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 ...

ARS CHIRƲRGICA. Liber Tertius. OF TUMORS.

The ARGUMENT.

I. Of Tumors arising from Blood. 1. Of Tumors in General. 2. Polysarkia, Corpulency; and Atrophia, Wasting and Consuming. 3. Apo∣stema, an Apostem. 4. Sinus in Apostematibus, Hollowness in Apostems. 5. Phlegmon, an Inflam∣mation. 6. Bubo, a Tumor in the Groin-Emun∣ctories. 7. Ecchymosis, a Contusion, or Bruise. 8. Carbunculus, a Carbuncle or Plague-sore. 9. Parotis, a Tumor in the Glandules of the Ears. 10. Phyma, or Phygethlon; a Tumor of the Almonds or Glandules of the Jaws and Throat. 11. Gan∣graena & Sphacelus, a Gangrene and Mortifi∣cation. 12. Paronychia Arabum, Panaritium; a Felon. 13. Epinyctis, Furunculus; a Push. 14. Perniones, Chilblains and Kibes. 15. Aneu∣risma, Rupture or Swelling of an Artery. 16. Varix, Rupture or Swelling of a Vein. II. Tumors arising from Choler. 17. Erysipelas, Ig∣nis Sacer, Rosa; Anthonies-fire. 18. Herpes Miliaris, Ʋlcerous Pustles. 19. Herpes Exedens,

the Eating-Pustle. 20. Exanthemata, the Small-Pox. III. Tumors arising from Phlegm. 21. Oedema, the White Swelling. 22. Tumor Cysticus, Atheorema, Meliceris, Steatoma; the Cystick-Tumor. 23. Ganglion, Lupia; a Wen. 24. Gummi, Nodi, Tophi; Gums, Nodes, Tophs. 25. Fungus; Spungy, Soft, or Proud Flesh. 26. Bronchocele, Tumor in the Throat. 27. Strumae, Scrophulae; the Kings-Evil. IV. Tumors arising from Wind. 28. Em∣physema, Tumor Ventosus; the Windy-Tumor. 29. Hernia Ventosa, the Windy-Rupture. V. Tu∣mors arising from Water. 30. Hernia Aquo∣sa, a Watery-Rupture. 31. Tumor Aquosus, the Watery-Tumor. 32. Hydrops, the Dropsy. 33. Hydrocephalus, Dropsy of the Head. VI. Tu∣mors arising from Melancholy. 34. Polypus, Noli me tangere; Cancer-like Tumor in the Nose. 35. Scirrhus, the Hard and Painless Tumor. 36. Cancer, the Hard and Painful Crab-like Tumor. 37. Spina Ventosa, Cancer of a Bone. 38. Elephantiasis Graecorum, the Arabian Le∣prosy. 39. Elephantiasis Arabum; Elephantiasis of a Part, or Cancer-like Swelling of a Part. VII. Tumors, from the Solid Parts falling out of their places. 40. Hernia Intestinalis, Rupture of the Peritonaeum, by which the Bowels fall into the Cods; where also, of the Rupture of the Navel.

I. TƲMORS arising from BLOOD.

CHAP. I. Of TƲMORS in General.

I. A Tumor is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. also, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Tumor, plu. Tumores; also, Inflatio, pl. Inflationes; in English, a Swelling, and Swel∣lings.

II. 'Tis true, the ancient Greeks, as Hippocrates, call a Tumor 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Oidema, or Oedema; and this word with the more ancient Physicians signified in general, all, and every particular preternatural Tumor; as is observed by Ga∣len, in Prognost. 1. Text. 29. & in Comment. Aphoris. Lib. 4. Aphor. 34. & Lib. 5. Aphor. 65, 66.

III. But now with us, Oedema is taken for a particular Tumor, white, and painless; happening in the Joints, and more espe∣cially in the Knees; of which we shall speak in its proper place.

IV. A Tumor then is a re∣ceding of any Part from its natu∣ral state, by its augmentation in magnitude or quantity; thro' a diserasy, intemperies, or distem∣per of the Blood, Lympha, and other Humors.

V. This Disease is called by the Arabians, Bothor: but if a Tumor Apostemates, they call it Dubellet, and Dubellatum.

VI. We speak of Tumors pre∣ternatural only; for every swel∣ling or augmentation of a Part beyond its natural habit, is not to be reputed a preternatural Tumor: for as much as there is not the least hurt or detriment of any one Action, or any thing preternatural, or besides the intent of Nature; but only something that is not natural, but is above that which is according to Nature, as Galen testifies.

VII. And therefore where the magnitude of some one Part may be extended beyond its natural habit, but so, that its natural Operations are not impeded, and that there is no sense of Pain accompanying it; in this case, the Tumor or Swel∣ling is not preternatural, and so to be called a Disease, but rather a Symptom; as in Nurses Breasts distended with Milk,

and in a Woman with Child, near her time, &c. these things happening according to the laws and course of Nature.

VIII. From what has been said it appears, that a Tumor is a Disease of magnitude, augmented beyond Natures intention; and has its production from some∣thing which is preternatural adjoined to the Part affected; to which some Authors will have added, a Solution of Unity.

IX. The Differences. They arise, 1. From the containing cause, as Humors, Wind, or a solid Substance. Those which arise from Humors, have ob∣tained no particular appella∣tion, but are called by the general name of Tumors.

X. If they proceed from Wind shut up in any Part, and dis∣tending the same, they are called by the Greeks Emphysemata, and by the Latins Inflationes.

XI. If the cause is a solid substance, as Flesh, Skin, or some∣thing cartilaginous or bony; all these proceed from Humors, and are therefore referred to the first kind.

XII. 2. From changing of place: as when the solid Parts change their place and situation, slipping down upon some other Part, distending and elevating the same; of which kind are Hernia's or Ruptures, &c.

XIII. 3. From the quality of the conjoin'd Matter; as being hot or cold, moist or dry, soft or hard.

XIV. 4. From their Magnitude; some are great, and these are called by a simple and general name Tumors: some are small, and these are called Tubercula.

XV. 5. From their situation some are internal, some external, and these again are either more deep and profound, or more superfi∣cial.

XVI. 6. From their figure; some are round, others long; some broad, and flatter; others higher, and sharp-pointed.

XVII. But the main differences of Tumors are only two: the first arises from the variety of Causes, the other from the Part affected.

XVIII. The Kinds. 1. Some proceed from Blood: as, 1. Poly-sarkia. 2. An Abscess. 3. A Phlegmon. 4. A Bubo. 5. Ec∣chymosis. 6. A Carbuncle. 7. Pa∣rotis. 8. Phyma, or Phyge∣thlon. 9. Gangraena. 10. Par∣onychia, Panaritia. 11. Epiny∣ctis, or Furunculus. 12. Per∣niones. 13. Aneurisma. 14. Varix.

XIX. 2. Some proceed from Choler: as, 1. Erysipelas, or Rosa. 2. Herpes Miliaris. 3. Her∣pes Exedens. 4. Exanthemata, or the Small-pox.

XX. 3. Some proceed from Phlegm: as 1. Oedema. 2. A∣theorema, Meliceris, Steatoma, 3. Ganglion, or Lupia. 4. Gum∣ma, Nodi, and Tophi. 5. Fun∣gus. 6. Bronchocele. 7. Strumae, or Scrophulae.

XXI. 4. Some proceed from Wind: as 1. Emphysema, Tumor Ventosus. 2. Hernia Ventosa.

XXII. 5. Some proceed from Water: as 1. Hernia Aquosa. 2. Tumor Aquosus. 3. Hydrops. 4. Hydrocephalus.

XXIII. 6. Some proceed from Melancholy: as, 1. Polypus, or

Noli me tangere. 2. Scirrhus. 3. Cancer. 4. Spina Vento∣sa. 5. Elephantiasis Graecorum. 6. Elephantiasis Arabum.

XXIV. 7. Some proceed from the Solid Parts removing out of their proper places: as, 1. Her∣nia in the Cods and Navel, Epiplocele: and from the Bones also proceeds that which we call Exostosis; which is hand∣led in the Chapter of Gums, Nodes, and Tophs.

XXV. But many of these Tumors procceed not simply from one single Humor, but complexly, from a combination of several Humors meeting together; as, Phlegm, Choler, Melancholy, and Watery Humors: so that the conjunct Cause cannot properly be said to be any one single Humor, but Mat∣ter generated out of Humors conjoined; which is denomi∣nated from the principal Hu∣mor abounding: and in this sence the Kinds of Tumors but now enumerated, are to be understood.

XXVI. Galen, ad Glauc. lib. 2. cap. 7. says, that in Apostems has been found substances, like Stones, Sand, Shells, Wood, Mud, Slime, Filth of Baths, Dregs and Lees of Oil, with many other like sub∣stances.

XXVII. And in his Meth. Med. lib. 14. cap. 12. he far∣ther tells us, that in some Tumors there was found sub∣stances resembling Nails, Hair, Bones, Shells, and Stones.

XXVIII. Fallopius, and with him Sennertus, testifie, that Worms are frequently found in Tumors; and that the latter of them had seen them himself.

XXIX. The Causes. The Ex∣ternal Causes may be Blows, Falls, Straining beyond Strength, &c. The Containing Cause is some∣thing beyond, or besides Na∣tures intent, added unto a Part; which heightens, dis∣tends, and swells it up to a greater magnitude than ordi∣nary.

XXX. Tumors are caused ei∣ther by Congestion, or Fluxion.

XXXI. Congestion is the heap∣ing up of Matter contrary to Nature, being the Recrements of the third Concoction, of that Nutriment which is distributed for the nourishment of the Parts of the Body; or the Nutriment it self, not so perfectly digested as it ought to be.

XXXII. This Matter is ga∣thered together by little and little into the Part affected. Prima∣rily, by something amiss in the Part, as weakness of the Con∣coctive power of the Part, whereby it cannot digest the Nutriment sent to it, as it ought to do. Secondarily, from the weakness of the Expulsive faculty; the Recrements not being thrust forth as they should be, the Pores being closed thro' Cold, &c.

XXXIII. Congestion is caused many times also from evil and unwholesom Food, causing such an abundance of Recrements, that the Expulsive faculty can∣not cast them all forth; or being so thick, that Nature cannot easily expel them: and

this is daily manifest in such as are much troubled with Fu∣runculi, or Pushes.

XXXIV. Tumors therefore which proceed from Congestion, are more slow, long, and tedious in breeding, than those caused by fluxi∣on; for that these latter are with great pain, redness, and beat∣ing, and come suddenly to a height.

XXXV. Fluxion is the falling down of some Humor or Humors, to some certain part, either by At∣traction, Protrusion or Trans∣mission, offending it either in quantity or quality, or both.

XXXVI. Attraction, or as some will have it, Protrusion, primarily proceeds from Heat, either by over∣much motion, or the heat of the Sun, or Fire, or sharp Medicines taken inwardly, whereby when the parts are heated, they draw to themselves Humors; or the Humors being heated are rarifi∣ed, and so for want of room are protruded to the Parts.

XXXVII. Secondarily, from Pain, because Pain is said to ex∣cite Tumors by attracting Humors to the part grieved. Or rather, Nature attempting to relieve the part pained, protrudes an extraordinary supply of Blood and Spirits more than usual, so that thereby she over-loads and hurts the parts she endeavors to Succor.

XXXVIII. Then the grieved part growing hot from that abun∣dance of Blood and Spirits protru∣ded; the part is then said to at∣tract more, by reason of this adventitious Heat; and the Pain weakning the Member, if it at∣tracts not, yet it readily receives the Matter protruded without any resistance in the least.

XXIX. Transmission is a kind of Protrusion, but with the least force imaginable, whereby the Hu∣mors as it were slide down into the part affected; which if they be not digested or evacuated by Transpiration, but remaining and still increasing, they cause a Tumor.

XL. There is then a part from which the Humor is sent, and a part which receives it, and a part thro' which the Humor is trans∣mitted: The parts then trans∣mitting are excited by Heat, whether it be external or inter∣nal, and thereby the Faculty is provoked to expulsion, and sometimes the Humor by its own weight descends into a part, as Water in a Dropsy, falling into the Feet and Cods.

XLI. The Parts receiving, are such as by their weakness are dis∣posed to the Reception, which weakness is contracted either in their first Formation, or af∣terwards by some accidental Hurt; or so constituted by Na∣ture, for the more easy receiving the Recrements of other parts, as the Glandules in the Ears, Throat, Arm-holes, Groin, Skin, &c.

XLII. For Nature (to preserve the Human Frame from Diseases) has purposely ordained some weak and feeble Parts, that so the principal Parts oppressed or burthened with Humors, might empty into them whatever is superfluous and burthensom, and these are the Skin and

Glandulous Parts afore-menti∣oned.

XLIII. Thus the Brain trans∣mits the recrementitious Humors to the Glandules of the Ears; the Heart to the Arm-pits, the Liver to the Groins, &c.

XLIV. The Barts thro' which the Humors are transmitted are either hidden, as those in an Ascites, by which the Water falls into the Cavities of the Abdo∣men: Or Manifest, to wit, the Arteries and Veins, the recre∣ments of the Blood and Lympha, being as it were, spued forth from their Capillary ends or mouths, and by this way it is, that Tumors are mostly pro∣duced.

XLV. Out of what has been said, it appears, that the causes of Tumors are threefold, viz. Primitive, Antecedent and Con∣junct.

XLVI. The Primitive Causes are external, as Falls, Blows, &c. which move the Humors, also ex∣ternal Heat, Food taken too raw, or cold, or in excessive quantity.

XLVII. The Causes antecedent are internal, as Humors offending either in Quantity or Quality, Intemperature, Weakness, and Pain.

XLVIII. The conjunct cause, is the Matter gathered together in the place or part, by reason of the aforesaid Causes.

XLIX. The Signs. If the Tu∣mor proceeds from the falling down of any part, it is known by sight; if it does not, we may safely conclude, that it proceeds either from Congestion or the afflux of Humors.

L. If from Congestion, it is known by the Signs delivered at Sect. 34. aforegoing: And this is peculiar to them, that they take not up so much room in the part, as Pushes, Pimples, and the like.

LI. If the Tumor was generated by Fluxions, it will be known by the presence of the contrary Signs: And if there was not any fore∣going Pain or Heat in the af∣fected part, it shews the Afflux was by Transmission.

LII. And contrariwise, if Pain and Heat did precede, the Fluxi∣on is caused by attraction.

LIII. The beginning of the Tumor is when the Part is first perceived to be distend∣ed: The Increase or Growth is, when the part seems to be raised into an indifferent large Swel∣ling, with Symptoms corre∣sponding. The height or state of it is, when it ceases to be any farther augmented, and all the Symptoms are at their high∣est pitch: and the Declination is, when the Tumor and Symptoms are sensibly diminished.

LIV. The Prognosticks. In∣ward Tumors are always more dangerous than outward or exter∣nal; and they have more or less danger of Death, according to the excellency and use of the part.

LV. The greater the Tumor, the greater the Intemperies or Distem∣per accompanying it: The more malign and vitious the Humor, the more danger and difficulty in the Cure. And contrariwise,

LVI. Tumors arising from Wind, are more easily helped; for they are discussed or dissipated in

a manner of their own accord.

LVII. Tumors arising from Hu∣mors, if they vanish not of their own accord, are terminated either by, 1. Discussion. 2. Or by Sup∣puration. 3. Or by Corruption. 4. Or by Induration.

LVIII. If by Discussion or Re∣solution, the Member or Part grows lighter, i. e. loses of its weight and heaviness; and there is a ceasing of the painful beat∣ing, with which it was before troubled.

LIX. If it is by Suppuration, which is, when the Humor cau∣sing the Swelling, is converted into Pus, or a purulent Matter, there is then a pain and palpi∣tation in the part, with Heat in∣creasing: But when the Matter is concocted and ripened, then the Heat abates, the Pain asswa∣ges, and the Tumor becomes pointed, and eminently eleva∣ted, the Colour is white, and the place (if felt on) is soft, and the Matter seems to fluctu∣ate, and yield to the Touch.

LX. But if the Matter lyes deep, the maturation will not then be so easily discerned, by reason of the thickness of the part, as saith Hippocr. lib. 6. Aph. 41.

LXI. If it be by Corruption or Putrefaction, wherein the Consti∣tution, or Habit and radical Heat of the part affected, is corrupted and destroyed by the maligni∣ty of the Matter now nigh at hand, there is a blackness or li∣vid Colour upon the part af∣fected, and the violence of the Symptoms cease.

LXII. If it is by Induration, when the Tumor acquires an accidental and adventitious hardness, it is known by a di∣minution of the Tumor, but an increase of its hardness, the Swelling lessening unexpected∣ly, which diminution, if it comes from an internal Cause, is always evil, unless the matter retreating, goes off by some critical Evacuation.

LXIII. The Cure by Resolu∣tion is easiest and safest; and next to that is Suppuration: Induration is a very Evil Symptom, but Corruption worst of all. See the Third Edition of Our Synopsis Medicinae. Lib. 1. Cap. 49.

LXIV. The Cure. The Indi∣cation of Cure is taken from the conjoin'd Cause; for upon the removal thereof, the Tumor goes away.

LXV. If there is any intempe∣rature accompanying it, you must alter it, as if it is of Heat, you must cool, if of cold, you must heat; if of dryness, you must moisten: but if of moisture, you must dry; and this altera∣tion is made by the application of such things as have the op∣posite Properties in them.

LXVI. In removal of the con∣joined cause, see whether the Tu∣mor is perfect, or may yet receive any farther increase; if it is not as yet at height, but only approach∣ing thereto, then we must have respect unto the antecedent Cause, as also Causes procatar∣tick, which are with all possible care to be removed, and this is most considerable when the Tu∣mor proceeds from Fluxion, or an afflux of Humors.

LXVII. In those Tumors the

Fluxion is to be opposed, and as much as may be, totally removed; by evacuating the flowing Hu∣mor, either by Vomiting, or Purging, or Urine; as by the habit and constitution of the Body it is requisite.

LXVIII. If you Vomit, the Oxymel Scilliticum exceeds in its use; which ought to be used six or seven times: if Purging, the Sal Mirabile exceeds all other Remedies: if you pro∣voke Urine, Sal Nitre dissolved in Parsley or Hydropiper Water, and well sweetned with Sugar, is an incomparable Medicine.

LXiX. This being done, you ought to give things corroborative, to strengthen both the Part which breeds the Humor, and the Part which receives it: for which purpose, nothing exceeds our Theriaca Chymica, or our Lau∣danum Specificum, or, Dr. Gar∣dner's Laudanum Samech, which may be given in a a fit Dose, at night going to bed, and re∣peated as you see need requires.

LXX. The Fluxion also is op∣posed, 1. By Derivation, which is when the Humor is derived unto the opposite Parts: 2. By Interception, wherein the motion of the Humors in their passage is hindred; either by thickning them, or by repulsion.

LXXI. And since the Humor is said to flow partly by Attra∣ction, which is caused by Pain and Heat; it is requisite that this Pain be eased by Anodyns, and the Heat by Medicaments which refrigerate.

LXXII. The Humor is taken away out of the Part affected, either by translating it to some other Part; or by evacuating it out of the Body.

LXXIII. It is translated into some other Part either by Astrin∣gent Medicines, which drive back; or by Constringing Medi∣cines, which by Compression bring the Parts close together; or lastly, by Attractive Medicines, which draw the Humor unto other Parts, and is effected by Pain, Heat, and Emptiness.

LXXIV. But as for Repul∣sives, they only take place, where the matter is not as yet impacted or stuffed into the substance of the Part, but only flows to, in the greater and lesser Vessels of the same; or else without the Vessels, in the vacant spaces of the same; whose substance is neither so thick, nor yet so thin as to resist the force of Repulsives.

LXXV. But if the Matter be already so impacted into the Part, that it is scarce possible, nor yet safe to repel it; you must then strive by Suppuratives to bring it to maturation.

LXXVI. The Evacuation of the Peccant-matter is either insen∣sible, or sensible.

LXXVII. Insensible is by Dis∣cussion: and this is to be en∣deavoured when there is no great store of matter in the Tumor, and that it is not very thick; and the parts also about it not compact and hard, but rare, and porous.

LXXVIII. If the Matter to be discussed be any thing hard, it is first of all to be mollified by Emollients; that it may the

more easily be discussed thro' the Pores of the Skin.

LXXIX. Sensible Evacuation, is by opening the Tumor with the Knife; and this if the Matter contained in the Tumor is in great abundance, and withal thick, and if the Part lying above it is close and compact.

LXXX. If the Tumor is per∣fect, that is, come to its height or perfection, you must then treat it as an Apostem; and after the same manner it is to be opened, cleansed, and healed; as in Chap. 3. following, we shall teach.

CHAP. II. Of CORPƲLENCY.

I. IT it is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Corpulentia, Crassities; also Corpulentia nimia; in English, Corpulency; and too great Corpulency: because Au∣thors say, that if it is not exceeding, over and above, or too great, it is no Disease.

II. It is no Disease whilst the Functions of the whole Body are perfect and entire, but when it begins to hurt them, then it is accounted for a Disease: and it is a Disease of Magnitude, as Galen, lib. de different. Morb. cap. 9. affirms, because it is not natural, but is above that which is according to Nature.

III. Histories of exceeding cor∣pulent people are extant; and the same Galen, in the place cited relates, that one Nicomachus of Smyrna had his Body grew to so exceeding a bulk, that he could not move from one place to another.

IV. And Sennertus tells us of a Rope-makers Wife of Stras∣burgh, a City of Alsatia, who Anno 1613. and in the thirty-sixth year of her age weighed 480 pounds weight.

V. And he tells us of another, upon his own knowledge, who weighed more than 400 pounds weight, who notwithstanding ap∣peared in publick: but, says he, in such persons as these, there is not an equal augmentation of all the parts of the Body, as it is in such as grow, and naturally increase; but their Fat and Flesh only exceed in that vast proportion.

VI. These things seem not in∣credible; for I my self knew a young Lady not exceeding 18 years of age, so fat and fleshy, as scarcely to be able to go cross her own Chamber; and being weighed, exceeded 300 pounds weight.

VII. I know also a Man now living, so bulky, that he cannot go alone, but is carried in a

Running-chair out of one Chamber into another: and by some of his Family about him he is re∣ported to weigh more than 460 pounds weight; and truly his bulk bespeaks it.

VIII. The Causes. The Pro∣catartick Cause is, plentifully eating good and nourishing Food; and the person so eating being of a pure, untainted, and sound Body; having the Native-virtue generating Flesh very vigorous, strong, and active; and withal leading an idle life.

IX. The Antecedent Cause is, an over-great abundance of good Blood, made of nourishing Meats, abounding with a good Juice: for this cause it is, that Cor∣pulency is referred to Tumors proceeding from Blood: but there is this difference between them, that the conjoined cause of this Tumor is Fat and Flesh; whereas the conjoined cause of other Tumors arising from Blood, is Blood.

X. The conjoined cause there∣fore of this Tumor of the whole Body, is Flesh and Fat: some∣times the Flesh is most aug∣mented, sometimes the Fat; and sometimes they are both alike increased together.

XI. Fat we conclude to be generated of the fat and oily parts of the Blood, falling out of the Arteries into the membranous parts, and then digested by the innate faculty and virtue of the Membranes.

XII. And this happens most to such as are of a cold and moist habit of Body: and Galen also maintains, that all Bodies tend∣ing towards a cold and moist temperament, become fat.

XIII. The Signs. It is evident to the sight: but if it only produces a kind of deformity, it is then no more than a Symptom: but if it offends or hurts any Action, it is then to be accounted a Disease.

XIV. The Prognosticks. Avicen was of opinion, that such a great quantity of Fat with which such corpulent people are troubled, hin∣ders the Body in its motion, in walking and operating, and straitens the Veins with an ir∣regular and dangerous constri∣ction; from whence proceeds obstructions of the passages of the Spirits, by which they are suffocated or extinguished.

XV. But this danger of Suffoca∣tion more belongs to such as grow thus vehemently Corpulent in their younger years: for that they have their Veins and Arteries always small; and by reason of this ex∣cessive increase of Flesh and Fat compressing them, they are not permitted to grow larger.

XVI. Persons thus affected with such an extream bulk of Body, are also apt to fall into Apo∣plexies, Palsys, Palpitations, and Diarrhoea's, by reason of their very great Humidities; as also into Lethargies, Coma's, Faint∣ing and Swooning Fits, &c.

XVII. And whether Men or Women, they are apt to be Barren; the Male not being able to gene∣rate, nor the Female to produce an Embryo in the Womb, they having little or no Seed at all: the Seed being produced of Blood, of which they they have

a very small stock: and if some of them have an indifferent quantity of Seed, yet 'tis such as is thin and watery, and unfit for Generation.

XVIII. And if the Women con∣ceive, (for it is they that have the most Seed) yet it is very rarely; and when they do, they soon miscarry: nor are they able to nourish the Child in the Womb, because they have an exceeding weak Appetite, which affords not Nutriment enough.

XIX. This Disease is rarely cured, and when it is, the Cure comes but very slowly on, nor can it be done in a short time: for the Patient ought to be endued with much patience, self-denial, mortification, and prudence; without which things, the at∣tempt of the Cure will be wholly vain.

XX. The Cure. The great store of Flesh and Fat is to be removed; which is done by wasting and consuming what is already generated, and preventing it for the future to be increased: and this is effected, by taking care, that too great an abundance of Blood be not bred, by using things which heat, and exsiccate or dry, much.

XXI. In order to the perform∣ing of all this, there is a two∣fold Consideration: 1. That which has respect to the Diet and Government of the Patient. 2. That which has respect to the Medicaments exhibited.

XXII. 1. As to Diet. Much Fasting, and an extraordinary Abstinence from Food, is much commended in a word, a con∣tinual spare Diet is absolutely necessary, for it very much tends to the diminution of the Corpulency.

XXIII. The Diet also ought to be hard, as well as sparing: be∣cause hard fare, and Meats not of so easy digestion, breed not Blood in such an extraordinary quantity, as to conserve or continue, much less increase such a prodigious bulk of Flesh and Fat.

XXIV. Dry Bread is a good kind of Food for them; so also would Water, if the fear of a Dropsy did not attend it: how∣ever, the Patient may now and then drink a little Water, and sometimes Mild-beer, (because that is opening) and sometimes Wine very much diluted with Water.

XXV. All their Food and Drink ought to be such as may render the Belly slippery and soluble: for by that means, much of the Nutriment which would be con∣verted into Blood and Flesh, will be beforehand carried off.

XXVI. Let them accustom themselves to much and often Exercise every day; beginning with small Exercises first, and then increasing them by little and little, till they become great: avoiding by all means an idle and sedentary course of life.

XXVII. No exercise exceeds that of fast Walking, and Run∣ning; which may at first be but little, but ought every day to be increased gradatim, both as to the speed in running, and as to the time of exercising it: and

the course ought to be continued every day for some months, yea years, till the gross of the Body is brought down.

XXVIII. Next, Friction of the whole Body with hard or course Cloths, is of good use; because it opens the Pores, and causes a transpiration of much of the fatty Sweat or Humidities, which con∣spire to the increase of the ma∣gnitude of the Body: rubbing the Body presently after all over with some sweet Oil, which if you please may be perfumed.

XXIX. And withal, if they have conveniency, they ought to Sweat once a day, by a dry me∣thod of Sweating: the best for this purpose, is Sweating in Hartman's Chair, with rectified Spirits of Wine. By this course I cured a Man of a prodigious bulk in about three months time, or a little more; beyond mine, and all others expecta∣tion.

XXX. Galen, Method. Med. lib. 14. cap. 15. says, he perfectly cured a Man of about fourty years old, who was exceeding fat and gross, even to the admiration of all who beheld him. And this he did, by giving him an Anti∣dote made of Sal Theriacale, and the right Theriaca Andro∣machi made of Vipers; causing him to use an extenuating Diet after it, and to exercise himself with swift running.

XXXI. And he fitted and prepared him for this exercise of Running, by gentle Frictions with rough and hard Cloths made of new linnen, till the skin became red, and then anointed him with a digestive Oil, with which he also anointed him after his running.

XXXII. 2. As to Medicines, Bleeding is wholly forbidden; for it is manifest, that much and constant bleeding has made many grow to an extraordinary bulk of Body, who otherwise would have been lean and slender enough: and Hippocrates seems to be against Bleeding in fat persons, because (as they are of a cold habit of Body, so) they are more pro∣pense unto cold Distempers.

XXXIII. Authors advise to frequent Purgations with Aloes, and Aloetick Medicines: I com∣mend my Cathartick Laudanum, which may be taken every night to gr. x, or xij. and in some persons to xv, or xx. it is a noble Medicine, and works admirably the next day, and that without any griping, pain, illness, or making faint; and possibly may more waste the Body (almost after an insensible manner) than a thousand other Medicines, which purge more vehemently: and yet this is not to be despised, as to its purging neither.

XXXIV. Some advise to Aloes made up with Myrrh and Nitre, as a proper Remedy; because Sal Nitre in a great measure wasts the Body by Urine, at least hinders its farther increase.

XXXV. Oxymel of Squills constantly taken for some few months, is a famous thing; and will certainly bring the Body down in some few months, if the Patient can be but per∣swaded to the constant use of it.

XXXVI. Authors commend all hot and bitter things: as Worm∣wood, Southernwood, Rue, Pellitory of Pain, Sage, Tyme, Savory, Myrrh, Frankincense; and generally whatsoever things work by Urine, as Fennel, Smal∣lage, Parsley, Hydropiper, Asparagus, Onions, Winter-cherries, &c.

XXXVII. Sennertus commends this Pouder: ℞ Sal Nitre ʒ j. Alum ℈ij. Cortex Guajaci, Sar∣saparilla, Myrrh, Frankincense, A. ʒ ij. make all into a fine pou∣der; of which the Patient may take a dram morning and evening every day, for two months together.

XXXVIII. The Salt of Vipers is commended, but is a thing dear, and hard to be got: the Salt of Sheeps or Bullocks flesh will do as well.

XXXIX. For them that can∣not take Pills, I commend a con∣stant Purging with Our Tinctura Purgans, or Tinctura Cathartica; and sometimes for change, with Elixir Proprietatis: but more especially with Sal Mirabile, because that answers the In∣dication, both by Stool and Urine; and if constantly used, will do wonders of this kind.

XL. In the intermediate days of Purging, this following Pou∣der may be given: ℞ Sal Nitre, Winter-cherries, Cortex Guajaci, A. ℥ j. Myrrh, Cloves, Nutmegs, A. ℥ ss. Camphir, Gin∣ger, A. ʒ ij. white Pepper ʒ j. make each into a fine pouder, and mix them together. Dose, ʒ j. morning and evening, in Barley-water, or Decoction of Parsley-roots.

XLI. Lastly, for a constant Drink, (instead of Beer, Ale, Wine, Water, or other liquors) this following is most excellent; because it wasts not only the Nutritious-juices, but even the Flesh and Fat, to a Miracle.

XLII. ℞ Raspings of Guaja∣cum lbj. Cortex ejusdem, Sas∣safras rasped, A. lbss. Fennel-seed, Coriander-seed, A. ℥ iv. fair Water lbxxx. Salt of Tartar ℥ iv. mix, digest scalding-hot for twenty-four hours; then boil in a Diet-pot till a Gallon is con∣sumed: strain out, and sweeten it a little with double-refined Sugar: of this let the Patient drink constantly every day, as his ordinary Drink, and continue the use of it for 3, 4, 6, or 8 months; as the condition of the Sick, and continuance of the Distemper shall require.

APPENDIX. Of an ATROPHIA.

XLIII. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Atrophia, vel Consumptio Par∣tis, vel Partium; and in Eng∣lish, a Consumption, or Wasting of a Part or Parts.

XLIV. There are several kinds of Consumptions, as a Phthisis; a Marasmos or Tabes; a Hectick; and lastly, an Atrophia, Pining or Wasting; which is called in general, and Extenuation of the Body; viz. when the Body is not nourished so much as it

ought to be, but is diminished and lessened, by reason of the withholding of Nourishment from it; and this is called in general an Atrophy.

XLV. Now an Atrophy is two∣fold: 1. General, of which we have already treated in Our Syn∣opsis Medicinae, lib. 2. cap. 31. and lib. 6. cap. 18. 2. Parti∣cular; which is the Wasting or Pining away of some particular Part or Parts; as a Foot, Leg, Thigh, Arm, &c. of which we shall treat here, and the rather, because falling under none of the general Topicks or Titles of this Art, tho' a part of the Chirurgians duty: and not be∣ing willing to give it a place by it self, we chose to treat of it in this Chapter, by way of Appendix; as being the almost opposite of too great Corpulency.

XLVI. The Causes. The Causes of the particular Atrophy, (like that of the whole Body, which consists in some one particular Bowel, whose action is necessary for the Nutrition of the whole Body) is contained in some particular Vessel or Vessels, beloning unto that particular Part.

XLVII. Yet however the general Causes are the same as in an Ʋni∣versal Atrophy; viz. the weakness of the Nutritive-faculty of the Part, and defect of Nourishment.

XLVIII. The Faculty is hurt when the Part is over-cooled, and left destitute of its proper heat and warmth: for then the Part can neither attract any nutri∣ment, nor retain it, nor yet alter, or assimulate it.

XLIX. And a Part is said to be refrigerated, and its hea•• decayed, and to be made dull, or stupid, and unfit for action, from many Causes; as, coldness of the external Air, lying long in cold Water or Snow, or being laid upon a cold place; as also by long lying upon the Parts, (by which the Spirits contained in it are as it were suffocated) from over-much rest, in the Palsy; or from the straitness of the passages thro' which the Spirits flow.

L. The Nutriment fails chiefly by reason of the narrowness of the Passages, (or their being obstructed or stopt up thro' the congelation of some Humor in the same,) thro' which it ought to flow to the Part wanting it.

LI. And this arises mostly from External Causes, as, when the Arteries which carry the Blood unto the Part for its nourishment are compressed by the Bones, when they are loosened or out of joint: or from hard and strait band∣age; as many times happens in such as have long had an Issue; or from some Tumor nigh unto the Part; or from the brawniness or hardness of the Flesh; or lastly, from the Ves∣sels being cut asunder, which are to convey the Nutriment.

LII. The Signs. The Disease is known by Sight; and the very Causes may be fully known by the relation of the Patient: but because it may have dependance upon many of them, they are therefore all of them to be enquired into, that so the me∣thod of Cure may be the more rightly prosecuted.

LIII. The Prognosticks. From the Causes, we are to make our Judgments of the Cure: for if the Causes may be removed, there may be hope of Health and Restoration; if they can∣not be taken away, but will re∣main, the Disease will also remain.

LIV. The more recent it is, the more easily it is cured; and contra∣riwise, the more inveterate and old, the more hard and difficult.

LV. If the Nutriment only is consumed, there is more hopes; but if much of the substance of Flesh is already wasted, it will be the more difficult; and most of all when the Membranous parts are already exsiccated, and very much dried: for such an Atrophy is as impossible to be cured, as that which befalls the Body thro' old-age.

LVI. If the Native-heat be not so far weakned, but that it may be restored, the hopes of recovery is manifest: for that the Cause being removed, and the Heat restored, Nourishment will again be brought to the Part affected.

LVII. The Cure. A Part being extenuated or withered away, for want of the Nutriment being conveyed to it, and the languishing of the Heat of the Part; we must do our endeavour to restore the decayed Heat again, and to make an attraction of the Blood to the same.

LVIII. Heat is restored to the Part many ways: as by a gentle Friction, or moderate rubbing of the Member, moving of it up and down, and soaking it in warm Water.

LIX. Now this friction, moving, and soaking it in Water, ought to be so long (and no longer) con∣tinued, than to cause the Part to look somewhat red, and as it were a little swoln; but not so long till it is again asswaged and fallen.

LX. The Parts affected may also be soaked and bathed in Baths made of the following particulars, or some of them, which may be easiest gotten; as Aniseeds, An∣gelica, Avens, Asarabacca, Bay-leaves, Basil, Bawm, Bears-breech, Bishopsweed, Brook∣lime, Briony, Calamint, Camels-hair, Camomil, Caraway-seeds, Catmint, Cedar-tops, Celan∣dine, Centory, Chervil, Citron∣peels, Cicely, Coriander-seeds, Costmary, Costus, Cresses, Cu∣min, Dittander, Dittany, Ele∣campane-roots sliced, Fennel the herb and seed, Fenugreek, Fetherfew, Fir-tops, Galingal, Gaultree-leaves, Goats-rue, Gen∣tian, Grains of Paradise, Ground-pine, Hartwort, Hops, Hore∣hound, Hysop, Jack-by-the-hedge, Juniper-tops and berries, Larchtree-tops, Lavender, Limon-peels, Mallows, Marjoram, Masterwort, Mastich-herb, Maud∣lin, Melilot, Mint, Mustard, Myrtle-leaves, Navew, Orange-peels and leaves, Parsley, Pars∣nip-tops, Pellitory of the Wall, and of Spain, Peniroyal, Pepper bruised, Pimpernel, Pinetree-tops, Plowmans-spicknard, Po∣lymountain, Radish-tops, Ram∣pions, Rocket, Rosemary, Rue, Sage, Savin, Savory, Saxifrage, Scabious, Scruvigrass, Skirret-tops, Smallage, Sneezwort,

Solomons-seal, Soapwort, South∣ernwood, Spignel, Tobacco, Tansy, Tarragon, Tyme, Tor∣mentil, Turneps and their tops, Valerian, Vervain, Worm∣wood.

LXI. The bathing and fomenting being over, (which ought to be repeated every day, for some considerable time) you may anoint with this Oil: ℞ Oil-olive, or Neatsfoot-oil, ℥ xiv. Chymical Oils of Aniseed, Amber, Caraways, Juniper-berries, Ca∣momil, Rosemary, Sage, Savin, Sassafras, Lavender, sweet Mar∣joram, Turpentine, A. ℥ j. Oils of Oranges and Limons, A. ℥ iv. mix them; with which anoint the Part morning and evening.

LXII. Or you may make the former into an Ointment, by ad∣ding Sheeps-suet ℥ xij. Chymical Oil of Cumm ℥ vj. pouder of Castoreum ℥ viij. with which you may anoint, as before.

LXIII. Sennertus advises to this Ointment: ℞ Bdellium, Opoponax, A. ℥ j. dissolve in Wine, and strain: to which add Hogs-grease, Goose and Hens grease, A. ℥ j. old Oil-olive ℥iv. Turpen∣tine, Wax, A. ℥j. boil till the Wine is consumed, and then add Ma∣stich, Frankincense and Fenugreek, all in pouder, A. ℥ j. mix, and make an Ointment; with which daily, morning and evening, anoint the places affected.

LXIV. After well Anointing, for a week or more, you may apply the following Emplaster: ℞ Turpentine, Balsam-capivi, Gum-Elemi, Wax, Rosin, A. lbj. mix them upon the fire; then add there∣to Galbanum, Opopopanax, Sagape∣num, strained, A. ℥ iv. Tacama∣hacca ℥ iij. Frankincense, Ma∣stich, A. ℥ ij ss. Long-pepper, Ginger, Cardamoms, Grains of paradise, all in fine pouder; Nutmegs, Mace, Cloves, Zedoary, Galangal, Winters-Cinamon, Mu∣stard-seed, all in fine pouder also, A. ℥ ij. mix, and make an Emplaster; which apply, after it has been fomented with the following Fomentation.

LXV. The Fomentation. ℞ Spirit of Wine lbvj. Pepper, white, and long, Ginger, Zedoary, root of Pellitory of Spain, Mustard-seed, Grains of paradise, all in pouder, A. ℥ j. Bay-berries, Rocket-seed, berries of Spurge-olive, Juniper-berries, Winters-Cinamon, A. ℥ ss. Cloves, Nutmegs, A. ʒ ij. Mint, Marjoram, Rosemary, Sage, Tyme, all dried, A. ʒ vj. mix all these Pouders together, and grind them in a hot iron Mortar, with Salt of Tartar ℥ iv. then put all into the Spirit, which digest in a cold place for a week, and decant off the clear Tincture for use; with which foment the Part, before laying on of the Emplaster.

LXVI. After the application of the former things for four, five, or six day, the Ancients used Dro∣pacisms, or Pications. Now a Dropax or Pication, was a soft Ointment made of Pitch mixed with Oil; which they applied to the extenuated part blood-warm, keeping it on till it was cold, and then they removed it, and applied a fresh one; and this was often repeated, till at length the Part became red, and something swelled:

which done, they removed the Dropax, and anointed the Part with sweet Oil, or some fat body, and in the evening re∣peated the same as before: which course they continued so long, till the Member grew thicker, and more fleshy.

LXVII. If this Dropax or Pi∣cation would do nothing, they made then use of Percussion or Beating, smiting the wasted Part with Ferula's or Rods, till such time as it became swoln and red, and then immediately anointed it with some Oil, or fat Medi∣cament: but later Physicians make use instead thereof, of green stinging Nettles.

LXVIII. Some have been cured by anointing with this Oint∣ment: ℞ Oil-olive, Sheeps-suet, A. ℥ viij. Chymical Oils of Camomil, Juniper, Rosemary, Savin, Sassafras, and Spike, A. ℥ ij. Mustard-seed, roots of Pyrethrum in fine pouder, A. ℥ ij. white Pepper in pouder ℥ j. Cam∣phir, Ginger in pouder, A. ℥ ss. Turpentine q.s. mix them.

LXiX. Others have been cured by manifold Frictions, and then immediately anointing with this Mixture: ℞ Oils of Amber ℥ iv. Oils of Spike, Rose∣mary, and Sassafras, A. ℥ j. Oils of Aniseed, Juniper, Limons, and Turpentine, A. ℥ ss. mix them; with this the Patient was an∣ointed twice a day, rubbing it in for half an hour at a time; and being continued for twenty days or more, they became perfectly well.

CHAP. III. Of ABSCESSES, or APOSTEMS.

I. THIS kind of Tumor is called in Arabick, Du∣bellet, and Aldubellet; in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and in Latin, Abscessus, pl. Abscessus; Tumor est qui suppuratur: in English an Apostem, pl. Apostems; a Swelling full of ripe matter.

II. The Description. It is a Tumor arising from corruption and putrifaction, chiefly in the end of a Disease; and in or near the Glandules, as behind the Ears, in the Neck, under the Arm-holes, or in the Groins, being repleat with a preternatural Humor, most commonly in its own Mem∣brane, yet sometimes not; if it proceeds from concussion, or other external hurt: whence follows inflammation of the Part, a Fever, and then a ge∣neration of Corruption, whence comes an Abscess.

III. But some Tumors are de∣nominated from their times; for whilst unripe, they are Tumors of that particular kind; but coming to suppuration, they many times lose their first appellation,

and are called Apostems, of which kind are Phlegmon's suppurated; and indeed any Tumor when it is maturated, is called by some an Apostem: whence it is ordinary to say, when a Tumor is ripe for Apertion, it is Apostemated.

IV. If therefore the matter which causes the Phlegmon or Inflammation is not dissipated in∣sensibly: Nature, which can never be idle, converts it in process of time, (especially if assisted with warm Medicaments, or any Blood be mixed with the pro∣truded Matter) into a certain rotten substance called Pus; which when it is wholly sepa∣rated from the Parts containing, and gotten together into the Part affected, is properly called an Abscess, or Apostem.

V. The Differences. They are taken, 1. From their Times. Some are maturated more speedily, as those which proceed from Blood, and are in a fleshy-part.

VI. Some are maturated more slowly, as those Tumors which are bred out of other Humors; and are seated near the Joints, and in Nervous parts, or parts which are weak, or have in them but little native Heat.

VII. 2. From the Matter. And this is various, according to the Humor it is generated of: out of good Blood is generated a Pus, less offensive; but out of other Humors is bred a sharp, putrid, green, yellow, or ill-coloured stinking Matter.

VIII. Sometimes this matter resembles Gruel, Honey, Suet, Wine-lees, Oil-lees; and some∣times it is like Honey and Snivel mixt together, or the substance of rotten Eggs; and that of so ill a savor, and so stinking, as not to be endured, &c.

IX. And sometimes living Worms, and other like Animals are found in them; for the Humors of the Body may pos∣sibly be wholly converted into Worms, and such like substances, in great variety.

X. 3. From the Tumor it self: for the matter in the hollowness of the Part, is either without a Membrane; or else is contained in a peculiar Cystis or Mem∣brane of its own.

XI. Yet some Authors are of opinion, that those Tumors alone, which proceed from Inflammation and Pain, and had within them a sharp corroding Humor, and not contained in any peculiar Skin or Tunicle, could properly be called Apostems.

XII. The Causes. Tho' they may proceed from other Tumors maturated, and so the remote and antecedent Causes in those cases are thence to be derived; yet they are also many times caused from external injuries; as falls, blows, bruises, &c. wherein Blood being extravasated by the external force, it is thro' the help of Nature, and the heat of the Part putrified, and so there arises an Apostem.

XIII. An Example of this kind, we have in Guiliel. Fabricius, Cent. 1. Obs. 63. A young Man 27. years old had a great Fall, and by the hilt of his Sword was hurt under the short Ribs and left Kidney, having also

his Loins much bruised: after some days, he felt a pain in the left part of his Loins, which by degrees became exceedingly sharp and intolerable: upon which followed loss of Sleep and Appetite, with some small kind of Fever; but the Part affected was not black and blew, or any way discoloured, or in the least swoln, but appeared as in perfect health.

XIV. In this condition he was tampered with by a certain DOCTOR, as a Nephritick, but all in vain, for the Doctor was mistaken; for it was a hidden Apostem in the Muscle Psooa. At length he sent for Griffonius, a learned Physician and Chirur∣gian, who presently discovered the whole grief, and the danger impending, from the Matter being shut up in those inward or deep parts: it now possessed his whole Loins; he therefore applied powerful Attractives, to draw all the Matter into some one place, where the principal Vessels were but few, and the Instruments of Motion might be least hurt: then he opened it on the left side, nigh to the fourth Vertebra, with a red-hot Razor, making the Wound as deep and as long as ones finger, from the end thereof to the hollow of the hand; out of which there flowed a great quantity of putrid and stinking Matter; which he afterwards cured according to Art.

XV. Sometimes they are caused from Fevers; where, by the fer∣mentation of the Febritick-heat, the Morbifick-matter is critically protruded into some particular Part, where Nature can best dispose thereof.

XVI. An Example of this kind we have from the same Fabricius, in the place cited, which happened also in the Muscle Psooa; where he tells us, that a certain Matron took her bed, with extream and acute pains about her Loins; having a Burning-fever, accom∣panied with Swooning-sits and difficulty of Making-water.

XVII. By the Signs, Symptoms, and kinds of the Pain, it ap∣peared to be a hidden Apostem; for outwardly nothing appeared, nor could any thing be discerned by the touch; and by the place, that it could be no where but under the Psooa-Muscle. She was told the extream danger, and that it would be with hazard of her life, unless it was opened; she gave consent, and it was opened with a Razor, on one side of the Spina Dorsi, thro' the Skin, and exterior Muscles, even to the Psooa; and there came forth a quantity of stink∣ing Pus, or Matter: after which, by abstersive and cleansing Me∣dicaments for some time ap∣plied, she became perfectly well.

XVIII. Sometimes also it is caused by Witchcraft; as when Hairs, Bones, Wood, Nails, Pins, Needles, Coals, Cockle-shells, or any thing of a like nature, is found; into which it is not possible for Humors to be na∣turally changed: in such cases, Artists ascribe the cause to Sor∣cery and Witcheraft.

XIX. The Signs. In a Phle∣gmon, it is easily seen when the

Humor causing the Tumor is changed into Pus,and in other Tumors also there are peculiar Signs: for till the Matter is changed into Pus, the Heat, Pain, Tumor, and other Sym∣toms are heightned, not dimi∣nished, as they are when it is ripe; as Hippocrates, Sect. 2. Aph. 47. affirms.

XX. When the Maturation approaches, the Apostem begins to be sharp-pointed, the Pus seeking its passage forth, and so the more lifting up the Skin: then also there is an abatement of the Fever and Heat, the Swelling round about a little diminishes, and the extension and hardness is something remitted, and the Patient has some ease, and is a little lightsom.

XXI. Then also, coming to perfect ripeness, if the place is pressed down with the fingers, there is a softness, and a kind of float∣ing of the Matter underneath, which is sensibly perceived in the Part.

XXII. Yet, that you mistake not, this is to be understood, where the matter is thin, and lies high; but if the Matter is thick, or lies deep, as under the Psooa-Muscle: (in which Muscle Apostems seldom appear out∣wardly, as by the two afore∣going Examples is manifest) there is no fluctuation at all to be perceived, and many times neither tumor nor discolouring, as Hippocrates maintains, Lib. 6. Aph. 41.

XXIII. The Prognosticks. An Apostem is generally Critical, or upon the end of a Disease: if it increases, and the Sick grows better, health is a coming.

XXIV. If it strikes inward, or falls down; or otherwise, if it yet increases, and the Sick grows worse, let him prepare for death, for it is near at hand.

XXV. Apostems lying hid, (as those in the great Muscle Psooa) are much more dangerous, than those which are apparent and outward; and by how much the more outwardly they lye, by so much the less danger.

XXVI. The sooner an Apostem comes to maturity, the sooner and easier it is to be cured; the more hard the matter, the more tedious and difficult the Cure. The rest of the Prognosticks see in the Third Edition of Our Synopsis Medicinae, lib. 1. cap. 49. sect. 9, ad 24.

XXVII. The Cure. Whilst the Abscess or Apostem is in the way of maturation, you must cherish the heat of the Part, by Medica∣ments that concoct, and increase Pus, and ease the present in∣tense Pain.

XXVIII. Such things are called Chalastica, and Anodyna, for for that they take from the part all sense of pain: and of this kind are Milk, Butter, Oil, Hogs-grease, Capons-grease, Ʋng. Di∣althaeae, Emplast. Diachyl. simplex.

XXIX. What things hasten Sup∣puration, we shall shew at large in Chap. 5, and 6. following: such are these, for hoc Tumors; Oil mingled with Water, and simple without mixture; Wheat-Hower, and Bread of the same; Fats of a Calf, of a Hog, of a Hen, of a Goose; Pitch, Rosin,

Wax mixed with Oil; Ʋng. Te∣trapharmacum, made up of Wax, Rosin, Pitch, and Fat, &c. the Mucilages of Lin-seed, Fenu∣greek-seed, Mallows, Marsh∣mallows. Or this Cataplasm:

XXX. ℞ Pouder of Althaea∣roots, Mallow-leaves, A. ℥ j. Wheat-flower ℥ j ss. seeds of Line and Fenugreek, A. ℥ ss. Saf∣fron ʒ ss. boil them in Milk or Decoction of dried Figs; to which add Hogs-grease, Unguent. Dial∣thaeae, A. ℥ j. mix, and make a Cataplasm.

XXXI. But if the Tumor be cold, you must use hotter things; such are Turpentine, Gums of the Fir-tree, Larch-tree, and Pine-tree; dried Figs, Rai∣sins, Lin-seed, Fenugreek-seed, rosted Onions, Leven, Oils of Camomil and white Lillies, old Hens fat, old Butter, Bdellium, Galbanum, Ammoniacum, Em∣plaster of Melilot, and Diachy∣son magnum.

XXXII. Or this Cataplasm: ℞ of the former Cataplasm ℥ vj. Leaven ʒ vj. Camomil ʒ ij. old Hens fat, Oil of Camomil, A. ℥j ss. mix for a Cataplasm. If you add white Lilly roots, Onions, Tur∣pentine, A. ℥ j. it will be yet stronger.

XXXIII. When the Apostem is come to full ripeness, it is then to be evacuated and cast forth of the Body: which is done either by Discussion, (which is very seldom and rare;) or, by open∣ing of it; (which is much the better way) be it done either of its own accord, or by Art.

XXXIV. Now to know when an Apostem is fit for opening, you must have respect to the signs of its maturation; which are, an abatement of the intense Pain and Inflammation: as we have shewn more at large in Sect. 20, 21, and 22, aforegoing.

XXXV. The Abscess being now found by the Signs to be fit for Apertion, you must perform it as we have taught, Lib. 1. Cap. 18. of this Work, where the Operation is expressed at large. If the opening is by Instrument, it is done with the Knife either red-hot, or else cold: but we now very seldom make use of the hot Iron, and then never but in cold Tumors; and that also, only when the Apostem is in those Parts which have many, or else large Veins and Arteries; that so the Flux of Blood, or Haemorrhage, may the better be prevented.

XXXVI. Now if upon opening of the Apostem, great pain should ensue, or a flux of Blood, or a swooning; in this case, the Se∣ction must be performed with the greatest speed and care that may be.

XXXVII. If an Haemorrhage be feared, you must have in a readiness, these things which stop the flux of Blood; as Frank∣incense, Aloes, white of an Egg, fine Bole, Sanguis Draconis, Pom∣granate rinds and flowers, burnt Alum, Caput. mort. of Vitriol, and several others, which both Our Doron, and our Pharm. Lond. are able to furnish you with.

XXXVIII. To prevent Fainting and Swooning, especially in Chil∣dren, Women, and fearful persons,

you ought to have in a readiness Spiritus Angelicae magis compo∣situs, Aqua Bezoarica, or Spiritus Cordialis, or that of Matthiolus; letting the Sick smell to Oil of Rosemary, or Spike, or Sa∣vin, which is better than either; or in desperate cases, to Spirit of Sal Armoniack.

XXXIX. And likewise that the Section may be rightly per∣formed, the Chirurgian ought to know the condition of the Part; the situation of the Veins, Arte∣ries, and Nerves; as likewise the nature of the Muscles: with∣out the exact knowledge of which, many irregularities, enor∣mities and errors may be com∣mitted, even to the hazard of the Patients life.

XL. For the Veins and Arte∣ries being cut, a violent Haemor∣rhage may follow; the Nerves being cut, either intolerable Pain may arise, or the Member may altogether be deprived of Sense, or both; and the Muscles being cut, the Part may be wholly deprived of its motion.

XLI. Moreoever, regard ought to be had to the Fibres of the Muscles, that Section may be done according to their conduct, and not overthwartly, or cross to them; and that some con∣sideration be had to the great∣ness of the Section.

XLII. If it be too little, the Pus cannot come forth without compression of the Part; which may both excite pain, and beget a brawniness, thereby hazarding a Fistula: if it be too great, there may be either an unsightly Scar, or the ambient Air may get too much in, and alter the Part.

XLIII. To make the Incision, Sennertus admits of either the Razor or Incision-knife; or a Knife myrtle-shaped, edged on both sides, with which the Ita∣lians and French open Veins; or with the Lancet; or lastly, with the Syringotomos, an In∣strument crooked, and of only use in the Incision of an in∣ternal or concavous body.

XLIV. The Incision being made, if there be but little Pus, you may gently press the part, that it may the better flow forth: but if there be much, you ought to evacuate leisurely, and by little at a time; lest if all should be let out together, the Spirits should be too much wasted, and swooning follow.

XLV. After Incision, and emptyng, of the Pus; the first day you may strew on the dust of Frankincense: on the second day, lay on some kind of Digestive; that if any thing remain not perfectly sup∣purated, it may be compleated.

XLVI. And if any kind of nastiness does occur, let it wiped away; and then cleansed with this: ℞ Turpentine ℥ j. Honey of Roses ℥ ss. Barley-meal, q.s. mix them, and apply it.

XLVII. If the Ʋlcer require yet more forcible cleansing, you must use stronger Abstersives; as, Ʋnguentum Apostolorum, Aegy∣ptiacum, &c. and at length Sarcoticks, or Medicines breeding Flesh are prudently to be apply∣ed to the consummation of the Cure, as in the Chapt. following we shall discourse more at large.

XLVIII. If an Apostem leys

deep, so as that it is concealed in many places; or if it is not opened in due time, but that delays are made, whereby it is kept too long; the Humor or Matter is then for the most part translated to some other place, and sometimes to the more noble Parts which cannot be, but with manifest danger to the Sick.

XLIX. Of this kind, Guiliel. Fabricius, Centur. 1. Observ. 81. gives us a remarkable Example, of a Child three menths old, which had an Apostem near to his right shoulder. The Parents (says he) would admit of no Incision, and by degrees the Tumor much abated; at length it was opened, but a very small quantity of matter issued forth, and in a short time it sunk wholly away: but the Humor gradually gliding downwards into the Abdomen and Genitals, it destroyed the native heat; upon which followed a Gan∣grene, and in a few days more, a Sphacelus; so that in a short time after the Child died.

L. From what has been said it appears then, that delays of opening Apostems, are not to be permitted, in any Part; much more if they be in Parts, where the Matter is easily translated to those we call the more noble; and that sometimes it is better to open them a little too soon, than a little too late; the for∣mer being an error, at most, on the right hand.

CHAP. IV. Of a SINUS in Tumors.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Sinus; and in English, the Hole of a Tumor or Apo∣stem.

II. The Description. Is it the hole or hollowness of a Tumor or Apostem, which being emptied of its Pus, is notwithstanding filled again; for which reason it is, that the sides of the said hollowness do not close, and grow together with the Flesh which is underneath it; but there is a certain cavity or hol∣lowness left remaining, very difficultly, if not-impossible, to be cemented.

III. Now the mouth and en∣trance into the Apostem and Ʋlcer, is generally strait and narrow; but within it is more profound or deep, enlarging it self into a proportional bredth.

IV. The Causes. They arise mostly from Apostems or suppurated Tumors, not soon enough opened, or not well cleansed.

V. For the Pus being longer kept in the Apostem than it ought to be, acquires a sharp or corroding quality; by which it makes many

winding and turning passages; to which there is an afflux of Humors from the adjacent parts, and many times from the whole Body: for which reason it is, that this Sinus, or Windings to and fro, is difficult to be filled up with Flesh, and healed.

VI. The Differences. They are manifold: 1. As to Magnitude; for some are greater, some lesser; some shallower, some deeper, some less capacious, others broader.

VII. 2. As to Figure; some are streight, others with many turnings and windings; some long and deep, others roundish, or globular.

VIII. 3. As to the situation, or way of Running: some run up∣wards, and so give better hopes of Cure; for that by its orifice the Pus may the more easily flow forth: some tend, or run down∣wards, so that the Pus cannot flow forth; for which reason, with the Syringotomos it may be opened on the lower part.

IX. The Prognosticks. If the Sinus is not speedily cured, it contracts a Callus, and degene∣rates into a Fistula; and will not then be cured, without much difficulty and danger.

X. The hopes of Cure are taken partly from the Sinus it self, as not being large, deep, winding, or depending: partly from the Part; as being in an upper part, not in a part depending: and partly from the Matter flowing forth; as being well digested, without much swelling, or any very sensible pain; being white in colour, and small in quantity.

XI. If the Pain is wholly vanisht, and the whole place is equal; not feeling with a hollow or yielding softness; it is a good Argument that the Sinus is already filled with Flesh.

XII. But if there is much pain, or any swelling or tumor, the matter flowing in great quantities, and as it were continually, of an evil colour, as green, blew, yellow, or blackish; and indi∣gested, or otherwise very putrid, and extreamly stinking; the hopes of Cure are very small.

XIII. The Cure. The Indica∣cations are taken from the Sym∣ptoms, which are chiefly two, Solution of Ʋnity, and Hollowness: and therefore there must be a Unition; which that it may be accomplished, the Hollowness must be filled with Flesh.

XIV. Now the Cavity cannot be filled with Flesh, except the temper of the Part is as it ought to be; and that the Sinus is free and clean from all its impurities and filth: we must labour there∣fore to remove the Distemper of the Member, if any be, and then that the Sinus be throughly cleansed.

XV. The former is done with Alteratives of a contrary temper; and Purging once or twice a week, with Pilulae Catharticae, Tinctura Purgans, Tinct. Cathartica, or Sal Mirabile, Pulvis Catharticus, or Pulvis Cornachini.

XVI. Then see to the Orifice of the Sinus, if it looks not down∣wards, cause it to look so, by opening the lower part thereof; that the filth may have a free passage forth; and such a like

Sinus, by applying Abstersives, is easily cured.

XVII. Now in this case, some∣times the whole Cavity must be laid open; sometimes an Ori∣fice must be opened only on the inferior part: but the opening the whole Sinus is most in use, because the Ulcer thereby may be the more easily cleansed and healed.

XVIII. Yet this is only when the Sinus is great, and the whole Part may be laid open without danger: otherwise we only open it in the bottom thereof; which done, it is throughly to be cleansed and dried, that no Pus be left remaining.

XIX. For if any of the filth be left behind, there are com∣monly Recidivations or Relap∣ses which follow it, or else it degenerates into into a Fistula: and tho' the parts may seem to be conglutinated, yet they stick not firmly together, but after∣wards separate again.

XX. Now to help on the re∣moval of the Pus, Pillows, or Bolsters and Swathbands are of great use, thereby straitly to com∣press the hollowness, from the higher part of the Sinus, to∣wards its Orifice.

XXI. This being said, we must come to consider of the Medica∣ments fit for this purpose; as 1. Bar∣ley-water, especially if mixed with a little Red-wine. 2. Mel∣icrate, or Water and Honey boil'd together. 3. Mulsum, or Wine and Honey boiled together; which both cleanses and cor∣roborates together.

XXII. To these things you may add, the White Potion, which is thus made: ℞ Strasburgh-Turpen∣tine ℥j. three yolks of Eggs, grind them together till they are well mixed, then add to them, Barley-water three quarts; with which wash the Sinus for some days.

XXIII. To these things we may add, Honey of Roses, Barley-meal, Bean-flower, Orobus-meal, meal of Lupins, Spirit of Wine, Alum-water, Oxymel, Unguentum Ae∣gyptiacum; which laft is the strongest of them, and to be used in the most filthy Ulcers.

XXIV. ℞ Honey of Roses strained ℥ ij. Barley-flower enough to give it a thick Body: or, ℞ Turpentine, Honey of Roses, A. ℥ j. juices of Wormwood and Smallage, A.℥ ss. boil them together; then add of Lupin, Bean, Barley flower, A. q.s. mix them well together.

XXV. Or, having for some days cleansed with the Mixture at Sect. 22. aforegoing, wash only with the following Mixture, with which sometimes the Cure is only and compleatly per∣formed. ℞ Well-water lbiv. Saccharum Saturni, Roch-alum, A. ʒ vj. white Vitriol ʒ iv. Spirit of Wine ℥ vj. mix them.

XXVI. But if the Sinus are manifold, or with many turnings and windings, or of an extraor∣dinary depth, so that it is alto∣gether impossible to open them wholly; nor that Unguents can possibly penetrate thro' the whole Cavity: in this case, liquid Abstersives must be used, which may (by the help of a Syringe) insinuate themselves into all parts of the Sinus.

XXVII. And sometimes, as

soon as the Medicine is cast in, the Orifice is to be stopt, (for some little time) that the Me∣dicament may remain there for a while; which may be best done with a short Syringe, if the Orifice is narrow, holding the Syringe in all the while, to pre∣vent the immediate flowing back.

XXVIII. ℞ Fair-water lbv. Honey ℥ iv. juices of Centory and Wormwood, A. ℥ ij. Aloes ℥ ss. dissolve by boiling, and strain.

XXIX. If it be very foul, ℞ Barley-water lbiv. Honey ℥ iij. Unguentum Aegyptiacum ℥ vj. mix them.

XXX. The Sinus being suffi∣ciently cleansed by the use of these things, or others of like nature, you must then come to the use of Sarcoticks, Incarnatives, or Flesh-breeders: for tho' Nature her self will generate Flesh, yet Art and Medicines many times assist her so, as to remove the recrements which hinder her in her operation; which since they are an impediment to her, are wholly to be taken away by means proper; so that the filth and impurities may be throughly taken away from the Ulcer, and the humidities dried up.

XXXI. Now Sarcoticks or Flesh-breeders, cannot be said properly or really to generate Flesh, for that is the work of Nature alone: but are so called from their being assistant to her, in removing (as was said before) the impediments, by their cleansing and drying qualities.

XXXII. Yet they ought not to be over-drying, but such as may agree with the natural temper of the Part: for as much as there is not the same degree or measure of driness in all Bodies, nor yet in all Members.

XXXIII. The more gentle Sar∣coticks are, Barley-meal, Bean-meal, Rosin, Frankincense: the stronger are, Orobus-meal, pou∣der of Orrice-roots, of Aristo∣lochia, Myrrh, Scammony, Aloes, Tutia, Pompholyx, &c. out of which you may make various Compositions.

XXXIV. A mild Sarcotick. ℞ Turpentine ℥ ij. Gum Elemi, Capivi, Frankincense, Mastich, Olibanum, Colophony, A. ℥ ss. Wax, Oil, A. q.s. mix, and make an Ointment.

XXXV. A strong Sarcotick. ℞ Round Birthwort-root, Orrice-root, Comfrey-root, all in pouder, A. ℥ ss. Mastich, Olibanum, Frank∣incense, Myrrh, Aloes, A. ʒ ij. Scammony ʒ j. Turpentine, Honey, A. q.s. mix them well together.

XXXVI. If it is Flesh of a harder kind which is to be gene∣rated, and in a Body more than ordinarily dry, and the Ʋlcer lyes open, then you may apply Topicks in a dry form, as Sarcotick Pouders, to strew on: as,

XXXVII. ℞ Frankincense, Mastich, Olibanum, Rosin, A. ℥ j. make all into a fine pouder. Or thus: ℞ Aloes, Frankincense, Mastich, Olibanum, Rosin, Sanguis Draconis, Sarcocol, A. ℥ j. make all into a pouder.

XXXVIII. This is better: ℞ Fine Scammony, and make it into a subtil pouder. Or this: ℞ Scammony, Myrrh, Olibanum,

A. ℥ j. make them into a fine pouder. Or this: ℞ Scammony in pouder ℥ iij. fine Aloes, Myrrh, A. ℥ j. Coloquintida in pouder, ℥ss. mix them.

XXXIX. This is a most ex∣cellent thing: ℞ Scammony in pouder, Mercurius dulcis levi∣gated, A. ℥j. Myrrh, Aloes, A. ℥ss. Coloquintida in pouder ʒ ij. mix them.

XL. But if the Sinus is not open, Sarcoticks of a liquid form are to be injected, after the manner of Cleansers; and the Orifice being kept close, they are to be kept in for a while.

XLI. For this purpose, red Port-wine, in which Myrrh, or Myrrh and Aloes has been dis∣solved, may be injected; or Wine, in which Scammon has been dis∣solved: or a Decoction of round Birthwort-roots in red Port-wine, in which you may dis∣solve Myrrh: also, a Deco∣ction of Comfrey-roots, Horse∣tail, red Roses, Myrrh, Frank∣incense, Aloes, &c. in red Port-wine, are admirable in this case.

XLII. After all, it may be a question, whether the deeper and more extream parts of the Sinus are well cleansed and congluti∣nated? But this you may know by the Pus that flows out, if it is but small in quantity, well digested, and no pain is per∣ceived: but if after the fifth or seventh day, a crude and raw Humor shall come forth, it is a sign of no good healing, or conjoining the Parts; and that Flesh is not as yet bred therein.

XLIII. In this case, you must use Medicaments which more forcibly dry, yet without any biting; which may be conti∣nued till the Sinus is in a man∣ner filled up.

XLIV. Then some aggluti∣nating Medicament is to be ap∣plied, which may gently, and with∣out any acrimony, close together, and heal the tender Flesh which is generated and bred, con∣joining the divided parts.

XLV. After the Agglutinative has been applied, you may put upon it a new soft Spunge, dipt in generous Wine, or in Mulsum, or in a Decoction of Pomgranate-peels, Red-roses, and Myrrh, made in red Port-wine, and you may bind it round on; which binding let begin from the bottom of the Sinus, and so go forwards to the Orifice.

XLVI. And about the bottom, let the swathing be as hard and strait as may be, (but so, as not to cause pain,) and then slacken it by little and little, till you come to the very mouth of the Sinus it self; over which let the Medicament be laid after a loose manner.

XLVII. Nor must you too closely stop up the Orifice, but leave a place for the Pus to come forth; for which purpose, the Emplaster laid on may have a hole cut in the middle thereof.

XLVIII. This was the ancient way of curing a Sinus, and hollow Ʋlcers; but Arcaeus in his Book of Wounds, l. 2. c. 7. gives us ano∣ther more compendious course, discovered by himself in curing

Apostems newly opened; by which, on the third or fourth day at farthest, all the aforesaid cavity of Apostems might be perfectly cured.

XLIX. If the Apostem or Tu∣mor (says he) is great, let it be opened as well as may be; so wide, that ones Finger may go into the Orifice; that thereby all the Pus contained may flow forth, by a gentle compression of the place.

L. The Pus being evacuated, stop the mouth of the Sinus with a Tent, and lay over the Sinus a Bolster; which let lye with∣out stirring it, till the next day following.

LI. Then loosen the ligature, and let the hollow Ʋlcer be care∣fully purified or cleansed from all the Pus: (I suppose he intends, with abstersive Lotions or In∣jections) that nothing may be left remaining underneath.

LII. This done, let a small Pipe of lead be put into the Ori∣fice, reaching even to the cavity or hollowness; but by no means be forced any farther: upon which lay Emplastr. Basilicon, spred upon linnen Cloth; in the which the Pipe also may be contained, that it falls not forth; but always leaving a hole at the orifice of the leaden Pipe.

LIII. Then on either side of the Sinus let triangular Bolsters be laid, that all the hollow space may be filled up with them; leaving the orifice of the Sinus in which is the leaden Pipe or hollow Tent, free and open; not letting it be stopt up with the Bolsters, nor any ways ob∣structed by the ligature or bind∣ing; so that all the Pus con∣tamed may wholly run out.

LIV. Then let the place co∣vered with the Bolsters be rowled about with a Rowler; beginning from the bottom of the Sinus, and so going towards its Ori∣fice, thereby to force away the remaining pus or filth.

LV. Thus bound up, leave it till the day following, then loosen the Ligature, and search how much of the Cavity remains, by which you will know, whether the Bolsters did exactly press upon the hollowness.

LVI. For all these placs or hollownesses, which were com∣pressed by the Bolsters, will all of them be found conglutinated, and joined fast together; the which being manifest, the Bol∣sters are again to be bound on after the same manner as before, and so to continue till the next day.

LVII. But now if any Pus or Humor seems to be left in any place, this is to be prest forth (as before) with the Bolsters and Swathing; by which means the gaping or hollow places will coalesce, and be joined close together.

LVIII. Which as soon as you perceive, the Bolsters are to be removed, and you may lay upon the Ʋlcer a Plaster of Arcaeus his Leonine-composition, spred upon linnen Cloth; or some other Emplaster of like kind, as Dia∣palma, &c. every day wiping and cleansing it six or eight times.

LIX. Now here is to be noted,

1. That Arcaeus his Method is only in use in Apostems newly opened; but in an old Sinus, or where it may be callous, or fistulous, the former Way is much the better and safer.

LX. 2. That the Bolsters be sufficiently compressed with the Rowlers; both to press forth the Pus, and also to conjoin the disunited parts; other∣wise no healing can be expected.

LXI. 3. That there may not remain any reliques of the indi∣gested or putrid Matter thro' the Part; which if any be, will be known by the continuance of the Tumor, and redness of the colour; and therefore the due and thorow Cleansing must be endeavoured with all the speed that may be.

CHAP. V. Of an INFLAMMATION.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Phle∣gmone, and Inflammatio; in Eng∣lish, a Phlegmon, or Inflam∣mation.

II. The Description. It is a Tumor, rising gradually with pain, vehement heat, and redness, with a protrusion, and beating in the part; from a preternatural flux of Blood.

