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 ...

I. The Cure of a Fistula of the Brest.

VIII. The Cure is perform'd by the general precepts aforegoing: as, 1. Good and proper Diet. 2. Pe∣ctoral Decoctions and Diet-drinks, 3. Proper Topical applications.

IX. As to the Diet, if there is neither Hectick nor Marasmos, a greater variety of Meats may be permitted; than when these Symp∣toms are present: but let the Food be easy of Digestion, and which may give good and strong nourishment, of which let the Patient Eat moderately: for Bread, Bisket is to be chosen, and for Meat the Flesh of Birds, and other Flesh easy of Digesti∣on, which ought always to be drest by roasting; and let his Drink be some of the following Decoctions, which may some∣times be mix'd with a little Wine.

X. As to the Pectoral Decocti∣ons and Diet-drink••, we shall chief∣ly furnish you out of Franciscus Arcaeus: but these following Simples are chiefly commended, out of which you may make a Choise, and form what Diet-drinks you please.

XI. The chief Vegetable Sim∣ples. Agrimony, Alheal, Adders Tongue, Alkanet-root, Aniseeds, Angelica, Avens; Bawm, Bishops-weed, Bistort-root, Borrage-roots and flowers, Burdock-roots, Burnet; Caraway-seeds, Catmint, China-root, Catechu, Cinkfoil, Clowns Woundwort, Colstfoot-roots and flowers, Comfrey-roots, Coriander-seeds, Currants blew; Dead-net∣tle, Devilsbit, Dill-herb and seed; Elecampane-roots, Eryngo; Fen∣nel-roots and seeds, Figs blew, Fluellin; Germander, Guajacum∣and bark; Horehound, Hyssop; Jamaica-pepper, Juniper-berries; Ladies-mantle, Liquorice; Mai∣den-hair,

Mint, Mallow-roots and flowers; Origanum; Parsley roots, leaves and seed, Pellitory of the wall; Raisons of the Sun, Rhu∣barb; Sarsaparilla, Sassafrass, Sanicle, Scabious, Selfheal, Speed∣wel; Tansie garden and wild, Tormentil; Valerian, Violet-leaves; Winters Cinnamon, Wood-bind; Yarrow; Zedoary.

XII. Franciscus Arcaeus his Pectoral Apozem. ℞ Pearl or hull'd Barley, Raisons stoned, Ana. M. iv. Bugloss-roots bruis'd and cut, M.iii. Carduus ben. M. ii Parsley-roots cut and bruis'd M. i. Cumin-seed ℥ii. Liquorice cleansed and bruis'd ℥jss. Jujubes N^o. xx. Damask Prunes, N^o xv. Water lbxiv. boil to the consumption of a third part, and strain out strongly: to which add Sugar Penides, Sy∣rup of Roses, Syrup of the two open∣ing Roots without Vinegar, A.℥iii. white Sugar lbss. Cinnamon ʒiss. mix, and make an Apozem.

XIII. Of this he advises to take ℥xii. two or three times a day, (as Morning, Noon, and Night:) It will, says he, help the diffi∣culty of breathing, (which all these kind of Patients have) for it stops the flowing down of the Humor, corrects and purges the Blood, and does withal suffici∣ently nourish the Body.

XIV. But he advises, that every day the Body be evacuated, either naturally, or by help of some Emollient or Lenitive Clyster, that he eat the Flesh of a Chick or Pullet, boiled with Parsly-roots and Cinnamon, (but Roasting is better) and eat Almonds (blanched) and Raisons sto∣ned, both after Dinner, and af∣ter Supper.

XV. When this Decoction is done, and drunk all up, his Body (says he) may be gently purged with Pil. Aggregativae cum Aga∣rico, that the Humors which are concocted and moved, may be eva∣cuated or cast forth: Afterward he would have this following Diet-drink prepared, with which he says the Patient will be per∣fectly cured, and brought to a good habit of Body.

