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. XXXV. Of a SCIRRHUS.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Tumor duras; in Latin, Scirrhus; and in Eng∣lish, a Scirrhus, or Hard Tumor.

II. The Definition. It is a preternatural Tumor, of a stoney kind of hardness, without sense or pain, and not yielding to the touch.

III. The Causes. The Antece∣dent Cause is a thick, viscous, clammy, cold Humor, such as is that of Melancholy; or it is caused of Melancholy mixt with Phlegm, Choler, or Blood.

IV. By Melancholy here, Phy∣sicians understand not that thick black Humor, which is called Cho∣ter adust, but that Melancholy which is natural; viz. the thick, and more feculent part of the Blood, or a thick recrement of

the Blood protruded; or a Mat∣ter arising from an indurated Inflammation.

V. By Phlegm also, is not meant that humid and thin Humor, which is the Cause of Oedema; but an Humor thick, viscous, glutinous, and extraordinary dry.

VI. Of the former, or of both these Humors mixed together, and retained in the Part over-long, (the more thin and subtil parts being transpired and gone, and the more gross and thick being left behind) is a Scirrhus gene∣rated.

VII. 'Tis true, thick Humors may flow to a Part, yet they im∣mediately cause not a Scirrhus; but it is by degrees, and after some time, that it becomes such in the Place affected; viz. from the gradual perspiration of the thinner Humor, leaving the thicker Matter behind, which by degrees is impacted in the Part, and grows hard.

VIII. And from hence it is, that tho' a Scirrhus may be an original, and be of its self, yet for the most part it follows upon other Tumors; as a Phlegmon, Erysipelas, Oede∣ma, &c. not sufficiently or rightly cured; where the thin∣ner parts, by heating Medicines are unseasonably or over-much dissipated; or by Repercussives, repressed and driven back, &c.

IX. But Paraeus assents not to all this, but will have it to be caused from an Alimentary Juice, but more thick than is fit for the nourishment of the Flesh; which becomes hardned either in a Phlegmon, or from some other Cause; where the Blood being discussed by the vehement heat, the Matter that remains, is thickned and hardned.

X. The Kinds. It is said to be twofold, according to the Matter that causes it: viz. 1. Perfect or Legitimate, when it proceeds from Melancholy alone. 2. Imperfect or Illegiti∣mate, when it proceeds from Melancholy mixt with other Humors, and has some pain.

XI. A Scirrhus is said also to be, 1. Original, when it is the first Disease; beginning small, and rising slowly and gradually to its bigness. 2. Derivative, when it arises from some other Tumor going before.

XII. And so accordingly they will have it to be Scirrhus Phle∣gmonodes, Oedematodes, Ery∣sipelatodes; to which some have added Scirrhus Cancrosus, when it has an aptness to degenerate into Cancer.

XIII. The Signs. An Original Scirrhus usually begins small, like a Vetch or Pea, and gradually increases to a considerable ma∣gnitude, without shifting or changing of its place.

XIV. It is accompanied with great hardness, is void of pain, and white colour, but sometimes inclining to livid; and being pressed hard with the fingers, it is said to want sense; at leastwise, it is much less sensible than any other part.

XV. The Scirrhus being with∣out sense, it is then said to be absolute and confirmed: now the reason of its want of sense, is, because the influx of the natural

Spirits is hindred by the mat∣ter impacted, and Temper or Tone of the Member it self is so changed, as to become be∣numbed or stupid.

XVI. A Derivative Scirrhus is known from it following some other Tumor; as a Phlegmon, Ery∣sipelas, Oedema, &c. wherein the accidents belonging to those Tumors, suddenly change into that of Scirrhus.

XVII. It is hard and im∣moveable, like the other, and many times of a dark red colour, accompanied with sense, if pressed upon; and is many times full of pain, tho' not continually pain∣ful like a Cancer.

XVIII. The Prognosticks. If it is without pain, and Hair grows upon it, it is altogether incurable; and if livid, it is very dan∣gerous, and often degenerates into Cancer.

XIX. Wiseman says, an ori∣ginal, exquisite, or true Scirrhus, being altogether without sense, admits of no Cure; because the induration of the Part is so great, that it will not receive a free afflux of the Blood into it, but keeps its hardness, in despite of all Applications.

XX. A derivative, illegiti∣mate, or imperfect Scirrhus, which is small and painful, sometimes (tho' very seldom) admits of Cure, but sometimes terminates in a Cancer.

XXI. If it has a mixture of Phlegm with it, it seldom changes the colour of the Skin: and if it is big and hard, and has Hair grows upon it, it is uncurable, but degenerates not into Cancer.

XXII. But tho' it is not altoge∣ther incurable, if at first, fit and proper Remedies be applied; yet notwithstanding it is not easily cured; especially if it is in any of the more noble parts, as Liver or Spleen.