III. The Place. It is manifest chiefly in Fleshy parts, to wit, the Musculous, and sometimes in parts that are Membranous; as in a Pleurisie, in the Membrane which girts about and encom∣passes the Ribs; in a Phrensy, the Membranes of the Cerebrum; in an Ophthalmia, the Membranes and small Vessels of the Eye; oftentimes in the Glandulous parts, as in Bubo's, Parotis, &c. and in the Bowels also; as the Brain, Liver, Spleen, Womb, Reins, &c.

IV. The Causes. The Proca∣tartick Causes are Wounds, Fra∣ctures, Blows, Contusions, violent Exercise, Surfeiting, critical Eva∣cuations; or any thing which may cause a Solution of Unity in the Part, the Skin remaining whole.

V. The Antecedent-cause is Ob∣struction, and things breeding Ob∣struction, also the breeding much Blood; whence it comes to pass, that the Blood or Matter ob∣structed, not finding its way out, increases, and by a conti∣nual addition without circula∣tion, a Tumor is produced.

VI. The Conjoined-cause is Blood, if it is a pure Phlegmon; but as it may also arise from the mix∣ture of other Humors, as Lympha, Serum, Phlegm, Choler, or Melan∣choly, so it receives other Names; as if from Blood mixt with Choler, it is called Phelgmone Erysipelatoodes; if from a mix∣ture

of Phlegm, Oedematoodes; if from a mixture of Melan∣choly, Scirrhoodes.

VII. From this Blood, or Blood mixt mixt with Humors, arises a Ferment in the Part affected, with a hot Effervescency; causing many times a putrid Pus or Matter.

VIII. Galen saith, it is caused from a hot fluxion of Blood, which when it has seized upon, and seated it self in some Musculous part, at first the greater Veins and Arteries are filled up, and dis∣tended; and after them the lesser: and so it is carried on, and continued, till it arives at the Capillaries, or least Vessels.

IX. In these, when the matter of the Fluxion is forcibly impacted, and cannot be any longer contained in the Vessels, it is then extrava∣sated, or transmitted unto the outward parts; partly by Anastomosis, thro' their own Mouths; and partly by Dia∣pedesis, or percolation or sweat∣ing of it out thro' the Tunicles; and partly by Diaeresis, or break∣ing of the Vessels; whereby the void spaces that are betwixt are filled full with the Flu∣xion.

X. For since the Arteries and Veins run along unto every par∣ticular Part; so long as the Blood flows in a due measure, and is contained within those its receptacles, by circulation, no Inflammation or Phlegmon can be at all: but then it hap∣pens only when the Blood is in an over-abundant manner, and all on a sudden is emptied and poured forth by the said Vessels into the substance of the Flesh.

XI. This is evident in an Ophthalmia: for in the Tunicle Adnata, replenished with innume∣rable of these Capillary-vessels, whilst the Eye is free from dis∣temper, they are so very small, that they are hardly to be di∣scerned by the most piercing Eye: but as soon as the Eye is in∣flamed, and those Vessels pre∣ternaturally replenished with Blood, then they notoriously shew themselves, and become very conspicuous.

XII. And in like manner it is most agreeable to Reason, and even Truth it self, that it should be the same in all other Inflam∣mations whatsoever, and in what part soever.

XIII. But yet there will be no Phlegmon or Inflammation, tho' the lesser and Capillary-arteries are even filled up with Blood; until that at length by and thro' them the Blood is impacted into the remaining parts, or substance of the Flesh.

XIV. And this is done, when that the Blood being emptied thro' those Capillary-arteries into the substance of the Flesh, it cannot flow again or circulate thro' the ends or mouths of the Capillary-veins, by reason of some thick or viscous Matter obstructing them.

XV. The Differences. The chief Differences of an Inflammation, are taken; 1. From the Variety of the conjoined Gause. 2. From the various Qualities of the Blood, which stirs up, and makes the Inflammation.

XVI. The Kinds And so a

Phlegmon is said to be, 1. True, as that which springs from Blood alone. 2. Spurious, which comes from Blood mixt with other Humors.

XVII. The Spurious is three∣fold, viz. Erysipelatoodes, Oede∣matoodes, and Scirrhoodes; as we have already discoursed at Sect. 6. aforegoing.

XVIII. As for the Blood, as it is more acrimonious and sharp, so it makes the Tumor more sharp and painful, and contrariwise: now this is no change of its substance, but of its qualities; for if the Blood changes its substance, it excites not any kind of Blood-tumor at all, but the Tumor is denommated from some other Humor.

XIX. The Signs. They are ma∣nifold; as, 1. Tumor and dis∣tension: for the great quantity of Blood does not only fill the Arteries, but even the whole substance of the Part; all of it is distended or stretched out, but chiefly the Skin.

XX. 2. A very great and intense Heat, from whence the Tumor has its name and denomination; which is caused from the over-great afflux of hot Blood detained in the Part; and an obstruction of the Pores of the Skin, that the hot Exhalations or Vapors can∣not sufficiently perspire, nor the heat be cooled as it ought to be; together with putrifa∣ction of the Blood and Humors.

XXI. 3. A vehement Pain: for where there is a vehement Heat, or hot Distemper, and a solution of Ʋnity, (as there must be in all Tumors) together with a distention of Parts, there must also be a great Pain: now this Pain is various, and much dif∣ferent; as distending or stretch∣ing, pulling or twingeing, pres∣sing and burthening; accord∣ing to the quality of the Parts affected.

XXII. 4. Resisting the Touch: for tho' the inflamed Part is not hard of its own nature, yet being so much filled with Blood, and distended thereby; it must necessarily resist the Touch (in some measure) and appear as it were hard to the feeling.

XXIII. 5. Redness of the Part: for the Blood imparts this colour thereto; there being nothing in Mans body which assumes a redness of colour, but the Blood primarily, then the Flesh.

XXIV. 6. A Pulse, or beating Pain in the Part: there is per∣ceived a beating of the Arteries of the inflamed Part, which when the Part was well, was not per∣ceived: but this happens not to all places, but only to such of them as have some notable Arteries, and other parts which are endued with an exquisite sense; and when the Inflam∣mation is grown to a consi∣derable bigness; as says Galen, de Loc. affect. lib. 6. cap. 7. viz. when the Inflammation tends towards Suppuration.

XXV. The Prognosticks. A Phlegmon, if small, does often resolve; (which is known by abating of the Symptoms, and growing less) but if great, and the matter is thick, and deep in the Flesh, it does often suppurate.

XXVI. If the Inflammation vanishes, and the Tumor suddenly strikes inward, with a Fever, or other evil accidents, it is dan∣gerous.

XXVII. If it neither resolves, returns back, nor comes to Sup∣puration, it grows into a scir∣rhous hardness.

XXVIII. If it falls in the Fleshy parts, it is said to end in fourteen days; if on the Ten∣dons and Ligaments, in about forty days.

XXIX. An Inflammation ex∣ternal, often frees the internal parts from many Diseases, and is healthful; except it is very great and malign; for then you may fear a Gangrene, or some other danger.

XXX. That is dangerous which seizes on the Eyes, Jaws, Ʋvula, great Vessels, Penis, or Joints.

XXXI. In a Young person, and in Summer-time, 'tis sooner cured than in Elder persons, or in Winter-time, or cold weather; and sooner in a lean, than a fat Body.

XXXII. The end is good, when Nature overcomes the matter which breeds the Inflammation, which happens, when the Tumor is either resolved by insensible perspiration by Discussives, and is the best kind of curing it: or when it is suppurated, and turned into Pus, or purulent Matter.

XXXIII. The end or event may be said to be evil, when Nature does not overcome the Morbifick-matter; which is, when (if the Tumor is external) it suddenly vanishes, or strikes inward; or when the natural heat being overcome and extinguished, it becomes a Gangrene: so that if it is not presently cut off, death must ensue.

XXXIV. The end or event is not good, when upon Resolution, or Discussion, the thinner parts are removed, leaving the thicker behind; by which the Tumor becomes hard, and degenerates into a Scirrhus.

XXXV. Now if the matter is not very thick, nor deep, or shut up under a hard and deep Skin, the Body not very corrupt, and nature strong; then a Reso∣lution by an insensible Perspi∣ration may be expected.

XXXVI. But if the matter is much in quantity, and thick, lying deeper than usual, and under a thick Skin; a Suppuration is to be expected.

XXXVII. If the Tumor dimi∣nishes without application of Re∣percussives or Repulsives, it will retreat inwards.

XXXVIII. If the heat, pain, red colour, and pulsation of the Tumor ceases without manifest cause, the Tumor still remain∣ing, the approach of a Gangrene may be presaged.

XXXIX. If over-strong Dis∣cussives be applied in the beginning, where the matter is very viscous, and hard withal, the natural heat being strong and vigo∣rous, the thicker parts will be scattered and dispers'd, and leave the thicker behind, which will degenerate into a Scirrhus.

XL. The Times of an Inflam∣mation. It is necessary to know the Times of a Tumor, in re∣lation to the Cure; lest we run

our selves into an errour, whilst we apply improper, or contrary Medicaments.

XLI. Now then Inflammations, as all other Diseases, have four Times, or Crises; viz. the Be∣ginning, the Increase, the State, and the Declination.

XLII. The Beginning is, when the Part begins to swell and be distended, when as yet no Action is hurt or hindred. The Increase is, when the tumor, pain, stretching, and heat are increased.

XLIII. The State or Height is, when the tumor, distention, heat, pain, and all other Sym∣ptoms are most vehement, and in the height of their extremity. And the Declination is, when the Morbifick matter is diminished, the pain and heat, together with the other Symptoms, are become more remiss and gentle: or otherwise, when the Tumor is come to ripeness, being con∣verted into Pus, or purulent Matter.

XLIV. But as to these Times or Crises, they are sometimes shorter, sometimes longer; and sometimes a Phlegmon is sooner, and sometimes later terminated: for Galen, in Aphoris. lib. 6. Aph. 49. saith, that which is of a thinner substance, is sooner digested than that which is thick or tough, which requires a longer time; and that which is thick and viscous, will have yet a more larger time.

XLV. The Cure. The Indica∣tions of the Cure of this Disease, depend chiefly upon the Times of the Disease; for each Time or Crise has it own proper Indi∣cation.

XLVI. The beginning. The chief Indication here is taken from the Antecedent and Conjoined Causes, by removing the one, and repelling the other: now the Antecedent Cause is Obstruction, and an increase of Blood: the Con∣joined Cause is Blood it self, as we have before declared: and they ought to be removed in the very same order, in which they follow one another.

LXVI. The Obstruction is re∣moved by Aperients or Openers, and such Catharticks as have power to call back the Humors, or divert the Fluxion: of the first kind are the Spiritus Salis Armoniaci, Spirits of Blood, and Urine, and the Spiritus Ni∣tratus, which is a famous thing.

XLVIII. Of the second kind are Our Family-Pills, our Pilulae Catharticae, Tinctura Purgans, & Cathartica; an Infusion of Sena, and Rhubarb, and not inferior to any of them is the true Sal Mirabile.

XLIX. If the Body is repleat, and the Stomach foul, first Vomit once or twice, with Sal Vitrioli; or rather with the Tartarum Emeticum, or Oxymel Scilliticum; and then Purge with some of the former things: because sharp Blood, or Blood mixt with sharp Humors, cause the Fluxion.

L. Then again you may exhi∣bit the aperient Alteratives before named; which may be given in Syrupus Antifebriticus, and sometimes in Syrupus de Me∣conio; a little to cool the

Blood, and thicken the Humors.

LI. The Conjoined Cause, which is the blood in the Tumor, is resisted by application of Reper∣cussives or Repellers: and this is in a manner the only Time in which repulsion ought to be used.

LII. But that it might the more safely be done, Sennertus advises to Venesection, that the great store of the abounding Blood may be diminished, and be drawn back from the aggrieved place; and (says he) it is not to be omitted, if the strength of the Patient will permit it to be done: for that in this case, hardly can any Remedies be applied with safety, without the diminution of the Blood by this means, be first attempted.

LIII. For if Repellers be applied to drive back, the Body still con∣tinuing so full of Blood, it is much to be feared, lest the matte should not be received by the other Parts, and that thereupon it should endeavour to flow to some other particular Part, and possibly the more noble.

LIV. The Blood also is dimi∣nished by hindering its breeding, which is done, by a very sparing Diet, and eating such Food as affords not much nourishment: for which reason strong Ale and Wine is to be forborn, and Meats of a rich juice; and if the Sick (by long custom of using it) cannot forbear Wine; let it be very much diluted with Water: avoiding also all hot, sweet, fat, spicy, and astringent things.

LV. His Drink, if possible, should be Barley-water, or a middling sort of Drink, aculeated, with Spirit of Sulphur, or Sal Nitratum, or Vitriolatum; a•…•…'d his Food Watergruel, or Barley 〈◊〉〈◊〉 broth, with juice of Limons.

LVI. After Revulsion or Bleed∣ing, (which ought only to be done in the very first rise of the Distemper, and only when there is a great plenty of Blood, and a more than usual Fluxion, or rushing thereof to the Part af∣fected) Repulsion is next to be pursued, which is performed, by the application of Repercussive Medicaments.

LVII. Repercussives or Re∣pellers are of two sorts or kinds: one cold and moist, or Waterish; the other cold and dry, or Earthy; having also a thickness of parts, and an Astringent power: for which reason they act with a double force, 1. By their Cold∣ness: 2. By their Astringency.

LVIII. Cold and moist Repellers, are the more mild and gentle, and have power only to drive back the thin Humors, which are small in quantity, and seated in the superficies; and are pro∣sitably applied when heat and pain afflict the Part, and the Vessels are small and strait.

LIX. For they do not only oppose and resist the influx of the Humors, but also allay the heat; and by relaxation do something mitigate and asswage the pain.

LX. Of this kind are Housleek, Wall-peniwort, Lettice, Purslane, Endive, Suecory, Henbane, Night-shade, juice of Gourds, Water-leatils, Fleawort, Mandrake, Water-lilies, Arach, Violets; and all other things which are cold,

and endued with a Watery Humor.

LXI. However, among these there are several degrees, some having a less, some a greater efficacy: for Wall-peniwort and Fleawort repercuss less forcibly than Mandrake, Nightshade, Henbane, Housleek, Lettice, or Purslane.

LXII. Cold and dry Repellers, which are astringent, are proper in other cases; and chiefly if the Fluxion proceeds from a de∣bility of the Part, and that the pain is not very vehement.

LXIII. For they strengthen the Part receiving, that so it may refuse the Humors flowing into it, and drive back that which has already flown in: they are good also to be applied where the Vessels, thro' which the Blood flows are wide and large.

LXIV. Of this kind are, flowers and heads of Roses, leaves and unripe fruit of the Bramble and Mulberry, Vine-leaves and unripe fruit, Raison or Grape stones, red Sanders, unripe fruits of Medlars and Services, wild Pears, Quinces, leaves and berries of the Myrtle, roots of Bistort and Tormentil, Pomgranate flowers and peels, Frankincense, Acacia, pulp of Slows, unripe and ripe, fine Bole, Terra Sigillata, Dragons blood, dried blood of Man or Beast, leaves and nuts of the Cyprus-tree, Oak-leaves, unripe Galls, Acorn-cup, Ceruss, Li∣tharge, Saccharum Saturni, Alum, white Vitriol, salt of Vitriol, lapis Haematitis, pouder of dried Toads, &c.

LXV. Out of these, several Mixtures may be made, as the circumstances of the Disease shall require: for of the Plants, the raw Leaves, &c. may be ap∣plied, or Spunges may be dipt in the juice of the same; or a Cataplasm of the whole sub∣stance; or Spunges dipt in a Decoction of them in Water, or red Port-wine.

LXVI. Some apply Cloths or Spunges dipt in Frog-spawn-water, in which Myrrh is dissolved: or a Lixivium of Quicklime, boiled with Wax and Oil of Roses: or the whites of Eggs beaten with Rose-water and Vinegar, and mixt with fine Bole, or lapis Haematitis; or a Cataplasm made with Ʋnguentum Populeon mixed with Bole-armoniack; or Milk, Bread, and Litharge, with a little Terra sigillata.

LXVII. Galen dipt a Spunge in Oxycrate, and applied it; and for the same purpose, Oil-Omphacine and of Roses, Oil of Myrtles, Ointment of Roses, the Ceratum Santalinum, Vin∣egar, Red-wine, juice of Plan∣tane, the Cataplasma Rabricii, Anacolema Schroderi, and Cata∣plasma contra Cruorem, are all of them said to be of good use: the last three see in Our Pharm, Lond. lib. 5. cap. 7. sect. 7, 13, and 14.

LXVIII. A Cataplasm of Barley-meal, boiled with Vinegar and juice of Plantane, i•• commended; so also a Cataplasm of Barley-meal, pouder of Pomgranate-peels and Sumach, with Hous∣leek and Red-wine, boiled to∣together. This Cataplasm, saith

Galen, ad Glauc. lib. 2. cap. 2. is absolutely the best in such like Disaffections: for that it drives back what flows in, drys up what is already in, and fortifies the Parts adjacent.

LXiX. ℞ Housleek ℥vj. Barley-meal ℥ v. Pomgranate-rinds, Su∣mach, both in pouder, A. ℥ ij. pulp of Sloes ℥ j. boil all in red Port∣wine, or Vinegar, for a Cataplasm.

LXX. ℞ Plantan, Lettice, Purslain, Nightshade, Red-roses, A. M. j. Water and Vinegar, A. q.s. boil them, and by addition of Barley-meal make a Cataplasm.

LXXI. ℞ Juices of Housleek, Plantan and Poppy, A. ℥ iij. Vin∣egar ℥ j. Oil-omphacine ℥ j ss. Barley-flower, enough to make it into a Pultess by boiling.

LXXII. ℞ Pouder of Pomgra∣nate-peels, Sumach, red Sanders, A. ℥ j. fine Bole ℥ iv. Barley-flower ℥ vj. juice of Housleek ℥ viij. boil, and make a Cataplasm: to which add Oil-omphacine, or Oil of Myrtles q.s. mix them.

LXXIII. This is stronger. ℞ fine Bole, Sanguis Draconis, Salt of Vitriol, A. ℥ j. Saccharum Saturni, Comfrey-roots in pouder, A. ℥ ss. mix them with the white of an Egg beaten up with Rose-water, and make a Cataplasm.

LXXIV. To these things are added Interceptives, which some call Defensatives; but they are the same with Repercussives or Re∣pellers, and differ only in respect to the place to which they are applied: the former being ap∣plied to the place affected, but these unto the parts and ways by which the Humor flows unto the affected Part; that they may intercept its passage, and stop up the way against it.

LXXV. These are generally ap∣plied to Parts having little or no Flesh, and where the Vessels most appear, as in the Joints, and just above the Joints: So in a Phle∣gmon in the Hand, they are applied to the Wrist; if be∣twixt the Wrist and Elbow, to the Elbow; if in the Shoulder, to the highest part thereof; if in the Foot, above the Ancle-bone; if in the Leg, above the Knee.

LXXVI. The common Defen∣sative is thus made: ℞ Fine Bole, Sanguis Draconis, Terra sigillata, all the Sanders, A. ℥ j. Oil-omphacin and Oil of Myrtles, A. q.s. Vinegar of Roses ℥ j. mix them, and boil till the Vinegar is consumed.

LXXVII. In this Prescript, the Oils are disapproved of, because they mollify, and if they lye long on, are apt to heat: and therefore it is better to mix the said Pou∣ders only with Oxycrate; and where you would have them act more forcibly, with the white of an Egg mixt with Oxycrate; for so they will stick the faster, and make a greater constriction.

LXXVIII. As for Example: ℞ Fine Bole, Sanguis Draconis, Sumach, flowers and peels of Pom∣granates, Red-roses, Myrtle∣berries, red Sanders, all in fine Pouder, A. ℥ j. Catechu, Jesuits∣bark, Opium, Salt of Vitriol, Saccharum Saturni, all in pouder, A. ℥ss. with whites of Eggs beaten with Vinegar, A. q.s. mix, and make a Cataplasm.

LXXIX. It remains now, that we enquire when these Medicines, even Repellers of any kind, are to be used, or whether to be used at all, or no: if they are to be used, they are only to be used in the beginning of the In∣flammation, before the Blood and Humors are impacted into the Part; but there are some cases, in which they may not be used at all.

LXXX. As first, if the Humor is malign, venene, or pestilential, wherein if Nature protrudes the Morbisick-matter outwards, we ought not to drive it back again to the internal parts; lest re∣treating to the more noble parts, it should increase the Disease, cause suffocation, or smite the Vitals.

LXXXI. Secondly, nor are they to be applied at any time, when Nature acting of her own accord, produces the Phlegmon critically, thereby ending some other Dis∣ease: for Nature in this case is no ways to be hindred in her operation.

LXXXII. Thirdly, nor are they to be applied to such Parts, which Nature has ordained to receive the recrements or superfluities of the more noble Parts; as the Glandules behind the Ears, in the Throat, Armpits, and Groins: for if Repercussives should be applied to these, it may be feared that the matter may again recur to the more noble parte, from whence Nature sent it for their relief.

LXXXIII. Fourthly, nor may they to be applied to other places, which too nearly neighbour upon the more noble parts; for fear, lest the matter being driven back, should invade those noble parts, and so cause a greater mischief.

LXXXIV. Fifthly, nor are they to be applied when the Phlegmon is too profound, or over-deep; for then their virtue will not reach to the matter, nor will they prevent the farther afflux: for by the repelling Medicine the exterior parts will be con∣tracted, and the Humors driven out of them inwards, and it may be obtruded even upon the place it self affected.

LXXXV. The encrease of the Phlegmon: and this is the time in which the Physician strives to perform the Cure by insen∣sible perspiration, or discussion: in this case Repellers may be applied, yet not alone, but mixed with Digestives or Discussives, that by the heat, the Humors or Matter may be somewhat atte∣nuated, and converted into Vapors.

LXXXVI. Now how Repercus∣sives are to be mixt with Di∣gestives, we are instructed by Galen, de Comp. Med. secund. Loc. lib. 6. cap. 1. As in the begin∣ning (saith he) Repercussives are useful; so in the encrease, even to the end, those Medicines which consist of a repelling virtue, and a digestive faculty, will be re∣quisite to discuss and scatter.

LXXXVII. But (says he) A∣stringents ought to have the pre∣cedency in the beginning of the Encrease; that is, ought to exceed the Digestives; in the middle of the encrease they ought to be equal;

and towards the latter end of the encrease, the Digestives ought to exceed the Repercussives; but at the end of the Encrease, then Digestives are alone to be used.

LXXXVIII. If therefore the Phlegmon admits not of cure by the first Intention, viz. by repel∣ling the afflux of the Blood and Humors, we must attempt it by the second Intention; which is to be done when it is in its augmentation or encrease, by a mixt Remedy, as we even now hinted at Sect. 85, 86, and 87. just aforegoing.

LXXXIX. This manner of Eva∣cuation of the Morbifick-matter, per 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, id est, insensibiliter, or by insensible transpiration, is performed by such Medicaments as the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. which being considered as Externals, we construe them to be dige∣stive, discussive, and resolving Medicines.

XC. Now Discussion or Reso∣lution, is only an evacuation of the Humor by insensible Transpiration: and therefore the Matter to be discussed ought to be thin and fluxil, and the Skin thin and poroas.

XCI. For if it is clammy, viscous and thick, and the Skin thick, and its pores closed and condensed; or the matter is in a place very deep, whereby it cannot find a ready way, or new passage forth, it will not easily be cured by Resolution.

XCII. Now since all Discussives are hot in quality, they are not as we said before, to be applied in the beginning of the encrease of the Phlegmon; but rather Re∣percussives, either alone, or mixt with Discussives.

XCIII. Nor can the Humor be resolved, attenuated, and con∣verted into Vapors, but only by heat: but as hot Medicaments are of various qualities: as some to Ra∣rifie, or open the mouths of Ves∣sels; some to Incide, or cut tough Humors; some to Attract, or draw them, and others to Cau∣terize, or burn: so also some are Diaphoretick or Discussive, and differ from all the former, having in them this singular and peculiar faculty, to thin them, and convert them into Vapors.

XCIV. The Internals are called Sudorificks, or Sweating Medi∣cines; and they are given to help forward the Operation of the external Diaphoreticks or Dis∣cussives; as Spirit of Sal Ar∣moniack, of Blood, or of Harts-horn, given in a Glass of Rhe∣nish-Wine or Sack, &c.

XCV. The Externals are two∣fold: some weaker, or milder; and same stronger.

XCVI. The milder are, Camo∣mil, Melilot, roots of Althaea, of white Lilies, and of Foenu∣greek; meals of Lupins, of Oro∣bus, and of Cicers, leavened Bread, Goose-grease, old Oil, Elder-tree flowers.

XCVII. The stronger are, Dill, Origanum, Tyme, Penyroyal, Fennel, Fetherfew, Hyssop, Mint, Angelica, Calamint, Horehound, Rue, Sage, seeds of Anise, Cara∣ways, Cumin, and Fennel, Orrice-roots: Gums; Ammoniacum,

Bdellium, Galbanum, Opopanax, Sagapenum, and Tacamahacca; Bears, Hens, and Ducks grease; Oils of Bays, Nard, and Rue; Ʋnguentum Arragon, Martiatum, Oxycroceum, Cataplasma de Fer∣mento, Resolutivum Foresti, & Rondeletii, Leven, and the Dung of Beasts.

XCVIII. But the strongest of all are, Soap in small quantity mixt with Hogs-lard, Nitre, Borax, Sulphur, Lime, &c.

XCIX. Out of the aforenamed materials, others more compound may be made: as ℞ Barley-meal ℥ iv. Linseed ℥ ij. Camomil-flowers in pouder ℥ j. Vinegar q.s. boil them together, and then add Oil of Camomil ℥ j ss. Oil of Aniseeds ʒ ij. mix, and make a Cataplasm, to be applied in the augmentation.

C. Or thus: ℞ Mallows, Pel∣litory of the Wall, Plantan, A. M. j. Oxycrate q.s. boil them: then beat them in a Mortar to a mash, and add Barley-flower ℥ ij. Fenugreek-seed ℥ j ss. Oil of Ca∣momil ℥ j ss. Oil of Fennel-seed ʒ iij. mix, and make a Cata∣plasm.

CI. Where note, 1. The milder sort are to be made use of, when the matter is in a place not very deep; and when the Body it self, and part affected is more soft and pliant.

CII. 2. That the stronger sort are used where the Inflammation is greater, and the Matter deep; as also where the Body and Part are more hard and condensed. Yet these are to be used with cau∣tion, lest they should discuss and resolve the thinner parts, leaving the thicker behind; making the Tumor become hard and incurable.

CIII. But this danger may be prevented, if with such things as forcibly discuss, you likewise mix such things as moisten and mollify: and that the Discussives be not very sharp or biting, lest they thereby augment the pain, and increase the fluxion.

CIV. The height or state of the Phlegmon. When it is manifest that the Phlegmon is not yet ended, neither by repercussion nor by discussion, but is come to the height or perfection, you must then endeavour to com∣pleat the work by Digestives and Anodyns.

CV. These following are approved Digestives: as, roots of white Lilies, Marsh-mallows, Onions roasted, leaves of Marsh-mallows, Mallows, Sorrel, Wood-sorrel, Camomil-flowers, Saffron, Figs, Raisons, Currans, Dates, Ammo∣niacum, Bdellium, Galbanum, Opoponax, Sagapenum, Taca∣mahacca, Tar, Turpentine, Gum Elemi, Copayba; Ducks, Geese, Hens, and Hogs grease, Oil of Lilies, Ʋnguentum Dialthaeae, Ba∣silicon greater and lesser, Em∣plastrum Diachylon, simple, & cum Gummis, Mithridate, Venice-Treacle, Our Theriaca Chymica, Hens and Pidgeons dung.

CVI. Out of these things several Compositions may be made: as, ℞ Flowers of Melilot and Ca∣momil, Mallow-leaves, A. M. j. Red-roses, Elder-flowers, A. M j.ss. boil them in sharp wine; then add meal of Fenugreek ℥ ss. Oil∣olive q.s. to which add of Spike

ʒ iij. mix, and make a Cataplasm.

CVII. ℞ White-lily-roots, Hens-dung, A. ℥ j. flowers of Camomil and Melilot, A. M. j. Red-roses M. ij. boil all in Water q.s. then add Barley and Fenugreek meal, A. ℥ j. ss. Saffron ℥ ss. Oil-olive q.s. mix, and make a Cataplasm; adding at last Oil of Spike ʒ ij. A stronger sort of Discussive is that of Paulus Aegineta, lib. 4. cap. 18. which perfectly dis∣cusses and scatters such Apo∣stems as are not concocted. ℞ Pouder of the stone Pyrites, Gum Ammoniacum strained, A. ℥ j ss. Bean-meal ʒvj. mix them up with Turpentine, which spread upon Leather, letting it lye on till it falls off of its own accord.

CVIII. ℞ Turneps roasted in the embers ℥ iij. roots of white Lilies and Althaea, A. ℥j. Saffron in pouder ʒ j. beat all together; and then add Basilicon, Ducks and Goose grease, A.℥ ss. Honey, meals of Linseed and Beans, A. ℥jss. yolks of Eggs, q.s. mix, and make a Cataplasm. This is not inferior to that of Paulus Aegi∣neta: ℞ Gum Ammoniacum strained ℥ ij. Galbanum ℥ ss. Li∣tharge ℥ iij. Old-oil, q.s. mix, and make a Liniment.

CIX. Now the height or state of a Phlegmon is known by the Symptoms; as the tension, pain, heat, redness, and symptoma∣tick Fever, being at height, and so remaining, neither increasing nor decreasing; the Veins of the adjacent parts also conti∣nuing in the same fulness and dilatation.

CX. In this case, the Digestives and Anodyns aforementioned may be made use of, and applied; and whatever other things may contribute to that end.

CXI. The declination of the Phlegmon. This is performed by Digestives or Discussives of the stronger kind, many of which we have enumerated at Sect. 97. aforegoing: but if the matter is grosser and thicker than ordi∣nary, that Digestives alone can∣not satisfie expectation; the matter is then to be made more fit for discussion and perspira∣tion; by inwardly giving gentle Sudorificks, and outwardly ap∣plying Medicins more mollifying.

CXII. In this case, we must not only abstain from such things as over-heat and dry, (since they wast only the thinner parts of the matter;) but we must also apply the greater Emollients, which moderately heat, and moisten withal.

CXIII. As Bears, Brocks, Goose, Hens, and Hogs grease, Sheeps-suet mixt with two thirds of Oil-olive, Neatsfoot-oil, roots of Althaea and white Lilies, Mallows, Linseed, Fenugreek-seed, Ammo∣niacum, Bdellium, Galbanum, Sagapenum, Tacamahacca, and such like.

CXIV. And these things are to be applied, when the matter is thicker than ordinary; and as we elsewhere shew, when we speak of Emollients or Mol∣lifiers.

CXV. This Composition is approved. ℞ Roots of Althaea ℥ j. leaves of Mallows, Origanum, flowers of Camomil, of Melilot, A. M. j. Elder-flowers M. ss. Fenu∣greek and Linseed, Dill-seed,

A. ʒ iij. Water q.s. boil, and make a Fomentation, to be applied with a Spunge.

CXVI. Or, ℞ Pouder of the flowers of Camomil and Melilot, of Bay-berries, A. ℥ ss. pouder of Dill-seed ℥ ij. meals of Beans, Fenugreek and Linseed, A. ℥ j. Oils of Dill and Camomil, A. q.s. mix, and make a Cataplasm.

CXVII. Thus have we shewn you all the Ways and Methods used by the most learned Artists, for the cure of a Phlegmon by Reper∣cussion or Discussion; but if thereby you cannot attain the end, you must then come to Scarification, or to the opening of the Part.

CXVIII. Now Scarification is of use while there is yet hope of Discussion, or that the Tumor will be brought to a cure without Sup∣puration: But the Opening of the Part is of use when all hopes of Resolution is past, and that it is manifest, that the Cure can only be performed by the means of Suppuration.

CXIX. Concerning Scarifica∣tion, Galen, Art. Parvae, cap. 95. saith, You shall more especially evacuate, both by the useful help of Scarification, and by the help of Medicines which have a fa∣culty in them to dissolve; in case you find any thing to be contained in the intervening middle spaces.

CXX. And, de Tumor. cap. 2. It is (says he) found expedient by Physicians in the case aforesaid, not only to discuss by heating Medicines; but also sensibly to evacuate some part of the Blood it self, by scarifying the Skin.

CXXI. But before this is done, we ought to be sure that the Matter is not yet turned into Pus, or is suppurated; for if it is so, or there is any hopes of Suppura∣tion, Scarification would be wholly vain, nor can it have any place at all.

CXXII. But if the Matter is not changed into Pus, nor yet any hopes thereof; and withal, that there is no likelihood that it should be wholly discussed by Topicks, then Cupping-glasses with Scarification must be ap∣plied.

CXXIII. For this is an ef∣fectual means, for the evacuation of the Matter, of what kind soever, which sticks and lies deep; and which seems to be in a ready way to degenerate into a Scir∣rhus.

CXXIV. But it is not to be used in the beginning of a Phle∣gmon, but after the Body is suf∣ficiently evacuated, and the Tu∣mor come to the height; that there may be no farther cause to fear that a new fluxion should be excited.

CXXV. It is also to be used only to those Parts, which in other cases may be thought fit to suffer this Operation, lest a greater evil should ensue. But after all, the best way is to do the Cure by Discussion of the Matter only, (if it may be) without Scarifi∣cation, to prevent as much as possible, the very fears of evil accidents to ensue.

CXXVI. The Cure of a Phle∣gmon, degenerating into an Apostem. Now when there is no hopes that the Phlegmon will be per∣fectly cured by any of the preceding Methods; but that

by the Signs present, it will come to Suppuration; (as from the vehement heat, and grievous pain, which increases every day more and more, with manifest pulsation or beating, and an evident extension of the Part increasing) then we must en∣deavour by all ways and means, the concoction or suppuration of the matter, or its conver∣sion into Pus.

CXXVII. And it is necessary, that the Tumor be suppurated be∣fore it is opened; for otherwise you will draw forth nothing, and rather add to the Disease, than cure it: for concoction and sup∣puration of the Matter, makes a kind of separation of the cor∣rupt Humors from those which are good, whereby they are the more easily evacuated.

CXXVIII. And this gathering together of the Pus, (being changed into an equal, smooth, and whitish Matter) into some one particular place, is calledby the Greeks 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and by the Latins, Abscessus; as in the pro∣per places we have shewed.

CXXIX. This Concoction of the Humor is Natures work alone, and the Physician only is an As∣sistant to her: for the native Heat it is which digests the Humors, and brings them to the perfection of laudable matter; and this is only when the Heat is vigorous or strong, and then it is equal, smooth, and white, and not very stinking: the con∣trary it is, if the Heat is weak.

CXXX. The Physician there∣fore when he finds the Heat languid, or weak, endeavours to cherish, preferve, and increase it (in the inflamed Parts) by proper Applications, for the easy and effectually generating of the said Pus, or laudable quittor.

CXXXI. This innate Heat is conserved and augmented, 1. By stopping it from breathing forth, and that it may not be dissipated by the ambient Air. 2. By appli∣cation of Medicaments hot and moist; which having a refem∣blance to the native Heat, may cherish and augment it.

CXXXII. And these are such as we call Emplasticks, having a certain clamminess in them; which may so sill the Pores of the Skin, as to prevent the going forth, and evaporation of the native Heat.

CXXXIII. For which reason it is, that things of an abstersive quality, and things which forcibly heat, (as Cataplasms of Bean-meal, Lupins, Chiches, Fenu∣greek, &c. seeing they let the Vapors exhale and vent them∣selves outwardly, may indeed be said to dry; but little or no∣thing farther Maturation: of which kind are these following.

CXXXIV. ℞ Roots of Althaea ℥ iij. leaves of Mallows and Bearsbreech, A. M. j. boil them in Water till they are soft; then add Turpentine ℥ ij. Hogs-lard q.s. mix, and apply them.

CXXXV. Or thus: ℞ Roots of Althaea and white Lilys, A. ℥ ij. leaves of Mallows and herb Mer∣cury, A. M. j. fat Figs cut in bits ℥ iij. boil all together to soft∣ness; then add Balsam Capivi, Gum Elemi, Turpentine, A. ℥ j. Wheat-meal ℥ ij. Linseed ℥j. But∣ter,

q.s. mix, and make a Cataplasm.

CXXXVI. Or, ℞ Althaea-roots, Onions, White-lilys, A. ℥ ij. Wheat-meal, Lin-seed, A.℥ j. Tur∣pentine ℥ss. Saffron ℈j. Hens-fat, Oil of Camomil, A. q.s. mix.

CXXXVII. Or, ℞ Onions roasted in the embers ℥ iij. roots of Althaea, White-lilys, A. ℥ j. Leaven ℥ ss. Saffron ℈ j. beat all together; then add Hens-dung, Basilicon, Ducks and Goose grease, A. ℥ ss. Honey, yolks of Eggs, meal of Lin-seed, A. ℥ j ss. mix, and make a Cataplasm.

CXXXVIII. Now here is to be noted, that if the Tumor seem cold, the hotter Simples are to be chosen, according to the tem∣perature of the Part: if it is hot, Maturatives only of the first degree, avoiding those of the second, which are only to be used where the Heat is less.

CXXXIX. And to accomplish this Maturation, Accidents are first to be removed: as 1. Pain; and this is removed by Anodyns only: Narcoticks or Stupefactives have no room here, lest they extinguish the natural heat of the Part, which is the principal efficient Cause of Coction, and thicken the Matter, making it the more rebellious. A Cata∣plasm of White-bread and Milk, with a little Saffron in it, is good here.

CXL. 2. Tension, or vehement stretching forth; and this is done by Relaxers which are temperate∣ly hot, of subtil parts, and not much drying: as Archangel, white Horehound, Mullein, Dill, Ca∣momil, Mercury, Melilot, Marsh∣mallows, Fenugreek, Turneps, meals of Barley, Beans, and Vetches.

CXLI. ℞ Camomil-flowers in pouder ℥ss. flower of Barley, Beans, and Vetches, A. ℥ ij. leaves and flowers of Althaea beaten M. j. Mutton-broth q.s. boil to the consistency of a Pultise, and add Oil of Camomil and Rape-seed, A. ℥ j.

CXLII. 3. Hardness. And here Emollients, and all manner of Salts and Oils are of use: as Mallows of all sorts, herb Mer∣cury, Coltsfoot, Borrage, Bu∣gloss, Spinage, Quince-seed, Cream, White-lilys, Figgs, Raisons, Marrow of beasts, Oil-olive, Oil of Almonds, Ammo∣niacum, Bdellium, &c.

CXLIII. ℞ Linseed-meal ℥ iv. roots of Althaea and White-lilys, boiled in Water and bruised, A.℥ij. herb Mercury, Mallow-leaves, A. M. j. Milk q.s. boil to the con∣sistency of a Cataplasm; to which add Ammoniacum strained, pulp of Figs and Raisons, A. ℥ j. mix them.

CXLIV. 4. Extream Heat. Here things moderately cooling must be used, (but not extream coolers, lest you induce a Gangrene) as Barley meal or flower, En∣dive, Succory, Navelwort, pulp of Melons, Lettice, Water-lilys, Plantan, Garden-nightshade: of these, or some of them, a Cataplasm may be made with Barley-flower and Fair-water; boiling them to a consistency, and adding to it a little Ʋnguen∣tum Populeon, or Rosatum, &c.

CXLV. Now come we to Sup∣puratives, which the Greeks call

〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and the Latins, Sup∣purativa; which are of two kinds, 1. Mild and gentle, as Mans grease, (which is Anodyn) Grease of Bears, Ducks, Geese, Hens; Oils of Olive, Almonds, and Rape-seed, Sweet-butter, Mal∣lows, Althaea, Violets, Lilly-roots, Figs, Linseed, Fenugreek∣seed, Wheat-flower, Saffron.

CXLVI. Example, of a Sup∣purative Cataplasm. ℞ Milk a pint, in which boil Mallow-leaves and herb Mercury, A. M. j. cut and bruised; Figs, Lily-roots, A. ℥ij. (both boiled in Water till they are soft) Wheat-flower ℥ iv. boil to the consistency of a Pul∣tise; to which add Saffron in pouder ʒ j. Linseed-oil, Oil of Sweet-almonds A. ℥ ij. with which mix Oil of Anise, or Fennel-seed ʒ ij. and make a Cata∣plasm.

CXLVII. If the Tumor is very hot, the Oil of Anise or Fennel-seed is to be left out; upon an exigence this has been found good, ℞ Milk ℥ viij. Wheat-flower ℥ iij. yolks of three Eggs, Oil-olive ℥ j ss. mix, and boil to a consistency. Also an Emplaster made of Oil, Wax, and a little Turpentine, is of good use; so also Diachylon simplex, if the Tumor is hot.

CXLVIII. 2. The stronger Sup∣puratives, which are, Ammonia∣cum, Balsam Capivi, Gum Elemi, Galbanum, Sagapenum, Tacama∣hacca, Turpentine, Tar, Ship∣pitch, Burgundy-pitch, Leven, Onions, Garlick, and Leeks roasted in the embers, Hens and Pidgeons dung, Badgers and Dogs grease; Oils of Camomil, Dill, Anise, and Fennel seeds; Saffron, &c. Diachylon cum Gummis.

CXLIX. An Example, framed out of these things, (which are chiefly to be applied to venene, or pestilential Fevers.) ℞ Roots of Althaea and white Lilies, Onions boiled and bruised, A. ℥ iij. Le∣ven ℥ ij. Linseed-meal ℥ j ss. Saffron ʒ j. Ammoniacum and Gal∣banum strained, pulp of Figs, A. ℥ j. Oil of Aniseeds ʒ iij. mixed with Oil-olive q.s. mix, and make a Pultiss of a good consistency. And to this add those others, described in Sect. 134, 135, 136, 137. aforegoing, and Sect. 190, 191, 192, 193. following.

CL. These things are to be ap∣plied till the Apostem is perfectly ripe; which then, if the Skin is thin and tender, breaks of its self: but if thick and tough, it is to be opened by Instrument; as we have taught at large, Lib. 1. Cap. 18. aforegoing.

CLI. Now before we come to this Manual-operation, we must be sure that the Apostem is perfectly suppurated; and this we shall know by its proper Signs, which are as follows.

CLII. 1. The Swelling contracts it self a little, and seems less than it was in the State: for whilst Nature with the help of Medi∣cines concocts the Matter, it is somewhat rarified, and some part of it is discust thro' the Pores of the Skin.

CLIII. 2. The Tumor does as it were draw it to a point, a pro∣minence: for when Nature over∣comes the Matter, it draws it together, and also to the Skin.

CLIV. 3. The Cuticula becomes a little shriveled, which is a good Sign; for it signifies that the preternatural Heat has left it.

CLV. 4. The vehement Heat also vanishes: for the Phlegmon being suppurated, the unnatural Heat goes away, leaving behind in the Part, only the natural Heat.

CLVI. 5. The Hardness and Tension will be much abated: for the Suppuration being pro∣duced by Discussion, many Vapors will be exhaled, which before stretched out the Skin, and made it hard.

CLVII. 6. The Colour also of the Part is changed, and from red, it is become white; more especially in the more elevated or pointed place.

CLVIII. 7. By pressing of the Matter, or place of the Tumor, you will find a fluctuation; which will be perceived by pressing it with two Fingers, a little distance asunder, one Finger at a time; by which pressing with one Fin∣ger, it will feel to fluctuate under the other, with a certain softness of the Part: but in this case we must be wary, for in some places a fluctuation will be felt, whilst they are sound, as in the Knee, or other great Joints: whereas also on the contrary, if the Matter is thick, and lyes deep, tho' it be ripe, yet no fluctuation will be felt.

CLIX. 8. Lastly, the Patient feels much ease in the Part, com∣pared to what it was in its height; because many of the sharp Vapors are resolved, and the concocted Matter is contracted into less room.

CLX. Having now found that the Apostem is fit to be opened, we are next to consider, how it is to be opened, and with what Instruments: nor is it at all to be delayed; for if the Pus is too long kept in, it destroys the temper of the Part, cor∣rupts those which are adjacent to it; and so either makes an intricate and winding Sinus, or else degenerates into a Fi∣stula; which principally hap∣pens when the matter is sharp and malign, or when the In∣flammation is in the Joints or Arms, &c.

CLXI. As for the waiting for Natures breaking of it, we are allowed, so to do only when the Tumor is not exceeding great, and is more especially in the outward most part of the Flesh and Skin, and a Skin that is very thick; otherwise it is not safe to expect a spontaneous or voluntary opening.

CLXII. The way and manner of opening the Apostem, or the Instru∣ments by which it is done: 1. With the Lancet or Incision-knife: and they are of use where the work is desired to be speedily done; also in small Tumors, which will be suddenly whole; and lastly, if the Apo∣stem is in the Face, or any other visible place, to avoid the deformity of a Scar.

CXLIII. 2. With a Caustick, which is commonly the vulgar Lapis Infernalis, or the silver one. The former is made either with the strongest Soap-lees, alone,

boiled to a soft Stone; which is best in Tumors in the convex Parts: or with the same Lees and unslaked Lime, boiled to the form of a soft Ointment: and this is most convenient in Parts concave or hollow.

CLXIV. The Caustick or Pyro∣tical Medicaments are of use in five cases: 1. When the Tumor ought to be kept long open: as in all contagious Apostems of the Plague, Pox, Kings-evil, &c. for where the Caustick is ap∣plied, there is always loss of substance, and many times the Orifice is roundish or Oval, which of all other figures, are longest in curing.

CLXV. 2. They are many times applied where the Patient is fear∣ful: tho' in truth the Incision-knife it self is much less pain∣ful, and much sooner done.

CLXVI. 3. When Apostems are large; for with them we make as large an Orifice as we please, and as large as the magnitude of the Apostem requires; by which means we shall not need to Tent, or enlarge it.

CLXVII. 4. They are also of greatest Service, where a Flux of Blood may be feared: for by their burning the Part, the Flux is prevented.

CLXVIII. 5. When the Apostem is deep, as in the Back, and other like places; for thereby the Matter will have a readier way for Evacuation.

CLXIX. To the two former ways at Sect. 162 and 163 above, Authors add a third way, which is the Actual Cautery, or Red-hot-iron: but this is not of any ordinary use, except to stop a Flux of Blood, (which we do with easier Remedies) dry a Carious Bone, or correct a Can∣cerous Part, being first cut off.

CLXX. As to the very act of opening the Tumor, these five things are to be considered; 1. That it be done where the Skin is thinnest, for so less pain will be caused; and in the most depending part, that the Matter may more easily flow out.

CLXXI. 2. That the nature of the Part be considered; so as to avoid Arteries and Veins, for fear of an Hemorrhage: as also Nerves, Tendons, and Mem∣branes, because of their exqui∣site sense.

CLXXII. 3. The largeness of the Incision, must be in proportion to the Part and Tumor: for if it is too little, then the Matter (if it is thick and grumous) will not easily flow out without pressing; which is apt to pro∣duce a Callosity, and make the Sinus a Fistula.

CLXXIII. 4. That if the Skin is only to be divided, then the Apertion is to be made streight a but if a Muscle also must be cut, then the Incision must be made according to the ductus of the Fibres.

CLXXIV. 5. That you consider the quantity of the Matter, which is to be evacuated at one time: for in great Apostems which are near the Joints, Back, Abdomen, or any principal Part, the Mat∣ter is to be taken away gra∣dually; because therewith many Spirits are spent and lost, whence comes Fainting, and

sometimes Swooning, and Death it self.

CLXXV. As for the Accidents which may happen upon opening, they are three: 1. Fainting; which is helpt by giving a spoonful or two our Aqua Be∣zoartica, or Spiritus Cordialis, inwardly, either alone, or mixt with a glass of Alicant, or other styptick Wine; or a little sup of choise Cinnamon-water.

CLXXVI. 2. Pain; if it is much, let the Part be embro∣cated with this: ℞ Oleum Re∣frigerans ℥ ij. Red-wine ℥ j. mix them together by shaking: but be careful that it touches not the edges of the Apertion, if it was made by Incision, lest it causes spungy or proud Flesh to grow.

CLXXVII. 3. An Hemorrhage, which is to be stopt by applying a Pouder: as, ℞ Aloes, Frank∣incense, Olibanum, fine Bole, A. ℥ j. Ashes of an old Hat ℥ ss. Sac∣charum Saturni, Salt extracted out of the Caput Mort. of Vi∣triol, A. ʒ. iij. mix, and make a Pouder: which lay upon Dos∣sels or Pledgets dipt in whites of Eggs, &c. and apply.

CLXXVIII. The manner of Applying the Potential Cautery. You must be sure before-hand, that the Tumor is perfectly maturated; which that you may not fail of, let some one of the following Compositions be applied.

CLXXIX. ℞ Althaea-roots, White-lily-roots, both bruised soft; Garlick, Onions roasted under the embers, Figs boiled soft, meal of Fenuereek, Leven, A. ℥ j. beat all into a pulp; to which add, Oil of Aniseeds ʒiij. ss. Hogs∣grease, q.s. mix them.

CLXXX. ℞ Roots of Althaea, Onions, Garlick, Leeks, all boiled soft, A. ℥ ij. meal of Fenugreek ℥ viij. Oil of Spike ʒ vj. Hogs∣lard q.s. mix them, and apply.

CLXXXI. ℞ Sharp-leven, Doves-dung, roasted Onions and Garlick, A. ℥j. Black-soap, Hogs∣lard, A. q.s. mix, and make a Cataplasm: this is much stronger than the former.

CLXXXII. Emplastrum Dia∣chylon mixed with Mustard-seed, pulp of Figs, and Salt, performs the same thing with the former.

CLXXXIII. This done, so that you are sure it is come to its persect ripeness, you must then come to the application of the Caustick Medicament, thus: Take a Cloth spread over with Ʋnguen∣tum Diacylon, or some other sticking Emplaster, in the midst whereof cut a small hole; lay this upon the Apostem close to the Skin, that it may stick: let the hole be somewhat nar∣rower and less, than you intend the Cautery, and upon every place where you would have it opened.

CLXXXIV. This done, take one of the Causticks mentioned in Sect. 163 aforegoing: or the Lapis Infernalis, in Lib. 1. cap. 64. sect. 7. aforegoing, which being some∣thing moistned with Spittle, apply it upon the Skin, at the hole of the Emplaster; and then lay on another Emplaster over that, upon the former Plaster.

CLXXXV. After three or four hours, remove the Caustick with

the Emplaster, and you will find the Part appear black, soft, and without any sense of feeling: this Eschar is made to fall off, by well anointing it either with Fresh-butter, Hogs-lard, Palm-oil, or some proper Digestive, which is better: but the only, and more excellent way is, to open it with the Incision-knife, for that the Patient will feel nothing of the Operation; and this is the safer and better way.

CLXXXVI. If the hole is not wide enough, it may be very easily enlarged, by putting into it a piece of prepared Spunge, or Puff-ball, an Elder-pith, or dry Gentian-root, or dry Rape-root; for that these things being filled full with humidity, will be then dilated, and so thereby enlarge and make wider the hole.

CLXXXVII. The Spunge is thus prepared. Take Spunge, and soak it well in the white of an Egg well beaten together, then squeeze it close together in a Press, and dry it leisurely in the shade: a bit, or small Tent of this, when dried, is to be taken and put into the hole of the Apostem.

CLXXXVIII. The Apostem being opened (by which of the ways it matters not) the Pus or purulent Matter is to be evacuated; but yet not wholly, or all at once, but by degrees; some of it at one time, and some of it at another; more especially if the Patient is weak.

CLXXXIX. For if it is great, and has much Pus within it, the evacuating of it altogether would not only be a great loss of Spirits, but might also be apt to cause Faintiness and Swooning; as we have before declared, at Sect. 184. afore∣going.

CXC. When the Pus is evacua∣ted, if there is pain, or any reliques of the Matter not suppurated shall appear in the circumference, or that the Pus is not well and per∣fectly suppurated; then the pain is to be eased with some Ano∣dyn; and some digestive Medi∣cament is to be applied, for the more speedy concocting of the remaining unripened Matter.

CXCI. As, Oil of Almonds mixt with yolks of Eggs; which both ease the pain, and digests the remaining Humor. Or this: ℞ Strasburgh-Turpentine ℥ j. yolk of one large Egg, grind them well together in a Mortar; then add Frankincense, Olibanum, Mastich in pouder, A.ʒi. Oil of Olives ℥ ss. Oil of Aniseeds ℈j. mix them well together: Diachylon cum Gummis is also very profitable in this case.

CXCII. The manner of Dressing, after opening. 1. If it was done by Incision, you must put into the Orifice, if it be small, a little Tent; or if it is large, Dossels with Pledgets, fortified with some Astringent pouder; as fine Bole, Frankincense and Flower, mixt with glair of Eggs; and then over all a Plaster of Diachylon, and so to bind it up, letting it to remain so for the space of 24 hours.

CXCIII. 2. If it was opened by Cautery or Caustick, as we have shewed from Sect. 194, to 198. you may apply your Dossels fortified

with Basilicon; over which you are to lay an Emplaster, (which is thus to be drest once or twice a day, as you see need requires, till you see the Eschar falls) and bind it up as aforesaid, but not with too hard a bandage.

CXCIV. If in the mean season spungy or proud flesh should grow up, it is to be removed with Ca∣theretick Medicaments; as red Precipitate, either alone, or sometimes mixed with Basilicon, in gentle Bodies; or mixt with a third part of burnt Alum, in more hardy Bodies.

CXCV. ℞ Ung. Basilicon ℥j. red Precipitate washed ʒ j. mix them well together, Again: ℞ Red Precipitate ʒ ij. burnt Alum ʒ j. mix, and grind them upon a Porphyry together; to which add Ung. Basilicon ℥ ij. mix them well into a body.

CXCVI. The next thing is, throughly to cleanse the Apostem, (without which, Flesh can nei∣ther breed, nor Agglutination be made) which you may do with this: ℞ Strasburgh-Turpentine, Gum Elemi, Balsam Copayba, A. ℥ ss. Mel Rosarum ℥ j. yolk of one Egg; mix, and give them a walm over the fire; then add Saffron in pouder ʒ j. and a little Barley-flower.

CXCVII. But if there is need of better Cleansing, ℞ Honey, Barley-flower, A. ℥ j. juice of Smallage ℥ ss. Saffron in pouder ʒ ss. mix them: and if the Cleansing ought to be more forcible, Ʋn∣guentum Aegyptiacum q.s. may be added.

CXCVIII. This following is good: ℞ Juice of the lesser Centory, of Smallage, A. ℥j. Honey ℥ iij. boil them together; then add flower of Barley and Orobus, A. ℥ j. take them off the fire, and mix with them Turpentine, Gum Elemi, A. ℥ ss. pouder of Flo∣rentine-Orrice ʒ iij. You may also use those other things which we have prescribed in the Cha∣pters of the Cure of an Apostem and Sinus, Cap. 3. and 4. afore∣going.

CXCIX. The Apostem being thus throughly cleansed, the next things to be applied are Sarcoticks or Incarnatives, viz. Flesh-breeders, that the Ulcer or Sinus may be filled with flesh: a Catalogue of which you may see in Our Doron Medicum, lib. 1. cap. 10. sect. 18. and in some of the following Chapters of this Book.

CC. And out of those singular things, you may make these fol∣lowing Compounds: ℞ Frank∣incense, Mastich, Olibanum, Rosin, A. ℥ j. Honey of Roses, Oil-olive, A. q.s. mix them. Or thus: ℞ Bugle, Comfrey, Sanicle, A. M.j. bruise them, and boil in Wine: squeeze forth the juice, and add to it Frankincense, Mastich, and Olibanum, A. ℥ ij. Honey, Tur∣pentine, A. q.s. boil to the con∣sumption of the Juice, and make an Ointment.

CCI. This is inferior to none: ℞ Fine Aloes, Bdellium, Myrrh, Sarcocol, Honey, A. ℥ j. Wine q.s. mix, and boil them to a due thickness. For a Wash none ex∣ceeds this: ℞ Fair Well-water lbij. Saccharum Saturni, Salt of Vitriol, or pure white Vitriol, Roch-alum, A. ℥ ss. or ʒ vj.

Spirit of Wine ℥ iv. mix, and dissolve: wash with it twice or thrice a day; it performs all the intentions of Cure, and heals to a miracle.

CCII. Lastly, the Ʋlcer being filled with flesh, we must then come to the use of Epuloticks or Cica∣trizers; a Catalogue of which you may see in our Doron Medi∣cum, lib. 1. cap. 10. sect. 20. to which you are referred: and of this kind are Emplastrum Al∣bum, or Diapalma, now called Diachalciteos, Emplastrum de Minio, without Soap; Ceratum Nigrum, Oxylaeum, and Refrige∣rans; with other things of like kind.

CCIII. Hitherto of a true and pure Phlegmon; it remains that we speak something of the bastard or mixt Phlegmon: which, as we told you at Sect. 6. afore∣going, was principally three∣fold, viz. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Phlegmone Erysipela∣toodes; where Choler is mixt with the Blood: 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Phlegmone Oidematoodes; where Phlegm is mixt with the Blood: and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Phlegmone Scirrhoodes, where Melancholy is mixt with the Blood.

CCIV. The Cure of these differs not much from that of the simple or pure Phlegmon; save, that in an Erysipelatoodes, things more cooling and moistning, are to be mixed; in an Oedematoodes, things more heating; and in a Schirroodes, things more warm∣ing and emollient.

CCV. If the Phlegmon, thro' carelesnss, or unskilful application, should become a Gangrene, you must pursue the Cure thereof, as we teach in the Chapter of Gangrene following, Chap. 11. mean season, if you fear any such thing, foment or bathe the Part affected with Our Powers of Amber, or with Spirit of Wine, mixed with Spirit of Sal Armoniack, and apply things healing and drawing.

CCVI. An Example of a Phle∣gmon, out of Hildanus, Cent. 3. Obs. 100. A young Man (says he) had a Phlegmon in his Foot, and being called to him, he found the Foot swelled, and full of pain, which reached to his Hips; the Patient was in a continual Burning-fever, restless, delirious, and fainting away sometimes.

CCVII. He prescribed him a spare Diet, and purged him with this Potion: ℞ Electuary of the juice of Roses, Diaturbith with Rhubarb ʒ ss. Syrup of Roses solutive ℥ j. Decoction of Agri∣mony, Speedwell, roots of the sharp-pointed Dock, inner bark of the black Alder-root, and Ani∣seed, q.s. mix, and make a Draught; which wrought gently: the evening of the same day, two hours after Supper, he gave him Laudanum gr. vj. which caused him to rest well that night.

CCVIII. The next day he took away ten ounces of Blood from the Arm of the side affected, being plethorick and strong: upon which his Fever, Pain, and Inflam∣mation much abated: then he anointed his Hip, Knee, and all

thereabouts, which were free from the Inflammation with this Liniment. ℞ Oil of Roses ℥ ij. Oil of Earth-worms, Mans-fat, A. ʒ ij. mix them. And because Galen says, fat things are not to be applied to the Part affected, he applied this: ℞ Seeds of Quinces, Fenugreek, Althaea, A. ʒ ij. pouder of Roses ʒ ss. Water q.s. boil to the rhickness of a Cataplasm: afterwards add the yolk of an Egg with the white. This was applied, and renewed as oft••as need required.

CCIX. Opon this, the pain was •…•…sed, and the place of ma∣turation appeared; to which he applied Emplastrum Basilicon and the prescribed Emplaster, all over the Foot: the sole, because it was very callous, he fo∣mented well with hot Milk, boiled with Fenugreek-seeds, Mallows, and Violet-leaves, and then pared away with a Razor the thick Skin: thus in a short time the Apostem broke in the sole of his Foot, after which he soon recovered. We have been the larger upon this Cure of a Phlegmon, because, being well understood, it seems to lay the groundwork or foundation of the Cure of all other Tumors, of what kind soever.

CHAP. VI. Of a BƲBO.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Bubo, Inflamma∣tio vel Tumor Glandularum; and in English, a Bubo, or Swel∣ling in the Armpits or Groins.

II. It is a Tumor and Inflam∣mation of the Glandules, chiefly the Kernels of the Armpits, or Groins; painful, hard, and red.

III. But Galen ad Glauc. lib. 2. cap. 1. defines it to be, an Inflammation in the Glandules of the Groins. For they being by Nature ordained as the Sinks of the superfluous Humors from the principal parts, if those Humors, and with them the Blood shall happen to be thrust forth together, and as it were by heaps, into them, an In∣flammation is forthwith excited: and this happens most-an-end in the Groins, and sometimes in the Armpits: if it be behind the Ears, it is called a Parotis.

IV. A Bubo is either Critical, or Symptomatical; the Critical is safe and healthful, and they are such as follow the declining of any Sickness, as Fevers, &c. The Symptomatical are either Ve∣nereal or Pestilential, and these shew from whence they pro∣ceed.

V. If a Bubo is little, and not painful, but easily brought to ma∣turation, it is called Phyma; where it is mixt with Choler, it is called Phygethlon; if it be in the Armpits, it is named Panus;

behind the Ears, Parotis; if con∣tracted from impure Coition, it is called Venereal.

VI. The Signs in general are, pain, redness, heat, pulsation, ten∣sion, and sometimes a Fever.

VII. That is to say, that in the Groins or Armholes there is a tumor or swelling, with redness of colour, hardness, resisting the touch, intense pain, accompanied for the most part with a gentle Fever.

VIII. And this is manifest, if the Bubo happens to be by Crisis; for then a Fever, or some other disease went before; which upon the appearing of the Bubo is abated, and the Signs of a good and hopeful Crisis preceded; the which if they be absent, the Bubo then is to be accounted for Symptomatical.

IX. And then if no signs appear of the Plague or Pestilence, or of Morbus Gallicus, it is a simple Bubo, and not malign and con∣tagious: but if the signs of the Plague are present, then it is malignant and contagious.

X. And if the Patient is in∣fected with the French Disease, it is then to be accounted Ma∣lign and Venereal, and to pro∣ceed from a Venereal Defile∣ment.

XI. The Causes. All Bubo's whatsoever have their Original from a preternatural protrusion of Blood (conjoined always with some vitious and corrupt Humor) into the Glandules of the Groins and Armholes, excited from the Fer∣ment of the said evil Humor; whereby Nature is stirred up to such a kind of excretion, or rather expulsion.

XII. But from hence the strength of the principal parts is to be observed; for that they are able to expel and thrust forth what∣soever is offensive and hurtful to them, unto these ignoble parts, and other the like Emun∣ctories.

XIII. Fabricius ab Aquapen∣dente will have some Bubo's to be from Blood only, excited at the instant time of the Crisis: but this seems not to me to be true, for certainly some evil Humor is always conjoined with the Blood. Yet this we say, that a Bubo does sometimes follow upon another Disease, and is excited by the Crisis, whether perfect or imperfect; and some∣times without any other Dis∣ease preceding it.

XIV. Yet in this last case, where no other Disease precedes it, (whereby it cannot properly be said to arise from a Crisis,) it is Na∣tures work to make an expul∣sion of the vitious Humors, and is a healthful protrusion.

XV. The Prognosticks. A Bubo (if not malign) being in the extream parts, soon suppurates, and is not dangerous; if it ripens slowly, it may turn to a Fistula.

XVI. A Malign Bubo, is for the most part a sign of sudden Death, though all outward signs may appear well.

XVII. A Venereal is only of difficult cure, especially if the folly of the Physician has been to use bleeding and repelling Medicines; whereby Nature has been diver∣ted from her work, and the ma∣lignity turned inward, which should have come outward.

XVIII. Bubo's arising under the Armholes come soonest to suppura∣tion, because they proceed from hotter Blood; as being nearer the greater Vessels, and the Heart, the Fountain of life and heat; which in this case for Suppura∣tion is alogether necessary.

XIX. Those which come in the Groins, are excited by a Blood less hot; and being likewise in a place more remote from the Heart, and but moderately hot, they are longer before they come to maturation: but those coming behind the Ears, proceed from a colder kind of matter; and as the place is also colder, so their suppuration is the slowest of all.

XX. The Cure. In a Bubo, (not Venereal or Pestilent) the Cure is to concede with Natures Operations; for the Matter is by no means to be driven back in∣to the internal parts, if there is any hope of its coming to ripeness, or may possibly be discussed.

XXI. If the Bubo is by Crisis, and that perfect, the Sick will the presently be freed from the danger of his Disease; and if there be signs of a good Crisis, nothing is to be disturbed, but the matter must be left to Na∣ture; and means must be used either to discuss, if possible; or speedily to bring it to sup∣puration.

XXII. In the case of Discus∣sion, excellent is the Balsamum Sulphuris to anoint with, applying over it Emplastrum Diasulphuris, or Emplastrum Hystericum, &c. See Our Pharmacopoeia's, &c.

XXIII. But if it will not be dissolved, then apply this Oint∣ment: ℞ Yolks of Eggs N^o ii. Balsam Capivii ℥i. Oil of Camomil ℥ss. Saffron ʒii. White-bread q.s. mix, and apply it, repeating it often: and being ripe, it may be opened by touching it with Butter of Antimony, &c.

XXIV. In these cases, Sudo∣rificks are good to be given in∣wardly, because they drive out∣wards: but Bleeding is extremely ill, so also Repercussives or Re∣pellers; because they drive back that into the inward parts, which Nature did drive or thrust forth for her relief.

XXV. Scarification with Cup∣ping, is not to be used in malignant Tumors; nor are Leeches to be applied, unless they are very much inflamed.

XXVI. If the Pain is violent, it ought to be eased with Anodyns; as this Liniment: ℞ Balsam Capivii, Balsam de Chili, A. ℥ss. Oil of Ben, Sheeps-suet, A. ℥jss. Bean-meal, q.s. mix them.

XXVII. Or you may apply this Cataplasm: ℞ Mallow-leaves M. i. Meal of Althea-roots and Fenugreek-seeds, A. ℥ii. Barley-meal ℥ i. Ducks-grease, Oil of Dill, A. ℥ss. boil all in Milk, to the consisteney of a Cataplasm.

XXVIII. But if the Bubo is Critical, and the Crisis is imper∣fect, the Humor is farther to be attracted into the part affected, by the application of Cupping-glasses, or by Medicines made of Leven, Black-soap, old Hogs-grease, Pine-tree-rosin, Dia∣chylon cum Gummis, and the like.

XXIX. If the Bubo is not Cri∣tical, and that no other Disease preceded it, yet is not Natures motion to be disturbed in the least: but if with the Blood, many vitious Humors be heaped up also, gentle purging may then be necessary; but yet so gentle, as not to molest Nature in her Operations.

XXX. In this case the Sal Mirabile is most to be commended, because it takes away the great abundance of evil Humors, without disturbance, or lessning of the Pro∣tuberance, by that act of Purging: and it may be given from ʒv. to ʒvi. or ℥i. at a time, dis∣solved in Broth or Posset-drink.

XXXI. The other part of the Cure is to be performed like as in other Inflammations, of which we have treated at large in the afore∣going Chapter: yet this is to be observed, that because the Glan∣dules (especially of the Groin) are colder than other places, the Discussives or Digestives ap∣plied, are to be of the strongest sort.

XXXII. Some advise to a Ca∣taplasm made of flower of Barley and Lupins, mixt with Honey.

XXXIII. Or this: ℞ Roots of Althea, of white Lillies, of wild Cucumers, A. ℥i. leaves of Par∣sley, Smallage and Pellitory of the Wall, A. ℥i. boil in Wine q.s. to softness, and beat them to a pulp, which pass through a Sieve: to which add meal of Lupins ℥ii. Oatmeal ℥i. pouder of Orrice root ℥ss. Oil of Camomil q.s. mix, and make a Cataplasm.

XXXIV. But Ceratum de Ammoniaco Forresti, or Ceratum de Galbano crocatum, or Em∣plast. Diasulphuris, are inferior to no other thing; which see in Our Pharm. Londinensis.

XXXV. If it yields not to Dis∣cussives, you must suppurate with very strong Attractives, such are roots of Aron, Birthwort, Brio∣ny, Cresses, Cantharides, Castor, Dittany, Ranunculus, Pellitory of Spain, Nettles, Galbanum, Euphorbium, Succinum, Sulphur, Leaven, Quick-lime, black Soap, Garlick, Figs, Onions, Mustard, Ox-gall, Pidgeons dung, Goats dung, Niter, Diachylon, Oxycro∣ceum, Mithridate, Venice Trea∣cle.

XXXVI. In this case, the Cataplasma Laxativa Schroderi is good, so also that Pro Adultis, as also the Dropax Confortans.

XXXVII. Or this: Take roots of Pellitory of Spain, Mustard, A. ℥ss. Salt ʒvi. Treacle of Androma∣chus ℥i. Onions, Pidgeons dung, A. ℥ii. Figs N^o xii. Leaven ℥jss. dissolved in Vinegar, enough to make it into a Cataplasm.

XXXVIII. Some take a Chick, Pidgeon, or Frog, divide it in the midst, and apply it warm to the part; others apply the Anus of a Hen or Pidgeon, the feathers being pulled off: but it is best forthwith in the beginning to apply a Vesicatory thereto, the next morning to open the Bli∣ster, and then to apply the Attractives.

XXXIX. The Bubo being sup∣purated, let it be forthwith opened, and that rather by Incision, than by Cautery: keep it open till the Tumor is wholly dissolved, and the Ulcer cleansed; then

heal it after the manner of other Ulcers.

XL. In a Pestilential Bubo, neither Bleeding nor Purging is to be used: Sudorificks and Refri∣geratives are good; outwardly, you must apply strong Attra∣ctives in the beginning.

XLI. The same is to be observed in a Venereal Bubo, (so long as there is any hope of curing it by external Remedies) lest the malign matter which Na∣ture has thrust forth, should re∣gurgitate, and so cause the Pox.

XLII. The Suppuration is to be endeavoured by all means; and then forthwith, although not perfectly ripe, to be opened: if it be tough, Cupping-glasses should be applied.

XLIII. If the whole mass of Blood is infected, you must manage the Cure then, as in the Cure of the Pox. In this case, our Quint∣essence of Guajacum and Sassa∣fras, drunk in good Beer or fra∣grant Wine, is excellent.

CHAP. VII. Of a CONTƲSION.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Effusio, Suffu∣sio, Sugillatio, Contusio; and in English, a Bruise, or Bruising.

II. It is the pouring forth of Blood or Humors, into the next adjacent spaces, thro' the Veins or Arteries; either by 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, anastomosis; or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, diapedesis; or by 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, diai∣resis, the skin remaining whole; which for the most part comes to pass, either by the vehement pressure of some heavy weight, falls, blows, stoning, or the like. Gal. de Fract. lib. 2. com. 16.

III. The Kinds. Galen. lib. de Tumor. cap. 10. & de Simp. Med. Fac. lib. 10. cap. 9. makes two kinds of Contusions; 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ecchymoma; which is the general name; and is when the Contusion is of a middle colour between red and black, to wit, of a livid or leaden co∣lour; and this the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Pelidna, Lividness.

IV. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Melasma, which is Blackness; and this is most familiar unto old persons, as oft as their Veins are bruised; as the other, to wit, Pelidna is familiar to Children, and such as are young.

V. But Paulus Aegineta, lib. 4. cap. 30. makes three kinds, ac∣cording the diversity of the parts affected; of which, the two first have relation to the Eyes, the last to the Nails of Fingers or Toes: these indeed are particular kinds as they have relation to those particular parts, but can by no means be accounted of, as in a general relation to the whole Body.

VI. The first is that which we

call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, hypopia; but by Hippocrates 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, hyp∣ophthalmia, i. e. subocularia, blewness under the Eyes. This second is 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, hypospha∣gma, called by some suggillatio, an Effusion of Blood into the Adnata, or Cornea-Tunicle of the Eye. The third 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, hyponychos, the Bruising of the Nails.

