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 ...

I. A CANCER not Ʋlcerated.

III. The Definition. Tumor praeternaturalis est, ab atra Bile originem trahens, rotundus, durus, inaequalis, coloris lividi aut sub∣nigri, magnas & eminentes cir∣cumquaque habens Venas, vel Venis circumcirca turgidis, pedes Can∣cri referentibus, dolore, caloré∣que gravis, aspectu teter & hor∣ribilis. A Cancer is a preter∣natural Tumor, taking its origi∣nal from burnt Choler, round, hard, unequal, of a livid or blackish colour; having great and eminent Veins every-ways round about it; or full of tur∣gid Veins, resembling the feet of a Crab, full of pain, and very hot, with a cruel and hor∣rible aspect.

IV. The Causes. Authors say the Procatartick Cause is from ill Diet, Meats of an ill juice, of a thick substance, and a hot qua∣lity; as Garlick, Onions, Leeks, Beans, Pease, Venison, and the like: the immoderate use of strong Wines, as Sack, Malaga, Sherry and Greek Wines; which exceedingly burn the Humors in the mass of Blood; hot Air, perturbations of Mind, strokes, blows and external violence, ill handling.

V. The Antecedent Cause is Atra-bilis, Choler adust or Me∣lancholy: but this they will not have to be natural Melancholy, which Galen, ad Glauc. lib. 2. cap. 10. affirms to be that part of the Blood which represents the Lees of Wine; which is made by the Liver, and is drawn by the Spleen, wherewith it is nourished: for this superfluous natural Melancholy, they will have only to breed a Scirrhus.

VI. They will have it then to be from Atra-bilis, which is either natural Melancholy adust, or yellow Choler adust; which is much more malign than the former; from a strong hot distemperature of the Liver, which burns the natural Melancholy and yellow Choler, and so generates this malign Atra-bilis:

the Spleen also by reason of its discrasy, not drawing to it self the superfluous natural Melancholy; whereby staying so long out of its own pro∣per place, it is inflamed and burned.

VII. Another Antecedent Cause, may be a stopping of the Hemor∣rhoids in Men, whereby they have been usual; and the stoppage of the Courses in Women, before their due time.

VIII. The Conjoined or near Cause, Galen, de Tumor. praeter∣nat. cap. 12. saith, is, from Atra-bilis seating it self in the Flesh; where if it is mild, it makes the Tumor which we call a Cancer; but if it is very sharp, it corrodes the adjacent Flesh, and causes an Ulcer, which is a Cancer ulcerated.

IX. Sennertus, Med. Pract. lib. 5. part. 1. cap. 20. says the conjoined cause of a Cancer is Atra-bilis, hot, dry, sharp, and salt, corrupting and corroding all things, generated and bred from the heat of other Humors; which heat now ceasing, or not being so vigorous, is the reason that it excites not a Fever, as is usual in a Phlegmon or Erysipelas.

X. Wiseman says, he believes not this Adustion of Humors to be the cause; but rather that the Matter of the Humor is in fault, which by some error in Concoction, becomes sharp and corrosive, it may be Arsenical, as appears by the Sloughs which are some∣times made in a Night.

XI. This Humor being sharp and corrosive of it self, is apt to convert whatever comes to it of Blood, into the same acrimony with it self: which is easily done, by mixing such an acrimonious Ferment with a Liquor that abounds with acid Salts, as the Blood of such persons usually does.

XII. And being such, it in∣creases apace while the Skin is yet whole; but much more, when upon breach of the Skin, the accession of Air adds to the vigour of the Ferment; upon which it grows fierce or en∣raged, and so thrusts it self forth into a Fungus, Tuber∣cles, &c.

XIII. But it seems to me, that the Antecedent Cause is more truly a discrasy of the Blood and Lym∣pha, being filled with an acrimo∣nious Salt, and a malign Sul∣phur; which they endeavouring to purge themselves from, let it fall thro' the mouths of some of the Capillary Arteries; and so protrudes it into the fleshy substance, where the Part is weak, and made apt to receive the same.

