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. III. Of SIMPLE ƲLCERS.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and the Latins Ulcus simplex, we in English call A Simple Ulcer.

II. The Kinds. Authors make two kinds of simple Ʋlcers: 1. One, where the Skin is only wanting. 2. Another, where there is a loss of Flesh also. The first is called planum, a plain Ulcer; the other cavum, a deep Ulcer. We shall consider them in the Cure but as one, for that the Cure of the former is compre∣hended in the latter.

III. Now a simple Ʋlcer, which is a solution of Ʋnity in a soft Part, with a dissolution of Magni∣tude putrified, is that which has neither a Disease, nor a Cause, nor a Symptom adjoined to it, or complicate therewith; be∣sides the solution of Unity, caused by erosion.

IV. The Kinds. The proximate, or nearest cause of an Ʋlcer is, a matter which has in it a cor∣roding quality, whether it is bred in the Body, or happens to the Body from without.

V. If this corrosive Humor is bred within the Body, it is gene∣rated either without the Part affected, or within the Part af∣fected it self: if without the Part affected, it is either a Cholerick Humor, or Atra Bilis, or Melancholy, or a salt Phlegm, or a salt, nitrous, and sharp Serum, which you may know by their particular Signs: these flowing unto any Part, may cor∣rode and exulcerate it.

VI. If the corrosive Humor is generated in the Part affected, it obtains its acrimony in the Part it self, by reason of some dis∣temper in the said Part, thro' a Blow, or Fall, or Overstraining the Part; whereby the Blood or some other Juice is extravasa∣ted; where by its long aboad and digestion, it becomes sharp, and so grows sharper and sharper, 'till it corrupts, putri∣fies, and becomes corrosive.

VII. But if its Cause hap∣pens to the Body from without, it is from septick, putrifying, or caustick Applications, whether they be Actual, or Potential. Or from Contagion; as in the Venereal Disease, Phthisis, Leprosy, Itch, &c. where the Virus or Poison is communicated by con∣tact, to the Pores of the Skin, where entring them, it exul∣cerates it, and there generates the like Disease.

VIII. The Signs. External Ʋlcers are manifest to sight and touch, so that they may be known without any other Signs: but the internal ones, which lye hidden, are known by the Probe, if way is made to search for them; or by the Excrements flowing from them, the Pain, and

hurt of some Action of the Part.

IX. The Excrements shew the Part affected, Pus, corruption or rotten Filth flow forth by the Anus, Urinary Passage, Nostrils, Mouth or Ears.

X. The Pain shews also the Part affected, and where the Ʋlcer lyes hid: a pricking pain shews, that the Part affected is nervous: a beating pain, that an Artery is hurt.

XI. The Action hurt, shews al∣so the part: if Sense or Motion is hurt, it shews, that the Nerves are hurt: if after eating, the Concoction is hurt by a vehe∣ment gnawing Pain in the Sto∣mach, it is a sign that the Sto∣mach is exulcerated.

XII External Causes do also give us some Signs: if Canthari∣des be taken inwardly (without due proportion and correction the Reins, Bladder, or Urinary Parts may be ulcerated: if sub∣limate Corrosive, Aqua Fortis, or Oil of Vitriol, be taken inwardly alone, without mixture or cor∣rection, the Throat, Gullet and Stomach, may be exulcerated.

XIII. The Prognosticks. If the Ʋlcer is only in the skin, or is only superficial, it is the more easily and speedily cured: but the deep∣er it is, and the more noble the Part, by so much the longer it is in curing.

XIV Ʋlcers in the Extremi∣ties of the Muscles, or in Parts sub∣ject to much Humidity, are more difficultly cured than those which are in the middle of the Muscle, or in Parts dryer.

XV. Ʋlcers Internal are more dangerous than Ʋlcers External, more especially, if any principal Part is drawn into consent or agreement with them, for then they oftentimes end in Death.

XVI. Ʋlcers in Cacochymick Bodies are tedious in curing; so al∣so if being cured, they break out again: for then it is much to be feared, that the Bone under is foul.

XVII. Ʋlcers near to, or upon Arteries, Veins, Nerves, or Ten∣dons, or any Parts of exquisite Sense, are dangerous; for they are able to draw into consent with themselves other Parts of an exquisite Sense also, or to induce an Inflammation.