VII. The Signs. A Bruise is easily known from the preceding external Cause, the Colour it self, and the Swelling, if there is any which are evidently seen: the Physician may also understand it from the relation of the Patient.

VIII. Sometimes the hurt part is not elevated into a Tumor, the Blood only insinuating it self into the spaces of the parts, making the Skin of a red, yel∣low, livid, or leaden colour.

IX. And sometimes the Contu∣sion, by reason of its greatness, and the pouring forth of abundance of Blood and Humors under the Skin, and into the substance of the Flesh and Muscles, is lifted up into a Tumor; with which there is sometimes (according to the nature of the part) Pain, and sometimes Inflammation, and perhaps at length a Gangren may be excited.

X. The Prognosticks. A Con∣tusion is generally without danger, (if the principal parts be not hurt) and the Blood, whil'st it is thin and not coagulated, may easily be dissipated or discussed.

XI. But if it is long deteined in the part, and the Contusion is great and considerable, and near some principal part, it may prove of dangerous consequence; for the corruption of the part af∣fected may be feared, with other mischief to the whole Body.

XII. For the Blood being coagu∣lated, and not insensibly discussed, or turned into Pus, (which is ab∣solutely necessary, where the Contu∣sion is great:) Putrifaction and a Gangren are at length in∣duced, which many times costs the Patient his Life.

XIII. If also the part affected loses its colour of wanness, livid∣ness, or greenness; and becomes very much distended, hard, pain∣ful, and inflamed; great danger is threatned, and a Gangren or Sphacelation is at hand.

XIV. The Cure. If the Con∣tusion is great, care is to be taken in the beginning, to prevent the afflux of Blood to the place, lest an Inflammation should be ex∣cited.

XV. To perform this, some Au∣thors prescribe Venesection; but this intravasates none of the Blood that is already out. However, Defensatives and Repercussives are to be applied near to, and about the part affected; to pre∣vent, as much as may be, the influx of Blood into the same.

XVI. And of this kind are Alum, Bole-Armoniack, Catechu, Terra sigillata, Sanguis draconis, Poppies, roots of Hounds-tongue, Henbane, Hemlock, juice of Hem∣lock, Roses, Myrtles, Cypress∣nuts, Opium, Camphir, Galls, Pomgranate-flowers, roots of the lesser Consound, Saccharum Sa∣turni,

Housleeek, Nightshade, Orpin, Nitre, &c. out of which Compounds may be made.

XVII. ℞ Bole ℥iv. Vinegar q.s. mix, and boil them; then add Balaustians, Red-roses in fine pouder, root of Consound in pouder, A. ℥ss. Oil of Myrtles q.s. mix, and make a Cataplasm.

XVIII. Or: ℞ Terra sigilla∣ta, Chalk, A. ℥ii. Vinegar q.s. mix and boil; then add pouder of Pomgranate-peels, Nut-galls in pouder, A. ʒvi. Sanguis draconis ʒii. Nitre ʒjss. Saccharum Sa∣turni ʒi. Oil-omphacine q.s. mix, and make a Cataplasm.

XIX. Or: ℞ Whites of Eggs ℥ii. Rose-water ℥i. Saccharum Sa∣turni ʒi. shake or beat them well together, and with Towe, apply them to the place affected.

XX. Or: ℞ Whites of Eggs ʒii. Rose-water ℥i. beat them well together, then add Oil of Myrtles ℥jss. fine Bole ℥i. Caput Mort. of Vitriol, Dragons-blood, A. ℥ss. Vinegar q.s. mix, and make a Cataplasm.

XXI. But this is to be observed, that you are not to apply many moist and clammy Medicaments; lest the extravasated Blood be putrified, from whence ma∣ny dangerous Symptoms may ensue.

XXII. If the Contusion is from some vehement cause, as a fall from some high place, crushing of a Cart, &c. whereby the Blood is poured forth in some extraor∣dinary manner; and that not only the external part may be hurt and bruised; the Blood will then be apt to coagulate or clot together; thereby inducing many evil Symptoms, extreamly dangerous, as Inflammations, violent (even the worst of all) Fevers, and very oft Death it self.

XXIII. When therefore there is the least fear that the Blood is extravasated, and faln into the more inward parts, and that it cannot be dissipated by external Medicaments; you must then endeavour to hinder its coagu∣lation; and if it be begun, that it may be dissolved, and that with all possible speed it may be carried off by Stool, Urine, or Sweating.

XXIV. For when once the Blood and Humors become putrid, the Disease will not be so easily cured; and sometimes not at all with∣out extraordinary and specifick Remedies, and great care, pains, and industry, and ap∣plication.

XXV. For this purpose, Phy∣sicians commend these following Simples; Winter-cherries, Pelli∣tory of the Wall, Fumitory, Hype∣ricon, Scabious, juice of Citrons, or Limons, Carduus benedictus, Vinegar, Chervil, Parsley, Hydro∣piper-water, Madder, Rhapontick, Rhubarb, Terra sigillata, fine Bole, Sperma Ceti, Crabs Eyes, Mummy, Volatil Sal-Armoniack, Salt of Harts-horn, Spirit of of Sal-Armoniack, and Spirit of Harts-horn.

XXVI. Sperma Ceti is given à ʒi. ad ʒii. dissolved in Vinegar, or Parsley, or Hydropiper-water.

XXVII. ℞ Hydropiper-water ℥iijss. Parsley-water ℥ii. Vinegar, or juice of Limons ℥ss. mix for a Dose.

XXVIII. ℞ Hydropiper-water ℥iv. Spirit of Harts-horn ʒj. mix for a Dose. Or: ℞ Parsley-water (in which Onions have been infused) ℥iv. Spirit of Sal-Armoniack ʒi. mix for a Dose.

XXIX. Or: ℞ Of Our Aqua Bezoartica, or Spiritus Cordialis ℥i. Hydropiper-water ℥iv. Spirit of Harts-horn ʒi. mix for a Dose. These things may be given upon the spot.

XXX. Then at night you may give of Our specifick Laudanum, à gr. ii. ad iii. or iv. drinking after it a little mull'd Sack. The next night, that the Body may be a little opened, you must give a Dose of Our Cathar∣tick Laudanum; so will the Patient have a gentle Stool (without pain, or griping) the next day in the afternoon.

XXXI. Some give this. ℞ Rhubarb ℥ii. Terra sigillata, Crabs-eyes, Ox-blood dried, Sper∣ma Ceti, A.ʒi. Nutmegs ℈i. mix, and make a Pouder. Dose, ʒi. or ℈iv. at a time, in Milk-water, or Hyodropiper-water.

XXXII. Or this. ℞ Rhu∣barb ʒiii. fine Bole, Goats blood prepared, Crabs eyes, Sperma Ceti, Mummy, Comfrey roots, round Birthwort root, Nutmegs, A. ʒi. make a Pouder. Dose, ℈iv. in Syrup of Limons: after these Examples you may make a thou∣sand other Mixtures.

XXXIII. Some give Balsams inwardly; the chief of which are Lucatella's Balsam, as also Balsam de Chili, Capivii, Peru, Tolu, &c.

XXXIV. This following is commended by some Practisers. ℞ Angelica, Bawm, Bugle, Be∣tony, Cinquefoil, Fennel, Ground-Ivy, Hyssop, Ladies-mantle, Parsly, Peniroyal, Sanicle, Sage, South∣ernwood, Smallage, Tormentil, Yarrow, A. M. i. fresh new made Butter lbiv. being gathered green, shred them, and boil them in the Butter till they are crisp, adding Wine lbi. then press forth the Li∣quor, and add again the same quantity of Ingredients, boiling as before, and pressing out: to the pressed Liquor add Strasburgh-Turpentine, Balsam Capivii, Bal∣sam of Tolu, Sperma Ceti, A. lbss. mix, and make a Balsam. Dose, ℥i. in Syrup of Vinegar or Li∣mons, and outwardly you may also anoint with the same.

XXXV. For Liquors, Mum that is choice, and Spruce-beer, are much commended; drinking some one of them, half a pint at a time, blood-warm, morning, noon, and night.

XXXVI. As for Topicks, at the beginning Astringents are to be mixt with Discussives, that the bruised Tunicles of the Vessels out of which the Blood is poured, may be strengthned and bound up; lest new mat∣ter flows thither thro' the pain.

XXXVII. For if Discussives be only used, they will by their heat be apt to drive more Blood into the contused Part, before the contused Vessels can be possibly restored to their natural state.

XXXVIII. For this purpose therefore the Skin of a Lamb or Sheep new taken off, is many times applied, before it is cold, sprinkled with a Pouder made of Myrtle-berries, Bay-berries, fine Bole,

Catechu, and Salt: and this is chiefly for external Contusions, made by beating, whipping, and the like.

XXXIX. And where it cannot be got, a white drest Sheepskin may be got to lay over the place; it being first drest with this: ℞ Balsam of Peru and Chili, A. ℥iii. pouder of Myrtle-berries, Bay-berries, Catechu, A. ʒvi. Salt finely ground ℥ss. mix them.

XL. And the next day you may dress the place with Balsam de Chili or Peru, or Lucatella's Balsam, or with some of those mixed with Ʋnguentum Nico∣tianae; because these things pre∣vent the flux of new matter, hinder putrifaction, and also sufficiently discuss.

XLI. If the Contusion is par∣ticular, and external, (the Skin not being broken) foment it with the Spiritus Ʋniversalis blood-warm; or with that Spirit, in which Camomil, Fennel, Fe∣therfew, Southernwood, Tansey and Wormwood have been five or six hours beforehand infused.

XLII. Then bathe it with Powers of Amber, and after that apply Balsam de Chili or Peru, and so bind it up. Some commend the root of Solomons-seal new gather'd, applied in form of a Cataplasm; or if in Winter, and dry, to be made into a Ca∣taplasm with Wine; which is said in one nights time to do the Cure, and cause the native heat to return to the Part con∣tused.

XLIII. Over the place also you may apply Clothes dipt in the following Liquor. ℞ Spiritus Universalis ℥xx. one Bulls Gall, Catechu ℥iv. in pouder, roots of Aron ℥jss. of Solomons-seal ℥iv. cut all small, digest six or eight hours, then apply it with the Clothes.

XLIV. But if by the use of all these things the Cure succeeds not, nor the matter is discust, you must then apply Cupping-glasses, and for the most part, with Scarification; because these extract whatever is contained in the Part, tho' the matter lies deep, and by the means of Scarification some of the Blood is also drawn forth.

XLV. If all these things avail nothing, but that signs of Suppu∣ration appear, as the swelling up a little of the place, a beating pain, a redness beginning to appear round about, with a softness to the touch; then you must promote the Suppuration by such things as we have declared in the Cure of a Phlegmon or Inflammation.

XLVI. The Suppuration being accomplished, the Apostem must be opened and cleansed, as we have before taught; and then the Ulcer is to be filled up with Flesh, and at length cicatrized, as is usual.

XLVII. But in this case, Sup∣puration must be used with cau∣tion; viz. that they be not of the stronger sort, but such only as are gentle and mild; lest a ca∣coethick, sordid, or putrid Ulcer be induced.

XLVIII. And therefore when we perceive the Contusion degenerates into an Apostem, we rarely wait for a present Suppuration; lest

the pus or purulent matter, being too long kept in the place af∣fected, should excite vehement Pains, malign Fevers, and a great Putrifaction; so as to cor∣rupt the adjacent Parts, Muscles, Nerves, Ligaments, and Bones, and cause cacoethick and putrid Ulcers, Fistula's, &c.

L. You must then never apply emollient and suppurating Cata∣plasms and Emplasters; because they, by reason of their moisture, are apt to induce putridness, and other evil Symptoms.

LI. In this case, Authors ad∣vise us, that the Apostem excited by coagulated or congealed Blood, be forthwith opened with an Incision-knife; and then a Tent put into the Wound, dipt in Ʋnguentum Aegytiacum; defen∣ding the whole part affected, and laying over it some proper Emplaster, which may preserve the native Heat, and kept it from putrifaction: and this is more especially to be observed if the Contusion is in the Belly, Hypochonders, Sides, or Back.

LII. For then the third, fourth, or fifth day, you must observe, whe∣ther there are any signs of an Apo∣stem (as swelling, with pain in∣creasing, pulsation, uneasiness, not enduring it to be touched, and a redness in the circumference:) for where-ever they appear, (tho' no lividness, blewness, yellow∣ness or blackness appear in the external parts) they demonstrate that purulent matter is gene∣rated, and an Apostem produced.

LIII. Ʋpon which, the place is speedily to be opened, that the Pus may be brought forth, lest it retires unto the more inward parts; making (as it were) Coney-boroughs, and eating asunder the Nerves, Ligaments, Muscles, and Vessels, thereby causing either speedy death, or some lingring Disease.

LIV. Then the Wound is to be ordered, as before directed; and during the whole course of the Cure, Vulnerary or Traumatick Potions are daily to be given.

LV. But if the hurt is great, or some error has been committed in the managing of the Cure, so that the place begins to look black or blew, and that by reason of the suffocation of the native Heat, a Gangrene and Mortifica∣tion is feared; you must then immediately scarifie the part, and apply Cupping-glasses, that so the putrid Blood may be evacuated.

LVI. This done, the part is to be fomented with Powers of Am∣ber, or Spirit of Wine, mixed with a little Spirit of Sal Armoniack, or with the Spiritus Ʋniversalis; or with the Liquor at sect. 43. aforegoing.

LVII. Or you may use warm. Vinegar, or the Decoction made of roots of Radishes, of Aron, of Solomons-seal, of Virginia Snake∣root, and Winters Cinamon, in Wine, or their Infusion in Spiri∣tus Ʋnversalis: for that these things dissolve and draw forth the clotted Blood from the very bottom of the Affect.

LVIII. After which you may apply Diachylon Simplex, or cum Gummis; or for want there∣of, any other drawing Emplaster.

LIX. Or this Cataplasm: ℞

Camomil, Smallage, Southernwood, Tansy, A. M. ss. juice of Aron or Musterwort q.s. mix, and make a Cataplasm; adding a little Spirit of Wine.

LX. If the Contusion is in the Muscles, chiefly those about the Ribs, the Flesh generally swells a little, with a kind of purulent Matter; which being pressed down, sends forth a kind of flatulent Air, with a little noise, leaving for a time the print of the fingers after it; which if it be about the Costae or Ribs, endangers a putrifaction or mortification, with a separation of the Flesh from the Bones.

LXI. In this case the Remedy must be speedy, by applying things which cleanse and restore the na∣tural Heat; after which it must be strongly drawn together, and firmly bound up, with Emplast. Diachylon, made up with a little pouder of Myrrh, or some other like Digestive.

CHAP. VIII. Of a CARBƲNCLE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Carbo & Carbunculus; and in English, a Carbuncle, or Burning-coal. Avicen calls it Pruna, & Ignis Persicus, the Persian-fire.

II. This Tumor is called by this name, because it is covered as it were, with a certain kind of Crusti∣ness, black like a Coal; and it is called Pruna, because the Flesh is black, and looks as if it were burnt with a Coal; and it is said to be a Fire, because the Part is pained as if it was burnt with Fire.

III. It is a Tumor proceeding from adust, thick, and inflamed Blood, degenerating into black Choler, and burning the Part. Or, it is a Pestilential Tumor in∣flamed, black, burning the place, and sometimes blistered, as if burnt with Fire, accompanied with great Inflammation and Pain, Vomiting, Trembling, sleep∣iness, cold Sweats, and Fevers.

IV. Some Authors would make a difference between Anthrax and Carbunculus, but there is none. The Cause, is from burnt Blood assuming the nature of Me∣lancholy, and so apt to corrupt.

V. There is sometimes but one great Pustle, sometimes many little ones, which being opened appear black, and inflamed round: the crust being removed, instead of Corruption or Matter, you will find spungy Flesh, the Part is very painful, with a Fever and Watching.

VI. The Description. It is a Tumor which has its original from a boiling and adust Blood, which corrupts the part, and arises in the outward parts of the Body; having a vehement pain joined therewith, invading the Patien with a Fever, and a manifestt swelling, black and hard.

VII. But Celsus, lib. 5. cap. 28. gives another kind of descri∣ption

of it, which seems to me to be a different species from the common. There is (says he) a certain redness, and thence comes forth, but not very far, certain Pushes or Pustules, black, and sometimes livid, in which there seems to be a rottenness, and be∣neath the colour is black; and the Body it self is more dry and hard than it ought to be. About the Tumor there is as it were a Crust, surrounded by an Inflam∣mation; the Skin cannot possibly be lift up, but is as it were fixed and fastned close to the Flesh underneath it; the Sick is extream sleepy, and sometimes there arises a kind of Horror, or Fever, or both: and the Disease proceeds, as out of certain roots, sometimes more hastily, sometimes more slowly: but above, when it first comes forth it looks of a whitish colour, and then immediately it becomes livid, with little Pushes or Pustules coming forth upon it: and if it chances to fall upon the Jaws, or parts near the Sto∣mach, it oftentimes causes Suf∣focation.

VIII. The Causes. Galen. de Tumoribus, lib. cap. 6. & ad Glauc. lib. 2. cap. 1. & Meth. Med. lib. 14. cap. 10. & lib. de Atra Bile, cap. 4. & 5. & de Differ. Febr. lib 2. cap. 19. saith the containing cause of a Car∣buncle, is a boiling thick Blood degenerating into the nature of black Choler, and having black Choler mixed with it, together with a conjoined malignity.

IX. But it rather proceeds from a malign and corrosive Salt, join'd with a poisonous Sulphur, which causes vehement sickness, great pain, burning and inflammation; by which Nature being grievous∣ly afflicted, she suddenly drives it forth from the interior to the exterior parts; and from the more noble members, to such as are less noble.

X. For this cause it is, that a Carbuncle is never produced by congestion or heaping up of Blood or Humors; but is always gene∣rated of a Defluxion, which is made all at once: nor is it produced of Melancholy, only as a Cancer, but of adust and burnt Blood, which degenerates into Melancholy, or has Melancholy mixed with it.

XI. The Procatartick Cause, is from an ill and unwholsom course of Diet, eating of Meats of a depraved and vitious juice, defiling the whole mass of Blood; and also from the external evil qualities of the Air; as being too hot and burning, corrupting the Humors; or malign and pestilential, depraving, infecting and poisoning the Blood and Juices at once, as is evidently seen in Pestilential times.

XII. The Differences. Some appear without Pustules, as the common Carbuncle, which is one uniform, round, hard, burning Tumor: and some with a Pu∣stule or Pustules, like such as are raised by burning with fire, which being broken, there lies underneath within, a crusty Ul∣cer; and of this kind is that which is described by Celsus, at Sect. 7. aforegoing.

XIII. They are also divided into Pestilential and Non-pestilential,

according as the Air is more or less malign and contagious; some in∣vading the Sick in a Pestilential constitution of the Air, others when no such Pestilential ma∣lignity is present.

XIV. The Signs. It arises for the most part from a small Pustle or Swelling, and sometimes from one of the greater Pustules break∣ing forth; or from many small ones like Millet-seed, lying very thick together; which when broken, a crusty Ulcer appears, like that made by a red-hot Iron.

XV. But before these Pustules break forth, there is a kind of itching felt in the part, near which one or more of these Pustules come forth: yet sometimes the Carbuncles comes forth without any such Pustule; a crusty Ul∣cer being excited, sometimes blackish, and sometimes of an ash-colour: in a very little time after which, it becomes like to a Bubo, and then it obtains a round sharp form, with vehe∣ment heat, and burning pain.

XVI. This heat and burning is more particularly exasperated at night, and it is so vehement, that the Sick can scarcely endure it without rubbing of the place af∣fected; from which rubbing, there arise many of the afore∣named Pustules.

XVII. The Flesh round about them grows hot, which when the Disease comes to the height, has a vehement burning heat: and the colour it obtains is sometimes blacker than that of an Erysipelas, or a Phlegmon; as if black was mixed together wtih red.

XVIII. The Sick has also a Fe∣ver, (from the burning Heat) which afflicts these more than those which are affected with a Phlegmon or an Erysipelas: they have also a nauseousness, a vomiting, de∣jection of Appetite, a trembling, panting and beating of the Heart, dotage or delirium, with frequent faintings and swoonings: all which Symptoms are so much the more vehe∣ment, by how much the Matter or Cause is more malignant.

XIX. Now tho' all Carbuneles are malign, yet all are not pesti∣lential, or have an adventitious malignity more than what is na∣tive to them: those which are Pestilential, are known, 1. From the Pestilential constitution of the Air; for it is scarcely pos∣sible for a Carbuncle to arise at such a time, and not be Pestilential.

XX. 2. From the Signs and Symptoms which appear, being more frequent, and more vehe∣ment, than in a Carbuncle which is not pestilent.

XXI. 3. From the Fever, which always appears of the nature of the Plague or Pesti∣lence; which tho' outwardly it seems sometimes not so violent, as in a Carbuncle which is not Pestilential, yet it burns more inwardly, and is much more dangerous.

XXII. 4. The fresh colour of the Face is changed, the Tongue becomes black and dry, the De∣jections liquid and cholerick, the Appetite prostrated, with nauseousness, and vomiting of most offensive and malign Humors;

difficulty of Breathing, stinking Breath, vehement Sweating, sometimes hot, and sometimes cold Sweats, with Sleepiness, and sometimes Watchings, De∣lirium, Fainting and Swoon∣ing, &c.

XXIII. The Prognosticks. If black, it is often mortal; so also if it vanish, or happen in the Emun∣ctories, or near to principal mem∣bers, or about the Stomach or Jaws, (where it generally choaketh:) but if it be little, appear first red, and afterwards yellowish, with Pustles, it is the less dangerous: for from a very little Pustle, it suddenly gets to an extraordinary greatness.

XXIV. By how much the blacker it is, by so much the worse it is; for it is produced by the most corrupt Blood: and the next to this, is the wan and yel∣lowish.

XXV. And those are the most mortal, which beginning once to wax red, do presently vanish again; for then the matter is trans∣lated to the more inward and noble parts, which generally kills the Sick.

XXVI. Where there is but one Carbuncle, it is less dangerous, than where there are many; for in this last case, it shews the vast quantity of the malign matter.

XXVII. In a Pestilential Car∣buncle, consider whether it comes forth before the Fever appears, or after: if before, it shews that Nature is strong, and able to expel the poison, before the Fever can suprize the Heart; but if after the Fever, the contrary; for that the Heart is seized with the pestilential Ve∣nom, which from thence dif∣fuseth it self into all parts of the Body.

XXVIII. The Place is next to be considered. It is always evil and pernicious, if it happens in the Emunctories, or near to any of the more noble and principal parts: but herein the strength of the Sick is to be observed; for one weak and languishing may soon be overcome, even by a small Disease; whereas one vi∣gorous and strong, may over∣come a Disease which is very strong and powerful.

XXIX. The Cure. The Indi∣cations of Cure have respect to the Antecedent cause, to the Con∣joined cause, and to the Symptom.

XXX. In respect to the Ante∣cedent cause, a fit Diet must be prescribed, and such things as alter and correct the heat and evil quality of the Blood. Sudori∣ficks are first to be given; as Spirit of Sal Armoniack, Harts-horn, Man's Scull, Our Theriaca Londinensis, specifick and volatil Laudanum, &c.

XXXI. This dore, the fervour of the Blood is to be allayed with Syrupus Antefebriticus, Sal Ni∣tre, Sal Mirabile, and other like things, which easily enter into the mass of Blood, and cool, alter, and correct it.

XXXII. Some Authors advise Bleeding, but you ought to be cau∣tious therein, lest you draw the ma∣lignity inwards to the Heart, and so destroy the Patient: since Bleed∣ing is generally acknowledged to be a Revulsive Remedy: and

therefore in this Disease it is scarcely to be admitted, for that the Natural and Vital Powers are deiected by the Dis∣ease; and having entred the Lists therewith, are now in the conflict, and not to be inter∣rupted, without eminent peril to the Sick.

XXXIII. Authors also advise to Purging; but in this you ought to be careful, lest thereby the Humor which Nature strives to thrust forth to the external parts, be drawn to the internal: and there∣fore, if it may at all be done, it may be more safe in a Car∣buncle not pestilential, than in one that is pestilential.

XXXIV. But if there is any considerable Fever joined there∣with, the crudity of the matter, and the malignity, forbid Purging: and indeed there is scarcely a Carbuncle to be seen, in which there is not something of ma∣lignity: and therefore the malign matter is rather to be protruded to the external parts by Alexipharmicks, than drawn inwards by Bleeding, and Drenching or Purging, as the usual way of some is.

XXXV. The Matter being sufficiently thrust forth by Sudori∣ficks, which in some measure allay the servency of the Blood, it is then to be altered, and cooled by other things which resist Malignity, as Sal Nitre, Sal Prunellae, Sal Vitriolatum, Sal Tartari Sulphuratum, juices of Wood-sorrel, Oranges, Limons, Citrons, Pomgranates, either simple, or in Syrup; or Syrup of Vinegar, or Vinegar medi∣cated with proper Alexiphar∣micks, as Angelica, Bawm, Sca∣bious, Carduus, Rue, &c. which may be given in all that the Sick drinks. Thus far as to the Antecedent cause, we now come to the Conjoined.

XXXVI. The Conjoined cause, which has respect to the Tumor it self, is not removed, as it is in other Inflammations, nor are Repercussives to be used or applied; but the malign and poisonous Humor is rather by Attractives, to be drawn from the more inward, to the more outward parts.

XXXVII. And therefore Au∣thors advise, that the Part af∣fected be forthwith scarified, and that with Lancings deep enough; that so the corrupt, malign, and poisonous Blood may be fully drawn forth; for that other∣wise, unless it be immediately drawn forth from the Part affected, it corrupts the Parts next adjoining.

XXXVIII. And being scari∣fied, you may apply Cupping-glasses, that the Blood may be the more effectually drawn out; after which the Part is presently to be cleansed, and well washed with warm salt Water, or warm Wa∣ter in which Nitre has been dissolved, that the Blood may not clod or coagulate in the Part.

XXXIX. And if the corrupt Blood seems not fully enough drawn forth, Scarification is again to be repeated. Where note, that the place being scarified, you are not to apply digestive, or suppurative Medi∣cines

to promote the Pus or purulent Matter, (because in this kind of Tumor, they increase the putrifaction and rottenness; and a Carbuncle in putrifying always creeps, and spreads farther and farther, to the endangering of a Mortifi∣cation;) but rather those things which are dying, and such as resist putrifaction.

XL. Of this kind is Morsus Diaboli, bruised green, and laid on, and boiled in Wine and drunk. Also a Cataplasm made of Orobus meal, pouder of Myrrh, and Oxymel; to which some add Ʋnguentum Aegyptiacum. Or, make a Cataplasm of green Sca∣bious bruised, yolk of an Egg, Barley flower, and a little Salt: which things are to be laid on the Carbuncle it self.

XLI. If the Humor flows into the Part with great Violence, then Attractives are not safe to be administred; lest the matter flowing in too great abundance, should make the pain the more vehement, thereby augmenting the Fever, causing Watch∣ings, and dejecting the natural Strength.

XLII. In this case such things as moderately repress and drive back, with a digestive quality, are to be used: as, ℞ Plantane, meal of Lentils, brown Bread, A. boil them in equal parts of Water and Wine, to a Cataplasm; and apply it, not upon the very Carbuncle it self, but only near it round about, some three fingers breadth distant from it.

XLIII. If Scarification do not, or the Carbuncle will not yield to these Remedies, you must come to Burning, and that immediately with all possible speed; for the least delay may bring the Sick into extream danger, yea even of death it self.

XLIV. Some use Potential Cau∣teries, as anointing the top of it with the Butter of Antimony; but the Actual Cautery is ac∣counted more safe, for that, by the heat and driness of the fire, does after a peculiar man∣ner resist Putrifaction, and pre∣serves the sound parts, from being infected with the putrid∣ness: it also draws from the very bottom and depth, all the malign, poisonoes, and corrupt matter.

XLV. Now in this case, this terrible Remedy, is not so painful as may be imagined, for the Pa∣tient is many times not very sen∣sible of it, for that the Flesh is mostly dead; and therefore the use of it must be so long conti∣nued, 'till in all the parts there∣of there be a sense of pain.

XLVI. This done, you must with all possible speed that may be, even in the space of twenty four hours, remove the Eschar or Crust, for that to delay it is dangerous: for which purpose, Authors advise to use Hogs or Goose grease, and such other like things: but these will not do, but rather increase the pu∣tridness.

XLVII. For this purpose, Guilielmus Fabricius commends this Ointment: ℞ Meal of Orobus, roots of Birthwort, of Florentine-Orrice, of the lesser Vernal Gentian, all in fine pouder,

A. ℥ss. Venice Treacle ʒii. Honey of Roses q.s. mix, and make an Ointment, which apply.

XLVIII. Horatius Augenius commends this. ℞ Vitriol in fine pouder, Hogs Lard, A. ʒii. choice Honey ℥ss. mix them, and apply for the same purpose. Some anoint with Ʋnguentum Aegy∣ptiacum.

XLIX. Paul Barbett com∣mends this following, which is much better. ℞ Venicle Trea∣cle, white Vitriol in fine pouder, A. ℥i. Honey of Roses ℥jss. Leaven, Turpentine, fresh Butter, A. ℥ii. Soot ℥ijss. black Soap ℥iii. Mu∣stard-seed, Saffron, A. ℥ss. yolks of Eggs N^o iii. mix, and make a Cataplasm.

L. The Eschar being removed, the Ʋlcer must be cleansed with Unguentum Fuscum Wurtzii, Aegyptiacum, and Honey of Roses, &c. often changing the External application: but be∣ware of Suppuratives, for the Humors are easily corrupted of themselves.

LI. Aetius writes, that wild Rue made into a Cataplasm with Honey and Raisons of the Sun, does quickly separate the Crust; and therefore such Medicines as resist Malignity, as Mithri∣date, Theriaca Andromachi, Our Theriaca Chymica, &c. are very proper to be mixed herewith.

LII. Others commend this. ℞ Rue M.i. Leaven, Figs, A. ℥i. Myrrh ℥ss. Pepper, Cloves in pouder, A. ʒi. Salt ʒii. mix, and make a Cataplasm, which apply morning and evening: it is said to separate the corrupt part or flesh, from the good and sound, in about two days time.

LIII. If it is a Pestilential Carbuncle, you must use Antidotes both internally and externally; among which are Our New Lon∣don Treacle, and Our Theriaca Chymica, which are chief.

LIV. And for taking off the Eschar, you may use some of the former things; chiefly the Cataplasm of Barbett, or the Oil of Mercury, or Joel's Cata∣plasm of Radishes beaten with Rose-vinegar. Or this: ℞ Scabious, roots of Comfrey, and Radishes, yolks of Eggs, common Salt, A. ℥ii. Squills, Onions roasted, Leaven, Soot, A. ℥i. Honey, Turpentine, A. q.s, mix, and make a Cataplasm; which spread up∣on Cloth or Leather, and lay it on hot, shifting it almost every hour.

LV. If you see the Crust be∣comes round, and a circular red∣ness appears, it is a good sign of health and recovery, and that Nature has now separated the corrupt parts from the sound: and when the Crust is wholly taken away, the Ulcer is to be cleansed with the things di∣rected at Sect. 50. aforegoing; or with Honey of Roses, and juice of Smallage.

LVI. After the Cleansing, it is to be filled up with Flesh, by apply∣ing Sarcoticks; the lips of the Ulcer are to be joined together, and at length Cicatrized with Epuloticks.

CHAP. IX. Of a TƲMOR behind the EAR.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, quod sit juxta Aures; in Latin, Parotis; and in English, a Bubo, or Tumor behind the Ear; and by Hippocrates these kinds of Tumors are called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Eparmata.

II. A Parotis is a Bubo or Inflammation of the Glandules near unto the Ears, viz. some∣times behind, sometimes besides, and sometimes under the Ears; for which reason it is said in the Definition, to be near to the Ears.

III. The Signs. It is known from the Place affected, from a violent beating, pain, redness, and swelling, for the most part be∣hind the Ears, and extending to the Jaws and Temples.

IV. And it generally appears with Heat, and a Fever; some∣times with Frensy, Convulsions, Swoonings, coldness of the Ex∣tream parts, with dejectedness of Spirit.

V. The Kinds. It is either Critical or Malign; and the Ma∣lign is either Pestilential, or Venereal.

VI. Now whether it is Critical or Symptomatical, the time of the Disease, and the signs of the Crisis, whether present or ab∣sent, will sufficiently mani∣fest.

VII. If it is only transmitted from the Head, there went before a vehement pain of the Head; the which, upon the breaking forth of the Parotis, either wholly vanishes, or is very much diminished.

VIII. The Causes. Blood is said to be the principal and conjoin'd cause of this Tumor, but it is seldom or never pure, but with a mixture of other Humors; as Choler, Flegm, Lympha, or Melancholy; and sometimes they are con∣joined with malign or pestilen∣lential Miasmata; from whence it is that they are also malign and pestilential.

IX. For Nature being provoked and stirred up by the vitious and depraved Humors, protrudes unto the External parts those defile∣ments with the Blood: and they are sent to the Part affected, either from the whole Body, or from the Brain.

X. It is also caused sometimes by Poison, which at any time may happen to be drunk, or taken into the Body; wherein if Nature be strong enough, (and the Poison ascends up into the Head) she sometimes protrudes it to the Glandules of the Ears.

XI. The Differences. The prin∣cipal Differences arise, 1. From the Matter: viz. according to the Humor with which the Blood is conjoined, whether simple, malign, or pestilential. 2. From the manner of their Beginning or

Generation; in regard that some of them may have their origi∣nal without a Fever, as Celsus, l. 6. c. 16. says, the Patient being in good health, Nature protru∣ding those Humors to such a particular Part, for the general good of the whole Body; and some may be with a Fever, acute or chronick; either be∣nign, malign, or pestilential.

XII. The Prognosticks. It is longer before it come to ripeness than other Bubo's: the Critical are healthful, the Pestilential dangerous, and for the most part a sign of sudden death.

XIII. The Venereal are not mortal, yet difficult to be cured; more especially if they be made worse by Bleeding, Purging, or Blistring.

XIV. The Cure. It is needful to consider in the Cure of the Parotides, whether they be Criti∣cal or Symptomatical, and of what kind of Humor they are bred: if they be Critical, thereby ter∣minating a Disease, or at least diminishing of it, then the whole work is to be committed to Nature, as Hippocrates advises, lib. 1. aph. 20. and nothing else is to be done, but only those things which ease Pain are to be laid thereupon, and the which may at one and the same time help forward the Suppuration.

XV. But let the Parotis be what it will, whether Critical or Symptomatical, great or little, benign or malign, be it what it will, this is to be noted, that no Repercussives, Repellers or Drivers-back, have place in any measure, lest that the matter be driven from the exterior to the interior, and from the more ignoble, to the more noble Parts.

XVI. If the Tumor hastens not fast-enough it self to come forth, but that Nature is weak, you ought to apply the gentler sort of Attractives; such are the Oils of Camomil, Flowerdeluce, Dill, Melilot, &c. not using the stronger, but with caution, lest the pain should be increased.

XVII. If Nature inclines to Resolution, you must assist her with Discussives; but if to Suppura∣ration, (which is much better) than with Medicines which con∣coct, digest and maturate; all which we have proposed in the Cure of Phlegmon and Bubo.

XVIII. The Apostem being sup∣purated, it must be opened, (as we in its proper place do teach,) and to be cured after the manner of other Ulcers.

XIX. If it be Symptomatical, and Nature be weak; or there be an over-great abundance of the Antecedent Cause, it is to be les∣sened by Evacuation: for where such plenty of vicious Humors are, it is not to be feared that Nature hereby may be averted from; and hindred in her work of Expulsion; but rather to expect, that being eased of some part of her burthen, she will the more easily afterwards expel what remains, and ought to be emptied forth.

XX. But yet, if notwith∣standing this Evacuation, whether Emetick, Cathartick, Sudorisick, or Ptarmick, Nature cannot sufficiently expel, then the

Expulsion is to be forwarded by Cupping-glasses with Scari∣fication, and other Attractives.

XXI. And hence it is, that either a Discussion, or (which is better, and most practised) a Suppu∣ration is to be procured, by those Medicines which we have pro∣posed in the Cure of Phlegmon and Bubo, aforecited.

XXII. But here you must ob∣serve the condition of the Tumor; for if it be more than ordinary cold and thick, you must use the hotter and stronger Discussives; and if there be any cause to fear that the matter may be hardned, you must make use also of Emollients.

XXIII. The Matter being soft∣ned and maturated, if it so tends, let the Apostem be opened, and cured; as we advise in lib. 1. cap. 18. & cap. 3. sect. 3 5. ad 47. of this Book, aforegoing.

XXIV. Now you must not expect that the Tumor should break of its own accord, nor are you to wait till then; lest the Pus being long retained, produce many sad and dangerous Symptoms; and (as Guilielmus Fabricius, Cent. 2. Observ. 39. well notes) seeks another passage, whereby it may cost the Patients their lives.

XXV. A young Maiden (saith he) was afflicted with a Parotis, which tho' she was not so much amiss or ill, as to take her bed; being all the while also free from any Fever, and came well out, so that on the 14 day the Apostem was as big as ones fist: yet because it was not timely opened, she was sud∣denly surprized with a Fever, Vomitings, Heart-qualms, and Swooning-fits, with Watchings, and want of rest, as also a ve∣hement pain in her Back and Reins: and tho' it broke of its own accord, yet in regard it was too long before it broke, little or no Pus at all came forth; it seeking a passage downwards, and at last it cost the Patient her life.

CHAP. X. Of PHYMA and PHYGETHLON.

I. THESE two kinds of Tumors, are really but one and the same Tumor, but so deno∣minated, as they proceed from different Causes: and therefore what the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. are called in Latin Phyma, and Phygethlon; also Tumor Glandularum; in English, a Swelling of the Glandules.

II. But they are thus distin∣guished: Phyma is a Tumor pro∣ceeding from Blood mixed with Phlegm, and is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and Phygethlon is a Tumor proceeding from Blood mixt with Choler, and is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉.

III. Phyma (says Wiseman, lib. 1. cap. 9.) is an Inflammation

affecting the Glandules under the Jaws, which are the conglobate Glandules; viz. neither the in∣ternal Salivary, which is Ranula; nor the external, which is Parotis.

IV. And this name Phyma is also given to the Tumor Phlegmo∣noodes, in and about the Anus; of which we shall speak anon.

V. The Cause. The principal Cause or Humor exciting Phyma, is Blood, but yet impure, being always mixed with Pituita, or Phlegm; for which cause Chil∣dren are most subject to them, more seldom Youths, and not often those of full Age; and the Inflammation is not so great and Intense.

VI. The Signs. It is known by its roundness and hardness, being much elevated, and little or no∣thing red, nor with much pain: but in time of Suppuration it is inflamed, and accompanied with pulsation, tension, &c. as in a Phlegmon, but sooner comes to Suppuration.

VII. About ten years since, my self had a famous Phyma under the right Jaw, as big as ones fist doubled, which much hindred my swallowing, and had almost cost me my life: it was a whole month before it came to maturation, and was accompanied with a Fever: James Wasse, one of our City-Chirurgeons, living in Clements-Lane, was the man who daily attended me, and did the Cure; he brought it to suppuration, then opened it with an Incision-knife, and in six weeks time saved me (through the goodness of God) out of the jaws of death.

VIII. Dr. Burwell, one of the Warwick-Iane Colledge, came several times to visit me in this Sickness, and prescribed Blood∣letting, and to carry off the mor∣bifick Cause by Purging: this he oftentimes (even as oft as he came) vehemently prest me to; but I refused it, not thinking that Practice according to the Principles of our Art; he often∣times also prest my Wife to the same, predicting otherwise my death.

IX. And told her, he should learn Experience by this Sickness of her Husbands; but he feared it would be with the loss of his life.

X. But agreeable to my Opi∣nion, was that of James Wasse the Chirurgeon; so that we took the contrary course, and by Su∣dorificks we assisted Nature in protruding the Morbifick-matter; and with alexipharmick Cor∣dials and Confortatives, we strengthned the Body, to sustain the shock, or encounter with the Disease.

XI. And externally moderate Suppuratives were applied; so that contrary to the Doctor's Pro∣gnostick, (whose counsel had I followed, I had certainly been a dead man;) I was signally preserved, and am yet in the land of the living, to give a report of the same to the World.

XII. Differences. Some, says Wiseman, have taken them for Strumae; but they differ from a Struma, which being contained

in a Cystis, does require to be eradicated by Escaroticks after Suppuration, and a discharge of the Matter: whereas these, after discharge of the Matter, are cured either of themselves, or by the ordinary intentions of Digestion, &c.

XIII. The Prognosticks. Sen∣nertus, lib. 5. part. 1. cap. 10. says it is altogether free from danger; and is likewise instantly augmented, and for the most part suppurated and healed, without the help of Medicine.

XIV. This may be true, where the Tumor is small, and is with∣out a Fever, and the Symptoms very gentle; but in such a case as mine was, the danger was very great; for the Tumor, even from its magnitude, had almost caused suffocation: and the rest of the Symptoms were so vehement, that my Life could never have been supported without the assistance of Medi∣cines.

XV. It is more easily cured in Children; more difficultly in Youths, and hardest of all in such as are of perfect Age.

XVI. The Cure. These admit not of Repercussives, but either of Resolution, or Suppuration, even from their first beginning: Wise∣man saith, all that ever he saw, terminated in Suppuration.

XVII. In the beginning he ap∣plies Diachylon cum Gummis, de Meliloto, &c. and in case of Pain, maturative Cataplasms; as in a Phlegmon.

XVIII. Tending to Suppuration, he drest it with Ung. Basilicon, and a Plaster; and being suppu∣rated, he opens it with a mild Caustick, or with an Incision-knife; and discharging the Mat∣ter, then dresses it with Leni∣tives, and after separation of the Eschar, incarnates by the common Sarcoticks, and the use of the Vitriol-stone; and lastly, heals, it up with Ʋnguentum de Lithargyro.

XIX. Sennertus is of opinion, that they ought to be suppurated with all possible speed; which Suppuratives ought (by reason of the coldness of the Part) to be the more strong and forcible.

XX. For tho' possibly some may be resolved or scattered by Discus∣sives; as Southernwood, Parietary, Fetherfew, Tansy, Marsh-mallow roots, Ammoniacum, &c. yet this happens but very seldom; and therefore it is the safest course artificially to open it, unless it break of its own accord; lest the long detaining of the matter matter should bring danger.

XXI. This Suppurative is commended. ℞ Althea roots, meals of Beans and Lupins, Lea∣ven, A. ℥i. choice Figs, Onions roasted, A. ℥ii. Balsam Capivii ʒvi. Oil of white Lillies, q.s. mix, and make a Cataplasm.

XXII. Or this. ℞ Balsam de Chili, or Peru, Turpentine, Honey, A. ℥i. Onions roasted, Mithridate, A. ʒvi. Ammoniacum ℥ss. Oil of white Lillies, q.s. mix them.

XXIII. If it is Pestilential or Malign, as was that of mine, you ought to provoke Sweat with Our volatil Laudanum, giving two or three grains every night.

XXIV. And every morning

fasting, half a spoonful or a spoon∣ful of my Tinctura Pestilentialis, in a glass of Sack, or some other proper Vehicle.

XXV. Tinctura Pestilentialis Nostra. ℞ Tincture of Salt of Tartar, or Philosophick Spirit of Wine lbii. Jamaica Pepper ℥ii. Virginia Snake-root, Contra-yerva, Cortex Winteranus, Cinamon, Bay-berries, Camphir, A.℥i. Gen∣tian, Cubebs, Zedoary, A. ʒvi. Cloves, Mace, Nutmegs, Opium, A. ʒii. Ginger Cochinele, Saffron, A. ʒi. mix, digest, and make a strong Tincture; which decant, filter, and keep for use.

XXVI. This Tincture strengthens the Stomach and Heart, fortifies the Archeus and Digestive Fa∣culty, causes Appetite, expels Wind, comforts and warms the Bowels, provokes Sweat, and is good against all malign Diseases, and such as proceed from Cold: it is an Arcanum against the Plague or Pestilence, and all pestilential and malign Fevers, Measles, Small-pox, &c. Dose, à ʒii. ad iv. or vj. in some proper Vehicle.

XXVII. And sometimes-in the day time, I took forty or fifty drops of my compound Tincture of Coral, in a little Wine also: by these things the morbifick mat∣ter and malignity were expel'd, partly in the Phyma, or Tumor, and partly in a continual breathing Sweat: nor was I out of a sweating condition, little or much, for near a whole month, both night and day.

XXVIII. By these things the Heart and Spirits were also kept up; and tho' an extream weak∣ness had universally seized me, yet I plainly perceived that Na∣ture got ground against the Disease.

XXIX. To maturate the Apo∣stem, this Cataplasm was ap∣plied. ℞ White Lilly roots, pulp of Figs, A. ℥iv. boil them in Milk to an absolute softness; then add crumbs of White-bread, q.s. boil again, and add Oil of white Lillies ℥ii. Mithridate ℥iv. Saf∣fron in pouder ℥ss. mix them well for use.

XXX. This was applied twice a day, as hot as it could well be endured; and in about three weeks time it came to ripeness: at what time the Chirurgeon opened it with an Incision-knife, out of which, near half a pint of green-coloured matter came away at several times.

XXXI. Then, the Abscess being cleansed, it was healed up in about three weeks following: after which I took two or three very gentle Purges, and became per∣fectly well: and this was the whole course I pursued in that Cure. See more here of Our Pa∣rateremata, or Select Physical and Chirurgical Observations, lib. 3. cap. 2. sect. 29.

De PHYMATE juxta ANƲM.

XXXII. It happens often in the lower part of the Intestinum rectum, where the Musculi Ani are inserted; and is many times the original of Fistula in Ano, they for the most part arising from these Abscesses; whether they break within and ulcerate there, or the matter descends lower,

and raises a Tumor without the verge of the Anus.

XXXIII. The Prognosticks. Those Phymata, which in the Anus produce the most dangerous Fistulae; the matter of which piercing thro' the Tunicles into the neighbouring Muscles, are seldom discovered, 'till they have made their way more outward among the Muscles of the Buttocks; and tho' they be discovered sooner, yet the Cure is most difficult.

XXXIV. If it appears out∣wardly, upon the verge of the Anus, tho' it is of much easier cure, yet if it be ill managed, the de∣fluxion of the Humor is continued; and the Sinus grows callous, and requires the same method of Cure which Fistula in Ano do; of which we shall hereafter speak in Lib. 5. following.

XXXV. The Cure. To pre∣vent the danger that may ensue by these Phymata, you must timely lay open the external Phyma by Causticks, that the Pus may have its free discharge; for if you open it by Incision, it must then be kept open by a Tent, which cannot easily be kept in.

XXXVI. And whether the Matter be stopt in by that, or the Tent slide out, and so the Ori∣fice close up, it is much alike inconvenient, and prolongs the Cure.

XXXVIII. If the Phymata are internal, they are soon, and easily cured; if, being timely discovered, they are opened by Incision.

XXXVIII. A Child four years old was much pained in Ano, four or five days, the Tumor appeared externally, and lay juxta Anum, as big as a Pheasants Egg, per∣fectly suppurated: I applied the milder Caustick on the decli∣ning part with Plaster and Bandage: the next morning I took off the dressings, and found the matter discharged thro' the Eschar, which was as I had design'd it, the bredth of a two-pence: I dressed it with a Pledget of Towe spread with Ʋng. Basilicon cum Oleo Rosarum; by this method the matter dis∣charged freely, without dis∣turbance in going to stool, and it was cured by the Maids dressing, I not visiting there. Wisenian.

XXXIX. One thirty years old, of a sanguine Body, was taken with a pain in Ano; I made a search with my finger dipt in Oil, but found nothing: after three or four days, the pain increasing, I made another search, and felt a swel∣ling on that part lying next to the neck of the Bladder: I took a crooked Incision-knife, and defending the edge of it, almost to the point, with a piece of Plaster, conveyed it in by my finger to the swelling, and made incision into the Tumor, which presently discharged a spoonful or two of matter: from that time he complained no more of pain; I cast in a little Oil of Hypericon warm, and dressing him no more, he was perfectly cured. Wiseman.

XL. I was sent for to one extreamly pained in Ano; viewing the Podex, I saw no external disturbance, I then anointed my

finger with a little Butter; and in passing it up in Ano, felt a Tumor, which I opened, as in the former Observation: the Patient desired to ease himself, and he did so, and discharged only a quantity of Matter well con∣cocted; from which time he complained of no more pain, and was cured in a day or two, by the benefit of Nature: nor did I cast in any Injections, lest they should get into the Ab∣scess, and make it sinuous. Wiseman.

Of PHYGETHLON.

XLI. Phygethlon, is a Tumor affecting the glandulous parts under the Jaws, and is called Panus; being an Inflammation, wherein Blood is mixed with Choler.

XLII. But Celsus, lib. 5. cap. 28. calls it Panis; from the similitude of its figure, being broad and flat, like a Loaf.

XLIII. The Cause. It is from a hot and fervent Blood, mixt with sharp Choler, as Galen, ad Glauc. lib. 2. cap. 1. affirms; and comes mostly after Fevers, a Fever being in some measure the cause thereof: or after some vehement pain of some other Part, chiefly the vehe∣ment pains of the Belly.

XLIV. The Signs. It is known by tumor, hardness, heat, dis∣tension, and greater pain, than probably a Tumor of that magni∣tude might cause.

XLV. There is oftentimes also a Fever, accompanying or preceding it; or some other vehement pain of the Belly, or some other part, as the Head, &c.

XLVI. And sometimes (it lying deeper than ordinary) none of the aforesaid outward signs at Sect. 44. are perceived, but only some certain prickings inwardly; and this, as it is long before it comes to maturation, so it is not fit to be converted into Pus.

XLVII. The Prognosticks. If it arises from any Ʋlcer, pain, stroak, blow, or any other exter∣nal cause, it is wholly void of danger.

XLVIII. That which follows upon Fevers (as in pestilential and contagious times) or proceeds from Swellings, either under the Armholes, or in the Neck, is the most dangerous, as Pau∣lus Aegineta saith, lib. 4. cap. 22.

XLIX. Celsus, lib. 5. cap. 28. saith, if it becomes not more hard than ordinary all of a sudden; and which, though it grows not red, yet notwithstanding is of a changed colour; it is of the safer kind, and has little danger in it.

L. The Cure. If it comes from Ʋlcer, pain, contusion, blow, or any other Procatartick cause, then its increase (as in other Inflam∣mations) is to be hindred by Coolers and Repellers.

LI. But if it is in Fevers, or is otherwise excited from some internal abounding of Humors, then Repercussives have no place, but only Discussives and Resolu∣tives; and if the Tumor is very hard, Emollients may be mixed with them; as Althea, Mallows, Arach, Chickweed, Parietary,

Figs, Ammoniacum, Galba∣num, &c.

LII. If the Matter be discus∣sed, then you must endeavour to suppurate it, by application of Maturatives; after which, it it is to be opened by Incision, unless it breaks forth of its own accord, and then to be cured as an ordinary Apostem.

LIII. An Observation from Wiseman. A little Girl was brought to him, as supposing she had the Evil, who had a flat, hard, round Tumor, lying under her Chin and part of the right Jaw, down towards her Throat; it was of a yellowish red colour, not much unlike an Erysipelas, but with∣out Vesication: he caused a Cataplasm made of white Lilly roots, &c. to be applied, by which it was suppurated in three or four days, and dis∣charged a well-digested matter, during which the hardness was resolved, and was cured in seven days, by the only use of that Cataplasm.

CHAP. XI. Of GANGRENE and SPHACELƲS.

I. THEY are called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Gangraena; and in English, a Gangrene. II. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Syderatio, and Sideratio, also Sphacelus; in English, a Sphacelus, or Mortification.

II. Sennertus saith, that Gan∣grene and Sphacelus are neither Tumors nor Ʋlcers; neither will he have Sphacelus to be so much as a Disease, since it is the very mortification, or destruction of the Part. Yet with the favour of that Learned Man, tho' in re∣spect to the Part only, he will have it no Disease; yet in re∣spect to the whole Body, it is a very great one.

III. A Gangrene is a great and terrible Distemper, tending to a Mortification, which may be in∣duced without any Tumor at all: but yet because it most frequently follows Tumors, and chiefly Inflammations, we thought good to treat of it among Tumors; whereas others, (because that when a Part is Gangrenated, an Ulcer necessa∣rily follows thereon, and that after a Sphacelus, an Ulcer is left remaining) treat of them among Ulcers.

IV. Gangraena, is an imperfect Mortification of the Part by little and little, thro' violence of much in∣flamed Matter and Blood, which so stop the passages, as that the natural heat cannot have recourse thereto. If it come of Inflammation, the red Colour, Pain, Sense and Beating decays; waxing pale, livid, black and soft, yielding to the Fingers, without rising again.

V. Or, It is an imperfect corruption of the Part, tending unto a 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, necrosis; to wit, a mortification or deadness: to which if there are not speedy Remedies applied, it becomes Sphacelus, or Syderatio, wholly dead; losing all sense and life, and feeling nothing, tho' it is cut or burnt.

VI. The Differences. From what has been said it appears, that there is no difference between these Diseases, but in respect of degrees, or greatness. In a Gan∣grene there is not yet a perfect corruption of the part, or absolute mortification of the whole part; but only an inva∣sion of the softer and more tender parts, as the Skin, Flesh, and Muscles.

VII. Whereas in a Sphacelus, the whole part is wholly de∣prived of all sense and life, and is altogether dead; and there is a perfect, absolute, and intire corruption or mortification, not only of the softer parts afore∣named, but the very Bones themselves also are corrupted and spoiled.

VIII. But when a Sphacelus is inducing, the softer parts, as Skin, Flesh, and Muscles are first mortified; while the Veins, Arte∣ries, and Nerves may remain safe and sound: but if the Sphacelus continues to go on, and the putrid part is not speedily separated, the Arteries, Veins and Nerves will at length be invaded, and at last the Bone it self.

IX. The Causes. It is caused, 1. From external Cold, or Re∣pellers. 2. External Heat, Burners or Corrosives. 3. Defect of Nutri∣ment. 4. Stoppage of the Pores, (as in splinting and rowling Fractures,) whence comes suffo∣cation of the natural Heat. 5. Ma∣lign Humors. 6. The Scurvy, which by a peculiar property, sometimes causes a Mortifi∣cation.

X. Whatsoever destroys the native heat of the part, that same may also be accounted a cause of a Gangrene and Sphacelus. Now the native Heat is destroyed, when by its contrary it is either corrupted, or suffocated, or diffipated, or extinguished for want of Nourishment.

XI. It is destroyed by its con∣trary, either acting by a manifest quality, as Cold; or else by a hid∣den quality, as by Poison: it is suffocated, when the Transpira∣tion is hindred: it is dissipated, by a greater Heat: it is ex∣tinguished, if necessary Food and Sustenance is denied it.

XII. 1. From external Cold, as travelling in Frost and Snow, in the Northern Regions; where the extream parts, as Nose, Ears, Hands, Feet, &c. are dead with Cold, by reason of the extremity thereof.

XIII. 2. From Poison; as in a Carbuncle from internal mali∣gnity; or external, as from the bitings and stinging of poisonous creatures; as the Viper, Rattle-Snake, Slow-worm, &c. or the application of Septick Medica∣ments, which being not wisely and carefully applied, corrupt the Flesh; or from the afflux of malign and poisonous Humors.

XIV. 3. From Transpiration hindred; as in great Inflamma∣tions, where the part stands in need of perpetual ventilation and cooling; which if hindred, the native Heat is suffocated by the abundance of Vapors: and this is done many ways; as by ap∣plication of Emplastick Medica∣ments in moist places, too strict bandage and rowling of the Part, and in applying over∣cooling Medicaments in a Phle∣gmon or Erisipelas.

XV. 4. From an external pre∣ternatural Heat, which wasts the radical Moisture and native Heat.

XVI. 5. From defect of Nourish∣ment; viz. of Blood and Spirits flowing into the Part, which are wholly necessary and requisite for the cherishing the native Heat implanted therein: and this is caused many times also from too hard ligature, or by applying of Medicines over-astringent and cooling; by which the de∣scent of the Blood and Spirits is wholly hindred.

XVII. The Signs. In a Gangrene the part begins but to die, nor is the sense totally abolished; but the Skin is in a manner red, and without any vehement ill scent.

XVIII. In a Sphacelus (called also Necrosis and Syderatio) the Part looks first pallid, after livid, then black; the Flesh is spungy, with great stink; the sense, heat, and pulsation is vanisht, and the Parts are altogether dead.

XIX. A Gangrene proceeding from Cold, has great pricking; first 'tis red, then pale, then black.

XX. If from external Heat, or Stoppage of the Pores, the redness turns to a whiteness, pain and pulsation ceases, and Pustles appear, from whence issues a gleety Humor.

XXI. If from defect of Nutri∣ment, it for the most part seizeth on the Joints; the part waxes cold, without Pain, Inflamma∣tion, or Tumor.

XXII. If from Venemous Crea∣tures or Humors, there is Faint∣ing, great Pain, always a Fever, and oft-times a Phrensy; with a little Pustle, under which ap∣pears a black Spot, spreading it self over the whole Part.

XXIII. If from the Scurvy, it for the most part begins in the Toes, with blackish Spots or Lines; degenerating into a dry Crust, with numbness, and at length mortification.

XXIV. In a Gangrene which is yet but beginning, you may observe a variety of Signs and Symptoms; according as it has its original from divers and different Causes: but if at length Pustles arise, and the Part becomes pale and wan, then Pains also come on, and a Fever is excited.

XXV. If the Gangrene happens from too hard Ligature, then the Part swells, and greater Pustles arise, full of a thin Humor, not much unlike the Washings of raw Flesh.

XXVI. In a perfect Corruption, and absolute Sphacelus, the life and sense of the Part are wholly abolished; the Pulse is wholly lost, the Part, if cut or burnt, is insensible of pain; the Flesh feels cold, and becomes soft and

flaggy; which yet afterwards being throughly dried, becomes black, hard, and wholly dead, and yields a noisom stink, like that of a dead Carcass.

XXVII. The Prognosticks. Gangraena, if it be not presently helped, the Part straightways dieth, that is, degenerates into Sphacelus, as also the parts ad∣jacent; and so suddenly causeth the death of the whole Body.

XXVIII. But if the Sick be young, the Constitution good, and the Nerves and Muscles be unhurt, it is less dangerous.

XXIX. It is more dangerous, if it proceeds from the bitings of Venemous Creatures. It is also dangerous if in moist parts, or if the Humors continually flow to the Part, or be in the Cavi∣ties of the Body, viz. in the Mouth, Privy Parts, Bowels, or Fundament.

XXX. That which happens from the Scurvy, is seldom cured; in Hy∣dropick persons it is always mortal.

XXXI. A Sphacelus is yet much the more dangerous, for the Part can no more be restored again, but is immediately to be cut off from that which has life in it; and which being not done, the sound parts which lye next or near to it, will be infected, and the putrifaction will creep at length into the rest of the Body, from whence comes dan∣ger of present death: but be∣fore which there usually goes, Doatings, Watchings, Faintings, Swoonings, Convulsions, Belch∣ings, Sobbings, and cold Sweats breaking forth over the whole Body.

XXXII. The Cure. The In∣dications of Cure have respect, 1. To the Antecedent Cause. 2. To the Conjoined Cause. 3. To the Vital Powers.

XXXIII. In respect to the An∣tecedent Cause, which is first to be considered (if it is present in the Body) before we come to To∣picks. The Diet claims the precedency, which ought to be cooling and drying; especially when the Gangrene is accom∣panied with an afflux of Hu∣mors, and follows great Inflam∣mations: in other Cases, the Diet is to be varied according to the varity of the Causes.

XXXIV. Then for taking away the Antecedent Cause, it is done either by Bleeding or Purging: con∣cerning which Barbett advises us to distinguish, that we may know when they are to be used with advantage or disadvantage, and ought to be according to the nature of the peccant Humor.

XXXV. But this is to be precautioned, That regard be had unto the Heart, that it be well; or otherwise to be defended against the malign Vapors and Humors proceeding from the putrifying part.

XXXVI. The chief things for this purpose among Simples, are roots of Angelica, Virginian-Snake-root, Contra-yerva, Ze∣doary, Lovage, Elecampane. Of Herbs; Angelica, Bawm, Borrage, Bugloss, Carduus, Rue, Scordium, Scabious, Swal∣lowort, Sage, Southernwood, Tyme, &c. Of Flowers; Saffron. Of Spices; Cloves, Nutmegs,

Mace, Pimento, Cinamon, Cor∣tex Winteranus, Ginger. Of Peels; Oranges, Limons, Citrons. Salts, of Carduus, Self-heal, Wormwood, Tartar, Pot-ashes. Of Animals; Cochenele, Vipers.

XXXVII. Among Compounds, these are chief; Treacle-water, Aqua Bezoartica Nostra, Our Tinctura Bezoartica, Diascordium, Mithridate, Venice-Treacle, Our New London-Treacle, Guttae Vitae mixt with four times its quantity of Syrup of Limons, Confectio Alkermes, Our Theria∣ca Chymica, which may serve instead of all the rest.

XXXVIII. The next thing is the Conjoin'd Cause, wherein are three Intentions of Cure. 1. Ei∣ther to prevent the Gangrene, when it seems to be inducing. 2. Or to hinder its spreading, and increasing. 3. To overcome it in the part, where it is present.

XXXIX. As to the first In∣tention of these, where the Gan∣grene is but coming on, Author's advise to Externals, as Leeches, Cupping with Scarification, (which some yet approve not so well of) and the application of such things as resist Putrifaction; as roots of Angelica, Birthwort. Herbs; as Wormwood, Car∣duus, Tobacco, Rue, Angelica, Germander, &c. Flowers; as Camomil, Melilot, Saffron, &c. Liquids; Lye, Brine, Urine, Camphorated Spirit of Wine, Powers of Amber and Turpen∣tine, Spiritus Ʋniversalis, which is instar omnium. Ointments, as Aegyptiacum, Fuscum Wurtzii, Mithridate, Our Theriaca Chy∣mica, &c.

XL. Now to know a Gangrene beginning, Wiseman, lib. 6. cap. 2. pag. 444. says, If the Tumor and Inflammation have been very great, and it changes colour suddenly, sinks down, the pain continuing, you may conclude a Gangrene is in∣ducing.

XLI. So also if there is a Wound or Abscess, if that Wound, &c. grow more painful, the Flesh loses its ruddiness, looks pale, and wi∣thered, and the Matter changes to be thin and gleety, you may then suspect its corrupting: in which case, it will be necessary that you scarify to the quick, and make it bleed freely. Now by the Patient's sensible feeling, and by the fresh trickling down of the Blood, you may judge of the Mortification.

XLII. But if the Gangrene has crept down, or seems to proceed from the bottom of the Wound, the Scarification ought to be made accordingly unto the fleshy parts: and if there be any Abscess or Apostem under the Muscles, or lips of the Wound or Ulcer, it is to be opened, and the Matter let out.

XLIII. Now in making such Scarifications, if you should hap to cut some Vessel, causing a flux of Blood, beware that you suf∣focate not the heat of the Part by thrusting in Dossils, whereby the mortification will be in∣creased; but stop the flux of Blood with some proper styptick Water, or Styptick-pouder, &c. Or you may use the Actual Cautery, whereby you will not

only stop the bleeding, but also hinder the progress of the Putrifaction: after which you may dress up the Wound, as we teach in the Cure of Burnings, &c.

XLIV. If in scarifying you prick or hurt a Nerve or Tendon, you will increase the Gangrene; so also if you burn them but in part with the actual Cautery, or sharp Medicines be applied on them, when newly hurt by Scari∣fication; for great Fluxions often arise from small disturbances of the Nerves and Tendons: when therefore they lye in your way, you had better cut them off, or burn them through, than hurt or prick them; after which the Ulcer will grow easy.

XLV. The second Intention of Cure is, to hinder the Gangrene from spreading, or creeping farther into the sound parts. Those parts are to be defended with Flow∣ers of Sal Armoniack, or Spirit of Sal Armoniack, or Spirit of Urine mixt with Spirit of Wine, whereby the Humors are kept from flowing, and also by applying the red Defensive Emplaster, or Vigo's Cerat, or this following.

XLVI. Take fine Bole ℥ ss. Galls, Cypress-nuts, Pomgranate∣peels, all in fine pouder, A. ʒiij. Barley-flower ℥vi. Oxymel sim∣plex, q.s. mix, and make a Cataplasm. Or: ℞ Fine Bole, Terra sigillata, A. ℥ ss. burnt Harts-horn ʒi. Camphir ℈i. Rose∣vinegar ℥i. Oil of Myrtles ℥iii. white of one Egg: mix, and make a Liniment.

XLVII. Sennertus advises, always to endeavour to hinder the sound Parts from receiving the Putrifaction; which is done by guarding and defending them with the afore-named Medica∣ments; or by these following, in which Scordium is put, for that it powerfully resists Pu∣trifaction.

XLVIII. ℞ Fine Bole ℥i. Ter∣ra sigillata ℥ss. Harts-horn burnt ʒi. Camphir ʒss. Wax ʒvi. Oil of Roses ℥iv. juice of Scordium ℥i. white of one Egg; mix, and make a Liniment. Or: ℞ Terra Le∣mnia ℥i. Vinegar of Scordium q.s. mix them.

XLIX. The third Intention of Cure, is the overcoming of the Gangrene in the part where it is present. And this is done by scarifying of the place affected, and cleansing it of the clotted Blood, by washing it with Brine; or a strong Lixivium of Wood-ashes, Tincture of Myrrh, or Spiritus Ʋniver∣salis, &c.

L. And that the Putrifaction may go no farther, some anoint or touch it round with Butter of Antimony, or Oleum Narcoticum, in which an eighth part of Mercurius sub∣limatus is dissolved; digesting them together 'till the Oil looks red, which not only perfectly cleanses all fetid Ulcerations, but also separates the gangrened parts from the living; removing the putrifaction, and yet not touching the sound.

LI. Then fill up the Scarifica∣tion with Trochisci Musae mixt with Precipitate, or in Dossils dipt in Oil of Cloves or Turpen∣tine

actually hot; Ung. Aegyptia∣cum is good here also, with the addition of Nitre, flowers of Sal Armoniack, Camphir, Mi∣thridate, Venice-Treacle, &c.

LII. But the usual Fomenta∣tion is a Lixivium made of Pot∣ashes, wherein the tops of Worm∣wood, Southernwood, Centory the less, Carduus ben. Scor∣dium, Swallowort, roots of round Birthwort and Gentian have been boiled; to which a quantity of Spirit of Wine is to be added.

LIII. Aqua Calcis, with a So∣lution of Sublimate in it, is of good use for this purpose; so also Aqua Lapidis Medicamentosi, the Powers of Amber, Powers of Turpentine, or Spiritus Univer∣salis, to foment withal. Cata∣plasms also made of the meals or flower of Barley, Beans, Lupins, Lentils, Pease, and Mithridate, boiled in a Lixivium of Pot∣ashes, with a little Oxymel added, are approved.

LIV. Then as to the Dressings, you are to consider well in the application of the Medicament, that in the destroying of one Gan∣grene, you do not excite another; which will easily be done, by the too long use of sharp Medicines: for which reason, when you feel the Ulcer warm, and find it to cease gleeting, desist their use, and dress it with warm Digestives, as Ʋn∣guentum Basilicum, with Oil of Turpentine, hot.

LV. And after Digestion, cleanse it with Detersives or Mundifica∣tives, as that ex Apio, or such other like, that the slough may the more speedily and easily be cast off.

LVI. Lastly, after Digestion, and sufficient cleansing, you must compleat the Cure by Sarcoticks and Epuloticks; as in Lib. 5. of the Cure of Ulcers following, we shall particularly teach.

LVII. The Vital Indication. This is not always requisite to be considered here, where there is a sufficient strength of Body, where there is no malignity, where the discrasy of the Blood is little, and the Humors of the Body not much depraved: But in a Patient weak, the disease or temper of the Air malignant, the Blood vitiated, and the Juices cor∣rupted, this last Indication will necessarily have place.

LVIII. From what has been said it appears, that the Diet must be composed of, 1. Strength∣ners and Restoratives. 2. An∣tidotes against Poison and Ma∣lignity. 3. Restorers of the Blood to its due Crasis. 4. De∣purators of the Humors, or Juices of the Body: to which add a due quantity of proper Traumaticks.

LIX. A Diet-Drink. ℞ Scor∣zonera roots, Parsley roots, A. lbj. Galangal, Angelica roots, Sca∣bious, Scordium, Bawm, Mint, A. ℥viii. Snakeroot, Contra∣yerva, Winter's Cinamon, A. ℥ii. Bloodwort, Sorrel, A. lbj. Self∣heal, Winters Green, Ladies Mantle, Saracens Consound, Bugle, Hypericon, Speedwell, A. ℥iv. fair Water 4 gall. boil to one half, then add Coriander and Dill seed bruised, A. ℥ii. Limon and Citron peels, A. ℥jss. Cubebs, Cloves,

Ginger, A. ℥ss. boil again a quar∣ter of an hour, then strain out, and bottle it up for use. Dose, half a pint in the morning fasting, half a pint at 11 be∣fore noon, and half a pint at 6 at night.

LX. A Medicated Ale, for the same purpose. ℞ Take Fennel and Parsley roots, Angelica roots, A.℥xii. Contra-yerva, Snake∣root, Winters Cinamon bruised, A. ℥iii. Rhubarb, Galangal, A.℥ii. Agrimony, Bawm, Mint, Parsley, Scabious, Scordium, Bloodwort, A. M. iv. Bugle, Fluellin, Ladies∣mantle, Saracens Consound, Self∣heal, Vervain, Yarrow, A. M. vi. Aniseeds, Coriander-seeds, Dill-seeds, Fennel-seeds, Pimento, all bruised, A.℥jss. Orange, Limon, and Citron peels, A. ℥i. put all into a Bag with a Stone in it, which put into 4 gallons of new Ale, and let them work up together: after three days, let the Sick drink of it, three quarters of a pint, plus-minus, morning and evening, and oftner, if they so please.

LXI. In this latter case, if the Patient is of a gross Body, and full of Humors, it may not be inconvenient to put in a fit quan∣tity of purging Ingredients, by which the morbifick Cause may in a great measure be carried off. To the former quantity of Ingredients, you may add Sena ℥viii. Mechoacan thin sliced, or bruised ℥iv. Carthamus-seeds ℥ii. but in thin and weak Bodies, these Ingredients must be for∣born. Hitherto of the General Cure; the Particular Cure, as it arises from Particular Causes, now follows.

LXII. A Gangrene from Ex∣ternal Cold. If it arises from vehement Cold, as in Denmark, Norway, and Swedeland; and it is only beginning, and not per∣fectly induced; known by its not being black, but being yet red with pain: then bring the Patient toward the Fire, but not too near, that by degrees the heat may be again restored to the Part.

LXIII. And for this purpose, let the Part be plunged in cold frozen Water, or strongly rub it with Snow, or Cold, for some considerable time; and inwardly give the Patient Mithridate, Venice-Treacle, or Our Theriaca Chymica in Sherry-wine, or in Canary: Or, Our Powers of Rosemary, Anise, or Angelica in a glass of Sack: Or you may give our Aqua Bezoartica, or Spiritus Cordialis ℥ii. by them∣selves.

