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. XXXVI. Of a CANCER.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 by Galen; in Latin, Cancer; and in English, a Cancer, or Hard painful Tu∣mor.

II. The Kinds. 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Cancer; whilst it is beginning, growing, or increasing, and not ulcerated. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Car∣cinoma; after it is broken, runs or gleets, by any means whatsoe∣ver; called by some, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Cancer ulceratus; or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ʋlcus can∣ceratum: of these we shall treat distinctly or apart; but some I know, will have Carcinoma to be a Cancer not ulcerated.

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.

II. A CANCER Ʋlcerated.

LXII. What we are to consider in an ulcerated Cancer, is either a Palliative Cure, or Extirpation: but if is fixed to the Ribs or Bone in any Part, or in a place dangerous, or not to be come at with Instruments, Excision also will be impossible.

LXIII. As for Diet, the Pa∣tient may eat Barley-cream, Rice-Milk with Water in it, Milk-Pottage, Ptisan made with Li∣quorice and the Opening Roots; Broths made with Borrage, Bu∣gloss, Endive, Succory, Spi∣nage, Lettice, Purslane, Sorrel; boiled in Broths made of Lamb, Mutton, Veal, Kid, young Hogs-flesh, Chickens, Pullets, Capons, Partridges, young Rabbets, &c. Fish living in clear and gravelly

Waters, Eggs, &c. a middling sort of Beer, not old; Mead, small Wines mixt with Wa∣ter, &c. they may eat Cucum∣bers, and things cooling and moistning.

LXIV. But Meats hard of digestion, heating and drying, are to be forborn; as dry Beans, Barley or Pease Bread, old Cheese, old and salt Flesh, old Rabbets, Hares-flesh, Venison, salt Bacon, Cabbage, Coleworts; as also all other things which thicken the Blood, heat, and inflame the Humors.

LXV. Purge also twice every Week with an Infusion of Sena, thus made: ℞ White-wine, fair Water lbiv. Salt of Tartar ʒii. Sena of Alexandria ℥ii. Liquo∣rice bruised ℥i. infuse in a Vessel close covered, in a boiling heat, for two or three hours, giving it at last a walm or two; then strain out being cold, for eight Doses; to be taken in the Morning fasting.

LVI. And in the intermediate days let the Body be kept with a cooling Diet, made with Fumi∣tory, Hops, and juice of fragrant Apples, with many Hog-lice bruised; abstaining from the things before commanded: as also from Garlick, Onions, Leeks, Shelots, Mustard, Pepper, and all other Spices: avoiding also grief, sadness, great labour, watching, and the like.

LXVII. Then outwardly dress it with Ung. Album, Nutritum, Tutiae, de Plumbo usto: or with this: ℞ Oil of Roses, white Wax, A.℥ ijss. juices of Nightshade and Pomgranates, A. ℥ ii. Ceruse, Aethiops mineralis, A. ℥ jss. Plumbi usti, Tutia prepared, A. ℥ss. Frankincense, Mastich, A. ʒii. mix, and make an Ointment.

LXVIII. Or, ℞ Ʋng. Tutiae ℥iv. Venice Treacle ℥i. Saccharum Saturni ʒi. juice of Cranes-bill q.s. mix, and grind them in a leaden Mortar to a consistence and blewness. Some commend Juice of Mullein boiled with Honey, or Tapsimel; others Valentia Pa∣paveris & Solani: Riverius says in his Observations, that he cured one by often dressing it with a mixture of Rose, Plan∣tane, and Corn-Poppy waters mixed with Mel rosatum.

LXiX. Or, ℞ Ʋng. Album, ℥ iv. pulvis Mercurii coagulati ℥ii. juice of Nightshade inspissate to the thickness of new Honey ℥i. Opium extracted, to the thickness of new Honey, with juice of Hen∣bane ℥ss. mix them in a leaden Mortar.

