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. IV. Of ULCERS with DISTEMPER.

I. WHat the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latin, Ulcus cum in∣temperie, we in English call, an Ulcer with Distemper.

II. The Kinds. It is either simple, or compound. The simple is fourfold, viz. hot, cold, moist, dry. The compound are, hot and moist, hot and dry; cold and moist, cold and dry.

III. The Causes. A hot In∣temperies or Distemper, may be caused from a fermentation of the Serum in the Blood, which may arise from an ill habit of Body, ill Diet, or the like; or from heat of the Air, or keeping the Part too hot; or from too hard Binding, or too sharp Medica∣ments.

IV. A cold Intemperies or Di∣stemper may be caused from the too great quantity of Flegmatick Hu∣mors, or the too much exposing it to the cold Air in dressing; or not defending it in cold and sharp weather, with warm Cloths and good Bandage; or from ap∣plying Medicaments too much cooling.

V. A dry Intemperies or Di∣stemper, may be caused from ex∣hausting of the natural Heat in Chronick Diseases, or in any hectick habit of Body, from too sparing a Diet, want of Drinking, defect of Nourishment in the Part, &c.

VI. A moist Intemperies or Di∣stemper, is caused from a Flux of Humors, or much Humors abound∣ing in the Body, a moist habit of Body, an hydropical Disposition, weakness of the Part affected, from a long continuance of the Ulcer, hard Bandage, or too moist and slabby Medicaments; or from want of Bandage, or moist, wet and foggy weather.

VII. The Signs. A hot Distem∣per is known by the heat of the Part exulcerated, of which the Patient complains; the Parts a∣bout the Ulcer will be red, hard, and Tumified; the Matter will be sharp, pricking, and some∣times an itching is also felt in the Part: hot Medicaments ap∣plyed, increase the Heat and Pain, whereas if cold Medicines are used, the Patient is mightily refreshed, and benefited withal.

VIII. A cold Distemper is known by the pale, and sometimes li∣vid colour of the Ulcer, and Parts about it; the Flesh in the Ulcer is whitish and loose, and the Sick complains also of cold, there being mostly withal, a cold habit of Body: and the Patient finds much good and ease in the ap∣plication of hot Medicaments.

IX. A dry Distemper is known from a dry habit of Body, for the most part going before; the co∣lour of the ulcerated Part is ill, and not lively; the Body is lean and dry, and so also the Mem∣ber

or Part diseased; the lips are thin and lank, with little moi∣sture, and in touching the Ulcer, it seems hard and dry, for that little or no Matter flows from it.

X. A moist Distemper is known from a moist habit of Body, watry Humors abounding, too much humidity in the Ulcer it self, the flesh is luxurious and flaccid; there is a great discharge of Ex∣mentitious Humors, and the Hu∣mor which flows is not acrimo∣nious.

XI. If the Intemperies or Di∣stemperature is compound, the Cau∣ses and Signs thereof are found our, and known from the Causes and Signs of the simple Distemper, by laying the Causes and Signs of each together.

XII. The Prognosticks. All Ʋlcers labouring under an Intem∣peries, tho' they be never so well handled, yet they are hard of Cure, and may be truly accounted a∣mong such as are stubborn or re∣bellious.

XIII. And Galen, Meth. Med. lib. 4. cap. 1. says, That for heal∣ing of Ʋlcers, the Flesh subjacent ought to be wholly temperate; and therefore it is, that Ulcers with distemper of the Part lying next under, are cured with some difficulty.

XIV. Ʋlcers with Distemper, hot, cold, or moist, are cured with less difficulty than those with Dry∣ness; for with one and the same labour, with the same Medicines, and at the same time, we may both remove the Distemper, and cure the Ulcer.

XV. But Ʋlcers with a dry Distemper, are the hardest of them all to be cured, because the cure of the Ʋlcer must be for a while neg∣lected and laid aside as it were, and the whole Intention must be first in removal of the dry Intemperies: and the Cure is also long in ef∣fecting, because the whole habit of the Body requires humecting and altering, which is a work of time, whereas those distempe∣red with heat, cold or moisture, may be cured, whilst you are re∣moving the Distemper.

XVI. The cure of an Ʋlcer with a hot Distemper. The Indicati∣ons of Cure, are the same with those of a simple Ulcer, save here, you must add, an alteration of the habit of the Body, or of the Ulcer and Part, or of both, as you see need requires.

XVII. Here you must use Cool∣ers and Anodynes, which you may impose not only upon the Ʋlcer it self, but upon the Parts adjacent round about. Such are Waters, Juices, Oils, and Ointments of Endive, Myrtles, Nightshade, Plantane, Roses, Sanders, Vine∣gar, fine Bole, burnt Lead, Sac∣charum Saturni, Turpentine, Cadmia, Whites of Eggs, Oils of Roses and Violets, Ʋng. Rosatum, Refrigerans Galeni, Album Cam∣phoratum, of Ceruse, of Night∣shade, and of Sanders, &c.

