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. I. Of ƲLCERS in General.

I. THEY are called in Greek, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. in Latin, Ulcus, pl. Ulcera; and in English, an Ulcer, pl. Ulcers.

II. The Definition. An Ʋlcer in the Solution of Ʋnity, putrified: or thus, An Ulcer is a Wound which is putrified, and sends forth stinking and putrified Matter.

III. Barbett defines an Ulcer to be a Solution of Continuty, with Diminution of Magnitude in the soft Parts, from a cor∣roding matter.

IV. The Differences. Joel, Chirurg. de Ʋlcerib. Tom. 6. Sect. 6. Et quanquam utraque affectio, & Vulnus & Ʋlcus, continuitatis in aliqua parte sit solutio & di∣visio; differunt tamen, quod con∣tinui solutio in Vulnere ab externis causis caesim illatis cum Sanguine eruptione inferatur: Ʋlcus verò, ut plurimum ab interna causa, erodentibúsque Humoribus produci∣tur; ex quo non Sanguis, ut ex Vulnere, sed, vel sanies, vel pus, vel putrida colluvies emanat: quanquam ab externis quoque causis, ut applicatione Causticorum Remediorum, aut morsu ictuque virulentorum Auimalium, paulatim Ʋlcera excitari possunt. Here he shews us the difference between a Wound and an Ulcer. Now altho' (says he) both Wounds and Ulcers are a solution and divi∣sion of continuity in some part; yet notwithstanding they differ; for that a solution of unity in a Wound, comes from external causes, as cutting, attended with a flux of Blood: whereas an Ulcer is for the most part from an internal cause, and is induced from eroding or corrosive Hu∣mors; from which Blood comes not as in a Wound; but either

sanies, or pus, or a flux of sordid filth: sometimes also it is pro∣duced from external causes, as application of Causticks, or bitings or stingings of venemous Beasts.

V. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek, Sanies in Latin, a thin, waterish, bloody Gleet or Humor, in English; which yet Blancard will have to be, a thick bloody Humor: but it is truly either thick or thin, according to the Parts from which it issues: Joel says, it for the most part flows from crude Wounds in the beginning of the Cure; chiefly if the Nerves or Ligaments are hurt, (and then it is always thin:) but if it comes from Wounds of the musculous Flesh, then we say with Blancard, it is thick and bloody. It also flows from many kinds of malign Ulcers, and then (says Joel) Colore vel albo Aquae, vel Sero simili; aut colore rubeo tanquam Aqua Sanguine pauco diluto, quod ut plurimum acre est & erodens, & cum in Ʋlceribus (tum in Vulneribus) dolores acer∣bos excitat. In malign Ulcers, it is either of a white watery co∣lour, or like to Whey; and sometimes of a reddish colour, as if a little Blood were diluted with Water.

VI. But this Excrement in malign Ʋlcers, is not properly called Sanies, but Virus, or Vi∣rulentia, as words of a more full, large, and ample signification: and unless this Sanies or Virus is first dried up, or absorbed in Ulcers and Wounds, it is im∣possible that they should be healed.

VII. Sanies is also always evil in it self, and by how much it differs from a watery substance or quality, as being of livid colour, stinking smell, and serous sub∣stance, by so much it is the worse.

VIII. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek, Pus in Latin Matter, in English; is a digested Excrement in Wounds and Ʋlcers; thicker than the Sanies, but thinner than Sordes; and if it is that which Authors call Pus optimum, & exoptatissimum; or laudable Quittor; it is white in colour, equal and smooth in substance, soft, and not in the least fetid or stinking.

IX. Such a kind of Pus be∣speaks a happy curing of the Wound or Ʋlcer to which it happens: whereas on the contrary; if it differs from this description, as being thinner than it ought to be, feculent, of an ash, livid, or black colour, and of a stinking smell, it is said to be very evil.

X. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 in Greek, Sordes in Latin, Corrupted Filth, or, Stinking Matter in English: it is a preternatural Excrement, coming from Wounds and Ʋlcers: and in Ulcers it is thick, glutinous, and very tenacious; sometimes livid, black, or of various colours, and always stinking.

XI. When such Recrements come from malign and putrid Ʋlcers, it shews them to be of difficult cure: the cause of such ill Ex∣crements, as Sanies, and Sordes, is from a weakness or error of the third Concoction, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or right temperature of the Parts affected.

XII. The Kinds. There are

several kinds of Ʋlcers, arising from several Accidents and Causes. 1. From the Form of the Ʋlcer. These arise from its figure, ma∣gnitude, and the like: some Ulcers are small, others great.