LXX. But if notwithstanding all the means that can be used, it cannot be kept at a stay, but that the Eating goes on, the Pa∣tient is in great pain, and Fluxes of Blood accompany it; it will then be necessary, to save Life, to come to the Extirpation of it: for the doing of which, Chirurgeons have three ways; 1. By Escaroticks. 2. By the Actual Cautery. 3. By Ex∣cision.

LXXI. 1. By Escaroticks. Hartman commends his Pulvis Benedictus, the Preparation of which see in our Doron Medicum, lib. 2. cap. 21. sect. 12. made of black Soot ℥iii. pouder of Aron-roots ℥ii. white Arsenick (ground

impalpable, and digested with Spirit of Wine) ℥i. mixed toge∣ther. This Pouder, the Ulcer being cleansed, is to be once, and but once strewed on, pretty thick; (unless it is taken off too soon, before the Roots are era∣dicated;) and an Oiled-cloth is laid over it, moistned with Fasting-spittle, that it may stick on.

LXXII. This procures great pain, but 'tis not to be removed till the Cancer and its roots are eradicated; anointing in the mean season round about it with Oil of Roses, or rather with Oil of Poppy-seed: when the pain ceases, and the Cancer is destroyed, remove the Pouder, and all that sticks to it.

LXXIII. Then cleansing the Ʋlcer, compleat the Cure with the Incarnative-pouder described in Our Doron Med. lib. 2. cap. 21. sect. 13. and the Litharge-Ointment described in lib. 3. cap. 4. sect. 22. of the same Book.

LXXIV. Others commend Oil or Butter of Antimony, anointing it round therewith: but not∣withstanding this, if the Cancer is great, it ought with a Knife to be wholly cut off to the quick: or by burning it with Actual, or Potential Cauteries, to be removed.

LXXV. Some wash it with Water, Spirit or Oil of Soot, till an Escar is made; then apply Oil of fixed Arsenick (washed in Water) till the Ʋlcer is throughly cleansed. Or else strew on red Precipitate, or a Precipitate made with amalgamated Sol: after which it is healed with the Incarnative-pouder, and Li∣tharge-Ointment.

LXXVI. Others, when the Can∣cer is mortified, and the Ʋlcer cleansed, heal it with Balsam of Sulphur and Empl. Diasulphuris; giving them thro' the whole Cure, the Sena-Infusion before described; and a Diet-drink made of a great number of bruised Sows or Hog-lice, (often to be repeated, and for a long time to be used) infused in half White-wine, half Water.

LXXVII. Riverius in one of his Observations, commends the Escarotick in lib. 1. cap. 33. sect. 10. of this Work aforegoing, applied as there delivered. But he fays the Paste may be spread upon a Bolster six times lesser than the Cancer, which may lye upon it twenty-four hours, and it will make an Escar six times greater than the Bolster: with∣out doubt it ought to be much less than the Ulcer, because of its aptness to spread; yet not six times lesser.

LXXVIII. This Escarotick (says he) did eat the Cancer wholly away; and when the Escar fell off, the Ʋlcer was filled with flesh, and then healed up. But in case the whole Tumor had not been taken away, but some roots had remained, they must have been consumed with a mixture of red Precipitate and burnt Alum, well mixed together.

LXXIX. To incarnate the Ʋl∣cer, dry Lint was only used: but while the Paste was on, a Fever was presently excited, with vo∣miting, flux of the Belly, and

great provocation of Ʋrine; which Symptoms continued two or three days, Nature being of∣fended with the violence of the Escarotick: with the same Medicine a Cancer upon a Sol∣dier's Nose, which had eaten away the tip of it, was Cured.

LXXX. But Wiseman says, that by the use of these Escaro∣ticks, young Chirurgeons have been sometimes engaged to their preju∣dice; and that an eminent Chir∣urgeon undertook the Eradi∣cating of an Ulcerated Cancer in the Breast of a Woman who had strength, and courage to endure it: he applied one of the strongest Escaroticks, which penetrated deep, and made great sloughs, and by repeating the Escarotick, raised new.