XVIII. Ʋlcers old and invete∣rate, are not cured without danger and tediousness, more especially if they succeed other Diseases, unless the Body is well purged, and a good order of Diet be ob∣served.

XIX. If the Pus or Matter flowing forth is good, which is that of a middle consistence between thin and thick, white, light, equal, and not at all stinking; it gives hopes of an easy Cure: but if it is evil, thin and fluid, ill coloured, li∣vid, and foetid, it shews danger and difficulty in the Cure.

XX. If the Ʋlcer is great, be∣cause the external Air can work up∣on it; or if round, because then it's lips are hardly united; or, if it tends to look green, or livid, or black, because then, it shews a danger of extinguishing of the natural Heat; in all these cases, there will be either difficulty or danger, or both, in the Cure.

XXI. The Indications. 1. You must rectify the Cacochymie by due

Purging, and a fit Diet. 2. You must maturate the unperfect Mat∣ter by Digestives. 3. You must cleanse it from it's Filth by Ab∣stersives. 4. You must incarnate with Sarcoticks. 5. And lastly, You must produce the Cicatrice with Epuloticks.

XXII. The Cure. In Answer to the first Indication, you must purge with our Family Pills, Pil. Pan∣chymagogae, Catharticae; and if the Ulcer is inveterate, you may mix with the Purge Turpethum Mine∣rale, or the Princes Pouder, gr. ii. iv. or vi. after taking of which for three or four times, the Pa∣tient may purge again with Our Elixir Vitae, or a strong Tincture of Sena, or of Sena and Rhubarb in S.V. mixt with equal parts of Nitrated Water.

XXIII. Then the Patient may sweat with Tincture or Diaphore∣tick of Antimony, or Tincture of Tartar and Bezoar Mineral given in fragrant Wine, or in the Sudo∣rifick Tincture of Paracelsas. Or (which is best of all) you may sweat with our Liquor Vitae, or with Guttae Vitae, mixt with a few drops of Spirit of Sal Armoniack, or Spirit of Hartshorn, given in a Glass of Sack: giving conti∣nually thro' the whole Cure, for a constant Diet, some proper Traumatick Decoction.

XXIV. The second Indication, is the perfecting the unperfect Matter with Digestives. But you are to consider, whether it is necessary to use Digestives or no, by con∣sidering the temper of the Part ulcerated; for some Ulcers are in so good a condition at first, as to stand in no need of them, and then we immediately apply our selves to Abstersives for clean∣sing.

XXV. But then if we find the Ʋlcer requires this second Indica∣tion, you may apply to it some of the Digestives mentioned in the former Chapter; Or this, ℞ Tur∣pentine ℥i. mixed with the yolk of an Egg: Saffron in Pouder ʒss. Wheat-flower, q.s. mix them. This or Basilicon, you may say upon Lint, and apply.

XXVI. But in dryer Bodies, (says Wiseman) you may add to the former, Barley flower, Bean-flower, Colophony, Rosin, Frankin∣cense, Pouder of Faenugreek seed, to which sometimes Honey of Ro∣ses and Syrup of dryed Roses, are added: but (says he) Basilicon is not inferior to any.

XXVII. These Medicaments ought to be of a moderate consisten∣cy, not too liquid, lest they make the flesh to lax; or run off from the Pledgits, making the Sore uneasy; nor yet too hard, lest they comply not with the form of the Ulcer. The deeper Ulcers may admit of the more liquid, that they may reach to the bottom, and they may be applyed upon Lint in the form of Pledgits, Dos∣sils or Tents, over which may be applyed some Refrigerative Empl. as Diapalma, Empl. Al∣bum, to temper the Heat of the Part.

XXVIII. They ought also to be of a Lenient Quality, temperately hot and moist, in proportion to the habit of the Body as it is Strong or Weak, and to the tem∣per of the Part they are apply∣ed to.

XXIX. Sennertus thinks, that sometimes it is not good to use Di∣gestives alone; but to mix Ab∣stersives with them, however to vary the Medicine according to the Constitution: in a soft and moist habit, use this: ℞ Tur∣pentine ℥ii. Oil of Roses ℥i. Yolk of one Egg, mix them. In a dry habit this: ℞ Pine Rosin, Oil of Mastich, A. ℥i. Pouder of Oliba∣num, and Mastich, A. ʒiss. mix them.