XIII. Some Ʋlcers are long, others short: some broad, others narrow: some streight, others ob∣lique: some equal, in which the Flesh appears in all places alike wasted: others unequal, in which a greater part is consumed in one place, than in another: some Ulcers creep like a Coney-borough, other are Fistulous: and of those which are fistulous, some have narrow mouths, others broad: some have round lips, others the contrary.

XIV. 2. From the Part af∣fected. Some Ulcers are said to be internal, others external; some slight and superficiary, others profound, and difficult to approach to: some are in parts superior, others in parts inferior and depending: some in parts musculous or fleshy, others in parts membranous, nervous, and full of Vessels.

XV. 3. From Accidents, taken from things without the nature and constitution of the Ʋlcer: some are recent and new, others are inveterate or old: some are clean, others are foul: some are simple, others complicate.

XVI. 4. From the easiness, or difficulty of Cure. Those are easy of Cure, which are recent, sim∣ple, superficiary, and accompa∣nied with the least Symptoms, having a laudable Pus.

XVII. Those are of difficult Cure, which proceed from the more grievous Diseases, or Causes: or which are conjoined with ap∣pendent Symptoms; as intem∣perature, flux of malign Humors, Sanies, Sordes: or if there is a putridity, hardness of the lips, or they breed Worms, or are cavernous, eroding, rotten, or cacoethick.

XVIII. 5. From Symptoms inhe∣rent: some are void of pain; others are with pain, itching, pricking and burning: some are with distemper of the Part, In∣flammation, Gangren: others are with a Callus, Hypersarcosis, Ero∣sion, Cancer, Worms, and Rot∣tenness of the Bones.

XIX. 6. From the Causes: come are from Causes internal, as from sharp Humors, having a corroding faculty: and this Humor is generated either with∣out the Part affected, that is in the other parts of the Body, and so comes to the place where the Ulcer is by fluxion: or, it is generated in the very Part affected by it self. Others are from Causes External; as the application of Septick or Cau∣stick Medicaments: the Actual Cautery, also actual Fire it self; for that the Escar which is left remaining, is rather to be ac∣counted among the number of Ulcers, than of Wounds.

XX. Out of what has been said, it appears that Ʋlcers differ, 1. In form or figure. 2. As to the Part affected. 3. As to outward Accidents. 4. As to Symptoms inherent. 5. As to the easiness and difficulty of Cure. 6. As to the Causes from which they arise; from which

several Differences, those varie∣ties of Ulcers named or expressed in the ARGUMENT of this Book, are said to spring or be derived.

XXI. Other Authors, as Bar∣bett, takes these kind of Ʋlcers, 1. From the Form, and so they are either great or little, long or short; broad, narrow; right, transverse; equal, unequal; su∣perficial or deep. 2. From the Part affected, as being sometimes in the Skin only, sometimes in the Muscles, Nerves, Tendons, Vessels, Joints. 3. From the Symptoms, and so it is with Dis∣temper, Pain, Fluxion, Putrid, with Tumor, with proud Flesh, Callous, Discoloured, Cavernous, Verminous, Carious, Cacoethick, Phagedenick, Cancerous, with an Escar, Fistulous or Gangre∣nous. 4. From the Causes, which are either Internal, from ero∣ding Humors; or External, from outward Injuries.

XXII. Others make but two Kinds. 1. Those which arise from the nature and constitution of an Ʋlcer. And so an Ulcer is ei∣ther simple and without Sym∣ptoms, where the consolidation or healing may be immediately attempted: or complicate, and with Symptoms, in which some or all of them must be re∣moved before unition can be procured; and these proceed either from inward Causes, as fretting Ulcers, Nome, Phage∣daena, ulcerated Cancers, &c. or from outward Causes, as Conta∣gion, Poyson, Burning, &c. 2. Those which are taken from the Part affected; and they are either inward, possessing some of the Viscera, or parts adjacent to them; or else outward, affecting the Skin, Muscles, Nerves, Ten∣dons, Vessels, Joints.

XXIII. Wiseman divides Ʋl∣cers into two several Kinds, or makes them arise from two several Differences; which he will have to be first Essential, from the Form, or from the Efficient Cause. From the Form, 1. From the Figure, as being straight, oblique, round, crooked. 2. From the Magni∣tude, as being great, small; su∣perficial, deep; long, short; broad, narrow. 3. From the E∣quality, in which the Flesh is alike plain, or inequality, in which it is corroded more in one place than in another. 4. From the part affected, as being internal or external, and the latter in the Flesh, Membranes, &c. From the Efficient Cause, which is either inward from some sharp, eroding, malign Humor; or external, from bur∣ning, biting, stinging Poyson, Contagion, &c. Secondly, Ac∣cidental, which arise from induced Symptoms, such as we enumerate at Sect. 21.73. aforegoing.