LXIV. When the cold and pain remit, embrocate the Part with Oil of Dill or Camomil, mixed with ⅓ of Oil of Juniper∣berries, or Oil of Aniseeds or Amber: Or with a Decoction of Turneps, mixt with Powers of Turpentine.

LXV. Afterwards you may foment with S.V. in which Spirit of Sal Armon. or Flowers of Sal Armon. are dissolved; or with Powers of Amber and Juniper, Oils of Turpentine and Spike, or the like; laying over the Part a Cataplasm of Mithri∣date, mixt with a little Oil of Amber.

LXVI. And in those Northern Countries, they give them burnt

or mull'd Wine, with pouder of Cina∣mon, Cloves, Nutmegs, and Ginger, and the like Spices. Or this Deco∣ction: ℞ Rue M. ss. Swallow∣wort, Angelica, A. M.j. Scordium M. jss. Pepper bruised ʒi. boil in White-wine, and strain: to a pint of which add of Our Spiritus Cordialis ℥iii. And the Patient being in bed, make him to sweat with the Warming-stone, or application of glass Bottles filled with hot Water.

LXVII. But if the Part is al∣ready gangrened, known by its being blackish, and stiff with cold; you must then immediately scarify the Part, and foment it with the former hot Medicaments, and continue the use of the former things, as we have be∣fore declared.

LXVIII. A Gangrene from too much Heat. Let the Diet be cooling, and the hot Humors (being qualified) evacuated with proper Catharticks, if the Dis∣ease takes its original from an internal Canse.

LXiX. Then let the Part affected be scarified, and wash with Dia∣clysma frigidum; to a pint and half of which you may put Vin∣egar half a pint, Salt an ounce and half: or you may wash with this: ℞ Fair Water ℥xiii. Vin∣egar, juices of Sorrel and Scor∣dium, A.℥viii. juice of Germander ℥iv. Salt ℥jss. Lupins ℥ss. mix, and boil to the consumption of a third, and use it hot.

LXX. Or you may use the Spiritus Universalis, to ℥iv. of which you may put juices of Scor∣dium and Germander, Spirit of Wine, A. ℥iii. after which apply Ʋng. Aegyptiacum, or Fuscum Wurtzii, &c. but proceed not to an actual Cautery, unless necessity force it.

LXXI. A Gangrene from Tran∣spiration hindred, as in too hard Ligature, application of Empla∣stick Medicaments in a Phle∣gmon, &c. The Binding is then forthwith to be removed, or the Emplastick-body taken a∣way; and Scarification being made, you must wash the Part with Spiritus Ʋniversalis, Spirit of Wine camphorated, Powers of Amber or Turpentine; or some other of the former di∣rected Medicines.

LXXII. And then you must apply Medicaments discussive, and non-putrifactive: and the Blood and Humors flowing over-much into the Part, are to be emptied out of the whole Body by Bleeding, Cupping, with Scari∣fication, Derivation, Purging, and other fit Remedies.

LXXIII. And round about the part affected, Defensatives are to be applied, as directed at Sect. 45. &c. aforegoing. But as to the Gangrene it self, the Scarifications ought to be many, and deep enough, that great plenty of Blood may be eva∣cuated: but yet their greatness and depth ought to have respect to the greatness of the Affect it self; according as it is more or less nigh unto putridness and a Sphacelus.

LXXIV. After Scarification, as directed, you may use the Me∣dicaments at Sect. 71. aforegoing; or this following Wash, which is much commended: ℞ Strong

Lye and sharp Whitewine-vinegar, A. lbii. Scordium, Wormwood, Lupins bruised, A. M. j. roots of Flowerdeluce, round Birthwort, Swallowort, A. ℥ss. boil to the consumption of one third part; then strain, and add fine Aloes, Myrrh in fine pouder, A. ℥ss. boil again a little, and lastly add Honey of Roses ℥i. S.V. ℥ iii. mix them.

LXXV. The Part being washed with the former, then apply Ung. Aegyptiacum, for that it is reputed to be the most excellent Remedy to remove Putridness, and to separate the dead and putrid Parts from the living and sound. But this Ointment is not to be applied alone; but there∣upon a Cataplasm is to be imposed, which resolves, drys, and hinders Putrifaction. Take Mithridate ℥iv. Myrrh ℥ii. round Birthwort in fine pouder ℥iss. Cam∣phir in pouder ℥ss. Honey of Squills q.s. mix, and make a Cataplasm.

LXXVI. Or, after Scarifica∣tion, you may wash with this Water: ℞ Vitriol ℥i. Oak buds or tops M. i. Frankincense ℥ss. Camphir ʒii. Ʋrine lbijss. mix, boil to the consumption of a third, and strain out for use: and after washing, apply the fol∣lowing of Guilielmus Fabricius, (which is to be applied when the corruption is more than ordi∣nary. ℞ Verdegrise, Honey, A. ℥iii. Decoction of Wormwood and Scordium lbi. Vinegar of Squills lbss. juices of Rue and Germander, A. ℥ii. Alum, Sal Armoniack, A. ℥ss. mix, and boil to a good thickness; then add Venice Treacle, Mithridate, A. ℥ss. Camphir ʒi. mix them, and apply.

LXXVII. A Gangrene from Poison, or the afflux of malign Humors. If the Poison is from without, as the biting of a Rattle∣snake, &c. then such things as do strongly attract the Poison, dry it up, and destroy it, are to be made use of; for which purpose, nothing seems better than the application of the actual Cautery; giving inwardly cooling, cordial, and sudorifick Medicaments.

LXXVIII. The Part affected being either burnt or scarified, then such things as resist Putridness, and prevent the Necrosis or Spha∣celation, are to be used, viz. the strongest Attractives, and such as resist malignity and putridness, as Wormwood, Rue, Dittany, Angelica, Swallowort, Scordium, Radish-roots, seeds of Cresses, Garlick, and Oni∣ons roasted in Embers, Lea∣ven, &c.

LXXIX. The Gangrene being mastred, the Ʋlcer is to be cleansed with juice of Smallage and Honey of Roses, to which Spirit of Wine may be added, and with other things proper to the same intention; and Defensatives are also at first to be applied round about, that the Poison may not spread it self any farther into the interior and more noble parts, nor yet spread broader into any of the adjacent places.

LXXX. But if the Poison proceeds from within, Defensa∣tives are not to be used, but the malignity is only to be sent forth

into the external parts: 1. By Alexipharmick and Sudorifick Medicaments. 2. To be drawn forth by Scarification and Attractives, Cupping-glasses, Leeches, &c. and in this case, Barbett saith, that he had seen Bleeding and Purging oftner to do hurt, than good.

LXXXI. If the Gangrene is from the afflux of malign Humors, or a malignant Quality, a cooling and drying Diet is to be ordered, with Sauces made of the juices of Oranges, Limons, Citrons, and Pomgranates: the depraved and malign Humors are to be eva∣cuated by Purging Medica∣ments, and sometimes by Bleed∣ing, if need requires it, or the nature of the Sick will bear it: and the malign Matter is by Topicks, as Burning, Scarifi∣cation, Attractives, &c. to be drawn forth.

LXXXII. And inwardly the Malignity is to be expelled and protruded to the External parts, with such like things as we usually give in malign Fevers, viz. Medicaments made of Citrons, Limons, Angelica, Borrage, Bugloss, Bawm, Carduus bened. Dittany, Scordium, Sorrel, Swallowort, Mithridate, Our Theriaca Chymica, &c. endea∣vouring a powerful Sweating, the malignity may be driven outwards, &c.

LXXXIII. A Gangrene from an Atrophia, or want of Nourish∣ment. In this case, advise to Meats hot and moist, and easy of digestion, which generate much, and good Blood: and outwardly the Body is by all means to be moistned, by rub∣bing and anointing it with sweet Oil, Oil of sweet Almonds, Oil of Ben, and pure Neats-foot Oil; avoiding all things which exsiccate and dry the Body.

LXXXIV. Here is no place for Defensatives, but the Part already affected with the Gan∣grene is to be drawn with vehe∣ment Attractives, that it may be supplied with Nutriment; and it is gently to be rubbed and chafed, with application of Cupping-glasses without Sca∣rification.

LXXXV. But if there is al∣ready a present Putridness, you must apply things which do alike both attract and resist Putrifa∣ction; such as are, Salt-brine mixed with juice of Scordium, Tar mixed with meal of Lupins or Orobus, Myrrh mixed with Mithridate and Cress seeds, Spiritus Ʋniversalis, campho∣rated S.V.

LXXXVI. And if the Gangrene has already proceeded on, you must proceed to Scarification, and the Lotions afore-mentioned, dres∣sing it afterwards with Ʋnguen∣tum Aegyptiacum, with other things afore-named.

LXXXVII. A Gangrene pro∣ceeding from the Scurvy. This is not common, yet Authors have taken notice of it; as Sennertus, Barbett, &c. This most usually begins in the Extream parts, as of the Leg or Foot, with black and purple Spots; after which there appears a crusty and gangrenous Ulcer, drys, so as it yields neither the thinner Matter, which we call Sanies,

nor the thicker, which we call Pus.

LXXXVIII. Then one or other of the Toes begins to dye, af∣ter which red lines and purple spots appear upon the juncture of the Foot, according to the length of the Part.

LXXXIX. This Gangrene dif∣fers from the common, very much; for that arises from Causes mani∣fest; and there always runs forth from the mortified or sphacelated Part, a thin stinking Humor, the Member is soft and putrid, and yields a filthy stink, like that of a dead Carcass, creeping far in a short time, and quickly kills the person that has it: where∣as the Scorbutick Gangrene in∣vades without any manifest cause, creeps but very slowly, and kills not the Sick 'till after a long time: the Part is dry, so that no moisture flows from it; and when the corrupt Part is taken away by Instrument; the Flesh seems to be of a dark or blackish red, and remains dead the next day also, without any perceivable stink which may offend.

XC. And as soon as ever the Disease has seized upon one Foot all over, it then presently after, (without any evident cause) begins to appear in the same manner, with Spots of a red purple colour on the other Leg and Foot, and not long after, one or other of the Toes of that Foot becomes wan and livid, and in a very little time it is found to be perfectly dead: at length the Sick is taken with an Apoplexy or Epilepsy, upon the first fit whereof they dye.

XCI. Sometimes again this Dis∣ease is induced suddenly, viz. when the peccant Humor is thro' terror, fear, anger, wrath, or other like causes, disturbed and protruded (as it were in a mo∣ment) unto the Toes, after the same manner as an Erysipelas is wont to arise, causing the Part so affected presently to dye; from which cause this kind of Gangrene is called by some Syderatio, Blasting; or as the Vulgar phrase it, Planet-struck.

XCII. This Disease seizes most usually on the Tendons, causing almost intollerable pains, afflicting the Patient night and day: and because it seizes the Ten∣dons, which do not so soon and easily putrify as the Flesh; therefore it is that it creeps on so slowly, being sometimes one whole months space in creeping over one whole Joynt, before it seizes upon another; notwith∣standing that within the Foot, almost all the Tendons are al∣ready infected.

XCIII. It is seldom or never cured, because this malign acid Humor has insinuated it self very deep into the Tendons, that it cannot easily be taken away: so that it many times continues three, four, and sometimes six months before that it klils the Patient.

XCIV. As to the Cure, the Internals must be highly Antiscor∣butick, mixt with Antidotes which have power to absorb the acid Humor, and destroy the mali∣gnity; which are to be given

both medicinally and dieteti∣cally, as the Physician shall direct.

XCV. Order cordial Medica∣ments, giving after Sudorificks; which let be followed close with strong Tinctures, Elixirs, or Potestates of Scordium, Rue, Dittany, Scurvigrass, Cresses, Swallowort, Our New London-Treacle and volatil Laudanum are good things, as also Our Theriaca Chymica.

XCVI. Outwardly foment the affected Parts with this. ℞ Gua∣jacum rasped, Sassafras rasped, Fennel-seed, A. ℥i. roots of An∣gelica, Celandine, Cress-seeds, A. ʒvi. Scurvigrass, Watercresses, A. M. j. S.V. lbj. infuse a night, then distill in B.M. to driness.

XCVII. Or you may anoint with this. ℞ Oil of Earth∣worms, of Bays, of Rue, A. ʒii. Castor ʒi. Spirit of Wine ʒiii. mix, and make a Liniment; and apply over, Emplastrum de Gal∣bano crocatum Mynsichti, Empl. Polychrestum, ad Strumam, vel Arthriticum.

XCVIII. If these things do not, you must apply Cupping-glasses, Scarify, &c. then wash with Brine in which flowers of Sal Armoniack are dissolved; or with Spiritus Ʋniversalis, mixt with camphorated S.V. and after apply Ʋng. Aegyptiacum, and over it some resolving and drying Cataplasm.

XCIX. If yet there be no amendment, you must come to Cauteries; either Potential, as Butter of Antimony, red Pre∣cipitate, &c. or Actual: af∣ter which you must remove the Escar in due time, lest new Putrifaction grow under it.

Of a SPHACELUS.

C. When the whole Mem∣ber is corrupted, or become per∣fectly dead, it is then sphacelated, as is before declared, and then it is no way to be cured, but by cutting off: the way of doing which, whether in the dead or living part, we have fully and plainly declared and taught, in Lib. 1. Cap. 32. aforegoing.

CI. Yet if you please, with what is there said, you may take the following Notes. Celsus, lib. 7. cap. 33. advises to make the Section between the sound Flesh and the dead, and rather to take away some of the sound, than to leave any of the dead Flesh remaining: but this our mo∣dern Physicians disapprove of, because of the accidents and dangers which follow, viz. im∣moderate profusion of Blood, vehement pain, fainting, swoon∣ing, &c.

CII. Fallopius advises to make the Section in the dead part alone, and cuts with a Razor into the dead Flesh, (even to the Bone) and then takes it off with a Saw; after with red-hot Irons he burns the Flesh and greater Vessels, even to the causing of pain.

CIII. The Putridness is some∣times apt to creep farther; but you will see when it ceases to increase, because it will divide it self from the sound part of its own accord, and be sepa∣rated by Nature, upon the

applying fit and proper Medi∣caments.

CIV. But if you see the Putrid∣ness creeps forward by great steps, and that Nature of her own accord begins not to separate the sound from the corrupt; you may not then make the Section in the corrupted part, without present danger: and the reason is, that sometimes the Putrid∣ness creeps farther underneath near the Bone, than it appears to do upon the Skin and outward parts.

CV. If in this case you make the Section in the mortified part, the interiour Putridness will al∣ways creep farther, deeper, and broader, and so hasten the death of the Patient; or else you must reiterate the Section, and so put the Patient to a second torture.

CVI. But then in amputating in the sound Part, the sense of pain may very much be moderated by tying the Ligatures very strait, thereby intercepting the passage of the Animal Spirits for a time; and so the Instrument being sharp, the Cutting will be quite finished, before the Patient shall peceive what is doing.

CVII. And tho' the Section is made in the dead part, yet all manner of pain is not then pre∣vented; for when the Saw comes to cut asunder the Bone with the Periostium, there will be excited very acute and sharp pains; and if to avoid them, the am∣putation is made in the Part where the said Membrane is dead, and the Bone is corrupted, it is to be feared, so great a putridness will be left re∣maining in the Vessels and Muscles, (which are very apt to receive the putrifaction) that it is scarcely possible to be extinguished, tho' with the actual Cautery it self.

CVIII. Nor do these Cauteries destroy the whole Putridness with∣out much pain; of which there ought many to be applied, in removing or destroying the whole substance that is morti∣fied; which if so effectually applied, they by their vehe∣ment heat melt the Fat and Humors; thereby exciting ex∣traordinary pain, and so con∣sume the Flesh, that a great part of the Bone sticks forth naked and bare; so that of∣tentimes it requires a new Section.

CIX. If then you make the Amputation in the sound part, the Muscles and Vessels being drawn strongly upwards towards the sound part, the Member below is to be very straitly tied down with Ligatures; by which binding, 1. The very great flux of Blood will be prevented: 2. The sense of the Part, by restraining the Animal Spirits, will be somewhat dulled: 3. The Mu∣scles thus drawn upwards, (when the Section is ended, and the Ligature loosened) will again devolve downwards, and the better cover the extream and naked parts of the Bone.

CX. And if it should chance that there should be a greater flux of Blood than ordinary, yet it may prove for the addvantage of

the Patient; for thereby the Blood in the Vessels, which possibly may have received some putridness, may be evacuated, whereby the danger of the putridness re∣turning, or creeping farther, will be prevented; and then when you think fit, you may stop it, by the application of Styptick Waters, Pouders, and the like.

CXI. A Styptick Pouder. ℞ Roman Vitriol calcin'd to whiteness in the Sun ℥iv. Saccharum Saturni ℥ii. Roch-alum in fine pouder ℥i. Blood dried and reduced to pouder ʒvi. mix, and make a pouder, for the present stanch∣ing of Blood.

CXII. This is yet much better. ℞ Caput mortuum of Vitriol, calcine it in an open Fire to a purple blackness; then with fair Water elicit the Salt, filter the Solution, and abstract to driness, and keep the Salt for use. Where note, that some after this, calcine the Salt again with a red-hot Iron. This is wonderfully sty∣ptick, and stanches Blood with∣out any caustick or burning quality.

CXIII. As to the place of Se∣ction; if it is in the Feet, and the Sphacelus has got above the Ancles, the Leg is best to be cut off a little below the Knee; for it will be more commodious to the Patient, and he may the better wear a wooden Leg. The Amputation is not best to be made always very near to the dead part; because when the Sphacelus is just by the Ancle, the remaining part of the Leg will be troublesom to the Sick, and much impede his motion: but in these cases you must do as the Patient will have it.

CXIV. But in the Arm, as little as may be is to be taken away; and the Amputation is to be made as near the spha∣celated Part, as is convenient for the health of the Patient.

CV. If the Sphacelus is in the Fingers or Toes, the Section will be best to be made in the very Joint: for in the Joint (if the Disaffection will admit) the Amputation will be made with the least danger, and with the least pain.

CXVI. For the Nerves and Tendons, as soon as they are cut asunder, immediately contract themselves upwards, and are covered with Flesh; nor does any Convulsion follow there∣upon.

CXVII. From what has been said it appears, That the practice of the Ancients, in stopping vehement fluxes of Blood in Amputation, was always by the actual Cau∣tery, or Burning: But this way Paraeus very much inveighs against, because of the ex∣ceeding barbarity and cruelty thereof.

CXVIII. For that it causes, 1. Extraordinary Pain. 2. Dan∣gerous Symptoms may happen to the Nerves and nervous Parts. 3. Very much of the sound Flesh is consumed, whereupon the Bones are left bare, and the Flesh, together with the Ci∣catrice, is either not at all brought over the end of the naked Bone; or if be, it is

with much difficulty, and length of time.

CXIX. He therefore by the Crows-bill lays hold of the Ves∣sels, draws them together, and binds them up with a Ligature, tying them very straight, or closes them with a Cautery, and so loosens the Bandage; after which he applies some such-like Pouder, as that in Lib. 1. Cap. 32. Sect. 14. upon Towe dipt in the whites of Eggs, for the stanching of Blood.

CXX. I must confess, with∣out any such Ligature or Cau∣tery, the Blood may be stanched with the application of the said Pouder, or with Crepitus Lupi, so much used by the Chirur∣geons, being applied and laid upon the mouths of the Vessels which so vehemently bleed: but more effectually with the Styptick Pouders above descri∣bed at Sect. 111. and 112. afore∣going.

CXXI. The Wound being thus drest and bound up, it is to be placed in a direct middle posture or figure, upon Pillows stuffed with Down, or Hares-hair, Wheat∣meal, or the like.

CXXII. And this Method is so long to be used, till there is no cause of farther fear of an He∣morrhage; and then Digestives are to be applied, 'till you see the Wound become purulent: then these things being laid aside, you are to make use of Cleansers, such as are described Lib. 1. cap. 32. sect. 23. aforegoing.

CXXIII. In the mean season, you must endeavour to draw the lips of the Wound together, that the Flesh may cover the Bones; which Paraeus does by sewing together the lips of the Wound in the form of the Letter X, or crosswise: but the Dry Su∣ture seems to me to be much more convenient.

CXXIV. Thus: ℞ Mastich, Sanguis draconis, fine Bole, Sar∣cocol, white Starch, A. ℥ss. mix them (being in fine pouder) with the white of an Egg: with this make Plasters of linnen Cloth, of a convenient bigness, by throughly moistning it therein: which let be applied unto the extremities of the Wound on both sides, crosswise; and so let them stick 'till they become dry, and cleave fast to the Skin; which then with a Needle and Thread you may sew, and draw them together, as you see ne∣cessary and convenient.

CXXV. Lastly, if you have used the actual Cautery, you must endeavour that the ends of the Bones which have been hurt by the red-hot Iron, or Air, may fall off. For which purpose, some burn them again with a red-hot Iron, taking great heed to avoid the Flesh: others make use of Em∣plastr. de Betonica, or of a Ca∣tagmatick, or Fracture-medica∣ments; others of other things: by which means the corrupted part of the Bone will fall off in about thirty or forty days.

CHAP. XII. Of a FELON.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Panaritium, and Parony∣chia Arabum; in English, a Felon.

II. It is a Disease that seizes upon the Fingers end, and upon the ball of the Finger; being a small Tumor, hot, and by reason of the Nerves, exciting most vehe∣ment, and almost intolerable pains.

III. The Causes. It has its original from adust Blood, joined with a malign Humor, chiefly Melancholy; which Nature thrusts forth unto the Fingers ends, and there causes an Inflam∣mation.

IV. The Kinds. It is twofold. 1. One which is benign, and begins in the Flesh; which tho' it is painful, yet is less painful than the other. 2. The other, which is malign, and begins at the Bone, and seizes first upon the Peri∣ostion it self, whereby the pain is almost intolerable, and so comes gradually outwards: and this truly, in my opinion, is little different from that Dis∣ease which we call Spina Ven∣tosa; of which in its place.

V. The Signs. They are known by swelling, redness, and pain; appearing in the Fingers ends, chiefly on the ball of the Fin∣ger, and sometimes near the roots of the Nails; the pain is vehement and intense, by reason the near adjoining Ner∣vous parts are affected.

VI. The Patient can take no rest night nor day, (more espe∣cially if it is the latter kind) and the pain, by reason the Nerves are affected, is oftentimes extended thro' the whole Fin∣ger, yea many times thro' the whole Hand, and sometimes thro' the whole Arm.

VII. There is, for the most part, a continual Fever present; and if it be of the second kind, many times a disturbance of the spirit, faintings, swoonings, &c.

VIII. The Prognosticks. If the matter is benign, and not very sharp, the Symptoms are less ve∣hement, and more tolerable; but if malign, more grievous and vexatious.

IX. The first kind is without any great danger, because it is seldom accompanied with ma∣lignity, soon comes to ripe∣ness, with a kind of whiteness, which being opened with the Lancet, the matter is let out; and it heals almost of its own accord.

X. The latter kind is always malign, and causes vehement Sym∣ptoms; for which reason it is not without its dangers: sometimes it corrupts the Bone, Ligaments, and adjacent Nerves; so that the utmost Joint, to∣gether

with the Bone, apo∣stemates.

XI. Sometimes the whole Fin∣ger is corrupted, yea sometimes the whole Hand: and sometimes (as Barbett says) from the extre∣mity of the pain, the death of the Patient is caused.

XII. I remember when I was a Youth, I had one of this latter kind, upon the ball of my Fore∣finger of my left Hand: the pain was so vehement, that for five or six days, I had no ease night nor day; nor for the first three days did any thing appear, or any discolouring, but only the end of the Finger was a little swell'd: however with proper Applications, it was soon cured, without any detriment to me.

XIII. The Cure of the Benign Felon. Wiseman says, Repellents are commended in the beginning, but not with much astringency: but Sennertus says, that repel∣ling and astringent Medica∣ments are by no means to be applied; lest the Humor should be the more impacted into the Part, the Pain augmented, and the Nerves and Bone corrupted.

XIV. Yet as Defensatives up∣on the Parts adjacent, they may be imposed; such as these. ℞ Oil of Myrtles, juice of Night∣shade, Ana, and with fine Bole make a Cataplasm. Or, ℞ Barley and Bean flower, A. ℥i. Camphir ʒss. mucilage of Flea∣bane and Vinegar, A. q.s. mix, and over the Fire make a Cata∣plasm. ℞ Pouder of the green sort of Galls, and with Vinegar make a Cataplasm.

XV. Or: ℞ Mucilage of Flea∣bane-seeds, juice of Nightshade or Plantane, A. ℥i. Vinegar ℥ss. fine Bole q.s. mix, for a Cataplasm. Or: ℞ Mucilage of Fleabane∣seeds ℥ii. Vinegar ℥ss. fine Bole, q.s. mix them.

XVI. To the Affect it self you may apply the Worms that are found in the middle of the Teazle∣heads, being found alive; because they alleviate the pain, and sometimes discuss the Tumor: but because they are not always to be had, we must have re∣course to other Remedies; as ℞ Green Tobacco, and bind the leaf on the Part: if that cannot be had, moisten dried Tobacco-leaves in Wine, and apply them. Or, ℞ Unguentum Nicotianae ℥i. Rosin in pouder ℥ss. mix, and apply.

XVII. But if it tends to Sup∣puration, ℞ Mucilage of Flea∣bane-seeds, meals of Linseed and Fenugreek, A. ℥ss. yolk of one Egg, Hens or Goose grease ℥ii. Saffron ʒss. pouder of Rosin or Tobacco-leaves q.s. mix them. Or: ℞ Ʋnguentum Nicotianae ℥i. yolk of one Egg, meal of Lin∣seed, Tobacco in pouder, A. ℥ss. Rosin poudred, q.s. mix them.

XVIII. When the Tumor is maturated, the Apostem is imme∣diately to be opened, and the Pus to be taken forth; then the Ulcer is to be cleansed with Abstersives, incarnated, and healed.

XIX. For which purpose, Seanertus commends this: ℞ Aloes ʒiii. Myrrh, Frankincense, Sarcocol, A. ʒi. Honey of Roses ʒii. Turpentine ℥ss. mix them.

This I commend by Experience. ℞ Ointment of Tobacco ℥i. Honey of Roses ℥ss. Tobacco in fine pou∣der, Rosin in pouder, Myrrh, A. mix them, and apply.

XX. A Child was pained with a small red Swelling about the inside and root of the Nail of one of its Fingers, Ceratum Galeni was applied to it; the second day it shined, or was like a Blister, it was opened with a Needle, a thin yellow matter was discharged, and by dressing twice with Ʋng. Basilicon, it was cured. Wiseman.

XXI. A Gentleman had a very large one upon the ball of his Thumb, like a great Blister; it was let out with a Lancet, and cured with Ʋnguentum Tutiae. Wiseman.

XXII. Another under the fore∣part of the Nail and Finger was very painful, but was suppurated by Lenients; the matter was let out, part of the Nail cut off, and it was cured in few days. Wiseman.

XXIII. A Woman had one of these in the end of her Finger, with vehement Pain, Fever, Fainting, Swooning, Nauseousness, Vomiting, and other Symptoms. The Finger was fomented with Milk, in which flowers of Ca∣momil and Melilot, and seeds of Fenugreek and Quinces were boiled: then the superficies of the Skin were shaved off, under which small red Spots appeared; these were opened with a Knife, and a drop or two of red Water came forth; after which linnen Cloths dipt in Aqua Vitae, in which Venice-Treacle was dissolved, was ap∣plied; by which means the Pain was taken away: and by this only Remedy, the very next day the Finger was healed. Guilielm. Fabricius, Cent. 1. Observat. 97.

XXIV. Another Woman, by reason of a Paronychia, could neither sleep nor rest for three days: the Skin was shaved off, under which, in the very tip of the Finger, a small Spot about the bigness of a great Pins head was found, in which was about one drop of an ichorous Humor: it was opened, and Cotton dipt in Aqua Vitae, mixt with Venice-Treacle, was dissolved, was applied; and about the whole Hand and Wrist a double linnen Cloth, dipt in Vinegar mixt with a little Water, was wrap∣ped; the pain immediately ceased, and the next day the Finger was cured. Guil. Fabric.

XXV. But that Author ad∣vises (by reason the Skin in that part is of a great thickness) to make the Incision forthwith, in the very beginning; because other∣wise, by the afflux of Humors, a Tumor and Inflammation will be excited; and so the Flesh lying underneath, yea even the Bones themselves, will be in danger of being eaten through.

XXVI. The Cure of a ma∣lign Felon. These ought imme∣diately to be laid open, pene∣trating to the Bone: for if you wait the time of Suppuration, the Bone, Flesh and Nerves will infallibly be corrupted: for ma∣ny times, (before there is any

outward appearance in the Flesh) it rots the Bones, Liga∣ments and Membranes; so that there is scarcely any remedy but Amputation, chiefly if there is any danger of running farther, or infecting the parts adjacent.

XXVII. Guido, and Vigo, call it a cruel, vehement, and mortal Disease; and they report to have seen some so vehe∣mently tormented therewith, as to die thereof: But this I pre∣sume is, according as the Cure is managed, by falling into ignorant and unskilful Hands.

XXVIII. Vigo advises to apply the actual Cautery, because it has an admirable virtue in cor∣recting of Malignity and Poison, which offend the Bone and Nerves, and eases the vehement pain; then to cleanse it with Ʋng. Aegyptiacum, mixed with Aqua Vitae, or a little Aposto∣lorum.

XXIX. Wiseman proposes an immediate Incision to the Bone; then letting it bleed a while, he dresses it with a Pledget of Ʋnguentum Basilicon, over which he lays Emplast. e Bolo; and in a day or two after, according as the Patient is easy, takes off the Dressings; and continues with fresh applica∣tion, till it is cured.

XXX. If it is rebellious, and on the second day after taking off the Dressings, he finds the Wound open and undigested, he dresses it with a Dossel dipt in red Pre∣cipitate, with Emplaster and Bandage: the third day after he dresses it again, at what time the Slough does mostly come off with the Dossel.

XXXI. Then he dresses it with a less Dossel spread with Basilicon and Precipitate, with a Pledget of Ʋng. Diapompholigos, and an Emplaster over it, whereby it digests, and in six or seven days after is commonly healed.

XXXII. Now the reason why it sometimes heals not by agglu∣tination with the first or second dressing, is from the acrimonious Ichor, which offends at the bottom of the Wound, and many times pierces deeper: which shews indeed the neces∣sity of timely laying open Tumors of this kind; unless you find they go away by discussion, which is very rarely to be seen.

XXXIII. If the Tumor has been ill handled, by application of Suppuratives, till the Putrifaction within has rotted the Ligaments and Periostion, corrupted the Bone, and extended the Apostem to the second or third Joint. In this case, lay open the Apostem by Incision from the Fingers∣end downwards, even the whole length of the Abscess; then dress it with red Precipitate, applying Dossels over it, spread with a Digestive, to keep the lips of the Wound distended.

XXXIV. And with snips of Empl. Diapalma, rowl it up, leaving way for the Matter to discharge: over which put a moderate Bandage, to press out the Matter in the Part, and restrain the influx; the better to reduce the Finger to its former shape.

XXXV. The third day dress it again, and if you find the Ʋlcer sordid, and overgrown with proud Flesh, rub it with the Vitriol∣stone, and fill the Ulcer again with red Precipitate, dressing it up, as before: By which me∣thod, deterging the Ulcer, let it be incarnated with Sarco∣ticks, and the Cure finished with Epuloticks, and proper Bandage.

XXXVI. The Vitriol-stone is of great use in these Ʋlcers, which so abound with luxurious or proud Flesh, among the Tendons; for by it, the corrupt Flesh is dried up, without offending the Nerves, Tendons, or other sound parts: and the Ulcer may be deterged, according as it is touched more or less; and the Bone it self, where it is bare or carious, may be dried by it, and disposed to moulder off.

XXXVII. And where the Hy∣persarcosis is great, by sprinkling it with Precipitate, the Ulcer is the more speedily freed from its Putrifaction.

XXXVIII. Where the Ʋlcer seems to be rebellious, with a kind of malignant Humor attending, whereby the Cure succeds not, but is like to be very tedious and unsuccessful, by the increase of the putrifaction, and rotting of the Bone; the best Remedy in this case, is the cutting off the Finger in the next joint beyond the Putrifaction; or otherwise in the middle of the joint, with a Chezil, as Mr. Wiseman pra∣ctised.

XXXIX. Then to dress up the Stump with Pulv. Galeni cum albumine Ovi, rowling it on, and the second day after to dress it with Turpentine mixt with the yolk of an Egg, whereby it be∣comes digested; after which it is to be incarnated with com∣mon Sarcoticks, and cicatrized with Ʋng. Desiccativum rubrum, and Pledgets dipt in Aqua Calcis.

CHAP. XIII. Of a PƲSH, or BILE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, (〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. quo∣niam noctu generatur, ut Galenus & Celsus docent; vel magis, non quod noctu oboriatur, sed quoniam noctu vehementiùs ho∣minem excruciet, ut Paulus Aegi∣neta & Aetius existimant;) in Latin, Furunculus, & Epiny∣ctis; in English, a Push, or Bile.

II. The Kinds. It is twofold: 1. Furunculus, the great Push or Bile. 2. Epinyctis, the little Push. The first is a Tumor about the bigness of a large Pigeons Egg, the latter about the bigness of a large Horse-Bean.

III. And of the Furunculi, some are mild and gentle, seizing only upon the Skin; others are malign, which descend deeper, and are mischievous and dangerous, not to be cured without great dif∣ficulty, its roots being deeply fixed: they are also sometimes Sporadick, and sometimes Epi∣demick, which if they happen in a Plague-time, are not with∣out sufficient danger.

IV. The Differences are, 1. In magnitude; the Furunculus being greater, the Epinyctis being lesser. 2. In the greatness of the affect; the first being more painful, troublesom, tedious and diffi∣cult to cure than the latter. 3. In the time of breaking out; which as Galen says, the Epini∣ctys does in the night: but in this, I think those Ancients are mistaken, for it breaks out as the Furunculus does, at any time; but it seems to be most troublesom in the night, where∣as the other seems to be night and day alike.

V. The Signs. Celsus, lib. 5. Cap. 28. says that Furunculus is a Tumor a little acuminated or sharp-pointed, with Inflammation and Pain; and then especially, when it is perfectly converted into Pus.

VI. It is indeed a small In∣flammation in the beginning, a Pustule growing bigger and bigger by degrees, seldom exceeding the bigness of a large Pigeons Egg, with a certain kind of pain, and redness of colour; when it is come to its full bigness, and withal tending to a point; which happens about the ninth or tenth day, at farthest.

VII. If it is Epidemical and Pe∣stilential, it is then black and green, and there is present a malign Fever, with other evil Symptoms: but it differs from a Carbuncle in this, that altho' it proceeds from thick and vitious Blood, yet the matter of a Carbuncle is more adust or burnt: also a Furunculus will admit of Sup∣puration, whereas a Carbuncle will not.

VIII. Tho' many times there is but a single Furunculus breaks forth at a time; yet sometimes many of them break forth, in various parts, together.

IX. The Epinyctis, says Aegin. l. 4. c. 9. & Aet. tetr. 4. serm. 2. c. 61. is a small Pustule, breaking forth of its own accord, somewhat reddish; which being broken, there comes forth a bloody filth and matter, not greatly excrutiating the Patient in the day∣time, but giving a pain more than ordinary in the night, and sometimes many of them break forth (in diffe∣rent places) together.

X. Pliny, l. 20. c. 6. says they are pale and wan Pustles, which disquiet much in the night-time: but Celsus, l. 1. c. 28. has given the most ab∣solute description of them. Viz.

XI. Pessima Pustula est quae 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Epinyctis, vocatur. Ea colore vel sublivida, vel sub∣nigra, vel alba esse consuevit: circa hanc autem vehemens Inflam∣matio est, & cùm adaperta est, reperitur intùs exulceratio mucosa: Color est Humori suo similis: Dolor ex ea supra magnitudinem ejus est, neque ea saba major est. Atque h••c quoque oritur in eminentibus partibus, & fer•• noctu. Ʋnde

nomen quoque à Graecis ei Epi∣nyctis impositum est. Viz. This Pustule which is called Epinyctis, is the very worst of all the kinds: its Color is usually pale and wan, or blackish, or else white: there is also conjoined with it a great Inflammation, and within, it contains a pu∣rulent and filthy matter: the Colour is much like to the Humor of which it is generated: the Pain which it gives, much exceeds its magnitude, not being bigger than a (large) Horse∣bean. It also arises in the emi∣nent or principal Parts, and most commonly in the Night; for which cause this name, Epi∣nyctis, is imposed upon it by the Greeks.

XII. The Causes. Galen. de Comp. Med. lib. 5. says Furunculus has its original from thick and vitious Blood, but not so burnt and corrupted as in a Carbun∣cle; which Nature severing from the rest, expels and drives forth, as offensive and useless, unto the superficies of the Body.

XIII. The cause of Epinyctis is Blood, corrupted with a salt and serous Humor mixed with Flegm, and sometimes with Choler or Melancholy; for which reason it is that the colour is not al∣ways one and the same: and by reason of the pituitous Hu∣mor mixed in the Tumor, it is, when suppurated and opened, found abounding with a puru∣lent and filthy Matter.

XIV. Some are of Opinion, that the cause of these Tumors is the same with that of the Car∣buncle, save that here is no mali∣gnity present: but for my part, I judge the contrary, unless it be in a Plague-time, and then I think the case is much altered.

XV. The Procatartick Causes of all these Tumors, is an evil course of Diet and Living, breed∣ing an evil and scorbutick habit of the Body: the Antecedent Causes, are the evil Humors produced by that ill way of Living; which being impregna∣ted with an acid and sharp Salt, causes them to ferment with the Blood, and so break forth: and the Conjoin'd Cause, is the Blood thrust forth with the Matter fermenting.

XVI. The Prognosticks. Hip∣pocrat. Epidem. lib. 6. sect. 1. says, these Tubercles which bunch forth externally, and are sharp-pointed, equally maturate, and are not hard, or divided as it were into two parts, but have their tendency downwards, are the more hopeful.

XVII. And Celsus, lib. 5. cap. 28. says, that in a Furun∣culus, Bile, or great Push there is little or no danger, tho' nothing is done for the cure thereof, be∣cause it suppurates of its own accord, and so breaks forth. It is the Pain that accompanies it, which induces the application of Medicines, for the more speedy ease of the Patient.

XVIII. Epinyctis, or the small Push, is yet less dangerous, and rather denotes the strength of the Expulsive Faculty; but it is troublesom, by reason of the Pain it causes, and the restlesness which it brings with it in the night-time.

XIX. The Cure of Furunculus, or a Bile. You must first endeavour Suppuration by external applica∣tion, with the same things as in a Phlegmon; as Raisons of the Sun, Figs bruised, and laid upon the Part, Diachylum, white Lilly roots, roots and leaves of Althea, Mallows, herb Mercury, and all Emollient Gums.

XX. Or you may apply Em∣plastr. Diachylon cum Gum∣mi, de Meliloto, de Muci∣laginibus, Tripharmacum, de Minio cum Sapone, or proper Cataplasms.

XXI. Or, ℞ Meal of Linseed, roots of Althea in pouder, A. ℥ss. fat Figs N^o iv. Raisons of the Sun stoned ℥i. Water q.s. boil them together to a Cataplasm, adding at the end Goose or Capons grease, or fresh Butter, q.s.

XXII. If the Pain is vehe∣ment, apply this: ℞ Mucilage of the seeds of Fleawort, Althea, Linseed, A. ℥ii. Barley meal or flower ℥ijss. Oil of Lillies, Ca∣pons grease, A. ℥jss. Saffron ʒss. yolk of one Egg: mix, and make a Cataplasm.

XXIII. When the Tumor is maturated, it is to be opened (unless it breaks of its own ac∣cord:) and then it is to be cleansed with this: ℞ Juice of Smallage, Turpentine, A. ℥i. yolk of one Egg, Barley-meal, Fr•…•…k∣incense, A.ʒiii. Rosin in pouder ʒiss. Honey of Roses q.s. mix, and make a Liniment.

XXIV. And over all apply this Cerat: ℞ Sheeps suet, Calves suet, A. ℥iii. Turpentine ℥jss. Oil-olive ℥i. Wax q.s. mix, and make a Cerecloth: after all, evacuate the Humor with pro∣per Catharticks and Antiscor∣buticks.

XXV. The Cure of Epinyctis. The Tumor is to brought to suppu∣ration, as in the former; then breaking, or being opened, they are to be cleansed with Abster∣sives, and washed with some proper Styptick Water to dry them up: or you may apply a Mixture made of equal parts of Sulphur vive and Litharge, mixt with Wine.

XXVI. If they be very painful, Anodyns are of good use; as a Cataplasm of Mithridate and pouder of Bay-berries, after which they may be healed up, with Ʋnguentum Tutiae, or some such like thing.

XXVII. Lastly, let the Pa∣tient keep from all things, sharp, acid, and salt; and purge out the vitious Humor, by proper Antiscorbutick Catharticks.

CHAP. XIV. Of CHILBLAINS or KIBES.

I. THIS Disease is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, i. e. Hyeme;

in Latin, Pernio, plu. Pernio∣nes; Fen English, Chilblains, Bloody-falls, or Kibes.

II. It is a peculiar kind of Tumor or Inflammation, which arises chiefly in Winter-time, upon the Heels, Toes and Fingers, with other parts of the Hands and Feet: But Wiseman will have them only to be called Kibes, which happen upon the Feet and Toes; Sennertus saith that he once saw a Nobleman, which had such a kind of Disease on the very tip of his Nose.

III. The Causes. This Inflam∣mation arises from the Winters cold; weakning those parts, by the entrance of cold Atoms, and the drawing Blood and Pain into the Part.

IV. The Signs. There is a swelling in the Part, with redness, and an extream itching, so that the Patient cannot forbear scratch∣ing or rubbing of them; some∣times to the breaking of the Skin, and then they exul∣cerate.

V. These Tumors many times go away of their own accord in Summer-time, and then again about the beginning of Winter return again, with the old swelling, redness, itching, &c.

VI. The Prognosticks. There is no danger in this Disease; yet notwithstanding if they be not speedily cured, they commonly prove tedious, and of long continuance, and often return again for many years.

VII. If the Tumor grows very great, and meets with many heats and colds, it commonly breaks and exulcerates; and then the Tumors which were before cal∣led Chilblains or Bloody-falls, lose that name, and get the appellation of Kibes.

VIII. The Cure. It is to be considered, 1. As Chilblains, be∣fore they are broken. 2. As Kibes, after they are broken and exulcerated.

IX. The Cure before they are broken, is, as Sennertus advises, to rub the Parts affected with Snow, or dip them into frozen Water, or Snow-water, or Water full of Ice: others advise to put the Part into a warm Decoction of frozen Turneps: or when the itching and heat is over, to dip them into a pail of cold Water almost frozen. The De∣coction of Lupins is an approved thing.

X. Some have been cured by fomenting the Part with Milk blood-warm, wherein Bay-berries, Camomil, Fennel, Origanum, Pe∣niroyal, Rosemary, Rue, Savory, Southernwood, &c. have been boiled: others by holding them to the flame of a Candle, (in the fit of the itching) and to burn them as it were therewith: others bathe them with S.V. or rather with Beef-brine.

XI. Or you may make Com∣pounds, after this manner. ℞ White Port-wine sbi. Alum ℥i. boil, and bathe the••with. Ointment of Roses with Oil of Turpentine, to anoint withal, is an approved thing. Or after Bathing, you may anoint with Honey, with which pouder of Sulphur vive has been mixt.

XII. ℞ Oil of Bays ℥ii. Ho∣ney ℥i. Turpentine ℥ss. mix them.

Or, ℞ Oil of Mace, fresh Butter, Turpentine, A. ℥i. mix them. Or, ℞ Oil of Wax, Oil of Roses, Honey, Olibanum, A. ℥i. mix, them.

XIII. The Cure, after they are broken and exulcerated. Let the Ulcer be cleansed with the Li∣niment in Chap. 13. Sect. 23. aforegoing: Or, ℞ Frank∣incense, Roch-alum, both in fine pouder, A. ℥i. mix them, adding thereto a little Wine; laying over Emplastr. Catholicon, or some other good Vulnerary.

XIV. An Ointment made of the ashes of River-crabs mixt with Honey and Oil of Roses, is approved; pouder of Aloes also to strew upon them, is an ex∣cellent thing; and if very foul, Ʋng. Basilicon mixed with red Precipitate, is to be applied. But in my opinion, nothing exceeds the pouder of Scam∣mony, strewed on dry.

XV. For that cleanses, purifies, and incarnates. If the Bone is foul, I have known it to scale it, and make it white, remove all the impediments and acci∣dent which may befal the Cure, cleanse, repress proud Flesh, and yet incarnate and heal: so that there is scarcely a better singular thing for this purpose, or for the cleansing of any foul Ulcer in the World.

XVI. Then over the Pouder lay this Emplaster of Barbett, which is admirable. ℞ Frank∣incense ʒii. Litharge, Myrrh; A. ʒjss. red Lead ʒi. Galls, round Birthworth-roots, both in pouder, A. ʒss. Camphir ℈i. Mer∣cury sublimate gr.•• vi. Sheeps or Rams suet, Rosin, A. q.s. mix, and make an Emplaster, adding a little Oil-olive.

XVII. And afterwards wash the Sore with Saccharum Saturni dissolved in Spirit of Wine, or some other proper Liquor, to cause a speedy healing.

XVIII. Lastly, if the Ʋlcers prove rebellious, they are to be cured after the common me∣thod, as we shall teach in Lib. 5. following.

CHAP. XV. Of an ANEƲRYSM.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Aneu∣rysma; and in English, an Aneu∣rysm, or Rupture of an Artery: it is so called, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, i. e. supra dilatare, to dilate, or widen above: but mo∣dern Physicians have found from Practice and Observation, that it is more than a dilatation of an Artery, viz. more than a rupture of the inner Coat, and dilatation of the outward Coat; and that it is (as Wiseman has well obser∣ved) a downright rupture thro' both the Arterial Coats.

II. Definition. This Disease is therefore an eruption of Blood out of the Artery, by a rupture of both the Coats of the same, and filling the spaces of the Muscles adjacent thereto, with Arterial Blood. For as the aforenamed Author says, it is not probable that a force big enough to burst the inner Tunicle of an Ar∣tery, which is so very tough and firm, should leave the exterior whole, which is much softer and weaker, leisurely to be extended by the Blood.

III. Barbett also defines an Aneurysm to be a Tumor besides Nature from a rupture of an Ar∣tery; continually beating, easily yielding to the Fingers, and as suddenly returning.

IV. The Kinds. An Aneurysm is either great, or small. The great can never be but with the rupture of both the Coats of the Artery, whereby the Blood insinuates it self into the interstices of the Muscles: the small may be (according to Barbett) from an erosion of the internal Tunicle, the ex∣ternal being only extended: but if the Tumor is of the bigness of ones Fist, 'tis impos∣sible but that the external must be broken too.

V. The Place. Sennertus says, an Aneurysm may happen in every part of the Body, but more fre∣quently in the Throat, where it produces a Bronchocele: it happens likewise in the Head, nigh unto the places of the Arte∣ries, and in all other parts of the Body also where the Arteries may be wounded; as also in letting Blood in the Arm, &c. when an unexpert Artist in attempting to open a Vein, does withal either prick, or cut asunder the Artery lying un∣derneath it. Aegineta, lib. 4. cap. 53.

VI. The Causes. All Arteries (except such as are disperst thro' the Brain and upper parts) consist of a double Tunicle: and therefore what things soever contribute to the rupture of those Tunicles, are the cause of this Disease; and these causes are either Internal or Ex∣ternal.

VII. The Internal cause is ei∣ther from some corrosive Humor or Salt corroding the Tunicles; and that is either innate in the Blood, which eats thro' some parts of the Vessels thinner than ordinary; or being highly fermented by other Causes, causes an unexpected Rupture: or extern to the Vessels, which fixing upon some particular Part, may at length meet with an Artery, and gnaw that asun∣der also; as in a Cancer, is often seen.

VIII. The Internal Cause, if it is in the Blood it self, is from an Impetus arising either from the violent motion of the Blood; which being greater than the Artery can sustain, does force its way thro' the sides of the Ves∣sel, making a rupture in it; whereby the Blood filling the interstices of the neighbouring Muscles, it incrassates the Membranes, and forms its self a Cystis.

IX. Or it may be from the too

great quantity of Blood in that Part, being more than the Vessel can contain; which opens mostly in the Nose, Lungs, or in the Brain, (there causing an Apo∣plexy:) or in the Stomach, Guts, Reins, Anus, &c.

X. Or from some violent mo∣tion of the Body, or vehement passion; by which the Blood is forcibly driven from the Heart, towards some peculiar Artery: which being intercepted by some violent contraction of the Muscles, thro' which it must pass, it of necessity breaks the Vessel; as in violent Vomitings, and other vehement Strainings. Aneurysms are often made in the Neck, Arms, Legs, Belly, Thighs, &c.

XI. The External Causes are Wounds or Punctures, made by Incision-knife, Lancet, or Weapon; cutting, bruising, or any other thing which may break and divide the Coats of the Arte∣ries.

XII. The Signs. It is known by a Tumor gradually increasing, and of the same colour of the Skin: if it is small, there will a continual pulsation be felt in it, and it easily yields to the Fingers: But if great, and it rises suddenly, and is white and soft from its first appearance, there will no pul∣sation be felt, nor any return of the Blood, if compressed with the Hand: yet you may conclude it to be an Aneu∣rysm, there being no Hu∣mor, but the Blood only, which can so suddenly make such a Tumor.

XIII. The often increase and decrease of the Tumor, is a sign of an Aneurysm, the diminution being the return of the Blood into the Artery, whence it as often comes out again; but this is in a small Aneurysm: the contrary is found in a great, where, as Barbett observes, there is a noise heard, as of boiling Water: and this hissing noise is not only to be perceived when it is pressed down by the Fingers, but also at any other time, upon putting the Ear close thereto; which is thought to proceed from the motion of the Vital Spirit, thro' strait and narrow places.

XIV. If it is from the pricking of a Lancet, the manner of the springing out of the Blood will shew it; and if it does not bleed, yet a Tumor immediately thrusts up under your Finger, with pulsation, the Blood forcing its way into the inter∣stices of the Muscles, tho' not quite to the Skin: but the Tumor will be more compact or scatter'd, as there was care taken at first to restrain it within compass.

XV. In some of these there is redness and inflammation, by reason of the expansion of the Parts beyond their capacity, or from the putrifaction of the Blood: in which latter case, a Fever and Fainting for the most part accompany it.

XVI. The Differences. They are taken, 1. From the Magni∣tude, great or little; possessing the whole Member, or a part only. 2. From its Situation; as being

superficial, near the Skin; or deep in the Muscles. 3. From its shape; it either keeping the shape of the Part, which is when the orifice in the Artery is small; or losing that form, when the eruption is so sud∣den and great, as it cannot be kept within bounds: or when it is by an unskilful Artist, managed with Lenitives and Discussives, being mistaken for some other Tumor, whereby the Membranes are more relaxed, and made to give way.

XVII. The Prognosticks. All-Aneurysms are very difficult of cure: Barbett says, not at all, if great, without taking off the Member: Sennertus says, those which are recent, and less, will admit of cure; the greater no ways, but by Amputation or Section; because the Blood will not be driven back by Astrin∣gents, nor the Artery admit of consolidation.

XVIII. If the Tumor is opened, it brings the Patient into extream hazard of death; and remarkable Instances there are of such as have died under the hand of the Artist, at the time of opening; because of the extream profusion of Blood, and great wasting of the Vital Spirits.

XIX. However, not being opened, Sennertus says the Tumor has no great danger in it, but life may be lengthened out for a long time; and he knew a Woman who had an Aneurysm as big as a Walnut, in the inward bending of the Arm, (thro' the unskilfulness of the Artist, who in opening of a Vein, cut the Artery also) for the space of above thirty years, injoying her health all that time: and there∣fore concludes, that it is better to bear with some inconve∣nience, than to run the hazard of a dangerous Cure.

XX. Barbett says, it is for the most part a long Disease, yet he has sometimes seen it kill, without any other accidental cause, in the space of two years: but this, I prefume, is intended of large Aneurysms.

XXI. Wiseman says, those which are large, and arise from Arteries deep in the Muscles, to which application cannot be made, are incurable: but if it is in a Part capable of Bandage, and application of Medica∣ments, the Cure is feasible; or it may be palliated, to the ease of the Patient.

XXII. The Cure of a small Aneurysm. So soon as ever it is perceived, let Astringents and Repellers be imposed upon the place affected, to repel and qua∣lify the Blood, and close up the hole of the Artery: for which purpose, Emplastrum ad Herniam, either the common, or of Our Prescription, are of exceeding good use.

XXIII. Sennertus commends a thin plate of Lead to be hard bound on, which does repel, thicken, and close the loosened Artery, and keep the Blood within its Channels: or you may ma∣ster it (as Wiseman says) with Escaroticks, or the Actual Cautery.

XXIV. The Medicaments pro∣per in its first appearance, if it

arises from an Internal Cause, are such as are good to restrain its motion, and agglutinate the Ves∣sels; as fine Bole, Terra sigillata, Gypsum, Aloes, Catechu, Opium in pouder, Frankincense, Dra∣gons-blood, Blood dried, Ox∣liver poudred, fine Wheat-flower, Sal Vitrioli, Saccharum Saturni; juices of Plantane, Mouse-ear, Shepherds-purse, dead Nettles, Periwinkle, Yar∣row, and the like. Compounds may be made of the Pouders of the former, with Juices of the latter; or mixt with Vin∣egar and the whites of Eggs.

XXV. Other things also may be prepared of the roots of Com∣frey, Mastich, Pomgranate peels and flowers, Acacia, Hypocistis, unripe Sloes dried and reduced to pouder, unripe Bramble∣berries in pouder, Myrtle-berries, Nutgalls, Loadstone, Lapis Haema∣tis, Crocus Martis astringens, &c.

XXVI. But if it is in a place incapable of Bandage, you must content your self with the ap∣plication of Emplastrum Caesaris, Catagmaticum, Album, or some such like.

XXVII. If it is near the Trachea Arteria, the Patient may wear a Plate of Gold or beaten Lead upon it, covered with Sars∣net, or some such like.

XXVIII. If it lies where you may take it up, the Cure is then best performed by dividing it: the manner of the Section is thus: The Tumor or outward Skin being opened, the Artery that is to be cut, must be intercepted by binding it about with two Bands, and then it must be dissected between the two Bandages; which Bandages are not to be loosed, till Nature has covered the Wound with Flesh, and the danger of an Hemorrhage is over.

XXIX. But as this is an Operation so cruel, that few or none will submit to it, so has it likewise much of danger in it, nor has the Sick always cure by it: for upon loosning the Bandage, either an Hemorrhage may be feared, or else a new Aneurysma may be caused.

XXX. If it is only a small Aneurysm, wherein the inner Coat is only broken, the outward di∣lated or extended, the manner of the Operation out of Paulus Aegi∣neta, lib. 6. cap. 37. is thus: Let a streight Section be made long-ways, then part the lips of the Skin far asunder by little Hooks, so that the Artery may be made bare, severing it from the Membranes by Instru∣ments fit for this purpose: then after the transmission of a Needle under it, tye it with double Threads; and with a Lancet or Incision-knife, prick the middle of the Artery, that what is contained therein may be evacuated; after which ap∣ply Suppuratives, till at length the tyes of the Threads fall off.

XXXI. But if there is the rupture of both Coats of the Ar∣tery, let the Skin be divided, and the Artery tied both above and below; and cut out the middle with the Tumor, not loosing the Ligatures, till the Wound is perfectly cured,

and there is no fear of an Hemorrhage.

XXXII. Immediately after opening of it, the Hemorrhage of the Part ought to be stopt with Astringent Pouders, and Sty∣pticks, either Pouders or Waters; such as we have prescribed in cap. 11. sect. 111, 112. aforegoing; or the Royal Styptick, over which a Compress is to be put. This Method of curing by Se∣ction, is so cruel that few will endure it, besides the hazard and danger that is in it: Wise∣man says, you ought well to be advised, before you attempt the Cure by opening it.

XXXIII. If it is caused by Putrifaction of the Blood, and it burst forth suddenly upon you, the Life of the Patient will be in danger: then you must be quick in application of Restrictives, Astringents, or Stypticks, and good Bandage: after which you have time to consider what to do against the next Dres∣sing or Eruption; for if it breaks not out again of it self, you are not to open it; and for the future, you must en∣deavour the Cure by the Me∣thod that hereafter will follow.

XXXIV. In great Aneurysms, Sennertus says, the more secure and safe course is only to bind hard, and press together the Tumor with Medicaments (Compress) and Bands, that it may no farther augment. But Barbett says, that by reason the Ope∣ration at Sect. 30. and 32. above is dangerous, painful, and trou∣blesom, and many times of little benefit; it is better, to preserve Life, to amputate or cut off the Member.

XXXV. If the Aneurysm is caused by a Puncture in Blood∣letting, you may permit it to bleed freely; but if it bleeds not well, immediately loosen the Bandage, and apply a Compress with Styptick Pouders, or dipt in the Royal Styptick Liquor: or for want of them, in Oxy∣crate.

XXXVI. Let it be held firmly upon the Apertion by a Servant, whil'st the Artist makes Revul∣sion by opening a Vein in the other Arm, by a long evacua∣tion, to fainting, if requisite.

XXXVII. Mean season apply Astrictive or Styptick Pouders to the Arterial Wound, with good Restrictive Emplasters over it; defending the upper part of the Arm, by application of Cloths wrung out of Oxycrate: then with a Rowler with two heads, rowl it two or three times upon the wounded Part; and (the Arm being bowed the while) rowl the Arm upwards, and turning the Rowler about the Neck, return it again backward to the Part affected, fastning it on the outside of the Arm; and make the Expulsive-bandage from the Hand upwards.

XXXVIII. This Rowling and Bandage ought so to be done, as to be for the ease of the Patient; let him then be put into his Bed, and his Hand placed upon his Brest; and give him cordial and cooling Juleps, Opiates, &c. to quiet and allay in some measure the motion of the Blood.

XXXIX. The Bandage being thus well made, open it not hastily, because many times the first dres∣sing secures the Patient. The great mischief in this Cure proceeds from Ignorance, in binding up the Arm carelesly; upon which the Patient the next day complaining, he em∣brocates and foments the Tu∣mor; thereby making way for the Blood to empty it self into the interstices of the Muscles, causing a Tumor of the whole Arm.

XL. In this case, Wiseman says a laced Sleeve and Glove may be of great use. If this Method fails, the Cure is to be performed by the Directions before delivered.

CHAP. XVI. Of VARIX.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, by Aristotle, hist. Animal. lib. 3. cap. 11. and Plutarch, in vita Caii, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. but by Galen, meth. Med. lib. 10. cap. ult. out of whom Paulus Aegineta, lib. 6. cap. 82. and Aetius, Tetr. 4. Serm. 2. cap. 48. have it, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Venae dila∣tatio; in Latin, Varix; in English also Varix; and the Dilatation or Widening of a Vein.

II. The Signs. Varices are easily known, let them happen in what part of the Body soever; by their turgency, their crooked figure, and azure or blew colour; which is more or less evident, as the Veins lye superficial, or more deep.

III. The Veins are much larger swoln, blacker than formerly, soft, easily yielding to the Fingers, and as soon returning again.

IV. In a Hernia varicosa, there is an unequal knotted Tumor in the Vein leading to the Testicle, with relaxation of the same Testicle; and if the Testicles are filled with Wind, the Vein is also distended, and painful.

V. The Places. They may hap∣pen in divers parts of the Body, but most frequently in the Thighs, Legs, Testicles, (which Tumor is specially called Kir∣socele) and Fundament, in the Hemorrhoidial Veins.

VI. They often happen also in the lower parts of Womens Bel∣lies, under the Navel, (caused in them many times from hard labour:) and sometimes in the Temples, as Paulus in the place mentioned, testifies.

VII. The Causes. Galen, de Atra bile lib. cap. 4. says, They are generated from great store of melancholy Blood, which Nature oftentimes transmits unto those Veins which are in the Thighs; by which being distended and dilated, they are rendred va∣ricose, or swoln up, and the

Skin that touches them, becomes in process of time of a black colour.

VIII. But if the Blood is not adust, or mixt with Melancholy, then the colour of those Veins being dilated, will scarcely ever be of that black hue, as in the former case is declared; nor indeed does good Blood, tho' never so plentiful, scarcely ever produce Varices, without it be thick, which by its weight tends down∣wards upon the Thighs.

IX. Hippocrates, in Coacis Praenot. versus finem, says, Va∣rices happen not till ripeness of age; for that a thick and me∣lancholy Blood is not generated sooner in the Body: and in∣deed they often happen to Men of a Melancholy temper, Women with Child, and such like.

X. The more remote Causes, are all those things which produce and breed melancholy Blood; especially a distempered Spleen, which helps towards the gene∣ration of these Varices.

X. Wiseman says they proceed from the Restagnation of gross Blood; which being transmitted into the Veins, either by reason of the depending of the Part, or from some other pressure upon the Vessel; or else by its own grossness, proves unapt for Circulation.

XII. So that instead of con∣tinuing its current proportionably to the other Parts, it stops in the place, and as it were coagulates or thickens; and by degrees in∣creases it self by the accession of the like particles of the succeeding Blood; and thereby dilates the Vessels into a capacity large enough to receive it: but this thickning of the Blood in a Varix, is not so much as to stop the passage wholly up; for the current always forces its thinner parts by the sides of the Coagulum, and so increases the dilatation.

XIII. This Affect most com∣monly happens in Cutaneous Ves∣sels, where the Veins have little or no assistance from Muscular Flesh; which by a continual pressure forces the Blood for∣ward, and permits it not to stagnate.

XIV. Another Cause may be, from the weakness of the Vessels, either natural or accidental; in which the valves of the Varicose Veins are so feeble, that they cannot sufficiently support the Blood in its ascent; but falling down again upon the sides of the Vessels, its weight proves too much, or rather an over∣match, for its circular mo∣tion.

XV. The Veins prove varicose many times, in Women with Child, from that exceeding thickness of the Blood; occasioned from its being robbed of its nutritious Serum; and sent partly to nou∣rish the Foetus in the Womb.

XVI. The Veins are also varl∣cose in Cancers, either from the coagulation of the Serum, or gru∣mousness of the Blood some where in its passage; by something pressing upon the Part, or some compression made by the matter of the Tumor; by which it happens, that the current

of the Vein beyond it is stopt, and so is forced to swell.

XVII. In a Woman with Child, if the burthen lyes vehemently, or presses much upon the Ramus Illiacus, on either side of the Body, it makes the Thigh and Leg on all that side va∣ricous.

XVIII. The external Causes are, from too strait Gartering, which may cause Varices in the Leg: so the weight of the Te∣sticles, or pressure of a Bolster-Truss in a Rupture may render them varicose.

XIX. Riding much on horse∣back does the like; because of the pressure made upon the in∣side of the Thigh by the Sad∣dle, more especially if riding with long Stirrups.

XX. They may also proceed from Blows, overmuch strainings, as in the Bellies of Women who have hard travel in Child-bearing, long and tedious Foot-journeys, extream hard Labour, and the like; where the continual standing puts the Muscles up∣on contraction; whereby they press upon the upper Branches of the Thigh-Veins, and so straiten them, and hinder the free ascent of the Blood.

XXI. The Prognosticks. Va∣rices are not dangerous in them∣selves; for they rather free the Patient from imminent and dan∣gerous Diseases; especially such as proceed from Melancholy.

XXII. Hippocrates, lib. 6. aph. 21. says, Insani si Varices vel Haemorrhoides supervene∣rint, Insaniae fit solutio: i. e. If Varices or the Hemorrhoids happen to such as are Mad, they are thereby freed from their Madness. Moreover, the whole Body is by them throughly purged from all the flatulent Blood.

XXIII. Galen, de Venae se∣ctione, adversus Erasistratum, cap. 6. & libri de Atra Bile cap. 4. says, that Madness, Pleurisies, Pain of the Reins, Hemorrhoids, Coughing, Spit∣ting of Blood, Apoplexies, Cachexies, Dropsies, and other Diseases may arise from their being unreasonably taken away.

XXIV. And if they break, and flow intemperately, they may also cause Cachexies, Dropsies, Con∣sumptions, and other the like Diseases: and Sennertus says they are sometimes changed into the Elephantia Arabum, which is a cancerous Tumor of the Feet.

XXV. The Cure. These Vari∣ces ought not to be cured, unless they be very great, and that the Veins and Skin by reason of their extension are so exte∣nuated, as to endanger a Ru∣pture; whereby a great profu∣sion of Blood, and Death it self may ensue.

XXVI. Nor are they to be cured, unless they be inflamed, or extreamly painful, or if there is present some great and mali∣gnant Ʋlcer; lest they being removed, some more vehement mischief should ensue; since those things only may be said to cure, that wholly frees the Patient, not causing or gene∣rating Diseases more dangerous than the former.

XXVII. But if there is a ne∣cessity of curing them, the Cure must be begun with Purging and Bleeding; not once or twice, but often to be repeated, letting forth some of the Blood in the Varix: and whatsoever is amiss in the Liver and Spleen, or other Viscera, is to be corrected and amended, by altering, strengthning, astringent, and exsiccative Medicaments.

XXVIII. If the Varix is small and inconsiderale, Aquapendens orders it to be cured by Astringents: as, ℞ Gum Tra∣gacanth, dissolve it in Astringent Wine, or in juice of unripe Grapes, or of unripe Bramble-berries; to which add fine Bole, Mastich, Sanguis Draconis, Catechu, Ana, all in fine pouder; so much till the Tragacanth becomes as thick as Wax; so that in the palm of the Hand it may be reduced into the shape and form of a Wax-Candle: and sometimes also he used Hypocistis, for the same purpose.

XXIX. These Medicaments he applied, according to the length of the Varix, binding it down with a part of a Reed tied fast thereupon, with a narrow Band∣age; and over all, a Hose, or Buskin, made of a Dogs skin, which he put about, and fastned it about the Thighs, by lacing it on.

XXX. Hippocrates, in his Book of Ʋlcers, teaches us how to make an Evacuation of the Blood, that is already flown in. The Vein (says he) is not to be cut with any great and wide gash, lest thereby a great Ulcer should be caused; but the Varix is again and again to be pricked, whensoever it shall be fit; by which means, the Blood already flown in will be evacuated. And this you must do by little and little, not all at once, but as it were by degrees, till the Vein does even fall down and sink; upon which then it will be good to apply such Astringents, as we have mentioned before (at Sect. 28.) with good and strong Bandage.

XXXI. Aquapendens approves not much of the Chirurgick way of Cure, whether it be by Section or Burning; but thinks the Work is better to be done by inter∣ception of the Blood, with Astrin∣gent Medicines and strong Band∣age: and of this opinion is Mr. Wiseman. However, be∣cause we are willing that young Artists should know the Way of doing these things, we will give the Method of the Ope∣ration, from Paulus Aegineta, Corneiius Celsus, and Avicenna.

XXXII. From Paulus Aegi∣neta, lib. 2. cap. 82. Tye a String (says he) about the upper part of the Thigh, and cause the Diseased to walk, that the Varix may fill; then mark it with Ink, according to the situa∣tion, the length of three Fin∣gers, or more.

XXXIII. 2. After lay the Patient on his back, with his Thighs extended; and with an∣other String bind the part above the Knee; so will the Varix be filled, or lifted up a considerable height.

XXXIV. 3. And with an

Incision-knife, in the place marked, cut, but only no deeper than thro' the Skin, by no means dividing the Vein: distend the lips of the Section or Skin, with a little Hook; excoriating or flaying off the Membranes with a crooked Incision-knife, sò that the Vein may be laid naked and bare.

XXXV. 4. Then loosen the Thigh-bands, and by a little Hook, elevate the Varix; under which put a crooked or bowed Needle, drawing with it a double Thread, cutting in two the bow.

XXXVI. 5. This done, divide the Vein in the midst with a Venesectory-incision-knife, and eva∣cuate or let forth the Blood, as much as is needful; and by squeezing it out with your Fingers, if occasion requires it.

XXXVII. 6. After this, with one of the Threads tye close toge∣ther the upper part of the Vessel; and the Thigh being extended streight out, with your hands press forth the Blood which is in the Thigh: then with the other Thread tye close together the nether part of the Vessel or Vein.

XXXVIII. 7. This done, you may now either cut off and take quite away, that part of the Vein which lyes between the Ligatures; or otherwise let it remain, till at length, with the Threads it falls out of its own accord.

XXXIX. 8. The Operation being over, put in drying Lini∣ments, or styptick Pouders, and over, a long spleen-like Empla∣ster, after it has been throughly washt in Wine or Oxycrate, or with some styptick Liquor: then bind it down close, and cure it according to Art.

XL. From Cornelius Celsus, lib. 1. cap. 31. where he shews the Operation by Cutting, much as is before declared; and also by Burning with a red-hot Iron, in this manner.

XLI. Si recta est, si quamvis transversa, tamen simplex, si mo∣dica est, meliùs aduritur. Ad∣urendi ratio haec est. Cutis super∣inciditur; tum patefacta Vena, tenui, & retuso, Ferramento can∣dente modicè premitur; vitaturque, ne Plagae ipsius orae adurantur, quas reducere hamulis facile est. Id, interpositis ferè quaternis di∣gitis per totum Varicem fit, & tum superimponitur Medicamen∣tum, quo adusta sanantur. Viz. If the Vein is streight, or tho' it may be transverse, provided it is single; or if not very great, it is better to be cured by Burning. The manner of of which Burning is this. The Skin is first to be opened by incision, then the Vein being laid bare, it is moderately to be pressed down or burnt with a small and blunt Cauterzing-Iron made red-hot; and great care is to be taken, so to shun the lips of the Wound it self, that they be not burnt; which to reduce again with small Hooks, will be easily done. This may be performed by in∣terposing four or five fingers in a row, thro' the whole Varix, and then applying such a Medi∣cine, by which the parts burnt may be healed.

XLII. But, says he, if the Veins or Varices are crooked, and are as it were implicated into certain orbs or bunches: so that many of them are as it were involved and folded one within another; it is then more con∣venient to take them forth by Section, as is before de∣clared.

XLIII. Avicen, lib. 3. Fen. 17. Tr. 1. cap. 18. advises to cut the Skin, till the Varix appears; and this is indeed to be done long-ways, and not either obliquely or trans∣versly; then you must extract all the Blood that is in it, and cleanse it, by cutting it in length. Again, sometimes it is to be drawn forth with a Needle, and so to be cut: and sometimes the taking it forth with a Cautery, is better than the cutting it forth.

XLIV. Wiseman, l. 1. c. 14. says, If you proceed by Section, that you must divide the Skin, and separate the Teguments, and having raised the varicous Vein; you are to pass a Ligature above, and another beneath it, making a deligation of them; then slit the Vein, cast out the gross Blood, and afterwards digest and heal it, as you do in an Aneurysm.

XLV. Fabricius Hildanus, Cent. 4. Obs. 85. has this History. An extraordinary strong Man had in his left Leg a malign and inveterate great Ulcer, to∣gether with a Varix of a vast magnitude, equal in thickness to the brawny part of the Arm above the Wrist, and nearly a span long.

XLVI. It began in the very Ham, and descending towards the Foot, it made a ring, and two circumvolutions: whenever he lift up his Leg any thing high, the Blood presently fell back; and putting it down again, it immediately descended.

XLVII. He instituted a fit course of Diet, several times purged him, bled him in the Arm of the same side; and placing the Patient on a Bench, in the very Ham, he gently separated the Skin from the Vein it self.

