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 ...

ARS CHIRƲRGICA. Liber Quintus. OF ULCERS.

The ARGUMENT.

I. Of Ʋlcers in General. II. Of Medicines appropriated to Ʋlcers. III. An Ʋlcer simple. IV. An Ʋlcer with Distemper. V. An Ʋlcer with Pain. VI. An Ʋlcer with Flux of Humors. VII. An Ʋlcer sordid, foul, and putrid. VIII. An Ʋlcer with Tumor. IX. An Ʋlcer with Proud-flesh. X. An Ʋlcer Callous. XI. An An Ʋlcer Discoloured. XII. An Ʋlcer Cavernous or Hollow. XIII. An Ʋlcer with Worms. XIV. An Ʋlcer Varicous. XV. An Ʋlcer Carious, with foul Bones. XVI. An Ʋlcer Cacoethick, or Malignant. XVII. An Ʋlcer Phagedenick, or Eating. XVIII. An Ʋlcer Cancerous. XIX. An Ʋlcer by Burning or Scalding. XX. An Ʋlcer Fistulous, or a Fistula. XXI. An Ʋlcer Gangrenous. XXII. An Ʋlcer of the Head. XXIII. An Ʋlcer of the Eye. XXIV. An Ʋlcer Fistulous of the Eye; or, Fistula Lachrymalis. XXV. An Ʋlcer of the Nose, Ozena. XXVI. An Ʋlcer of the Ear. XXVII. An Ʋlcer of the Mouth. XXVIII. An Ʋlcer of the Throat. XXIX. An Ʋlcer of the Neck. XXX. An Ʋlcer of the Sto∣mach. XXXI. An Ʋlcer Fistulous, of the Brest

or Thorax. XXXII. An Ʋlcer of the Back and Loins. XXXIII. An Ʋlcer of the Womb, and its Neck. XXXIV. An Ʋlcer of the Bladder, or its Neck. XXXV. An Ʋlcer of the Groin. XXXVI. An Ʋlcer in the Yard. XXXVII. An Ʋlcer Fistulous in the Anus, or Fistula in Ano. XXXVIII. An Ʋlcer of the Joints. XXXIX. An Ʋlcer of the Arms and Hands. XL. An Ʋlcer of the Thighs, Legs and Feet. XLI. Ʋlcerated Piles, or Hemorrhoids.

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.

CHAP. II. Of MEDICAMENTS appropriated to ƲLCERS.

I. BEFORE we set upon the Work of Curing Ʋlcers in earnest, we thought fit to Arm our young Artist with all such Pharma∣ceutical Necessaries as are requisite to the performance thereof: and the Medicaments for this pur∣pose are sixfold, viz.

• 1. Repercussives, or Repellers.
• 2. Helminthicks, or Worm-Killers.
• 3. Digestives, or Suppuratives.
• 4. Abstersers, or Mundifica∣tives: Cleansers.
• 5. Sarcoticks, or Incarnatives.
• 6. Epuloticks, or Cicatrizers.

II. Some of these various sorts of Medicaments we have treated of already, in Lib. 4. Chap. 2. Sect. 16. ad 57. as Digestives, Sarcoticks, and Epuloticks: and therefore

of those three kinds we shall be very brief here; as only sup∣plying in this place, some few that were wanting there.

I. Repercussives, or Repellers.

III. Simple Repellers are, Fair Water, Nitrated Water, Lettice, Endive, Succory, Knotgrass, Horstail, Periwincle, Woodbind, Nightshade, Comfrey, Purslain, Cucumbers, Navelwort, Housleek, Plantan, Yarrow, Vine-leaves, Barberries, unripe Bramble-berries, Sloes, Myrtle-berries, Pomgranate-peels, Balaustians, Red-Rose-leaves, Oak-bark, leaves and apples of Mandrakes, Henbane, Thorn-apple-leaves, Poppy of the sorts, white, black, and red; deadly Nightshade, Red-wine, Verjuice, Vinegar, juice of Quinces, Lime-juice, juice of Limons, Tanners-Woose, before the Leather is put in, &c. Crocus Martis, Caput mortuum of Vitriol, Saccharum Saturni, coagulated Mercury, burnt Lead, &c.

IV. Sometimes in the Country, where you have not Medicines at hand, you must be forced to use some of the afore-mentioned Ve∣getable Simples, either their Juices, or Decoction, or Pulp in Cataplasms: these things you are to apply to the parts ad∣jacent to the Ulcer, in Pled∣gets of Cotton, Lint, or fine Tow, moistned in their Juices, &c. and above these Stuphs of Linnen or Woollen Cloth, or Flanel, dipt in the same and wrung out, according to the Temperature of the Patient, &c.

