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. XVII. Of an ƲLCER PHAGEDENICK.

I. WHAT the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus Phagedae∣nicum; we in English call, A Pagedenick Uler, or, An Eating Ulcer.

II. The Kinds. This Ʋlcer is twofold: 1. That which the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; and the Latins, in imitation of them, Phagedaena; also Ʋlcus exedens: and we in English, The Eating, or Sprealing Ʋlcer. 2. Nomae, also Ʋlcus depascens, or the Can∣cerous Ʋlcer; of which we shall treat in the next Chapter. This Phagedaena is derived 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; ab Edendo, à 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, to Eat: so that it may well be called, An Eating Ʋlcer.

III. It is an Ʋlcer with a Tumor; for which reason, some Authors have accounted and treated of it among Tumors, as Galen de Tumoribus, cap. 14. But whereas there is always an Ul∣cer joined with it, the more modern Authors (whom we here follow) think it more reasonable to be handled in the Discourse of Ulcers.

IV. The Differences. It dif∣frain Herpes exedens; for that corrodes and eats up the Parts lying near round about it; but it corrodes and eats thro' the Skin

only: whereas Phagedaena is a deep and profound Ulcer; and does not eat only thro' the Skin, but even to the parts under∣neath; eating thro' the Flesh also.

V. It differs also from Nomae, or the Cancerous Ʋlcer: for tho' that is an eating Ʋlcer also, yet it is an Ʋlcer with an eating or devouring putridness, creeping but slowly, and without any Tumor: whereas a Phagedaena is an Ulcer without any putridness, tho' abounding with matter; eating profoundly thro' the Flesh, and creeping to the parts adjacent lying round about it; and is always accompanied with a tu∣mor about its lips, by which it is distinguished from Nomae.

VI. The Cause. It is caused generally from adust Choler or Melancholy, or else from yellow Choler with salt Phlegm, and a serous or wheyish Humor, mixt therewith: which Humor is not so thin, as to produce only an Herpes; nor yet so thick and malign, as to produce a Cancer.

VII. Now this Humor comes either from some Part affected with a hot and dry Distemper; or else it is made adust, by some pre∣ternatural heat and driness in the Part affected.

VIII. Wiseman says, in a Caco∣chimick Habit, an Herpes exe∣dens often arises on the Nose and Face, from a small Pimple, or fiery Pustle; which being heated by scratching, or picking with their Nails, becomes at length corrosive; and from a Herpes exedens, becomes phagedenical: this by a farther exasperation, becomes cancerous: these (says he) differing, but only as the Humor becomes less or more sierce.

IX. The Signs. They are known by what was said in the Differences, at Sect. 4. and 5 above: but some∣times the Ulcer takes its original from an Abscess in the Flesh; and sometimes it begins in the Skin, and after eats into the Flesh, spreading into the parts round about, and dissolving the Flesh in the bottom of the Ulcer.

X. And the Humor causing this Ʋlcer, by reason of its great abun∣dance, fills the lips of the Ʋlcer, and causes a swelling to appear: but by reason of its acrimony and malignity, it frets, gnaws, or eats the parts adjacent which are sound.

XI. The Prognosticks. All these kinds of eating Ʋlcers are difficult to be cured; and if they happen in a Body of a hot and dry tem∣perature, where the Aliment sent to the Part, (tho' it be good) is made sharp and corro∣sive; they are so much the more hard of cure.

XII. They resist the force of ordinary Medicaments; which tho' they are applied to other Ulcers with good success, yet in this kind of Ulcer they be∣come utterly ineffectual.

XIII. If this Ʋlcer happens in a cacochyn ick habit habit of Body, it is yet more rebellious: and here the Constitution of the Body must be altered, before this Evil can be cured, which is a matter of very great difficulty.

XIV. If it happens in decrepit Age, or in such as are in a Hectick

Consumption, where the natural heat, and radical moisture are almost spent, and only acrid and salt Humors abound, the Ulcer then will scarcely admit of any cure at all.

XV. If it happens from the French-Pox, it is cured by Speci∣ficks for that Disease: but if it comes from either Causes, so (says Wiseman) it is extream difficult, and does frequently terminate Cancerous.

XVI. The Cure. There are two chief Indications of Cure: 1. To remove the Antecedent Cause. 2. To destroy the Con∣joined Cause.

XVII. The Cause Antecedent is removed, 1. By Purging; which you may do, first, by Emeticks, if the Stomach is foul, and the strength of the Body will bear it; and that may be done with Wine-Vinegar, or Honey, or Oxymel of Squills, or with Tartar Emetick, or Infusion of Crocus Metall. or Vinum Antimoniale, or some other Antimonial Emetick.

XVIII. Secondly, by Purgation, which may be done with an Infu∣sion of Sena and Rubarb, Syrupus Catharticus, Pulvis Catharticus, Tinctura Purgans, Pilulae Cathar∣ticae, Family Pills, Pulvis Corna∣chini; or some Mercurial Purge made with up Princes Pouder, white Precipitate, Turbith Mine∣ral, &c. suited according to the Constitution.