XXIV. The Causes. The cau∣ses of Ʋlcers are threefold, viz. 1. External, called Primitive, from Falls, Blows, Burnings, Scaldings, Contagion, Poyson, unnatural Food, &c. 2. Internal or Antecedent; from sharp and corrosive Humors, as salt Flegm, Choler, Melancholy, Serum, cor∣rupted Lympha. 3. Near or enjoined; as eroding Matter ga∣thered together in the place, by reason of the aforesaid Gauses.

XXV. If this eroding Humor proceeds from internal Causes, it then springs from an Excess of acrid Serum, which if mixt with any other Humor, as Blood, Choler, Melancholy, Phlegm, or Lympha, receives its denomination from them.

XXVI. These Humors when they abound so much, as to recede from a right Temperament, they are apt to separate from the whole Mass, and to be protru∣ded either quite out of the Body by natural Excretions, as Excre∣ments; or else fall, and settle upon some particular Member or Part, and so generate an Ul∣cer.

XXVII. Being thus separated, and protruded from the Mass of Blood, they loose their Balsamick Property, and become acrid and eroding, or corrosive: and by how much the longer this Humor has been extravasated or protruded, by so much the more acrimoni∣ous and eroding it becomes: de∣generating at long run, into those very Excrements voided by the Ulcer it self.

XXVIII. The External Causes we mentioned first, at Sect. 24. a∣bove; where speaking of Contagi∣on; we here say, that those things are to be referred to that Head, which proceed from Psoora, Itch, Leprosy, and contacts with Ve∣nereal Persons; the particles of which Contagion being commu∣nicated to the Skin, does slyly insinuate it self into the Pores thereof, and so exulcerating there, begets the like Disease.

XXIX. From these Diversities of Causes, a diversity of Excre∣ments does flow, viz. Sanies, Pus and Virus; a description of which, we have already, given you at Sect. 5. ad 11. aforego∣ing: yet these few following things are to be noted concern∣ing them.

XXX. As to Sanies, Celsus will have it to be twofold, 1. Ichor, which is a thin whitish Gleet, incident to ill disposed Ʋl∣cers, especially among the Nerves and Tendons: it is generated of a nutritious Serum, degenerated into a sharp virulent Serum. 2. Meliceria, a thick glutinous Hu∣mor of a pale or yellowish Colour, not much unlike to Honey, and affecting Ulcers of an ill condi∣tion, near and in the Joints, which erodes the Membranes and Joints.

XXXI. But (says Wiseman) that which we call Sanies, is a thin excrementitious Humor, gene∣rated from abundance of Serosity in Ʋlcers, making them moist: of which Humors some are hot and reddish Coloured, others cold and pale Coloured; and where this Humor is, it is called a Sa∣nious Ʋlcer.

XXXII. As to Pus, it is a mat∣ter of a middle consistency between thick and thin, for the most part of a whitish Colour, and not of an ill Smell: but if it is of a greenish or yellowish colour, it common∣ly smells rank, but not stinking. If the Constitution is good, and the Serum well conditioned, then a good sort of Pus is made, which is white, smooth, of e∣qual substance, not thin, and easy to the part; and every day it appears nearer and nearer to

the nutritious Juice, till by de∣grees the Ulcer fills up with flesh, and heals. This is generated of a good Serum, flowing to the part affected for its nutriment, which by the weakness of the part, is not assimilated, but con∣verted into a whitish Substance, called Pus or Matter, and where this is, it is called a Purulent Ʋlcer.

XXXIII. Sordes is a thick glutinous Matter, and stinking, differing in kind, as being whitish, sometimes greyish, and sometimes blackish, and then it is most stink∣ing, also unequally coagulated in its Substance. It is generated of much tough matter, which ren∣ders the Ulcer foul; or of Blood and Serum grown Phlegmatick, and afterwards gross and slimy, which for want of Heat does still degenerate, and corrupt into Sordes, a thick glutinous stink∣ing matter or filth; and where this is, it is called a Purid Ʋlcer.

XXXIV. Sennertus says, That Internal Humors causing Ʋlcers flow unto the part affected, either by transmission or by attraction; but Modern Authors will not allow of Attraction. We conclude there∣fore, that they flow by Protru∣sion; for which (if we could now spare time) we would ren∣der sufficient Reasons.

XXXV. Sennertus will have referred to the Tule of Contagion, those Atoms and Vapors exhaling from the Lungs of Phthisical Per∣sons, and by others attracted and drawn in with the Breath, whereby they exulcerate their Lungs, and so cause in them a Phthisis, or Consumption.

