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 ...

X. Sinuous Ʋlcers.

XXXVII. Sometimes after the Separation of the Escar, the Ʋlcer becomes Sinuous, especially after a great afflux of Humors; and where Bandage cannot be used to preserve the Tone of the Parts, as in the upper Parts of the Thigh and Hip, &c. or from the large∣ness of the Wound, Contusion of the Flesh, &c. or Laceration of Parts, whereby there is a great loss of Substance, and an Acrid Matter, inducing such a like Ulcer.

XXXVIII. Sometimes also it becomes Sinuous from a Cacochy∣mical or Scorbutick habit of Body, or may be induced from Lues Venerea being joined with it; in which Cases, you will scarce∣ly ever Cure the Patient, with∣out exhibiting Antifcorbaticks or Antivenereals, &c.

XXXIX. If the Wound is in∣flicted on the higher part of a Mem∣ber, whereby the Pus cannot dis∣charge it self, but may be apt to lye and create a Sinus, you must perforate it thro' the bottom, ei∣ther with a Syringotomus, or with a Seton-Needle, retaining a

twisted Thread or Silk in the Ulcer, till the lower Orifice is digested, and then drawing out the Silk, to keep it open by a Tent for some time, 'till the upper part is healed; and then as the Matter diminishes its flow∣ing out of the depending Ori∣fice, the Tents may at length be removed, and the Wound heal∣ed up.

XL. But to prevent Sinuosi∣ties, you will do well to enlarge the Orifice at first, and to keep it so wide open, that the Pus may have a free passage out; which if it cannot be by the way the Bul∣let went in, you must then con∣sider so as to find out the best place to open it, so as it may be discharged, as we have before directed.

XLI. But before you do this, it would be also well to consider, whether it cannot be done without such an Apertion; as by altering the position of the Part, Com∣pression, Bandage, hollow Tents, &c. and therefore you must endeavour by Stuphs, Sponges, Compresses, and good Bandage to force out the Matter, that the hollow sides may ag∣glutinate.

XLII. These Stuphs, Sponges, &c. may be dipt and wrung out of an Infusion or Decoction of Baiau∣stians, red Roses, Sumach, Pom∣granate-peels and Catechu, made in red Wine, and that the Mat∣ter may the better discharge between whiles, you ought to dress it the oftner.

XLIII. And Injections are to be made with a Decoction or Infusion of Roots of round Birthwort, Flo∣rentine, Orrice, of Zedoary, Ca∣techu, Aloes, Myrrh, Sarcocolla, and Allum in Aqua Calcis, to which Spirit of Wine and Ho∣ney of Roses may be added.

XLIV. If the Orifice is small, and the Sinus lyes shallow, as un∣der the Skin, and in a place where it may be safely opened; you may widen it with Crepitus Lupi, Gentian-roots, Elder Pith, or prepared Sponge, and after∣wards cut it open with a pair of Probe-Scissars, or with an Inci∣sion-knife, the Director being placed within; or you may lay it open by a Caustick.

XLV. The Sinus being thus di∣vided or opened, you may digest it with Turpentine mixed with yolks of Eggs; or cleanse with some proper Abstersive, variety of which you may see when we come to Treat of Ulcers in General: Af∣terwards Sarcoticks are to be used, which that they may be made the more drying, Pouders of Frankincense, Myrrh, Rosin, and Orrice-roots with Honey, may be added.

XLVI. If the Sinus runs trans∣verse Arteries, Veins, Nerves, Tendons, &c. the best way will be to make the position of the Part, so as its Orifice may be depending, (for Cutting will there be dange∣rous) and by Digestive, and Ab∣stersive Injections to dress it for some time, and afterwards by Sarcotick and Styptick Injecti∣ons, with good Bolsters, Com∣press, and Bandage, keeping the Orifice open with a Tent, and so compleat the rest of the Cure according to Art: But if after all your Endeavours the

Ulcer grows Fistulous, you must then Cure it, as we shall here∣after teach in lib. 5. cap. 10, 12, and 20.