XLVIII. Then with a Thread twice doubled, and put into the eye of a crooked Needle, he wound it about the upper part of the Varix, and in like manner in the lower part of the same: then he caused his Leg to be taken off the bench, and set upon the ground; that the Blood ac∣cording to its custom might flow downwards: after which he tied the Thread hard, and made fast the knots at both ends of the Varix, both upper and lower.

XLIX. After, with an Incision-knife, he made an Incision almost in the upper part of the Varix; that the Blood contained there∣in, as in a long and little Bag, might flow forth.

L. But the flux of Blood proving to be greater, than what was proportionable to the Tumor; he exactly viewed the place, and found a blind passage in the lower part of the Ligature, which entred into the Varix, from which the Blood flowed.

LI. This, because it could not

be tied with a Thread, he first applied to the entrance thereof, the Escarotick Ʋnguent; and af∣ter that, he put on in great abundance his own Astringent Pouder, with the white of an Egg for stanching the Blood.

LII. All these things he bound fast 〈◊〉〈◊〉, with a Swathband throughly moistned in Oxycrate, which he left till the following day: after which he healed the Wound after the usual manner of a Vulnerary Cure, and in a short time the Man became perfectly well and sound.

LIII. But after all, the Pallia∣tive Cure, with Aquapendens, Sennertus, Wiseman, and others, is rather to be embraced, than this of Section.

II. Tumors arising from CHOLER.

CHAP. XVII. Of an ERYSIPELAS.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Erysi∣pelas, Rosa, & Ignis Sacer; in English, Anthony's Fire. Of this Ignis Sacer, Lucretius, lib. 6. makes mention.

Et simul Ʋlceribus quasi inustis omne rubere Corpus, ut est, per membra Sacer cùm dicitur Ignis.

Red burning Ulcers the whole Body vex, As Ignis Sacer does a Part perplex.

II. Definition. It is a Tumor besides Nature, from Choler, or Choler mixt with some other Humor, as Blood, Phlegm, Me∣lancholy, or Serum, thrown forth the most part into the Skin it self, sometimes on the subjacent Muscles, causing pain, heat, and other Symptoms. Wiseman says, it is generated of a hot Serum in the Blood.

III. The Differences. It is per∣fect, when it proceeds from simple Choler; it is imperfect, when Blood, Phlegm, Melancholy, or Serum are mixt with it.

IV. And from this mixture of other Humors with Choler, the imperfect Erysipelas takes its name: 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Erysipelas phlegmanoo∣des 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Erysipelas oedematoodes. 3. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Erysipe∣las scirroodes.

V. But if Choler is joined with a malignant or caustick Salt, mixt in the Serum of the Blood; it causes 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Erysipelas ulcerosum; wherein, an Ulcer is joined with it, which sometimes consumes the Skin only, and sometimes the Flesh also with it.

VI. The Causes. In a pure Erysipelas, Barbett seems to say that Choler is the cause thereof; but in a bastard, it is Choler mixt with other Humors; as Blood, Phlegm, Melancholy, or Serum: whence those things which are good in a Phlegmon, are often∣times beneficial in an Erysi∣pelas.

VII. Yet Galen, ad Glauc. lib. 1. cap. 2. seems to say, that the cause of an exquisite Erysi∣pelas is, a most thin and hot Blood, or a cholerick Blood, hot∣ter than Nature requires: where he determins that pure Choler is not the original and effi∣cient cause of this Tumor, but rather of a Herpes.

VIII. Again, contrariwise, in his Book de Atra Bile, cap. 5. and Meth. Med. lib. 14. cap. 1, 2, 4. and lib. 17. cap. 2. also in lib. de differ. Febr. cap. 5. and many other places, he asserts Choler to be the true cause of this Tumor: which latter Opinion most of our Physicians follow.

IX. Wiseman says, lib. 1. cap. 6. pag. 34. that the Humon causing it, simply considered in it self, is very thin and sharp, much affecting the Pores of the Skin, in which it usually lodges; and in a great measure ows its con∣finement thither to their being shut up; they being covered with a Cuticula, whose density hinders transpiration, from whence pain and redness arise.

X. And, says he, oftentimes other Humors are invited thither, so that the Tumor enlarges it self, and becomes compound; and as he will have it to be generated of a hot Serum in the Blood, so he will have the same to be a thin cholerick Humor, which is the cause of a pure Erysipe∣las, whose fountain is Blood; which by its capillary Arteries discharges it upon that part, as oft, as in cholerick, malign, and pestilential Fevers it is prompted thereunto.

XI. There are also external Causes, as heat of Sun, sharp Medicines, vehement Travelling, Contusions, Fractures, and the like: all which in cholerick Bo∣dies, thro' the turgency of the Blood, cause a separation of the Humor, when Nature for her relief casts it forth into the superficies of the Skin.

XII. The Places. Whilst it is simple, the Skin only is the seat of it, or the Periosteum, or a Bone that lies bare: but if compound, it affects the Flesh also, and the adjacent parts. Wiseman.

XIII. As to the particular Parts, it most commonly invades the Nose and Face, Legs, Thighs, Arms and Shoulder-blades, and some parts of the Back: but it may affect any Part, where Na∣ture is disposed to cast the Humor out upon it.

XIV. The Signs. There is redness mixt with yellowness, great heat, sharp pain, easily giving way

to the touch, and as easily re∣turning again: the swelling and extension of the Part little, and the pulsation less.

XV. It is always accompa∣nied with a Fever, except it be from an external cause; and yet then as it begins with some little rigor, so it is continued with a small kind of Fever.

XVI. A pure Erysipelas affects the Skin with a shining, or pale red, or citron-colour, without pul∣sation, or circumscribed tumor, spreading from one place to ano∣ther. Or, its colour may be said to be a shining yellow∣ish mixt with red; with ve∣hement heat, pricking pain, and blistring the Skin, and creeping about the Part affected.

XVII. It may be known from a Phlegmon by these tokens; that whereas a Phlegmon is under the Flesh, deep among the Mu∣cles, its heat is less, its sym∣ptomatick Fever less; the pain of the Tumor more, its colour of a dark red, by reason of thick Blood, the pain dull, heavy, and stretching and swel∣ling, not yielding to the touch, and being pressed with the finger, not becoming white: also it possesses but one place, and is manifested with a single elevation and circumscription.

XVIII. Now in an Erysipelas, the Tumor is superficial in the Skin, Heat more acute, Fever greater, Pain less, but more sharp and pricking, Colour brighter; Tumor yielding to the touch, and returning again; which being pressed upon, becomes white, spreads it self round the adjacent places, and with∣out circumscription or eleva∣tion, unless in many little Blisters.

XIX. The Prognosticks. A pure or simple Erysipelas is seldom dangerous, unless the Matter is repelled from the external to the internal parts.

XX. But if it seizes on the Jaws, or on the noble parts, or is accompanied with a Wound, Fracture, Dislocation, or Putrifa∣ction; it is dangerous, and more difficult of cure.

XXI. If it is with a Fever, that diminishes, as the Erysipelas increases; according to Hippo∣crates, sect. 9. aph. 25. When the Matter is sent from within outwards, the Viscera are re∣lieved, and the Patient recovers: But the sudden return of the Humor inwards is a bad sign, ill Symptoms frequently fol∣lowing, and sometimes death it self, if the Emunctories were affected.

XXII. Galen, in his Comment on the same Aphorism, says, That Suppuration in a malign Erysi∣pelas is not good, but does for the most part corrupt; as is seen by the discoloured Pustles which arise about them.

XXIII. An Erysipelas upon the adjacent parts to a bare Bone, is evil; and if a delirium happens, there is imminent danger.

XXIV. An Erysipelas invading upon Wounds, Ʋlcers, Fractures, and Dislocations, is mostly mortal; if it does not come from the application of too hot external Medicines.

XXV. An Erysipelas appearing

in the Head, is more dangerous than in other parts; because upon the Morbifick-matter pas∣sing to the Meninges, a Phrensy or Raving is induced; if it passes to the Muscles of the Neck, a Quinsey.

XXVI. The Cure. The Indi∣cations of Cure have respect to Causes, Procatartick, Antecedent, and Conjoyn'd; and so according∣ly we shall institute a proper Diet, proper Internals, and proper Externals.

XXVII. As to the Diet, as in hot Tumors, it ought to be (both Meat and Drink) cooling, and sparing; the Food may be Grewel, Penado, Chicken or Mutton Broth with cooling Herbs; and their Drink, Barley-Broth, Emulsions, Juleps made of distilled Waters, the white Decoction made of burnt Harts-horn, made pleasant with Syrup of the juice of Citrons, Limons, clarified Whey, &c.

XXVIII. Galen, Meth. Med. lib. 9. cap. 5. permits the Patient to drink as much cold Water as he will; because it resrigerates the Body, quenches Thirst, cools the Liver, and abates the heat of Choler: but with this permis∣sion, the Stomach ought to be strong, and the Season hot, if also it is made pleasant with Syrup of Limons, it will be so much the better.

XXIX. Small Beer boiled with a crust of Bread is good, especially in Summer-time, when the Air ought to be made arti∣ficially cool.

XXX. All hot, sharp, fat, and sweet things are forbidden; as also too great Motion of the Body, Anger, Venery, Costive∣ness, and much Watching.

XXXI. The second Indication has respect to the Antecedent Cause; where Bleeding and Purging are chiefly to be consi∣dered.

XXXII. If the Erysipelas comes upon Wounds, or such like acci∣dents, and where it affects the Head, Face, or Neck and Throat, endangering a Phrensy or Quin∣sey, (which latter may hazard Suffocation,) or in a Phle∣gmonoodes, Authors prescribe Bleeding.

XXXIII. But in an exquisite Erysipelas in other parts, Bleeding is forbidden; because, not only the good and bad Blood are both taken away together, but the Patient is also much weak∣ned thereby; and the Blood is made more subtil and vehement in its motion, and the Cholerick Humor is excited.

XXXIV. If it is a simple Erysipelas, and be but in the Skin, you must evacuate the redun∣dancy of Humors, and repress the ebullition of Choler, with proper Catharticks.

XXXV. If the Body is caco∣chymick, purge with proper Cho∣lagogues; as, Electuarium leni∣tivum, Diacatholicon, Diapru∣num solutivum, an Infusion of Sena and Rhubarb, in fair Wa∣ter, &c.

XXXVI. If the Inflammation is not extream, the Decoction of cooling Herbs, with Cassia dissol∣ved in them, will be of good use; which may be repeated, as you see cause.

XXXVII. After due purging, sweat gently with Antimonium diaphoreticum, Bezoardicum minerale, vel solare, in Tinctura Corticum, or a little Treacle-Water.

XXXVIII. If the Body is ple∣thorick or gross, purge with Cassia, Manna, Tamarinds, Cre∣mor Tartari, Sena, Rhubarb, made with Whey, or Decoction of Barley, and the Opening Roots, Syrupus catharticus, and the like.

XXXIX. After which, give Spirit of Sal Armon. in Milk or Water; or some Treacle-water, or Our Spiritus Cordialis, to open the Pores, and provoke Sweat.

XL. The third Indication has respect to the Proximate or Con∣joyn'd Cause; and this relates only to Topicals.

XLI. In Applications to the part affected; consider whether the Disease is from an Internal or External Cause; and whe∣ther it is great, or small.

XLII. If it is from an Internal Cause, Internals are first to be used, as we have before directed, to wit, Evacuation by Purga∣tives; unless it is remote from the principal Parts, and the heat is vehement; in which case, you may pretermit Inter∣nals, and apply Externals, gently to refrigerate the Heat; and then proceed to Purging.

XLIII. If it is from an Ex∣ternal Cause, you may safely apply Refrigerants, without any previous Evacuation; because the Affect took its rise meerly from the distemper of the Part; as heat of Sun or Fire, sharp Medi∣cines, Contusion, Fracture, &c.

XLIV. But as to Topicks, you must avoid the application of Oils, or fat things; because they in∣crease the Putrifaction, by stop∣ping the Pores; and are apt more to inflame the Part, or induce a Gangrene.

XLV. Nor must you in any case apply astringent and repel∣ling Medicines, which are cooling and drying; especially if they have an Emplastick property with them; lest the sharp and corrosive Vapors being kept in, should erode and corrupt the Part. 2. Or extinguish the Natural Heat, and create a Gangrene. 3. Or revert the Humor inward upon the Viscera, and so some∣times cause Death.

XLVI. Fabricius Hildanus, Cent. 1. Obs. 82. gives us a fa∣mous Example, to make us beware of using of Oils or Ʋnctuous bodies in an Erysipelas. A Country∣man having an Erysipelas in his left Hand, by a Barber's advice anointed his Hand and Arm with Oil of Roses for several days; on which Pain and In∣flammation succeeded, and all the Symptoms grew worse and worse, till the whole Hand was gangrened: when he came to me, (says he) I scarified the Part, and applied other things for the cure of a Gangrene, and so he was made well.

XLVII. Let therefore the To∣pical Applications be cooling and moistning; let them be actually cold, liquid, and thin, and often changed or renewed; not much astringent, lest you dry the

Skin, and prohibit Transpira∣tion: so that including the Humor, it should grow sharp, corrode the Parts, or cause Apostemation, or some other worse evil, and so Death.

XLVIII. For this reason, Spi∣rit of Wine is very evil, not only because it is hot, but because it is of such an exsiccating quality. I knew one who had an Ery∣sipelas in the brawny part of his left Arm, One of the Quacks was sent for, who immediately prescribed bathing it with camphorated S.V. and to lay over it Cloths dipt in the same; the Bathing was repeated four or five times the first day, and again at bed-time: the next morning the Part was livid, and a Gangrene had seized the Arm; and the mighty Doctor not understanding the condition of the Sick, boasted he had done the Cure, and so continued another day the same Means; on the third day a Sphacelus was manifest: an honest Chir∣urgeon was sent for, who told the Relations that there was no remedy but cutting off, and it was doubtful whether that would do, by reason of the proximity of the Affect to the more noble parts; for which reason he declin'd the Opera∣tion, in a few days more, the Sick was seiz'd with Vomiting, Fainting and Swooning Fits, and upon the eighth day died.

XLIX. Simples proper on this occasion are, Fumitory, Plan∣tane, Fleawort, Maidenhair, Lettice, Purslane, Nightshade, Marsh-trefoil, Hemlock, House∣leek, Horstail, Navelwort, Ducks∣meat, Poppies, &c. the juice of them may be expressed, and applied.

L. Or you may make a De∣coction of them in Water and Vinegar, in which Myrrh may be dissolved: or a mixture of Frogspawn-water two parts, with Vinegar of Roses one part, in which Myrrh as aforesaid, may be dissolved.

LI. If it is a simple Erysipelas, after cooling Topicks have been applied, and other general Remedies, the total discussion ought to be left to Nature.

LII. You may foment with Saccharum Saturni dissolved in juice of Housleek, upon which you may apply Ceratum frigidum Galeni, or a Cataplasm of the leaves of Plantane, with Frog∣spawn-water.

LIII. If at any time you use Repellers, be sure to mix Discus∣sives or Resolvents with them.

LIV. Wiseman commends this, ℞ Ceruse ℥viii. Litharge of Gold ℥iv. Mucilage of Fleawort seeds, and of Quince seeds, extracted with Nightshade-water, juices of Nightshade and Maidenhair, A. ℥iii. Vinegar ℥ii. Oil of Roses and Myrtles, A. lbss. Calves suet ℥iv. boil to the consumption of the Juices, then add Frank∣incense in pouder ʒx. Wax q.s. mix. and make a Cerate.

LV. Ceratum infrigidans ••a∣leni. ℞ Oil of Roses lbi. white Wax ℥iv. mix, and wash them with Vinegar and juice of Night∣shade, and make a soft Cerate.

LVI. These things strongly draw forth the Heat, viz. Diapalma,

vel Empl. album, dissolved in Vinegar: or leaves of Tobacco, Coleworts, or Henbane, bruised and applied, and often re∣moved: or Sheeps-dung boiled in Vinegar; flowers of Elder, Melilot, and Camomil, boiled in new Milk: or Chalk scraped, and strewed upon the Part, laying Cap-paper over it.

LVII. This Fomentation is good: ℞ Wine-vinegar, juice of Housleek, A. ℥v. Myrrh in pouder ʒiii. Saccharum Saturni ʒi. Opium ℈i. mix, dissolve in a a gentle heat, and dip linnen Cloths in it; applying them warm, and often renewing them.

LVIII. But as for Opiates and Narcoticks, you ought to be very cautious in using them; unless there is exceeding great Pain, and the place affected be far from any principal Part.

LIX. Heurnius commends Castle∣soap dissolved in fair Water, to foment with warm: or Bulls-dung boiled in a Frying-pan with Vinegar, Camomil, and Elder-flowers, till it comes to a Liniment, these are good for the Face.

LX. If the Disease proceeds from Internal Causes, Decoction of Sage, with a Solution of Castle-soap is to foment with∣al; over which Ceratum insrigi∣dans Galeni may be put: but if it is Critical, you may use Ceratum album, or refrigerans; described in Our Pharmacopoeia aforegoing.

LXI. If the Heat is vehement, the application is daily to be re∣newed; if not, once in two days will be enough.

LXII. Barbett commends this: ℞ White Troches of Rhasis ʒi. Camphir ℈i. S.V. ℥i. Elder-water ℥vi. mix; and apply them as before.

LXIII. And if the Erysipelas is in the Face, the same Barbett commends the fumes of Mastick and Frankincense; to be used five or six times a day.

LXIV. For an Erysipelas in the Head, Aetius commends a Swal∣lows nest made into pouder, and mixt with Honey; which is to be anointed on the Part with a Feather.

LXV. Wiseman advises us, not to be too forward in our Ap∣plications to the Face, or parts about it: but he says, he com∣monly used Aqua Calcis with Linseed-oil, well shaked toge∣ther, with good success.

LXVI. And he applied this following, where greater drying was required. ℞ Spirit of Vin∣egar in which Litharge or Minium has been boiled: let it settle, pour off the clearest, and filter it; which put into a Glass with Oil of Roses, and shake them toge∣ther.

LXVII. Or, ℞ Saccharum Sa∣turni ℥ss. Oil of Roses, or rather Oil of Ben ℥i. beat them up to∣gether: this, or the former, apply with a Feather twice or thrice a day.

LXVIII. If the Erysipelas is ulcerated: ℞ White Troches of Rhasis ʒii. red Myrrh, Litharge of Gold, A. ʒi. flowers of Sulphur ʒss. Sarcocol ℈ii. whites of Eggs q.s. mix, and make a Liniment, which apply.

LXiX. Or this of Wiseman:

℞ Oil of Roses ℥vi. Sheeps-suet ℥iv. white Wax ℥ii. Ceruse ℥jss. Trochisci albi Rhasis, Tutia in pouder, A. ʒjss. burnt Lead ʒi. Camphir ℈ss. make an Ointment by grinding the Ingredients in a leaden Mortar for two hours: this will cicatrize the Ulcers.

LXX. How long Externals, in the first Intention, are to be ap∣plied. Truly, When the Heat is altogether, or nearly abated, and when the Skin has recovered its own colour, you are to desist from application, especially of cold To∣picks; lest the Skin becomes livid or black, and a Gangrene be induced, or a Mortification: and then apply Resolvers and Discussives to corroberate the Part, and restore it to its natural Tone.

LXXI. For tho' an Erysipelas does not arise with any circum∣scribed Tumor, yet after it is vanished, the Part is swell'd; and in progress of time, for want of discussion, may become oedematous, or otherwise grow into a hard Tumor.

LXXII. In these cases, you may first foment with this De∣coction: ℞ White Port-wine a quart, tops of Wormwood, Camomil flowers, red Roses, A. ℥jss boil; and to the Decoction add Brandy or S.V. ℥iii.

LXXIII. And then apply over the Swelling either Ceratum de Galbano, or de Gummi Elemi, or Spermatis Ceti, either of which will discuss, or soften and dissolve the Tumor: See them in the Pharm. Chirurgica, in lib. 1. cap. 76. sect. 3, 4, 8. of this present Work.

LXXIV. If a Gangrene is al∣ready induced, foment with a weak Lixivium of Potashes, in which Calamine, Centory the less, Hyssop, Mint, Peniroyal, Scordium, Southernwood are boiled: then apply Hippocrates his Cataplasm, made of Barley-flower, Vinegar, and Oil of Roses, warm. Or this: ℞ Barley and Bean flower, A.℥vi. weak Lixivium lbiv. boil to the thickness of a Plaster, adding Oxymel simplex ℥iv.

LXXV. But if the Skin looks black, and has passed into a Mortification, you must scarify, and then pursue the Cure according to the Rules deli∣livered in the former Cha∣pter.

CHAP. XVIII. Of ƲLCEROƲS PƲSTƲLES.

I. THIS Disease is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Herpes miliaris & ulcerosus; in English, Ulcerous Pustules, or an Ulcerous Herpes. It is so called, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, à serpendo, from Creeping.

II. It is a preternatural Tu∣mor, springing from yellow Cho∣ler, mixt with a salt Serum,

disfiguring the Skin with cor∣roding and spreading Pustules.

III. The Causes. The Proca∣tartick Cause is taking cold, lying in cold places, eating and drinking sowr and salt Meats, and even to surfeiting and drunkenness, and persisting in even a continued surfeiting course of living, where∣by plenty of evil Humors are bred.

IV. The Antecedent Cause is Choler mixt with a putrid Lym∣pha, or with a preternatural salt Ferment in the Blood; which being by some violent action, surfeiting, or the like, stirred up into act, causes this kind of Breaking-out.

V. The Conjoined Cause, is a salt, watery, and pus-like Matter protruded out into the Cuticula.

VI. The Signs. It rises in a cluster of small Wheals, not much differing from the colour of the Skin, and are first discovered by their itching: and being rub∣bed or scratched, there issues out a thin serous Humor: or not being scratched, they swell many times to the bigness of small Tares, or great Pins-heads, which drying, they become a Scab.

VII. They many times creep up and down; and as they heal in one place, they often break out in another; being mostly of a cluster, like to Millet-seed.

VIII. The Prognosticks. There is little of danger in this Disease, unless rendred so by the unskilful use of Repellents: it is without a Fever, but is of difficult cure, especially if it is in the Face, Nose, or Ears.

IX. If it is neglected, or ill handled, it eats deep into the Flesh; and then in what part so ever it is, it is very hard to be cured, degenerating some∣times into Herpes exedens.

X. The Differences. There are three kinds of Herpes: 1. Simple, to wit, the Shingles; which tho' they proceed from Choler, or a cholerick Blood, yet they dif∣fer from the other two kinds; because these of the first sort are for the most part Critical, as coming forth after a Fever or Ague, or some other illness. See Lib. 2. Cap. 24 aforegoing.

XI. 2. The millet-like Herpes, being mostly like Millet-seed, as to bigness, which differ from the former, in the Humor causing them; and from the latter, in the form of the Tumor or Breaking-forth; and in the place first affected, which is the Cuticula.

XII. The eating Herpes, which affects the Cutis or Skin, and many times the Flesh also: this, says Sennertus, is of the nature of an ulcerated Erysipelas, from which notwithstanding it differs in the thinness of the Humor.

XIII. There are two Indica∣tions of Cure: the first, which respects the antecedent Cause; the second, which respects the conjoined.

XIV. In respect to the antece∣dent Cause; the Diet ought to be the same as in an Erysipelas, cooling and moistning, and which may attemperate Choler, and salt Phlegm.

XV. Bleeding here is not al∣lowed, but Purging is very necessary;

and since it has its original from yellow Choler, mixt with a salt Lympha or Serum, they are first especially to be purged out of the Body: and it is the opinion of Sennertus, that un∣less the Body is purged, the Sick will never be perfectly cured.

XVI. For this purpose, you may make use of Rhubarb, Me∣choacan, Jallap, Scammony, Cam∣bogia, Sal mirabile, Juice or Syrup of Damask-roses, and Sena; which last is said to purge all Humors: these may be given in Infusion, Decoction, or some proper me∣dicated Ale: Decoctions of Sarsa and China, are also good.

XVII. In respect to the conjoin'd Cause, Barbett is not for repelling Medicaments, lest being drove to the internal parts, it should excite a Fever, and other ill Symptoms: and therefore he advises to the often use of Fasting-spittle, which does good.

XVIII. He also applys the pou∣der of Lapis scissilis, mixt with Vinegar, with great success. Some use Mustard boil'd in Butter, to which others add Gunpowder: Lye also, and Urine, he says, has helped many.

XIX. Pouder of Chalk mixt with Cream, is said to be good to anoint withal; fomenting before∣hand with hot Lees of Wine: also Ʋnguent. Fuscum Wurtzii is excellent here, being prudently applied. Or,

XX. ℞ Mastich, Frankincense, Lapis calaminaris, Goat-suet, A. ℥ss. white Troches of Rhasis, Litharge, Myrrh, A.ʒiii. Sarcocol, flowers of Sulphur, A.ʒii. Wax, Turpentine, q.s. mix, and make an Emplaster, and apply it.

XXI. Wiseman says that this Disease comes near to the nature of the Itch, and is to be treated with Purgatives and Altera∣tives, much of the same kind with those which are proposed for that.

XXII. And as for Topicks, he advises such as powerfully dry: you may foment with Lac Vir∣ginis, and then anoint with Oleum Anodynum, Oleum Colo∣cynthidos, Ʋnguentum ad Sca∣biem, vel Tutiae; over which you may apply Ceratum album, vel Oxylaeum, vel Refrigerans, to consummate the Cure. If broken, cleanse and dry with Lixivium of Calx vive, mixt with Saccharum Saturni.

XXIII. If these things do not, you must anoint daily with Un∣guentum Nicotianae; which com∣monly masters the Disease, tho' it is very rebellious and stub∣born.

XXIV. Valescus de Taranta commends this following for a Secret. ℞ Greasy Wool of a Sheep, and roast it by the Fire until it is black, which make into a pouder, and mix with Rose-water, till it becomes a Liniment: with which anoint the Part affected with a Feather thrice every day, till it be well.

CHAP. XIX. Of EATING PƲSTƲLES.

I. THIS Disease is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Herpes exe∣dens; but by Celsus, Ignis sacer: in English, the Eating Herpes, or Eating Pustule.

II. The Differences. This is the third kind of Herpes, and differs from the two former; chiefly in the Humor causing it, and the manner of its progress, which is by eating.

III. It is almost like to an Erysipelas exulcerated, but does differ from that in the thinness of the Humor; as Galen, Meth. Med. lib. 14. cap. 17. affirms in these words:

IV. Est (inquit) admodum tenuis Humor, qui Herpetem ex∣citat, adeo profectò, ut non solum omnes interiores Partes, quae uti∣que carnosae substantiae sunt, trans∣eat, sed etiam Cutem ipsam ad summam usque Cuticulam, quam solam, quòd ab ea retine∣tur, tum erodit, tum exedit; quando si hanc quoque sudoris vice transiret, haudquaquam Ʋl∣cus excitaret. Viz. It is (says he) a very thin Humor which excites the Herpes, even so thin, that it not only passes thro' all the interior Parts, which are likewise of a fleshy sub∣stance, but also thro' the very Skin it self, even unto the utmost part of the Cuticula or Skarf-skin, the which alone, for that it is kept in and re∣teined, it both erodes or gnaws, and likewise then eats thro'; whereas should it pass thro' it by sweating, it would not excite any manner of Ulcer.

V. The Causes. The Proca∣tartick and Antecedent Causes are almost the very same, as in an Erysipelas: yet in this more disposed to the generating of an excrementitious yellow Cho∣ler, than of a cholerick Blood.

VI. Wiseman says, that the Matter or Humor added to the Choler partakes much of acri∣mony, and proves exceeding cor∣rosive: and indeed it is caused from a corrosive and malign Salt, mixt with an exceeding thin excrementitious Bile.

VII. The Signs. It is a broad Tumor, which has little or no height in it; so that the Part is scarce∣ly lifted up at all, but seems rather to be exasperated, than to swell up to any considerable heighth, accompanied with a certain kind of hardness and pain, with a sense of heat and burning.

VIII. Celsus, lib. 5. cap. 26. says, Est Malum cum summae Cutis excoriatione, & exulcera∣tione; sine altitudine, latum, sub∣lividum, inaequaliter tamen; me∣diumque sdnescit, extremis proce∣dentibus; ac saepe id quod jam sanum videbatur, iterum exulce∣ratur,

ac circa proxima Cutis, quam malum occupaturum est, tumidior & durior est, coloremque habet ex rubro subnigrum: viz. It is (says he) a Disease with excoriation and exulceration of the Epidermis or Scarf-skin, without any height at all, broad, somewhat pale and wan, or almost livid, yet unequally; the middle of which becomes whole, when at the same time, the extream parts thereof are in their progress and motion for∣wards: and many times, that which seems to be altogether whole and sound, becomes ex∣ulcerated again; and the Skin which is next about it, that the Herpes is even now ready to seize upon, is somewhat more swelled, and harder; and it has a colour changing from red, to that which is dark and blackish.

IX. Wiseman, lib. 1. cap. 17. says it is rather an Ʋlcer than a Tumor, but is indeed an Ʋlcer with a Tumor; it rising in the Skin in a small Tubercle, on the top whereof appears an Ulcer like a pin-hole; and is for the most part without in∣flammation or pain.

X. When it arises alone, it is scarcely taken notice of; it mat∣tering but little, unless it is pricked, and then it scabs soon after with a thin scurf.

XI. But in its progress, it shews its evil nature and con∣dition, by eating away the Skin; and indurates the Flesh under∣neath it, and the Parts there∣about.

XII. Sometimes I have seen (says he) these Ʋlcers arise in the Skin, somewhat distant one from another, making an unequal farrow; as from the upper Lip by the Nostril, creeping to that side of the Nose, so to the ridge of it, and down again to that corner of the Eye; healing in some places, whil'st it eats deep into the Flesh in others.

XIII. This Herpes in Lues Venerea often arises from a simple Herpes, while the matter is shut up by the Scab, and corroding underneath, makes an Ulcer, which breaking out, appears like an Honey-comb, bigger, or lesser, long or round, as the Disease has more or less ma∣lignity.

XIV. The Prognosticks. It is not easily cured, and usually of long continuance; unless in the Cure a due regard is had to the antecedent Cause, and Habit of the whole Body.

XV. Wiseman says, if it be not (well and) timely treated, it degenerates or terminates in a Phagedena, or cancerous Ʋlcer: but when it arises from Lues Venerea, the very worst is cureable.

XVI. The Cure. Let the Diet be cooling and moistning, attem∣perating Choler, and absorbing the acid and corrosive Salt; and purge the Humor off, either with Our Family-Pills, Electua∣rium Catharticum, or Pilulae Catharticae: or with an Infusion of Sena, Rhubarb, and Liquo∣rice, in White-wine.

XVII. Bleeding is not permit∣ted, but Baths are excellent,

and their Waters taken at fit times, are said safely to cure this Disease.

XVIII. This Purging-pouder is good. ℞ Cremor Tartari ʒiii. Tartar vitriolate ʒss. Scam∣mony in fine pouder ℈ii. mix them. Dose, ℈ii. either every morning, or every other morning, with Broth.

XIX. ℞ Wormwood-tops, Scor∣dium, Mechoacan thin sliced, A. ʒiii. Aniseeds, Caraways, A. ʒii. choice Sena ℥ i. Rhubarb thin sliced ʒ j ss. cut and bruise all, put them into a Bag with a Stone in it; which put into white Port-Wine lbv. after two days drink of it. Dose, half a pint every morning, fasting.

XX. ℞ Raspings of Guajacum ℥iv. Sarsaparilla, roots of the sharp-pointed Dock, A.℥ijss. Li∣quorice bruised ℥i. Fumitory M.ii. Groundpine M j. choice Sena ℥i. Scammony in pouder ʒii. dissolved in a little Wine, fair Water lbvi. White-wine lbjss. mix, digest in B.M. for twenty-four hours; then boil a little, and strain out. Dose, from ℥iv. to ℥vi. or viii. every morning fasting.

XXI. As to Topicks, you may anoint with Ʋnguent. Fuscum Wurtzii, Mercuriale, Cosmeticum, vel ad Scabiem: but nothing is superior to an Ointment made of green Tobacco, raised in England from Virginia Seed; or bathing the Affect with the juice of the same, and laying a green leaf over it: this cures it in a short time.

XXII. Barbett commends this: ℞ Ʋnguenti Fusci Wurtzii ʒiii. Ʋng. Albi cum Camphora ʒjss. Ceruse, Sulphur, Myrrh, A. ʒi. Verdigrise purified, Mercurius dulcis levigated, A. ʒss. Oil of Roses q.s. mix, and make an Ointment.

XXIII. Or, ℞ Flowers of Sulphur, Ceruse, Camphir, A. ℥ss. Lapis Prunellae, Saccharum Sa∣turni, Mercurius dulcis levi∣gated, A. ʒii. old Rape-oil, or Oil of Scorpions, A. q.s. mix, and make a Liniment; and over it, you may apply Emplastr. Diasul∣phuris Rulandi.

XXIV. Lac Virginale con∣stantly used, as five or six times a day, or oftner; and Cloths dipt in the same laid over; is an ex∣cellent thing, and used for some considerable time, certainly cures.

XXV. 'Tis certain that one of the conjoined Causes of this Evil, are certain Animalcula, or little Worms, (which by some Microscopes I have perceived) which perpetually gnaw and eat: and therefore whatever effectu∣ally kills them, cures this Dis∣ease; for which purpose (be∣sides Mercurials) nothing seems to be more effectual than Sac∣charum Saturni, of which the Lac Virginale is made, and Tobacco.

XXVI. As to the latter, where green Tobacco cannot be got, I have done great Cures of this kind, by 1. Bathing often with a Lixivium of the ashes of dried Virginia Tobacco. 2. By Anointing with the Ointment made of dried Virginia. 3. By Washing sometimes with an Infusion or Decoction of the same Tobacco in Water. 4. By Applying a Leaf of the same,

moistned in the said Infusion or Decoction, over the Ulce∣ration, or Part affected.

XXVII. Sennertus commends this: ℞ Litharge, Ceruse, A. ℥ii. Pomgranate-peels in pouder ℥ss. Frankincense ʒ j ss. Verdi∣grise, Alum, Myrrh, A. ʒi. Wax, Oil of Myrtles, A. q.s. mix, and make an Ointment. But if this (says he) will not serve the turn, but that the Ulcer and putrifaction creeps farther, you must have recourse to the stronger sort of Remedies.

XXVIII. ℞ Sheep-suet, Oil-olive, A.ʒiv. Auripigmentum ʒii. corrosive Sublimate ʒss. Quick∣silver kill'd with fasting-spittle, ℥ss. Litharge of Gold and Silver, and Ceruse A.ʒiii. mix them in a glass Mortar, for use. Wise∣man.

XXIX. Mercurius dulcis, red and white Precipitate, Arcanum Corallinum, or Turpethum Mi∣nerale mixed with some proper Ointment: or Sheep-suet and Oil-olive, ana, oftentimes serve to good purpose in curing this Disease.

XXX. But in the more rebel∣lious, they are to be fomented with a good Lixivium; or an Ablution of Turbith Minerale. And sometimes Spirit of Vi∣triol, and the Caustick-stone it self may be used: but such Corrosives are not to be ap∣plied to the Face; more espe∣cially not the Nose, because the Cartilages and Bones lye so near the Skin.

XXXI. Municks advises to this Wash. ℞ Roots of White Hellebor, Elecampare, Florentine-Orrice, Althaea, A. ℥i. pulp of Coloquintida ℥ss. leaves of Savin, Tobacco, A. ℥i. Roch-alum ℥ii. Litharge ℥viii. Rain-water q.s. mix, and boil to ℥xl. strain, and add Wine-vinegar ℥xii. mix them for use.

XXXII. Or this. ℞ White Hellebor-roots ℥i. roots of Ele∣campane, of Florentine-Orrice, of Esula, and Althaea, A.ʒvi. leaves of Savin M. i. pulp of Coloquin∣tida ʒiii. Alum ℥ss. seeds of Stavesacre ʒ vi. Litharge ℥ vi. Oak-ashes ℥viii. Water q.s. boil to lbiii. or ℥xl. strain, and add Wine-vinegar ℥vi. mix them.

CHAP. XX. Of the SMALL-POX.

I. THIS Disease is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Pustularum eruptio; ab 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, effloresco: also by Hippo∣crates, Epidem. lib. 3. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, quas Pustulas Interpretes vocant, i. e. Papularum eru∣ptiones: in Latin, Exanthemat•…•…, Ecthymata, from the Gre•…•…; also Variolae, from Vari, Pimples; because they are a sort of Pim∣ples or Pustules, breaking forth

of the Flesh, upon the Skin: and in English, it is called the Small Pox.

II. The Definition. The Small Pox are a pustular Eruption be∣sides Nature, of a morbifick Mat∣ter, thro' the Flesh into the sub∣stance of the Skin; by reason of a Fever, and preternatural Ferment of the Blood and Lympha with Choler, and the help of the Expulsive-faculty.

III. The Causes. They are either remote, or present: the remote, are the radical Impurities of the Mothers Blood, which the Child in the Womb receives into it self with its Nourishment; and lies dormant or hidden for some Months or Years, in the fleshy substance of the whole Body.

IV. The present Cause, is the boiling of Choler, or fermentation thereof with the Blood and Lym∣pha, stirred up by some accidental provocation, and induced by a strong preternatural Heat, in∣ducing a continual, violent, and malign Fever.

V. The Kinds. This disease is twofold; first, that in which the manifold Pustules breaking out, are each of them entire, and distinct one from another: se∣condly, that in which they run all into one, as it were, and much like a Bladder, which the Vulgar call the Fluxing kind.

VI. This latter kind is very rarely caused or excited by any one Humor whatsoever; but for the most part there are many Humors mixed together, especially cholerick, salt, and serous or wheyish Humors; which making the ferment greater and more universal, cause the Pox to break out in such heaps, so as to flux as it were, together.

VII. And it seems to me, that this Fluxing kind of Small-pox is that very Disease which the Greeks called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. (〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, vel 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, quod est, bullire, & fervere:) and the Latins, in imitation of them, Phlyctaenae, Phluctides, Phluzacia, and Phluseis; (tho' we under those names now understand another Disease, as you may see, Lib. 2. Cap. 25. aforegoing.)

VIII. For this sort of Small-Pox are at first little Pustules, which afterwards become little Bladders, which flux or run one into another; excited and caused by the exceeeding fervency of the Humors; being as it were boiling-hot, and most sharp; like to those Blisters which are raised by burning fire, and scalding-hot Water.

IX. The Signs of the Pustu∣lar kind. This Disease, at its first beginning is attended with chilness and shivering, vehement pain in the Head, with a strong pulsation in the Forehead and Temples; great sleepiness, diffi∣culty of breathing, intense heat, redness, and sense of pricking over the whole Body, with a pain of the Back; which sometimes alone, or appearing with other Symptoms, foreshews the Small-pox.

X. For thro' the Back are carried the great Artery and Vein, in which the malignant

Blood fermenting or boiling, does send forth a sharp effervescency to the adjacent Nerves and Membranes; for which cause it is, that pains are especially felt in those parts.

XI. There is also a heaviness in the Eyes, swelling of the Face, with some redness, hoarsness, panting of the Heart, with a con∣tinent, or at least continual Fever; which exciting the fer∣ment of the Blood and Humors, protrudes the Morbifick-matter from within, to the outward parts.

XII. Generally on the fourth day from the first illness, or falling down of the Sick, sometimes sooner, and sometimes later; the Small-pox come forth, in Spots or small Pustules; (accompanied with a continual Fever, from the ebullition of the Blood and Humors;) at which time, the Symptoms (at least their vehe∣mency) either abate, or dis∣appear.

XIII. At their first coming out, the Pustules or Wheals are red∣dish; and they are scattered over the Face, Neck, Brest, Arms, Hands, Thighs, Legs, Feet; and in gross Bodies, and where the Ferment is high, they generally appear in great numbers over the whole Body.

XIV. As the Pustules grow bigger, the Face swells, with pain and stiffness in the Jaws; and next after the Face, the Hands and Arms swell, and the Fingers begin to be distended, growing in all parts bigger and bigger, till they come to their utmost height and magnitude.

XV. And as they grow bigger the intervals between the Pu∣stules, which were before white, begin to be red, and much swell'd, with a continual pain: and about eight or nine days after the first invasion, they will be come nearly to the height; in which time, (if the Morbifick-humor is in great abundance) the Eye∣lids will swell, and the whole Face and Head will be vehe∣mently tumified, (and propor∣tionably other Parts) swelling sometimes nearly to double their true magnitude.

XVI. The Pustules are at first smooth and red, but as they grow in ripeness, they grow rougher and rougher, with a whitish yellow colour: also in the Hands, and other parts of the Body, they grow whiter and whiter, after∣wards yellowish, casting forth a yellowish Humor, in colour almost like candied Honey, and in thickness almost like new Honey.

XVII. As the Pustules grow to their bigness, the inflammation of the Face, Arms, Hands, Back, and all other parts, comes also to its height; so that the inter∣spaces between the Pustules appear of a florid red colour; and the milder or gentler the Pox are, the more lively the colour.

XVIII. This Eruption of the Morbifick-matter is generally at∣tended with vehement Thirst; excited mostly from the intense∣ness of the Heat, and violence of the Fever.

XIX. The Pustules being come to their height, about the eleventh

or twelfth day (and in some later, where the Humor is in great plenty) the inflammation and swelling abate, and the Pustules either break or dry, and so scab, in order to their withering and falling off: but this is to be understood of those which are in the Face, and those parts of the Body which are con∣stantly kept in Bed, and very warm.

XX. But those which are in the Hands and Arms, continue longer; remaining still white and fresh, for at least two or three days more; after which they break, and scab also.

XXI. On the fifteenth, six∣teenth, or seventeenth days they go away intirely from the Face and Body; but from the Hands and Arms, on the nineteenth, twentieth, and twenty-first day; and they fall off in Scales or Scabs, according to the nature of the places affected.

XXII. Where the Humor is very sharp and corrosive, and where it is long a drying away, lying all the while upon the Cutis, it generally leaves seams, pits, or holes; but this is more especially in the Face and Hands; as being Parts lying more cold, and most exposed to the ambient Air.

XXIII. In a hopeful Small-pox, the Body is generally costive or bound: there is also (after the first few days are over) a natural kind of Sweat, which helps to protrude the Morbifick-matter; which continues more or less, thro' the whole course of the Disease.

XXIV. In some there is little or no Sweat, or it immediately vanishes; the Sick is anxious, and vehemently sick at Sto∣mach, pisses little and often, is continually restless, tossing up and down, which Sym∣ptoms are generally attended with another, viz. a Delirium, or Light-headedness.

The Signs of the Fluxing Kind.

XXV. To distinguish these in Name from the Phlyctaenae, or Ignis sylvestris, mentioned Lib. 2. cap. 25. we will henceforth call them 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, i. e. Phlyctaenae morbidae; because they shew forth a very corrupting and vehement Disease. And therefore in this Fluxing kind, tho' the Symptoms are nearly the same, yet they are much more corrupting and vehement: for it is this kind chiefly, which leaves pits, scars, or seams be∣hind it, by reason it corrupts or eats the place upon which the Humor lyes.

XXVI. The Fever in these, as also the sickness at Stomach, nauseousness, or inclination to vo∣mit, anxiety of Mind, and rest∣lesness of Body are much more vehement; and they come forth on the third day, or sooner, seldom later; and the sooner they are protruded, the more apt they are to Flux, or run together into one.

XXVII. But sometimes thro' the violence of other Symptoms, as vehement Sickness at Stomach, with Vomiting, or a Looseness or Flux, which accidentally happens

before the breaking forth of the Pox, and continues a day or two after, (which scarcely ever hap∣pens in the former kind:) or a Catarrh, or any great Hemor∣rhage; whether by the Nostrils, Urine, or Stool, the protrusion of the Pustules are retarded till the fourth or fifth day.

XXVIII. So that it appears, that the separation of the Mor∣bifick-matter, and febrile Ebul∣lition or Fermentation, are in the first three, four, or five days: But the real protrusion or coming forth thereof, is per∣fected by Nature in some suc∣ceeding time: in little Abscesses arising in the Skin, which, the Humor being serous, and more fluid, with the dissolution of a very sharp Salt, causes a fluxing of them one into an∣other.

XXIX. Many times, thro' the ill managing of the Sick, several bad Symptoms succeed; as Sleepi∣ness, Watchings, Phrensy, Light-headedness, or Dotage, falling down of the Pustules or Wheals; with sometimes little black Spots on the heads of them; or a depression in the middle, pur∣ple Spots being scattered almost every where between the Pu∣stules; together with spitting or pissing of Blood, or some other Hemorrhage; or a suppression of Urine, pain, restlesness, trem∣bling, &c. many of which Symptoms happen in the first six, or seven days of the Dis∣temper.

XXX. The Pustules come out sometimes after the manner of an Erysipelas, (but none but Fools and Ignorants will call it an Erysipelas; for where the Small-Pox is, that is Disease enough of it self, without the addition of any other:) and sometimes like the Measles, (yet 'tis no Mea∣sles) which may be distin∣guished by the differing signs of the Disease, and the time of breaking out.

XXXI. A kind of Catarrh, or Spitting, sometimes in persons of ripe age, begins at the time of breaking forth; sometimes two or three days after, spit∣ting at first a thin matter; which on the tenth or eleventh day grows more viscous or thick.

XXXII. And a Looseness or Flux in Children and the younger sort, is apt to seize also, before the breaking forth of the Pox, and many times continues a day or two after, which scarcely ever happens in the former Pustular kind: but this Loose∣ness seizes not so early, as the Catarrh or Spitting does Men.

XXXIII. Whil'st the Disease is in the increase, the Pustules rise not to any eminent height, but rather run together like red Blisters, in the Face; (so as many times to cover the whole Countenance) and many other Parts; which by reason of the fluidity of the Humor, swell sooner than the Pustular kind.

XXXIV. Afterwards, they seem to be like a white Bladder or Skin, and in the Face, are not much higher than the surface thereof; tho' the whole Face seems to be extreamly swelled:

those which are in the Hands and Feet are larger, and the farther or higher you go from the extremities of the Limbs, the lesser they are.

XXXV. The eighth, ninth, or tenth day sometimes, being past, the white Skin grows daily (but gradually) rougher and rougher, and of a brownish colour; and the pain in the Skin is more intense, till the Scabs fall off; which in this so vehement a Disease, seldom happens till after three Weeks are past.

XXXVI. The Symptoms do not immediately abate, after the coming forth of the Pustules, as they do in the Pustular sort; but the Fever, and the other Sym∣ptoms do continue also to vex the Sick for many days afterwards. And as in both kinds, the Fever is present from the be∣ginning to the time of pro∣trusion or eruption; so it continues to the time of full ripeness; after which it sensibly abates, and vanishes away of its own accord.

XXXVII. During the extream heat of the Fever, the Sick seems to be as it were in a Furnace or Oven; and it is generally accom∣panied with great Thirstiness, and sometimes a Hoarseness; and a Cough many times seizes them as they drink, making the Drink to come forth thro' the Nose.

XXXVIII. You must note also, that the nearer the Pustules or Bladders are to ripening, the more brown they grow, and indeed so much the more dangerous they are: but the yellower they are, the less they flux or run toge∣ther, and the more quickly go away.

XXXIX. Presently after the Scabs or Skin are come off in the Face, it is spread over with a kind of mealy or white Scales or Scurf, of a very eroding nature, which many times causes pits, scars, or seams; and tho' then the swelling of the Face should decline, yet it goes not wholly away, till some days after.

XL. The Prognosticks. If the Sick is so violently thirsty, that nothing can quench it, grows hoarse, is extream sleepy, or le∣thargick, and his Catarrh or Spitting ceases; without any apparent swelling of the Face and Hands, beginning, and con∣tinuing till the Pustules are fully come out, conclude Death is at hand.

XLI. The greater, and more in number the Pustules, chiefly in the Face, the greater the danger: the lesser and fewer, provided the Sick has no heart-sick, fainting, or swooning Fits, the less danger: and if they be of a violet-colour, green, or livid, or black, they are dangerous, and for the most part mortal: so also if they strike in again.

XLII. The Fever increasing after their being full come out, difficulty of Breathing, unquench∣able Thirst, Looseness, Bloody-flux, bleeding at Nose, or otherwise; and black or blew Spots, with black or livid Urine, are all signs of Death.

XLIII. A suppression of all Evacuations in the state of the Sickness, a Frenzy, or Lethargy

after the eleventh or fourteenth day, great quantity of Ʋrine, the Fever not abating; plentiful Sweats, not diminishing the Dis∣ease; a violent Flux in the beginning of the Disease, and continuing; the eruptions small, and of an evil colour, where the putrifaction is great, if they fall back again, tho' not quite in, (whereby the malign Morbifick-matter retires to the more noble parts,) all these are signs of Death.

XLIV. If they be slow in coming out, or they be hard, or vastly great in number, or if they touch one another; or the Sick breathes not freely, or the Fever abates not after their breaking forth; or if there is violent Vomitings, Sickness at Heart, Fainting, or Swooning; or there be Frenzy, Delirium, Raving, or Dotage, or Convulsions with raving, trem∣bling of the Hands and Tongue, or Heart-burning, or Hiccough, great loathing of Food, many and violent Excretions in the beginning and increase of the Disease. These Symptoms, I say, tho' they are not always mortal, yet they are very evil, and exceeding dangerous.

XLV. The Pulse like that in perfect health, is dangerous, for Nature out of weakness concocts not the Humors: and then tho' the Sick seems freed from his Fever, yet he grows worse and worse, and draws towards death.

XLVI. If they come easily out, and easily, or soon ripen; if there is Sneezing (provided the Lungs are sound) or a suppression of all Evacuations, in the beginning and augmentation of the Disease, or Deafness in the state of the Disease; or the Urine is with signs of Concoction, or the Symptoms be not great, or there are Critical Sweats, or other Critical Evacuations, in the state and declination, wherein the Sick is better after them: these, I say, are all Signs of good Health, and Recovery.

XLVII. However, whil'st the Disease is in its beginning and increase, it will be prudence to suspend judgment; for it will be dubious and uncertain, till about the end of the state or declina∣tion. And if you would give a more exact and perfect judg∣ment, you ought diligently to study and learn Our Prognosticks, which we have largely and clearly delivered, in the Third Edition of Our Synopsis Medicinae Lib. 1. from Chap. 46. to Chap. 66.

XLVIII. The Cure. The Indi∣cations of Cure are fourfold, and have respect, 1. To the Nature or Essence of the Disease; which is to drive from the Centre to the Circumference. 2. To the Cause; which is the Morbifick-matter to be protruded, or thrust forth thro' the Pores of the Skin. 3. To the Symptoms; so as to secure the first Indica∣tion, and in the due time to abate them. 4. To the Vital Indication; which has respect to the strength or weakness of the Sick: all which we shall pursue (thro' God's assistance) in the following Discourse, and in their due Order.

XLIX. But before we enter

upon the true Method of Curing, we think it necessary to reflect upon the present Mode of Pra∣ctice, now managed by some per∣sons, who are thought to be Men of great Names, but lesser Skill; as it has relation to Bleeding, Purging, and Blistering; where∣in we hope to deliver our Mind, with a kind of Demon∣stration: especially being con∣sidered with respect to the un∣erring Principles of Our Art.

L. I know I cannot do this, without meriting the Malice and Envy of some particular Men; but the truth of it is, it is of such as are my profest Enemies, and such as have determined, and publickly declared my Ruine and Destruction; who have already by all unjust methods at Law persecuted me, and still con∣tinue to do the same. But on my part, I oppose them not for malice or envy sake, nor with any respect to the Evil they have done me; for I freely forgive them all: but only for the sake of Truth, which I desire to bring to light, for the benefit of Mankind in general.

LI. I cannot think without terror, of the Death of Her late Majesty, when I consider with what Methods She was managed. I must confess, I would not hazard a Negro, (whose Life I may value but at 20 l.) under those pernicious courses of Bleeding; but infinitely less, that of so good, and so great Queen: a Life so valuable, that nothing can be put in the balance against it: since other courses may be pursued, with a thousand times less danger.

LII. But what shall I say in this case? 'tis the eternal fate of the Great, to fall under such ill circumstances, and under such Fatal Mens hands: and for this, we have the Authority of the Poet; as you have it in Mr. Gould's admirable Poem up-Sn the Memory of Her late oacred Majesty, QUEEN MARY, in the following Lines or Words.

Ye Sons of Aesculapius, boast no more, That you the Weak to Health and Strength restore: Vain is your Learning, and your Art a Cheat; At least, 'tis ever Fatal to the Great. All you can do, is but [hap-hazard] Guess, And a whole Colledge has the worst Success. For like a two-edg'd Sword, you both ways slay;

I add this Line.

By want of Skill, and sometimes by foul Play.

Who under you escape, had yet no doubt, Sooner recover'd to their Health without. You are your selves an Epidemick Ill: For one you let escape, you thousands kill. To Plagues and Pestilential Blasts a-kin; Their Poisons reign without, but yours within.

From you, 'tis weakness to expect Relief; Both Atheists in your Practice and Belief. From GOD, can Favour on your Work be shown, When you so boldly argue there is none? Those that would live, must your Prescriptions shun:

I add:

Who Sacrifices to your Net 's undone. Under this just Reproof, you justly stand; Y' are evil Omens to our mourning Land. Night-birds, and Birds of Prey, foreboding ill; Who ne're approach, but with design to Kill. Where th' Carcass is, like Vultures you resort; And if you come, Death makes the Dire Report. We call to Witness our Indulgent QUEEN, Who, we believe, had liv'd, had you not been. We cannot help Our Faith; Believe we must: And We believe She 'd liv'd, had some been just. Your Prescripts are but formal Acts of Fate; Who scapes your Hands, you think does dye too late. Death's Harbingers you are; you go before. And to its splendid Entry ope the Door. Abandon them, my Soul! and fly, my Heart! And let me dye by Nature, not Their Art.

LIII. Haec autem obiter. Now to the purpose in hand. First, as to Bleeding: it is my Opi∣nion, that it is against all the Indicationes Curativae; and this we shall endeavour to prove or demonstrate to the Under∣standing, from the following Arguments.

LIV. Either there are Princi∣ples in Our Art, upon which we build, and by which we ought to be guided, or there are none. If Our Art consists of Principles, we ought either to Act by, and ac∣cording to them, or not: if we ought, then all the Indications or Methods of Cure in every Disease, are to be squared according to those Principles; and he that Acts not according to those Precepts, shews him∣self to be a Cheat, Ignorant, or something worse. But if we ought not to walk by them, then it is manifest, that the Art it self is precarious and vain; and they are all Fools, who make it their Business to study and break their Brains about an Art, whose Principles have no Worth or Usefulness in them.

LV. But if the Art is built upon no Principles, but that all that is done in it, is only Opinion, Chance, and Hap-hazard; then the Art it self (as it is called) is no Art, but a meer Cheat, and Delusion; the Profession thereof all Trick, and Designing: and the Practice thereof tho' under the most specious title of Doctor or Collegiate) nothing but Vil∣lany, Impudence, and Quacking.

LVI. But we presume, the Pro∣fessors thereof will readily grant us, that the Art is built upon Principles, that those Principles are rational, and the Indications of Cure raised from them, reasonable, and necessary to be followed. And that he that acts not by those Principles, acts precariously and dangerously, as to the Patient; and his Practice, as to himself, is meer Confidence and Quack∣ery.

LVII. If this is granted, we will then consider the Indicatio∣nes Curativae, in this particular Disease, as built upon those Prin∣ciples: and they are four, as you may see in the third Edi∣tion of Our Synopsis Medicinae, Lib. 1. Cap. 75, 76, 77, 78, 79, and 80. and so are taken, 1. From the Nature or Essence of the Disease. 2. From the Causes. 3. From the Sym∣ptoms. 4. From the strength or weakness of the Sick, which is called the Vital Indication, all which we shall consider di∣stinctly, with reference to Bleeding, &c.

LVIII. The Essence and Nature of this Disease is, to protrude or thrust forth the Morbifick-matter, from the Centre to the Circum∣ference. And therefore, what∣ever Methods are taken contrary to this Indication, must be extreamly prejudicial to the Sick, if not destructive and fatal.

LIX. Now Bleeding (tho' many rash and ignorant persons use it in this Age, in the Cure of this Distemper) is diametrically oppo∣site to this Indication: For all Physicians account Bleeding a Revulsive Remedy, which calls from the Circumference to the Center: and if so, then the Morbifick-matter, which ought to be thrust forth, is imme∣diately drawn into the Blood by the Veins, (for they will be filled again) and so by Circu∣lation conveyed to the Heart.

LX. From whence we con∣clude, that unless the Disease is very gentle, the Morbifick-matter but little in quantity, and the Patient very strong, and natu∣rally of a good habit of Body; if this Remedy be used, the Sick must patiently submit to his Fate; for Death stands at the door: as we have in some hundreds of Patients particu∣larly observed.

LXI. The second Indication arises from the Cause, which is the Morbifick-matter to be thrust forth; that we may hinder the augmentation thereof for the future, which Nature now endeavours to diminish by cast∣ing forth.

LXII. But Bleeding is opposite to this Indication: for the evil Matter now in part protruded, thro' the Fermentation of the Blood and other Juices, being by this means drawn into the Blood again; the whole Mass thereby becomes in a very short time putrified, and all the Juices of the Body converted into the very Matter or Cause of the Disease.

LXIII. This augmented or mul∣tiplied Putrifaction being thus joined again with the Blood, which Nature had been for a long

time before separating, by Cir∣culation with the Blood comes to the Heart and smites it, empoisons the noble Parts, stagnates the bloody Juice, and suffocates the vital Flame.

LXIV. The third Indication of Cure, has respect to the Symptoms. Where the Symptoms are more extream, and shew more danger than the Disease, the Intention of Cure is to be directed to remove, or alleviate them. But where the Disease is more vehement, that is first to be considered, because upon the remedying of that, the Symptoms of their own accord cease or vanish.

LXV. So in this Disease, the Fever is one of the Symptoms, which tho' never so strong and intense, is never so dangerous as the malign matter to be protruded: and is therefore here to be neglected; and not only for that Reason, but for another more powerful, viz. because it is assistant in expelling the Morbifick-matter.

LXVI. The diminution then of the febritick Heat is to be avoided, yea it ought to be kept up to the height; otherwise the pro∣trusion will be weak and imper∣fect, and in general proves fatal to the Sick. 'Tis a great error indeed, to cause an abatement of the Fever; for 'tis the strength and height of the Fever, which saves the Life of the Patient.

LXVII. 'Tis that violent Heat, which is the effectual Cause of a compleat protrusion of the Mat∣ter into the surface of the Skin: and not only so, but 'tis also the cause of a more speedy expulsion, and bringing the Disease to a much more speedy, healthful end.

LXVIII. For the more languid that Heat, the more danger; and if the Fever goes either quite away, orconsiderably abates, 'tis a thou∣sand to one but the Sick dies suddenly, or in a little time becomes past all hopes of reco∣very.

LXiX. But if the Heat be conserved, and the Fever let alone, you will see in a short time, by the plentiful eruption of the Pustules, (if there is a plenty of the Morbid-matter) that the danger of Death will quickly be over, to the great ease, comfort, and satisfaction of the Sick.

LXX. And that after Nature has made a sufficient protrusion, the Fever it self (for want of fuel) will presently vanish of its own accord, without the help of any Medicine: and this is that which in the space of thirty-three Years Practice, I have, I believe, above a thousand times observed.

LXXI. It is objected, That by the violence and continua∣tion of the Fever, the Small-pox may come forth too plentifully; or much more than otherwise they would do; to the great prejudice, and greater danger of the Sick. We readily answer, 1. That they cannot come too plenti∣fully out; for all the Morbid-matter, which Nature has pre∣pared, and separated from the Blood and other Humors, ought to be expelled. 2. That there

is no danger to the Sick, simply by their coming forth plenti∣fully: but directly on the con∣trary, the danger is, if they do not come fully forth, as they ought to do.

LXXII. If there is not a plenty of Matter to be expelled, they cannot come plentifully forth: but if there is a plenty of that Matter, it ought to be all expell'd, otherwise several in∣conveniences will unavoidably ensue.

LXXIII. If the Body is weak, and the Constitution very faulty, as Cachectical, Scorbutical, &c. the not coming compleatly forth, for the most part, hazards the Patient's Life. But if the Sick is of a strong habit and consti∣tion of Body, whereby Nature is so able to contend with the Disease, as to vanquish the dan∣gers of Death; then some evil Symptoms, as running Sores and Ulcers, Scabs, Itch, Biles, &c. are apt to seize upon the Patient; in some presently; and in others, in some little time afterwards.

LXXIV. Or else some other pernicious and ill-natured Disease is apt to seize and afflict them; as the Scurvy, Leprosy, Kings-Evil, Consumption, &c. which by reason of the remaining universal defilement of the Body, will not be easily ma∣stered or overcome; without much trouble, and long and tedious courses of Physick.

LXXV. It is also to be ob∣served, that the greatness of the Fever, is in proportion to the prepared and separated Morbid-matter now ready for expulsion: if it is little in quantity, the Fever is never great; and some∣times, where the Pustules are very few, as here and there one) scarcely to be discerned; so that the Patient goes up and down the House, as if nothing ailed them. But where it is much in quantity, the Fever is great, and always in proportion to the Matter to be expelled, as it were by Natures designa∣tion.

LXXVI. 'Tis also observa∣ble, that more Matter than Nature has prepared and separated, will not be protruded, do what you will, neither by the height, nor continuance of the Fever, use of Sudorificks, or any other means whatsoever. And therefore, what Matter the has separated for expulsion, ought not to be pre∣vented, by abating the Sym∣ptoms thro' Bleeding, lest other greater evils do ensue, as we have before declared.

LXXVII. The last Indication of Cure, is the Vital Indication, respecting the strength or weakness of the Sick, against which Bleed∣ing is diametrically opposed. For take away the Blood, in which the Vital potency resides, and you manifestly weaken the Sick more and more, and diminish the Spirits, which ought to oppose, or encounter the Dis∣ease.

LXXVIII. For Nature thro' Bleeding, being weakned, (not only by being robb'd of her de∣fence, but by introducing an Enemy, who universaily defiles her Oeco∣nomy, and quenches the Vital

Flame) there is immediately an universal weakness spread over the whole Humane Frame, and the contest of Nature with the Disease ceases, by Natures being overcome. This Truth is so evident, that we cannot but speak it with grief, when we do but think of that late precious Life, which by that means, we faithfully believe, was lost.

LXXIX. From what has been said, it is manifest, that Bleeding in this Disease, is a very inimi∣cal course to the Patient, let the Practisers thereof say what they can for themselves: and if they alledge Experience against us, we will bring Experience against Experience; and justify by the universal Management of this Disease thro' the whole King∣dom, yea almost thro' the whole World, That above a thousand does well without it, to one that does well with it.

LXXX. And generally speaking, every one that is born into the World, and now alive, who in their order or course, have had this Disease, and have overcome it without Bleeding, ought to be opposed to the novel Practices of these times: for that thro' the whole Kingdom, yea thro' the whole Universe, there is not one to a thousand, that are let Blood in it; yea I am of opi∣nion, that there is scarcely one of ten thousand in the whole, that is; and yet gene∣rally, they live and do well.

LXXXI. Whereas, let us but examine amongst those that are let Blood, and we shall find by sad experience, that scarcely ten live in an hundred. Take an equal number on both sides, suppose a thousand which may have this Disease, and are not let Blood; we find, that by the help of a good Nurse, and care∣ful looking after, that at least nine hundred and fifty, do well; which is compleat nineteen in twenty.

LXXXII. Whereas in a thou∣sand that have this Disease, and are let Blood, at least nine hun∣dred and fifty of them dye; which is again full nineteen out of twenty. And this my own Eyes are Witnesses of: I knew ten in one Family, all which had the Small-pox at the same time almost, one after another; six Children, a Wife, and two Brothers; they were all let Blood, in order to the Cure, and were all lost: the Master of the House fell sick after∣wards of the same, and refused that course, by reason of the ill success of the other nine; and lived and did well. Now what can be said to such an Example as this?

LXXXIII. But to give Our Adversaries all the advantage that can be, suppose among those that are let Blood, the one half of them should live, yet the odds of living are on our side, who are against Bleeding. And to justify our selves in this Opinion, we will consider the whole Body of our own Nation, which you see at this day is full of People; and yet, that tho' the greatest part of them have past past this Disease, (take the whole Kingdom throughout)

not one in ten thousand of them (I mean, of them that are living) have been let Blood in this case. Which is a mighty and weighty Consideration, and worthy to be taken notice of.

LXXXIV. As for my own part, in my time of Practising, I am very confident I have had at least a thousand Patients sick of this Disease, not one of which I ever let Blood, or caus'd it be done, and yet they all liv'd and did well; nor had I ever (I bless God for it) a Patient sick there∣of under my hands, which died.

LXXXV. And yet I freely con∣fess, that the Disease is sometimes so malign and deleterious, that no Methods whatsoever can save; and therefore where I see mortal Symptoms, I always forbear med∣ling: and truly it is a great and good piece of knowledge in our Art, to be so well skill'd in the Prognostick part thereof, as to foresee the danger of the Sick; which being well under∣stood, gives the true Physician a great reputation; by avoiding the Infamy, which otherwise might attend him.

LXXXVI. If it be enquired, Whether Blood may not be taken away before their coming forth; we answer, No. In any Patient of mine, were I sure the Small-Pox would succeed, I should al∣ways forbid it: and my Reason is, because it would make the protrusion of the Pustules very languid and weak; whereby, if it did not hazard the Patient's life, yet this evil might fol∣low, that by reason thro' weak∣ness of the Expulsive Faculty, there might not be a full ex∣pulsion of the Morbifick-matter, the remaining part thereof would lay the foundation of some other more pernicious Dis∣ease; as the Measles, Leprosy, Kings-evil, Apostems, Consum∣ptions, &c.

LXXXVII. When any of the Blood-suckers Patients dye, the Pustules seem to fall in again, grow flat and dead, or to dent in in the middle; and sometimes to turn purple, livid, or black; with many livid, or purple spots in the interspaces. Then to excuse themselves, they say it was a dangerous and malign Disease, and complicated with an Ery∣sipelas, Purples, Spotted-fever, or the like; by reason of which Complication, 'twas impossible for the Sick to escape death, what course soever had been taken.

LXXXVIII. To which we an∣swer, That this is only a blind for their Ignorance, and an Ex∣cuse for their cursed Male-practice: for many (if not most) of those miserable Patients might have lived, if they had not fallen into those Blood-suckers hands: and it is for the most part Bleeding, (where the Sick dyes upon it) which is the cause of such-like Spots appearing.

LXXXIX. But as for a Com∣plication of the above-named Dis∣eases in the Small-pox, we never once knew it, in the thousand cases we have seen, nor do we believe it possible to be: it is the nature of the Disease, not to admit them. The Small-Pox is Disease enough of it

self, we need not add others to it, to make it worse.

XC. As for an Erysipelas, the Small-pox it self is so like it, in its first approaches and coming out, that it is not every one that can distinguish between them. But however, the Small pox cannot in any wise admit of an Ery∣sipelas to be joined with them; their natures are as different, as are the methods of their cure.

XCI. And when purple or livid Spots appear, upon the falling down of the Pustules, or death of the Patient, they no more demon∣strate a purple or spotted Fever, than they do the Dropsy or Gout. 'Tis the property of the Dis∣ease, when Nature is upon the yielding part, or is already over∣come, to send forth those Sym∣ptomata, as Tokens of her ensuing Fate.

XCII. These things being said, we shall now address our self to the Cure; wherein we shall do our endeavour to explicate it, according to the best Methods of Practice; and what I my self have found admirably successful in all my undertakings, where∣ever I have been concern'd in the Cure of this Disease.

XCIII. First, Purging we for∣bid, as dangerous; (almost for the same reasons as we do Bleed∣ing) lest it should induce a Flux of the Bowels, whereby their plentiful eruption might pos∣sibly be hindred: 'tis better of the two, to keep the Body Costive, than to admit of any thing which may hazard a Flux of the Belly.

XCIV. But upon the Patient's first falling ill, if the Body is Cacochymick, or has a fulness of Humors, or the Stomach is foul, or a Vomiting be present; you may safely enough give some proper Antimonial Emetick, as Vinum Benedictum, Tartar eme∣tick, and the like; because it at once empties the Stomach of abundance of filth, adhering to its Tunicles, and gives upon the spot, a wonderful relief to Nature.

XCV. But in the progress of this Cure, I think a good, honest and careful Nurse is most to be relied on; I am sure, much more than on the Blood-sucking Doctors, and No-Doctors of these times; under whose hands, the greatest part of those who fall into them, miscarry.

XCVI. If extream Thirst af∣flicts the Patient, it may be allay'd by small Beer, in which Saffron has been infused, and made pleasantly sharp with Spiritus Nitratus: or with this, ℞ Fair Water three quarts, burnt Harts-horn ℥ii. boil till a quart is consumed: towards the end of boiling put in a crust of Bread; then strain, and sweeten with treble-resined Sugar ℥ii. or better, adding also the juice of one Limon: of which give the Sick, as need requires.

XCVII. Give this every night going to bed. ℞ Our Tinctura Opii, or Guttae Vitae, or liquid Laudanum, a gut. vi. ad xvi. Spiritus nitratùs gut. xx. Milk-water, or the former Decoction of Harts-horn ℥iii. mix for a Dose. But be sure to regulate the

Dose of the Opiate, according to the age and strength of the Sick. If it is a young Child, gut. iii. or iv. may be Dose enough, and you may sweeten it with a little white Sugar.

XCVIII. And every Morning give this. ℞ Bezoar-mineral gr.xii. Bezoar-stone, Cochinel, A. gr. vi. Salt of Amber gr. iv. mix for a Dose, if it is a Man. But if it is a Child, it will serve for two Doses.

XCIX. If the Tongue and Throat are clammy, rough, hot, and dry, inject the following Gar∣garism with a Syringe. ℞ Of the former Decoction of Harts-horn ℥viii. Honey of Roses ℥jss. Tin∣cture of Saffron and Cochinele ʒiii. dulcified Spirit of Nitre gut. xxx. mix them.

C. If the Pustules seem to strike in, fall flat, or sink in the middle, let the Composition at Sect. 98. above, be repeated every six hours. Or this Mixture. ℞ Milk-water ℥viii. choice Cana∣ry ℥i. Spiritus cordialis ʒss. Tincture of Saffron and Cochinel ʒii. Spirit of Sal Armoniack, or Spirit of Harts-horn ʒijss. mix them, for four little Draughts.

CI. Or this. ℞ Our Theriaca Chymica, Electuarium Antepesti∣lentiale, A. ℥ss. mix them. Dose, à gr. xvi. ad ʒi. to be repeated every six hours, till the Pustules begin to arise again: or either of the particulars may be given alone in the same Dose.

CII. If upon the eleventh, twelfch, or other succeeding days the Fever goes not off; but that the Sick is unquiet, uneasy, and restless, and that death seems to be at the door, give the Pulvis Antifebriticus, à ʒss. ad ℈ii. or ʒi. in the Harts-horn-Decoction. Or this: ℞ Aqua Elementaria ℥vi. Spiritus Cordia∣lis ℥i. Spirit of Harts-horn ʒi. mix for a Draught.

CIII. If a vehement Flux is present, give à gr. ½ ad ii. of a simple Extract of Opium, mixt with, or dissolved in Tinctuce of Catechu; to be repeated every Night, so long as need requires, and given in the Harts-horn-Decoction.