XIX. 2. By Diet or Wound Drinks, which are to be made of Decoction; of Guajacum, Sarsa, China, Tormentil, Bistort, Bur∣dock, and Comfrey roots; to which Vulneraries, as Agrimony Angelica, Avens, Betony, Bawm Hypericon, Ladies-mantle, Sani∣cle, Solomons-seal, Wound∣wort, &c. may be added.

XX. If the Humor flows to the Ʋlcer in any great quantity, it is to be diverted by Revulsion, Deri∣vation, and Interception, if it is possible. Some commend the Pur∣ging with Confectio Hamech, à ℈i. ad ʒss. mixed with Mercurius dulcis, à gr. 12 ad 24. and this to be repeated twice a Week.

XXI. The second Indication of Cure is to destroy the Conjoined Cause, which is done by Topicks. The virulent Humor affecting the Ulcer requires (says Wise∣man) to be dried up; and the Intemperies to be corrected. But because these Ulcers differ much one from another in their cor∣rosive qualities, according to the different habits of Body, the Medicaments therefore must accordingly vary.

XXI. If the Ʋlcer wants Dige∣stion, Digestives must be applied, before any thing else can possibly be done: for Digestion has a kind of Fermentative Power, by which it alters and changes the nature of the acrimonious and corrosive Humor, destroying its property, at least making it more mild and gentle.

XXIII. Then, if the Intempe∣ries is hot, your applications are to be cold, with some little Astringency, as Ung. Tutiae, è Plumbo, de Calce, de Lithargyro: or you may apply Ung. Populeon, mixed with Album Camphora∣tum, in equal quantities.

XXIV. If these things will not do, or answer expectation, you

must proceed to stronger: but by the Authority of the Ancients, you ought to scarify these Ul∣ters, or some-ways provoke them to bleed; that the sharp Blood and Humors may be there∣by discharged.

XXV. Aegineta has this Pou∣der. ℞ Ʋnslakt Lime, Chalci∣tis, or Vitriol, A. ʒii. Auripig∣mentum ʒ i. make all into a pouder. ℞ Unguen. Nicotianae (of Our Prescription) ℥i. of the former Pouder ℥ii. mix them, and apply it.

XXVI. You may wash with the Water of the Griffin, which is a most admirable thing; or with some drying Medicaments, which may repress the afflux of Humors; as Aqua Calcis, Aeruginosa, Alu∣minosa, or a Decoction of Plan∣tan, Horstail, Bramble-tops, Ba∣laustians, Red-roses, Cyprus-Nuts, Galls, &c. made in Smiths-Forge-Water, or Red-wine, q.s.

XXVII. After which, the Ulcer may be sprinkled with pouders of Tutia, burnt Harts-horn, burnt Ivory, and Oister-shells, Pom∣granate-peels, Catechu: or they may be mixed with Ointments.

XXVIII. ℞ Ung. Diapom∣pholigos ℥iii. fine Bole, Sanguis draconis, Balaustians, A.℥ss. Oil of Roses, q.s. mix, and make an Ointment; which apply with Compress wet, and wrung out of some Astringent Decoction, over all.

XXIX. The Ʋlcer thus drest, is not to be opened again in three or four days: for the tempera∣ment of the Part being weak, the frequent exposing it to the Air, renders it more weak, and the Medicaments less ef∣fectual.

XXX. To this purpose Galen, Comp. Med. cap. 4. upon the Me∣dicament of Asclepiades, has these words: For unless the Me∣dicament shall stick somewhat long upon the Skin, it effects but little or nothing; which most Physi∣cians are ignorant of.

XXXI. And the truth is (says Sennertus) there is commonly a great Error committed in this very point, whilst they think that to be the best course, to wash the Ʋlcer three or four times a day; when that the Medicament does act nothing at all, unless by the native Heat it is drawn forth into act: and in regard that in long continued Ulcers, the heat of the affected Part is very weak, it needs much time therefore to excite and draw forth the strength and virtue of the Me∣dicine.

XXXII. For which reason, the Medicament ought to be kept sticking upon the Part for a long while; nor is its action to be disturbed, for that the virtue and strength thereof is not in a little while to be drawn forth by the heat of the Part af∣fected; for which reason, no new or fresh Medicament is pre∣sently to be applied: yet if the Humor is very sharp, it is the oftner to be wiped away; lest lying in the ulcerated Part, it should more and more corrupt the same.

XXXIII. Or you may apply Ung. Fascum Wurtzii, Ung. Ni∣cotianae Nostr. or some such like; 'till the Ʋlcer ceases sprending,

appears red, is cleansed, and is in a good condition; then you may heal it up with Sarcoticks and Epuloticks, as is usual in other Ulcers.