V. The more cold sort, and such as are Narcotick, must not be too long applied; but must be removed, before the Part becomes livid, or of a leaden colour.

VI. These things being applied, the Part ulcerated is to be con∣veniently rowled up, the Rowlers having been first also moistned in those Juices or Decoctions: and if your Simples are of a watery substance, it will be good to mix other things which have an astringent force with them; for thereby you will the better cool the Part, abate the Inflam∣mation, repress the Fluxion, and more effectually repercuss the Humor.

VII. Of the former Simples, Compounds may be easily made: as, ℞ Oil of Roses, made of Oil-omphacine; juice of unripe Grapes, juice of Red-roses, A. ℥ii. simmer them over the Fire, till the Juices are consumed.

VIII. Oils made of pure (not rank) Oil-olive, as of Myrtles, of Quinces, of Mastich, of Henbane, of Poppy, of Mandrakes, by Infu∣sion, &c. Where note, that if an Inflammation is present, then Oily Repercussives are not to be used.

IX. Cataplasms made of the Juices of some of the former Sim∣ples and Barley-flower, fine Bole, Terra Sigillata, Amber in pouder, Catechu, Saccharum Saturni, whites of Eggs, Vinegar and Ver∣juice, beaten together, adding a little Oil, as you see convenient.

X. Ointments; as Ʋnguentum Album, Camphoratum, Populeon, Cosmeticum, Tutiae, Triapharma∣con; which may be used either

by themselves, or mixed to∣gether.

XI. Emplasters; as Emplastr. Album, De Minio cum Sapone, Mercuriale; Ceratum Album, Ce∣ratum Nigrum, Ceratum Oxylaeum, Refrigerans, Spermatis Ceti, &c. Diapalma, or Empl. Album, made with juices of Plantan, Horstail, Knotgrass, Yarrow, Comfrey, Nightshade, Lettice, Purslain, Housleek, Periwincle, &c. ad∣ding them by little and little, as the Emplaster comes to a con∣sistence.

XII. A Defensative of Barbett. ℞ Lignum Guajacum rasped, long Birthwort roots, A. ℥i. Agri∣mony, Centory the less, Wormwood, A. M.i. Wine q.s. boil, and strain out: to every five Ounces of which add, Meal of Orobus ℥i. Myrrh in fine pouder ℥ss. Honey ℥iv. S.V. ℥ii. Venice-Turpentine q.s. mix, and make a Liniment.

II. Helminthicks, or Worm-killers.

XIII. Worms many times breed in some ill-conditioned Ʋlcers; and therefore when you perceive them, they are either to be taken forth with some fit Instrument; or otherwise, if they stick fast in the Flesh, or hide themselves, they are to be kill'd with some proper Medicaments to be ap∣plied.

XIV. Simple Helminthicks. Aloes, Cambogie, Scammony, Euphorbium, Myrrh, Rhubarb, Aron-roots, Birthwort-roots, Squills, Onions, Garlick, Centory, Colocynthis, Dittany, Elecam∣pane, Germander, Horehound, Orobus, Opium, Pepper, Southern∣wood, Savin, Tansey, Tobacco, wormwood, Bullocks gall, and the Galls of other living Creatures, pouder of Earthworms, Saccha∣rum Saturni, Verdigrise, white and red Precipitate, Mercurius dulcis, corrosive Sublimate, Cin∣nabar Natural and Artificial, Mercury coagulate, or amalga∣mate; the Prince's Pouder, Vi∣trum Antimonii, Crocus Metallo∣rum, Tartar-Emetick, Sulphur, Vitriol, Nitre, with many other things of like kind: and from the aforegoing Simples you may make the following, and other the like Compounds.

XV. ℞ Aloes, meal of Lupins, A.℥i. Myrrh, Verdigrise, A. ℥ss. Bulls gall ℥ii. Honey q.s. mix, and make a Liniment.

XVI. ℞ Aloes, Cambogia, Scammony, A. ℥ss. Euphorbium in fine pouder ʒii. Verdigrise ʒi. To∣bacco ℥i. Colocynthis in fine pouder ʒiii. Bulls gall, Honey, A. q.s. mix, and make a Liniment.

XVII. ℞ Aloes in fine pouder, Tobacco finely poudered, A. ℥ i. flowers of Sulphur, Mercury coa∣gulate, Coloquintida, A.ʒii. Eu∣phorbium, pouder of Earthworms, Verdigrise, A. ʒi. Oil of Harts-horn ʒss. Oil of Tobacco made by Infusion ℥jss. Sheeps-suet q.s. mix, and make a Ointment.