CIV. When the Pustules are fully come out, and begin to grow yellow, the purulent matter may be let out, by pricking them with a Needle, or the point of a Lan∣cet, or cutting off their heads; after which, you may anoint them with a Feather, with the following Mixture. ℞ Sheeps-suet ℥ii. Oil of Ben ℥jss. Sperma Ceti ℥i. mix, and make an Ointment; with which anoint, 'till the Pustules are fully dried up.

CV. This is commended. ℞ Oil of Ben ℥iijss. pure white Sperma Ceti ℥i. juice of Limons ℥ss. in which let be dissolved Saccharum Saturni ʒii. mix, and make a Liniment; with which anoint twice a day.

CVI. The Scabs being fallen off, there is wont to succeed a notable Scurf, which in many eats even into the Skin: to prevent which, and to clear it of the Scurf, you must daily, two or three times a day, or as oft as you see occasion, wash with Aqua Tartarisata blood-warm; or rather with Lac Virginale,

than which I think nothing is better.

CVII. If in the beginning of the Disease, there happens to be either spitting or pissing of Blood, or a Bloody-flux, you must ne∣cessarily give Our Tinctura Mi∣rabilis, à ℥ss. ad ℥i. mixt with some convenient Vehicle. Or this Pouder: ℞ Catechu in pouder ℈i. Crocus Martis astrin∣gens ℈ss. Opium in pouder gr. i. mix for a Dose; to be repeated as oft as need requires.

CVIII. If the Disease is vehe∣ment, the Fever great and in∣tense, and the Pustules break forth generally over the whole Body, in very great numbers, or run every where into a flux; the Sick ought to keep their Bed, be carefully tended and lookt after; and, as much as may be, avoid taking Cold, for that is as much as the Life is worth; and their Food may be boil'd Barley, Barley-broth, or rather boil'd Rice, and Rice-broth, Ponada, &c. drink∣ing also the Harts-horn Drink before described, Canary-whey, which comforts the Spirits; white Posset-drink made with Ale, and sweetned with double-refined Sugar.

CIX. Lastly, at the End of the Disease purge the Body well; either with Sal mirabile, Our Family Pills, Pilulae Cathar∣ticae, Tinctura purgans, Tinctura Cathartica, Syrupus Catharticus, an Infusion of Sena and Rhu∣barb, or some other proper Purge, agreeable with the habit and constitution of the Body; which let be repeated at least three or four times. The want of doing this, (which carries off all the remainders or re∣liques of the Distemper) has been the cause of Scurvy, Gout, Consumptions, Apoplexies, Apostems, foul Ulcers, Botches, Biles, Scabs, Leprosy, and Kings-evil, breaking out after∣wards, and seizing upon the Patient

CX. Some, when the Pustules rise not as they ought to do, or when they find them to fall down again, apply Vesicatories, or Blistering-Emplasters: but they only put the Patient to a very great deal of pain and tor∣ture, without doing any gene∣ral good, or any good at all: for as much as they draw but only from particular Parts, and Parts adjucent to the Applica∣tion, and so leave the Sick worse than they found him.

III. Tumors arising from PHLEGM.

CHAP. XXI. Of an OEDEMA.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Oedema; and in English, Oedema, and, the White-swelling. 'Tis true, Hippocrates and other ancient Physicians, under the name of Oedema understood all other Turnors whatsoever; because it signifies an eminency, rising up, or swelling: but those of later times understand only one certain kind of swelling, which is the White-swelling here in∣tended.

II. Definition. Tumor est praeter Naturam, ab Humore seroso aut pituitoso ortum habens, albus, mollis, laxus, indolens, & caloris expers; prementi Digito cedens, & per congestionem frequentiùs, quàm per affluxum Humorum pro∣ductus. It is a Tumor besides Nature, arising from a serous or pituitous matter, white, soft, loose, without pain, and void of heat; yielding to the Fingers being prest, and oftner caused by conge∣stion, than fluxion, or a flux of Humors.

III. The Kinds. It is perfect, when it proceeds from Phlegm only: imperfect, when it pro∣ceeds from other Humors; as Blood, Choler, Melancholy; whence they are called Oedema Phlegmonoodes, Erysipelatoodes, Scirrhoodes.

IV. The Cause. It is caused from Phlegm alone sometimes, and sometimes from a mixtion of other Humors, as is mentioned in the Kinds. But Barbett thinks it to be produced from the ill disposition of the Lympha∣ducts.

V. Galen, ad Glauc. lib. 2. cap. 3. saith, that it is caused by a Pituitous matter; or else by the Spirits, when they are full of Vapors. But by that great Man's leave, tho' in the similar Parts there may be some kind of flatulent Spirit collected, which may tumify the Part; yet this Tumor is not properly Oedema, but rather 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, a Windy Tumor: of which hereafter.

VI. Sennertus says it proceeds from a serous Humor abounding in the Body, and descending upon the Part, and there abiding and sticking fast, as in a substance more cold than other parts of the Body.

VII. The Conjoined Cause is Phle••m contained in the Blood,

when it is so increased, that it irritates and stirs up the Expul∣sive Faculty: for Nature being then excited, protrudes the Matter out of the greater Ves∣sels into the less, and expels it from the more noble Parts to the weaker; till at length it is received and retained, by the most weak and infirm Part.

VIII. The Procatartick Cause is, an errour and default in San∣guification; producing such a like Humor, which must be found out from the Patient's Diet, Exercise, and way of Living.

IX. The Places. Altho' it may be excited in all parts of the Body whatsoever, yet it chiefly arises in the Hands, Knees, and Feet; as is manifest in such persons as are afflicted therewith; as in such as are Hydropical, Cache∣ctical, Phthisical, or Struma∣tick.

X. The Signs. It is known by being a Tumor soft and loose, so that if it be pressed down with the Finger, it easily gives way: for the moist Phlegm softens and loosens the Part; yet being thicker than the Lympha or other Humors, it sticks in the Part.

XI. It is altogether without pain, or any pulsation; for not dissolving perfectly the unity, it cannot be dolorous.

XII. It is also of a white, or whitish colour, because there is in it no preternatural heat, but only so much as is conformable to Na∣ture: or rather, there is a coldness of the Part, from its weakness, and nature of the Matter congested therein.

XIII. The Prognosticks. It is not suddenly generated, but grows by degrees, or by little and little: because the Humor is cold, thick, and sluggish; and there∣fore not fit for any speedy motion.

XIV. It often happens to old people, gross and phlegmatick. Bodies, and in Winter time; and to such who with gluttony and much drinking, continually debilitate the natural heat.

XV. It is a Disease, which in it self (without other accidents) is of no danger: nor is it great, or the cause thereof, of any dangerous consequence, nor has it usually any ill Symptoms joined therewith.

XVI. It is said to be dangerous, if it happens to such as have a Cachexy, Dropsy, Consumption, or Kings-evil: but then this danger comes not simply from the Oedema, but from those Dis∣eases which the Oedema fol∣lows: for which reason, you ought to distinguish whether it arises of it self, or follows upon some other Disease.

XVII. If it happens in the Feet or Knees, after long Dis∣eases, from Crudities collected by the Disease, or from a refrigeration, or other dangerous faults of the Liver, it is then dangerous, and may threaten death, from the Causes upon which it depends: but otherwise if no such acci∣dents be concurrent with it, there is no danger at all.

XVIII. If it degenerates into a Scirrhus, or by any accident comes to Apostemats, it will be

of very difficult cure, if not totally uncurable.

XIX. But yet tho' Oedema is a Disease, which of it self is without any danger, yet notwith∣standing it is of a long continuance; because it arises from a cold and clammy Matter, which cannot be overcome in a long time.

XX. Sometimes it terminates by a Resolution, unless it degene∣rates into a scirrhous Nodosity, or the like: for the much using of Digestives, many times makes the matter wax hard.

XXI. The Cure. Indications of Cure are threefold: 1. The removing the Procatartick Cause. 2. Removal of the Antecedent Cause. 3. Remo∣ving of the Conjoin'd Cause; which is done by Topicks, or External Applications.

XXII. As to the removing of the Procatartick Cause; let the Diet be such as does not generate or breed Flegm, but rather such as destroys it.

XXIII. Let his Bread be Wheat, and chiefly Bisket: his Meat, Flesh of good nourishment, and easy digestion, as roasted Mutton, Veal, Pullets, Rabbets: his Fish, such as swim in stoney and gravelly places: his Drink, Medicated Ale, with Wine sometimes.

XXIV. Let the Air he lives in, be drying and heating, use Exercise before Eating, to ••tir up the Native Heat; be merry and chearful, avoiding Melan∣c••oly as much as may be: diurnal Sleep is also to be avoided, also Blood letting, and such things as bind the Body, or over-much cool it, as Cheese, cold Fruits, as Cucumbers, Melons, &c.

XXV. The Antecedent Cause is removed by due Purgation, either upwards or downwards. If the Stomach is foul, give a Vomit of Tartar-emetick, à gr. ii. ad v. or vi. according to age and strength; or with Vinum eme∣ticum, or Vinum or Acetum scil∣liticum; repeating the Dose two or three times.

XXVI. Then purge with Dia∣jalapa, or Diagamba, or Our Family Pills, Pilulae Catharticae, Syrupus Catharticus, or Pul∣vis Corna••hini, or Tinctura pur∣gans: or you may often purge with an Infusion of Sena and Mechoacan, which is admirable: and then cut the tough Phlegm with Oxysaccharum, by often giving it in Infusio Catholica, or alone.

XXVII. Sudorificks are some∣times given with good success, be∣ing exhibited in the times be∣tween Purging.

XXVIII. A proper Diet ought also to be instituted, such as this of Barbett. ℞ Florentine-Orrice ℥i. Sena ʒvi. roots of Parsley, Sea-holly, A.℥ss. Rhubarb, Agarick trochiscated, A.ʒiii. Ci∣namon, seeds of Siler montanum, A. ʒii. Cloves ʒss. infuse them in old White-wine a quart: and take every morning ℥iv. or ℥v. for a Dose.

XXIX. Or this Electuary. ℞ Electuary of the juice of Roses ℥i. Jalap ʒi. Spirit of Salt ℈i. mix, and make an Electuary; of which let the

quantity of a Bean or Hazle-nut be taken every third or fourth day.

XXX. By the often use of one or other of these Medicines, he says he has many times cured an Oede∣ma; but withal rowling the Parts with Rowlers twelve or fifteen yards long; begining from be∣low upwards, allowing thereby no liberty for the Humor to descend. By this method the noble Parts are strengthned, the evil Humors evacuated, and the Parts affected in a few days restored.

XXXI. But in order to the Essential Cure, you must observe whether the Oedema follows any other Disease of the more noble parts: if so, the Intentions of Cure must first be directed to them; that the Disease upon which it depends may be taken away; otherwise the Oedema will never be cured.

XXXII. The Conjoined Cause is next to be considered. By Fri∣ctions and hot Fomentations, warm the Part affected; or rub it well with Oil, mingled with Salt: or foment it with a Decoction of Wormwood in Wine, in which a little Salt of Wormwood, or of Tartar has been dis∣solved.

XXXIII. Or anoint with Un∣guentum Martiatum, or with Balsam de Chili, with which once I cured an Oedema; bathing the Part also with the Powers of Amber, and applying over a Resolutive Emplaster.

XXXIV. But in the beginning Repellers are to be mixed with Discussives, but so that the Dis∣cussives may exceed; afterwards use only Discussives or Resolu∣tives: as Ʋnguentum Adstringens mixed with equal parts of Ʋnguentum de Althaea, or Ʋng. Comitissae, or Ʋng. Rutaceum, or Ceratum de Ammoniaco, or Gera∣tum Galeni, mixt with a few flowers of Sulphur; or the Cataplasma Resolutivum Foresti, Diachylon simplex, &c.

XXXV. Or you may apply this, which is stronger. ℞ La∣bdanum ℥jss. Olibanum, Oil of Rue, A. ℥i. flowers of Sulphur ʒvi. Storax Calamita, Cow-dung, A. ℥ss. Alum, Nitre, Vine-ashes, A. ʒii. Turpentine, Pitch, A. q.s. mix, and make an Emplaster. Or, ℞ Cow-dung ℥iii. Pigeons-dung ʒii. mix, and fry them with Oil, and apply it.

XXXVI. ℞ Rose-vinegar ℥jss. Oils of Myrtles and Earth-worms, A. ℥i. fine Bole, Terra sigillata, A. ʒiv. Aloes ʒiii. Acacia, San∣guis draconis, Cyperus roots poudered, A. ʒii. Saffron ʒss. Wax q.s. mix, and make a Liniment.

XXXVII. Or this. ℞ Bean∣meal ℥ii. Vinegar ℥i. flowers of Sulphur, Vine-ashes, Sal-gem, A. ʒii. Oil of Nuts, Camphir, A. ʒi. Turpentine, Wax, A. q.s. mix, and make a Cerate.

XXXVIII. This Cataplasm is excellent. ℞ Roots of Althaea ℥iii. briony, Dwarf-elder, A. ℥ii. leaves of Sage, Rue, A. M. i. Savin, M ss. boil them in equal parts of Wine and Water: in the end add Wine-vinegar ℥iii. beat all well together; then add Bean∣meal ℥ijss. Leaven ℥jss. Cow-dung ℥i. Vine-ashes, common Salt,

A. ℥ss. Hogs-lard ℥ii. Oil of Camomil ℥iv. mix them.

XXXIX. Bandage (says Wise∣man) is of great help in this cure; so that we can do nothing consi∣derable without it. Those I espe∣cially commend to you, are, a laced Stocking, Trowze, Sleeve, Glove; because they sit most firmly, and may be worn with the greatest advantage, and least trouble or prejudice to the Health of the Patient; yet it requires consideration, and care how they be laced: for by unequal lacing, a Tumor may be raised; and by an equal over-hard lacing, the most fleshy Part may be emaciated.

XL. And Sennertus says, that in applying of Medicaments of any kind, whether Liniments, Ointments, or Emplasters, we must before-hand make the Part hot by Frictions and Fomenta∣tions; otherwise the Applica∣tions will scarcely effect the Cure, by reason of the cold∣ness of the Part.

XLI. The Frictions may be made with course hot linnen Cloths, the Fomentation with Decoction of Camomil, Feather-few, Hyssop, Origanum, Tansey, Wormwood, &c. in Wine: for by the Frictions and Fomen∣tations together, the Heat and Blood will be called into the Part, and the superfluous Humor will be scattered.

XLII. But if the Tamor will not resolve, but that it is neces∣sary to bring it to Suppuration, you may do it with the Cata∣plasm, at Sect. 38. afore∣going, adding thereto, pulp of roasted Onions, Basilicon the less, A. ℥iii.

XLIII. The Abscess being sup∣purated, let it be opened either with a Caustick, or the Knife; and let it be throughly cleansed with juice of Wormwood and honey of Roses, mixt with Turpentine and Frankincense; fill the hollowness with Ʋn∣guentum Basilicon, or Nicotianae, and at length heal it up ac∣cording to Art: but it com∣monly proves a long time, be∣fore the Cure is perfected.

XLIV. If it should degenerate into a Scirrhus, you must use only Emollients: and for this pur∣pose, we use Vinegar, in which Lapis Pyrites or Fire-stone, or a piece of a Mill-stone heated red-hot has been quenched: afterwards anointing the Part with old Oil, in which roots of wild Cucumbers and Althaea, have been boiled.

XLV. Or this. ℞ Mucilage of Althaea roots, Linseed and Fe∣nugreek, Goose grease, Veal marrow, pouder of Orrice root, pouder of Hermodacts, Camomil flowers, A. ℥ii. liquid Storax, Myrrh, Frank∣incense, Oil of Camomil, A. ʒx. Wax, q.s. mix, and make an Emplaster.

XLVI. Scultetus has this Ob∣servation. With the noble Lime-water, says he, made use of for some days, I have discussed obstinate Oedematous Tumors. ℞ A piece of Quicklime, the quantity of a Walnut, put it into boiling Water till it is dissolved; which done, stir them toge∣ther, and let them settle: de∣cant off the clear Water, and

dip into it a new Spunge, which press out, and apply hot to the Part; it being first an∣ointed with Oil of sweet Al∣monds, or Hogs-grease.

XLVII. The same practice (says he) is to be given to a Spunge dipt into Posca or Oxycrate, viz. Vinegar and Water mixt to∣gether; being applied in the beginning or augmentation of the Disease. Scult. observ. 72.

XLVIII. In an Oedema Phle∣gmonoodes, which is somewhat like an Erysipelas, and for the most part invades the Limbs, being very troublesom, nothing is found better than this: ℞ Lye of Vine-ashes lbi. Sal-nitre ʒjss. common Salt, Wine-vinegar, A. ℥i. mix them. After general Remedies, dip double linnen Cloths in this lukewarm, and apply, binding them on with Rowlers: it wonderfully drinks in, discusses, and in three or four days at most, helps dan∣gerous Oedema's, threatning Mortification. Scultet. observ. 98.

XLIX. Munick, Chirurg. lib. 1. cap. 6. sect. 14. commends this, from great Experience. ℞ Re∣ctified S.V. Wine-vinegar, A. ℥vii. common Salt ℥ss. mix, and dissolve: this Liquor apply with double Cloths dipt in it hot, with strict ligature (rowling it from below upwards) but not too much compressing the Parts.

L. About three years since, I had a Maid-servant in cure, who having an obstruction of her Terms, had forthwith an Oedema in her Knee; it was very large: I first well purged her with my Family Pills three or four times; and gave her Tinctura Martis to provoke her Terms, which was effectually done: after which, (making her keep her Bed, for about seven or eight Weeks) I gave her every night my Guttae Vitae, beginning at fifty drops, and increasing the Dose gra∣dually, till it came to an hun∣dred; which she continued the taking of, the whole time of the Cure.

LI. And outwardly, after Fri∣ctions, I bathed it well with my Spiritus Anodynus, (which is a Tincture of Opium, &c. in Spirit of Wine:) and after, anointed it with Balsam de Chili, ap∣plying over it a Plaster of Mi∣thridate. This course was con∣stantly repeated, morning and evening; and in about 8 weeks time she was perfectly well.

LII. Where an Oedema is very obstinate, whether it breaks, or breaks not, there is nothing equal to a gentle Salivation; which being skilfully and careful∣ly performed, does the Cure to a wonder; for that it causes an effectual revulsion of the Humor to another Part.

CHAP. XXII. Of the CYSTICK TƲMOR.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Tumor Cysticus; in English, the Cystick Tumor, or, Tumor contained in a Bag.

II. The Kinds. It is three∣fold, according to the threefold Matter contained in the Cystis, or Bag: viz. 1. When it is like unto Frumety, called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Pultis genere; in Latin, Athe∣roma. 2. When it is like unto Honey, called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; à 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Mel, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Cera; in Latin, Meliceris. 3. When it is like unto Suet, called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, à 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Sebum seu Sevum; in Latin, Steatoma, Tumor sevosus.

III. They are all of them also called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Choeratodes; because they have some resem∣blance to that swine-like Disease the Scrophula; when contained in a Cystis or Bag.

IV. The Definition. Atheroma is a preternatural Tumor, con∣tained in a proper Cystis; caused from a Humor or Matter like to Frumety or Paste, made of boiled Barley or Wheat; of the colour of the Skin, without pain, hot easily yielding to the Fingers; nor when removed, suddenly swelling out again.

V. Sometimes in an Athero∣ma, there is mixt with the pultis∣like Matter, hard substances, and stony bodies; sometimes a sulphur-like substance, somtimes small Bones, matted Hair, and the like.

VI. Meliceris is a preternatu∣ral Tumor, contained in its own proper Cystis, proceeding from a honey-like Matter, of a white colour, painless, round, and easily yielding to the Fingers; which being removed, present∣ly returns again to its first figure.

VII. The Tumor in this, is greater than the former, its figure is rounder and higher, and the Humor thereof thinner.

VIII. Steatoma is a preter∣natural Tumor, contained in its proper Cystis, caused from a matter like to Suet, and of the same colour, and soft: it arises from a small beginning, in∣creases gradually and leisurely, difficultly yields to the Fingers; which being removed, it re∣turns again to its former magnitude.

IX. The Differences. How they differ one from another, the Signs aforegoing shew: but (says Bar∣bett) if the Matter of any of these Tumors is gathered together about the Joints, it is called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ganglion: if about the Glandules of the Neck, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Choeratodes, Glan∣dula, Scrophula, or Struma: if

in the Arms or Legs, Tuberculum; if from the Pox, Tophus, or Gumma. So that in the main, it seems, that he makes them but as a species of the Kings-Evil.

X. But if they happen in the Head, they are called, 1. Talpa, which is referred to Atheroma. 2. Testudo, or Topinaria, which is referred to Meliceris. 3. Natta, which is referred to Steatoma, growing forth especially on the Back.

XI. The Causes. The Antece∣dent Cause is Phlegm; in the one more, in the other less; receding from its natural constitution: and sometimes (tho' seldom) it is mixt with Melancholy.

XII. Platerus is of pinion, that these Tumors are not gene∣rated from excrementitious Hu∣mors, or Phlegm; (for that it would be obnoxious to putrid∣ness) but from an alimentary Juice: viz. such as is by Nature provided for the nou∣rishment of the Part.

XIII. For (says he) if the Humor is thicker than is neces∣sary for nourishment, then a fleshy substance or Excrescence is bred: but if the Humor is extraordinary thick, then it becomes a Scir∣rhus: but if the Humor is thinner, then it suddenly ends in an Apostem, in which dif∣ferent matter is generated, ac∣cording to the difference and variety of the Juice mixt with other Humors) which has bred this Tumor; which yet comes not to suppuration in like manner, as other Apostems bred from Blood; nor yet is it turn'd into Pus, but into an∣other kind of Substance, con∣tained in a proper Cystis.

XIV. All these sorts of Tumors have their cause from a very inconsiderable beginning; and they are tedious, and increase but by little and little; being in∣cluded in their own peculiar Tunicle.

XV. The Signs. Atheroma yields when it is touched, as if it were a certain loose body, and returns back slowly: but what it has within, (as also Meliceris and Steatoma) is only to be guessed at by conjecture: so true it is, that it cannot be certainly known, till it is cast forth; as Celsus says, lib. 7. cap. 6.

XVI. Meliceris is rounder in figure, more extended; and when pressed down, it suddenly yields and gives place to the touch; and upon removal of the Fin∣gers, as soon returns back again.

XVII. Steatoma is harder than the other, and resisteth upon the touch, having the bottom there∣of more solid: but tho' it is hard, yet it differs from Stru∣mae, because it is nothing so hard as Strumae, nor has it an inequality like it.

XVIII. The Tumors called Talpa, Testudo, and Natta, are easily known, 1. From the Place, because they almost always hap∣pen in the Head. 2. From their Form and Substance; being soft Tumors, at least not very hard, and shut up in their own pro∣per Cystis.

XIX. TALPA (from its

creeping like a Mole) runs under the Skin and Flesh, and seems to feed upon the Cranium or Skull; the matter whereof is more gross and thick than in Testudo, and so may be referred to Atheroma.

XX. TESTUDO, is a great Tumor in the Head, soft, or not very hard, of a broad form, much like the manner of a Tortoise; growing forth at first in form and fashion of a Chesnut, after∣wards like an Egg, containing a soft kind of matter, in a Cystis; for which reason it is referred to Meliceris, which sticks so fast in the Scull, that it vitiates it, and causes rottenness.

XXI. NATTA, is a Tumor great and soft, without any pain or colour, growing on the head, back, shoulders, and somtimes other parts, hanging by a small, slender root; yet sometimes it increases to the weight of some pounds, and in bigness, to the quantity of a large Melon: the Matter con∣tained, seems to be fleshy, but indeed it is no Flesh, but like unto Fat, and therefore is re∣ferred to Steatoma.

XXII. These three last Tumors have the same Cause, which the three former Tumors have; but in this lyes the difference, that in these there is a greater quan∣tity of Matter; for which reason, their magnitude or bulk is much greater.

XXIII. The Prognosticks. Atheroma, Meliceris, and Stea∣toma carry no danger in them; yet they are generally of long continuance, and without any great hurt, continued and neg∣lected.

XXIV. Sometimes they Aposte∣mate of their own accord; but if so, they are not of so diffi∣cult cure as Scrophulae, or a Scirrhus.

XXV. If they be elevated, and exposed to motion, they are easily cured; but if they lye deep, and not exposed to the touch, with much more difficulty.

XXVI. In cutting them out, much care is required, because of the danger of great fluxes of Blood; or the cutting or pricking of some Nerve. Many Chirur∣geons for want of skill, in cutting away these Tumors, many times cut away the Nerves that lye under them.

XXVII. These Tumors (says Barbett) are scarcely ever cured, but by Manual Operation. If the Vesicle is broken, or not all taken out, there remains a Fistula, or foul Ulcer; whose cure will be both difficult and tedious.

XXVIII. Talpa, Testudo, or Natta, being in the Head are dangerous, by reason of their nearness to the Scull; for that they corrode the Scull, and corrupt it, chiefly about the Suture.

XXIX. If they are without any corruption of the Scull, they are the more easily and safely cured: but if there is present a great corruption of the Scull, it is much better to let the Tumor alone, than to cure it.

XXX. As in Atheroma, Meli∣ceris, and Steatoma, so in Talpa, Testudo, and Natta, there is no

perfect recovery to be hoped for; unless the whole Cystis, together with the Humor contained in it be taken forth; for if any thing is left behind, a new Tumor of like kind will arise again.

XXXI. The Cure. Tho' Athe∣roma, Meliceris, and Steatoma, differ in their names, yet they have almost but one way of curing. Universals are to be premised, and the whole Body is to be purged from the vitious or or offending Humor, both by Vomit and Stool.

XXXII. Afterwards the con∣joined Matter, which is the cause of the Tumor; and the Cystis it self is to be taken away, if need requires.

XXXIII. Barbett says they are sometimes, but very rarely removed by Resolvents: Senner∣tus says, that Atheroma is cured by Discussives and Suppura∣tives; and for the most part, has no need at all of Section.

XXXIV. Barbett cured some with Balsam of Peru; some with Empl. Oxycroceum; some with this following: ℞ Labdanum ℥i. red Myrrh ʒiii. Camphir ʒi. mix, and make a Plaster.

XXXV. Another. ℞ Gum Ammoniacum, Sagapenum, A.℥ss. flowers of Sulphur ʒiii. Oil of Amber ʒi. Euphorbium, and roots of Pellitory, A. ʒss. mix, and make a Plaster.

XXXVI. This of Sennertus is good. ℞ Labdanum, Bdel∣lium, Galbanum, Ammoniacum, Propolis, Turpentine, A. q.s. mix, and make an Emplaster. Un∣slaked Lime also (he says) mixed with Grease or Oil, is very useful, and of singular benefit.

XXXVII. Or this: ℞ Ship-Pitch ℥i. Gum Ammoniacum, Sulphur, A. ℥ss. mix them. Or this: ℞ Roots of Sowbread, Hogs-lard, A. q.s. to which add a little Sulphur, and make a Cataplasm.

XXXVIII. If these Tumors tend to suppuration, which is very rare, you must assist Nature with Maturatives: and if they break, and the Matter discharge out of the Tunicle, then you must use Corrosives, for other Medi∣cines will be too weak.

XXXIX. Cathereticks for this purpose, are roots of white and black Hellebor, burnt Galls, burnt Date-stones, Verdigrise, burnt Alum, Quicklime, Mercury-sublimate, Vitriol, Spirit of Salt, Oil or Butter of Anti∣mony, Liquor of Tartar, red Precipitate, Oak-ashes, Vine-ashes, Ʋng. Aegyptiacum, Ʋng. Fuscum Wurtzii. Some use Ar∣senick and Orpiment, but with great danger in some places, as near the Nerves and nervous Parts; but to the Skin and fleshy Excrescencies, they may be better applied.

XL. This Ointment is also of good use. ℞ Dulcified Vitriol ʒi. Verdigrise ℈i. Ung. Aegy∣ptiacum ℥ss. mix, and make an Ointment. Others commend red Precipitate mixt with Honey, or Honey of Roses.

XLI. But if the Tumor open; not of its own accord, then you must come to Section; that so the Cystis (whether it contains a

butter-like, a honey-like, or suet-like substance) may be taken forth, and cut away.

XLII. The Skin is not to be cut transversly, or overthwart; but streight forward, or a little ob∣liquely, like to the form of a Myrtle-leaf; then the Cystis, or Membrane containing the Hu∣mor, is to be freed from the Skin, and the Part lying under it: after which it is to be wholly cut off at its root, with one singular cut.

XLIII. Now in this Operation great care is to be taken, that the Cystis be not hurt; for so the Humor that is contained there∣in, flowing forth, will hinder the Operation; and be a means that some of it, or some of the Humor may be left behind; which if it should so chance, is to be consumed by Cathere∣ticks: for if any part of the Tunicle is left remaining, the Tumor will again return.

XLIV. If these Tumors are in the Head, (the Cystis being taken forth) the Pericranium must be cut, and the Scull shaved, lest there be any remainder which may generate the Tumor afresh.

XLV. If the Patient will not admit of Section, the Skin is to be opened with a Caustick, and the Cystis being taken forth, the Ulcer is to be consolida∣ted, cutting away the Skin, whatsoever of it is superfluous.

XLVI. An Observation. A Child three years old had an Atheroma, a large soft Swelling without inflammation: the Bone being suspected to be carious, a Caustick was applied, which gave vent to a matter not unlike Butter, and by search with a Probe, the Cranium was felt bare. It was drest with Lenients, and after separation of the Escar, the Cranium was bare, as broad as a shilling: it was drest up with Linimentum Arcaei hot, and the lips of the Ulcer with Ʋng. Basilicon mag. The second day, it was fomented with Decoction of the tops of Hypericon, Ori∣ganum, Betony, red Roses and Balaustians in Wine and Water: the Bone was drest with Dossils of Lint, prest out of S.V. and the lips were drest with Ʋng. Diapompholigos, touching them sometimes with a Vitriol or Alum Stone. By this means the Bone incarned, united with the lips of the Ulcer, and cica∣trized from the edges round; during which some small pieces of Bones cast off, and the Ulcer easily healed. Wiseman.

XLVII. Another. A Coach∣man had a troublesom Meliceris on his right Shoulder, which after preparing and purging the Body, there was applied the Cerate Dia∣sinapios to it, thus made. ℞ Old Oil ℥xi. Sal Gem, Litharge of Gold, Ceruse, A. ℥iv. Mustard∣seed poudred ℥ii. Galbanum, Opo∣panax, A. ℥ss. Wax, Turpentine, A. ʒii. Vinegar q.s. mix, and make a soft Cerate. The effect of this Cerate against a Meli∣ceris, I lately experienced in another person; who by my advice apply'd it to a Meliceris in the right Knee, as big as a Goose-egg, which it totally discussed in a months time, with all those other Humors,

which were gathered to the Part in the beginning, thro' the neglect of general Reme∣dies. Scultetus.

XLVIII. If any of these kinds of Tumors hang like Figs by a slender stalk, they are not to be cut out by opening the Skin, but they are to be cut off by the roots: or in timorous people, you may bind it about its roots with a Thread, drawing it harder and harder every day, to stupify it; which is there to be left, till the Tumor falls off: but where the Patient has courage enough, 'tis best to be cut away with a sharp Knife.

XLIX. If it bleeds much, (after cutting off) you must either stop it with a Styptick, or lightly burn it with a red-hot Iron; and when the Escar is fallen, you must heal it as a common Ulcer: this way the Ulcer is but small, and equal, and the Cure soon done.

L. Some of these Atheromata, which lye upon the Parts with a large Basis, are of very dif∣ferent magnitudes: some are as big as a small Nut, some as big as a Walnut, others as big as an Egg; but the great ones are as big as a large Melon or Pompion: and I once saw one, upon the Back of a Gentle∣woman, as big, nearly, as an half-bushel.

LI. Now these great ones, by reason of many Veins and Arte∣ries, cannot be taken forth, but are wholly to be cut off at once, after the manner as a Cancer is cut off: taking it away by the very roots; after which, to stop the flux of Blood, it must be drest up with Stypticks, Digestives, Sarcoticks, and Epu∣loticks.

LII. Scultetus, instead of taking hold of it, as you do of a Cancer in cutting it off, has a large pair of Pincers made on purpose, with which he takes hold of the whole Apostem, as far as the roots of it, and so proceeds to the amputation, or cutting off: those which are of the lesser sort, are cut forth by opening the Skin, and separating it, and not otherwise.

LIII. In this latter case, you must be very careful that you hurt not the Cystis, especially in an Atheroma, and a Meliceris: but in Steatoma, the tallowy substance being more solid, it will hardly run forth, so that there is less danger in hurting the Bag.

TALPA, TESTƲDO, NATTA.

LIV. These give little hope of cure where the Bone is much corrupted; otherwise, when they reject all other Remedies, they may be taken away by the Knife, thus; Divide the Skin in form of a Cross, then take forth the Cystis whole; which done, sepa∣rate the Pericranium from the Cranium, and scrape the Bone with a Rasp, till you come to the sound Part.

LV. After which, sprinkle upon it some Astringent pouder, and let the Skin be forthwith con∣solidated again; which if it is too loose or large, (which is

very seldom) is in part to be cut off, or taken away.

LVI. Ʋniversals are here first to be premised, and the Body sufficiently evacuated; then the Matter making the Tumor is to be taken away by Digestives and Resolvers, or by Suppuratives, or Manual Operation; as is directed at Sect. 53. afore∣going.

LVII. It is rare that these Tu∣mors are cured by Discussives; but when you have occasion to make use of them, they may be such as we apply in Scro∣phula's, or such-like Tumors.

LVIII. If they cannot be cured by Discussives alone, then Suppu∣ratives are to be apply'd; such as that in Chap. 21. Sect. 38, and 42. aforegoing, of this Book. Or this: ℞ Roasted Onions, yolks of Eggs hard boiled, A. N^o iii. Hogs-lard, or fresh Butter lbss. pulp of Althaea-roots lbi. Mithridate ℥v. mix, and make a Cataplasm.

LIX. But you must not wait for a perfect maturation, because the Pus soon gets a sharp and malign quality, and so corrodes the Scull; but as soon as any signs of Suppuration appear, the Tumor is to be opened.

LX. The Incision is to be made either downright, or else in the form of a Cross, according to the place, and largeness of the Tu∣mor: then the Pus being wholly emptied, the Ulcer is to be throughly cleansed with Ʋng. ex Apio, or some other fit Medi∣cine: as, ℞ Barley-flower ℥ii. Sar∣cocol ℥i. Myrrh, Scammony, A. ℥ss. Honey q.s. mix them.

LXI. Or, cleanse with this. ℞ Ung. Nicotianae ℥ii. Tobacco in pouder ʒii. mix them. Or, ℞ Ung. Nicotianae ℥ii. pouder of Scammony ʒ vi Honey q.s. mix them. Scammony it self also alone applied, is an ex∣cellent thing: so also Scam∣mony mixt with Myrrh.

LXII. The Ʋlcer being throughly cleansed, it is to be filled up with Sarcoticks or Incarnatives; and then consolidated according to Art, with Epuloticks or Cica∣trizers.

LXIII. But if the Bone is cor∣rupted, it is then to be scraped with a Rasp or Scraping-iron; as is above directed at Sect. 53. after which it is to be cured as other Ulcers, which are ac∣companied with rottenness of the Bones.

CHAP. XXIII. Of a WEN.

I. THIS Tumor is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Ganglium, Lu∣pia; and in English, a Wen.

II. What the Ancients meant by Ganglion, is hard to be

determined, nor yet have we any any Disease common with us, that agrees with those Signs and Sym∣ptoms declared by Sennertus; but our more late or modern Authors, under the names of Ganglion or Lupia, intend that Tumor called by the Vulgar a WEN.

III. A Wen is a preternatural Tumor, proceeding sometimes from Phlegm, and sometimes from Phlegm mixed with Blood and other Humors; sometimes hard, sometimes soft, but most com∣monly round, and of a fleshy substance.

IV. The Places. It generally happens in those places which have little Flesh, being dry and ner∣vous: as the Forehead, Eye∣brows, Back-bone, Joints of the Toes, &c.

V. The Kinds. They are two∣fold: 1. Those which are contained in a Cystis, or Bag as it were. 2. Such as are without a Cystis, and seem to be one continued lump of Flesh with the adjoining Flesh of the Body.

VI. The Causes. The Proca∣tartick Causes are, heavy and dull blows, falls from high places, overstraining of any Part, or, any other violence; whereby the mouths of the Capillary Arte∣ries may be made too open, or the mouths of the Capillary Veins may be obstructed, so as to hinder the due Circulation of the Blood.

VII. For those Arteries (which are appointed to carry the Nou∣rishment to the Muscles) yielding or casting out their bloody Juice, and it not being received in again by the mouths of the Capillary Veins; whereby the Blood joined with Lympha, becomes extravasated, Nature forms it into a new body, and makes such a preternatural Tumor as we call a Wen.

VIII. The Antecedent Cause is sometimes Lympha alone, some∣times Lympha join'd with Serum: and sometimes join'd with Blood if it proceeds chiefly from a lymphatick, serous, or pituitous matter, it is generally included in its proper Cystis; otherwise, if from Blood, not so, but is one continued piece of Flesh with that of the Body.

IX. The Conjoined Cause is for the most part a fleshy sub∣stance, contained in its proper Cystis, or not contained; having its own particular Veins and Arteries, by which it is nou∣rished, and made daily to in∣crease, and grows sometimes to a very great magnitude.

X. The Signs. If it is not con∣tained in a Cystis, it sticks more firmly to the Part, and is as it were immoveable; as those upon the joints of the Toes, &c. but if it is contained in a Cystis, then it is more moveable with your Fingers, up and down.

XI. It is a Tumor arising from a very small beginning, and grows in a round or globular form by little and little, sometimes to a very great magnitude: some grow as big as a Nutmeg, and never any bigger, some as big as Wal∣nuts, some as big as large Eggs; others again to a vast bigness, even to the greatness

of a large Melon or Pom∣pion.

XII. In some they cease growing after a year or two, in others they grow for the space of six or seven years together: some of them easily yield to the touch, others with more difficulty; being mostly of a fleshy sub∣stance, and generally without pain.

XIII. The colour is many times white, or of the colour of the Skin, especiall where Lympha or Phlegm is the principal cause: if much Blood is conjoyn'd, it is red∣dish; if Choler be joyned there∣with, the colour is yellowish, and the Tumor a little painful; but if Melancholy, it is livid, and very hard to feel to.

XIV. As the Tumor increases, the Vessels, as Veins and Arteries, grow big also; so that they appear sometimes under the Skin, as thick as ones Thumb.

XV. The Prognosticks. This Tumor is not in it self malign; but by evil Applications it may easily be made so: however, the best of Remedies seldom answer expectation.

XVI. If it is great, and of long continuance, it will never come to Resolution: if evil Medicines be applied, it oftentimes dege∣nerates into Cancer: but this is chiefly to be understood of such as are contained in no proper Cystis.

XVII. If it is about a Joint, there is scarcely any cure for it: for in that case, cutting will be very dangerous.

XVIII. The Cure. While it is in beginning, you may hinder its encrease, as Paraeus says, (lib. 7. cap. 20.) by somewhat a strong and frequent rubbing with your Fingers: for so (says he) their Cystis or Bag, together with the Skin will wax thin, and the con∣tained Matter grow hot, and be attenuated and resolved.

XIX. But if this nothing pre∣vails, (we speak of that contained in a Cystis) you must press upon it hard with your whole Hand, or a hard piece of Wood, as heavy as you can, till the Cystis is broken; and then apply and bind strongly unto it a plate of Lead besmeared with Quicksilver: Paraeus says, he has many times found by experience, that it has a wonderful force, to re∣solve and waste the subject Humor.

XX. But if the Wen is in such a place, where you can make no strong impression; as in the Face, Breast, Stomach, Throat, or Belly; then this resolving Emplaster may be applied. ℞ Gum Ammoniacum, Bdellium, Galbanum, A. ℥iii. dissolve them in Vinegar, and strain thro' a Sieve: then add Oils of Lillies and Bays, A. ℥i. pouders of Orrice-root, Sal Armoniack, Sulphur vive, and Roman Vitriol, A. ʒss. Aqua Vitae ℥ss. mix, and make an Emplaster.

XXI. But whilst this is doing, it will be good to prescribe uni∣versal Purgers; and then to take the Tincture of Salt of Tartar for many days together.

XXII. And whilst the Tumor is small, strive to resolve it, by often anointing it with Balsam of Sulphur; and applying Empl.

Hystericum, or de Galbano croca∣tum, which is accounted one of the greatest Resolvers; or Ce∣ratum de Ammoniaco Foresti, (which see in Our Pharmacop. Lond. lib. 5. cap. 5. sect. 4. and cap. 6. sect. 61. or the Empl. de Ranis, with double or treble Mercury, which is inferiour to none of them.

XXIII. Oribasius made use of this. ℞ Ammoniacum, Galba∣num strained, old Oil, Rosin, Ce∣ruse, A. ℥i. Wax ℥iv. mix them, and apply it.

XXIV. But indeed in the be∣ginning, such things as repell and astringe are to be applied; rowling the Part upon them gently. ℞ Pomgranate-peels, Bistort-root, A. ʒi. rust of Iron, burnt Lead, Quick-silver killed. A. ʒii. fine Bole, Blood-stone, A. ʒjss. Turpen∣tine, Wax, A. q.s. mix, and make an Emplaster.

XXV. Some commend Sorrel-leaves roasted under the Embers and applied, being mixed with Oak-ashes in form of a Pultise: others apply Suppuratives, then open it, and cure it as an∣other Ulcer.

XXVI. Some use an Actual Cautery; because by it, its en∣crease may be staid for a long time; and sometimes it wholly removes the Tumor.

XXVII. Where the neck or root of it is small (or so small as a Thread may be applied) cast a strong Thread, or small Pack∣thread about its neck twice, and tye it with a double knot; drawing it straiter and straiter every day, 'till it is deprived of its colour, feeling, and life; which will be in eight or ten days time.

XXVIII. Then with a crooked Knife you may easily take it off, without any great pain, or flux of Blood: but this ought to be done in a cold and moist habit of Body, or one of a Phlegma∣tick constitution; but in San∣guine or Cholerick habits, it will so afflict, that it will scarce∣ly be endured: however, you ought to anoint with some anodyn or cooling Ointment, and use perswasions to the Pa∣tient to bear it.

XXIX. Some use Potential Cauteries, as this: ℞ Ʋnslak'd Lime, Goose-grease, Turpentine, A. ℥i. Ammoniacum strained ℥ss. mix them, and apply it.

XXX. Others, (if they will not resolve) gently and carefully anoint it, or rather touch it with Oil or Butter of Antimony, round about the roots thereof: and then with a sharp Instrument (all things being fit) cut it off according to Art; presently washing the place with Ablution of Saccharum Saturni warm, or applying some other Styptick, and then healing it up, as an∣other Ulcer.

XXXI. But if you design to take it away by Section, (which is to be done, when the Wen is grown to so great a mass, that it cannot be cured by other means, but yet withal where there is no danger by reason of its too great magnitude, too close adhesion to the adjacent Parts, or too near to the greater Arteries and Veins, for in all these cases, it will

be better to let section alone:) the manner is thus:

XXXII. Make a small inci∣sion in the Skin, even unto the Cystis, in which the Matter of the Tumor is included; thro' which a Probe of the thickness of a Finger, round at the end, but hollow in the middle, is to be conveyed in, between the Skin and the Cystis, and to be drawn about even to the root of the Wen: and then after this, upon the Skin, an Incision is to be made large enough, in form of the Letter X, or crosswise; after which, presently draw off the Skin from the Cystis, corner∣wise, towards its root, with your Fingers wrapt about with a linnen Cloth, or separate it with an Incision-knife; after which, cut off the Wen by the root.

XXXIII. If there arises any Hemorrhage from the larger Ves∣sels, (which are as it were its roots) upon their being cut, it is to be stopt with the Royal, or some other proper Styptick: after which it is to be well bound up, a portion of the Skin with which it was covered being first cut off, and only so much left as is enough to cover the Part; after which, let it be cured as some other green Wound.

XXXIV. If any of the sub∣stance of the Tumor should be left behind, it must either be cut again, or else consumed with caustick Medicaments.

XXXV. Paraeus says, he took away a Wen which hanged at a man's Neck, as big'as a man's Head, which weighed eight pounds: and he says, that being called on a time to open the Body of a great Lady, he found in one of her Breasts a Stone, as big as a Hen-egg, hard and compact like a Pebble; taken by the Physicians and Chirur∣geons whilst she was living, for a Cancer; because it was very painful to her, when pressed upon.

XXXVI. The Cure of a Wen not contained in a Cystis. Whilest it is young, and in its beginning, you must apply Discus∣sives or Resolutives, and such things as make supple, as are Emollients: Natural Baths of Sulphur are good in this; also Empl. Diasulphuris Rulandi, which dissolves much.

XXXVII. But you must beware how you apply Suppuratives, lest you create an incurable Ʋlcer; at least such a one as will be very difficult to heal, or may prove phagedenick, whereby the nervous parts near about the Joints may be corrupted.

XXXVIII. In a Tumor there∣fore of this kind, your best way will be, to be contented with a Palliative Cure, and such things as may keep it from growing bigger, or degenerating into Can∣cer; of which kind are Ʋng. Diapompholigos, a Plate of Lead besmeared with Quicksilver, Emplastrum de Ranis, with triple quantity of Mercury, &c.

CHAP. XXIV. Of GƲMMS, NODES, TOPHS.

I. THESE kinds of Diseases are called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Tumor gummosus, nodosus, tophaceus, & callosus; in English, a Gumm, Node, Toph, or Callous Tumor.

II. The Differences. There is some difference as well in the natures of these Tumors, as in their names: and tho' they may all happen to one and the same person, and at the same time, yet always in different parts of the Body, and from different causes.

III. A Gumm, called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Tumor gummosus; is a Tumor happening in the brawny parts of the Body, or in the substance of the Flesh; and this is for the most part softish, and of a much softer substance, than either a Node, or a Toph.

IV. A Node, called, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Tumor nodosus; is a knotty hard kind of Tumor; and commonly affects the Nerves, or Nervous parts.

V. A Toph, called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Tumor callosus; also, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Tumor tophaceus, a hard, stoney-like Tumor, is an Exostosis, or bone-like substance, growing out upon a Bone, or a stoney Concretion growing in the joints.

VI. The Places. A Gumm happens many times upon the brawney part of the Arm, as be∣twixt the Wrist and the Elbow, and between the Elbow and the Shoulder: also upon the fleshy parts of the Buttocks, Thighs, and Leggs, and many times upon the hairy part of the Head, and Forehead, and seve∣ral other parts, as Wrists, Ancles, &c.

VII. A Node is always an Affection of the Nerves, or Ner∣vous parts, following many times upon Convulsions, or after severe Cramps; and sometimes in those places where the Lympha∣tick Vessels run.

VIII. A Toph is always found upon the Bones, or in a Boney place; being a hard Callus, or bone-like substance; and is seated generally under the Periostion, upon the Shins, &c. and some∣times in other parts, as the Joints, in the Gout, where it is stoney.

IX. The Causes. A Gumm, for the most part, arises from the Venereal Disease; which causes a fugitive, malign, pitui∣tous Humor to fly up and down the Body; till it meets with a plentiful Viscosity, sufficiently able to stop it in its career, and then hold it fixt in the Part where it so appears.

X. A Node, is caused for the most part by a contraction of the

Nerves in Spasmatick-paroxysms; or thro'a rupture of some of the Lymphatick-vessels, in the Pox; and other Diseases: where that Juice being sharp, and making its way, and not being able to get thro' the Skin, it hardens into a Matter, much like to a Knot in a Nerve, or some Cartilaginous substance.

XI. A Toph arises from many causes, as sometimes from breaking of the Bones, the Bone-making Faculty and Juice, being too powerful and luxuriant; but mostly from a sharp and malign Humor, in the French-pox; which touching the Bone, seizes upon it, where making its seat, it grows hard and great, extending the Periostion; or from a Li∣thontriptick Juice; which be∣ing scattered up and down the Body, Nature for her relief sends to the Joints, and there hardens it into the substance of Chalk-stones.

XII. The Signs. These are all known by sight, and from what has been said in their Differences, places they seize on, and the variety of causes which produce them. Gumms are known by a broad large swelling in the Flesh, making the very place somewhat harder, and somewhat higher than the adjacent Flesh; sometimes of the colour of the Skin, and sometimes of a kind of red∣dish hue, especially if any sort of pain attends them; which being nipt with your Fingers, as hard as you may do any other fleshy substance of the Part, puts the Patient to ten times as much more pain.

XIII. A Node is hard in feel∣ing, much like to a hard, nervous, or cartilaginous substance, some∣times as large as a small Hazle∣nut, sometimes as big as a large Nutmeg; sometimes bigger, sometimes less, generally pain∣ful, and sometimes not easy to be felt by the Fingers in places nervous, or where the Nerves and Lymphatick-vessels pass.

XIV. A Toph or Exostosis is known from the Place, which is generally upon some naked Bone; as the Shins, Jaw-bones, &c. From its Form, it being broad in its Basis, and lifted up higher than the rest of the Flesh: and from its Sub∣stance; it being very hard, like to a bone, and not yielding to the Fingers: its Colour is the na∣tural colour of the Skin, and is very full of pain, chiefly in the night time, and when warm in bed; whence come those which are called Nocturnal Pains; this kind of Tumor generally following upon, and being one of the Symptoms of the Pox: Stones in the Joints, are known by Sight.

XV. The Prognosticks. These are all of difficult cure, and only to be removed, by curing the Dis∣eases which cause them. Gumms proceeding from the Pox, are easier of cure, than either Nodes or Tophs, because they are removed by resolution with Externals only; and sometimes by Internals only, by such things as take away the Disease which causes them.

XVI. Nodes are of very difficult Cure; and tho' many times, at length they are cured by Reso∣lution,

yet they also many times, remain during the whole course of the Patient's life.

XVII. Tophs are the hardest of all to cure, where they are of a stoney hardness; as those of the Joints in the Gout, which are said to be incurable.

XVIII. And Exostoses upon the Shins and other places, admit of no other cure, but laying open the Part, and scaling the Bone, or Excision; which is a work of time, labour, difficulty, and hazard; together with removing the original Cause, viz. the Pox it self.

XIX. The Cure of Gumms. These, as they arise from the Pox, so the internal Remedies must be such as cure that Disease; the chief of which are, the Princes Pouder, Precipitate per se, white Precipitate, Turpethum Mine∣rale, Arcanum Corallinum, Aurum Vitae, &c.

XX. Outwardly you may apply this: ℞ Juice of Night∣shade, Oil of Lillies, Vipers fat, A.ʒiv. boil to the consumption of the Juice; then add, artificial Cinnabar ʒiv. Opium, Castile-soap, A. ʒii. Sublimate in fine pouder ʒiss. Labdanum, Wax, A. q.s. mix, and make an Emplaster.

XXI. Or anoint with this Liniment. ℞ Distilled Oils of Turpentine, Euphorbium, Amber, and Guajacum, A. ʒii. crude Opium ʒiv. Quick-silver killed with spittle ʒi. mix, and make an Ointment or Liniment.

XXII. Or you may apply Em∣plastrum de Ranis, with double or treble quantity of Mercury, or Emplastrum Mercuriale, de∣scribed in lib. 1. cap. 77. afore∣going, which is inferior to no other Medicament.

XXIII. I have also many times cured Gumms, by bathing the place affected two three times a day with this Water. ℞ Sub∣limate corrosive in fine pouder ʒi. boiling Water ℥x. mix, and dissolve.

XXIV. A Child seven years old, had a Gummy-swelling en∣compassing the Muscle Mastoides, on the right side of her Neck, also the Fingers of her right Hand were affected with the like Swel∣lings. The Gumms upon the Neck and Fingers were embro∣cated with Ʋng. Magistrale ad Strumas and Empl. ad Tophos, applied over all: during which Applications, the Child was frequently purged with Calo∣melanos and Diagredium; and drank a Decoction of Sarsa, Burdock-roots, Scrophularia the greater, flowers of Sage, Betony, and Rosemary, &c. But the Cure not succeeding with these, there was given her a few grains of Theriaca Metallorum, by which she Salivated; during which the Gummy-tumors resolved, and several Ulcerations she had, dried up. But to confirm the Cure, she took Sudorificks, and purged frequently. Wiseman.

XXV. A Woman thirty years of age, had a Gumma on the Muscle Mastoides, (whether from the Pox, or Kings-evil, is doubtful,) she took Calomelanos, ad ℈i. and repeated it as oft as was thought cenvenient, with a Decoction of Sarsa; by which course, some Ʋlcers in her Throat were also healed. The Gumma

lessened, her Chaps being now already sore by the Calomela∣nos, two Doses of Turbith were given her; beginning with gr. 7. and so higher, by which a Salivation was raised, which resolved the Gumma; after which she was purged, and with a drying Diet she was cured. Wiseman.

XXVI. The Cure of Nodes. These are more difficult to be cured th••n the former, and can only be ••ielped by curing the Disease which causes them.

XXVII. If they proceed from Convulsions of the Nerves, or Spasmodick Paroxysms, give in∣wardly this: ℞ Powers of Rosemary, Lavender, Sage, Li∣mons, Anise, and Amber, A. ℥i. mix them. Dose, one spoonful, in a glass of Ale or Wine, mor∣ning and evening.

XXVIII. And outwardly, bathe with the same Mixture, or with Oil of Amber, or with this. ℞ Pure, sweet, golden-coloured Palm-oil ℥i. Spirit of Nitre, Oil of Amber A. ʒii. mix them well, and anoint there∣with daily, two or three times a day.

XXIX. Sennertus commends natural Sulphurous Baths; as also Emplast. Diasulphuris Rulandi, which he says is here very useful, and of singular benefit. However, nothing in the World seems to out-do the force of the Spiritus Mirabilis, bathing with it twice or thrice a day.

XXX. But if they proceed from a Venereal or Pocky Cause, nothing can absolve the Cure, but inwardly to give Mercurials, to cause a compleat Salivation; as we have taught in lib. 2. cap. 38. of this present Work.

XXXI. And outwardly to anoint the Node with Ung. Mer∣curiale, Cosmeticum, vel ad Sca∣biem; and to apply over it Cera∣tum ad Tophos, Emplastrum de Ranis; with treble quantity of Mercury; or the Emplaster de∣scribed at Sect. 20. aforegoing:

XXXII. Or, which is better, our Empl. Mercuriale, in our Phar∣macopoeia Chirurgica, described Lib. 1. cap. 77. sect. 8. afore∣going. If these things do not, the Affect is incurable.

XXXIII. Some have attempted to remove them by Chirurgical Operation; but by reason of the Parts in which they happen, which are mostly Nervous, it cannot be done without great danger, and much pain; besides rendring the Part deformed, and many times useless, as to its natural operations.

XXXIV. The Cure of Tophs. These, as they always proceed from a Venereal Cause, so their cure must be attempted only by a radi∣cal cure of the Pox; which can be done but by a through-salivation: wherein you are to consider the age, sex, strength, and habit or constitution of the Body; and accordingly to ex∣cite it, by such things as may be most agreeable.

XXXV. Then you must come to Topicks, which give us but little hopes; without laying open the Part to the Bone, and taking away the Exostosis, (or it may be only a foulness of the Bone) by proper Medi∣caments,

or Manual Opera∣tion.

XXXVI. Scultetus, Obser. 65. had a Man who complained of a Venereal Toph on the left Leg, which would neither yield to a Sudorifick course, nor the-Cerate in Sect. 39. following. He there∣fore laid open the Shin-bone (which was foul) with a Cau∣stick; and shaved it away to the sound part, with the Scraping-Irons: which done, he applied a Drying-pouder to the Bone, and with dry Lint, Incarnatives, and Epuloticks he healed it up as an ordinary Wound, and so perfectly cured the Man.

XXXVII. Now here is to be noted, that no Fat, or Oily Me∣dicines are to be used to the Bone, except they are extream drying: or such Oils and Balsams as are made by Distillation, and so have lost all Unctiousness.

XXXVIII. It is also observa∣ble, that sometimes the virulency of this Disease is such, that it penetrates and corrupts the Shin-bone to the Marrow; in which case, the use of the Rasp or Scraping-iron is not sufficient; but besides them, Trepans, and red-hot Irons or Cauteries, are necessary to the rooting up, and consuming the remaining foulness, which will not be separated by the Tinctura Ex∣folians, or sprinkling upon it the pouder of Euphorbium.

XXXIX. If the Nocturnal Pains are recent, and the Toph but young, it is many times cured by anointing with Ung. Mercu∣riale, or Cosmeticum, or ad Scabiem, and applying over Empl. Mercuriale; or this of Sculte∣tus: ℞ Diachylon with Gumms, Cerate Oxylaeum, Citrinum, A. ℥i. Quick-silver (killed with fasting-spittle) ℥ss. Oil of Gua∣jacum ʒ i. pouder of Indian To∣bacco ʒss. mix, and make a Pla∣ster.

XL. But if these things do not, so that the Pains remain, and the Tumor is not discussed, it is a certain sign that the Bone under the Gumm or Toph is corrupted: and therefore it is necessary to make incision upon the Toph long-ways, upon the Shin-bone, with an Incision-knife; and then the Bone being uncovered, to rasp or scrape it away with the Scraping-iron, where it is corrupted.

XLI. The Bone being made bare, this Pouder to cleanse it, is good. ℞ Euphorbium ʒi. Sar∣cocol, Mummy, A. ʒss. make each into a pouder, and mix them. Barbett.

XLII. But if the corruption of the Bone is so great, that it can∣not be removed by Medicaments, then you must come to Manual peration, as afore declared; scraping the Bone only, if the corruption is small; but per∣forating it, if it is great; or rather using the Actual Cautery: for without these you will not be able to make a perfect Cure.

XLIII. The Padua Chirurgeons do it thus. The first day they cut the Toph with an Incision-knife, upon the length of the Shin-bone, to the Bone it self: then they dilate the Wound, with Tow wet in Glair of Eggs, and they bind up the Leg with convenient

Ligature, to repress any afflux of Humors

XLIV. The second day, they remove the Dressing, opening the Wound artificially; and then having well defended the sound parts about it, that they may not be hurt, they fill it with a Caustick, and after that cover it with a Plaster, reaching all over it, but not going round the Leg, and bind it up again, according to Art.

XLV. The third day, the Em∣plaster and Caustick are removed, and then they apply things to make the Escar fall off; which being taken away, they scrape away the rottenness, 'till the Bone appears sound: and lastly, with drying Pouders they cover the bone with Flesh.

XLVI. Where note, that they first cut the Toph, that the Cau∣stick may the sooner come to act; yet incision is not always first necessary; for we now gene∣rally apply the Caustick first upon the whole Skin, and then open it with an Incision-knife to the quick; wherein, if the Caustick has not had its full effect, we sometimes apply it again a second time, and that with good success; as was done to a late Patient of mine, with all the advantage imaginable.

XLVII. A Man having a Toph upon the shin of his right Leg, from a Venereal cause, (of which he had been lately cured (was first purged, and prescribed a De∣coction of Sarsa, &c. also Anti∣monium Diaphoreticum, and Em∣brocations and Emplasters were applied to resolve the Toph: but after six weeks course, it remained almost as painful as before.

XLVIII. Ʋpon which considera∣tion, it was concluded to lay it bare; it was done with the white Caustick: after, the Escar was divided to the Bone, and at the next dressing, raised the Escar off; then the Toph was scraped with a Rasp, and dressed dry, as is usual in Ulcers with Caries.

XLIX. The Lips of the Ʋlcer were digested with Unguentum Basilicon applied warm: after∣wards the Bone was incarned, and the Ulcer was cured in the space of two months; but not with∣out great trouble to the Chir∣urgeon, and much pain to the Patient. Wiseman, lib. 7. cap. 4. observ. 53.

L. If in the Operation of this Cure, proud Flesh should arise upon the Lips, or in the middle of the Ʋlcer, it may be taken away by strewing upon it red Precipitate dry, and laying over it Pledgets spread with Basilicon mixt with Precipitate, or on which Preci∣pitate is strewed, &c. and at length, after due cleansing, the Ulcer is speedily healed, by washing it with some styptick Liquor, and applying de Minio, or some other drying Empla∣ster.

CHAP. XXV. Of a FUNGUS, or SPONGY FLESH.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in La∣tin, Fungus; and in English, a Fungus, or Spongy Flesh.

II. The Kinds. It is twofold, viz. either True, or Bastard: the True, is that which is properly so called.

III. The Bastard is fivefold: viz. 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Pterygium, parva Ala; an Excrescence of Flesh about the nails of Fingers or Toes, or Flesh growing in the corner of the Eye. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Condyloma, a flat Swelling in the Fundament. 3. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Ficus, the Fig in the the Fundament. 4. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Cristae, the Comb in the Fun∣dament. 5. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Thymi, the Tyme-flower-like Excrescence of the Fundament.

IV. The Definition. A Fun∣gus properly so called, is a fleshy Tumor arising from a Membrane any ways wounded, hurt, or bruised; growing up suddenly, like a Mush∣room, (whence the name) and naked, without any skin to cover it.

V. The Place, From Galen, de loc. affect. lib. 1. cap. 1. Avi∣cenna, in the fifth of lib. 4. tract. 3. cap. 1. and Guil. Fabricius Hil∣danus, cent. 2. observ. 25. it appears to be a Tumor, chiefly arising from the Membranes of the Brain being hurt or wounded: When the Cranium is broken (says Galen) if the Me∣ninx or Membrane is broken also, a Fungus does arise: and, says Avicen, When the Scull is broken, if the Meninx or Membrane goes forth, a Tumor called Fatera, i. c. Fungus, is caused.

VI. But as Hildanus observes, they may happen in other places also; as the Ear, Palate of the Mouth, Gumms; and also upon the hurting, or wounding of an Artery, and in several other places.

VII. The Cause. 'Tis caused from a gross melancholy Blood from the broken Vessels of the Scull and Dura Mater, or from a su∣perfluous Humor; as it were sweating forth thro' the hurt Membranes; and is changed into the substance of the Flesh, by the Plastick or Formative Faculty of the Part.

VIII. For Nature (which can∣not be idle) does form into this fleshy substance, the superabun∣dance of the flowing Humor; because the Part, by reason of its debility, is not able to con∣vert it into the nourishment and substance of the same.

IX. The Signs. It is very easily known, for that, out of a Membrane (in any part) hurt, bruised, or wounded, there springs

or grows forth a spongy, soft, pale, naked Flesh; or not covered with skin; which in a very short time grows to a very great ma∣gnitude; being narrow beneath, and broad above.

X. The Prognosticks. If it is in the Head, it is very dangerous, and hard to be cured: nor is it of easy cure, let it happen in what Part soever, especially where there is an afflux of vitious Humours.

XI. It ought to be cautiously handled; for if it is not ma∣naged aright, it is very apt to degenerate into the nature of a Cancer.

XII. The Cure. Ʋniversals are to be premised, yet such as are gentle, according to the strength of the Patient, and great∣ness of the Affect; and what the nature of the Part will ad∣mit of.

XIII. Then Topical Medicines are to be applied; which are such things as exsiccate, or corrode: or it must be removed by Ma∣nual Operation, as excision, or cutting out.

XIV. Medicaments which ex∣siccate or dry are much more safe, than such as corrode and eat: because Corrosives are apt to alter the quality of the Part, exasperate the Tumor, and cause it to degenerate into the nature of a Cancer.

XV. For this purpose Authors commend Roots of round Birth∣wort, of Florentine Orrice, of Angelica, of the true Acorus: Herbs; as Carduus ben. Horse∣tail, Plantane, Rosemary, Rue, Savin, Storksbill: Flowers; as red Roses, Balaustians, La∣vender: Gumms or Rosins; as Mastich, Frankincense, Oliba∣num, Myrrh: Mineral Prepara∣tions; as Tutty and Lapis Ca∣laminaris prepared, burnt Lead, Saccharum Saturni: Ashes of Frogs and Sea-crabs.

XVI. But in the beginning use Clysters, at least every other, or every third day. ℞ Posset-drink or Mutton-broth lbi. brown Sugar ℥iii. Tinctura purgans ℥i. Powers of Aniseeds ℥ss. mix.

XVII. Foment twice a day with this. ℞ Red Port-Wine lbii. Spiritus Vini Camphoratus ℥ss. Powers of Lavender, Limons, Peny∣royal, Rosemary, Amber, and Tur∣pentine, A. ʒss. mix: and with a Spunge, or double Flannel, foment therewith hot.

XVIII. Then dry the Head and Part with hot Linnen, and be∣sprinkle the Fungus, and whole Wound with this. ℞ Zedoary, Calamus Aromaticus, Winter's-Cinamon, A. ʒiv. roots of round Birthwort, Florentine Orrice, Gua∣jacum wood, Rhodium, A.ʒv. Mar∣joram, Rosemary, Rue, Sage, Savory, Southernwood, Tyme, A.ʒvi. make each into a fine pouder, mix them. Or, ℞ Red Oker, Tutty prepared, ashes of Toads, A. ʒi. pouder of Savin ʒiii. mix, for a pouder; which sprinkle on, and apply over all Emplast. Basilicon, or other proper Salve.

XIX. But if it is grown so great, that none of these things will make an impression upon it, but that you must come to excision, as when it is nearly so big as an Egg; then either take it away with the Knife, or tye it at

the root hard, with a strong silken Thread, and in a while it will fall off.

XX. Thus being removed, then sprinkle over it some of the Pouders before-mentioned, or this following. ℞ Zedoary, Ga∣langal, Winter's Cinamon, round Birthwort-roots, Rhodium, Flo∣rentine Orrice, Spicknard, Schoe∣nanth, A.ʒii. make each into a pou∣der apart, and mix them; over which apply the afore-named Emplaster.

Of PTERYGIUM.

XXI. Pterygium of the Eye, we have treated of already in the third Edition of our Synopsis Medicinae, lib. 3. cap. 30. to which we refer you: that which remains to be spoken of here, is the Pterygium of the Nails of Fingers or Toes.

XXII. It is an Excrescence of Flesh, growing out of the sides of the Nails, chiefly in the Toes by reason of the Nails growing into the Flesh.

XXIII. The Signs. It is known by the Tumor, or Excrescence on the side or root of the Nail, redness, inflammation, and troublesom pain; (yet, not but what the Patient may endure) being chiefly pain∣ful in going.

XXIV. The Causes. In the Fingers it may be caused by a Whitloe going before, or some Pustule preceding it.

XXV. But in the Toes it may be caused from some pressure of the Nail, or bruise, especially where the Nail is thick and hard, as some thick and overgrown Nails are; which causes pain and in∣flammation, and afterwards an eruption of Matter; which being exasperated by a conti∣nual pricking or pressing of the Nail, causes an Ulcer and cor∣ruption, from whence Excre∣scencies and loose Flesh are thrust forth round about; so that many times the Matter corrupts the Tendons and Bones.

XXVI. The Differences. They arise from the Cause and the Part affected: some rise superficially in the sides of the Nails, with erosion; others arise from the Tendons, and corrupt the Bones.

XXVII. If the Tendons or Membrane under the Nail are affected, the pain is more vehe∣ment: if the Bone is corrupted, it is known by the stinking smell.

XXVIII. The Prognosticks. If it affects only the Skin, the cure will be easy; and if the Nail is pared away, the Ulcer will soon heal.

XXIX. If it arises from the Tendons or Membranes at the root of the Nail, the cure will be more difficult; and in cacochy∣mick, and old people, it may endanger a Gangrene.

XXX. The Cure. Ʋniversals being premised, cut away your Nail, so that you may apply the Medicaments which may consume or dry the loose Flesh, and cica∣trize it: in which case you may use dry Lint, or Lint dipt in Aqua Calcis and dried, or pou∣ders of Zedoary, round Birthwort root, Orrice root, Balaustians,

Pomgranate-peels, fine Bole, Tutty, &c.

XXXI. But in stronger habits, you may dress it up with red Precipitate; avoiding the appli∣cation of moist or greasy Me∣dicines, for they rot the Nails, and increase the Ulcera∣tion.

XXXII. The Excrescencies a∣rising from the Tendons, or Mem∣branes at the roots of the Nails, are to be drest with more powerful dryers; as Aes ustum, Squamma Aeris, Calx viva, Tro∣chisci Polyidae, Andronis, Musae, red Precipitate, and the Cau∣stick Stone it self, being care∣fully used; and lastly, with the Vitriol or Alum Stones, or some proper Styptick Liquor, you may produce the Cicatrice.

XXXIII. Scultetus, Observ. 82. says, fleshy Excrescencies of the Fingers and Toes are soon consumed with this Pouder. ℞ Caput mor∣tuum of Vitriol, burnt Sponge, A. ℥i. mix them for a pouder: and being taken away, they may be cicatriz'd with Ceratum Di∣vinum.

Of CONDYLOMA, FICUS, CRISTAE, THYMI.

XXXIV. Condyloma is a soft round Tubercle, distending the internal wrinkled Tunicle of the Anus, of the same colour with the Skin, and for the most part without pain.

XXXV. Ficus is a Tumor almost representing a Fig, but not altogether so great; yet with a large head, a long neck, and narrow root; being often very painful, and the bigger, the more full of pain.

XXXVI. Cristae are a kind of hard Excrescences, arising a little distance from the orifice of the Anus; and not unlike a Cocks Comb, but not full out so high.

XXXVII. Thymi are also hard Excrescences, somewhat resembling the tops of Tyme when in flower: not much unlike to Warts, save, that they differ in their manner of growing.

XXXVIII. The Causes. They are all of them caused from a gross pituitous Blood, joined with a viscous Lympha; which thro' the force of the Expulsive-faculty, are protruded thro' the Pores of the Skin, and thro' the Plastick-power of the Part, are brought into this form.

XXXIX. The Cristae and Thy∣mi generally rise from Lues Ve∣nerea, and have mostly the Rha∣gades to accompany them: they are accounted as a Symptom of the Pox.

XL. The Prognosticks. Con∣dyloma and Ficus are of no difficult cure, if the Disease, or the Matter causing them be re∣moved: Cristae, generally a∣rising from the Pox, are only cured, by curing that Disease.

XLI. Thymi, are the worst sort of Excrescences, and are gene∣rally more malign than painful; and if ill handled, are apt to degenerate into Cancer.

XLII. The Cure. Since most, or all of these Affects, proceed generally from a Venereal Cause, it is absolutely necessary, to prosecute their removal, by

first eradicating that Disease, by Salivation, Diet-drinks, of Sarsa, &c.

XLIII. But if they proceed not from a Venereal cause, (as sometimes they do not,) then you must first purge and cleanse the Body with Universals, continued for some time; at least five or six times repeated.

XLIV. Then by Topicks you must apply your self to the Ex∣crescences themselves, which if it be at their first budding forth, are to be helped by astringent and drying Medicines, viz. round Birthwort root, Orrice root, Zedoary, Acorus, Lignum Guaja∣cum, Cortex Winteranus, Oak bark, Cortex Winteranus, Cate∣chu, Pomgranate peels, Balau∣stians, Myrtle berries, Sumach, Chalk, fine Bole, Terra sigillata, Lime washed, Alum, Saccha∣rum Saturni, burnt Lead, Rust of Iron, Crocus Martis, Aes ustum, red Precipitate, &c.

XLV. Some of these things are to be made into Decoctions, to foment the Affect withal: others of them are to made in∣to Pouders to strew upon the Part, or to be mixt with dry∣ing Ointments, and applied upon Towe.

XLVI. If these things stop not their growing, you must then come to Manual Operation, cutting them off, either with Scissars, or a Knife; and then consuming them by Escaroticks, as red Precipitate, &c. or the Actual Cautery.