XXX. Or this: ℞ Honey of Roses, juice of Smallage, A. ℥i. Turpentine ʒvi. Pouder of Frankin∣cense, Barley-flower, A. q.s. mix, and make a Liniment.

XXXI. If you anoint the Parts about, with Triapharmacum and Ung. Populeum mixed together, you may prevent Fluxion and Inflammation.

XXXII. The third-Indication, is the removing of the Pus or Mat∣ter, which is done by Abstersives; and this is done by such Medica∣ments as we have described in chap. 2. sect. 27. ad 36. afore∣going.

XXXIII. Digestives are no long∣er to be made use of, than till the Matter is well digested: for be∣ing used too long, the Ulcer may be made sordid. In these kind of Ulcers, says Wiseman, I have frequently digested, deterged, and incarned with Ʋng. Basilicon, mixed with red Praecipitate.

XXXIV. This Abstersive is also commended. ℞ Oil Olive, Rosin, Wax, A. ℥vj. Ship Pitch, clear Vernish, A.℥iv. Gum Elemi, Beef-suer, Turpentine, A. ℥iii. Ma∣stich, Myrrh, both in Pouder, A. ℥i. White Praecipitate, ℥iss. mix, and make an Ointment.

XXXV. The fourth Indication is the filling the Ʋlcer up with Flesh, by the help of Sarcoticks; such as we have described in lib. 4. cap. 2. sect. 31. ad 46. and in cap. 2. sect. 38. ad 52. aforego∣ing.

XXXVI. Sennertus commends this: ℞ Turpentine, Frankincense, A. ℥i. Aloes, Colophony, Mastich, Myrrh, A.℥ss. Gum Elemi ʒii. mix, and make an Ointment.

XXVII. But you ought to make a choice of such Medicaments as are most fit and convenient for each se∣veral and particular Constitution; for the moister the Body is, by so much it requires Medicaments that are less drying and Abster∣sive; and contrariwise, the more dryer it is, the stronger and more drying sort of Remedies: if they are weaker than is fitting, great store of Sanies will be ge∣nerated with a loose and flaggy Flesh: if they be overstrong and drying, the Ulcer will be ren∣dred dry, its lips red, the flesh consumed, and sometimes the Recrements bloody, with a kind of biting in the Part.

XXXVIII. And therefore the form of the Medicaments are some∣what to be considered, and they are wont to be applyed either liquid, or soft, or dry: in Bo∣dies hard and dry, and when a harder Flesh is to be generated, Sarcotick Pouders are to be sprinkled upon the Ulcer: As,

XXXIX. ℞ Frankincense, ʒiv. Colophony, Sanguis Draconis, A. ʒii. Mastich, Olibanum, A.ʒi. mix, and make a Pouder. ℞ Frankincense ʒvi. Aloes ʒiv. Dra∣gons Blood, Sarcocol, Olibanum,

A. ʒiss. make a Pouder.

XL. You are also to consider the season of the Year; for in a hot season, more cooling Applications are required; and in cold wea∣ther, the more heating; so that at such times, a thicker Compress is to be applyed, and the Rowler to be oftner wound about, than in hot weather.

XLI. Wiseman has this Sarcotic. ℞ Venice Turpentine ℥iv. Fran∣kincense ℥i. Aloes, Myrrh, A. ℥ss. Gum Elemi ʒiii. Oil of Hypericon, q.s. mix, and make an Ointment. The more drying Sarcoticks (says he) are, Roots of Orrice, round Birthwort, Meal of Lupins, Asafaetida, Sarcocol, made up with clarified Honey.

XLII. If these Medicaments be well adapted to the nature and dis∣position of the Ʋlcer, the Pus or Matter will appear of a good consistence, and in a less quan∣tity; and the Flesh will be of a natural colour, firm, and in a healing condition.

XLIII. The fifth and last Indi∣cation teaches, the Cicatrizing of the Ʋlcer after it is sufficiently In∣carnated, and this is done with Sarcoticks, such as we have de∣scribed in lib. 4. cap. 2. sect. 47. and in cap. 2. sect. 53. and 58. ad 62. of this Book aforegoing.