XVIII. ℞ Tobacco in fine pou∣der ℥i. Scammony ℥ss. Colocynthis ʒii. Euphorbium ʒi. white Preci∣pitate ʒss. mix, and make a Pouder, to strew on.

XIX. Take fair Water lbii. corrosive Sublimate in fine pouder ℥ss. put all into an Earthen Pip∣kin, and dissolve by Boiling; then pour forth, straining it thro' a

Cloth, and affuse thereon Oil of Tartar per Deliquium; so will the Mercury Precipitate of an Orange-tawny colour, which wash in much fair Water, or in S.V. and keep it for use: this Water after Precipitation, kills all sorts of Worms, by washing the Ul∣cer therewith, and laying dou∣ble linnen Cloths dipt in the same, over the Ulcer. The Pre∣cipitate also kills Worms, being mixt in any proper Ointment to be laid on.

XX. Take of the former Orange∣precipitate ʒi. Scammony in fine pouder ʒiv. Tobacco in fine pouder ʒviii. mix them; to strew upon the Ulcer full of Worms. Or, you may mix this Pouder with Ointment of Tobacco ℥ii. Ox-gall ℥i. and so apply it.

III. Digestives, or Suppuratives.

XXI. Simple Digestives. The greatest part of these we have enumerated already in Lib. 4. Chap. 2. Sect. 16. aforegoing of the Work; but to them there mentioned, these few following may may be added: as, Calves-suet, Capons-fat, Colophony, flowers of white Lilies, Linseed, muci∣lage of Althea-roots, Rape-oil, Rosin. And these, if there is any callosity or hardness: Bird∣lime, Balsam Capivii, de Chili, Burdock, Flowerdeluce-roots, Gum Elemi, Galbanum, Melilot, Pitch, Princes Pouder, Spanish Saffron, Storax, Turbith mine∣ral, new Wax, Wax made from the Myrtle-berry in Carolina and Virginia.

XXII. Of those mentioned in the place afore-cited, and these here added: viz. Of Flower or Meals, Pulps, Mucilages, Juices, Oils, Fats, Suets, Gums, Bal∣sams, and Rosins, compound Digestives may be formed, of various kinds and compositions, according to the habit or tem∣perature of the Patient, nature of the Ulcer, and season of the Year.

XXIII. Tetrapharmacum of the Ancients, commonly called Ʋnguentum Basilicon minus, made of Pitch, Rosin, Wax, and Oil, melted, and mixt together, is an excellent Digestive. You may see great variety of Com∣pounds, in Lib. 4. Cap. 2. Sect. 17. ad 30. aforegoing.

XXIV. To those you may add, Dialthea simple, Basilicon the greater, the Golden Ointment, if red Precipitate, or the Princes Pouder rather â ℈i. ad ℥i. of the Ointment, be added to them. For the Precipitate, or the Princes Pouder, or Turbith-mineral, do admirably digest and thicken any ichorous Humor.

XXV. And over these things you may apply Emplastrum Dia∣chylon simplex, if in Summer∣time; or Diachylon cum Gummi, if in the Winter-time, where the brims of the Ulcer are hard: otherwise Diapalma, or Empla∣strum Album, made with Juices, (as directed at Sect. 11. above) may do well enough.

XXVI. In a callous Ulcer, you may apply this: ℞ Of the pulp of Figs and Raison, A. ℥i. juice of white Lily-flowers, Barley-flower, A. ʒiii. mucilages of Althea, Linseed, and Fenugreek, A. ʒii. Saffron in pouder ℈i. mix them.

IV. Abstersives, or Mundifiers.

XXVII. Simple Abstersives. Birthwort roots, both long and round; Horehound, Smallage∣root, Turbith, flower or meal of Orobus, Vetches, Tobacco, roots of Aron, Orrice, Hermodacts, and of white and black Helle∣bor; juices of Celandine, Car∣duus, Beets, Coleworts, Gentian, Centory, Scordium, Wormwood, bitter Almonds, Savin; the Ashes of all Vegetables, because of the Salt which is in them; but the ashes of some things are more powerful than of others; as the ashes of Bean-stalks, of Tobacco, Vine-branches, Aloes, Cambogia, Scammony; Cockle and Oister shells calcin'd; Arsenick white, Orpiment, Vitriol calcin'd to redness, Alum burnt, Verdi∣grise, corrosive Sublimate, white and red Precipitate, the Princes Pouder, Turbith mineral: these two last are as powerful as Ar∣senick, or corrosive Sublimate, and much more safe; for they sooner dispatch their Opera∣tion, are more familiar to the Body of Man, and cause not so much Pain, nor so great an Inflammation.