XVI. The Diet-drink. Take very thin and soft raspings of Gua∣jacum ℥viii. Bark of the same ℥x. Liquorice scraped and bruised ℥ii. Aniseeds, Cumin-seeds, A. ℥jss. Raisons stoned M. j. Water lbxii. Wine lbxii. mix, and boil till a third part is consumed; add dried red Roses M. j. Hermodacts well bruised ℥ii. boil them again a lit∣tle, then removing the Matter from the Fire, let it cool and stand till the next day; then strain off, first the clear, which keep by it self; the remainder strain out by expression, and keep it in another Vessel by it self.

XVII. The first straining he is to take instead of Drink at Dinner and Supper: but of the latter straining, which is the thicker, he is to take ℥vi. every Morning fast∣ing, and every Night going to Bed, cold in the Summer time, but warmed in the Winter. And to the former Jaeces, fresh Wa∣ter and Wine may be put, of which a second Decoction may be made, for his ordinary Drink.

XVIII. This Decoction, says he, is able of it self to nourish and maintain, as also to make fat, tho' the Patient only eats Raisons, yea, tho' he be in a Continual Fe∣ver,

or in a Consumptitn: but then he must be utterly forbidden all other Drink, for this Liquor has great strength in it self, and is able to support the Patient.

XIX. If he is very weak he may eat the Flesh of Birds, or Mutton, or Kids Flesh, twice a day; otherwise if he be strong, and in a good habit of Body, he may eat Flesh but once a day, and at Night Raisons only and Bisket; and if he can forbear Flesh, it will be yet better that he eats only Raisons and Almonds, or Bicket at every Meal in the day: this Course he may pursue for 10 or 12 days: and after 30 days are past, he may eat Flesh once or twice a day, as he sees fit, but all the while keeping his Bed, even (if need require) till the fortieth day.

XX. But if the Fistulous Pa∣tient has an Hectick Fever, the former Diet-drink must be wholly forborn; or if it is given, then things which cool and moisten also, must be given with it, as Barley, Borrage, Bugloss, Cowcumer, Lettice, Purslane, Spinage, Suc∣cory, Sorrel, &c. also Emulsi∣ons made of Decoction of hull'd Barley, or Almond Milk with Almonds, Seeds of Pompions, or Melons, Muskmelons, Citruls, Cucumbers and white Poppies, &c. Philonium Persicum, Syrup of white Poppies, red Poppy-water, with Juices of Citrons, Limons, &c. mixed with white Sugar.

XXI. If there be a Marasmus con∣firmed, which is an immoderate dri∣ness, with a vehement Consumpti∣on of the whole Body, (known by the Eyes grown hollow, and hid as it were in their holes, fading of the lively Colour of the Skin, the Forehead dry, and the Skin stretch∣ed like the head of a Drum, the Eye-lids heavy, and scarcely able to open, Temples hollow, Face thin, with the Jaw-bones sticking out, the Cheeks consumed, the Lip and Chin thin, as if nothing but Skin covered the Jaw-bones; the Brest nothing but Skin and Bones, and the Cavities of the Brest and Belly hollow, and as if no Vifcera or Guts were contained in them, the Muscles being so consumed, and the Cavities so drawn in, that nothing but the Fibres and Skin seem to remain, and the whole Man seems only to be a living Skeleton:) in this case the Physician ought to attempt nothing, for the Pati∣ent is incurable.

XXII. But if the Marasmus it only in the beginning, known by the Skin becoming flagey and loose, agi∣lity and strength decaying, faint∣ness of the Spirits, with a mani∣fest defect and impotency in all the actions and functions of the Body, Animal, Vital, and Natural: I say, in this case there may be some hopes, and therefore a Restorative Diet is to be appoin∣ted, which may repair or re∣store the wasted Radical Humi∣dity.