XLVII. After which, you must prosecute the rest of the Cure, by Digestives, and Epuloticks, ac∣cording as the Intentions of the Cure require: and to prevent their future growing again, we have commended to us by Authors, Ashes of Vine-branches and Bean-stalks, to be mixed with Vinegar, and applied to the Part.

CHAP. XXVI. Of BRONCHOCELE, RANULA, TONSILLAE.

I. THE first of these Tumors is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. à 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Aspera Arteria; & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Hernia: in Latin, Bronchocele, Hernia gut∣turis: and in English, a Tumor of the Neck, or Throat

II. The second of these Tumors is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Ranula; and in English, a Tumor or Apostem under the Tongue.

III. The third is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Tonsillae, & Morbus Glandula∣rum; and in English, the Tumor

or Swelling of the Almonds of the Ears.

IV. The Signs. A Bronchocele is known by a great Tumor on the Neck, either on the sides, or on the Throat, or both; mostly con∣tained in a Cystis, and of the colour of the Skin; large gene∣rally, but more flat than high; in which the quantity of the Flesh seems to be increased; and it is mostly without pain; not very hard or soft.

V. Ranula is known by a soft Tumor or Swelling under the Tongue, of the colour of the Skin, much about the bigness of a Pigeons Egg, hard and round; and when painful, of a reddish colour: the Tongue being turned up, it thrusts its self forth. It is an impediment both to speaking and swal∣lowing: it is mostly included in a thick Cystis, and when sup∣purated, the matter looks of a whitish colour.

VI. Morbus Glandularum, or Swelling of the Almonds, is known by sight, being increased in magni∣tude; and when very large, filling almost the whole passage of the Throat: it is an impediment to speaking, and taking any thing down the Throat; and without much pain, except in the time of swallowing; which proves very troublesom to the Patient.

VII. It is a soft fleshy Tumor, of a round or oval figure, re∣taining the natural colour of the Skin, and of a dull sense; so that the body thereof may be pierced with a Knife or Bod∣kin, without causing pain, or drawing Blood.

VIII. The Causes. A Bron∣chocele is said to arise from preternatural Phlegm, and an acid Lympha joined with Wind; contained for the most part in a Cystis, lying between the Skin and Aspera Arteria: but some∣times it is without a Cystis, possessing the Muscular-flesh.

IX. Ranula is caused by a Pituitous-matter, arising from congestion of Humors in the infe∣rior Salival Gland; causing a soft Swelling, and possessing those Salivals under the Tongue; which in its progress fills up the space between the Jaws, and makes a Tumor externally un∣der the Chin.

X. Tonsillae are caused by con∣gestion of Humors gradually, with∣out pain; and therefore are seldom taken notice of, 'till by their growth they bring several inconveniencies with them; as, Catarrh, Cough, difficulty of Swallowing, wherein, in drink∣ing, the drink many times runs out at the Nose.

XI. They arise from a cold and pituitous Lympha, and differ from the common Swellings of the Almonds, as Tumors made by congestion, do those made by fluxion: the latter being of sudden growth, and terminating as soon: whereas the Tumor we here intend, may have been many years a growing, in∣creasing and decreasing with the Moon, as all Tumors caused by congestion in the Glands do.

XII. The Kinds or Species. Authors account all these Tumors as a Species of Struma, or the Kings-evil; and therefore will

have them to proceed mostly from the same Causes.

XIII. The Prognosticks. Bron∣chocele is of difficult cure, and dangerous; whether contained in a Cystis, or not; if it waxes very great, and grows hard, pressing upon the Aspera Arte∣ria, it may endanger Suffoca∣tion: that without a Cystis, which will not be discussed, many times becomes incurable.

XIV. That in a Cystis, is many times to be removed by Excision: that without a Cystis, whil'st recent, is in the possi∣bility of being resolved, taking away withal the internal Cause.

XV. Ranula, is a Tumor not dangerous as to Life; but more troublesom, as impeding several of the Operations of Nature: yet it is of difficult cure, and very troublesom to the best Artist, putting him many times to the trouble of Excision.

XVI. Tumor Tonsillarum, if it is small, the trouble is but little; several people having them from their Infancy with∣out much inconvenience.

XVII. If the Tumor is great, there may be great danger of Suffocation; nor will they easily discuss, sometimes never: when they will not discuss, they may be cut off, without any danger or difficulty.

The Cure of BRONCHOCELE.

XVIII. Ʋniversals must be premised, as in the cure of Strumae; purging the Body with our Family Pills, Pilulae Catharticae, Pulvis Cornachinii, Tinctura pur∣gans, or an Infusion of Sena and Rhubarb.

XIX. Give also Clysters every other day, to make a more ef∣fectual Revulsion of the Humors from the Part affected. ℞ Broth, or Posset-drink lbi. Tincture of Colocynthis ℥jss. brown Sugar ℥iv. mix, for a Clyster.

XX. And in the intervals of Purging, give this following Pou∣der. ℞ Aethiops mineralis, Be∣zoar mineralis, native Cinnabar, A.ʒvi. Myrrh, Orrice root, Ze∣doary, A. ʒiv. Alum burnt, Bwax, Ens Veneris, Scammony, A. ʒii. Cloves, Long-pepper, Spicknard, A.ʒi. make all into a fine pouder, and mix them; to which add treble refined Sugar ℥v. Dose, ʒii. every Morning, when Purging is intermitted.

XXI. Outwardly apply over the Tumor a Plate of Lead, besmeared with Quick-silver; or, Empl. de Ranis, with treble Mercury; or, our Emplast. Mercuriale, Em∣plast. Diasulphuris Rulandi; or, Ceratum è Gummi Elemi, Ce∣ratum Spermatis Ceti, Ceratum ad Tophos, Emplast. Diachylon cum Gummis; or, Emplast. ad Strumam, which is inferior to no other: see them in Our Pharm. aforegoing.

XXII. These things, whil'st recent, may prevail: but if they do nothing, there is no other Re∣medy (as to Internals) but Sa∣livation; which yet let be care∣fully performed, for fear of Suffocation. If none of these things do, you must remove it by Section. See the following Example.

XXIII. A Maid thirty years old, strong of Body, had one of these Tumors on the left side of her Neck, reaching from her Ear to the Aspera Arteria, and stretching over it upwards to the other side of the Neck; it was soft, and seemed to be full of Matter, but was without in∣flammation.

XXIV. A puncture was made into the body of it, which dis∣charged a stinking Serum, much like Horse-piss; the Tumor then sunk, and felt unequally hard, and it was drest up with a Pledget of Ʋng. Basilicon, and Empl. Diachalciteos.

XXV. The next day, taking off the dressings, the swelling was lank; a Caustick therefore was applied the length of two inches, about three fingers-bredth from the Ear: the Escar was opened, and a foul matter discharged; after which it was drest up with Dossels dipt in red Precipi∣tate, with Lenients over the Escar; and from that time, the falling off of the slough was hastned.

XXVI. After the separation of it, another sort of matter was protruded, not much unlike that of an Atheroma and Meliceris mixed together: with the Probe-Scissers it was laid open towards the Aspera Arteria, and with the Fingers several Vesiculae were pulled out, some con∣taining a foul Serum, others a gritty substance: also gobbets of Flesh came away, with which the basis of the Abscess seemed to be laid.

XXVII. Being thus cleansed, it was filled up with Dossels dipt in Precipitate, and the lips were kept open: this method of dressing was repeated every other day, and the strumous Excrescences were rubbed with the Vitriol-stone: the sinus contracted narrower within, but the Tumor being strumous, it would not heal whil'st any hollowness re∣mained, but filled up with that sort of Flesh, and raised a Tumor.

XXVIII. Whereupon a Caustick was applied, upon its upper part towards the Ear, and it was divided with a pair of Scissers, and the Sinus fill'd with red Pre∣cipitate, dressing the lips with Digestives. After the Escar was separated, the strumous flesh was eradicated with the Vitriol-stone and Precipitate, and cicatriz'd from the Ear downwards; but with some difficulty, the Basis proving false more than once, in one part or other.

XXIX. Some of this strumous Flesh rising among the Vessels, and uniting over them, made Sinus's so deep, that it was diffi∣cult to divide those, without danger of the Vessels: But no Cure being to be expected whil'st this remained, a Ligature was passed with a small Probe under the Fungus; and by deligation, and application of Precipitate, the Fungus was consumed, so that that the deepest Sinus was laid open.

XXX. This done, by applica∣tion of Epuloticks, a Cicatrice was induced upon them; and thus the Abscess was healed well near to the Aspera Arteria: after

which, the other side was laid open, and by the same method, the matter was eradicated, and the Tumor cured, as the other before. Wiseman, lib. 4. cap. 4. Observ. 10.

XXXI. If the Tumor is con∣tained in a Cystis, whereby neither External applications, as Resolvers, nor yet Salivation will prevail, you must attempt the Cure by Section.

XXXII. Make an Apertion in a right line, observing the fibres of the Muscles, which being on the Neck, must be long-ways; taking heed that you hurt no Artery, Vein, or Nerve; (rather than to hurt any of those Vessels, you had better cut the fibres cross:) If the Tumor is great, you must make a double incision cross∣wise, taking heed as aforesaid, of the Vessels: then with your Fingers remove the Bag, which seldom or never sticks very fast to the Skin; and cutting off the little Artery by which it is fed, take heed, that not the least particle of the Bag may remain, lest it grow again; after which, heal it up as another Ulcer.

The Cure of RANULA.

XXXIII. First let Ʋniversals be premised; cleanse the Stomach and Ʋpper-region by proper Eme∣ticks; then give Ʋniversal Cath∣articks, which repeat five or six times: afterwards keep the Body soluble, and perfectly cleanse the Bowels with the Clyster in Sect. 19. aforegoing, repeating it as oft as you see occasion.

XXXIV. To the external part of the Tumor apply Discussives, or Resolutives; such as are ap∣plied in a Struma, where there is hopes of doing the Cure by Resolution; of which kind are Emplastrum Diasulphuris Rulandi, Our Diachylon cum Gummis, Ceratum è Gummi Elemi, Cera∣tum de Spermate Ceti, Ceratum ad Tophos, Emplast. ad Strumam, or Our Emplast. Mercuriale.

XXXV. And the Topicks to apply to, or to wash the Tumor under the Tongue, are also Discussives; the chief among which are all man∣ner of Salts, and hot Aroma∣ticks; either in substance, or decocted in some proper Liquors, and so to be held in the Mouth.

XXXVI. Barbett commends the following Pouder, by which he says they are often cured. ℞ Pepper, Ginger, A.ʒi. roots of Florentine-Orrice, Hermodacts, Calamint, Origanum, A. ʒss. Ma∣stich ℈ i. make of all a Pouder.

XXXVII. These may be boiled in Wine, to wash with and hold under the Tongue; or mixt with Oxymel, to besmear the Part with; or it may be strewed dry, or rubbed upon the Tumor, and oft repeated in the day-time: for by the heat it creates in the Part, the Tumor seems to be discuss'd.

XXXVIII. But if these things will not do, you must open the Tumor by help of an Actual Cau∣tery, in one or more places; that the Humor may come forth, and afterwards dress it with Honey of Roses. But Barbett rather

approves of Incision with a Lancet, or Incision-knife.

XXXIX. An Observation. A Woman thirty five years old had a large Ranula between her Jaws, under her Tongue, reaching to her Fore-teeth, making a great swelling under her Chin, which was troublesom to her, and caus'd a croaking in her speech.

XL. She had before passed under a course of Physick unsuc∣cessfully: the matter was proposed to be let out by an Actual Cautery, but she refused; whereupon it was opened by Incision on each side near the Tongue; and out of it came two Blood-porrengers full of an albuginous matter, upon which the Tumor sunk.

XLI. Search was made with a Probe, and it was found that the matter had not only made a deep cavity downward••, but all the inner part of the Tongue was ren∣dred hollow: it was then drest with Syrupus de Rosis ficcis: and Empl. ad Herniam, mixed with a third part of Empl. Caesaris was applied externally under the Chin; deterging it after∣wards with Mel Aegyptiacum, dissolved in Decoction of Sage, Betony, Smallage, &c. and then it was incarned and cicatrized.

XLII. Some time after the Tumor rose again as formerly; whereupon it was opened with the Actual Cautery, on both sides of the Ranula; by which the matter was again discharged, and the Tu∣mor sunk. During the time of the Cure, she was purged, and put into an Antistrumatical Course, and so at last was cured. Wiseman, lib. 4. cap. 8. Obs. 1.

XLIII. A young Fellow had also a painful Ranula under his Tongue; incision was made into it, according to its length, and there came forth a Stone bigger than that of an Olive: it was after∣wards drest with Syrupus de Rosis siccis, and thereby in a few days cured. Wiseman.

The Cure of TONSILLAE.

XLIV. Preparation is to be made for the Cure, by Ʋniversal Purgation, Clysters, &c. and Derivation by Vesicatories, Cupping, Issues, &c. especially if there is Inflammation, and the Tumor is caused by Flu∣xion.

XLV. But if they are made by Congestion, the speedy and only way of cure is by Extirpation; either by Excision, at once cutting them off; or else by application of the Actual or Potential Cautery; among the latter of which, Butter of Antimony is accounted the chief.

XLVI. Wiseman says, that the way by Potential Cautery is, by working with a Caustick-stone, and other Escaroticks, fixt in such an Instrument as may serve to eat into them, without offend∣ing the neighbouring sound Parts; and so to make way into the body of the Gland, consu∣ming it within; and at length the exterior parts of it will fall in pieces, and so the whole will be eradicated.

XLVII. Such a like Tumor in

those places, I once saw Dr. Tho∣mas Gardner, chief Chirurgeon to the King's Houshold, (and now attending his Majesty's Person in his Camp in Flanders) open, with a great deal of dexterity, at Sir John Roberts his House in Bromley by Bow, by touching it with Butyrum Antimonii twice; and then cutting it with an Incision-knife, the Tumor yielded near a quarter of a pint of matter, presently wasted away, and became healed in a very short time after.

XLVIII. The way by Excision, is by making a ligature about the Basis of them; and then cut∣ting or snipping them off with a pair of crooked Probe-scissers.

XLIX. In doing this, consider how they are radicated: if they be rooted deep in the Throat like a Crista, if in cutting them out, you only cut the part you tied, and cut the ligature at the same time, the matter or sub∣stance may fall down into the Throat, and so hazard choaking.

L. Whil'st therefore you hold the ligature with one hand, with the other hand you must pass the Scissers down as close by the Basis of it, as you can, so as by one snip, you may cut it clear off.

LI. But for fear of failing, 'twill be necessary to have another ligature fitted in an Instrument for this purpose, and the Patient's Head to be held steady; that in case you fail in the first attempt, and it fall into the Throat, you may readily re∣turn it, and tye it at the same time, which is easy enough to do.

LII. The Excision being made, the bleeding may soon be stopt with Oxycrate; and you may cica∣trize it in a few days time, by touching it with the Vitriol and Alum Stones.

LIII. Observations. A Man, twenty five years old, long subject to defluxions from overgrown Ton∣sils, had taken much Physick unsuccessfully; so that no other way of Cure appeared, but by Excision. The right Tonsil was very large, and a ligature was made upon it, with design to cut it off at that instant: but for fear of a great flux of Blood, it was deferred to the next morning; at which time it was shrunk, and much lessened.

LIV. Then hold being taken of the Ligature with one hand, and with the other passing the Probe-Scissers close by the root of it, at one snip, it was cut off, and brought away with the Ligature, it scarcely bleeding a drop: the remaining Basis was rubbed with the Vitriol-stone, and after∣wards he gargled with Barley-water sweetned with Syrupus de Rosis siccis, and in four or five days time it was cicatrized; and the Man recovered a better degree of health. Wiseman.

LV. A Girl twelve years old was often troubled with Catarrhs, and difficulty in swallowing, thro' a great Tumor in the right Tonsil; Excision was advised. A liga∣ture was made upon it, and at the same time it was cut off: afterwards, by rubbing it with the Vitriol-stone, it was cica∣trized in a few days. Wiseman.

LVI. A Woman, twenty six years old, subject to Catarrhs, from the preternatural growth of the Amygdalae, was also cured by Excision: a Ligature was made upon the one, and it was cut off, washing her Mouth after with Oxycrate: then a Ligature was passed upon the other, and it was also cut off; after which she gargled and washt her Mouth: afterwards the Basis of them was rubbed with a Vitriol-stone. Wiseman, lib. 4. cap. 7. Ob∣serv. 2, 3, 4.

An Appendix, concerning cutting off the UVULA.

LVII. If there is an elongation of the Uvula, thro' a great afflux of the Saliva, it oftentimes happens, that it touches upon the root of the Tongue, or upon the Epiglottis; causing a frequent, and almost continual hauking, whereby in process of time a vexatious Catarrh is produced.

LVIII. Such was the case of a Maid-servant, her Uvula hung dangling upon the root of her Tongue, not swelled, nor inflamed. Supposing that to be the cause of her Distemper, the lower part of it was taken hold of with the Forceps, and then im∣mediately it was cut shorter with a pair of Scissers; it bled not a spoonful, and afterwards cicatrized of it self, without application of any Medicine: and so she was freed from her Catarrh.

LIX. Such another was cut off in one of the King's Servants at Hampton-Court; as also some others, who were so affected, and thereby they were freed from their Catarrhs, when all other Remedies failed. Wiseman.

CHAP. XXVII. Of the KINGS-EVIL.

I. THIS Disease is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, vel, Pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Scro∣phula, Struma; and by some in the Plural only, Scrophulae, Strumae; I suppose, because oftentimes, many of these Tumors hang together: and in English, Scrophula, Struma, and the Kings-evil. The Greek and Latin Names are taken from Swine, because that kind of Beast is more frequently troubled with this Disease.

II. The Definition. Galen, Method. Med. lib. 14. cap. 11. defines, Strumae to be scirrhous Swellings, shut up in a peculiar Membrane.

III. Aetius, Tetrab. 4. Serm. 3. cap. 5. Strumae (dixit ille) sunt Carnes subcandidae, facile auge∣scentes, in Membrana contentae, & in summa Glandulae induratae, quae in Collo, sub Alis, & In∣guinibus oriuntur, ubi Glandulae Vasis substratae sunt, ut in aliis

quoque jam relatis Glandulis. Ali∣quando etiam, sed rarò tamen, ex Carne eorundem locorum fiunt; quae affinitate quadam ad Stru∣marum naturam vertitur, & Ma∣teriae accessione augetur. Viz. These Strumae (says he) are a kind of Flesh somewhat white, easily encreasing and growing, enveloped in a Tunicle or Cystis; and in a word, they are Glandules or Kernels hardned, which arise in the Neck, under the Arms, and in the Groins; where they are situated under the Vessels, even as in other parts related to the Glandules already mentioned. And some∣times likewise (but it is very rare) they are bred from the Flesh of the self-same places, which by a certain relation thereunto, is converted into the nature of Strumae, and does increase by an accession of matter.

IV. Barbett says that Strumae or Scrophulae, are preternatural Tumors of the Glandules of the Neck, contained in their own proper Cystis or Tunicle.

V. The Differences. The Tu∣mor or Tumors are sometimes in a Cystis, sometimes not; some∣times moveable, sometimes fixt; sometimes small, sometimes great; and sometimes but one, sometimes many; sometimes not ulcerated, sometimes ul∣cerated.

VI. The Places affected. They are generally the conglomerated Glandules of the Neck, called the Salival Glands: But that Struma which is not contained in a Cystis, (as that which is fixt for the most part is not) may happen to many other parts of the Body; as the Back and Back-bone, upper Lip, the Breast, Arms, Wrists, Hands, Fingers, Thighs, Legs, Ancles, Feet, &c. where it first appears, in an obscure, diffused Tumor; afterwards it breaks, and be∣comes ulcerated, and many times fistulous.

VII. To these you may add those Glands about the Ears called Parotides, or the Stenonian Pas∣sages, from Steno, their first discoverer. And it is to be noted, that the Salival-passages, pro∣ceed from the conglomerated Glandules of the Neck.

VIII. The Causes. Authors say, that they proceed from a Pituitous Humor, or from Phlegm mixt with Melancholy, by reason of the hardness, which for the most part goes along with the Tumor. Where∣upon it is, that such as are Phlegmatick-melancholy, who are gluttonous, and usually eat Meats cold and moist, and to drink cold Waters, or Snow-water, are more especially af∣flicted with Scrophula.

IX. And hence it is, that in several Regions, where the Inha∣bitants constantly drink crude, cold, and snowy Waters, (as gene∣rally in the Alps, &c. where this Disease is Endemical) they are all of them for the most part troubled and vexed with these Strumae.

X. Barbett says, that since the use of the Glandules of the whole Body, is certainly to percolate the Lympha; therefore of necessity the grosser Lympha (or the

Lympha vitiated) is the Cause of this Disease; from whence first of all proceeds their hard∣ness, and afterwards an in∣creasing and pertinacious Tumor.

XI. And so when any of this vitiated Lympha is shed abroad into other Parts, as the fleshy substance of the Body, the stru∣matick Tumor is then fixed, here and there, (tho' not in Glands) where-ever Nature finds a weak Part to protrude it to. And from hence it comes to pass, that in many Patients the whole habit of the Body is Strumatick also, and the Disease breaks forth in several places at once, making it rebellious, and very tedious to be cured; to the very great vexation, both of the Patient and Physician.

XII. And because Struma some∣times degenerates into Cancer, which is caused from a very sharp Humor or Lympha; Deckers does say, that the Humor or Lympha must have also an offending sharpness in it.

XIII. Others say, they are caused from gross and raw Juices, contained, 1. In the conglobate Glandules; which they receive from the Arterial Blood, con∣vert and perfect into Lympha, and from whence the Lympha∣tick Vessels do proceed; which convey it either into the Chyli∣ferous or Sanguiferous Vessels. 2. In the Conglomerate, which they receive from the Ve∣nal Blood; either the Lym∣pha again, or some other pecu∣liar Juices; where they ought yet be brought to a greater perfection, and are conveyed by other proper Ducts to the Parotides and Maxillary Glands, from which the Salival Ducts arise, which convey the Spittle into the Mouth.

XIV. Platerus will not have Phlegm and Melancholy alone to be sufficient for the generation of these Tumors; for that then they would not be of any long conti∣nuance, but would rather corrupt and apostemate, or turn into Pus: but that there is rather another Juice joined with them, nourish∣ing these parts; for Glandules are nourished with a thicker Juice than other fleshy parts: and therefore if this Juice is vitiated, or exceeds in quantity, it then generates this kind of Tumor.

XV. The Signs. The Tumor is sometimes roundish, sometimes longish, sometimes irregular, as to its form; sometimes single, some times complicated, and sometimes seated in a Glandule, and some∣times not; as when it happens on the Spina Dorsi, Lips, the Wrist, Hand, Finger, Ancle, &c.

XVI. It is for the most part void of pain, unless when it grows extraordinary big; and it is many times so hard, as not to yield to the impression of the Fingers.

XVII. They are known also by their slow growth; for they are not suddenly generated, or all at once, but by degrees; and where there are many Kernels, one after another. First of all, the Humor flows unto one Glan∣dule, in which is excited a Tumor, first soft and loose; and then there grows another, in like manner soft and loose.

XVIII. These Tumors are at length hardned; and many times they increase in number, till there hangs down from the place affected many Glandules, as it were so many branches: but this is chiefly to be understood, when it affects the Neck, and parts adjacent.

XIX. When it happens in the Joints and other parts, it is not contained in a Cystis, but is a broad diffused Tumor, without any considerable pain, 'till it grows very great; and mostly of the colour of the Skin, hard, and immoveable; which in process of time breaks, and becomes a foul Ulcer, or running Fistula; and many times fouls and rots the very Bone it self, after an extraordinary manner.

XX. The Prognosticks. These Tumors are always hard to be cured, and long in performing; especially if they be many, have been of long continuance, and are very great, and hard, or fixt.

XXI. By how much the more moveable they are, by so much the more easily cured; and when cured, they for the most part leave behind them great Scars.

XXII. If they grow very great, and painful withal, they are dangerous, and apt to become Cancerous; and if they stick to a Bone, they generally corrupt it, and hardly admit of cure: the like if they be fixt to any great Nerve or Vein, lye deep, or are hereditary: in all these cases, a Palliative Cure is the best.

XXIII. If in curing them by Section, you should divide the Recurrent Nerve, the Speech will certainly be lost, and many times Life withal.

XXIV. The Cure. The Indi∣cations of Cure are threefold: 1. To attenuate, attemperate, and evacuate the thick, acid, or vitious Lympha. 2. The Tumor is, if possible, to be discussed; otherwise, to be softned and ripened. 3. If it comes to Sup∣puration, it is at length to be taken away, either by Incision, or Escarotick Medicaments.

XXV. The first Indication is answered by Internals: First, such things as attenuate, incide, and evacuate the Morbifick-matter contained in the first Passages. I commend upon Experience Oxymel of Squills, which may be taken every other Morning; from one spoonful to two spoonfuls or more; in a glass of Wine and Water.

XXVI. Afterwards it may be taken a spoonful at a time, every morning; for 14 or 16 mornings, in like manner.

XXVII. Afterwards you may purge twice a Week, with Our Family Pills, Pilulae Catharticae, Pilulae Mirabiles, Tinctura Pur∣gans, or some such like thing.

XXVIII. In the intervals of Purging, give something that is specifick against the Disease, and may attemperate the acid Hu∣mor, by absorbing it; which is done by Alcalies, chiefly such as are volatil.

XXIX. Of this kind, the Spi∣rits of Sal Armoniack, of Harts-horn, of Cows-horn, Ox-horn, Ox and Horse-hoofs, of Beef, &c. are said to be chief, whether inward∣ly used, or outwardly applied,

given in a convenient Vehicle.

XXX. A famous thing is Salt of Hog-lice: they that cannot get the Salt, may take the Pouder of them; being first washed clean, then drowned in Wine, and dried in an Oven, 'till they will reduce to pouder. Dose, à gr. x. ad xxv. in any proper Liquor, for forty or sixty days.

XXXI. These following Inter∣nals, have also the property of consuming Scrophula's, and in∣ducing their healing, if ulcerated: viz. Roots of Swallowort, round Birthwort, Briony, Jallap, Me∣choacan, Sowbread, Dropwort, Pilewort, Figwort, Devilsbit, Orrice-root, Squill, Vervain, flowers of Broom, of Privet, Crabs burnt, Eggshels burnt, Sal Gem, Sponges burnt, ashes of a Lizard, &c.

XXXII. Johannes Prevotius commends the Electuary of green Lizards, as a great Secret, and certain Remedy for the cure of the Kings-evil. Dose, to Children ʒii. to Men or Women ℥ss. ʒvi. or ℥i. at most, continuing it for thirty or forty days: anointing also outwardly with the Oil of Lizards. See their Preparations in Our Doron Me∣dicum, lib. 3. cap. 2. sect. 9. Hercules de Saxonia commends those things also, as most ex∣cellent.

XXXIII. In like manner the pouder or ashes of Spunges and Sea-crabs may be given; by mixing them with Honey, and making them into an Electuary, as you do the pouder of Li∣zards.

XXXIV. As for the Diet or Food, it ought to be such as is prescribed usually in the Cure of an Oedema and Scirrhus, which may consume the cold phlegmatick Humor, and alter the habit of the Body: Purging also with proper Phlegmagogues, such as are the aforementioned things: or a Diet-drink made of Sena, Rhubarb, Mechoacan, Horse-radish roots, and Scurvigrass.

XXXV. Avoid Bleeding, as the most pernicious thing; (it is the advice of Barbett, and other great Men) but sometimes, in the intervals of Purging, the Patient may sweat, by the ex∣hibition of volatil Alcalies; which is a good expedient in this Cure: so also the dulcified Spirit of Nitre.

XXXVI. Pouder of Vipers, given ad ʒi. is a famous thing; so also the Salt of Vipers, given ad gr. x. or the Powers of Vi∣pers given ad gut. xxx. in any convenient Vehicle.

XXXVII. And for their con∣stant drink, let it be Decoctum Ulmi; in a gallon of which let five hundred Hog-lice be bruised and boiled; than which, there is no greater Specifick in the World, I have proved it several times: For by the constant taking of this Liquor, the quality of the whole mass of Blood and Lym∣pha comes to be perfectly altered, and the scrophulous habit of Body to be throughly changed, so that the Patient mends upon it to a wonder: it may be drank as common Drink, mixed with a little White-wine. See the Prepa∣ration thereof in Our Pharm.

Bateana, lib. 1. cap. 16. sect. 29. And see more of this Cure, in Our Synopsis Medicinae, (the Third Edition) lib. 6. cap. 15.

XXXVIII. If yet the Disease is so rebellious, that none of the afore-prescribed Methods will do, you must then come to the last Remedy, which is Salivation; which is to be done with a great deal of care and gentleness, with proper inward Mercurials: And this I have done several times with happy success; but this way succeeds best, when it is in any other part but the Neck and Throat; if it be in these, it may be done, but it must be with much caution; lest by the too great afflux of Humors, the Patient should be suffocated.

XXXIX. The second Indica∣tion is answered by the applica∣tion of Externals, which are of three kinds: 1. Discussives and Resolutives, where there is hope of Resolving. 2. Suppuratives or Maturatives, where there is no hopes of Resolution. 3. Pal∣liatives where it is indurated, so that its degeneration into Scirrhus or Cancer is feared.

XL. If they be loose, small, and not very hard, there is hopes of Resolution; in which case a simple Ointment made of Pile∣wort roots is an excellent thing: much more if an half part of Our Hercules be mixt with it.

XLI. Or anoint with this Liniment of Barbett: ℞ Oils of Myrtles and Bays A. ℥i. Ʋng. of Martiaton ℥ i. Quick-silver extinct with flowers of Sulphur ʒvi. mix, and make an Ointment, with which anoint twice a day: if the Tumors are not consumed with this, they will at least be diminished.

XLII. Balsam of Sulphur is a good thing to anoint withal; so also Ointment made of Tobacco, green or dry: if it is made of green Tobacco, it ought to be such as is raised with us from Virginia Seed: and it is so much the better, if it is mixed with white Precipitate ʒii. native Cinnabar ʒi. to one ounce of the Ointment.

XLIII. This of Poterius is a singular good thing: ℞ Green Tobacco leaves M. vi. fresh Butter lbii. Venice Turpentine ℥iv. mix, and insolate eight days; strain out by pressing; to the expressed matter add Wax, Gum Ammonia∣cum, Galbanum, A. ℥ii. which mix; and being almost cold, add crude Antimony, Cinnabar artifi∣cial, both in fine pouder, A.℥ss. Myrrh, Frankincense, A. ʒii. (I add pouder of Tobacco leaves ℥i.) mix again, and make an Ointment.

XLIV. ℞ Oil of Bricks, com∣monly called Oleum Philosopho∣rum ℥vi. Oils of Juniper and Turpentine, A. ℥ i. Spirit of Nitre ℥iii. mix them, and there∣with anoint. Balsamum mirabile is excellent to anoint with in this case: so also to bathe the Part affected with Spiritus mi∣rabilis.

XLV. Or you may anoint with Ung. Cosmetic. or ad Scabiem, or Mercuriale; and apply over the Tumors Ceratum de Galbano, è Gummi Elemi, vel Ceratum ad Tophos; or Our Diachylon cum Gummis; or Our Emplast.

ad Strumam, vel Mercuriale; all which see in Our Pharmaco∣poeia Chirurgica, in Lib. 1. cap. 74 sect. 5. 8. 9. cap. 76. sect. 3. 4. 9. and cap. 77. sect. 3. 8. and 10. aforegoing.

XLVI. Barbett commends this Emplaster: ℞ Ammoniacum, Bdellium, Galbanum, A.℥ss. Bay-berries, Cummin, Pellitory of Spain, Stavesacre, A. ʒvi. Pi∣geons dung ʒi. Goats dung ʒiii. Hogs-grease ℥jss. Oil of Camomil ℥i. Wax, Pitch, A. q.s. mix, and make an Emplaster.

XLVII. Cinnabar ℥i. is good to be added to it: and if the Tumor is painful, you may also add to it Opium ʒvi. or ℥i. be∣cause it has not only the virtue of easing pain, but also of Discussing and Resolving.

XLVIII. This following Em∣plaster is also good. ℞ Empl. è Cicuta cum Ammoniaco ℥ii. pure Gum Elemi ℥ss. flowers of Antimony, Mummy, A. ℥ ss. red Precipitate ʒv. flowers of Sal Armoniack ʒiii. Juniperine Bal∣sam of Sulphur q.s. mix, and make a soft Emplaster; which spread upon Leather, and apply to the Part affected, renewing it once every two days.

XLIX. This also is of singu∣lar efficacy. ℞ Red Precipitate q.v. Quick-silver as much as it will absorbe, or suck up by grind∣ing in an iron or glass Mortar: put this Mixture into a thin Cloth, and strain from it all the Quick-silver which would not unite: to this Mixture put de∣purated juice of Nightshade, q.s. insolate for some days; decant the juice, and repeat it three times: this done, mix of this Pouder ℥i. with Oil-olive, Sheeps-suet, A. ℥ss. first melted together, and almost cold, and make an Ointment: it resolves much, and eases pain.

L. But where a Resolution can∣not be accomplished, and the Tumor is great, and manifestly contained in a Cystis, and free from any great Vessels, the best way is by Section; making an incision thro' the Skin, and separating it from the Cystis, then cutting it off by the root, as we have taught in the former Chapters.

LI. If this cannot be com∣modiously done, you must then endeavour a Suppuration; and this is most commonly per∣formed in a Phlegmonoodes, with this Cataplasm: ℞ Onions, heads of Garlick, A. N^o ii. bake them in an Oven, 'till soft, old Leven ℥ii. Mucilage of Althea and Lilly roots, Mithridate, A.℥i. pouders of Fenugreek and Linseed, Hens and Pigeons dung, A. ℥ss. Figs roasted, N^o vi. Oil-olive ℥jss. Oil of Juniper ℥i. Saffron ʒii. mix, and make a Cataplasm.

LII. Wiseman says, that to hasten the Suppuration, it is com∣mon to pinch them hard; and some say, to thrust a Thorn into them, to inflame them, thereby to hasten their ripening: you must endeavour a perfect con∣coction; for if you open them, while any part of the Gland is hard it will increase, or put you upon a necessity of eradicating it, or else to leave the Cure imperfect.

LIII. Being perfectly ripe, the

way of opening the Tumor, is mostly by Incision, because it makes the least Scar: but if the Struma is large; the way by Caustick may be better, because it makes a large Orifice, and with less pain assures a Cure.

LIV. The Matter being dis∣charged, you may cleanse with the Mundificative ex succo Apii, Basilicon, red Precipitate, and the Vitriol-stone; and afterwards incarnate and cicatrize, as in other Abscesses or Apostems.

LV. In old and hard Struma's which admit not of a compleat Suppuration, but break out into small holes, which growing bigger and bigger, become so many painful Ʋlcers, spreading one into another, the body of the Gland remaining hard, without hopes of maturation; these you may dress two or three days with a Pledget of Ʋnguent. Basilicon, which will qualify the heat, and moderate the Ulceration, and then by interchangably applying Dis∣cutients or Lenients, you may happily waste the whole Gland, the Patient taking the mean while specifick Internals.

LVI. In some Strumae ulcera∣ted about the Chops, I have seen (says Wiseman) a Fungus thrust forth, so that with my Spatula thrust under them, I have thrust them quite out, and healed the Ʋlcer in few days: in others, where they are incapable of being so soon thrown out, I cut off the protuberant part, and consumed the remaining Basis with Escaroticks.

LVII. When therefore the Stru∣mae are large, or lye deep, and near considerable Vessels, Extirpa∣tion by Causticks and Escaroticks is the best way. 'Tis true, it requires more time, but 'tis sure, and the only way Patients generally admit of; for the very notion of cutting with a Knife, frights them.

LVIII. In order then to this work, the Patient ought frequently to purge, and constantly to take some antistrumatick Diet, &c. otherwise new Tumors will arise whil'st the old ones are eradi∣cating.

LIX. Then such Escaroticks are to be chosen, as may penetrate deep into the Gland, and do the work with the least pain: But indeed all Medicaments fit for this work are very painful, yet the strongest Causticks are most pro∣per to begin with, so they be kept within their bounds.

LX. Of these there are several kinds: as, 1. Soap-lees, boiled up to a Stone; but this will spread, in spight of all Defensa∣tives. 2. The Causticks made of Arsenick, Sublimate, and Vi∣triol; which spread also. 3. Calx viva, boiled up with Lixivium Saponis; which spreads least of all.

LXI. Simple Escaroticks are, 1. The Caustick-stone. 2. Corro∣sive Sublimate. 3. Arsenick. 4. Au∣ripigment. 5. Ʋnslaked Lime. 6. Oils of Vitriol and Sulphur. 7. Butter of Antimony, &c.

LXII. Simple Cathereticks are, 1. All sorts of Vitriol. 2. Ver∣digrise. 3. Squamae Aeris. 4. Chal∣citis. 5. Misy. 6. Sory. 7. Burnt Alum. 8. Arcanum Coralinum. 9. Red Precipitate.

LXIII. Of these Compounds are made: as, 1. Trochisci de Minio Vigonis, made of Corro∣sive Sublimate, Minium, and Leven. 2. This of John Arden, more Escarotick. ℞ Corrosive Sublimate ʒiv. Ceruse, Starch, A. ʒiijss. Arsenick in fine pouder ʒjss. juice of Asphodel ʒx. best Vinegar ʒv. mix, and boil to the con∣sumption of the humidity; then pouder it, and incorporate it with Auripigment calcin'd ʒjvss. Leven ʒxvi. mix, and with a lit∣tle Rose-water, make Troches. 3. Pulvis sine pari. It is made of corrosive Sublimate, Auri∣pigment, Quicklime, ana. 4. Tur∣bith-mineral alone. 5. Red Pre∣cipitate alone. 6. Red Precipi∣tate mixt with burnt Alum. 7. The Vitriol-stone.

LXIV. The gentlest of those Preparations with Corrosive Sub∣limate, are too painful to be applied in tender Bodies, and scarcely to be endured in the strongest, tho' taken off in four or six hours after: for that the Salts having penetrated, the pain will continue vehement for a long time after; many times affecting the neighbouring parts with Tumors and great Inflam∣mation, and sometimes affecting the Head with terrible pains, as also Palpitations of the Heart, Faintings, &c.

LXV. The Cathereticks most commonly used, are Turbith-mineral, red Precipitate, and burnt Alum, which are indeed the mildest, and therefore of a more slow operation, but may serve ordinarily, and in tender Bodies.

LXVI. The Method of applying them is this. 1. It is best to chuse that Caustick which will spread least; which you are to spread long, in proportion to the Tumor, reaching from the lowest part thereof upwards; because in consuming it, the Scrophula will sink downwards; and defend the sides with Pla∣sters, that it do not spread.

LXVII. 2. The lips being once divided, they give way, and as the Escarotick, penetrates into the body of the Gland, the sides will fall in, and be eradicated out of the aperture, tho' very small; which the less it is, the less Scar will remain from the Cicatrice, and the sooner it will be cured.

LXVIII. 3. The Escar being made, divide it the whole length, and with a Caustick-stone, rub into it, 'till it has penetrated into the body of the Gland; the which it will the sooner do, if you press into the same place with a Stick dipt into Oil of Vitriol, or Butter of Antimony.

LXiX. 4. This done, dress it up with Ung. Basilicon, mixt with a little Linseed-oil; embrocating the Parts adjacent with Oil of Roses mixt with Vinegar, and over all lay Empl. è Bolo: being thus drest, it is painful; but it lasts not above half an hour.

LXX. 5. The third day after dress it again; and if the Escar in the middle is dried hard, dress it with Lenients: but if it feels soft, rub it again interchangably with the Caustick-stone, and Oil of Vitriol, or Butter of Antimony, thrusting them every

way into the body of the Gland; but taking heed, that the lips of the Ulcer may not be en∣larged thereby.

LXXI. 6. Thus proceeding, most of the Struma will be wasted, before the first Escar in the cir∣cumference will fall off: after which you may consume the re∣mainder with red Precipitate, and keep it open by Dossels of Lint, letting the lips grow nar∣rower in the mean time; and so heal it with a Cicatrice, as another Sore. Wiseman.

LXXII. This is the Method for very large Strumae, the lesser will not admit of this Way; to such you may apply the strongest Catheretick Pouders, as you see cause. But if they affect the Muscles, Nerves, Tendons, Li∣gaments, Joints, &c. they require more caution in their extirpation.

LXXIII. The Cure of the Evil which is without a Cystis, af∣flicting the Muscles, Tendons, and Joints. The gumminess upon the Muscles and Tendons require Emollients and Discussives, and differs not much in Cure from that of a Scirrhus.

LXXIV. The Evil affecting the Joints increases gradually, and rises by congestion: it is twofold; 1. That which rises Externally, upon the Tendons, between them and the Skin, or them and the Bone. 2. That which rises Internally, within the Bone it self, which we shall consider in the Chapter of Spina Ventosa.

LXXV. The first of these arises for the most part from an Humor overmoistening the Tendons and Ligaments; which very much relaxes them, and produces a weakness and uneasiness in the Joint, raising a Tumor exter∣nally; which in process of time corrodes and rots the Mem∣branes and Bones, thro' its acidity.

LXXVI. First purge with Mer∣curials and Antimonials, and keep the Patient to an Antistra∣matick Diet, to alter the habit of the Body; and apply to the Tumor Emplasters of an astrin∣gent and dry quality, as Empl. de Minio, è Bolo, &c. with moderate Bandage; and let the Member be placed in such a position, as may prevent the falling down of the Humor.

LXXVII. Afterwards strengthen the Joint by Fomentations, and Emplasters of a discussive and astringent faculty: but if yet the Tumor grows greater, and will not discuss by any appli∣cation, it is to be feared, that the Bones are hurt.

LXXVIII. Now since these kinds of Swellings are for the most part caused by an Hypersarcosis within, they are not to be opened, without some assurance of a rottenness of the Bone: for otherwise upon opening, it will only yield a G••eet, and the Hypersarcosis will be protruded in a Fungus.

LXXIX. If also in some par∣ticular place Suppuration does appear, and upon opening, a matter much like whites of Eggs does come forth, you may conclude the Bone is corrupted, (especial∣ly in the Hand or Foot) and the longer the opening is delayed,

the more rotten the Bones will be.

LXXX. In this case, discharge the matter, making the vent large, according as the Vessels will per∣mit; and proceed in the Cure, as in an Ulcer with rottenness of the Bone, and keep the member in such a position, that the Joint may not be contracted.

LXXXI. If much proud Flesh shall grow up in the Ʋlcer, it will hazard the rotting of the Bone underneath; and if the Bone is once carious, it is not then the work of Nature, but of Art: for 'till the Hypersarcosis is re∣moved, the Bone will never exfoliate, but the Evil will still increase, and the Bones rot in pieces, one Apostemation coming upon another; so that the Patient will consume, and dye miserably.

LXXXII. In this case, the proud Flesh must be removed by such things as the Patient can bear; as Precipitate, either alone, or mixt with Basilicon, or burnt Alum, as the occasion may require: then way being made to the Bones, they are to be made bare, and such as are loose are to be taken out, the others you must dispose to exfoliate.

LXXXIII. Then cleanse the Ʋlcer well by Detersives; for which purpose nothing seems better than Ung. Nicotianae, and che∣rish the native Heat by discus∣sive, and drying Fomentations; and by Compresses (pressed out of Lime-water, or the Water of the Griffin) and convenient Bandage, endeavour to restore the Part to its natural form and magnitude.

LXXXIV. If it becomes of a scirrhous hardness, or seems to degenerate into Cancer by reason of pain, then nothing is to be attempted more than a pallia∣tive Cure. ℞ Ceratum de Gal∣bano lbi. Pulvis Mercurii coagulati ℥vi. Oil-olive q.s. mix, and make a soft Emplaster.

LXXXV. Or this. ℞ Empla∣strum album ℥iv. Sacchar. Saturni, Opium, (dissolved in Water, and inspissated to the thickness of new Honey) A. ℥i. shining Soot ℥jss. volatil Sal Armoniack ʒvi. soften with Oil of Nightshade, q.s. and make an Emplaster.

LXXXVI. Or, ℞ Emplast. de Galbano lbss. Empl. Mercuriale lbi. mix them, and apply. Or, ℞ Sheep-suet ℥ii. Oil-olive ℥ivss. melt, and mix; to which add Oils of Juniper-berries, Fennel-seed, Anniseed, and Amber, A.ʒi. volatil Sal Armoniack ℥iii. Sac∣charum Saturni ℥jss. Opium ex∣tracted ℥i. white Precipitate, native Cinnabar, A.ʒvi. mix them, and anoint therewith.

OBSERVATIONS.

LXXXVII. A Girl ten years old, had hard Kings-evil Swellings on three of her Fingers: she was cured by the Smoak of Vinegar poured upon red-hot Flints, morning and evening for a Month together. Riverius, Ob∣servat. communicat.

LXXXVIII. A Maiden, four∣teen years old, was much troubled from her Infancy with Ʋlcers in her Ears and Fingers, Lips much swelled, darting Pains, Scurvy, with Glandules of Neck and Ears

exulcerated, and the rest scirrhous, and so swelled, that she could scarce move her Neck. She drank the Decoction of Guajacum, with cutting and opening Medi∣cines, four times a day, with eight drops of Spirit of Sal Armoniack in it: and once a week she took this Pouder. ℞ Jalap ʒss. Tartar vitriolated gr.v. Oil of Fennel gut.ii. make a pouder, for a Dose; which gave her three or four Stools. And outwardly there was applied Emplast. de Ranis cum Mercurio, softned with Oil of Rue and Soot; but the Glandules being exulcerated, Ʋng. Basilicon was first applied, and after that, Balsamum Sulphuris Rulandi; with which in about three months she was cured. Deckers.

LXXXIX. A Gentlewoman was three years troubled with a hard painful Tumor in her Neck, to which was applied this. ℞ Em∣plast. de Ranis cum Mercurio ℥ss. fine Galbanum ʒii. Saccharum Saturni, volatil Sal Arm. A.ʒss. soften with Oil of Rue, q.s. and make the consistency of a Plaster. By the application of this the Pain and Swelling va∣nished away. Deckers.

XC. A young Lady cholerick and lean, had many scrophulous Tumors, and being afflicted with a continual Hectick-fever died: her Body being opened, there was found above a thousand Glan∣dules upon her, little and great, from the Jaws to the Os Pubis; which were within of the same colour with those in her Neck, viz. yellow; Medicines were wa∣rily apply'd, yet with no suc∣cess. Barbett.

XCI. A Youth twelve years old had a Struma under his right Jaw, of an oval figure. Inci∣sion was made into the Skin, according to its length; then se∣parating it, a Ligature was fast∣ned under it, and so it was cut out, leaving the Ligature to digest off. It was drest with a Digestive made of Turpen∣tine, and Emplast. è Bolo: after Digestion, it was deterged, in∣carned, and cicatrized. Wise∣man.

XCII. A Woman twenty eight years old, had a large Struma on the left side of her Neck, of an oval figure, and moveable under the Skin: an Incision was made the full length of it, and the Skin being every where sepa∣rated from it, it was pulled out, and a Ligature was tied about the Vessels under it, and then cut off: it was drest with a Dossel spread with the Di∣gestive of Turpentine, dipt in Pulvis Galeni, with Pledgets of the same Digestive over it, and a Restrictive Plaster over all, with good Bandage; and after Digestion, it was incarned and healed. Wiseman.

IV. Tumors arising from WIND.

CHAP. XXVIII. Of the WINDY-TƲMOR.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Latin, Em∣physema, pl. emphysemata; Apostema ventosum, Inflatio, Inflationes: in English, Windy Tumor, or Tumors, a Windy Apostem, &c.

II. Definition. A flatulent Tumor is a preternatural swelling, proceeding from Wind, shut up within the Membranes of several Parts, as under a thick Skin, or the interstices of the Mu∣scles, and yielding to the im∣pression of the Fingers, but suddenly returning again.

III. Or, It is a Swelling pro∣ceeding from Wind, not pitting, but yielding to the Fingers, con∣tained within Membranes, and which if shaken, makes a rum∣bling noise.

IV. Galen, lib. de rat. Vict. in Acut. Com. 4. Text. 21. Tumor est, collecto Spiritu flatulento in quibusdam cavitatibus, vel sensui expositis, vel ratione contempla∣bilibus. It is a Tumor made by á flatulent Spirit collected in certain cavities; these cavities being either exposed to the sense, or such as are to be ap∣prehended by reason.

V. Now what these Cavities are, which are to be apprehended by reason, he explains himself, ad Glauc. lib. 2. cap. 5. And that they are those very Pores of the Similary Parts, and those little spaces which are interposed between the said Similary Parts.

VI. Wiseman says, it is a light puffy Tumor, easily yielding to the pressure of the Fingers, and rises again in the instant you take them off.

VII. The Differences. 1. In respect to the kinds; being either pure, or mixed. A Pure Em∣physema is seldom found, unless in cases of Wounds in the Brest; where the Air getting in be∣tween the Muscles and Mem∣branes, does puff them up, much like to the inside of a Shoulder of Veal. A Mixed Em∣physema is that which is mixed with some Humor, which is chiefly, or always Phlegmatick.

VIII. 2. In respect to the place; some are inward, some are out∣ward. The Inward are in the membranes of the Bowels, and

sometimes in their very Cavi∣ties; as the Stomach, Abdomen, Womb, &c. of these we say nothing here. The Outward may be on the Eye-lids, the great Joints, the Scrotum, Navel, and other membranous parts; the Scrotum being the usual seat of the Hernia ventosa, of which in the next Chapter.

IX. 3. In respect to its quality: some are without pain, in which the Wind is in motion; others with pain, in which it is quiet, from its too great distention.

X. The Causes. The proxi∣mate or conjoined Cause is Wind, or a flatulent Spirit; which is, as Galen testifies, de Sympt. Caus. lib. 3. cap. 4. from a weak and languishing heat: for as absolute cold cannot excite any Vapor; so on the other side, vehement heat discusses the Vapor.

XI. The antecedent cause is Phlegm, viscous Lympha, or some other thick Humor; sometimes alone, and sometimes mixt with a little Choler, which as Ferment turns it into froth, and so gene∣rates Wind: and it always happens upon a debility of the Part; which endeavours a con∣coction of Humors, but is unable.

XII. The procatartick or remote causes are flatulent Meats and Drinks; cold, moist, and cloudy Air; idle and sedentary Life; the suppression of accustomed Evacuations, Stoppages of the Pores of the Part, and thickness of its Membranes; to which add, external injuries, which con∣tribute to the hurt and weak∣ness of the place affected.

XIII. The Signs. The Part is inflated like a Bladder, yields to the Fingers, but immediately rising again, and makes a kind of rumbling noise, if shaken.

XIV. It is of an uncertain bigness, sometimes very large, sometimes small; without any weight to the Part that it possesses.

XV. The Tumor being pressed with the Fingers, tho' it yields to them, yet it leaves no pit: whereby it is distinguished from ••edema; for that also yields to the Fingers; but then it leaves a Pit after it.

XVI. It is of the colour of the Skin, without any alteration: unless it is full of pain, by reason of its lying deep, among the sensible parts, or near the Periostion.

XVII. A crackling is often felt, if it is in the Knee, or other outward part: and it most com∣monly affects the Joints, but chiefly the Knee and Wrist; and Parts membranous.

XVIII. The Prognosticks. If they be small, and proceed not from any rebellious cause; or affect only the lesser Joints, they are of easy cure; and if need be, may be opened at any time.

XIX. If it is great, it argues a great debility of natural Heat, and great plenty of morbifick Matter; and therefore the more difficult of cure, because more stubborn and rebellious.

XX. An Emphysema affecting the greater Joints, is of most difficult cure, and not to be opened without great consi∣deration.

XXI. If the Matter is detained

in the Muscles, it is then hardly cured, and with much trouble; for that the Spirit is produced, bound up and included by the containing Membranes, and dis∣per'sd into all parts of the Muscle.

XXII. The Cure. The Wind that distends the Part, is to be taken away. Means also must be used, that it may not breed again, and flow to the Part. And the Pain, if any be, is to be mitigated, and removed.

XXIII. In order to the per∣formance of these things, the Diet is first to be considered; which is to be the same as in Oedema, Pease, Beans, Carrots, and all crude Fruits, and windy things do extreamly hurt. Wine, and other things moderately heating; as the Potestates Anisi, Carui, Caryophyllorum, Ju∣niperi, Lavendulae, Limonum, Rosmarini, Rutae, Salviae, &c. do very much profit.

XXIV. The Matter out of which the Wind is bred, is to be evacuated; which is ef∣fectually done by purging once or twice a week with Tinctura purgans, Syrupus catharticus, or Oxymel scilliticum.

XXV. The Stomach and whole Body is to be corroborated by giving inwardly Tinctura Cordialis, Tinct. Martis, Tinct. Sacra, Tinct. Salis Tartari, Elixir Me∣tallorum, &c. as also, Sudori∣ficks, the chief whereof are, Our Specifick Laudanum, Guttae Vitae, Theriaca Chymica, Lauda∣num Samech, &c.

XXVI. Every night going to bed, after taking a Dose of Lau∣danum, &c. let the Patient take a glass of Hippocras, or spiced Wine; and a like draught of the same every morning fasting.

XXVII. But for correcting the Wind, expelling it, and to hinder its breeding, nothing is better than the Spiritus nitratus, which effectually opens all Obstru∣ctions, and causes a dissipation thereof; take it ad ʒii. in a glass of Hippocras, or spiced Wine.

XXVIII. As to Topicks, they are to be such as by their heating and attenuating quality, may open the Pores, and discuss the Flatulencies; which of Simples these are chief: Roots of Ange∣lica, Galangal, Lovage; Herbs, as Avens, Bawm, Camomil, Dill, Fennel, Fetherfew, Hys∣sop, Marjoram, Mint, Penni∣royal, Rue, Southernwood, Tansy; Flowers, of Camomil, Elder, Melilot, Saffron; Seeds, Anise, Caraways, Cumin, Fen∣nel; Oils of Mace, Nutmegs, Spike, and all hot distilled Oils.

XXIX. Of Compounds, this is good. ℞ Tops of Angelica, Bawm, Camomil, Dill, Hyssop, Ori∣ganum, Southernwood, A. M.j. Wine lbvi. boil, and make a Fomenta∣tion, which apply for half an hour or better: or you may make it in a small Lixivium of Pot-ashes.

XXX. You may also em∣brocate with the following Mixture. ℞ Powers of Rose∣mary, Juniper, Savin, Amber, A. ℥i. Powers of Turpentine ℥ii. mix, and bathe therewith: or you may mix with them

Oil-olive ℥ i. and so anoint with them.

XXXI. Or you may anoint with this Liniment commended by Barbett. ℞ Common Oils of Wormwood and Rue, A. ʒii. Oil of Nutmegs by expressision ʒi. distilled Oil of Mace ʒss. Castor dissolved in Aqua vitae ℈ii. mix, and make a Liniment.

XXXII. Oil made of wild Cucumbers, is approved of, as a most excellent thing to anoint with: or this, ℞ Oils of wild Cucumbers, of Dill, of Rue, A. ℥ss. expressed Oil of Nutmegs ʒii. Oil of Amber ʒss. mix, to anoint withal.

XXXIII. It is good to bathe with Spiritus mirabilis, or an∣oint with Ʋnguentum mirabile, or with this Balsam following. ℞ Common Oil of Rue ℥ii. Tur∣pentine half an ounce: mix with the Turpentine Oil of Vitriol ʒvi. till the Turpentine is perfectly dissolved; then mix that with the Oil of Rue, and make a Balsam.

XXXIV. After, you may apply this Cataplasm of Barbett: ℞ Rue, Calamint, A. M. ss. Goats dung ℥vi. Bean meal ℥ii. seeds of Anise and Cumin, A. ℥ss. Bay-berries, Salt, A. ʒiii. Nitre, Sulphur, A. ʒi. Wine q.s. mix, and boil to softness, and beat all up into a Cataplasm.

XXXV. Or this Emplaster. ℞ Oil of Spike ʒiv. Mastich, Venice-Soap, A. ʒiii. seeds of Cumin, Caraways, A. ʒii. Castor dissolved in Aqua vitae ʒi. roots of Pellitory of Spain, ashes of Earthworms, A. ʒss. Wax, Tur∣pentine, A. q.s. mix, and make an Emplaster.

XXXVI. Or this: ℞ Faeces of new Wax from the Press lbjss. crums of brown Bread lbss. flowers of red Roses ℥iv. boil all in White-wine, then beat them together, and add Gloves, Nut∣megs, Ginger, Pepper in fine pou∣der, A. ʒiii. seeds of Anise, Bishops-weed, Cumin, Fennel, A.ʒiv. Oils of Camomil, Dill, and Rue, A. ℥ii. mix, and make a Cataplasm.

XXXVII. If need require, Blistering, Scarifying, and Cupping are to be done: but if neither by these things, nor the former applications, the Tumor will discuss, but is inflamed, and grows painful, you must then use Anodyns.

XXXVIII. But if the Tumor is in a place where it may be safely opened, the speediest way of Cure will be by cutting into it; and then it is to be cured, as in the Cure of an Absceess we have shewed.

XXXIX. A Tumor in the Knee of long standing, great, soft, and loose, was cured by this Ca∣taplasm. ℞ Roots of Briony, Orrice, Lillies, Daffodils fresh gathered, beat them together, and boil them in Wine and Aqua vitae, and make a Cataplasm: this was applied hot every day upon the Swelling, and bound on; and in three Weeks time it did the Cure. Platerus, Observ. lib. 3.

XL. The like has been done by application of a Cataplasm, made with wild Radish roots and Vinegar, and applied hot.

XLI. Great Inflations of the Knee, have been sometimes cured, by application of a large bli∣string Plaster, made with Can∣tharides, sour Leven, and a little Vinegar.

XLII. A Woman thirty years old, had a swelling on her right Knee, encompassing the Rotula, and had been growing near two years. It was supposed flatulent, and so was treated with Fomen∣tations, Embrocations, and Em∣plasters: but it heating, and increasing, Empl. de Bolo was applied, and a Knee-piece laced on: by the continued use of which the Tumor was re∣strained, and the Knee reco∣vered its former strength. Wiseman.

XLIII. Another Person had in the Knee a round soft Tumor, lying on each side the Rotula, of the same colour with the Skin, which much disabled her from walking: Empl. ad Herniam was applied, with an addition of Ceratum Hyssopi; and a Com∣press of brown Paper, soaked in Aqua Fabrorum, over which a laced Knee-piece was put on, and streightned proportionably: by renewing these Dressings, in about ten days the Swelling discussed, and her Knee re∣covered its former strength. Wiseman, lib. 1. cap. 27. Obs. 4 & 5.

XLIV. A young Woman had a puffy Swelling on her left Foot, near her Toes, stretching over the Toe next the little one, of about two Fingers breadth, without in∣flammation, or much pain. It was endeavoured to be discussed, but it resisted, and was inflamed: then Emplast. è Bolo was ap∣plied, and a Sock to be laced, with a Bracer lockt to it, for the Toe; and by Compress and careful lacing, the Tumor was suppressed, and she had much ease, and in some Months she was cured. Wiseman, ibid. Observ. 7.

CHAP. XXIX. Of a WINDY RƲPTƲRE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ventus, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ramex, Ru∣ptura; in Latin, Pneumatocele, Hernia ventosa, Ramex vento∣sus, Ruptura ventosa; in English, a Windy Rupture.

II. The Kinds. It is twofold: 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Hernia ventosa Scroti, a Windy Rupture of the Cods. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Hernia Umbilicalis ventosa, a Windy Rupture of the Navel. See Synop. Ased. lib. 5. cap. 18.

III. Definition. It is a col∣lection of Wind in the Scrotum, and parts adjacent to it; or else in the Navel, making the parts to swell, or stick out.

IV. The Causes. The proxi∣mate or conjoined Cause is Wind, or a flatulent Spirit, protruded into the Part thro' its weak∣ness, or want of natural Heat; the antecedent is a viscous Lym∣pha, or a superabundance of Phlegmatick matter: and the procatartick or prime Causes, are, evil temper of the Air,

Food of evil Juice, violent mo∣tions, and overstraining of the Body; and in Children many times strugling and crying.

V. The Signs. They are known partly by the swelling out of the Part. That in the Groin is many times large, sometimes hard, sometimes not; but that in the Cod is for the most part hard; because it is apt to swell much, is sud∣denly grown to its bigness, round, and yet light, possessing for the most part the whole Scrotum, and Cremaster-muscle, and sometimes the very Yard, it self.

VI. When it is at its full big∣ness, it resists the touch, and is clear, like unto a Bladder full of Wind; and the Yard is some∣times greater in one place, than in another. If it is in the Groin, it is nothing near so large, and more oblong, and seldom affects the Yard.

VII. That in the Navel is known by the protuberance, clear∣ness of the Skin, softness, and easily yielding to the touch; be∣ing also less painful than the former.

VIII. The Prognosticks. If it is recent, it is easy of Cure; but if it is inveterate, or of great magnitude, the Cure will be performed with much difficulty.

IX. If it has been of long standing, and in a Scorbutick or Cacochymick Habit of Body, it is dangerous; so also if it proceeds from any malign Cause.

X. If it be not discussed, or reduced, it causes in length of time many other Diseases; and sometimes it so spreads, as to possess the whole Body.

XI. The Cure. The Indications of Cure are, 1. To expel or carry off the Humor causing the Wind. 2. To strengthen the Viscera, by Carminatives. 3. To remove the conjoined Cause, by Topicks and proper Compresses.

XII. Purge the Body (if strong, with Oxymel scilliticum) with Syrupus Catharticus, Electua∣rium Catharticum, Pulvis Cor∣nachini, Pulvis Antimonii, or Pulvis Catharticus; which last is a most admirable thing; and re∣peat the Purgation two, three, or four times, or as oft as you see occasion.

XIII. Strengthen the Bowels with Carminatives, as Potestates seminum Anisi, baccarum Juni∣peri, Cariophyllorum, Limo∣num, Virtutum; Tinctura Cor∣dialis, Tinctura Martis, Salis Tartari, Sacra; Spiritus Nitra∣tus, Elixir Metallorum; or other things of like nature.

XIV. As to Topicks, foment in the beginning with this: ℞ Angelica, Bawm, Calamint, Ca∣momil, Fenel, Fetherfew, Origanum, Southernwood, Tansy, A. M.i. bruise, and boil all in Posca, or a mixture of equal parts of Wine and Water lbiv. boil to the Con∣sumption of a third part; and foment hot with Spunges.

XV. Or you may embrocate with this: ℞ Oil-olive, or Oil of Ben ℥iii. Oils of Caraways, Ju∣niper, and Aniseed, A. ʒi. mix them, and anoint therewith. Some anoint with Oils of Euphorbium and Elder, mixt together.

XVI. If the Tumor is with

pain and inflammation, use Ano∣dyns; applying such Cataplasms and Cerats or Emplasters, as have power to soften and re∣solve.

XVII. As these Diseases are most incident to Children, so they ought to be used with great care and mildness: Fienus cured se∣veral, by often heating them against the Fire, and making dry Fomentations, with hot Cloths oftentimes applied.

XVIII. The Emplaster (which ought to be either ad Herniam, or some such as we have described in the former Chapter) being applied, the Part is to be bound up, either with a Bag-truss, or a Bolster-bandage, according to the Place affected; both to keep the Part warm, and keep the Applications on: and so to be continued, 'till such time as the Cure is perfected.

XIX. The Hernia Umbilicalis ventosa, is to be cured exactly after the former manner: but the Cure also consists in the well reducing of it, and retaining it so by Agglutinatives, strong Binders, and good Bandage.

XX. If thro' neglecting it, the Skin should wear thin, and mor∣tify, you must dress it as a Morti∣fication: and after the separa∣tion of the Escar, you must endeavour to take up the Peritonaeum, stitch it close, and incarn it with the rest of the Ulcer; and being cicatriz'd, apply good Bandage, to retain it in its place.

OBSERVATIONS.

XXI. A Child seven years old had a Hernia ventosa in the Groin, as big as a Pullets Egg, soft, but yet so strait, as it scarcely yielded to pressure. Bandage did it no good, but made it more painful; Fomentations and Em∣plasters we applied, as in a fla∣tulent Tumor, and it was bound up with a Bolster-truss; and with proper Internals, it was cured in some time after. Wise∣man, lib. 1. cap. 28. Obs. 7.

XXII. A Child had a Hernia ventosa in his left Testicle, the Wind being gotten into the Tunica vaginalis which encompassed the Testicle round, so as the Testicle could not be felt. The Tumor was so intense, that it would not yield to pressure. For the Cure Discussives and a Bag-truss were advised. Wiseman. ib. Obs. 8.

XXIII. A Child three years old, had one of these Tumors lying the whole length of the production of the Testicle, like to the upper∣most of those Bladders we find in Carps: and the same Wind having raised up the Tunica vaginalis, made the Testicle, not unlike the lower round Bladders which are united to the afore∣mentioned upper Bladders in the same Fish: the Cure was performed by Discutients, and a Bag-truss. Wiseman, ibid. Observ. 9.

XXIV. A Child two months old had a Hernia ventosa in the right Inguen, down into the Tunica vaginalis; the Tunicle of the other Testicle was also distended: Empl. è Cymino was put over the Scrotum and In∣guina, with a Bag-truss, the Tumor not being capable of Reduction or other Bandage.

The Child had an ill Nurse, and was galled by its Piss; for which cause, Empl. Diachalciteos was applied, and renewed daily: upon good Bandage, the Tumor would be very inconsiderable, and sometimes quite discussed: but upon neglect of bracing the Truss close, it would appear big again: it had a Rupture in both Groins; upon which ac∣count, a double Bolster-truss was laid on. Wiseman, ibid. Observ. 10.

XXV. The same Child had a Hernia Umbilicalis ventosa, which was cured by external ap∣plication of Astringents and Com∣pression, exactly according to the method of the following Obser∣vation. Wiseman, ibid.

XXVI. A Child four months old had a Hernia Umbilicalis ventosa, to which was applied a mixture made of pouders of Frankincense, Mastich, Aloes, Sanguis draconis, with the white of an Egg; Emplastr. è Bolo, with a small Button sticking in the middle, made of some snips of the same Emplaster; by which the Emplaster under it was kept the closer: these were bound on to make a Com∣pression. Above the Navel, it had also another Rupture: a Compress was made of some pieces of Empl. ad Herniam, which was kept upon the place, by applying over Empl. è Bolo: by this method, these Hernia's were in few weeks cured. Wise∣man, ibid. Obs. 1.

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.

VI. Tumors arising from MELANCHOLY.

CHAP. XXXIV. Of a POLYPUS.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Multipes; ex 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 multus, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 pes; in Latin, Polypus, Sarcoma, Noli me tan∣gere; in English, a Polypus, or Cancerous Tumor.

II. The Kinds. It is twofold: 1. That in the Nostrils, which is properly called Polypus. 2. That which happens in other Parts, which they generally call Sar∣coma, and Noli me tangere.

I. Of POLYPUS.

III. Definition. Polypus is a pre∣ternatural Tumor, being a fleshy Excrescence, long, and hanging in the Nostril, hindering respira∣tion, and threatning suffoca∣tion in time of sleep.

IV. Celsus, lib. 6. cap. 8. Est Caruncula, inquit, modò alba, modò subrubra, quae Narium Ossi inhaeret; & modo ad Labra pen∣dens Narem implet, mod•• retrò per id foramen, quo Spiritus à Naribus ad Fauces descendit, adeò increscit, ut post Ʋvam conspici possit. — Feréque mollis est, rarò dura; eaque magis Spiritum impedit, & Nares dilatat, quae ferè 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 est, itaque at∣tingi non debet. It is a Caruncle (says he) sometimes white, some∣times reddish, which sticks close to the Bone of the Nostrils, and sometimes hangs down to to the Lips, filling the Nostril; sometimes it grows upwards, thro' the same passage of the Nostril by which the Breath is drawn inwards, increasing so much, as that it may be seen beyond the Uvula. — It is mostly soft, seldom hard; and by so much the more as it fills the Nostril, it hinders the Breathing; which is almost of a Cancerous nature, and there∣fore not to be touched.

V. The Causes. It is caused of a thick and viscous Humor, or flegmatick matter mixed with the Blood, falling down from the Brain; which not being acrid, seldom comes to exulceration.

VI. Sometimes it arises from a Melancholy Humor mixed with an acrid Salt; and then it is

painful, and is apt to degenerate into Cancer.

VII. The Signs. It is known by sight, and the Description afore∣given by Celsus; being purely a piece of Flesh growing in the Nostril, and hanging down.

VIII. The Prognosticks. If it soft, white, and void of pain, it is is easily cured: but if it is red∣dish, with more difficulty.

IX. If it is of a brown, or livid colour, it is scarcely curable; more especially if it be livid and stinking, being of a Cancerous nature.

X. The more deeply it is rooted, the more dangerous it is; because nearer the Brain, and the more difficult to have Medicines ap∣plied to it: but the more external and visible, the less difficult of cure.

XI. If it proceeds from an acrid Salt, and melancholy Hu∣mor, it is apt to degenerate into Cancer; and this is that which Celsus thinks not fit to be touched, lest it becomes a Can∣cer, and overspreads the whole Face.

XII. But that which has no∣thing of a Cancerous humor in it, tho' inveterate, yet it admits of Cure by Chirurgery, viz. with the Knife, and drying Medicines.

XIII. The Cure. The Body is to be universally purged, as is usual in all Diseases of the Head, with such things as have a general tendency; of which we need say no more in this place.

XIV. The Humor may be de∣rived by application of Vesicato∣ries, Seton, Fontanels, &c. and the Head strengthned with pro∣per Cataplasms, Cerates, and Emplasters; which may be applied to the Forehead, or fore-part of the Head, to inter∣cept the Fluxion.

XV. The piece of Flesh then hanging in the Nostrils, is to be eradicated and taken away; which is to be done, either with the Knife, or other proper In∣strument, or with Medicines.

XVI. If the Polypus has a slender root, it is to be taken away either with a Thread, or the Knife: if it can be easily come at, let it be cut off by the roots, with an Incision-knife; some nip them off with a pair of Pincers.

XVII. After extirpation, the Wound is to be healed with things drying and styptick: and the outward parts are to be de∣fended with things strengthning and astringent applied to the Forehead.

XVIII. ℞ Pomgranate-peels, Balaustians, A. ʒi. Cadmia fossi∣lis ʒii. Crocus Martis, crude Antimony, A.ʒss. Litharge, Load∣stone, Mastich, Myrrh, A.ʒi. make a fine pouder; which apply to the Wound, mixed with Mel Rosarum, &c.

XIX. If this does nothing, for that some part of the roots of it remain, you must then come to Exedents. ℞ Alum burnt, Ba∣laustians, fine Bole, ana; make them into a pouder.

XX. Or this, which is stronger. ℞ Vitriol ʒiv. Alum, Galls, Pom∣granate-peels, A. ʒii. red Myrrh, Birthwort-root burnt, A.ʒi. make them into a pouder.

XXI. This is yet stronger.

℞ Vitriol ℥iv. Alum, Verdigrise, A.℥ss. Vinegar ℥vi. mix, and cal∣cine in a luted Retort: mix this or the former with Mel Rosarum, and apply them.

XXII. This is said to be most effectual. ℞ Arsenick red and yellow, Alum, Galls, A. ℥ss. Galls, A. ℥ss. make them into a fine pouder. And some have been perfectly cured with the Pulvis Cathereticus Clossaei, as also the Pulvis Causticus Bar∣betti; which last see in Our Doron Med. lib. 2. cap. 21. sect. 28.