XIV. And the Conjoined Cause is, those extravasated Recre∣ments of the Blood and Lympha, which (being protruded as afore∣said in a Part accidentally weak, or naturally apt to receive a flux of Humors) thro' the depravity of the same, and a vitious Ferment therein; are farther changed into a malign and poisonous Matter, of a vehemently dele∣terious nature, consisting of a stinking Arsenical Sulphur, and a Catheretick or highly corro∣sive Salt, extreamly subtil and penetrating.

XV. That this is true, the Death of Mr. Smith, one of the Chirurgeons of St. Thomas Ho∣spital in Southwark, gives wit∣ness. For at the cutting off of a large Cancerated Breast, he had (after the Breast was off) a curiosity to taste the juice or matter contained in one of the little Cystis's or Glands of the same, which he did by touching it with one of his Fingers, and then tasting it from the same, with his Tongue.

XVI. He protested that it im∣mediately, like a Gass, pierced or went thro' the whole sub∣stance of his Tongue, and down his Throat, not less sharp or biting than Oil of Vitriol, Spirit of Nitre, or some vehement cathere∣tick or caustick Salt: and altho' he presently spit out, and wash'd his Mouth with Water, and that oftentimes, and also with Wine, and drank pre∣sently very freely of Wine after it; yet could he not get rid of the Taste thereof, but it continued with him, and brought him (who was a very strong Man) into a Consumption, or wasting and pining condition, with several other ill Symptoms; and in a few Months after kil∣led him, the Taste thereof never going off from his Tongue, to his dying hour: and the tasting of the Juice or Matter of that cancerated Breast, he declared upon his death-bed, and near the last moments of his life, to be the true cause of his languishing condition and death.

XVII. The Places. This Dis∣ease is apt to seize upon any fleshy part; as the Cheeks and Jaws, Sides, Back, brawney parts of the Arms, Thighs and Legs, Hands and Feet; the Liver, Spleen, and Womb; but chiefly such parts as are Glandulous; and many times it begins in the Glandule of a Part; and most often affects Womens Breasts, by reason of their loosness, great humidities, and strong ferment they contain.

XVIII. The Signs. A Cancer in its beginning is very difficult to be known, not exceeding a Pea or Bean in bigness, and increasing slowly to the bigness of a Melon or Pompion sometimes, (yet some∣times it suddenly grows great;) and discovers it self by its grievous Symptoms. Galen, meth. Med. lib. 14. cap. 9.

XIX. It is hard in substance, full of pain, hot, and of a livid, or blackish colour: roundish, but with some inequality, and full of turgid Veins: the whole resists the touch, and as it in∣creases in magnitude, increases in malignity.

XX. The Hardness is from the thickness of the Humor; the Pain is from the conjoined Cause, being sharp and corrosive; the Heat proceeds from the extremity of pain; the Livid or Blackish Colour, from the malignity and poison, which even discolours the purest Me∣tals; its Roundness, from the thickness of the matter, which cannot spread abroad; its In∣equality, from the ferment of the Humor, and because some∣times it is contained in several

little Glands; and its Turgid Veins, like to Crabs Claws, from the Recrements of the Blood filling those Parts; which by reason of matter obstructing, or pressing upon them, hinders its getting forth.

XXI. It is known in part by the place, (tho' it may breed in almost all parts of the Body,) as in the Lips, because glandulous and loose: so also in the Breasts, for the same reason; and in the Womb, from the retention of the Courses.

XXII. Aegineta, lib. 6. cap. 45. says, a Cancer happens to sundry places, but chiefly to the Womb and Breasts of Women: and Galen says, Cancerous Tumors are chiefly in the Breasts of Women, which have not their Purgation according to Nature. Gal. ad Glauc. lib. 2. cap. 10. and the reason seems to be from the consent of Parts: for that the Mammariae Veins meet with the Ʋterinae, under the Musculi recti of the Belly; by which way there is a translation of the matter from the Womb to the Dugs.

XXIII. Sennertus says, that with the Pain there is always a Pulsation attending it, together with a Heat more than ordinary.

XXIV. Where the Pains are very sharp, as if one were struck with a Dart; the Matter there is very corrosive, and will cer∣tainly in a little time break forth in a Gleet, or some dan∣gerous stinking Ulcer.