XVIII. Now tho' the Ʋlcer may require drying Medicines, yet since the heat it self, by consuming the Humors, does make the Ʋlcer the more dry, we must make use of the milder and gentler sort of Dryers, but withal such as are endued with some kind of an Astringent Power, and have also an Anodyn property, be∣cause

Heat generally induces Pain.

XIX. Wiseman advises for Topicks, Ʋng. Diapompholygos, Tutiae, Album, è Plumbo, è Calce, Basilicon with Praecipitate, and to apply over the Part affected, Ʋng. Album Camphoratum, Empl. Diapalma cum succis, Empl. Oxe∣laeum, Ʋng. Refrigerans, Nutritum, & Populeon; and over them may be applyed, Cloths dipt in Oxy∣crate, or Red Wine, or juices of Plantane, of Lettice, of Purslane, of Shepheards Purse, mixt with Vinegar or Red-wine, &c.

XX. Some advise to the use of Aqua Calcis vivae, in which some Litharge has been boiled: also to Snow-water, in which a little Vitriolum Album has been dissol∣ved; Or Epsom-water lbi. with which Vinegar ℥iv. is commixed.

XXI. Sennertus advises to this. ℞ Oil of Roses, Turpentine often washed in Rose or Plantant-water, A. ℥i. Barley-flower, q.s. mix, and make a Liniment.

XXII. Or this. ℞ Burnt-lead, Pompholyx (both washed) A.ʒiss. Oils of Roses and Violets, A. ℥iss. Wax, q.s. mix, and make an Ointment.

XXIII. Now these cooling Me∣dicaments are to be imposed, not on∣ly upon the very Ʋlcer it self, but also upon the Parts adjacent to it, and round about it. The hot Di∣stemper being thus removed, the Ulcer is to be cured with Sarco∣ticks, which yet ought to be less heating and drying, lest the hot Distemper should return again.

XXIV. The Cure of an Ʋlcer with a cold Distemper. Here the Ulcer and Distemper may be cu∣red at one time with Healers or Vulneraries: Barbet commends Oils of Hypericon, Nard, Orrice, Cammomil, Rue, Dill, Rosin of the Larch-tree, Plaster of Betony, Spirit of Wine: to these you may add Syrup and Honey of Roses, Rosin of the Pine or Fir, Tar, Pitch, &c.

XXV. And upon the adjacent Parts, you may use a Fomentation of generous Wine, in which Rose∣mary, Sage, Rue, Wormwood, Hysop, Origanu, Mint, Camo∣mil, and Bay-leaves, or Zedoary, have been Decocted, adding a little Spirit of Wine.

XXVI. And to deterge the Ʋl∣cer, Wiseman advises to Mundi∣ficativum ex Apio, Mundificati∣vum Paracelsi, Ʋnguentum Aposto∣lorum: Empl. Diachylon ireatum, de Betonica, Barbarum magnum, Diasulphuris, flos Ʋnguentorum: after which, you may proceed with Sarcoticks and Epuloticks.

XXVII. In this cold Distemper, a good Diet is to be observed, &c. as in Cold and Oedematous Tumors, with Purgations to carry off the Cacochymia, and alterative De∣coctions, to attenuate and recti∣fy the Humors, dressing the Ul∣cer it self the mean while, with drying, heating, and detersive Medicaments.

XXVIII. You may apply (after a heating Fomentation,) Basilicon majus & minus, or Arcaeus his Li∣niment upon Pledgets; and over these Diachylon cum Gummi, or Emp. de Mucilaginibus, or Stipti∣cum Paracelsi; but you ought to observe the Age of the Patient, season of the Year, and magni∣tude of the Ulcer.

XXIX. The cure of a moist Di∣stemperature. In these Ulcers, slabby and greasy Medicaments (says Wiseman) are to be forborn, and drying to be used, for that the Part is weakned thro' too much humidity; and with your Dryers, Corroboratives are to be mixed, of an Astringent Faculty.

XXX. Barbet advises to Cyprus Roots, Hypericon, Betony, Hore∣hound, Sage, Wormwood, Mastich, Frankincense, Ceruse, Red-Lead, Litharge, Burnt-lead, calcin'd Vi∣triol, Emp. Gryseum, de Minio, and other things which are very dry∣ing.

XXXI. If to this Distemper a∣ture, a flux of Humors is joined, then Catharticks, Repellents, and Intercipients are necessary; Issues are also good if the Ulcer is in∣veterate; but no fat, or unctu∣ous things are to be applyed, on∣ly those things which are strong∣ly drying, which ought often to be renewed.

XXXII. To the former things you may add, Catechu, Dittany, Fether-few, Hyssop, Mint, Marjo∣ram, Lavender, Southernwood, Time, roots of Tormentil, Cincfoil, Zedoary, Sumach, Bay, and Myrt∣tle-berries, Nutmegs, Winters-Cinnamon, Cyprus Nuts, Balausti∣ans, Red-roses, Frankincense, Ma∣stick, Saccharum Saturni, &c.

