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. VI. Of ƲLCERS with FLƲXION.

I. WHAT the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus Rheumaticum, and Ulcus cum Fluxionibus; we in English call, An Ulcer with Fluxion, or with a Flux of Humors.

II. This is an Ʋlcer with Dis∣temper, and having also a Flux of Humors joined with it: for it is hardly possible for an Ulcer to be affected with a Flux of Humors, or of Matter, but it must primarily be affected with a Distemperature.

III. The Causes. They are either, 1. By Transmission; the pec∣cant Humor in either quantity or quality, being protruded or sent forth from some other Part thro' the strength of Nature. 2. By Attraction; wherein the Part affected thro' heat or pain, draws them. 3. By the natural Motion of the Humor; falling upon that Part by reason of its weakness, or low situation; which makes the descent of the Humor more easy.

IV. The Excrements which come from the afflux of Humors to the exulcerated Part are manifold, as Celsus, lib. 5. cap. 26. has decla∣red.

Besides Blood, there is Sanies, and Pus, which do issue forth from Wounds and Ul∣cers.

V. Sanies, (inquit) sit San∣guine tenuior varie crassa, & glu∣tinosa, & colorata. Pus crassis∣simum, albissimumque, glutinosius & Sanguine & Sanie. Exit San∣guis ex vulnere recenti, aut jam sanescente. Sanies est inter utrum∣que tempus: Pus ex Ʋlcere jam ad sanitatem spectante. Rursus & Sanies, & Pus quasdam spe∣cies Graecis Nominibus distinctas habent. Est enim quaedam Sanies, quae vel 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ichor; vel 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Meliceria nominatur. Est Pus, quod 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 appellatur. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, tenuis, subalbidus, ex malo Ʋlcere exit, maximeque ubi Nervo laeso Inflammatio secuta est. Meliceria crassior & glutinosior, subalbidus, Mellique albo subsimilis fertur: haec quoque ex malis Ʋlce∣ribus, ubi Nervi circa Articulos laesi sunt, & inter haec loca ma∣xime ex Genibus. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, tenue, subalbidum, quasi unctum colore atque pinguitudine, Oleo albo non dissimile, apparet in magnis Ʋlceribus sanescentibus. Sanies, (says he) is thinner than Blood, yet variously thick, glutinous, and coloured. Pus is most thick and white, and more glutinous than Blood and Sanies. Blood comes forth from a Wound recent, or now upon Healing: Sanies comes forth between these times: Pus comes forth of an Ulcer, just now upon Healing. Again, both Sanies and Pus have certain Species, distinguished by their Greek Names. There is a kind of Sanies which is called Ichor, or Meliceria; and there is a Put which is called Elaeodes, Ichor is thin, somewhat white, and is thicker, more glutinous, and not much unlike Honey; and this comes out of evil Ulcers, when the Nerves near the Joints are hurt, and more especially from the Knees. Elaeodes, which is thin, whitish, and looks fatty, not much unlike to white Oil, comes from great Ulcers when they are nigh healing.

VI. But Pus properly is that Excrement of the Ʋlcer which has its original from Blood, or from Flesh bruised and dissolved; and it appears in Ulcers void of all other Excrements.

VI. All the other Excrements which proceed from other Humors, are comprehended under Ichor or Sanies, and Sordes: the thin and watry Excrements they call Sanies, and some call them Virus; from which thin Excre∣ments the Ulcer is rendred moist. The thicker Excrements they call Sordes, from which the Ulcer is made sordid and foul.

VIII. The Signs. An afflux of Humors, is known by a Tumor or Swelling, which appears not only in the lips of the Ʋlcer, but also in the near-adjoining Parts; and by the Pain, which is very grie∣vous, especially if the nervous Parts be affected.

IX. It is also known from the great store of Excrements, greater by far, than what is in proportion to the magnitude of the Ʋlcer; with an Inflammation according to the quality of the Humor; and there is a great difficulty in the

Cure, for that the Humors flowing hinder it.

X. The Prognosticks. All Ʋl∣cers with an afflux of Humors, are very hard to cure; in regard that from the afflux, the Ulcer is made moist and painful, and so swells up, and increases thereby.

XI. And by how much the Fluxion is the greater, and also by how much the flowing Humor is the worse; by so much the more diffi∣cult will the Cure of the Ʋlcer be. And Celsus in the place before cited, gives you signs how you may know the goodness or bad∣ness of the Humor causing the Fluxion.

XII. The Cure. The Indica∣tions of Cure, have respect, 1. To the Antecedent Cause. 2. To the Consequent Cause, or Con∣joined. 3. To the Healing-up the Ulcer.

XIII. As to the Antecedent Cause; the Humor abounding and flowing, whether it offends in quantity or quality, or in both, is to be removed by Purging, and Revulsion.