XXIII. And where there is hopes of a Cure, yet it is not ac∣complished, but in a long time; because the thick, hard, and cold matter is not easily mollified and softned; nor can it be done, but by little and little.

XXIV. And when the Cure is to be done, it is either by Resolu∣tion or Discussion, or else by Suppu∣ration: but Suppuration is very rare, and mostly, not without danger; for that it very easily degenerates into Cancer, espe∣cially where the Melancholy Humor partakes of a corrosive, sharp Salt.

XXV. The Cure. It respects, 1. The Procatartick Cause. 2. The Antecedent Cause. 3. The Con∣joined Cause, where the applica∣tion of Topicks comes under consideration.

XXVI. As to the first Indication, the Air ought to be clear, and hot and moist; Food, such as represses the Melancholy, &c. Humor, and breeds good Blood; as Chickens, Pullets, Eggs, Kid, Lamb, Veal, Mutton, young Rabbits, &c. boiled with Borrage, Bugloss, Endive, Succory, Lettice, Pur∣slane, Sorrel, &c. Bread made of Wheat and well baked: things hot and dry are to be avoided.

XXVII. Let their Drink be a middle sort of Ale or Beer, (and not stale,) white Port∣wine, Rhenish-wine and Water,

Whey clarified with Fumitory, Mead, &c.

XXVIII. Let Sleep be mode∣rate, and a constant exercise of Body, to waste the superfluous Humors: let the Mind be kept pleasant and chearful, and the Body soluble; and if it be not so, let it be made so by Clysters: and Courses, Hemorrhoids, if stopt, provoked.

XXIX. The second Indica∣tion, is the Evacuation of the Humor; as with Infusion or De∣coction of Sena, Tinctura Purgans, Syrupus Catharticus, Pilulae Catharticae, Pulvis Cornachini, and other things of like nature; to which add Aurum Vitae, as a specifick.

XXX. This Purging ought to be frequent, and many times re∣iterated; because the Humors abounding are thick, tough, hard to be removed: and some∣times gentle Sweating.

XXXI. Some also make Re∣vulsion to the contrary Part, by Frictions, Cuppings, Scarifica∣tion, &c. or make Derivation, by the Seton, Fontanels, or Issues, &c.

XXXII. The third Indication has respect to the Conjoined Cause; which is to be treated with such Topicks, as the nature of the Disease requires.

XXXIII. And here you are not to use Repercussives or Repellers, for they hurt, by reason the tough, hard and cold Humor is uncapable of being driven back, as hot Hu∣mors are. For this Humor or Matter, as it will not give way to them, so it will rather the more incrassate or thicken them, and as it were impact them, and make them stick faster in the Part.

XXXIV. In this case therefore, you ought to use Emossients, to soften the hardned Matter; and afterwards, when it is softned, Discussives to scatter it.

XXXV. But you ought not to use the strongest Emollients, which do too much mollify, lest you should cause it to degenerate into Cancer: nor the strongest Discussives, which too much discuss or re∣solve, lest you cause it to pass into a stoney hardness.

XXXVI. For which reason, it will be most safe to let the whole course of the Cure be mixt; and that you use not alone any one Medicine, which has in it a power either only to moisten, or only to discuss, but such as mollify and discuss: but not together, but by turns, and one after another.

XXXVII. Yet some Artists mix Emollients with Digestives; for which purpose Galen commends the Fomentation of Vinegar, wherein the Pyrites has been extinguished: the Part being first fomented with the De∣coction of the emollient Herbs; which alternately are often to be repeated: and in this man∣ner, the Scirrhus, which is almost desperate, may be cured.

XXXVIII. Sennertus advises, in a Scirrhus which is but newly begun, to use those Medicaments which are of the milder sort: but in an old or inveterate Scirrhus, or if it is in a Tendon or Ligament, those that are more strong.

XXXIX. Among the milder sort of Emollients are, Oils of sweet Almonds, of Camomil and white Lillies; Butter, Hens, Geese, Ducks, Hogs, Dogs, Foxes, Man's Grease, (which last is a Specifick;) Vipers fat, Marrow of Veal, and of a Hart; Muci∣lages of roots and leaves of Marrows, Marsh-mallows, Line and Foenugreek-seed, Arach, Wax, fat Figs, &c.

XL. Among the stronger Emol∣lients these are numbred; old Oil-olive, Whale-oil, Bears-grease, Bdellium, liquid Storax, Tar, fat Rosins, Turpentine, Balsam Capivii, de Chili, Gi∣lead, Peru and Tolu, Ammonia∣cum, Galbanum, Opoponax, and Sagapenum.

XLI. Among Compounds, Oint∣ment of Marsh-mallows, Empl. Diachylon simple, Treatum, & cum Gummis, Diachylon composi∣tum, and that of Melilot simple, &c.

