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 ...

V. Tumors arising from WATER.

CHAP. XXX. Of a WATERY RƲPTƲRE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Aqua, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ramex; in Latin, Hy∣drocele, Hernia aquosa; in English, a Watery Rupture.

II. The Kinds. It is twofold, 1. Hydrocele, properly so called: 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Hydromphalus, Tumor Umbilici aquosus, a Wa∣tery Tumor of the Navel: this by some is called, Ʋmbilici pro∣cidentia, the thrusting forth of the Navel.

I. Of HYDROCELE.

III. The Definition. It is a Watery Swelling of the Scrotum or Cods; and is either Simple, or Complex: Simple, is when it is an original Disease; Complex, is when it is joined to, or is the

product of another Disease; as of an Ascitis, or an Anasarca; of which we have nothing to say here, but shall (God wil∣ling) treat of them in their pro∣per places.

IV. The Kinds. When it is an original Tumor of the Part, the Water lyes either without the Tunica vaginalis, affecting the whole Scrotum: or else it is con∣tained within the said Tunicle: or otherwise, it is held in a Cystis of its own: in which case, you will find one side swell'd, the other yet remaining in its natu∣ral magnitude or state: or if both Testicles are affected, you will feel the Tumors distinct.

V. The Causes. An original or simple Hydrocele is generated or caused as all other Watery Tumors are; to wit, by a separation of the Serum from the Blood out of the Arteries; which not re∣turning into the Veins again, lodges it self in the Skin, or between the Membranes, or some other part the Body.

VI. The Procatartick Cause, is some vehement overstraining of the Body, violent hard labour, fall from some high place, bruise, blow, or the like.

VII. The Signs. Where it is original or simple, and lies without the Tunica vaginalis, it affects the whole Scrotum, fills it like a Bladder, and discovers it self by shining.

VIII. But if it lies within the Tunica vaginalis, between it and the Testicles, or in a particular Cystis, the Scrotum is propor∣tionably stretched, and somewhat wrinkled; and at first sight, it appears not much unlike an Hernia Intestinalis, or Zirbalis.

IX. But they are easily to be distinguished, forbidding the Pa∣tient to Cough; if you press with your Fingers upon the Pro∣duction, and nothing fills your Hand like Wind, it is truly an Hydrocele.

X. And if the Water is within the Tunica vaginalis of both Testi∣cles, you will find the Tumor to appear double.

XI. It is caused from an Asci∣tes, the Tumor is vastly great; if Anasarcous, the Scrotum is thick, soft, and shines, yields to the impression of the Fin∣gers, and works like soft Wax, and generally the Praeputium is swell'd: but of this in another place.

XII. The Prognosticks. In a simple Hydrocele, if it is from an External Cause, it is the more easily cured; and so much the easier, as the habit of the Body is good: but if it is Cacochy∣mick, the Water may be let out, and that without danger, as oft as it fills.

XIII. If it is complicated, it is the more dangerous; and if joined with a Dropsy, cannot be cured, unless the Dropsy is first cured; yet may serve to discharge the Water, both in an Ascites and Anasarca.

XIV. The Cure. The Indica∣tions of Cure, are, 1. To re∣move the Procatartick Cause. 2. To remove the Conjoined Cause. 3. To strengthen the Part affected.

XV. The Prime Cause is re∣moved, by observing a spare, drying

and attenuating Diet; and such as prevents the generating of moist and watery Humors.

XVI. To remove the Conjoined Cause, Discussives and Dryers are to be applied, and kept close to the Part with a Bag-Truss; which will also help to sustain the Part: lest otherwise, by the weight of the Humor, the Tu∣mor should be increased.

XVII. Then you are to consider the quantity of the Water, and the Place it is lodged in; if it is less than a Pint, open it not till it is bigger, lest you hurt the Testicle; except it is in a Child, and then you may open it, tho' it be not full out half a Pint.

XVIII. The way of doing it, is thus: Let the Patient be in a good light; and with one of your Hands press hard upon the Production, to make the Tumor more hard or tight: and if it is a Man that is affected, let another Person press with his Hand upon the other side, that the Scrotum may be the more firm or steady.

XIX. Then you may make the Puncture in the depending Part; but have a care not to cut the greater Veins of the Scrotum, lest making the Water bloody, you may think you have hurt some Part within.

XX. Let the Apertion be big enough to receive a small Pipe; which presently put in, and keep it there 'till you have drawn forth all the Water.