XXXVI. The Signs. We shall consider the Signs of Ʋlcers, as they have respect, 1. To those which are Internal. 2. As they have respect to those which are External, or in the outward parts of the Body.

XXXVII. Now an Internal Ʋlcer is discovered by the Excre∣tion, or kind of Matter which is expelled, whether by the Mouth, Nose, Urine or Stool.

XXXVIII. If the Ʋrine is pu∣rulent, there is danger of an Ʋlcer in the Reins or Bladder: if puru∣lent Matter is voided by Cough∣ing, it is probable that the Lungs may be exulcerated.

XXXIX. If a great quantity of such Matter has been ejected, and signs of an Apostem have gone be∣fore, you may conclude, it is an Apostematous Ʋlcer.

XL. But if the Purulent Mat∣ter has been but little, and no signs of an Inflammation, or an Apostem have gone before, then it is a pri∣mary Ulcer, proceeding from Erosion thro' a sharp Humor, dividing the unity of the sub∣stance of the Lungs.

XLI. Pus or Sordes, and Cor∣ruption, (says Sennertus) come∣ing forth, is a sure and certain sign of a hidden Ʋlcer, whether it is by Vomiting, or Coughing, Ʋrine or Stool: but then in what part it is hid, the property of the Pain, the Situation and Action of the Part hurt, must instruct us.

XLII. If the Pain is pricking, a Nervous part is hurt: but if it is a beating Pain, an Artery is hurt. The seat of the Pain discovers also, the part it self that is ex∣ulcerated.

XLIII. If sense or motion is hurt, the Part ulcerated is Nervous: if after eating, a biting or twinging Pain is felt, the Stomach is exul∣cerated: if any one has drunk Cantharides, the Bladder will be exulcerated: if Aqua Fortis, Oil of Vitriol, Corrosive, Sublimate, &c. the Jaws, Throat, and Sto∣mach, will be exulcerated.

XLIV. As to external Ʋlcers, their Figures and various differen∣ces, together with the help of the Probe, make them known by sight: in a great Ulcer there will be ve∣ry much Pus, or Purulent Mat∣ter, in a lesser Ulcer there will be less.

XLV. The external Causes may be known by the Relation of the Patient, as whether he was hurt by any Blow, or Fall, Bruise, Buring, Scalding, corrosive Medicine, Poyson, Contagion, or the like.

XLVI. The signs of the other Causes are particular; for if the Ʋlcer has its Original from an af∣flux of Humors, then there will be present signs of a Cacochymie, either in the whole Body; or of a vitious and faulty Consti∣tution in some particular Bowel, as Lungs, Liver, Spleen, Gall, Pancreas, &c.

XLVII. But if those vitious Signs be wanting, and that on the contrary, there is present a Distem∣per and Weakness of the Part af∣fected, it is then clear, that the cause of the Ulcer is generated in the part it self.

XLVIII. But then, what kind of Humor it is, which causes the Ʋlcer, whether corrupted Lvm∣pha, salt Flegm, Choler or Me∣lancholy, will appear from the Signs of each particular Viscus, and the Pus or Sordes, which flows forth, as also by the colour of the Ulcer, and the Pain there∣of, as pricking, twinging, &c. and the special signs of particu∣lar Ulcers.

XLIX. The times of these Ʋl∣cers have also their signs, for when that which first comes forth is thin, waterish, and crude, and that there is great store of it; it is then in its beginning: which very be∣ginning may also be discovered by the Seuses, by the Touch, and by the Sight: as also by the Causes of the Ulcer both exter∣nal and internal, and by the Pain, Itching, present and subsequent Symptoms.

L. When the Pus, or filthy Mat∣ter begins to be better concocted, and that its great abundance is di∣minished, then the Ulcer is said to be in its increment or en∣crease.

LI. In the State the Pus is at best; and in the declination of the Ʋlcer, the Pus is more lessened and diminished.

LII. And yet notwithstanding these several times are also known by the Itching, the Pain, and the Actions hurt; which if they are augmented, we may conclude the Ulcer is increased; but if they re∣mit, that all things are retur∣ning to their natural State, and that the Ulcer is then diminish∣ed, and in its declination.

LIII. The Prognosticks. Great care is to be taken in making of right and true Prognosticks, when an Ʋlcer is offered to be cured: for he that undertakes the Cure

of an uncurable Disease, discre∣dits his Art, and causes himself to be contemned, by such as are simple and ignorant.