XXV. If the Cancer is ulcerated, from the breaking of some of the Tubercles lying under the Skin, whether the matter is much or little, the Ulcer is painful, and very stinking, discharging a stinking Gleet; it also thrusts forth hard and painful Lips, and in time fixes to the Ribs, (where it is in a Breast, or Side) and in its progress becomes of a horrible aspect.

XXVI. These sometimes bleed, either through the eruption of some Vessels, or from the corrosion of the Humor gnawing them asun∣der: and sometimes a Cancer bleeds whilst it is yet whole; for the same reason, the Blood coming forth either at the Nipple, or some small pin-hole.

XXVII. Some ulcerated Can∣cers send forth a Fungus, others consume and eat all the Flesh away after a wonderful manner: both these often bleed, and in large quantities, because the Capillary Vessels are eaten asun∣der; whereby the strength of the Patient is quickly spent, and they soon dye, as consumed away, and exhausted.

XXVIII. The Prognosticks. Barbett says, a Cancer is seldom cured by Medicines, often by Chir∣urgery, but not without danger: all sharp Medicines exulcerate it.

XXIX. A Cancer of the Womb is said to be incurable, except it be very little, or may be taken away by Excision: so also a Cancer of any other internal part; as Mouth, Tongue, Palate, or Anus.

XXX. Galen, ad Glauc. lib. 2. cap. 10. says, that Cancers in the outward parts, may in the beginning be cured; but when they are come to a considerable

bigness, they can only be cured by Extirpation.

XXXI. To a Cancer inveterate, or of long continuance, in a weak person, you cannot safely use Ex∣cision, Actual or Potential Cau∣teries; but a Palliative Cure is only to be prescribed, which in a Cancer not exulcerate, has sometimes preserved Life even to very Old-age.

XXXII. An ulcerated Cancer can never be cicatrized, but as long as it so remains, the Sick will live in continual pain and filthiness, and at last dye mi∣serably; unless it is cured by Excision, Cautery, or Ustion.

XXXIII. If it proceeds from an internal cause in the Blood and Humors, it is generally incurable, by reason of its malign and poi∣sonous Ferment, and corrosive Salts; which yield neither to Purging, Vomiting, Bleeding, Sweating, Salivating, Diet-Drinks, Repulsives, Discus∣sives, Suppuratives, nor any other kind of Medicines, whe∣ther inward or outward.

XXXIV. If it is from external causes, as Bruises, &c. and lyes superficially under the Skin, they may be attempted by Chirur∣gery; yea tho' they lye deeper, provided they circumvolve no principal Vessel.

XXXV. But proceeding as a∣foresaid, from malignant Humors and corrosive Salts, tho' they may extirpated, yet the success will be doubtful: and tho' they seem to be absolutely cured, yet many times they breed again, and break forth either in the same place again, or in some other.

XXXVI. If it happens in the Head, Jaws, Cheeks, Neck, un∣der the Arm-holes, or Thighs, it is generally incurable; nor may the Actual or Potential Cau∣tery, or Excision be made use of; for those Parts are dan∣gerous to be cut, because of their Vessels, and the great flux of Blood that may ensue.

XXXVII. The Cure. Let the Diet, and regulation of the Non-naturals be as in a Scirrhus: Purge frequently, with such things as evacuate salt Phlegm, and Atra-bilis or Melancholy: avoid Bleeding, as most perni∣cious; as also Scarification, and the application of Suppuratives and strong Discutients.

XXXVIII. And if it is in a Woman whose Terms are stopt, cause them to return by Em∣menogogicks and Catharticks; and in Men the Hemorrhoids, where they have been accu∣stomed: and by Aperitives and Abstersive Medicines remove the Defect.

XXXIX. And inwardly, give the Spirit and Tincture of Tar∣tar; Tinctures of the Salt of Tartar, and of Antimony; Ma∣gisteries of Pearl, Oister-shells, Coral, Crabs eyes and claws; as also the Tincture of Luna, and Aurum potabile; which are to be given guttatim, in some proper Vehicle.