XIV. By Purging we must di∣minish and hinder the generating of the vitious Humor; and if the Fluxion is by any fault of the Liver or Spleen, it must be re∣ctified: for this purpose, the Cathartick must be adapted to the Constitution, and Humor abounding; as we have already, in many other places, declared at large.

XV. Also you must constantly administer some notable Trauma∣tick Diet or Wound-Drink; or the juice of Pellitory of the Wall, because it carries off the Humi∣dities and Humors by Urine.

XVI. If the Humor is too fluid, it must be made thicker by Alte∣ratives; as Endive, Succory, Sorrel, Purslain, Lettuce, &c. in Broths; as also with Barley-Cream, Emulsions, Citrons, Rasp∣berries, and the like.

XVII. And then Revulsion is to be made in some proper Part: of this kind, Issues have the first and chiefest place, being made in the contrary part: and Sen∣nertus says they are very neces∣sary in old and inveterate Ulcers; lest the Ulcer being healed, the Humor should re∣gurgitate into the Veins, and so fall upon the more noble Parts.

XVIII. The next Indication has respect to the conjoined Cause. And that must be removed, 1. By Interceptives, or Defen∣satives. 2. By Repercussives, or Repellers.

XIX. Interceptives or Defensa∣tives, are such as strengthen the Part, and shut up the Vessels; and in some measure drive back the Humor; and they are formed out of such things as are dry and astringent.

XX. Of this kind are, Plan∣tan, Knotgrass, Bramble-tops, and the Berries not fully ripe; Horstail, Elm-bark, Myrtle-berries, Acorns, Galls, Cyprus-Nuts, Balaustians, Pomgranate∣peels, Oils of Myrtles and Roses, astringent Wine, fine Bole, Terra Sigillata, Cortex Peruanus, Catechu, Opium, Poppies, red Roses, Dragons-blood, Alum, Vi∣triol, with whites of Eggs, &c.

XXI. Some of those things may be juiced, others poudred, and mixed with Ointments; or boiled in Oxycrate or red Wine, and applied with Stuphs.

XXII. And if the Fluxion is great, and in strong Bodies, Aqua Aluminis, and Aqua Calcis may be used: to the latter of which, (Wiseman says) a few grains of Sublimate may be added.

XXIII. If with the Fluxion, there is great heat, it is to be removed as we have taught in the Cure of a hot Distemper: if there is great pain, Anodyns and Le∣nients are to be chosen: and if there is withal a plenitude of Humors, slender Diet must be prescribed, and the Belly kept soluble with Clysters, &c.

XXIV. Repercussives or Re∣pellers are applied to the Ʋl∣cer it self: such are Alum-water, Rose-water, juices of Plantan and Cinkfoil, roots of sweet Cyperus, Ʋnguent. è Bolo, Nutritum, Album Camphoratum, Desiccativum Rubrum, Ceratum Galeni, Emplast. de Minio, è Bolo, &c.

XXV. But because these Ʋl∣cers are frequently affected with sharp Humors impacted in the Pores, which cannot be repelled, and by their acrimony excite Pain and Inflammation; you must have regard to the Ulcer it self, ap∣plying, (whil it you outwardly resist the Influx upon the Parts) Digestives and Detersives, but such as are more drying, than those for simple Ulcers, having but very little acrimony, such as we have enumerated in the cure of a moist Intemperies, in Chap. 4. aforegoing.

XXVI. And to the middle of the Ʋlcer, you may apply some drying Pouder, made of Litharge, Tutty, Lead, Saccharum Sa∣turni, Sanguis Draconis, Catechu, fine Bole, Terra Sigillata, Chalk, Chalcitis, Ʋng. Diapompholigos.

XXVII. The last Intention, is the Healing of the Ʋlcer, by Sarcoticks and Epuloticks: but here the Sarcoticks ought to be vehement, and of the strongest kind; not moist, oily, or fat, lest they moisten the Part, and loosen more: yet they must be without any acrimony or biting at all, that so no pain may be excited.

XXVIII. Sennertus has this ℞ Turpentine, burnt Lead, A. ℥i. Beef-suet, Tutty prepared, A. ℥ss. mix them. But if the Humor is crude and sharp, some Frank∣incense, or Pine-Rosin, must be added, to farther the Concoction thereof.

XXIX. And sometimes it hap∣pens, that what did good once or twice, may afterwards (the Hu∣mor being dried up) prove pre∣judicial and hurtful, by exciting a mordication or biting: in this case, the Medicine is to be changed, and more gentle ones are to be applied in the place thereof.

XXX. Lastly, the Ʋlcer being incarned, the Cicatrice is to be induced by Epuloticks. Guido, m Tract. 4. Doct. 1. Cap. 2. ad∣vises to lay on a thin Plate of Lead, with a Hole bored thro' it: for Lead cools it, and is of very good use in such-like Ul∣cers,

hindring the Influx of the Humor into the Part exulcera∣ted: and it will be yet the more effectual, if it is be∣smeared with Quickfilver; or you may dayly dress it with Ʋng. Diapompholigos.