XXI. Which being perform'd, apply a Pledget of Ung. Basilicon, and an Emplaster over it to keep it on, and a flanel Stuph wrung out of Tinctura mirabilis; all which may be kept close to the Part with a Bag-Truss, 'till the Wound is healed, and the Scro∣tum contracted; which will be in about two or three days time.

XXII. If the Water is in∣cluded in a Cystis, one or more, they must be opened each apart, and you must be careful to pass in your Pipe, and keep it in, 'till the last drop of Water is discharged; for if accidentally it should come out, it will be difficult to get in again; for the inner Tunicle hanging loose, the holes may not answer one ano∣ther; nor will it be so well opened again, as it was at first: thus the Water being dis∣charged, you must perform the healing as is before declared.

XXIII. But all this is but a Palliative Cure; if you would do it perfectly, you must make the Apertion large on the one side of the Cods; reaching towards the Production, according to the length of the Testicle, that you may open it, after the Water is extracted, the better to apply your Medicines to it, in case it should be affected.

XXIV. Now whether this Apertion is done by Incision or Caustick, it ought to be in a Body not Cacochymick, nor Aged; lest Inflammation, Colick, or Fever should seize them: in which case good Fomentations, Le∣nients, and Anodyns are to be applied to preserve the Natural Heat; as also Turpentine, Cly∣sters, &c.

XXV. Whilst the Tumor is small, possibly it may yield to Dis∣cussives; so also a Bruise some∣times, accompanied with Inflam∣mation: but if it should tend to Suppuration, you must assist Nature with Maturatives: but if it has any quantity of Water in it, the speedy cure of it is, by letting it out.

XXVI. And after all, you must apply over the whole Scrotum (to strengthen the Part) some Astringent Emplaster, as that ad Herniam, Caesaris, Catagma∣ticum; and with a Truss fitted to the bigness of the Cod, to keep it from depending or swagging.

XXVII. If the Tumor is com∣plex, viz. an Anasarca of the whole Scrotum, it is done by making many Punctures with a Lancet; by which the Water will come forth in a few hours; and the Wounds will after∣wards heal, without any other application than a warm Stuph.

XXVIII. But if there is an Anasarca of the Belly, the Seton is then most proper; which must be made transverse the Scrotum in the lower part of it, and kept open till all the Water is eva∣cuated: mean season, you must preserve the Native Heat, by application of warm Stuphs wrung out of Spirit of Wine, or red Wine, to a pint of which, Powers of Lavender ℥i. are put: and beware of sharpness of Humors, inflamma∣tion, and excoriation, lest a Gangrene ensue; which if you fear, let the Seton be with∣drawn.

II. Of HYDROMPHALUS.

XXIX. Definition. It is a Col∣lection of Water, or Watery-matter within the Navel, causing its pro∣trusion or sticking forth.

XXX. The Causes. The Pro∣catartick Cause may be external Violence, evil Diet, &c. The Antecedent Cause is a Cacochy∣mick, and Phlegmatick habit of Body, Hydropick Humors. The Conjoined Cause is Water, con∣tained within the Tumor.

XXXI. The Signs. It is known by the Tumor which sticks out, the Navel it self being turgid and prominent; the Tumor also is lax, soft, yielding a little to the impression of the Fingers; and many times large, so that a fluctuation of Water may be perceived.

XXXII. The Prognosticks. In Children it is easily cured, and without any kind of Danger: in Elder persons, not difficult, but more troublesom, by reason of motion.

XXXIII. If it proceeds from an Ascites, it is indeed dangerous, and not to be cured, without the cure of that Disease; of which in its place.

XXXIV. The Cure. If it is recent, small, and simple; not proceeding from an Ascites, it may be cured with Resolutives, Discussives, and Dryers, Empla∣stick bodies, &c. applying over a proper Bandage.

XXXV. But if the Tumor is large, the only and speedy way of cure is by Incision, thereby letting out the Water; then dressing it

with Basilicon, and laying over it Emplast. Album, with a good Bolster-bandage.

XXXVI. If it proceeds from an Ascites, it is to be opened in the place, and the Water gradually discharged; but it will not be perfectly cured, but with the cure of that Disease. See the third Edition of Our Synopsis Medicinae, lib. 5. cap. 18.

CHAP. XXXI. Of a WATERY TƲMOR.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Tumor aquo∣sus, vel serosus; in English, a Watery Tumor, or Swelling.

II. The Definition. It is a preternatural Tumor, collecting watery or serous Humors toge∣ther in some particular Part of the Body.

