Ars chirurgica a compendium of the theory and practice of chirurgery in seven books ... shewing the names, causes, signs, differences, prognosticks, and various intentions of curing all kinds of chirurgick diseases ... : to which is added Pharmacopoeia chirurgica, or, The medical store, Latin and English ... / by William Salmon ...

CHAP. XIV. Of an ƲLCER VARICOƲS.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus varicosum; we in English call, An Ulcer varicous, or, An Ulcer with a Varix.

II. We have already treated of Varix, as it is a Disease of it self, in Lib. 3. Cap. 16. of this Work aforegoing, so that no more need be said of that here: we are now only to consider an Ulcer, as being joined with it.

III. The Causes. What the causes of a Varix are, we have told you in the place cited; and also what the Causes of an Ulcer are, in Cap. 1. Sect. 24, ad 35; by joining of which together, you may find out the Cause of an Ulcer varicous.

IV. The Signs. They are also easily known by sight; by com∣paring the signs of a Varix with the Signs of an Ulcer, as they are delivered in Cap. 1. Sect. 36, ad 52, of the Book aforegoing.

V. The Prognosticks. A Vari∣cous Ʋlcer cannot be healed, unless the Varices be first of all healed; as Galen, Meth. Med. lib. 4. cap. 2. saith.

VI. And it is to be observed, that if the Varix be very great, that it is scarcely to be removed with the saving of Life; so very great is the danger of Death.

VII. And a Varix being ulce∣rated by the acrimony of the Humor, thro' some Accident or Bruise, Wound, &c. then Pain, Inflam∣mation, and Tumor may succeed.

VIII. The Cure. Wiseman says, The Cures of these Ʋlcers are

either Real, or Palliative; the Real or Perfect Cure is, the total cutting out of the Varix, as we have taught in Lib. 3. Chap. 16. Sect. 32, ad 44. from Paulus Aegineta, Cornelius Celsus, Avicen, and Wiseman.

IX. But this way (says Wise∣man) has not been admitted a∣mongst us; nor have I often seen a Varicous Ulcer could be cured by cutting off the Branch leading to the Ulcer, there being com∣monly more Veins concerned in it.

X. The Palliative Cure consists (the necessary Purging and Bleeding having gone before) in dressing the Ʋlcer with Digestives and Deter∣sives, according as the Ʋlcer is sanious or sordid: and while by good Bandage, or a laced Stockin, (if it is in the Leg) to repress the Humors impacted in the Part; by which Bandage, the lips of the Ulcer will be disposed to cicatrize with the Ulcer: but this lasts no longer than the laced Stockin shall be worn; from whence it is called a Palliative Cure.

XI. Some advise, that if a Varicous Ʋlcer contemns the ordi∣nary means, to take up the Varix both above and below, and to open it between the Deligations, according to the Method of Hil∣danus, in the place afore-cited, Sect. 45, ad 5., that the Blood may be discharged out of it; which is an Operation of no very great difficulty.

XII. And if in doing this there should be some unknown way (by some small branches of a Vein, which you had not before hand secured) for the Blood to fall into the Vein again, whereby an He∣morrhage does succeed, you must stop it with Pulvis Astringens and the white of an Egg, or Pulvis Stypticus, or some such like thing, with sitting Ban∣dage; the Swathband being also first wet in Oxycrate, or some Styptick Liquor; and then it is to be healed after the manner of an ordinary Wound.

XIII. An Observation. A Wo∣man 54 Years old, had a varicous Ʋlcer on her right Leg, which was much swelled, and somewhat in∣flamed. It was drest with Ʋng. Tutiae, and over it was applied Ʋnguent. Nutritum and Populeon mined together, which was rowled up with Compress and Bandage. A laced Stockin was provided against the next day, which was laced on, and the former Method of Dressing re∣peated: from that day the pain ceased, the Humors were repres∣sed by virtue of the Bandage, and the Ulceration cicatrized in ten or twelve days.

XIV. Another Man had Ʋlcers in the skin of his Legs in several places among Varices, without In∣flammation, but towards night they swelled, and were painful. The Ulcers were drest with Ʋng. Diapompholigos, and rowled up: within a day or two laced Stoc∣kins were put on, (the Ulcers being drest) with Compress un∣der them upon the Ulcers, and pieces of Vellum were laid be∣tween, to defend them from the wrincles of the Stockins: by wearing these, the Humors were restrained, and the Ulcers dis∣posed to Cure; which, with

Epuloticks, (an Issue being made in each Leg) was effected in few days.

XV. Another. A Woman that had a Varicous Ʋlcer in her Breast, which would not cure; the Varix lying under the skin felt like net∣work: it was hard, without inflama∣tion or discolouring, and discharged a well-digested Matter out of the Nipple, and some small openings near it. The Ulcer was drest sometimes with Ʋng. Basilicon, sometimes with Ʋng. Tutiae and Empl. è Bolo, applied over the Breast, with Bandage to support it; and fine Tow sprinkled with Ceruss, was worn under the Axilla: by which means it was cured in about a Months time.

XVI. Another. A Woman had a sordid Varicous Ʋlcer in one of her Legs. Her Leg was fo∣mented and drest, as in the former Observations, and by Bandage it was disposed for a laced Stockin. The Ulcers were dressed with Detersives, and with Compress and Bandage rowled moderately streight from the Foot to the Gartering: (for the Varix was from the Ham to the Ancle.) The Pituitous Humors impacted in the Part, thus rari∣fied, and the Ulcer cleansed, the laced Stockin was put on, with Compress upon the Ulcer; which streightned the Blood in its passage, and represt the Hu∣mors; and the lips of the Ulcer were made even, and cicatrized in a few Weeks, without either Purging or Bleeding, and the Leg reduced to its natural state. Wiseman, lib. 2. cap. 11. Ob∣servat. 1, 2, 4, 5.