XXIII. Let him have strong Broth and Jellies made of Chic∣kens, Mutton, Veal, Beef, Legs and Knuckles of Pork, Sheeps Trotters, Calves and Neats-feet, wherein Juice of Citrons or Li∣mons is to be put. Or they may be made with Damask-Prunes, Raisons of the Sun stoned, blue

Currants, Pippins, Pearmains, &c. Chicken-broth is also good, or Broth of hull'd Barley, and Almond-milk may be made with either of them, of which he may eat between Meals; drinking al∣so Asses, Mares, or Goats-milk, or instead of them Cows-milk, sweetned with Sugar of Roses: And let him now and then eat the Flesh of a Pig, or young Pork, Poached Eggs, Chickens, Lamb, Veal, Mutton, sweet Butter, Cream-cheese, Smelts, Whitings, Perches, Pickrells, Trouts, Flounders, Soles, &c. according as his Stomach and Appetite most desires, eating all these things by turns, in a per∣petual change of Diet.

XXIV. As to sopicks, these things (over and above the general method) are to be observed: 1. You may safely ditate the Fi∣stula with a Fistula-Tene, and Sponge: but in removing of the Callus you must be very careful; for if you apply the Pastils or Troches, they must not reach to the Cavity of the Brest, lest the point of it break off or melt, and so full upon the Septum Transversum, which it will erode, and so cause an Inflammation, a sharp Fever, a Paraphrenitis, and at last Death it self.

XXV. 2. That the Tent be armed with Populeon, wherewith the Fistula-pouder is to be mix∣ed, as has been before declared.

XXVI. 3. That the Callus be∣ing removed, the Ʋlcer is to be deterged with Mel Rosatum, mix∣ed with Aqua Calcis: but you must beware that you inject no Bitter Medicaments, because they are easily drawn in by the Lungs, from whence by the Aspera Arteria, they easily come to Throat and Mouth, by which a vehement Bitterness is felt, as Paraeus lib. 9. cap. 14. twice observed, thereby provoking Vomiting, and hurting the Ap∣petite, both which are obnoxi∣ous to this Cure.

XXVII. 4. The Ʋlcer being deterged, you must then consolidate, for Sores in this Part are not to be kept open long: You may inject Syrup of dried red Roses mixt with Comfrey, Plantane or Rose Water, laying a Pledger moistned in the Syrup over it, and over that Sticticum Paracel∣si, because it draws the Lips to∣gether, and skins also.

XXVIII. But if the bottom of the Fistula is lower than the Ori∣fice, a lower Orifice is to be made by Inciston. The left side is safer than the right; because in this side, the Liver by its Gibbosity, bears up the Diaphragma, and insinuates it self into the Cavity of the Thorax; so that if either of these should be wounded, Death may be supposed sudden∣ly to ensue.

XXIX. As to the Point it self which is to be opened, it may be about the beginning of the next Rib, and not at the lower end of that Rib, above which the Orifice of the Fistula shews it self, be∣cause under it are placed an Ar∣tery, a Vein, and a Nerve.

XXX. First divide the Skin towards the upper part of the lower Rib, then make way thro' the intercostal Muscles; this done, dry all things with a Sponge,

and put into the new Orifice a Tent of prepared Sponge, both to delate it, and to draw to it self the Quittor: If you do thus, not passing any farther than the division of the Pleura, so that neither the Diaphragma, Lungs, or Perlcardium, be touch∣ed, you will be safe.

XXXI. Or you may according to Aquapendens, run a crooked Silver Pipe into the Fistula, so that its end may touch the bot∣tom, thro' which pass a long Nee∣dle threaded with Silk; being drawn through, tye the ends of the Thread together: This Thread you may dress with some Corrosive Water, Lini∣ment, or Ointment, so long till the Callosity is removed; and then you are to Cure it after the manner of a simple Ulcer: But during the whole Cure, the Pa∣tient is to drink plentifully of a good Pectoral Diet drink, &c.

XXXII. And among the Re∣medies very powerful in this Case, are, Anisated Balsam of Sulphur, Powers of Anise and Fennel-seeds, and Sassafras, Tinctures of Anti∣mony and Coral, Volatile Sal Ar∣moniack, Salt of Hartshorn, Ens Veneris, Spirit of Wine, Balsam de-Chili, &c.

XXXIII. Scultetus, Tab. 39. Fig. 4. shews us the Incision of a Fistula of the Thorax. It was done suddenly, and almost in a moment, with a Syringotomos, the point of which was wrapt about with a small Ball of Wax, that when it was thrust in, it might not rend, or prick the Flesh.