XLIV. The Ʋlcer then being filled with Flesh, it remains now to be covered or cloathed; the co∣vering of the flesh is the Skin; and as flesh lost is to be resto∣red, so is the Skin which covers it: but the Skin being said to be a Seminal Part, it being lost, it is no more to be restored, be∣cause the Matter of which it is made is wanting: therefore we are forced to find out a Medium, which is called Cicatrix, being a soft kind of a Callus, and is no∣thing else but the superficies of the flesh so dryed, as to tepre∣sent the Skin: and as good blood is the material Cause of good flesh; so good flesh is the mate∣rial Cause of a good and pleasing Cicatrix.

XLV. The making of this Cica∣trix is the work of Nature, yet it is furthered by the applicati∣on of proper Epulotick Medi∣caments: and if the tempera∣ment of the Part is healthful or well-disposed, you will observe the Ulcer to begin to skin from the Edges, while it is filling with flesh within.

XLVI. The milder Epuloticks are, fine Bole, Chalk, Oyster∣shells burnt, Dragons-blood, red Roses, Balaustians, Lime washed, or Whiting, Ceruse, burnt Lead, Tutty, Sumach. A mixture of these may be sprinkled upon the Ulcer, or a Decoct. of them ap∣plyed upon Lint.

XLVII. The stronger are Alum, Saccharum Saturni, Vitriol com∣mon and Roman, Brass burnt, Chalcitis, scowrings of Brass or Iron, Verdigrise, Crocus Martis Astringens, Sarcocol, any of which being in Pouders, may be mixed with Ointments, and ap∣plyed upon Lint; but beware, that by the use of them, you do not consume the flesh instead of drying it into skin.

XLVIII. Among Compounds, that of Fallopius is much com∣mended, also Diapalma, or Em∣plastrum Album: and Heurnius

his Cerate mentioned in Meth. ad prax Med. lib. 1. pag. 108. of the Octavo, Rotterdam Impression, which is thus composed: ℞ Oil Olive Omphacine, Hogs-lard, Li∣tharge, A. ℥iii. Wax, Pitch, A. ℥iss. Rosin ℥ii. Ceruse ʒvi. Pou∣der of Lead ℥i. mix, boil over a gentle fire, and make a Cerat.

XLIX. Sennertus has this Pou∣der: ℞ Roots of Tormentil, Bi∣stort, round Birthwort, Acorn-cups, Egg-shells burnt, Frankincense, Dragons-blood, A. ℥i. Lapis Ca∣laminaris ʒii. Litharge ℥ss. make a Pouder.

L. And he used this Empl. with good success. ℞ Empl. Album, or Diapalma, Empl. Gry∣seum. Ʋng. Diapompholigos, A.℥i. Gum Elemi, ʒii. Saccharum Sa∣turni ʒi. Wax, q.s. mix them.

LI. The time when these Epulo∣ticks ought to be applyed, is when the flesh is grown up, almost to the lips of the Ʋlcer, before it is wholly filled up, lest before the Cicatrice should be produced, the flesh should receive too great an encrease.

LII. When the Ʋlcer begins to incarnate, you may dress it two or three days, with dry Lint only; and then two or three days with Ointment, and then with Lint again, laying over it Empl. Al∣bum, or Diapalma.

LIII. You are not to suffer the Ʋlcer to be round, for so long it will never heal: and if the lips of it grow thick, they are to be scarified with a Lancet, to let out the gross Blood which hin∣ders the Healing.

LIV. And since good Diet makes and preserves a good habit of Body, and a good temper in the Part, all those meats and drinks which make the Blood too hot, too sharp, too thick, or too thin, are to be shun∣ned; and those only to be cho∣sen which breed good Juice, and are easy of Concoction; and they are to be taken moderate∣ly, and at convenient or fit times.

LV. The Part it self must be kept quiet, for motion heats and disturbs it: if the Ulcer is too moist, enjoin Watching, because Watching dries the Body, and consumes superfluous Humidi∣ties: if it is too dry, sleeping moistens the Parts, those chiefly which are nervous, as Mem∣branes, Tendons and Liga∣ments.

LVI. If the Belly is costive, move it with a Clyster, or a Dose of Elect. Lenitivum, or some such like: and let the Mind be kept as much as may be, in tranquility, and free from perturbations.