XXVIII. Now the Time when Mundificatives are to be used is, when the Ʋlcer is well digested; which is when the Pus comes to be that which they commonly call laudable; the lips of the Ulcer are become soft and well-coloured, and no ill scent or fume seems to rise from the Ulcer: for if Sarcoticks be used, before the Ulcer is mundified or cleansed, nothing but a loose or proud Flesh will arise, which will not admit of Cieatrizing. Of the former Simple Abster∣sives, you may form various Compound-ones at pleasure, according to the following Examples.

XXIX. The Abstersive of Paracelsus. ℞ Honey ℥viii. Stras∣burgh Turpentine ℥iv. mix, and boil with a gentle Fire, to the con∣sistence of a soft Ointment; then take it from the Fire; and add thereto red Precipitate levigated ℥ii. (well washt in Rose-water mixed with a little Oil of Tartar) and the yolks of two Eggs, stirring them, 'till they are well incorpora∣ted. This is one of the best Abstersives or Mundificatives in the World: but here is to be noted, that the Precipitate need not be added, unless the Ulcer is very foul, inveterate, and re∣bellious, resisting weaker means.

XXX. The Mundificative of Fabricius ab Aquapendente. Take Juice of Smallage ℥jss. Syrup of Roses, or Mel Rosarum ℥ ss. Turpentine ʒii. meal or flower of Barley and Lupins, A. q.s. or so much as may bring it to a con∣sistency.

XXXI. In the Shops you may have Unguentum Apostolorum; which is best for plain, open, and superficial Ʋlcers; also Unguen∣tum Aegyptiacum, which is good to be injected into the sinuous Ʋlcers, being mixed with White-Wine, and Mel Rosarum.

XXXII. You have also Un∣guentum Aureum, and Unguen∣tum Basilicon; either of which being mixt with burnt Alum,

and red Preeipitate levigated, will make Medicaments, which will do two works at once, viz. both Digest and Mundify.

XXXIII. Take Basilicon ℥iv. Unguentum Aureum ℥ii. Scam∣mony in fine pouder ℥jss. Tobacco in fine pouder ℥i. mix.

XXXIV. Take Basilicon, Oint∣ment of Tobacco, A ℥iii. Scammony, Tobacco, both in fine pouder, A. ℥i. Princes Pouder ʒiii. mix them.

XXXV. Take red Prcipitate ℥i. burnt Alum ℥ss. levigate them together upon a Porphyry-stone, 'till they become impalpable pouder, then add to them Scammony ℥i. Ointment of Tobacco ℥iii. Basilicon ℥vi. mix them well together, and keep them for use.

XXXVI. From what hath been said, it appears that Abstersives are to be drying, without astri∣ction, and without any great hot or cold qualities, and of a subtil and penetrating substance; that by reason of their driness they may suck up, and consume the humidity of the Ulcer, and by their tenuity take away the glutinousness of the Pus; yet they ought not to pass the se∣cond degree of siccity, lest they consume the Flesh it self.

XXXVII. By this it appears, that Abstersion is the removing of the Recrements cleaving to the Ʋlcer; 1. By drying of it. 2. By dividing the particles of the glutinous matter, which destroys the viscosity by which it cleaves to the Flesh.

V. Sarcoticks, or Incarnatives.

XXXVIII. Simple Sarcoticks, or Flesh-breeders. To those enu∣merated in Lib. 4. Cap. 2. Sect. 31. you may add these: Clowns-Woundwort, Adders-tongue, Knotgrass, Solomons-seal, green Tobacco, fresh Galls; new made Butter, pouder of Vipers-flesh, pouder of Ox-blood, Bones calcined, Harts-horn calcined, Colophony.

XXXIX. Incarnatives are not to be used, 'till the Ʋlcer is suffi∣ciently cleased; which will be, as Celsus, lib. 5. cap. 20. says, when it appears red, has a quick sense, and looks clean, and neither too dry, nor too moist. If the Ulcer looks pale or whitish, or of a black or livid colour, and is almost insensible, being either too moist or too dry, 'tis mani∣nifest then, that Abstersives are yet to be used.

XL. But if it is a hidden or sinuous Ulcer, Galen, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, lib. 4. cap. 2. tells us, that we shall judge an hollow or fistulous Ʋlcer to be clean, when the Part begins to be more sensible of the Abstersives injected, than it was before: and then is the time for the admission of Incarnatives; and such are all those Medica∣ments, which are endued with these two qualities of Desicca∣tion and Abstersion, in a tempe∣rate degree.