LXXXI. But the use of it was not long continued; for the Gleet partaking of the Corrosives, ul∣cerated the adjacent parts; and the Cancer was so enraged by the Escarotick, as shewed that there was no good to be done by it.

LXXXII. Indeed (says he) if we could contrive Medicines, which may penetrate deep, with little pain, there might be some hopes of success: but 'tis evident that cancerous Excrescencies, and cancerous Ulcers of the Mouth are increased, by touch∣ing them with Oil of Vitriol or Sulphur, &c. upon which considerations, it seems, that there does remain, but three ways of treating a Cancer; viz. either by Palliatives, or the Actual Cautery, or Excision by the Knife.

LXXXIII. The Palliative Cure we have already shewed, which only hinders the farther augmen∣tation, and eases the pain; so that the Sick may lengthen out, and lead the remainder of his life with less torment and misery. Now to the things there enu∣merated, you may add Empl. de Ammoniaco made with Vin∣egar, Ceratum de Ammoniaco Foresti; Emplastrum de Galbano crocatum, Emplast. de Ranis with fourfold Mercury, or Our Empl. Mercuriale.

LXXXIV. 2. By the Actual Cautery. If the Cancer is in such a place, as you are in hopes to eradicate it, the Actual Cautery is then a certain Cure; but not by applying it lightly upon the upper parts; but by thrusting down to the root, with a Scoop, or Chezil-like Cautery, carry∣ing it away before you.

LXXXV. If there remains any rags, or roots of it, burn it down to a crust, with a proportionable Button-cautery: if this cannot be effected, then Palliatives are to be used, as are above di∣rected; by which means, the poor Patient who has an ulcera∣ted Cancer, may live tollerably well.

LXXXVI. 3. By Excision. Before you do this, see the Patient is fit for it; as having strength of Body, of a tollerable good habit, and not in a very declining age; that the Cancer is loose, and the Arm-pits and parts under it, be free from painful Glandules: and it would be better, if the ori∣ginal of the Cancer was from some external Accident, as a

Blow, &c. and the Operation to be done in the Spring or Autumn of the year; not in the extream heat of Summer, or cold of Winter.

LXXXVII. Then have in a readiness, 1. Good Rowlers. 2. Compresses or Bolsters. 3. Pled∣gets. 4. Defensatives. 5. Astrin∣gent or Styptick pouders, as in other Amputations: but Calcan∣thum, or calcin'd Vitriol, or other Escarotick-pouders are not good; for you cannot apply them to the mouths of the Arteries, but they will corrode the adjacent parts, and cause much pain, which ought not to be in Cancers: besides, they also require a strict Bandage, which is not without much trouble, on the Brest.

LXXXVIII. Wiseman propo∣ses the stopping of the Blood with a small Button-cautery, which (says he) is not done without some pain, but it is momentary, and serves to correct the indispo∣sition of the Part: these actual Cauteries ought to be of dif∣fering sorts, and kept ready hot for use; lest some relick of a Cancerous Gland should be left behind.

LXXXIX. But that very skil∣ful Man, Dr. Gardner, the Kings Chirurgeon, seldom or never stops the Blood, in this case, with the Actual Cautery; but always makes a provision of proper Stypticks, not corrosive; which he prepares from the Caput mortuum of Vitriol: which are always so effectual, as never to fail the purpose they are intended for, and ever stop the Hemorrhage, without any pain. These things done:

XC. Having placed the Pa∣tient in a Chair, take a couple of large Needles, with strong silken Strings, or others; which pass through the Cancerated Breast crosswise, towards the bottom of the Cancer; and taking these four ends tye them together, by which you are to hold, while you are doing the Operation. Then taking the Strings in your left hand, take the Knife in your right hand; which ought to be large, viz. long, broad, and very sharp: and beginning at the top of the Breast, cut it downwards; and with two or three cuts, cut it close near the Rib, and wholly off, so as to leave no part of the Cancer behind.