LIV. An Ʋlcer in a person of a good habit of Body, who digest his Food well, and sleeps well, is easy to be cured.

LV. An Ʋlcer in a Body Caco∣chymick, or of an evil Constituti∣on, where the Skin is of a Tallowy whiteness, or yellowish, or swarthy, is not so easily cured, because that salt Flegm, yellow Choler, or feculent Melancholy may a∣bound, which Humors hinder the Regeneration of Flesh.

LVI. Ʋlcers which remain un∣cured a year or more, either rot the Bone, or alter it.

LVII. Ʋlcers which are evil coloured and black, are malign, and so for that reason of diffi∣cult Cure.

LVIII. Ʋlcers in Bodies which are very moist, or very dry, are difficultly cured; the first is evi∣dent in aged people, and such as have the Dropsy; for super∣fluous Humidity hinders Desicca∣tion, and so Healing: the latter is also manifest, in such as have a defect of radical Moisture, which is a great impediment.

LIX. By how much deeper the Ʋlcer is, by so much it is the longer in curing: and if an Ulcer can∣not be cured in a long time; or when Cicatrized, it breaks out again; the cause is, the Bones being foul under it.

LX. If an Ʋlcer (being filled up, and ready to cicatrize,) begins to run again without manifest cause, it is in danger to become Fistu∣lous.

LXI. Ʋlcers near to the Nerves, Tendons, Arteries, or Veins, are dangerous; and in Cacochymick Bodys, their Cure is very tedious.

LXII. Hippocrates saith, That Ʋlcers having no hair about them, are hard to heal and cicatrize, also such as come from some Disease, as the Dropsy and Cachexia.

LXIII. Ʋlcers in Children, by reason of their exceeding humidity, and in Women with Child, where the most excellent and Balsa∣ick part of the Blood is used for the nourishment of the Child, are not easily cured.

LXIV. If the Matter which comes from the Ʋlcer is good, viz. of a middle consistence between thin and thick, white, light, equal, and not at all stinking, it gives hopes of an easie Cure: and on the contrary, if the Matter flowing is ill, viz. thin and fluid, pale, livid, and of an ill smell, it is of very difficult cure.

LXV. Ʋlcers which happen af∣ter critical Apostems in the Spon∣dyls of the Back; or great Joints of the Body, are for the most part mortal; because, after Sickness and Apostemation, Nature must be much weakned, and the natu∣ral Heat much abated, and the radical Moisture almost spent.

LXVI. Hippocrates also saith, that they who have Ʋlcers accom∣panied with a Tumor, do neither fall into a Convulsion, Raving nor Frenzy; but if the Tumor goes away without manifest cause, and the Ulcer is in the Back, a Con∣vulsion follows; but, if in the fore-part of the Body, a Raving or Frenzy; if in the Brest, an Empyema or Pleurisy.

LXVII. Old and Inveterate Ʋlcers (says Barbet) are not cu∣red without danger, except the Bo∣dy is before-hand well Purged, and a good order of Diet instituted: o∣therwise Diseases will ensue.

LXVIII. If the place in which the Ʋlcer is seated, is blackish, blewish, or greenish, it will be cu∣red with much difficulty; for the Blood and Juices are corrupt, and the Flesh of an ill compo∣sition, and degenerate.

LXiX. Ʋicers accompanied with Varices or Intemperature, or whose Sides or Lips are callous, are hard to heal.

LXX. Ʋlcers with around Fi∣gure, are cured with difficulty; and the reason is, for that con∣solidation being made by uniti∣on of Parts; the farther the Parts are asunder, the more slow∣ly it is performed: and a round Figure of all others, is, that whose Sides are at farthest di∣stance within the same bounds.

LXXI. Ʋlcers in the Extremi∣ties of the Muscles of the Arms or Legs, or such as penetrate the Bo∣dy, are very dangerous, and diffi∣cult to heal.

LXXII. And Ʋlcers in the Ex∣tremities of the Body, as feet and hands, oftentimes create Phle∣gmons, or other praeternatural Tumors, which in the Crisis are difficult to cure.

LXXIII. Hippocrates also says, If one Sick has an Ʋlcer, and he dies, the Ʋlcer will be before he dies, black, blew, or pale, and withal, dryed up.

LXXIV. Painful Ʋlcers in Children are dangerous, because their Bodies being raw, and their Spirits very subtil, they are easily spent, which much weak∣ning them, induces Death.

LXXV. Fistula's with many Caverns, are hard to heal: if near to any noble part (as in the Brest) or in the Bladder, Womb, or Bowels, they are dangerous, and sometimes mortal: in the Ribs, Back, Joints, or in Ano, they are dangerous and diffi∣cult: and in Cachectick Bodies, they are long in curing.