LXI. Now the Incarnating is properly and principally the work of Nature, viz. of the Temperament and Faculty of the Part; yet it is requisite to assist Nature, in the application of such things as may promote the same Intention, by removing the Impediments which may obstruct Nature in her course of operating.

XLII. For this cause, if you design to cure an Ʋlcer, you must apply Desiccatives to moist Ʋl∣cers, and Abstersives to sordid Ʋlcers: for in all Solutions of Unity, Nature being intent up∣on the Regeneration of Flesh where it is wanting; it is evi∣dent, that you will erre, or not accomplish your end, where Desiccatives and Abstersives (the true qualities of such as we call Incarnatives) are not to be applied.

XLIII. Out of the simple Sar∣coticks, compounds are made; of which we have given you many Examples in Lib. 4. Cap. 2. Sect. 32. ad 46. we shall in this place add only these following.

XLIV. A Sarcotick from Bar∣bett: Take Turpentine ʒvi. Basi∣licon, Aloes, Colophony, Mastich, Myrrh, A. ʒiv. Unguentum Fu∣scum Wurtzii, Litharge of Gold, A. ʒiii. Gum Elemi ʒii. Oil of Roses q.s. mix, and make an Ointment.

LXV. An Incarnative, from Clows. Take pure Turpentine, Oil of Roses, A. ℥vi. Pine-rosin ℥iv. yellow Wax ℥iii. Gum Elemi ℥ss. (or rather ℥ii.) mix, and make an Ointment.

XLVI. Another. Take Rosin, Wax, A. lbss. Turpentine ℥iv. Barley-flower ℥ii. Olibanum, Ma∣stich, Oil of Mastich, Honey of Roses strained, A. ℥i. Myrrh, Sar∣cocol, ℥ss. mix, and make an Ointment.

LXVII. Another. Take Rosin, Wax, Oil of Roses, A. ℥xii. Tur∣pentine ℥vi. Olibanum ℥iv. Mastich ℥ii. Saffron ℥ss. mix, and make an Ointment.

XLVIII. Another. Take Rosin, Wax, Oil of Roses, A. ℥vi. Tur∣pentine, ℥v. Honey of Roses ℥iv. Mastich, Myrrh, Olibanum, Sarco∣col, A. ℥ss. Aloes, Saffron, A. ʒii. mix them.

XLIX. Take Oil-olive lbjss. Ship-Pitch lbi. Wax, Rosin, A. lbss. Beef-Suet ℥viii. Turpentine ℥iv. yolks of Eggs N^o iv. mix them. If with either of these three last, red Precipitate q.s. be mixed, they will excellently di∣gest, mundify, and incarnate: but if you mix with them burnt Alum, q.s. they will then ad∣irably mundify, heal, and cicatrize.

L. Take Oil-olive, Rosin, Tur∣pentine, Lapis Calaminaris, A. lbi. Sheeps-suet, Wax, A. lbss. mix, and make an Ointment; it in∣carnates and cicatrizes Ulcers.

LI. Take Oil-olive, Sheeps-suet, Rosin, A. ℥iv. Wax, Gum Elemi, A. ℥i. juice of green Tobacco raised from Virginia seed lbi. green Tobacco leaves stamped M. ii. boil them over a gentle Fire, 'till the Juice is consumed, then strain, and keep it for use.

LII. In the Shops you have always ready, Ung. Basilicon and Ung. Aureum, much commmended. But this is to be noted, in making compound Incarnatives: 1. That they be neither too soft, nor too hard: if too soft, the heat of the Part will cause them to spread, and fall from the Ulcer, and they will be apt to generate proud Flesh; if too hard, the weaker Parts will hardly have the Benefit of them. 2. That they be smooth and equal; otherwise, they will

cause pain to the Part. 3. That they exceed not the first degree in drying: especially if the Patient is of a soft and tender Constitution; for in such, the milder Desiccatives are required for the generality of soft Flesh; but if the Patient has a hard and dry Flesh, stronger Desiccatives are to be made choice of. 4. That when the Ulcer is in a place not so fleshy, as in the joints; heads, and tails of the Muscles, your Desiccatives must be forcible. 5. That if the Ulcer is large and moist, more strong Driers are to be used, than in those which are small, and drier.