III. The Kinds. 1. A wa∣tery Tumor in the interstices of the Muscles, which is when the whole Body is swell'd with Water, and this is called Ana∣sarca. 2. A Dropsy of the Belly only, or Belly and Legs, called Ascites. 3. A Dropsy of the Belly, in which Water is mixed with Wind, called Tym∣panites 4. A Dropsy of the Head, called Hydrocephalos. 5. A Dropsy of the Brest and Lungs, called Hydrops Pectoris vel Pulmonis. 6. A watery Tumor of the Navel, called Hydrompha∣los. 7. A watery Tumor of the Cods, called Hydrocele. 8. A watery Tumor of some other singular Part of the Body, called in general Tumor aquosus, which is what we only intend in this Chapter, the other seven kinds being particularly hand∣led in their proper places.

IV. The Differences. It dif∣fers from Oedema, because in this, being pressed with the Fin∣gers, the print remains not so long, as it does in Oedema: from a flatulent Tumor, because it makes no sound, as that does: from other pituitous Tumors, by reason of its shining, and manner of pitting: from a Phlegmon, and Erysipelas; because they are with pain, this without: from a Scirrhus, because it will yield to the Touch, whereas a Scirrhus will not, &c.

V. The Causes. Barbett says it is caused from Serum or Salt-water, produced from the lost heat of the Parts; which serve to making of Chyle and Blood.

VI. Wiseman says it is caused from Serum extravasated, which according to the place on which it lights, does denominate the Disease: which place, says Sen∣nertus, is some part that is loose, or that has in it a cavity or hollowness.

VII. And indeed the Causes

of these Waterish Tumors are, whatever may increase the Serum of the Blood beyond its due quan∣tity; or keep it preternaturally in any part of the Body, where∣by it stagnates in some one or more places.

VIII. The Procatartick Causes are ill Digestion, defect of Sangui∣fication, caused many times thro' intemperance, and great Hemor∣rhages, or frequent Blood-lettings; whereby the Blood being weak∣ned, thro' the diminution of its quantity, cannot convert the Aliments received into Blood, but lets them degenerate into Serum; and withal is not able to carry the Serum along with it to the Emulgent Arteries; but lets it fall by the way into the receiving Parts: from which cause these waterish Tumors arise.

IX. The Antecedent Cause is a Watery habit of Body, and a defect in the Ferments of the Viscera, the Kidneys not sepa∣rating the Serum from the Blood; or the conglobate Glandules not doing their duty as they should do: whereby thro' a kind of stagna∣tion of several Juices, as the Lympha, &c. the Blood be∣comes too acrimonious and hot, and so runs in a great measure into Serum or Water; which being extravasated in any part of the Body, produces a Tumor of this kind.

X. The Signs. It is known by its softness, being softer than an Oedema, and more yielding to the Fingers, and as suddenly re∣turning again; without pain, and withal shining.

XI. If the Water is near the Cuticula or Cutis, the Tumor has a kind of perlucidness in it; the nearer the Skin, the more they shine; the deeper under the Skin, the less: but those that lye very deep, or are contained in a Cystis, do not discolour the Skin at all, nor cause any considera∣ble pain.

XII. If the Swelling is very large, it is so much the more shining; and you may by shaking it, perceive a kind of undulation.

XIII. Wiseman says, that some of these Tumors, if in a dark room, you shade them, as Women do an Egg with their hands, holding a Candle to the other side of it, you will find a kind of faint transparency.

XIV. The Prognosticks. These Tumors are not dangerous, if the principal Parts which feed them be not too much debilitated; yet they are difficultly cured, more especially if they happen in the Joints.

XV. Nor is there any danger of Life, unless the Viscera be very much obstructed or tainted: but the more inward they are, the more dangerous; so also, if the more noble Parts are affected.

XVI. The Cure. The Indica∣tions of Cure are, 1. To remove the Procatartick Cause. 2. The evacuation of the Antecedent Cause. 3. The removing the Conjoin'd Cause.

XVII. The first Indication is answered in observing a proper Diet, much like that prescribed in Oedema. All moist and hu∣mid things are to be avoided, and such as generate watery Humbrs: things hot and dry,

and attenuating are best, Spices chiefly excepted; also strong Waters, and salt Food.

