letting out of the Water, we have at large declared in Lib. 1. cap. 16. aforegoing of this Work: so that what we have there said, need not be here again repeated. See more of the Cure of this Dis∣ease, in the third Edition of Our Synopsis Medicinae, lib. 5. cap. 19. and lib. 6. cap. 4. sect. 131, ad 140. of the same Book.

XLVII. Tho' Barbett's way of making the Paracentesis, is by many approved of, yea by the most Excellent Sylvius; yet some great Artists have a few Exceptions against it. Wiseman says, that while the Belly is distended with abundance of Water, it may succeed well: but that it is not to be pretended to, farther than the evacuation of half the Hu∣mor; for then (says he) you will be in danger of wounding the In∣testines: and therefore he con∣cludes it an unfit Instrument to discharge a Dropsy: nor will our Patients admit of so many openings, as will be necessary to empty an Hydropical Belly.

XLVIII. He therefore concludes, that a Pipe, made taperwise, with holes in the side, (whose Descri∣ption is in Paraeus) according to the old method, to be best: this is to be conveyed in thro' a hole made by puncture.

XLIX. The Cannula or Pipe is to be stopt with a Screw or Plug, which may be put in or pulled out at pleasure; and the Pipe is to be kept in the Hole by Bandage, till all the Water is evacuated, by degrees, and at fit times, as you see convenient. You may consider all the ways which Authors have taught, and chuse that which in reason you find to be most convenient and safe.

III. Of a TYMPANITES.

L. The Definition. A Tym∣panites is a preternatural Tumor of the Belly, from a Collection of Wind, or rather Wind mixed with Water, in the cavity of the Belly.

LI. Riverius says, that in an Ascites there is not only Water, but Wind also; so that the Dropsy has its name from that which predominates: if there is more Water than Wind, it is an Asci••es; but if there is more Wind than Water, it is a Tympanites; if the Wind and

Water is equal, it may be doubted whether it is an Ascites, or a Tympanites.

LII. The Tympany is called by Hippocrates the Dry-dropsy, Sect. 4. Aph. 11. They (says he) who have pains and tor∣ments about the Navel and Loins, which cannot be eased by Medicines or otherwise, are fallen into a Dry-dropsy.

LIII. The Causes. The remote Causes are evil Diet, and such things as breed Wind; among which is the immeasurable drinking of Strong-waters, and Brandy; which over-heating the Internals stir up a Flatus, by converting the pituitous and watery Humors into Vapors, which fill the cavity of the Abdomen.

LIV. But Platerus says, that this Wind thus distending the Belly like a Drum, is not always contained in the cavity of the Belly, but sometimes in the Guts only. In this case I am confident, it must be very painful, because of the vehe∣ment stretching of the In∣testines, whose Tunicles are so very nervous: but then, it seems to me to be more a Colick, than a Dropsy.

LV. The Antecedent Cause Riverius will have to be a crude, pituitous, or melancholy Humor stirred up, and made thin by Heat, and resolved into a Flatus, or thick Vapors, hard to be dis∣solved: which Humor (says he) is partly in the Stomach, partly in the Guts, but especially be∣tween the Midriff and Guts; from whence it is more hard to be moved, than from the cavity of the Parts aforesaid: besides, the greatness of the pain shews that the Cause is deep in the substance of the Mesentery and other adjacent parts, and can∣not easily be removed; for were it in the Stomach and Guts, it would easily admit of remedy.

LVI. The conjoined Cause is Wind, mixt also with a watery Humor or serous Lympha, fallen into the cavity of the Abdomen, and filling it; as also the inter∣stices of the Membranes, from a rupture or opening of the Mouths of the Lymphaducts.

LVII. The Signs. The Belly is equally and vehemently swelled, as in an Ascites; but by reason of Wind mixt with some Water, it is not so heavy as if it were all Water.

LVIII. If the Sick lies on his Back, the Belly will appear dis∣tended, and feel hard; so that being struck upon, it will sound almost like a Drum; and turning from one side to an∣other, the noise and fluctuating of the Water will not be ob∣served.

LIX. The Face is not so altered from its natural ap∣pearance, as in the two other kinds of Dropsies: belchings, and breakings of Wind do often happen, as also croaking and noise in the Bowels; and pains of the Navel and Loins do pre∣cede, as is evident out of Hippo∣crates, Sect. 4. Aph. 11.