XXIII. Others have had them eradicated with the Liquor Mer∣curii sublimati, (in Our Pharm. Lond. lib. 4. cap. 11. sect. 24.) but it may be fit to make it with double or treble quantity of Mercury: this is only Corrosive-sublimate dissolved in fair Wa∣ter, about ʒi. to a pint.

XXIV. Aquapendens and Sen∣nertus commend a pair of For∣ceps, with which they are to be laid hold of, pull'd forth, and then cut off; after which, some of the former astringent and drying Medicines are to be applied; or else the afore de∣scribed Escaroticks, to eat in, and take it away by the roots.

XXV. Or these following. Butter of Antimony, Spirit and Oil of Vitriol, or Sulphur, Lapis Medicamentosus Crollii, Oleum Mercurii, Menstruum duplica∣tum, &c. which last see in Out Seplasium, lib. 2. cap. 6. sect. 22.

XXVI. But in the use of these things, you ought to defend the Nose with some cooling Ointment; and they are to be conveyed to the Part in Pipes fitted for this purpose.

XXVII. If you use the actual Cautery, you must beware of the adjacent Parts and apply it to the Part thro' a Pipe.

XXVIII. If it is Cancerous, viz. livid, or black and blew, or pain∣ful, it is not then to be touched; for if you meddle with it, it soon degenerates into Cancer, and becomes incurable.

XXIX. In this case, ℞ Ung. è Plumbo, juice of Nightshade, Rose-water, A. ℥i. grind them a long time in a leaden Mortar, till the Mixture is sufficiently blew, and anoint therewith.

XXX. Or, ℞ Two yolks of new laid Eggs, grind them in a leaden Mortar even to blackness: to which add, Aethiops Mineralis. Oil of Ben, A. ʒii Camphir ʒss. mix, and anoint therewith. Or, ℞ Ung. è Plumbo ℥i. Aethiops Mineralis ʒii. Extract of Opium ʒi. mix them in a leaden Mor∣tar as aforesaid, with which anoint.

II. SARCOMA, or Noli me tangere.

XXXI. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Carnositas, Carnis praeter naturam incremen∣tum, is that other sort of Polypus, of which Celsus in the place afore cited) speaks in these words; Illud aliud genus ferd quidem ferro curatur; interdum tamen inarescit, si addita in Na∣rem per Linamentum aut Peni∣cillum ea compositio est, quae habet Minii Sinopici, Chalcitidis, Cal∣cis, Sandarachae, singulorum p. i. Atramenti Sutorii p.ii. There is

another kind, which may indeed be nearly cured with the Knife: yet sometimes it is healed by drying Medicines, being applied to the Nostril with Lint, or a Pencil; such as this, ℞ Fine Bole, Chalcitis, Lime, red Arsenick, ana p. i. common Vitriol p. ii. make all into a fine pouder.

XXXII. Sarcoma to me seems to be only a species of Polypus, but happening in a different place: for whereas the Polypus specially so called, happens only within the Nostril; this other spe∣cies happens in other parts, as about the Nose, Lips, Chin, Cheeks, near the Eyes, Breasts, Arms, Thighs, Legs, Shins, Ancles, &c.

XXXIII. Sennertus, lib. 1. part. 3. sect. 4. cap. 3. Caeterùm differt à Polypo, Sarcoma, in∣quit, ut genus à specie, figurâ item, & magnitudine: nam Sar∣coma rudis quaedam Carnis massa est, certâ figura carens, & saepe in magnam molem excrescit: etiam carne à Polypo distat, quo∣niam durior est, & dolorem infert, ac nigrescit aut livescit, ac Venas circumquaque crasso Sanguine tur∣gidas habet, ac plerumque intus prope viciniam Narium, & Pala∣tum nascitur. Viz. Moreover, (says he) Sarcoma differs from Polypus, as genus from species; and that both in figure and magnitude: for Sarcoma is a certain rude mass of flesh, of no regular form, and often∣times grows forth into a great lump: it differs also from Poly∣pus in the substance of the Flesh, because it is harder, and with∣all painful; and grows either blackish or livid, having turgid Veins round about it, filled with a gross or thick Blood: it is also produced inwardly, near to the Palate, or the ad∣jacent parts of the Nostrils.

XXXIV. From what has been said, it appears, that a Sar∣coma is of two kinds, viz. be∣nign and malign: the latter of which is denominated again, according to the place it af∣flicts: for if it possesses any part of the Face, as Nose, Lips, Cheeks, Eyes, Chin, it is called Noli me tangere: but if it pos∣sesses other lower parts, as the Breast, Arm, Thigh, Leg, Shins, Ancles, &c. it is called Lupus, the Wolf.

XXXV. The Causes. The Be∣nign arises from a thick Blood mixed with a Pituitous Humor, tough and viscous, extravasated; and filling some particular Glan∣dule of the Cutis, which by a daily aggravation of fresh mat∣ter increases into this form and substance.

XXXVI. The Malign arises from a thick Blood mixed with Atra-bilis, or a Melancholy Hu∣mor, acrid and corroding; which being also extravasated, and separated from the nourishment of the Part, grows into a malign Sarcoma.

XXXVII. Signs. Noli me tange∣re, is a Tumor, or Ʋlcer arising about the Nose, Lips, Cheeks, Mouth, or Chin; being for a long time, as a Year or more, no bigger than a Pustule, and is as it were a very small and inconsiderable Push.

XXXVIII. Its growth and in∣crease is very slow at the beginning,

afterwards is it becomes a little larger Tumor; and (possibly by ill handling) a corrosive Ulcer, having a resemblance with, and being very like to an exulce∣rated Cancer.

XXXIX. In other parts of the Body, where it is called Lupus, its beginning is like the former; but when it becomes exulcera∣ted, if it is in a very fleshy Part, it corrodes or eats much more; and as I suppose, from that vehement corrosion, it was cal∣led The Wolf.

XL. The Prognosticks. The Be∣nign is more easy of cure, the Malign more difficult; and if it be truly Cancerous, not to be medled withal, unless it is to∣tally taken away by the roots.

XLI. Noli me tangere, which is benign, (being a small, round, acuminated Tubercle, without much pain, unless it be touched or rubbed,) is always exasperated by sharp Medicines; and Corro∣sives are apt to make it dege∣rate into a Phagedenick Ulcer.

XLII. The Malign, if they be ulcerated, yet corrode but slowly; for saith Rogerius, in c. 5. Cancer plus corrodit uno die, quam Noli me tangere in uno mense: Noli me tangere does not corrode or eat so much in a month, as a Cancer does in day.

XLIII. And being once ulcera∣ted, if it is vehemently exaspe∣rated, or enraged, it immediately becomes a true Cancer.

XLIV. The Cure. The Benign (which is not deeply rooted) may as Celsus says, be almost cured with the Knife alone; drying Medicaments being afterwards applied to it, to heal it.

XLV. But if it is Malign, it is scarcely at all to be touched, but only with Palliatives; as Ʋng. è Plumbo, mixed with Aethiops Minerale and Opium; Ceruse, Saccharum Saturni, Sal Jovis, (which is a Specifick in this case) Mercurius dulcis ground small with a few drops of Oil of Tartar, Emplastrum Mercu∣riale, a plate of Lead besmeared with Quicksilver, Lixivium of Quicklime, &c.

XLVI. If you determin the Extirpation thereof by Chirurgery, the Body ought to be beforehand sufficiently evacuated, by such things as purge Melancholy: and some∣times a little gentle Salivation may be profitable, if it is in any of the lower or depending parts of the Body.

XLVII. Then you may come to the Extirpation; which is best done with the Actual Cautery: but here you must be sure to burn to the roots of it; or else to apply after the Actual Cau∣tery, Escaroticks, which may consume the very roots thereof.

XLVIII. But by reason the Actual Cautery is so dreadful, that few will admit thereof, we will shew you the Method of doing it with the Potential Cautery; which is thus. First, draw a Line with Ink round about the Tumor, as far as you intend to burn it. This done,

XLIX. Secondly, begin with the Caustick-stone, made sharp-pointed, which press upon the middle of the Tubercle, burning deep into it: and to quicken the Work, touch it with Butter of Antimony,

or Oil of Vitriol upon a Stick, and then again with the Cau∣stick-stone interchangebly, till you have consumed the Tuber∣cles, and the Parts marked within the Line.

L. Thirdly, whilst this is thus doing, dry up the Salts, which are dissolved in the humidities of the Tumor, with armed Probes; af∣ter which wash out the Salts of the Caustick with warm White-wine; and then divide the Escar, and wash it again with Milk, or a soft Lime-water, till the Tumor or Part is freed from pain.

LI. Fourthly, then dress it with Ung. Basilicon cum Oleo Rosa∣rum upon a Pledget, and apply over all Emplastrum è Bolo: by which things the Escar will be separated, and a deep round Ulcer left.

LII. Fifthly, then digest with Ung. Basilicon nigrum, mixed with red Precipicate; after which you may incarnate and cicatrize with Ʋnguentum Tutiae, or some other like Medicine.

LIII. Lastly, you must be sure to eat deep enough at first, to consume the very root of the Tumor; otherwise after the coming off of the Escar it will arise again, and put you to new trouble; whereas being once effectually done, it returns no more.

LIV. Wiseman says he saw one on the outside of a Man's Arm, a little above the Elbow; which was a small Tubercle, as big as a Hazle-nut, of a blewish colour, and looked as if it had been a Varix; without inflam∣mation, hardness, or change of colour in the Parts adjacent: he covered it with a Cup made of light wood, with straps fastned to it to tye it on, to defend it from the pressure of his Sleeve. And such another he saw on the Arm of a Woman, of 40 years old; it was on the outside of the Arm, and of a blew colour.

LV. And such a like one I once saw on the inside of the left Arm of a Man, a little above the bending of the Elbow; and an∣other like one, on the Leg of ano∣ther Man of about 50 years of age: they were both of them much about the bigness of a small Nutmeg: they shewed them to me, to have my Opi∣nion; but would not admit of any thing in order to have them cured, or removed.

LVI. An Observation from Wise∣man, Lib. 4. Cap. 6. Obs. 10. A poor Woman had a large Tu∣bercle on the right Canthus, also a Polypus in that Nostril: after the separation of the Tubercle, a Fungus thrust forth, which was very vexatious in eradi∣cating, and unsuccessful: then the Polypus was attempted:

LVII. It was taken hold of by a Ducks-bill Forceps, and pulled outwards; then a Needle with a twisted brown thread was passed thro' it, as Fabricius ab Aquapenente advises; and pul∣ling by that and the Forceps together, it was drawn out about the length of two inches; but was attended with a flux of Blood from the Nose, Mouth, and Eye; which was stopt by Syringing up Oxycrate.

LVIII. At the next dressing

of the Ʋlcer in the Canthus, the Fungus was missing, and a great hole found in the Bone of the Nose; upon which it was con∣cluded, that the Fungus which was there, was the root of the Polypus: the Bone was much corrupted, but the External Cure of the Ulcer was hastned, the Exfoliation of the Bone being left to Nature.

LIX. A certain Noble Woman had all the right side of her Face over∣spread with a Lupus, or a phage∣dene Ʋlcer, which grievously tormen∣ted her for a long time; she sought in vain to the Physicians for help, as well French, Italian, and Spa∣nish, as Germans, together with other Foreign Physicians; but was at length perfectly cured by an ordinary and vulgar Barber-Chirurgeon, by application of Chickens cut into very many thin and broad pieces, which were daily applied to the Part affected, often changing and renewing them: and at length by this only Remedy she was recovered to her pristin health and sound∣ness. Mauritius Cordaeus upon Hippocrates, lib. 1. comment. 7.

LX. I knew also a certain Wo∣man who had a Lupus for a long time on her left Side, below her Breast, which vehemently tor∣mented her; which was by the advice of an old Woman cured in a short time, by the only application of raw Beef to the Part, cut in thin slices, and often renewed.

LXI. But if the Malignity is so great, that none of these things will prevail against the Ʋlcer, or give the Patient any ease; and it is in a Part where Cutting or Burning, or the use of Escaro∣ticks may be safe, there are no other Remedies to be attempted: otherwise the Patients must en∣dure the torment and vileness of the affliction all the days of their lives.

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.

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.

CHAP. XXXVII. Of a CANCER of a BONE.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Cancer de Osse, Spina ventosa; and in English, The Cancer of a Bone.

II. Definition. It is a preter∣natural, hard, and painful Tumor of the Bone; arising within the Bone, or between the Bone and the Periosteum.

III. The Causes. The Proca∣tartick Causes may be the same with those of a Cancer, or of hard strumous Tumors; for which reason, some will have it to be a species of the Kings-Evil.

IV. The Antecedent Cause, is a sharp Humour, or thin acid Serum, in the Medullary-juice; which corroding the Bone, makes its way thro' the Peri∣osteum; after which there fol∣lows an Ulcer of the Flesh and Skin, which is incurable, till the Bone is made sound.

V. The Conjoined Cause, is that sharp Humor or Scrum, separated from the Blood and Lympha, which seizes upon the Fibres, and make a solution of continuity there, corrupting at length the inte∣rior part of the Bone it self; passing its subtil and malign Humor thro' the porosities it had made.

VI. This sharp malign Humor by degrees so affects the external surface of the Bone, as to raise thereon a preternatural Tumor, which extending the Periosteum, causes much pain and torment: which pain, if it grows so sharp, as to cause an Inflammation, then an Abscess or Apostem suc∣ceeds, and therewith a fetid, painful Ulcer, difficult to be cured.

VII. The Differences. They arise, 1. From the Humor. 2. From the place of its Begin∣ning. 3. From the Parts af∣fected.

VIII. 1. From the Humor. The milder the Humor is, the slower the Tumor arises, and sometimes scarce any swelling appears, or any pain is felt; gradually swelling, and never corrupting exter∣nally. The sharper the Humor is, the sooner the Tumor arises; so that sometimes it appears in 24 hours, passing thro' the cor∣tex of the Bone, and imme∣diately (as it were) causing an Abscess.

IX. 2. From the Place. For it begins either within the Bone,

or without the Bone, between the Cortex and the Periosteum; and according as the interior part is harder or softer; or the external Cortex is solid, or porous, so it suffers solution sooner or later.

X. 3. From the Part af∣fected: as, 1. In the Cranium, where the Humor passes for the most part thro' the inferior Lamina, affecting the Dura ma∣ter, &c. causing great Pain, Spasms, Convulsions, Epile∣psies, &c. this is seldom dis∣covered before death. 2. In the great Bones of the Knees, Shins, Ancles, Elbows, Cubi∣tus, &c. where the Humor increases but slowly, and gene∣rally produces Apostems, arising externally from the protube∣rance within. 3. In the Os Tali, or Heel-bone; which is spungy within, and full of external Pores, in which it makes its way speedily. 4. In the Jaw-bones, which are some∣thing porous also. 5. In the Toes. 6. In the Fingers ends; where it is called Paronychia, or a Felon; of which we have already treated, in Chap. 12. aforegoing, of this Book.

XI. The Signs. The most visi∣ble Signs, are a protuberance or swelling of the Bone, without dis∣colouring of the Skin; which is either with much pain, or with∣out much pain; according as the Humor causing it is either sharper, or milder.

XII. It is known also by the Apostem arising there-from, which is always between the Membranes and Tendons: and something of Fluctuation may be felt, be∣fore the external Skin is much inflamed.

XIII. The Apostem being opened, if you then search with a Probe, you may many time find it pene∣trates deep into the Bone; and yet the Cortex of it will be white: whereas in other Apo∣stems, which begin externally, when the Bone is bare, it will be only superficially carious, and stained with the matter.

XIV. The Orifice, says Barbett, is very little, the edges are paler, the matter which flows forth, is thin; the Flesh is soft, and somewhat swell'd, at least (as in an Ulcerous Excrescency) it increases of its own accord.

XV. Where it affects a Bone that is spongy, it is admirable to see how quickly the Fibres of it will be softned, by the sharpness of the Serum of the Blood, and made apt for a sudden disten∣tion; as if it were rather Mus∣cular, than Boney.

XVI. The Prognosticks. This Disease is always of difficult cure: and Barbett says it is incura∣ble, unless the Bone be made sound.

XVII. It is more easily cured in the lesser Bones; as the Cra∣nium, Jaws, Fingers, and Toes: but if it is in the larger Bones, it is for the most part desperate; and if at length performed, it is very long first.

XVIII. Infants and Children are most subject to this Disease; because their Bones are softer, and more porous: Old persons are seldom troubled with it, for the contrary reason.

XIX. The Bone thus swelling, or seeming to have an Exostosis upon it, as being big, and seeming to be very hard; yet if you open it, it will be found in∣wardly carious, or spongy and rotten.

XX. The Cure. The same method is to be taken here, as is proposed in Apostems and Ʋlcers with Caries: seeing when this is Apostemated or Ulcerated, it is nothing more or less, than such a Disease; except you will say the Humor is yet more sharp and malign.

XXI. If it is not ulcerated or broken, if very painful, you must first of all use Incision; which must be made according to the length of the Part, and that to the Bone it self: for the sooner this sharp corroding Humor is let out, the better it is, and withal pre∣vents more mischief, which by its being longer retained with∣in, it would do.

XXII. Being opened, you must dress it with things astringent, drying, and resisting Putrifaction; as Euphorbium, Spirit of Vi∣triol or Sulphur mixed with Spirit of Wine, Tincture of Myrrh, camphorated Spirit of Wine.

XXIII. But before opening, while the Disease is recent and young, (a good Diet, and regulation in the Non-naturals being observed) you ought to purge the Body well with proper Catharticks, and use a good Diet-drink; such as we prescribe in strumatick Tumors: and outwardly things astringent and drying; as Emplast. e Bolo, Empl. Caejaris, de Minio simplex, & cum Sapone; Empl. de Ranis cum Mercurio; or Our Empla∣strum Mercuriale, &c.

XXIV. But after opening as aforesaid, Barbett commends the Pouder made of Turpentine, by boiling it in Water to hardness: he commends it as an excellent thing upon his own Experience, being mixt with Ʋnguent. Fu∣scum Wurtzii, or Aegyptiacum: an actual Cautery also, says he, will be convenient.

XXV. The Cure will also be accelerated, if instead of Tents made of Lint, Elder-pith be used; because it imbibes the thin and sharp Humors, by which the Action of Nature is promoted.

XXVI. This is an experienced thing. ℞ Ʋng. Aegyptiacum ℥ii. Tobacco in fine pouder ℥ss. Euphor∣bium ʒi. mix them, and apply it. You may daily wash it also with Juice of green Tobacco, raised from Spanish seed, or with a Tincture of dried Tobacco, drawn with S.V. or with Spi∣ritus Ʋniversalis.

XXVII. If it is in the Cra∣nium, it is not protuberant, yet you ought to make inspection; and proceed accordingly by scra∣ping, or the Trepan, as the Symptoms shall indicate to you.

XXVIII. Those in the Jaws are visible, and require vent by extraction of the Teeth: after which the Caries must be con∣sumed or removed, by drying Applications; of which the Actual Cautery is the most speedy and convenient.

XXIX. The Ʋlcers in the greater Bones, are to opened also; that the matter may be

discharged, and the Bone laid bare, in order to Exfoliation, if possible.

XXX. But if the interior part of it is corrupted, then it will be best to keep that part of the Ʋlcer dilated which lyes over the aperture, and in the Bone, by some Dossel dipt in S.V. or Camphorated Spirit, or Tinctura Exfolians, and to heal up the rest of the Ulcer; prescribing also such Internals, as may dispose the Body to a better habit.

XXXI. For seeing that for the most part these Diseases arise from the distemperature of the whole mass of Blood and Lympha; and that when one Cancer is almost cured, another appears in some other place; therefore it is highly necessary to have regard to the evil habit of the whole Body: for which purpose, the following (or some such-like) Medicine may be taken.

XXXII. ℞ Roots of Comfrey, Osmond-royal, China, Sarsaparilla, A. ℥ii. bark of Guajacum ℥iv. Rhu••arb, Agarick, A.℥jss. Sena ℥ijss. Cinamon ℥ss. Cloves ʒii. infuse all in Barley-water lbxii. or q.s. then boil with a gentle Fire to lbviii. Strain, and dulcifie with Syrup of Comfrey ℥viii. and make an Apozem. Dose, ℥iii, iv, or v. to a Man or Woman: it Purges gently, hastens the Cure, and preserves from farther mischief.

XXXIII. Those of the Fingers and Toes are to be laid open by Incision, in case of Apostemation, the length of the Protuberance and the Bone cut into, or cut out, as you see the case requires; and then the Caries dried up, with such things as are before re∣lated. ℞ Mel Rosarum ℥ i. pouder of Tobacco ʒiii. Euphor∣bium, Camphir, A. ʒi. mix them.

XXXIV. The greater Bones will take more time to exfoliate them; and if the rottenness begins within it, it will consume the very substance of them; so that no Exfoliation can be expected, but a total removing of the Bone it self, without which no Cure can be expected: and in this case, Nature it self is so munificent, as sometime to supply the vacuum with some Callus, or Cartilaginous substance.

CHAP. XXXVIII. Of an ELEPHANTIASIS.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Elephantiasis, Lepra Ar••bum; and in English, the Elephantiasis, or Elephantick Disease, the Ara∣bian Leprosy.

II. The Name is derived from the Elephant; because those af∣fected with this Disease, have

their Skin, and Members af∣fected therewith tumid and swoln, scaly, rough and rugged, full of lumps, and unequal, like to the rough skin of Elephants. Of this Disease we have spoken at large, in the third Edition of Our Synopsis Medicinae, lib. 6 cap. 15. so that little need be said of it here; excepting what belongs to the Chirurgick part, which is contained in this present Discourse.

III. Description. The Lips of such as are troubled with an Ele∣phantiasis, are made thick, and the Nose swells; so that it looks as if it were pressed down, or become flat; the Ears become flaggy, and much wasted, the Jaw-bones are coloured as it were, and overspead with a certain kind of redness, and Tubercles or swel∣lings appear here and there in the Forehead, like as if they were Horns or bunchings-out; the Cheeks and Face are also affected with a certain roughness and redness; and the Chin it self is dilated, like as it is in those that laugh.

IV. It is said to be indeed an universal Cancer of the whole Body, comprehending under it many kinds of Diseases: so that this appears to be an Affect greater than all other Diseases, and a Disease almost remediless and incurable.

V. The Causes. Authors say, it arises from Atra-bilis joined with a malign property, diffused and spread abroad thro' the whole Body.

VI. But doubtless it is caused thro' a Discrasy of the Blood and Lympha, defiled with a kind of Arsenical or stinking Sulphur, and a malign Vitriolick Salt; which being conveyed with the Blood and Lympha all over the whole Body, and altering the Fer∣ment thereof every where, causes this so universal a defile∣ment.

VII. The Antecedent cause is from a hot and dry distemper of the Viscera, and Parts destinated for Nutrition: from whence it is, that the Blood and Lympha are as it were burnt, or very much altered, by the evil Fer∣ment of the Parts; and they being changed, make in their distribution, that universal change thro' the whole Body, which is usually seen in the pro∣gress of this Disease.

VIII. The Procatartick Cause is a lewd, debauched, luxurious, libidinous and evil course of Life: the frequent and common use of salt Meats: as also the much eating of great quantities of Sugar, and of sharp and sowr things, or Meats overgross and thick, eating of Mans-flesh, and the like.

IX. To this add the Habit of the Air; for this Disease being mostly Endemical, it is chiefly to be found in some particular parts of the World: where 'tis thought the Air contributes much to its beginning, growth, and in∣crease; as in Aegypt, Palestine, Arabia, Africa, Spain, in some parts of Italy and Germany, and in Narbon and Aquitane in France: as also the Air in which Elephantiack persons breathe; for that the Disease is

affirm'd to be certainly conta∣gious.

X. The Kinds. It is said to be twofold: 1. General; of the whole Body, which is called Elephantiasis Graecorum, or Le∣pra Arabum; of which we speak in this Chapter. 2. Particular; which only affects a Part, and is called Elephantia, or Elephantia∣sis Arabum; of which we shall (God willing) speak in the next Chapter.

XI. The Signs. Celsus, lib. 3. cap. 25. has given you the whole Idea of this Malady, which you may see at large in Our Synopsis Medicinae, lib. 6. cap. 17. sect. 7. to which we refer you: and Sennertus has given you a larger enumeration of the attending Symptoms: all which you may see in the place afore-cited, from Sect. 8. to 14.

XII. To these aforesaid Signs, declared by those Authors, we add these following: 1. There is an augmentation of Magnitude in most parts of the Body; it being swel∣led up and down, especially in the external Parts; whose beauty, feature, and figure are thereby corrupted.

XIII. 2. There is also a hot and dry Distemper, by which the Parts of the Body are made uneven and rough, and as it were exul∣cerated and corrupted.

XIV. 3. There is also in Men a suppression of the Hemorrhoids, where they have been usual, and long accustomed; and in Women, a stoppage of their Terms or Courses: or the sudden drying up of some long-continued running Ulcer; whose Humor being detained in the Body, grows worse and worse, and at length acquires Malignity; which insinuating it self into the Veins, infects and taints the whole mass of Blood.

XV. 4. When this Disease is first invading the Patient, there goes before it, and is present, a sluggishness, or slothfulness, with a slow and difficult breathing; a stinking Breath, unfitness for motion; a daily and continual Costiveness of the Belly, and the Urine is like unto Beasts Urine; as Horses, Bullocks, Oxen, and an extream prone∣ness to Venery.

XVI. 5. The Voice is hoarse and obscure; by reason that the Lungs, and parts serving to Re∣spiration, are filled or oppressed with thick and adust Humòrs: and by reason also of the driness and roughness of the Trachaea Arteria.

XVII. 6. The Veins under the Tongue swell, and become blackish; and the Glandules which lye near unto the Tongue, and round about it, have in them round Tubercles, like unto the Scrophulae in Swine, or those which we call the Swine-pox.

XVIII. 7. In a word, the whole Body is defiled with an exceeding great pollution, and a great de∣formity attends every part thereof: it wants either in its figure or shape, b••ing either greater or less than it should be, in all its Members. The surface of the Sain is changed, being red and dis∣coloured, hard, scur••fy, and full of little Tubercles, not much unlike the Elephants hide or

Lion's forehead: the Voice is altered, and sometimes almost gone; and the Breath so abo∣minable, as not to be endured.

XIX. The Prognosticks. This Disease is said to be wholly in∣curable, unless taken in its begin∣ning; and then it is performed with very much difficulty, great trouble, and a tedious application of Medicines; for that few Me∣dicines are found, that can sub∣due and conquer the malignity thereof.

XX. And by reason that this Disease discovers not it self soon, nor is at all manifest, 'till it has taken deep root, and tainted all the Blood and Humors with the greatest Malignity; so that it has (as I may say) fixed it self thro' all the Bowels, and the whole Foundation of the Fleshy Mass, and even corrupting them throughout, for these Reasons, it is esteemed by all Authors to be incurable.

XXI. But yet, as it would be great folly to attempt this Cure where the Disease is inveterate, or has been of long standing, so as that it has corrupted the whole Body: so it would be as great a weakness and inhumanity, to deny our help and assistance, for the Cure of such as only seem to be affected therewith, but are indeed not so diseased; or where it is yet but in its infancy, or beginning.

XXII. Actius, Tetrab. 4. serm. 1. cap. 120. saith, Huma∣num enim, & plenum benevolentiae signum est, in extremis malis, etiam usque ad Experimenta ve∣nire, ad difficultatem Affectionis compescendam: viz. For (says he) it is humane, and a great sign of good nature, in the greatest extremities, or the worst of Diseases, to make such Trials as may possibly tend to the benefit of the Sick.

XXIII. The Cure. For, what Diet is necessary, or what things are to be avoided; we shall refer you to the third Edition of Our said Synopsis Medicinae, lib. 6. cap. 17. sect. 26. ad 31. and come now immediately to the Medicinal and Chirurgick Cure.

XXIV. The Humor ought often to be evacuated, which let be chiefly with Mercurial Prepara∣tions: and outwardly a Cataplasm of green Tobacco, mixt with pouder of Bay-berries q.s. is to be laid all over the Belly, and kept there so long as the Patient can conve∣niently endure it: for it works both upwards and downwards, and purges the whole universal Man; evacuating all offending Humors, of what kind soever.

XXV. And this Application is to be repeated; and that so often as the age, strength, habit of Body, and condition of the Sick will permit.

XXVI. But the most potent of all internal Remedies, are such as operate by Salivation; be∣cause they drain away all the impure Lympha in the whole Body; throughly purge and alter all the Mass of Humors, and do as much as is possible to be done by any kind of Eva∣cuating-Medicines.

XXVII. And tho' by this way the Humors and Juices are much sweetned, and altered; yet it is

to be imagined, by reason the Disease is so deeply fixed in the fleshy Mass and Humors, that one single Salivation cannot perform a compleat Restauration; but that it must be many times, and often repeated, sometimes by Internals only, and sometimes by Externals, as by Unction: because the whole substance of the Flesh, and the Skin also, seem to be throughly defiled therewith.

XXVIII. And by reason this kind of Operation much weakens the Body, there is to be that di∣stance of time between each Sali∣vation, as that the Patient may be restored, and gather a compe∣tency of strength again: for to continue it too long, or to repeat it too soon, one time after another, are equally dis∣advantageous to the deplorable Patient.

XXIX. For Alteratives, we commend the Viper-pouder, to be taken ʒi. at a time, every Night going to bed, when the course of Salivation is over; or in the times between each Salivation: and every Morning fasting, the Pote∣states Viperarum; which may be given, à gutt. 20. ad 40. in Mead, or clarified Whey, or some other proper Liquor or Vehicle.

XXX. To these things we may add, native Cinnabar, Tincture of Antimony, Mercurius Diapho∣reticus, Bezoar-mineral, pouder of Toads-flesh, (long to be continued, because it is a Spe∣cifick) the pouder and ashes of Kites-flesh, wonderfully com∣mended by Sennertus; and the Specifick of Vitriol, so much extolled by Hartman: which may be given singularly, or rather alternately; because Na∣ture delights in variety and change, and that for a long time together.

XXXI. But for Alteratives, nothing seems to have more and greater effects than the Tincture of Luna, and Aurum potabile; which have a power to alter and change, cleanse and purify the whole mass of Blood and Humors, after a very admirable manner; and to drink withal, for some considerable time, the Decoctum Ʋlmi, as ordinary Drink, because it seems to be specifick in this Cure.

XXXII. Barley-broth made with Vipers-flesh, taken for many Months together, is a singular Experiment. And because the whole Diet in this Cure ought to be cooling and moistning, and withal cleansing, we com∣mend Whey clarified with Fu∣mitory, or with Borrage and Bugloss, Endive and Succory, Sorrel, and sharp-pointed Dock, Purslane, Lettice, &c.

XXXIII. And Sennertus says, that this Disease more than any other, seems to require as it were variety, and an interchange of Remedies; and also certain ces∣sations and intermissions, from all sorts of Medicines: and then the same are to be used again afresh, and new ones are to be added; for that scarcely ever any one did recover of this Disease, that placed the hope of Cure in one only Preparation, tho' it were never so generous and prevalent.

XXXIV. Thus much for Inter∣nals: we now come to Topicks; among which Sennertus commends a Bath of fair Water, in which the Patient may sit up to the Neck for the space of one hour. But, says he, the Bath ought to be so temperate, that no Sweat may be caused, either in the Bath, or after the going out of it: for if any Sweat is caused, it is a sign that the Bath is hot∣ter than it ought to be.

XXXV. 'Tis true that many Physicians send their Patients to the Natural and Mineral Waters, and hot Baths; but because they dry vehemently, they many times do more hurt than good; especially at the beginning of the Disease, whilst the heat and driness are at highest.

XXXVI. And therefore a Bath of sweet fair Water is thought to be more proper and safe; because it tempers the driness, discusses the Excrements of the external habit, and looseneth the Skin: but it ought often to be re∣peated, even twice a day, and that for several Months toge∣ther.

XXXVII. And every time owning out of the Bath, the Skin ought to be anointed with some fat thing; as Vipers-grease, Man's-fat, Oil of Toads, Oil of Ben, &c. to keep the Skin soft and smooth: or a cooling Ointment may be made of the juices of Nightshade, Henbane, Hem∣lock, and Poppies, for the same purpose.

XXXVIII. Some commend the p•…•…der of the roots or leaves of ••ack 〈◊〉〈◊〉, as much as the quantity of a large grey Pea, or somewhat more, to be put into a new cut Issue, whether in the Arm, Shoulder, or any other pro∣per place; and to be kept there∣in for some considerable time, as the Artist shall see convenient; viz. 'till it causes a very great Tumor, and mighty Flux of Humors to drain through the same.

XXXIX. This Application is so powerful, that it needs not twice to be repeated; and it attracts the Humors so powerfully from all parts of the Body; and so plentifully, that no Salivation is comparable to it; nor yet any other kind of Evacuation, whether inward or outward: and being used in many other Diseases, it will never cease running, 'till all the Morbisick-matter is per∣fectly drawn away: for it com∣pleatly drains all evil, corrupt and malign Humors, from all parts of the whole intire Man.

XL. Places full of Scurf, Scales, and dry Scabs may in time of Bathing be often rubbed with common Soap, to loosen them, bring them off, and dry them: and the largest Scales, and such as stick fast, Wiseman rubs with the Caustick-stone; which did not only hasten their falling off, but also scowrs the Skin excel-

XLI. And where the bigger Scabs separate, there remains for the most part a discolouring, and little Excrescencies of Flesh, by which those Scabs were held so close on, as if they were nailed fast: these Excrescencies he rubbed off with the Caustick-Stone, and where there was

occasion, dressed the Parts with Ʋnguent. Tutiae, or Ointment of Litharge.

XLII. He also Bathes in warm Water, rubbing the Body with Balls of Wheat-bran and Soap; which he continues for several days, till the Body seems to be clear. Sometimes he Bathes in warm Water, wherein he dissolves a small quantity of corrosive Sublimate; and alternately uses Salivation for twenty or thirty days together, repeating the Salivation with Turpethum mi∣nerale and Ʋnguentum Neapolita∣num by turns, till the surface of the whole Body is cleansed of all its Defilements.

XLIII. From what hath been said it appears, that other Baths than that of fair Water may be used; as a Lixivium of Quick∣lime, Spiritus universalis made very weak, a Decoction of Flowers of Sulphur and Salt of Tartar in fair Water, a De∣coction of Hellebor-roots; a Solution of Saccharum Saturni, Nitre, or white Vitriol in fair Water; a Decoction of Tobacco, and the like.

XLIV. These things alter the Humors very much, and overcome the Malignity almost to a wonder: but because they dry vehe∣mently, therefore several Au∣thors speak much against them.

XLV. But there is no Argument against Experience. I know them to do good upon my own Expe∣rience; and there is nothing to be objected against them, but their great drying property: to remedy which, we prescribe: 1. To Bathe with these kinds of Baths one time, and then with simple fair Water another time; and so to use them alternately. 2. After bathing with them, to anoint all the whole Body with Oil of Ben, rubbing it very well in; or using some other sweet and cooling Oil, or Ointment.

CHAP. XXXIX. Of the ELEPHANTIASIS of a PART.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in La∣tin, Elephantia, vel Elephan∣tiasis Arabum; in English, The Elephantiasis of a Part.

II. Definition. It is a preter∣natural, irregular, and cancerous Tumor of the Feet; deforming them, and making them thick and bulky, not much unlike to Elephants Feet.

III. The Causes. It is said to be caused originally from Varices, and to arise from Melancholick and Phlegmatick Blood; or ra∣ther, the Recrements of the Bloody-juice, setling upon the depending Parts; as the Legs, Ancles, Feet.

IV. The Signs. Haly Abbas, in Theoric. lib. 8. cap. 18. saith, Ʋlcera quae in Pedibus & Cruri∣bus siunt, Elephas vocantur; & Elephanticus Morbus Apostema est Melancholicum, quod in Cruribus fit & Pedibus; & ejus si••num est, quòd Pedis figura Elephanti figurae similis sit: viz. Those Ulcers which arise in the Feet and Legs are called Elephas; and the Elephantick Disease is a Melancholy Tumor or Swel∣ling, arising in the Legs and Feet; and the sign thereof is this, that the shape or figure of the Foot, resembles the form of an Elephants Foot.

V. The Foot, or Leg, and some∣times both, become a very great irregular Tumor, and of an ex∣ceeding thickness: the Legs are tumid, and much swoln; very red sometimes, sometimes wan and livid, and sometimes black.

VI. And besides the irregula∣rity, this Tumor is sometimes full of little Tubercles, and dry Scabs; and sometimes it is abounding with Ulcers.

VII. And as to its magnitude, it is often so great and irregular, that not only the form of the Foot is lost, but also the Toes are so swallowed up and hidden, as they can scarcely, and sometimes not at all be seen.

VIII. This kind of Disease you may often behold in Beggers, by the High-ways, and corners of Streets; who get their Liveli∣hood, by begging in those publick and common places: I have often seen them as I have passed up and down Cheapside, London; lying in the passage, to move peoples charity, as they gazed on them.

IX. The Prognosticks. It is difficultly cured without a long and continued course of Physick; and if it once becomes invete∣rate, it is for the most incura∣ble: because that from all parts of the Body, abundance of Humors are protruded, and thrust down thither.

X. The Cure. It is done by a long and continued evacuation of the Morbifick-matter, with those things we have before men∣tioned in the Cure of an Ele∣phantiasis Graecorum, in the for∣mer Chapter.

XI. For unless those vitious Humors be often evacuated, and emptied forth of the Body; and the evil disposition of the Bowels (from whence those Humors are supplied) be cor∣rected and amended, there can be no hopes of a Cure.

XII. The sum therefore of the Cure, consists in a long and conti∣nual course of Physick, as is pro∣per for so contumacious and rebel∣lious an Affect, and a perpetual evacuation of the Morbifick-matter; which can best be done with a course of Salivating only, and oft to be repeated at due intervals of time.

XIII. During the doing of which, the growth and increase of the Tumor is to be prevented, by Medicaments partly astrin∣gent and drying, and partly by Discussives and Resolvers, alternately used.

XIV. Of which kind are, Bawm, Camomil, Elder-leaves, Fennel; roots of round Birth∣wort,

Orrice; Gums, as Ammo∣niacum, Bdellium, Galbanum, Opopanax, Sagapenum, a Ca∣taplasm of green Tobacco-leaves raised from Virginia-Seed, which is an admirable thing; an Amal∣gama of Saturn and Mercury, or Jupiter and Mercury, &c.

XV. Amongst Compounds, there are Forestus his Cerate of Ammo∣niacum, Mynsicht his Emplastrum de Galbano crocatum, Vigo his Emplastr. de Ranis with a four∣fold quantity of Mercury, a Plate of Lead besmeared with Quicksilver, Ʋng. Nicotianae, Cosmeticum, ad Scabiem & Mercuriale, Empl. ad Strumam, & Mercuriale, with many others of like kind.

XVI. To these things, add proper Baths, and often Bathing; according to the Directions which we have given in the former Chapter; which are in∣deed not only often, but for a long time to be repeated.

XVII. But if the Disease is so inveterate, as to be fixed and con∣firmed in the Part, as to be out of all hopes of Cure, you have nothing more to do, but constantly to apply palliative Remedies to the end of the Patient's life: unless he will admit of that last and absolute means, to wit, Amputation; which at once frees him from his Disease, and continued trouble together.

VII. TƲMORS, Ex Partium decidentia.

CHAP. XL. Of RƲPTƲRES.

I. IT is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Ramex, Ruptura, Hernia; and in English, a Rupture, or Bursteness.

II. The Kinds. The general kinds are three: viz. 1. Proper. 2. Common. 3. Remote: as we have declared in Lib. 1. Cap. 8. aforegoing, of this Book.

III. The Proper are three∣fold: 1. Hernia Intestinalis: 2. Hernia Inguinalis: 3. Hernia Omentalis. The Common are sevenfold: 1. Hernia Humora∣lis: 2. Hernia Seminalis, or Hernia Vasis deferentis: 3. Her∣nia Carnosa: 4. Hernia Vari∣cosa: 5. Hernia Ventosa: 6. Her∣nia Aquosa. The Remote, are

threefold; 1. Hernia Ʋmbilica∣lis. 2. Hernia Ʋterina. 3. Her∣nia Gutturalis.

IV. Of the Proper, the Hernia Intestinalis is already treated of, both in Our Synopsis Medicinae, lib. 5. cap. 14. and in general terms, in this present Work, in lib. 1. cap. 8. of the common we have already handled; the Hernia Carnosa and Hernia Vari∣cosa, in our said Synopsis, lib. 5. cap. 17. a Hernia Ventosa, in lib. 5. cap. 15. of the said Book, and in cap. 29. afore∣going of this present Work; a Hernia Aquosa, in lib. 5. cap. 16. of the said Synopsis, and in cap. 30. of this Book also; of the Remote, we have also handled; a Hernia Ʋmbili∣calis, in Synopsis Medicinae, lib. 5. cap. 18. a Hernia Ʋterina, in lib. 5. cap. 72. of the same; and 1 Hernia Gutturalis, in cap. 26. foregoing, of this third Book of Our Chirurgery.

V. But in regard we have been very brief in our Discourses of the Hernia Intestinalis, and Umbili∣calis in the places afore cited; and something is wanting in our treating of a Hernia Carnosa, we shall in this present Chapter re∣sume the same again, supplying that here, which was defective there; and withal we shall now, treat of those other Hernia's of which in no other place, in any of our Works, we have said any thing at all; tho' they fall not so properly under the title of this Chapter.

VI. The thread then of the Discourse of this Chapter, will be concerning, 1. A Hernia Inte∣stinalis. 2. A Hernia Inguina∣lis. 3. A Hernia Omentalis. 4. A Hernia Humoralis. 5. A Hernia Seminalis, or Hernia Va∣sis deferentis. 6. A Hernia Car∣nosa. 7. And a Hernia Ʋmbi∣licalis: of all which in order.

I. Hernia Intestinalis.

VII. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in La∣tin, Enterocele, Oscheocele, Hernia Intestinalis, Hernia in Scroto, Hernia Peritonaei; in English, a Rupture of the Peri∣tonaeum, wherein the Guts fall into the Cods.

VIII. It is either perfect, when the Guts fall quite into the Scro∣tum; or imperfect, when they fall down but part of the way, and this latter is called only a Relaxation.

IX. The Peritonaeum is the Membrane that is either broken or relaxed, and lines all the inside of the Abdominal Muscles; then passing to the Back, does there involve, and give Coats to the Viscera: it is strong, and every where double; in the duplica∣tures of which, all the Viscera are hid, and thro' which all the Vessels do pass.

X. The lower part of it is the strongest, to enable the Belly the better to bear the weight of the Intestines: and being every where double, admits not of a perfora∣tion, for the transmission of the Seminal-vessels; but does so re∣ceive them between its Coats, as that passing between the first Coat, leaves it every where intire, even both at Navel and Groin: in which latter place, the Seminals do take the outer Coat of the

Peritonaeum along with them; which containing them in it self, does at length make that Tu∣nicle which involves the Testi∣cle, and is called Elytroïdes, or Tunica vaginalis.

XI. Here then, if the inward Lamina, or Coat is strong, it keeps the Guts and Humors with∣in the capacity of the Abdomen; so that tho' it is full of Water, yet it transmits none into the Scrotum: for the watery Tu∣mors of the Cods in Hydropical persons are generally Anasar∣cous; as coming outwardly into the Membranes of the Scrotum, and not passing from the cavity of the Abdomen thither.

XII. But if this inward La∣mina or Coat is thro' force, or any weakness broken or relaxt; then the Intrails are protruded to the Scrotum; and if broken in the top of the Process, the Bowels fall down into the lower parts of the Cod: but if the said top of the Process suffers only a relaxation, then the Mem∣brane being extended contains the Guts, and that membranous Partition that lies between the Guts and Scrotum, is visible.

XIII. The Causes. In Chil∣dren it may proceed from much crudity or moisture, vehement cry∣ing, strugling, and holding their Breath too strongly.

XIV. In elder persons it is caused from violent Exercise, jumping, leaping, vaulting, falling from a high place, blows, carrying great burthens, hard riding, vomiting, straining at stool, or exceeding great weight of the Bowels in fat People.

XV. The Signs. If the Peri∣tonaeum is broken, it is known by the sudden rise of the Tumor; whether made by blow, fall, overstraining, and the like; in which case, the Guts slide down into the Scrotum, or lye in a great Tumor in the Groin.

XVI. If it is caused by a blow or fall, Blood is sometimes extra∣vasated, and the Tumor is pain∣ful, whether in the Groin or Cods, and it soon falls from the Groin to the Cods; where, by laying your Hand upon the pro∣duction of the Peritonaeum, just at its going forth from the Abdomen; and withal causing the Patient to sneeze or cough; you may distinguish it from a Sarcoma, or Hernia carnosa, by perceiving the motion of the Gut, when it is there.

XVII. The Prognosticks. In young Children it is easily cured, if carefully managed; but in youths, with more difficulty: if under twenty, or while growing, they are curable, tho' the Guts are fallen down into the Cods.

XVIII. In people of full growth, the edges of the Peritonaeum sel∣dom or never unite, because they many times grow callous: and if the Gut is not speedily reduced, grievous pain succeeds, with Colick and Fever, because of the detention of Excrements; from whence many times comes inflammation, vomiting of Ex∣crements, yea sometimes Gan∣grene, and Death it self.

XIX. If the Rupture is very large, the Guts many times do their duty, as safely in the Scrotum, as if they were in their

true and natural places in the cavity of the Abdomen.

XX. If it is only a relaxa∣tion of the Peritonaeum, as it is least dangerous, so it is the easiest cured of them all.

XXI. If a Hernia Intestinalis be neglected in Women-kind, it will make a round Tumor near the Pudenda.

XXII. The Cure. In the first place, you must cause the Patient to lye upon his Back, and en∣deavour the reduction of the Gut; let his Head be declining, and his Hips raised high, causing his Heels to be drawn up to them.

XXIII. Then with your Hands, and warm Cloths, try to reduce it, by pressing moderately and gra∣dually upon it; but taking care withal, that you do not hurt or bruise the Testicle.

XXIV. If it will not yield to these, there being a repletion of hard Excrements, you must give Clysters of fat Broth, with much Salt; or Posset-drink lbi. with brown Sugar ℥iv. or the ordinary Turpentine-Clyster: or this; I•• Fat Broth lbi. brown Sugar ℥ii Aloes ʒi. mix and dissolve, and exhibit it warm; which repeat, till the Bowels are em∣ptied.

XXV. In the mean season, foment the Scrotum with a De∣coction of Camomil in Whitewine, applying hot Stuphs dipt in, and s•…•…eezed out of the Liquor; for some considerable time: and if the Excrements seem to be hardned therein, soften it, by applying after the Fomenta∣tion some emollient Cata∣plasm, made of Figs, Onions, Lilly roots, and Mithridate.

XXVI. The Guts being thus emptied, let them be reduced as before directed; and apply over the Part, Emplast. ad Herniam, or Our Empl. of an Ox-gall: Or this; ℞ Loadstone in fine pouder, Aloes, Dragons-blood, Bole Armo∣niack, Terra sigillata, Crocus Martis astringens, Mastich, Oli∣banum, Sarcocolla, Frankincense, A. ℥ss. Ox-galls evaporated to the consistence of an Extract, Tur∣pentine, Wax, A. q.s. make an Emplaster; which apply, and renew it, when you find it will stick no longer.

XXVII. Then bind up the Part with a Bag-truss, made with Bol∣sters stuft with Cotton, and fitted with a steel Spring to keep the Bowels up, and all things close and firm. Or the Bolsters may be be fixed with steel Plates, having Worms and Screws therein; by which the Bolsters may be made to sit closer, or or more distant; and keep the Gut up, without pressing upon the Spermatick-vessels, or Os Pubis: and these may also be useful in an old Rupture, and where the hopes of Cure are vanished.

XXVIII. Where the Rupture is very large, thro' the often fal∣ling down of the Bowels, a Bag∣truss is to be proportioned, with a hole for the Penis to pass through; which is to be put on whilst the Patient is in Bed, and in a declining posture: by which means the falling down of the Bowels will be much hindred, and the Patient much eased in his going abroad; and if he

is young and growing, may be in the possibility of getting a Cure.

XXIX. Rest is of exceeding great advantage to the Sick; and therefore the Patient is required to keep his Bed 40 or 60 days: for by this means great Ruptures have been cured, to which all other means had been applied in vain, and the Patient ac∣counted as desperate.

XXX. And if the Patient has any need to sneeze, or cough; and upon going to stool, or any other violent motion, he ought to feel, and lay his Hand hard upon the place affected; that if there should be any danger of a Prolapse, or Relapse, it may thereby be prevented.

XXXI. As for Internals, and the remaining part of the Cure, we refer you to Lib. 1. Cap. 8. of this Book; and to the third Edition of Our Synopsis Medi∣cinae, lib. 5. cap. 14. afore∣mentioned, where you may have abundant satisfaction: tho' after all, it is my belief that rest, lying in bed, and a good Truss contribute more to the Cure, than all other things in the World, whether inwardly given, or outwardly applied.

XXXII. For things inwardly given can never come to the Part, but pass with the Ordure thro' the Bowels, without making any stay there: unless the virtue of the Specifick, by mixing it self with the Chylous Juice, and so joining with the Blood, does by circu∣lation approach thereto, when it is consign'd for the nourish∣ment of the Part. Which Con∣sideration, in my opinion, signi∣fies not much to the Cure; but only makes the Bloody and Nutritious Juices somewhat more consolidative and agglutinating.

XXXIII. Nor can things out∣wardly applied come directly to the Part hurt, any more than the other; there being the Scarf∣skin, Skin, Flesh, Membranes, &c. between, and interposing be∣tween the substance of the Agglutinatives and the Rupture it self.

XXXIV. If the Compress or Bolster sits uneasy, let a Quilt be made to lye under it, or brown Paper doubled, and soaked in Smiths Forge-water, wherein some Astringents have been boiled; by which the Truss will sit the easier, and the better retain the torn or relaxed parts to∣gether, for their more speedy agglutination.

XXXV. But if the Gut by reason of its long prolapsion, and the Excrements being hardned therein, cannot be reduced by the methods before prescribed; let the Patient be put into a half Bath, keeping on the Bag-truss the while: after which, coming out of the Bath let him be set on his Head, or carried with his Head downwards; by which means many times the pro∣lapsed Bowels are often re∣duced.

XXXVI. But if yet all endea∣vours should prove ineffectual, and the Patients Life is in apparent danger; which is manifest by manifold Vomitings, Sickness at Stomach, Inflation of the Belly, thro' the Patient's not going to

stool; it is better doubtless then to lay open the Production, whilst there is strength; than to let the miserable Patient perish under the force of his Disease: since the Operation may be done without any matter of difficulty or danger.

XXXVII. The way of doing it is thus. Lay the Patient flat on his Back, on a Table or Form, and bind him thereon; then make incision upon the upper part of the Scrotum, to the Production of the Peritonaeum; which must also be divided, without touching the Guts or Omentum: then pass in a Cannula, like the common Director, but as large as a Goose-quill, which put into the cavity under the Process of the Peri∣toneum upwards, avoiding the Guts: then make an incision of such a length as may be sufficient to put your Fingers into the Scrotum, and raise the Intestines and Omentum, which then reduce into their natural places within the cavity of the Abdomen.

XXXVIII. The Bowels being thus reduced, you must stitch up the Wound, as in a Wound of the Abdo∣men, taking up with your Needle so much of the Production as may shut up the Cavity, and hinder the falling down again of the Bowels. This done, you must Cure the Wound, as we shall hereafter shew in Lib. 4. fol∣lowing, where we treat of Wounds of the Belly; this being not so large or dangerous, as many of them are.

XXXIX. There are many other ways of doing this Operation, two of which are by Incision; the first of which divides the length of the Process, laying the Seminal Vessels bare: the other is Castra∣tion. There is another way, which is by Puncture, taught by Paraeus; and two other ways also, the one by the Actual Cautery, the other by the Potential: but as they are all of difficult performance, with much hazard, and great cruelty; so we never meet with a Patient which will submit to any of those ways of Cure; for which reason sake, we here totally omit them.

II. Hernia Inguinalis.

XL. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Bubono∣cele, and Hernia Inguinalis; in English, A Rupture in the Groin.

XLI. This is also either perfect, when the Peritonaeum or Rim as they call it, is absolutely broken: or imperfect, when it is only stretched or extended.

XLII. It is a Tumor in the Groin, either of the Guts, or of the Omentum: the latter of which we shall speak of under the next Head.

XLIII. The Causes. The Pro∣catartick or remote Causes, are violent Exercises, falls from high places, blows, stroaks, leaping, wrestling, riding hard, crying, vomiting, coughing, &c.

XLIV. The Antecedent Causes, are viscous and flatulent Humors, in great abundance, with a great repletion of the Belly.

XLV. The Cause in Women, is

many times a dilatation of the Membrane in Travel; or because of a transition of the Ligamenta Ʋteri teretia, which pass be∣tween the Laminae or duplica∣ture of the Peritonaeum, after the same manner as the Seminal Vessels do in Men.

XLVI. The Signs. If there is a Rupture of the Peritonaeum, the Tumor is the greater, more difficult to be reduced; and in the reduction, you may many times hear a little kind of noise.

XLVII. But if it is only re∣laxed or extended, it is known by the smalness of the Swelling, and its more easy reduction with the Fingers.

XLVIII. The Prognosticks. Where it is broken, it is of dif∣ficult cure; Children and growing people may be cured; Old people never.

XLIX. If the Rupture is large, and the Intestines come much forth, and has been long unreduced; being filled either with Wind, or hardned Excrements, or both, the reduction will be difficult and painful, and sometimes hazardous to the Life of the Patient.

L. The relaxed Membrane is much more easily cured; as we hinted in the same case, in a Rupture in Scroto.

LI. The Cure. First use Fo∣mentations, emollient and discu∣tient Cataplasms; and then strive to reduce it with your Fingers.

LII. After which, apply a Catagmatick, or an Astringent or Agglutinative Emplaster; which keep close to it, with either a Whale-bone, or Steel Truss, made with fit Bolsters for the compression of the Tumor; as is taught in the foregoing Discourse.

LIII. Inwardly give Vulnera∣ries, and strong Agglutinatives; and let the Patient rest, and be quiet, keeping his bed for 40 or 50 days; performing the rest of the Cure exactly as in an Oscheocele, before described.

III. Hernia Omentalis.

LIV. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Epi∣plocele, Hernia Zirbalis, and Hernia Omentalis; in English, A Rupture of the Peritonaeum, wherein the Omentum or Caul breaks forth.

LV. This is twofold; 1. Into the Groin. 2. Into the Cods: and these are both of them either a compleat Rupture of the Membrane, or a relaxation of the same.

LVI. The Causes are the same with the Hernia Intestinalis; whether it is Oscheocele or Bubo∣nocele.

LVII. The Signs. It is known by its softness, inequality, and slip∣periness of the Tumor: it is also of a continued bigness, whe∣ther the Patient is full or empty.

LVIII. The Prognosticks. It is not dangerous: yet by reason of its softness and slipperiness, it is, after reducing, difficultly retained within it, proper place; but in Children, it is of easy cure.

LIX. And it is more easily cured in such Bodies whose Habits are humid and sanguine, than in such as are dry and melancholick: but if the Tumor is small and recent, and only in the Groin, the Cure is not difficult, be the Habit of the Body what it will.

LX. The Cure. Whether it is in the Cod or in the Groin, the Method of Cure is exactly the same with the Hernia Intestinalis, and Hernia Inguinalis aforegoing: Rest, Lying-abed, and a good Truss being the chief: so that no more need be said here.

IV. Hernia Humoralis.

LXI. It is called Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Hernia humoralis; in English, An Humoral Tumor of the Cods.

LXII. Concerning this Tu∣mor, Sennertus, Med. Pract. lib. 3. par. 9. sect. 1. cap. 7. hath these words: Recentiores hîc adhuc unam Herniae speciem addunt, quam Humoralem vocant, eámque ab omnibus Humoribus, exceptâ Bile, provenire statuunt. Verùm si à Sanguine sit hic Tumor, & quidem cum Inflammatione, per∣tin••t ad Inflammationem Scroti & Testium, de qua supra dictum: viz. Modern Physicians (says he) do here to these add one other species of a Hernia, which they call a Humoral Hernia; and make the same to proceed from all Humors, Choler only excepted. Now if this Tumor proceeds from Blood, with In∣flammation, it is a Phlegmon of the Cods and Testicles; of which before.

LXIII. From this of Senner∣tus it appears, that a Hernia humoralis is nothing more nor less, but a Phlegmon of the Cods and Testicles; which may be either simple, or an Oedemato∣des, if Phlegm is mixed with it.

LXIV. The Causes. These are the same with other Phlegmons, of which we have treated at large in Chap. 5. aforegoing of this Book.

LXV. The Signs. It is known by the Tumor, Colour, Heat, Pain; and other Symptoms of an Inflammation.

LXVI. The Prognosticks. It is a Disease long in curing, the Part being cold and membranous; sometimes it discusses and re∣solves, sometimes it comes to Suppuration; if it continues long, it is of dangerous con∣sequence, for it corrupts the Testicle.

LXVII. Cure. First, the Cure is to be attempted by Discussives and Resolutives; and then gentle Purging, with Bleeding, ought to be administred: the Sick may also be purged by proper Clysters, which are often to be repeated: a Vomit with Turpe∣thum minerale, is good.

LXVIII. And in this Cure, as in the other Hernia's, Rest, with lying in Bed, are material Expe∣dients; together with a Bag-Truss to hold up the Testicles, and such other Medicaments as the nature and accidents of the Tumor require.

LXiX. But if you find it will not discuss nor resolve, you must change the Applications, and use 〈◊〉〈◊〉 things as will promote the

Suppuration; then make incision in the side of the Cod, after cleanse the Ulcer, and consoli∣date the Wound, exactly as we have taught in the Cure of a Phlegmon: so that nothing more need be said of that mat∣ter in this place.

LXX. If afterwards there remains a hardness, you must resolve it by Discussives and Emol∣lients; as Avicen advises: ℞ Crums of houshold-wheaten Bread, boil them in Oxymel, and add a sixth part of Gum Ammonia∣cum; which mix, and boil to the thickness of a Cataplasm: apply it warm, and remove it twice every day.

V. Hernia Seminalis.

LXXI. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Spermatocele, Hernia Vasis deferentis, Hernia Seminalis; and in English, A Tumor of the Cods, proceeding from an Afflux of the Seed.

LXXII. The Kinds. It is twofold: 1. Spermatocele, or Hernia Vasis deferentis; when the Vas deferens falls twisted into the Scrotum. 2. When there is a great afflux of the Seed to the Testicles, in persons abounding with that Humor.

LXXIII. The Causes. The Procatartick Cause, is high Feeding of things greatly nourishing, Idle∣ness, and Dalliance. The Ante∣cedent Cause, is Seed not being timely or sufficiently evacuated. And the Conjoined Cause, is Seed contained in, and dis∣tending the the Vas deferens, and other Seminal Vessels.

LXXIV. The Signs. It is known, by feeling where the Vas deferens is fallen into the Cod; in the latter case, it is more difficult to know: the person is at first extream∣ly lecherous, and desirous of Coition.

LXXV. But that failing, the Testicles begin to swell, and the Tumor gradually increases, with a dull kind of pain, and heaviness of the Cods: this still increasing, puts the Patient to a trouble in going.

LXXVI. And as the Tumor increase, the pain increases. At the first, the Scrotum is lank, and one Testicle feels tumified and swell'd: and tho' possibly, both Testicles may be swell'd in this Disease, yet the Affect seldom seizes more than one Stone; which is for the most part the left, but sometimes the right only.

LXXVII. And if no stop be put to the Disease, the Cods grow to an incredible bigness. I once saw a Hernia Seminalis, which was bigger than any Ostriches Egg, as big as little Child's Head; which being opened by Incision, it discharged nearly a quart of Seed, or some other thin Hu∣mor, not much unlike whites of Eggs.

LXXVIII. The Prognosticks. It is of difficult cure, unless recent: but if inveterate, and the Tumor is very great, it is cured with much trouble and pains, and seldom without Section.

LXXIX. Where the Disease has been of long standing, tho' the

Patient meets with a Cure, yet it leaves the Part so weak, that it is apt to return again; unless great care is taken in pre∣venting it.

LXXX. The Cure. If it is from the Vas deferens falling down twisted into the Cod: let the Patient lye backwards, and with your Hands you will easily re∣duce it, without any farther inconvenience in it.

LXXXI. The Method of Curing hath nothing peculiar in it self; but you must contrive such Bands, as may keep reduced the faln down Parts, in their right places, without hurting the sound ones.

LXXXII. But in this, as in an Enterocele, Rest, keeping Bed for some time, and a strait Bag-truss, are of essential moment.

LXXXIII. If it is in the latter case, whilst it is recent, if the Man be unmarried, Mar∣riage ought to be proposed; because that effectually takes away the Conjoined Cause.

LXXXIV. Then due Purging, both upwards and downwards; and to be reiterated every day, or every other day many times, according to the strength of the Patient, 'till there is an apparent diminution of the Tumor.

LXXXV. You may Vomit with Vinum benedictum, or Tartar emetick; but nothing is equal in this case to Turpethum mine∣rale, which is to be often repeated: afterwards, or between whiles, let the Patient purge with Catharticks, which evacuate the Pituitous Humor.

LXXXVI. And outwardly, Dis∣cussives and Resolutives are to be applied: but this only while the Disease is recent, and the Tu∣mor small, together with rest and ease, and a strait Bag-truss.

LXXXVII. But if the Tumor is grown so great, as that none of the other things will have any effect, there will be then a necessity of doing the Work by Section; thereby to discharge the Part of the abounding Humor, as in the Case before mentioned we have declared: afterwards the afore∣going Methods must be pursued, and the Wound healed up, as before declared.

LXXXVIII. But it ought not to 〈◊〉〈◊〉 perfectly healed up, but a 〈◊〉〈◊〉 is to be left in the bottom of•• the Scrotum; which is to be k•…•…pt open either with a Can∣nula, or a Tent, for some consi∣derable time; 'till the ultimate of the Matter is drawn forth, and the Testicle, and whole Part, seem to be restored to their due form and strength: other∣wise a Relapse is to be feared, and then the work will be to be done over again.

VI. Hernia Carnosa.

LXXXIX. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Sarcocele, Ramex carnosus, Hernia car∣nosa; and in English, A Fleshy Rupture of the Cods.

XC. Definition. It is a Sar∣coma, or lump of Flesh growing to, or round about the Testicle; which in outward appearance is hard, and many times of a Scirrhous nature or disposition.

XCI. The Causes. It is caused from a Rupture of some of the Capillary Vessels of the Part, by which Blood flows more than ordi∣narily to the Testicles and Cods; which not being protruded in to the Capillary Mouths of the Veins, is by the Plastick-power converted into the substance of the Flesh.

XCII. The Signs. Tho' it is possible to affect both Testicles, yet it commonly seizes but one, and that, Authors will have to be the right; because Nature does more easily cast out the Blood to it, by the Seminal Vein, springing from the Vena Cava.

XCIII. It grows by little and little, the Testicle growing every where greater; and is known by a hard Swelling, which may be felt with the Fingers; sometimes with a little pain, but many times without any pain at all, espe∣cially if it is Scirrhous.

XCIV. It is distinguished from a Rupture of the Peritonaeum, or Guts; because in this, there is no swelling in the Groin, as there is always in that.

XCV. The Prognosticks. It is of difficult cure, tho' it be recent; but uncurable, if inveterate; unless it be done by Section.

XCVI. If it has been indeed of long continuance, and grown very great; it is apt to degenerate into a Scirrhus, or Cancer; ac∣cording to the habit of the Body, and disposition of the Humor abounding.

XCVII. The Differences. It is twofold: 1. One, in which the Sarcoma, or fleshy substance sticks close to the Testicle, and cannot be separated, without taking away Testicle and all. 2. Another, in which the Sarcoma compleatly involves the Testicles; but is round about loose from it, so that it may be separated and cut off, without any hurt to the Stone it self.

XCVIII. The Cure. While it is recent and very young, the Patient is to Purge often, and also Vomit; which is more espe∣cially performed by Turpethum minerale, which is indeed ac∣counted as a Specifick in this case: afterwards, pouder of Restharrow-roots, and Opiates are to be given every night.

XCIX. And outwardly, things repercussive and drying are to be applied; or Empl. de Ranis, with a fourfold quantity of Mer∣cury, or our Empl. Mercuriale.

C. Anointing with Mercurial Ointments also is good, over which you may apply Ceratum de Galbano, Ceratum nigrum, Ceratum de Spermate Ceti, or Ceratum ad Tophos, which ex∣ceeds them all.

CI. And besides these, the Emplastrum Mercuriale before mentioned, Our Empl. ad Stru∣mam, and Empl. Arthriticum, we commend upon our own experience; also Our Diachylon with Gums, where it is but just begun.

CII. Add to all these things, a Bag-truss, which may tye up the Testicle very straight; rest also, and lying in bed for 6 or 7 Weeks, without which, nothing at all will be done.

CIII. But when it is manifest,

that no Physical means, whether internal or external will do, you must then positively attempt the Cure by Manual Operation: and in doing this, you must consider whether the Sarcoma is fixed to the Testicle, or hangs loose from it.

CIV. If the fleshy substance is fixed fast to the Testicle, so as it cannot be separated, 'tis certain, that if you design a Cure, you must come forthwith to Castration; (those other courses with Esca∣roticks, being both painful, troublesom, and dangerous) the Method of which we have plainly taught in the third Edition of Our Synopsis Medi∣cinae, lib. 5. cap. 17. sect. 18, 19, 20.

CV. But if the Sarcoma be free from the Testicle, and the Testicle hangs loose in it, (as for the most part it does) then having opened the Testicle longways, you must gently draw forth the Sar∣coma, with the Stone it self: and with a very sharp Knife you must carefully make inci∣sion through the fleshy sub∣stance; but with this caution, that you do not in the least touch the Testicle it self.

CVI. This done, with your Fingers turn out the Testicle; and cut the Sarcoma, slitting it upwards, (on the same side you made the Incision) as high as you can: then holding the Testicle upwards, (which is to be done by an Assistant) let the Artist take all the Sarcoma into his left Hand underneath, and draw it forth as far as he can conve∣niently; and he will find the whole substance to hang upon a kind of Membrane, from which he may separate the Sarcoma, by an Incision-knife in his right Hand, at one single cut: then replacing the Testicle, he may heal it up as an ordinary Wound.

CVII. A Cure of this kind was done upon a Patient of mine, about three or four years since: it was a Frenchman who did the Ope∣ration; and tho' the Patient de∣spaired of his Life, the French Chirurgeon did it with such an assurance, that in about three minutes of time the Section was compleated, and not with the loss of two ounces of Blood, nor did the Man himself at all cry out: after which, the Wound was healed in about a weeks time, and the Patient restored to his perfect health. Where note, the Sarcoma here cut out, weighed four pounds and a half, good weight.

VII. Hernia Ʋmbilicalis.

CVIII. It is called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Om∣phalocele, & Hernia Umbilica∣lis; in English, A Rupture of the Navel.

CIX. It is a breach of the Peritonaeum by the Navel, by which the Intestines or Omentum, are thrust forth.

CX. The Cause. The Proca∣tartick Cause is external violence, falls, blows, coughing, crying, great straining at stool, vomiting, or otherwise, &c. The Antece∣dent Cause, is a weakness of that part of the Membrane.

And the Conjoined Cause, is the Rupture or Breach it self.

CXI. The Kinds. It is two∣fold: 1. That in which the Intestines themselves strut forth. 2. That in which the Omentum or Caul is protruded.

CXII. The Signs. It is known by the diversity of the Matter therein: if the Intestine come forth, the Tumor is soft, une∣qual, and is put back into the capacity of the Abdomen, with some noise or rumbling.

CXIII. But if it is the Omen∣tum faln into it, the Tumor is soft, and of the same colour with the rest of the Skin.

CXIV. The Prognosticks. If it is recent, and in growing People, it is more easily cured: but if it is in elder people, and inve∣terate, it is either incurable, or with much difficulty.

CXV. If it is only distended, not broken, the Cure is the more easy: but if it is broken, and the Rupture large, it will be the more hard to heal.

CXVI. The Cure. Let the Patient abstain from all violent Exercises; rest, and for some time lye in bed; as also forbear all flatulent Meats and Drinks, or Fruits which engender Wind.

CXVII. Then the Sick being laid upon their Back, make a reduction of the Protrusion; and apply over it Emplast. ad Her∣niam, Catagmaticum, or some other glutinative or astringent Medicine, with a good Truss, Bolsters, and Bandage.

CXVIII. If these things do 〈◊〉〈◊〉, but the Sick seems to be uncurable, unless it be done by Manual Operation; we will here shew you the Method of doing it, according to Celsus; by Chirurgery, or Manual Ope∣ration.

CXIX. Lay the Patient upon his Back, that the Intestine, or Omentum protruded, may be put back again: then take hold of the Navel with a pair of Pincers, and draw it forwards; then pass quite through it at the Basis a Needle with two single Silk-Threds uncoloured; after which cut off the Thred by the Needles-eye, and tying the ends together, bind the root of the Navel lifted up, or pulled forwards, very strongly; that the part of it above the Ligature may dye, and fall away.

CXX. But Fabricius ab Aqua∣pendente, likes not so well of the former unpleasing Opera∣tion; and proposes therefore to do it rather with a Truss, which he hath often proved; applying a Glutinative Emplaster, or binding Cerate spread upon Leather. This Truss was made of double Di∣mity, or Linnen-cloth: on the part of which that covers the Navel, was a caveous Plate made like to a round Cake; in the center of which was a little round knob of Lint, which goes into the breach or dilatation of the Navel; to hinder the protruding Matter from coming forth again; upon which knob of Lint was placed the aforementioned Cerate: the Truss was then applied, and the Abdomen bound strait e∣nough: from the Truss, went

Bands to pass over the Shoul∣ders, to hinder it from falling down; and Straps on the lower part of it, to go underneath the Cods, to keep it from rising up.

CXXI. An Observation. One thirty years old, and of a fat gross Body, had a Hernia Um∣bilicalis, the bigness or breadth of the palm of a Hand: he had worn the common Navel-trusses, which sat not steady, but pinched him there, nor kept up the Rupture; his Belly being very great, and likely to suffer a greater Rupture, if the weight of it was not timely born up. He had a Bracer made, to lace in his whole Belly; under which a Bolster might be placed on the Navel; it reached from the Pubes to the Cartilago ensiformis, and laced behind: under this Empl. ad Herniam was put, with a quilted Bolster, wrought upon Sole-leather, which was tackt to the Bracer. Wiseman.

CXXII. One of a full Body who had a Hernia Umbilicalis, thro' a defect in Bandage had it much increased, with excoriation of the Skin; the Rupture in the Perito∣naeum was great, and the Omen∣tum and Guts had made their way to the external Skin of the Abdo∣men, which was worn very thin. The Excoriation was drest with Ʋng. Tutiae, &c. and a soft Compress applied between the Quilt and Emplaster; and a Belly-piece was made, to bear the weight, and retain the com∣pression. Afterwards a Bracer was made with a Bolster, to sit under the Belly-piece, which retained the Rupture; and the Paient went daily abroad. Wise∣man. See more of this matter, in Lib. 1. cap. 8. sect. 35, ad 39. aforegoing, of this Work.

EXPLICIT LIBER TERTIƲS.