XVIII. The second Indication is answered in purging away the serous and watery Humor by Stool and Ʋrine: which may be done with Tinctura purgans, Syrupus Catharticus, Pulvis A•…•…monii, Pulvis Catharticus, Pilulae Ca∣tharticae, Tinctura Phlegmagoga Grulingii, Hydragoga Grulingii, Resina Jalapae, Pilulae ex Duobus, or any other proper Hydra∣gogue.

XIX. This done, you must order, that the Diaphoresis and insen∣sible Transpiration may be free, and uninterrupted; as also that you provoke Urine, with Nephri∣ticks: to the end that not only the serous Humor may be eva∣cuated all ways, but that Nature might be a little cor∣roborated.

XX. A present fault or weak∣ness of any Bowel destinated for Concoction, is to be corrected: but that cannot be, 'till it is freed from the Watery Humor; which you may do by the Catharticks before enumerated.

XXI. Or else by some of these following, viz. Roots of Asa∣rum, Dwarf-elder, Jalap, Me∣choacan, leaves and inner bark of Elder, Euphorbium, Turbith, Cambogia, species Diacarthamum, Cream of Tartar; but above all, by the Vinum Hydragogum of Barbett, in Our Doron Med. lib. 2. cap. 23. sect. 3.

XXII. The third Indication, is next to be considered, which is the remo∣ving the Conjoined Cause, by Dis∣cussives and Dryers, which may absume the Watery Humor; the chief of which among Simples are, Rue, Elder, Danewort, Camo∣mil, Dill, Celandine, Centory, Calamint, Marjoram, Fennel, Hyssop, Southernwood, Savory, Fetherfew, Tansy, Tobacco, Wormwood; roots of Orrice, Briony, Sowbread, Birthwort; Bay and Juniper berries; Bean and Orobus meal; Salt, Alum, Sulphur vive; Ammoniacum, Galbanum, Opoponax, Sagape∣num, Bdellium: of which things you may form Fomentations, Cataplasms, and Emplasters.

XXIII. ℞ Tops of Southern∣wood, Wormwood, Origanum, Ca∣laminth, Marjoram, A. M. ii. flowers of Elder, Camomil, Rose∣mary, red Roses, A. M.i. Bay and Juniper berries, A. ℥ii. fair Wa∣ter, or Lixivium of Quick-lime, q.s. boil and dissolve therein Sul∣phur, Salt, Alum, A.℥i. and make a Fomentation.

XXIV. ℞ Sal Nitre, Sal Armoniack, Pot-ashes, white Pepper, A. ʒv. Euphorbium in pouder ʒii. Camphir ʒi. Oil of Rosemary ʒiii. Oil-olive ℥vi. mix them; and embrocate therewith the Part affected.

XXV. ℞ Bay-berries, Zedoa∣ry, Ginger, all in very fine pouder, A. ℥i. juice of Dwarf-elder ℥iv. Camphir, Oil of Juniper-berries, A. ʒiii. Oil-olive, Wax, A. q.s. mix, and make a Cerate.

XXVI. First foment the Part, to open the Pores; then apply Cataplasms, renewing them for some time, to discuss: and at last, apply a Cerate or Emplaster, to dry, comfort, strengthen, and restore the weakned Part.

XXVII. If by the application of these or the like things, the Cure succeeds not, you must then come to Section, or making an Apertion, to discharge the Water.

XXVIII. It is done with an Incision-knife. Where note, that if gross matter or dregs are mixt with the Water, the Apertion must be the more large. The Water and matter being emptied, cut off as much of the superfluous Skin as is necessary, and let the edges be brought together.

XXIX. Then dress it up with the common Digestive of Turpen∣tine, &c. applying also a re∣strictive Cerat, or Emplaster, with Compress, and good Bandage.

XXX. The second or third day after, let it be dressed again; which let be continued daily, 'till the Wound is agglutinated, cica∣trized, and perfectly cured.

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.

CHAP. XXXIII. Of a DROPSY of the HEAD.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. ab 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 aqua, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 caput; in Latin, Hy∣drocophalon; and in English, a Dropsy of the Head.

II. Definition. It is a preternatural Tumor of the Head, arising from Water contained either within, or without the Scull.

III. The Causes. That which is without the Scull, between the

Cranium and the Scalp, is caused from an effusion of Serum; from the bruising hurting, or rupture of some of the Capillary Ves∣sels, wherein the serous part of the Blood is extravasated; and this comes mostly from the ill handling of the Head by Mid∣wives and Nurses.

IV. That which is within the Scull, is caused from an effusion of the Serum or Lympha within the Scull; either between it and the Dura Mater, or between the Dura and Pia Mater.