LX. The Prognosticks. A Tym∣panites is much more dangerous than a Sarcites or Anasarca,

and nearly as dangerous as an Ascites, but kills not altogether so soon.

LXI. If it comes upon an acute Disease, it is evil; nor will it abate the Fever, but increase the pain, and cause death: but if in its beginning there is a Flux of the Belly, without crudity or want of concoction, the Disease is cured: but if it comes when the Disease is in∣veterate, it is evil, because it is from some fault in the Bowels.

LXII. Hippocrates says, that little and thick Ʋrine in a Dropsy, with a Fever, is mortal; but if the quantity of the Urine increases, there is hopes: and Celsus says, there is hopes of recovery, when the Sick voids more Urine, than he takes Drink.

LXIII. If the Patient seems cured, and there be in a little time after, a relapse, there is much danger: for it shews there is some incurable fault in the Bowels, which renews the Water again.

LXIV. If it happens in old Age, or in much weakness, and the Patient pisses by drops, it is very dangerous; and in a Me∣lancholy habit of Body, it is for the most part mortal, and Medicines are generally given in vain.

LXV. The Cure. For Inter∣nals, Rhubarb is commended, because it not only carries off the noxious Humor, but also strength∣ens the Liver and Bowels: and many have been cured with the use of Rhubarb, given à ʒi. ad ʒii. in some opening Decoction, every second or third day.

LXVI. Juice of blew Flower-deluce, is much commended. ℞ Juice of blew Flower-de-luce drawn with White-wine ℥ iii. of the best Manna ℥jss. mix for a Dose.

LXVII. And if the Wind is in the Guts, the Turpentine Clyster is of great efficacy. ℞ Venice Turpentine ℥i. two yolks of Eggs, grind and mix them well together, and add thereto Posset-drink, or Mutton-broth lbi. for a Clyster; which give a little more than blood-warm, re∣peating it once a day, as long as need requires.

LXVIII. Outwardly, apply over all the Belly a Cataplasm of green Tobacco leaves, (raised from Virginia seed) and brought to a consistence with pouder of Bay-berries. For want of such green Tobacco, you may make it of dried Virginia, moistned with a small Lixivium of Pot∣ashes; which keep on, so long as the Patient can well endure it. It works both upwards and downwards, and expels Hu∣mors admirably.

LXiX. These things, if the Disease be recent may do, giving also inwardly, Confortatives to strengthen the Bowels; as steeled Wines, Tinctura Martis, Syrup of Mars, Decoction of Juniper-berries, Wine of Juniper, Spirit of Juniper, Opiates, Antimonium diaphoreticum, Crocus Martis, Bezoar minerale, Troches made of the pouder of Rhubarb, and the like.

LXX. But if after all, no inward Medicines will prevail, nor yet any external Application, of which that of Tobacco is chief, you must then come to the last Remedy, which is the Paracen∣tesis; which is yet to be done in due time, according as we have before directed: for if the Bowels be corrupted, it will then be too late, and all that you do, will be in vain. See the third Edition of Our Syn∣opsis Medicinae, lib. 5. cap. 20. & lib. 6. cap. 4. sect. 141, ad 162.

IV. Of a Derivative HYDROCELE.

LXXI. Of an Original Hydro∣cele we have already spoker, in Chap. 30. aforegoing. A De∣rivative Hydrocele, is that which is caused by some o∣ther Disease, as the Dropsy: and this is twofold; 1. That which proceeds from a Sarci∣tes. 2. That which proceeds from an Ascites.

LXXII. If the Hydrocele pro∣ceeds from a Sarcites or Anasarca, it cannot be cured but by curing the Anasarca it self: which methods being taken, then, if the whole Serotum is vehe∣mently swelled, your best way to restore it, will be by opening it, by passing a Needle trans∣verse the lower part, and fitting thereto a Seton, keeping it open till all the Water is dis∣charged; preserving, mean sea∣son, the heat of the Part with Fomentations and warm Stuphs, wrung out of Claret-wine mixt with Powers of Oranges, or Lavender.

LXXIII. But if it proceeds from an Ascites, you must make an Apertion in the depending Part, into which you must put a Cannula or Pipe, and thro' which you must gradually dis∣charge the Water, till it is all drawn forth; as you do in Tap∣ping the Belly, every time fomenting the Part with warm Stuphs, wrung out of Claret-wine, &c. as aforesaid: after the Water is all drawn forth, you must heal the Wound as directed in Chap. 33. Sect. 21, and 26. aforegoing, being fitted with a Bag-truss.