LXXVI. All Fistula's are diffi∣cult to cure, and some are absolute∣ly uncurable: that which is but newly begun, not deep, in a young and sound Body, the edges not very hard, but some∣what soft with Matter, is more easily cured.

LXXVII. An Ʋlcer complica∣ted with another Disease, which maintains or continues it; the Ʋl∣cer according to the nature of the Disease, is either of easie or hard cure. So Venereal Ʋlcers in a humid and strong Body is easily cured; but if the Sick is in a Marasmus, neither the Ulcer, nor the Disease can be cured; be∣cause the use of Dryers (which are only profitable in this case) will increase the extenuation of the Body, and hasten Death. In like manner Ʋlcers in Hectick Persons, and Hydropicks, are e∣qually dangerous; for in the first, a good Juice flows not suf∣ficiently to the part exulcerated; in the latter, a superfluous humi∣dity hinders the desiccation and consolidation.

LXXVIII. No Ʋlcer can be cu∣red whilst the Bone remains foul: if the Caries is near the nervous

Parts, or in the Joints, or about the Tendons, Arteries or Veins, it is not easily cured, but for the most part, the Nerves and Ten∣dons are corrupted.

LXXIX. Soft Tumors in Ʋl∣cers are good, because they will yield to Medicaments: but if they are hard, they will not be easily cu∣red, because the Humor is the more Rebellious.

LXXX. If the Hair falls in places of the Body about the Ʋlcer, it is an evil Sign: for it shews, 1. Want of Nutrition. 2. Great acrimony and corruption of Hu∣mors, as in Quartan Agues, French Pox, Leprosy.

LXXXI. Inveterateor Old Ul∣cers, which eject 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Elae∣odes, a Pus like unto white Oil, are scarcely ever cured: for it shews a Colliquation of the Part, and a Consumption of the whole Body.

LXXXII. Inold, deep, and ma∣lign Ʋlcers, the Bone is commonly foul, and unless it be Scaled, no cure can succeed: that the Bone is foul, you may know by these Signs, 1. If the Ulcer is skinned, it breaks out again. 2. It yields thinner and more Matter, than its largeness requires. 3. Its Brims or Lips will not come in. 4. Its Lips become reddish. 5. If the Bone appears to sight, it is rugged, not smooth, and of a blackish or ruddy white Colour.

LXXXIII. Ʋlcers of the Blad∣der are very troublesom, and for the most part uncurable.

LXXXIV. In an Ʋlcer where there is cariosity of the Bone, and the colour of the Flesh is livid, the Patient is in danger; for it is a sign of the extinction of na∣tural Heat.

LXXXV. If an Ʋlcer casts forth much Sanies, or an Ichorous Matter, which is very thin, and of a pale, livid, or black colour; or if it is glutinous and stinking, fretting the Skin adjacent, it is hard to be cured: for this Hu∣mor keeps the Ulcer moist, not can it be easily dryed up, even by the most powerful Topicks.

LXXXVI. Ʋlcers of the Nose are hard to cure; for which, re∣spect must be had to the whole Body.

LXXXVII. From malign Ʋl∣cers, two kinds of Matter flow, 1. Sanies or Ichor, which is thin, which issues from Punctures of the Nerves, and Corruption of the Tendons and Periosteon. 2. Sordes, which is a thick, gluti∣nous, stinking Filthiness.

LXXXVIII. Hippocrates, Sect. 7. Aph. 21. is of opinion, That a Flux of Blood coming upon an Ʋl∣cer after strong pulsation, is of an evil consequence; for there must be a great Inflammation, and the Arteries must be much straitned, so that a Gangren may be feared.

LXXXIX. Ʋlcers of the Eyes for the most part leave blindness, e∣specially where the horney Tunicle is throughly corroded, whereby the Watry (and sometimes the Cry∣staline) Humor is sometimes let out.

XC. If an Erysipelas is pre∣sent, the Bone being bare; it is (as Hippocrates, Sect. 7. Aph. 19. will have it) an evil sign: for Flesh cannot be regenerated where such a sharp Humor is present, that causes so hot a Tumor.

XCI. Burnings from Lightning are generally mortal: from other things, if it hurts the great Ves∣sels, a Gangrene and Sphacelus often times ensue.

XCII. Burns of the Eyes and Groins, are very dangerous; but of the Intestines always uncurable: Burns great and deep, always leaves Scars behind them: and if an hairy Part is burnt, the Hair never grows again.