VI. Epuloticks, or Cicatrizers.

LIII. Simple Epuloticks, or Skin-breeders. To those enume∣rated in Lib. 4. Cap. 2. Sect. 47. you may add these following. Roots of Bistort; Sheeps-suet, Beef-suet, Deers-suet; Gum∣sandarach; Eggshels calcin'd, Harts-horn calcin'd white, Ivory calcin'd white, Cuttle-bone cal∣cin'd; Alabaster in fine pouder, Chalk finely poudred, which is done by rubbing it on a broad Tile, and searcing it; unslak'd Lime washed and dried, or Whiting, Umber in pouder, Pumice-stone poudred; Cinna∣bar, Crocus Martis, Regulus of Antimony, Henricus rubeus, or the Caput mortuum of Vitriol washt and dried; an Amalga∣ma of Saturn and Quicksilver in pouder, which is thus made: ℞ Lead ℥iv. mels it in a Cru∣cible, then take it from the Fire, and put into it Quick-silver ℥iii. mix them by stirring, and they will incorporate together, and when cold, beat and grind into a pouder.

LIV. These are not be used, 'till the Ʋlcer is filled with good Flesh; for it is in vain to attempt the latter 'till the former is well perfor∣med, lest the ulcer be healed up with much deformity. The Skin being lost by any Accident, Nature cannot repair it, for want of the Seminal Matter of which it is generated: so that there is a necessity of supplying this de∣fect by the help of Art; and it is done by thickning and hard∣ning the upper part of the new, or regenerated Flesh, so long 'till it becomes of the nature of the Skin, and is able to supply its office.

LV. These Medicaments must be, 1. Cooling; that the thin parts may be coagulated, and the thick parts brought together, as you see in Ice, or the top of a Hasty-pudding when it becomes cold. 2. Drying; to consume the thin parts; and the Cica∣trice is nothing but the Flesh thickned, dried, condensed, and made callous. 3. Drying in the third degree; Incarnatives are drying only in the first de∣gree, because they are only to dry superfluous Excrements: Glutinatives are dry in the se∣cond degree, because they dry not only the Excrements, but whatever Humor else, tho' Ali∣mentum, which flows to the Part: Cicatrizers are to be dry in the third degree, for that these dry not Excrements only, and other Humidities flowing to the Ulcer,

but they also dry the Humidi∣ties, and so have no place here; for they consume not only the Excrements, Humors flowing to the Part, and the Humidities of the Part it self, but the very subjacent Flesh also.

LVI. Now as some Epuloticks do dry more weakly, some more strongly; so the gentlest are to be used to the more moist and delicate Bodies, the stronger to the more hard and solid: and they are to be applied a little before the Flesh is even with the other Skin, as Galen, Meth. Med. lib. 13. cap. 5. has advised; otherwise the Cicatrice will be higher than the natural Skin, which will cause deformity.

LVII. And when the Sore is come to skinning, since the middle is always deeper than the circum∣ference or edges, milder Epulo∣ticks are to be applied to the middle, that the Flesh may not be too soon dried, but have liberty to grow to its full height: for which reason, soft Cerats or Unguents may be applied to the middle, Pouders and Cerats to the lips.

LVIII. Compoud-Epuloticks are made out of the simple, of which you have many very good ones in Lib. 4. Cap. 2. Sect. 48. ad 57. aforegoing; to the number of which, you may add these few following.

LIX. ℞ Sheep-suet ℥viii. Colo∣phony, Varnish, Wax, Oil-olive, A. ℥ij. melt all together; then re∣moving them from the Fire, add Calaminaris in fine pouder ℥i. Litharge of Gold, Tutia prepa∣red, Caput mort. of Vitriol washed, A. ℥ss. mix, and make a Cerat.

LX. Oil-olive, Turpentine, Wax, A. lbiv. Beef-suet lbii. Gum Elemi, Frankincense, A. lbi. liquid Storax, lbss. pure Verdigrise in fine pouder ℥iii. mix, and melt the seven former Ingredients together; then at last put in the Verdigrise, stirring them well together, 'till almost cold. This Balsam does all the Intentions of Healing; it digests, cleanses, breeds Flesh, and lastly, cicatrizes the Ulcer after an admirable manner.

LXI. ℞ Oil-olive, Beef-suet, A. lbi. Bees-wax, liquid Storax, A. lbss. Oil of Turpentine ℥iii. Camphir, Ceruse in fine pouder, Tutty levigated, Olibanum in fine pouder, A. ℥i. mix, and make an Ointment.

LXII. And to make the Cica∣trice as little deformed as may be, you may anoint every Night going to Bed, with the fol∣lowing Oil. ℞ Oil of Ben ℥i. Oil of Tartar per Deliquium ʒss. Sperma Ceti ʒiii. mix them. Or with this: ℞ Oil of Ben ℥i. Sperma Ceti ʒiii. Adeps Rosarum ʒii. mix them. This may serve for the Richer sort of People.

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.

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.

CHAP. V. Of an ƲLCER with PAIN.

I. WHAT the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus do∣loribus vel doloris plenum; we in English call, An Ulcer with Pain.