XXXIII. Wiseman advises to this. ℞ Burnt Lead, Pompholyx washed, A. ℥i. Oil of Myr∣tles, Wax, q.s. mix them. Also to the use of Ʋng. Diapompholy∣gos, Tutiae, è Calce, Nutritum, album Camphoratum, and Desicca∣tivum rubrum. Or to this: ℞ Aluminis scissilis ʒss. Cadmia ʒiss. Verdigrise, burnt Brass, A. ʒii. New Wax, ℥v. Sheeps Suet, q.s. mix, and make an Ointment.

XXXIV. If the Ʋlcer requires a Fomentation, it ought to be made of hot and drying Herbs, boiled in Wine or Oxycrate, adding after a little Spirit of Wine: if the Ul∣cer is but a little moist, you may to the stronger sort of the for∣mer Dryers, add a little Oil, with Rosin and Wax: but by how much the moister the Ulcer is, by so much the more sorcible, and strongly drying, ought the Re∣medies to be.

XXXV. Some advise to the use of Aqua Calcis vivae, in which Litharge has been boiled; and Water mixed with S.V. in which white Vitriol, or the common Coppe∣ras made of Iron, has been dissol∣ved. In a Quart of Red-wine you may dissolve ʒii. of Roman Vitriol, or ʒii. of common Vitriol or Alum: this common Copperas (which is made of Redriffe of Iron) is an excellent Desiccative, and very fit for the Cure not only of com∣mon Ulcers, but of those which are in the Eyes, Nose, Mouth, Throat, Bladder, Intestinum Re∣ctum, &c.

XXXVI. The Cure of an Ʋlcer with a dry Distemperature. In this you must abstain from dry∣ing Medicaments, till the Di∣stemperature is wholly gone, and apply your self to Moisteners. Now this is removed by a two∣fold, but differing means:

XXXVII. 1. By Attraction, drawing out the innate humidity to the Part affected, by opening the Passages, which before by reason of the great Dryness, were closed;

and this is done, partly by Dro∣paces, and partly by Friction: but this is of use only when other means will do no good.

XXXVIII. 2. By humecting or moistening; and this is done, 1. By fomenting with fair Wa∣ter, luke-warm; which is done with a Spunge, or Flannel, which is the most convenient way of moistening the Part; pouring warm Water on, or bathing in it, is not so proper. 2. By fomenting with Water and Oil; which, (says Sennertus) is far better, being used blood∣warm together; and they are much better, being used thus together, especially in Winter∣time.

XXXIX. This Mixture of Wa∣ter and Oil is called by the Ancients 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Hydrelaeum: Take Water two parts, Oil one part, and mix them: or, Take Water, Oil, A.q.s. mixing them: warm them in a Vial-glass, then shake well together till they are mixed, and so apply it to the ulcerate Part, in an Ulcer moderately dry.

XL. This Topick is of good use in Winter-time; for tho' warm Water warms the Part, yet it leaves it cold, because it draws out the heat to the superficies: but this Mixture is more excel∣lent; for the Oil stops the Pores, and keeps in the heat.

XLI. After fomenting, you may apply some Cataplasm, which has a moistning property with it, such as this. ℞ Mallow-leaves boiled to softness ℥jss. Oil, Barley and Wheat flower, A. ℥ss. Honey of Roses ʒii. Saffron ʒss. Hogs-lard q.s. or, ℞ Juice of Mallows ℥i. Oil-olive ℥ii. white Wax q.s. mix, and make an Ointment: or you may foment with Oil alone.

XLII. How long this Fomenting is to be used, you may know by the substance of the Part, and its colour: for when you see the Part a little tumified, soft and moist, and looks ruddy, you are then to give it over, for other∣wise the Humor attracted will be discussed.

XLIII. But if the Part in which the Ʋlcer is, is under an Atrophy, so that this fomenting with Oil, or Water and Oil, will not do, we must then in the first place endeavour to nourish the Sick with Meats of good Juice, which are easily distributed, that so much Aliment may be sent unto the Part affected.

XLIV. But if the Habit of the Body is cacochymical, you are before Fomentation, to empty it of those evil Humors by Purgation; lest too much moisture, or corrupt Humors be drawn, which will hinder the Cure of the Ulcer.

XLV. The Distemper being re∣moved, you may dress the Ʋlcer with Sarcoticks, yet such as dry but a little; lest otherwise there should be a relapse into the dry Distemper again; as Galen, Me∣thod. Med. lib. 4. cap. 1. pre∣cautions us against: and there∣fore to Sarcotick Pouders, Oil and Fats are to be added.

XLVI. As, ℞ Frankincense, Mastich, Olibanum, A. ʒi. Turpen∣tine ℥i. Oil of Roses ℥ii. Wax q.s. mix, and make a soft Ointment.

XLVII. Wiseman says it is to be dressed with mild Digestives, or with Basilicon mixed with

Precipitate, which is a good Detersive and Sarcotick: or with this: ℞ Frankincense, Ma∣stich, Sarcocol, A. ʒi. Venice-Turpentine ℥jss. Oil of Hypericon ℥ii. white Wax q.s. mix, and make an Ointment. The Ulcer being incarned, compleat the Cure with Epuloticks.