XCIII. Ʋlcers of the Thighs, are for the most part hard to be cu∣red; more especially, if they be cherished by any Distemper, or de∣fault in the Spleen: for then the thick and melancholy Humors, which flow to the Ulcer, do hin∣der the cure thereof: and in∣deed, the condition of the Ulcer is of great moment to be consi∣dered, both as to the Quantity and Quality of the Humor flow∣ing to it: being in a depending part, and the Body cacochymick, the very multitude of Humors (tho' otherwise they were not bad) is an impediment great enough of the cure. If also the Quality is amiss, it is the same, tho' the Quantity is not great. For if there is a dry Intempera∣ture, it will many times elude the force of the Medicament: and it is as bad when the Ulcer has continued so long, as to bring an habitual Discrasy up∣on the part, as in Nomae, and perannual Ulcers, which are sel∣dom cured; and if cured, it is with danger of the Patients life. The next worse than these, are Phagedenical Ʋlcers; and the worst of all, are such as are Can∣cerous and Sphacelous.

XCIV. The cure of Ulcers in general. In this general Cure, we shall consider Ʋlcers only under a twofold respect, 1. As they are sim∣ple, consisting in a solution of Unity and Erosion. 2. As they are Complicate or Compounded, having other Symptoms or Accidents joined with them.

XCV. A simple Ʋlcer, as to its loss of Substance, requires Incarna∣tion; and as to the Solution of Ʋnity, Ʋnion, this is performed by Exsiccation. Hippocrates, li∣bro de Ulceribus, & Galen, Meth. Med. lib. 3. cap. 3. says, That all Ʋlcers continually required De∣siccation.

XCVI. For so long as an Ʋlcer continues Sanious or Sordid, it can never heal: in which cases, Di∣gestion and Detersion are requi∣site: and whether you go about to Incarnate, or to induce the Cicatrice, drying Medicines must still be used.

XCVII. The loss of Substance is either in the Skin, or in the Flesh: if only the Skin is wanting, the Flesh is then to be so exsiccated with proper Medicaments, as that the Juices flowing to it, may be changed into a Cuticular or Membranous Substance; for that as Authors say, it is a Sper∣matick Part, and cannot be re∣generated.

XCVIII. If the Flesh is defici∣ent, it must be restored by Incarna∣tives, assisting Nature, who out of a part of that Blood, design'd for the nourishment of the Mem∣ber, generates new Flesh.

XCIX. Now in the Generation of Flesh in an Ʋlcer, there is a twofold Excrement to be separated.

1. One thin, which must be dry∣ed up. 2. Another thick, which must be deterged, or cleansed away.

C. Now in the cure of all sorts of Ʋlcers, there are four times, or Crises to be observed. 1. Princi∣pium, the beginning, wherein the Excrements running out, are wa∣terish, and thin. 2 Augmen∣tum, the encrease, in which the Recrements flow less, and are thicker. 3. Status, the state, in which no Iehor or Sanies flow forth, but only a thinner sort of Pus. 4. Declinatio, when the Pus is laudable, or white, thick, even, and well scented, which shews, the Ulcer is on the mending hand.

CI. The Cure of complicate or compound Ulcers. Here ma∣ny Indications offer themselves to be considered, according to the va∣rie••y of Causes and Symptoms, which do attend them. The first Indication, is the removing of the Antecedent Causes. The second Indication, is that which teaches to remove the proximate Causes, or those which are con∣joined.

CII. The antecedent Causes are foursold, 1. Cacochymia, which is an evil habit of Body, thro' the abounding of evil Humors; and this is to be removed by Purgation and Evacuation of the abounding Humors, by proper Emeticks and Catharticks.

CIII. 2. Contagium, or Infecti∣on, and this is to be overcome and resisted, by the exhibition of proper Alexipharmicks.

CIV. 3. Venenum, Poyson; and this is to be destroyed by the giving of potent and effectual Antidotes, which not only ener∣vate the Malignity, but even de∣stroy its very Nature and Force.

CV. 4. Intemperies, The Di∣stemperature of the Part, which is removed by things of a contrary quality, which is chiefly perform∣ed by Alteratives, out of which are made proper Diet Drinks, Wound Drinks, and the like.

CVI. The proximate or conjoin∣ed Causes, are to be removed by those Topicks, or external Appli∣cations, which are proper to the four Times or Seasons of the Ul∣cers, which we ennmerated but even now, at Sect. 100. afore∣going.

CVII. But in the Cure of these complicate Ʋlcers, there are many things which oftentimes hinder the Healing, and render the Cure dif∣ficult: As, 1. A Cacochymie of Humors, and Impurity of the Blood. 2. A Malignity of Hu∣mors. 3. A Defluxion of Humors to the part. 4. A Defect of good Blood, or a dry and consumptive habit of Body. 5. An ill habit in the Air, as being too hot and moist. 6. The foulness and pu∣tridness in the Ʋlcer it self. 7. Soft, proud, or mortified Flesh a∣bout the Ulcer. 8. The hardness of the Brims of the Ulcer. 9. A corruption of the Bone under the Flesh or Ulcer. 10. The Appli∣cation of improper Medicaments.