XXXIV. This armed Instru∣ment is to be thrust into the Fistu∣la, and when it comes to the bot∣tom of it, it is forced thro' the Skin and Flesh with the right Hand, so that the Ball of Wax, remaining in the Ʋlcer, the point of the Knife may come forth by the hole made, which being laid hold on by the Fingers of the left Hand, the distance between both holes is cut asunder at one stroke.

XXXV. The Syringotomos is a crooked Knife or cutting Instru∣ment, which upon the inside (a) has an edge, under the other side (b) it is blunt, or with a round back, and at the small sharp end (c) it both pricks and cuts.

XXXVI. This Instrument is chiefly used in all Parts of Fistula's having but one passage, that the end or bottom of the Fistula may be perforated, and the space be∣tween each hole cut asunder, as a∣foresaid, the point thereof being first armed with a Ball of Wax, that it may go to the bottom without any hindrance or hurt. See Tab. VII. O.P.

XXXVII. An Observation from Scultetus: The Fistula was in the Right side, and left by the Chirurgions of Hailbron as despe∣rate. Generals being premised, the narrow Orifice was dilated with Elder-pith prepared, till it would admit of the round Probe, wherewith he felt the Bone rough. To consume the Callus, he put in a Style dipt in this Ointment. ℞ Henbane seeds pou∣dred ℈i. burnt Alum, calcin'd Vi∣triol, A. ʒss. Butter washed in Plant ane-water q.s. mix, and make an Ointment.

XXXVIII. The Callus being re∣moved,

he put a Tent into the Fi∣stula, moistned on the top of it with a Decoction, and then sprink∣led over with Euphor bium poudred, the rest of it he covered with this Ointment. ℞ Ʋng. Beto∣nicae ℥i. Aegyptiaci ℥ss. mix them: This hinders the breeding again of any Callous Substance.

XXXIX. After two Months the Ribs threw off Scales, which being taken out, he diminished the Tent every day, and dipt it only in the Ung. Betonicae, till the Ʋlcer was incarnated; after which it was cicatrized with Ceratum Di∣vinum, the Sick in the mean time taking a Purging Wine.

XL. Another Observation from the same Scultetus. The Fistula was above the left Clavicle, with a very small Orifice. It was dilated (the Body being prepared and purged several times very well) with a Tent made of prepared Gentian Root, viz. cut into the shape of a Tent, and dried upon a Stone, with a Thread fastned to one end of it.

XLI. This was put into the hole, and kept in with a Plaster of Diapalma with proper bandage, for 24 hours; then the Tent was drawn out with a pair of Pincers: It was swoln with a bilious Matter, and black at the end; but searching into the Cause, the Bone was rough and moveable.

XLII. It was again Tented with a bigger Root, as aforesaid, (the Parts about being defended against Inflammation) an the third day with another bigger Tent, till the hole was big e∣nough to take out the Bone, which wat almost separated.

XLIII. The sixth day, the Fi∣stula was filled up with Buttons made of Sponge, fastned to a Thread, which did hang out of the hole, over which was put a Plaster, and Brest-plate Ban∣dage.

XLIV. The Sponge-buttons were thus prepared. Take a new Sponge never wetted, and dip it into an equal quantity of Wax and Rosin melted together, then press it strongly in a Press, letting it alone till it is cold; then take it from the Press and dry it in the shade, cutting it out into round Buttons, and fastening them to a Thread.

XLV. The seventh day, the Sponges were taken out, and the Fistula being very open, the Bone was taken hold of with a pair of Forceps, and drawn forth with very little pain.

XLVI. The eighth day, the Blood being stopped, there was sprinkled upon the naked sound Bone, this Pouder. ℞ Roots of round Birthwort, of Hog-fennel, of Orrice, A. ʒi. Myrrh ℈ii. Eu∣phorbium ℈i. mix them. This was applied with dry Lint, till the Bone was covered over with firm Flesh.

XLVII. The Ʋlcer was daily cleansed by sprinkling refined Sugar in pouder upon them, which does also mitigate Acrimony, and at length it was Cicatrized with Diapalma.