II. Pain is one of the Symptoms which obstructs the Cure of an Ʋlcer, whence various Accidents many times arise, as Fainting, Watching, Fever, and the like: for which reason, it ought im∣mediately to be mitigated, lest it attract, or cause an Afflux of Humors, or enlarge the Ulcer, or cause an Inflammation, or an Erysipelas to arise.

III. The Cause. This Pain for the most part arises from acrid, sharp, and corroding Humors, which gnaw the Ʋlcer, and heat the circumjacent Parts; pro∣ceeding either from a Cacochy∣mie of Humors abounding in the Body; or ill-applied Topicks, as Digestives not used timely enough, or Abstersives too long.

IV. The Signs. The Patient's being ill at ease will shew the Pain, and the Symptoms the Cause; whether from a Cacochymie, and abundance of Humors; or from want of Digestion, or Abs∣tersion, as is usual.

V. The Prognosticks. There will be no difficulty of removing of the Pain, if the Cause thereof is rightly apprehended, and that taken away.

VI. But if it continues any long time, it will be apt to induce a Flux of Humors, Inflamma∣tion, or other worse Symptoms.

VII. The Cure. The Indica∣tions are twofold: 1. To take away the Antecedent Cause. 2. To remove the conjoined.

VIII. The Antecedent Cause has relation to the Habit of the Body, and how that is in fault; and according as there is a Plethora, or Cacochymia, to make Evacua∣tion, either by Purging, Vomi∣ting, or Bleeding; by some, or all of them, as the condition of the Patient does require: and and then to strengthen and for∣tify the Body by cooling Juleps, Opiats, and a good Traumatick Diet, which may prevent the fluxion of Humors.

IX. This done, the proximate or conjoined Cause is next to be consi∣dered; which is to remove the Pain by things proper to the

Ulcer, and which have power to remove the Symptoms; and herein the Conjoined Cause is to be inquired into.

X. If the Ʋlcer is sanious, and the pain proceeds from thence, it wants digestion; and then such things as are digestive, which have a temperate heat in them∣selves, are to be applied.

XI. If the Pain is with Inflam∣mation, Lenients are to be used; as the Mucilages of Linseed, Fe∣nugreek-seed, Fleawort-seed, Quince-seed, Althea, extracted in decoction of Mallows, Oils of sweet Almonds, Camomil, Dill, Violets, Hens-fat, Hogs-lard, Saffron, yolks of Eggs, and Bar∣ley-flower, which may be made into a Cataplasm or Cerat with Wax: or Ʋng. Populeon, (if more cooling is required) Ʋng. Nutritum, Album Caphoratum, Emplast. è Bolo, Ceratum Galeni, may be applied to the parts about the Ulcer.

XII. And to the Ʋlcer it self, these Anodyns; as Saffron, Oil of Roses, yolks of Eggs, Turpentine, and Pine-Rosin; out of which Liniments and Ointments may be made, and applied.

XIII. If the pain arises from hot and acrid Humors fretting the Ʋlcer, it may be drest with Ʋng. Diapompholigos, è Plumbo, Tutiae, simply by themselves, or mixed with Basilicon; with a little red Precipitate, or some of the Princes Pouder; with Compress or Stuphs wrung out of Oxycrate or red Wine, which will allay the heat, and strengthen the Part, to resist the Influx of Humors.

XIV. If the pain is caused by a sordid Matter sticking to the bottom of the Ʋlcer, and hindring Transpiration, you cannot then (says Wiseman) remove the pain without Detersives; of which, red Precipitate, or the Princes Pouder, or Turpethum Minerale, are the best and mildest.

XV. If the pain is extream, you ought to fit the Medicament to the Cause; which being for the most part from hot and sharp Humors, are to be qualified with lenient Cataplasms, or with cooling Medicaments, or with Narcoticks.

XVI. A Cataplasm. ℞ Mal∣lows and Marshmallows, A. M.i. boil to softness, beat them, and pulp them thro' a Hair-sieve; to which add yolks of two Eggs, Saffron ℈i. Barley-flower, Linseed, and Fenugreek, Oils of Camomil and white Lillies, A.℥i. Mucilage of Althea-seed ℥jss. Oil of Roses ℥ii. mix, and make a Cataplasm.

XVII. Or, ℞ Crumbs of white Bread ℥ii. which soften in Milk, yolk of one Egg, Oil of Roses ℥jss. Barley-flower, Linseed, A. ℥i. pou∣der of Camomil-flowers, Oil of Water-Lillies ℥ss. Saffron ℈i. mix, and make a Cataplasm.