V. This extravasated Serum or Lympha is often found coagulated into a stiff glewy substance, all about the Vessels under the Basis of the Brain, involving all the roots and caudex of the Spinal Marrow; covering the Nates, Testes, and Glandula Pi∣nealis, reaching even into the Ventricles of the Brain.

VI. The Signs. If it is Exter∣nal, and the Water lyes imme∣diately under the Hairy-scalp, all the whole Head will be tumified; and if the matter is Oedema∣tous, it will pit, if you press your finger upon it; but if it is Serum, it will not pit, but return presently again.

VII. The Face will be pale and swelled, as also the Eyelids, which will sometimes be bloody and shining: in its increase it some∣times protrudes a wenlike Tu∣mor, but its fluctuation shews it to be full of Water.

VIII. This Disease most com∣monly befals Children; in whom, after some stay of the Humer in the Part, it is often found to turn to corruption, and stink.

IX. If it is between the Scull and Pericranium, you may feel the Scull as it were bare, and a fluctuation between it and the Pericranium.

X. If it is within the Scull, between the Cranium and Durae Mater, the Sutures are loose or disjoined; so that you may sometimes bury your finger between them.

XI. If it is between the Dura and Pia Mater, it makes the former to swell, and oft times to thrust it self forth between some of the Sutures.

XII Such Children as have an inward Hydrocephalus, are generally subject to the Rickets: and where it involves the roots and cauda of the Spinal Mar∣row, Nates, Testes, and Glan∣dula Pinealis, reaching to the Ventricles of the Brain, 'tis sel∣dom discovered 'till after death.

XIII. The Prognosticks. Such Children as are affected with this Disease, are very unhealthful, and in their Infancy subject to Con∣vulsions, Epilepsies, &c. and if they escape, they generally fall into the Rickets, or the Kings-evil.

XIV. If the Tumor is large, and possesses the whole Head, the Cure will be very difficult: but if it only possesses some singular external part, it will be effected the more easily.

XV. That which is next the Scull, is very dangerous: but that which thrusts forth, from within the Scull, is mortal.

XVI. The Cure. First, purge away the watery Humor with Hydragogues and Phlegmagogues;

as Pilulae Catharticae, Pulvis Cornachinii, Syrupus Catharticus, Resina Jalapii, or Scammony and Calomelanos, made up in form of a Bolus, &c.

XVII. Secondly, foment the Tumor with Discussives; such as tops of Angelica, Bawm, Ca∣momil, Dill Fennel, Fetherfew, flowers of Elder, Hyssop, Mint, Marjoram, Nep, Origanum, Peniroyal, red Roses, Southern∣wood, Tansy, Wormwood, &c. boiled in Wine, or a Lixivium of Potashes.

XVIII. If stronger things are required, you may add to the Decoction, flowers of Sulphur, Alum, Nitre, Saccharum Sa∣turni, Salt of the Caput mort. of Vitriol, &c.

XIX. Thirdly, embrocate with this: ℞ Oil of Nutmegs by expression ℥ii. Oil of Spike, of Oranges, and Limons, A. ℥ss. Oil of Vitriol ʒiii. mix them, and embrocate, the Hair being first shaved off.

XX. Fourthly, apply over all the Ceratum viride, or the Ceratum ad Tophos, em∣plastrum Diasulphuris, or Dia∣sinapi; or other things which are discussive and drying.

XXI. Fifthly, make Fonta∣tanels or Issues in the Neck, be∣hind the Ears, or other parts adjacent; and apply Vesicatories over the whole Head, or a part of it; according as the whole, or a part of it is tumified: which being healed, repeat their application, three or four seve∣ral times.

XXII. But if by all these things, the Humor is not dis∣cussed, drawn forth, or removed, you must then discharge the Water by small Apertions, letting it out gradatim: in the mean while, continuing the use of the milder Discussives and Desicca∣tives, to restore the Part af∣fected to its natural Tone.

XXIII. Or, if the Humor has gathered it self into one sin∣gular Part, and you are satisfied that it does not arise from within the Scull, you may cut into it, and let the Water out: or if it has a slender Basis, make a Ligature round it, and cut it off.

XXIV. If the Tumor seems to arise from within the Scull, you must forbear Excision, to avoid the Ignominy that may come upon it; for that these Tumors are generally mortal. See more hereof, in the third Edition of Our Synopsis Medi∣cinae, lib. 3. cap. 22. where you may receive farther satisfaction.