XCI. But others, instead of the Needles and Strings aforesaid, because their use seems to be fright∣ful and painful to the Patient, provide a kind of Forceps, turn'd at both ends in form of a Crescent, like Callaper-compasses; in such sort, that both ends may fall one upon another when shut; and with these Callapar-Forceps they lay hold of the Breast, and hold them with the Breast between them in their left hand, whilst they perform the Operation as aforesaid, with their right.

XCII. The Breast being thus cut off, the thicker Blood is every where pressed forth, and with Spunges wiped away; and the mouths of the Vessels are either closed with the Actual Cautery: or some proper Styptick with

Pledgets, is applied; and the whole is drest up with Astrin∣gent Pouders, as Pulvis Ga∣leni, &c. (which Wiseman used) a Plaster, a Bolster, a folded Napkin round the Breast, and a Scapulary, to uphold the whole Bandage, and keep it tight and firm.

XCIII. The Operation being done, and the Wound bound up; let the Patient be laid in her Bed, giving her upon the spot a little sup of Our Aqua Bezoartica, or some other Cordial Water, to revive her fainting spirits; and presently after an Anodyn-Draught, to allay the Ferment; such as this: ℞ Aqua Bezoar∣tica ʒvi. Aquae Menthae & La∣ctis, A. ℥jss. Spirit of Sal Armoniack, Guttae vitae, A. ℈ii. mix them, for a Dose.

XCIV. The next day after, either repeat the same Dose, or give Venice-Treacle or Mithridate, or Our Theriaca Chymica; which may be used as Antidotes against the malignity of the Disease, and virulency of the Humor.

XCV. The second or third day after, dress it with some Digestive; as with Turpentine, mixt with the yolk of an Egg: or with this; ℞ Venice or Strasburgh Turpen∣tine ℥ iii. juices of Nightshade, Plantain and Smallage, A. ℥ii. Syrup of Roses ℥jss. boil to the consumption of the Juices; then add Barley-flower, meal of Cicers, A.ʒiv. Saffron ʒii. yolk of an Egg, mix them.

XCVI. If there is pain, you may apply this Anodyn over it. ℞ Mucilage of Althea-root lbj. Wheat-meal, ℥ii. Oil of Roses ℥iii. boil to the thickness of a Cata∣plasm, adding at the end of the boiling, yolks of Eggs N^o. ii. Saffron ʒi. mix them: but if there is no pain, dress it up with Emplastrum C saris, or è Bolo.

XCVII. After Digestion, cleanse with Detersives, then bring on the Flesh with Incarnatives, and with Epuloticks cicatrize, as we shew in Curing of Wounds; and while these things are doing, things which purge Atra-bilis are often to be repeated; the Infusion of Sena aforesaid, and the like; or the Body is to be kept soluble with Cly∣sters.

XCVIII. If in Cicatrizing, the lips should grow callous, eradi∣cate it timely by the Actual Cau∣tery, whilst it is recent, and in a narrow compass, lying but on the superficies: for if you slight it, till it has seized the muscu∣lous Flesh, it will be too late, and then scarcely capable of a Palliative Course.

XCIX. Whereas, in the Appli∣cation of Escaroticks, mention is made of using crude Arsenick; Sennertus says, it cannot be ad∣ministred without much hazard and danger; and that Arsenick fixed by melting it with Nitre; by which a fixed Salt of Arsenick is made, divested of much, or most of its malign and poi∣sonous quality, is much more safe to be used.

C. And lastly, because Cancers are very apt to return again, the Body ought to be kept for some time after the Cure, with proper

Diets, made of Fumitory, Hog∣lice, dried Toads flesh, Vipers flesh, &c. and a constant and due Purging at certain intervals of Time, with such things as evacuate Atra-bilis; as Sena, Hermodacts, Scammony, black Hellebor, Lapis Lazuli.