XLII. Among Discussives, these are commended; Bean-meal, and meals of Lupins, Cicers, and Orobus, flowers of Camomil, Melilot, and of the Elder-tree; leaves of Angelica, Avens, Ale∣xanders, Bawm, Calamint, Ca∣momil, Dill, Elder, Dwarf∣elder, Fetherfew, Fennel, Hore∣hound, Marjoram, Mint, Ori∣ganum, Peniroyal, Rue, Sage, Southernwood, Tansy, Worm∣wood: Seeds of Anise, Cara∣ways, Cumin, and Fennel; roots of Florentine-orrice, and Ele∣campane: Oils of Bays, Nard, and Rue: Cataplasma de Fermento, Resolutivum Foresti, Leven, and Dung of Beasts; roots of wild Cucumbers, Briony, Solomon's-Seal, Orrice, &c.

XLIII. Among Compound, these; Ceratum de Ammoniaco Fo∣resti, Emplastrum de Galbano, or de Mastiche, or Oxycroceum, or this of Barbett: ℞ Gum Ammoniacum, Galbanum, Opopo∣nax, A. ℥i. flowers of Sulphur, red Myrrh, A. ℥ss. Camphir ʒi. Oils of white Lillies, Ducks-grease, A. ʒvi. Wax, q.s. mix, and make an Emplaster.

XLIV. Barbett commends this Cataplasm: ℞ Roots of Altheae ʒiii. Orrice ℥i. leaves of Cole∣worts, Parietary, Mallows, flowers of Camomil, Melilot, A. M.i. Lin∣seed ℥ii. boil them in Water, then beat them well together, and add Horse-dung ℥ii. Hogs-grease, Oil of Camomil, A. ℥iii. roasted or boiled Onions ℥ss. mix, and apply them.

XLV. A Cataplasm also of Briony-roots, Goats-dung, and Ʋrine, mixed together, and ap∣plied; often renewing it for several days, is accounted an excellent thing.

XLVI. But Sennertus says, that if it should prove tedious to use Emollients and Discussives thus alternately, or by turns, that at length they may be all mixed together: for that by this means, the Tumor will be both mollified and discussed, or dis∣sipated together.

XLVII. And for the same purpose, you may apply this: ℞ Fresh Butter, Scammony, Wax, A. q.s. mix, and make a soft Cerate, which renew every other day.

XLVIII. Or this: ℞ Ceratum

de Ammoniaco Foresti ℥jss. Sul∣phur vive, ʒiii. mix them, and apply it; renewing it once every day: or a Cataplasm of green Tobacco leaves.

XLIX. Or this: ℞ Meals of Beans, Fenugreek-seed and Lin∣seed, A. ʒvi. roots of Althea ℥i. Pitch ʒv. Goose-grease q.s. mix, and make an Emplaster.

L. Or this: ℞ Meals of Fe∣nugreek, Linseed, Althea-roots, pouder of Holyoke-roots, A. ℥i. boil them in Milk; then add fresh Butter ℥jss. liquid Storax, Ammo∣niacum, Bdellium dissolved in Vinegar, A. ℥ss. mix, and make a Plaster.

LI. Or this: ℞ Althea-roots, white Lilly-roots, Briony-roots, boiled and well bruised, A. ℥iii. fat Figs boiled ℥ii. Ammo∣niacum, Bdellium (dissolved in Vinegar) A. ℥i. liquid Storax ℥ss. Goose and Hens fat, Veal-marrow, A. ℥iii. Oils of Lillies and Camomil, Wax, A. q.s. mix, and make an Emplaster.

LII. If the Scirrhus is more confirm'd, and fixt among Liga∣ments and Tendons, the Fumes of Wine-vinegar, and Spirit of Wine sprinkled upon the Pyrites, or a red-hot Brick, are of special virtue in resolving these Tu∣mors; afterwards chafing the Part a little, apply the follow∣ing Emplaster.

LIII. ℞ Ammoniacum, Bdel∣lium, Galbanum, Opopanax, Saga∣penum, liquid Storax dissolved in Vinegar, A. ℥i. Litharge of Gold ℥jss. let them boil in Vinegar; then add Bean-meal, Sulphur vive, A. ℥ss. Oil of Lillies, Wax, A. q.s. mix, and make a soft Emplaster or Cerate.

LIV. If by the Ʋse of these Applications it should tend to Suppuration, you must treat it accordingly: but take heed that you be not deceived; for if it should prove no Suppuration, it may degenerate into Cancer.

LV. And if it inclines to Sup∣puration, you must have a care that it be not too much irritated by hot Medicines: and avoid Lancing it, lest it presently turns Cancerous: and Cauteries and Burning are far worse: except the Tumor is in a proper Cystis, and then the name of Scirrhus is improper.

LVI. If being suppurated, it breaks, cleanse it with the Ablu∣tion of Mercurius dulcis in Lime-water; Basilicon mixt with Mercurius dulcis levigated, or white Precipitate: and lay over all Diachylon simplex, or some other Emplaster of like nature.