CVIII. Now in order to the Cure, all these impediments, or as many of them as do occur, are to be removed, as the Indications op∣posite shall seem to instruct you.

CIX. In the beginning therefore of the Ʋlcer, the Sanies requires

Concoction, that it may be made thicker, and turned into good Pus or Matter; and in this case, Sup∣puratives are of good use: but they are not to be used to putrid Ʋlcers, for they increase the Putrefaction: and in purulent vlcers, they make the Ulcer more sordid.

CX. But if the Ʋlcer is caused meerly by the Pain, Suppuratives are of singular use; because by their Sanient and Digestive Virtue, they remove the Cause, and are to be continued, till the Matter is well concocted: and therefore it is, that we use them in the begin∣ning, lest the extravafated Hu∣mors should stir up Pain and In∣flammation.

CXI. In the Augment or En∣crease, when the Matter is less in quantity, and thicker, then we are to use Detersives or Clean∣sers.

CXII. In the state, or height of the Ʋlcer, when it is well cleansed, then it is necessary to use Sarco∣ticks or Incarnatives, that the Ulcer may be filled up with flesh.

CXIII. In the Declination, when the Ʋlcer is filled up with new Flesh; the next thing then to be done, is to apply Epuloticks or Cicatrizers, that it may be decently covered over with Skin, and with as little a Scar or Deformity as may be.

CXIV. Now here, some few things are necessary to be noted; First, That repelling Topicks are to be applyed to the Parts about the Ʋlcer, to repel the Humor which may flow to it. 1. Because that Suppuratives by their Heat being apt to draw, the Humors so in duced, may be repercussed. 2. That the Parts may be so strengthned, as to resist the Fluxion. 3. That by repelling the Humor, the Deficcation may be promoted. 4. That the in∣nate Heat of the Part may be strengthned, being thus kept in by the cold of the Repulsive.

CXV. And this Repulsion is performed by repelling Medicines, commonly called Defensatives, which are restringent and cool∣ing, and rather dry than moist.

CXVI. Secondly, That if it is in a depending Part, it be raised up, and placed equal with, or higher than the rest of the Body; which will be of great advantage in the Cure: and the Influx is also to be restrained, and the Mem∣ber strengthned by an expulsive Bandage.

CXVII. Thirdly, The Diet is to be proportioned to the Nature and Strength of the Patient, to re∣sist and diminish the Humors a∣bounding, whether in the whole Body, or some particular Part, and to contemperate their Acri∣mony.

CXVIII. Fourthly, The Eva∣cuating of the superabundant Hu∣mors, whether they offend in quan∣tity or quality; and this is done either by Purging or Vomiting, or both.

CXIX. Fifthly, To resist the Fluxion of Humors, (since most Humors proceed from that Cause.) 1. By Revulsion: by which, the Matter is drawn to parts far di∣stant; and the rectitude of the Parts and Vessels restored: if you respect the rectitude of the Part, and the Ulcer is in the

right Leg, the Revulsion is to made in the right Arm: but if the rectitude of the Vessels, the Revulsion is to be made in the left Leg.

CXX. 2. To resist the Fluxion by Derivation; which is made in the remote Parts by the appli∣cation of Leeches and Cupping-Glasses, both with and without Scarification, Epispasticks or Blistcring-Plasters, Friction, Bandage, &c.

CXXI. Sixthly, To correct the Humors, and remove the Acrimony: if too serous, to incrassate them; if too thick, to thin them: and this is done by Al∣teratives of a contrary quality, made in the forms of Diet-Drinks, Wound-Drinks, and the like; as we have hinted at Sect. 105. aforegoing.

CXXII. Seventhly, That after the Ʋlceris well digested, and yields a good sort of Pus, Mundificatives are to be applied: (for if Sarco∣ticks are used before the Ulcer is well digested and cleansed, then spongy or proud Flesh will grow:) and these Mundifiers must not be too sharp; which Error you will easily find out by the pain in the Part, which the Patient by feeling can inform you of.

CXXIII. Eighthly, In the curing of the Ʋlcer, you may know whether you have rightly proceeded, and according to Art, by the Effects of the Medicaments applied: for if they do good, or at least no hurt, it is a sign that they are proper to the Intention: but if they do harm, by making the Ulcer hotter or colder, drier or moister, or prevent not the corroding of the Humor; then they are to be changed, and others more agreeable are to be applied.