XL. But before you come to External Applications, you must consider whether the Cancer is recent and small, or inveterate and great; if recent and small, it sometimes admits of cure; but if inveterate and great, never,

without cutting off. And then, in this latter case, the Patient is to be consulted, whether he will be satisfied with a Pallia∣tive Cure only, or admit of Extirpation; if the last, we shall discourse of that when we come to treat of a Cancer ulerated: in this place then we shew the Cure of a small, recent Cancer; or the Pallia∣tion of a great inveterate one.

XLI. Now those things which only Palliate a large and invete∣rate Cancer, many times cure a small and recent one; of which kind, are these commended by Barbett: Roots of Aron, Drop∣wort, Figwort, Mullein; Leaves of Maidenhair, Housleek, Agri∣mony, Tobacco, Plantane, Night-shade, Hounds-tongue, Sperma Ceti, spawn of Frogs, burnt Toads, Crabs, Frogs, burnt Lead, Man's dung, Em∣plasters of Diapompholigos, of Saturn, de Ranis cum Mencurio, Diasulphuris, Camphir, Saccha∣rum Saturni, and Saccharum vel Sal Jovis, which Paracelsus commends, as the greatest of all Specificks: also Ʋnguentum Album, Nutritum, Populeon, Tutiae, de Plumbo usto.

XLII. Hartman says, he has cured many Womens Breasts, only with an Emplaster of Ammonia∣cum dissolved in Vinegar, and often repeating the same, to a perfect Cure; and he says he cured Ulcerated ones with the same, if you will believe him.

XLIII. ℞ Juices of Plantane, Endive, Housleek, Nightshade, Rose-vinegar, Cil of Myrtles, A. ℥i. Venice Turpentine ʒ ii. stir them together in a leaden Mortar, with a leaden Pestle; adding Saccharum Saturni, pouders of Pomgranate-peels, and of Citrons, A. ʒi. fine Bole, burnt Lead, Camphir, A. ʒss. mix, and make a Liniment.

XLIV. So also the simple Juices of Nightshade, Hemlock, Hen∣bane, Housleek, Endive, Succory, Lettice and Purslane are com∣mended; Cockle-fish boiled, and made into a Cataplasm; also River-Crabs, Crevises, and green Frogs, out of which an excel∣lent Oil is to be distilled by Descent, for the easing of the Pain, and abating the Tumor. See it in Our Doron Med. lib. 3. cap. 2. sect. 1.

XLV. Some make an Ʋnguent with the Ashes of Crabs or Craw∣fish, or Toads, mixed with Co∣riander-seed and Oil of Roses: also Metalline-Calces, washed, and freed from any biting quality: as of Lead, Tutia, Pom∣pholyx, Litharge, Ceruse, Anti∣mony, Marcasites, Jupiter; but Lead is very highly to be com∣mended by all, and may be used many ways.

XLVI. ℞ Terra sigillata, fine Bole, Ceruse, A. ℥ss. Tutia pre∣pared, pouder of green Frogs, A. ʒiii. Litharge ʒjss. Vinegar ʒvi. Oil of Frogs ℥i. Oil of Roses ℥jss. Wax q.s. mix, and in a leaden Mortar make an Ointment, which apply.

XLVII. And of those things which give a consistence to Juices, Pouder of Hermodacts, Calx of Jupiter and Saturn, Rye-meal and flower of Lupins are the best; because by a specifick

faculty, they allay the fierceness of a Cancer: so also Goats-dung mixt with Honey and Vinegar.

XLVIII. A Cataplasm of Snails and Alehoof is commended; and if it is painful, a Cataplasm of the pulp of Henbane and Hemlock roots, with Rye or Lupin flower, and Oil of Myrtles, is of good use. Or a Cataplasm of Frog-spawn, brought to a consistence with meal of Lupins: so also a Cataplasm of leaves of Herb Robert and Poppies.

XLIX. ℞ Oil of Quinces ℥ii. Vinegar of Elder or Roses ℥i. grind them in a leaden Mortar to a Liniment: 'tis a famous thing. Or, ℞ Emplastr. Dia∣palma ℥iii. juice of Nightshade and Henbane, A. ℥i. Oil of Roses ʒx. mix, dissolve, and make it of the consistence of a Liniment.

L. Aquapendens commends this. ℞ Garden-nightshade, Golden-rod, Sowthistle, A. Mji. boil in Water, bruise; and with Rye-meal lbi. Oil of Roses ℥v. make a Cata∣plasm. A Cataplasm of Radish∣seed and Vinegar is good; so also, a Cataplasm of Raisons ston'd, and leaves of Nightshade.

LI. A Preparation of Frogs, against Cancers. ℞ Live green Frogs N^o. 40. kill them, and fill their mouths full of Butter, which put into an earthen Pot well glaz'd, whose bottom is full of holes, and cover it: put this Pot into the mouth of another earthen Pot placed in the ground; lute these well together, and the cover of the upper Pot: then make a Fire of Charcoal about the upper Pot, which continue for five or six hours, to force down all the Moisture and Oil into the lower: which done, take the Frogs, and make them into fine pouder, which mix with the Oil per Descensum in the lower Pot: with which anoint the Cancer daily thrice a day.

LII. Paraeus commends a Plate of Lead besmeared with Quick∣silver: also this following Oint∣ment; ℞ Old Venice Treacle, juice of Lettice, Oil of Roses, A. ℥i. pulp of Crabs ℥ss. yolks of Eggs boiled hard N^o. 2. grind all in a leaden Mortar, to the con∣sistence of an Ointment.

LIII. Wiseman commends this. ℞ Pouder of green Frogs ʒiii. ashes of River-crabs ʒiv. Litharge of Gold ℥ii. burnt Lead, Tutia prepared, A. ʒii. Ceruse, ʒvi. juices of Nightshade and Plantane, A. ℥vi. Vinegar ℥ii. Ʋng. Populeon, Oil of Frogs, A. ℥iii. Veal-suet ℥iv. Wax q.s. mix, and make a Cerate.

LIV. Or, ℞ White Poppy seed ℥i. Henbane-seed ℥ss. Opium ʒi. Gum-Arabick ℥ss. make all into pouder, and mix with Oil of Roses and Myrtles, A. ℥iii. and with Wax q.s. make a Cerate; which is good in case of Pain, in ex∣tremity whereof, you may dou∣ble or treble the quantity of Opium.

LV. Many Mediums of this kind; for Cancers require variety of Applications, which are to be made of things which have a power to repress, discuss, and cor∣roborate; thereby not only to hinder the farther increase of the Cancer, but also to dimi∣nish, and quite take away that which is already in being.

LVI. But these Medicines ought to have a mediocrity in them, and not be sharp and biting; yet on the other side, if they be too weak, then they give no help or relief: but if they are too strong and violent, then they either repress and discuss the more thin parts, and so not only leave the more thick behind; but also render the Tumor the more unfit for future Applications, in order to their discussion or dissipation.

LVII. And while these things are doing, if the Patient has strength of Body, and vigour of Mind, and is willing, a gentle Salivation ought to be attempted; and if occasion be, to be twice or thrice repeated: for thereby the whole mass of Lympha, and all the Juices come to be re∣newed, so that a kind of new Ferment is begot in the Part.

LVIII. I speak this from Expe∣rience, having cured two remarka∣ble Cancers, (after much other means had failed:) one in a Woman about 30 years old, the other in a Woman about 36 years of age; where the Saliva∣tion was gentle, and continued in each about six weeks time.

LIX. And as to Purging and Diets, mentioned at Sect. 37. aforegoing, it is not enough that they be administred once, but are many times to be repeated; and that for the most part twice a week: for by that means, not only some part of the Humor will be revulsed from the Tu∣mor; but new matter, which would otherwise now, will be hindred, and taken away.

LX. Also, as to Topicks; if you apply hot and moist Medica∣ments, which usually suppurate Apostems, they will procure Putre∣faction in this: and if you apply Corrosives, you will assist the Malignity, and increase the Cancer.

LXI. If notwithstanding all that can be done, the Tumor still increases, and is in danger of Exulceration; it will be necessary to make the Patient acquainted with the danger: and if it is loose, and in a place where it may be safely extirpated, pro∣pose it to them in time; lest afterwards they do desire it, when it is late. If you come to Excision, the way and man∣ner of doing it, you may see Lib. 1. Cap. 33. of this Book, aforegoing.