XVIII. Or, ℞ Flower of Bar∣ley, and of Millet, A. ℥ijss. Milk ℥viii. boil to the consistency of a Cataplasm; to which add, pulp of Cassia and of Raisons, pulp of Pippins or Pomwaters, Oils of Roses, of Earthworms, of Eggs, and of Dill, A. ℥i. Saffron ʒi. mix, and boil to a consistency.

XIX. If you are forced by the vehemency of the Pain to use Coolers, these things are commen∣ded;

Juices of Mallows, Marsh-Mallows, Horstail, Cucumbers, Lettice, Purslain, Plantan, Water-Lillies, &c. to which Barley-flower may be added, with Saccharum Saturni, whites of Eggs, Ʋnguentum Album, Frog∣spawn-water, &c.

XX. If yet all these things avail nothing, but that the extre∣mity of the pain continues, you must come to the use of Narco∣ticks; the chief of which are these Simples: Hemlock, Hen∣bane, Housleek, Mandrake, Night∣shade, Peru or Thorn Apple, Opium, Poppies: from which you may make distilled Waters, or Juices, or Oils by Infusion; of which, with Henbane and Poppy seed, Extract of Opium, and Barley flower, you may make Cataplasms at pleasure, according as the exigency re∣quires.

XXI. ℞ Juices of Henbane and Nightshade, A. ℥ii. Barley-flower ℥ii. mix, and boil to a consistency; then add Oil of Poppy-seeds, Ung. Populeon, A.℥i. Ex∣tract of Opium ʒii. pouder of Hen∣bane-seed q.s. mix, and make a Cataplasm.

XXII. You may also dress the Ʋlcer with Rose-water, wherein a little Roman Vitriol, or some Roch-Alum has been dissolved; applying over all Diapalma, or Empl. Album; renewing the Dressing Morning and Evening, 'till the Pain is wholly gone.

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.

CHAP. VII. Of an ƲLCER, SORDID and PƲTRID.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, vel 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Ulcus cum sorde & putridine, vel, Ulcus sordidus & putridus; we in English call An Ulcer with filth and putri∣faction, or, An Ulcer sordid, or, foul and putrid. But Dioscori∣des, lib. 3. cap. 6. has 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ʋlcus putrescens: and Hippocra∣tes, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ʋlcera putrida.

II. The Differences. Ʋlcers sordid and putrid, differ only in degrees. That is sordid, which (proceeding from the afflux of moist Humors) becomes foul, with a thick and snotty Ex∣crement.

III. That is a putrid Ʋlcer, when the said Excrements come forth with a noisom smell, like unto that of a dead Carcas; and withal putrifies and corrupts the Flesh which lies under it, and contaminates the softer parts.

IV. Guido, Tract. 4. Doct. 1. Cap. 3. says, These Ʋlcers differ only in degree, viz. that the one is such in a lesser, the other in a greater degree: for if the Excre∣ments be simply thick and foul, then we call it a Sordid Ʋlcer; but if they likewise receive a putridity and stink, in so much that they putrify and corrupt the Flesh under it and the softer parts, then we call it a Putrid Ʋlcer.

V. The Causes. The proximate Causes of this Ʋlcer are depra∣ved malign Humors, in a Body cacochymick, receiving a putrid∣ness from external heat and moi∣sture: or by reason of the too much, or unreasonable use of moist, unctuous, or greasy Me∣dicaments.

VI. Or from the Ʋse of vehe∣ment and over-strong Abstersives; which resolve the sound Flesh, and stir up a putrifactive heat in the Ulcer; whereby the Hu∣mors become so sharp, that they corrode the parts circumjacent.

VII. The Antecedent Causes are, excrementitious and gross Humors in a cacochymick Body, from ill Diet, bad Air, Slothfulness and want of stirring, &c. also from malign Fevers, which by means of the Expulsive-virtue stirred up, transmit their malignity outwards.

VIII. The Signs. A sordid Ʋl∣cer is known by sight; there appears in them, a great abundance of viscid and clammy Impurities;

the Flesh is soft and flaggy, and the lively colour of the Part is vanished.

IX. If it proceeds from a flu∣xion of Humors, whether from the whole Body, or from any one Part thereof, it will be known by the Signs delivered in the former Chapter.

X. If it proceeds from the weakness and distemperature of of the Part, it may likewise be known by its own signs, and signs of the Distemperature; and there will not then be any appearance of a fresh and lively colour in the Part.

XI. If it comes from Ʋnctuous Medicaments, it then appears white, and the whiteness goes round about the whole Ulcer, like a border.

XII. If it is from strong Abs∣tersives, the Ʋlcer grows hollow, and every day more than other, a small quantity of thin hot Quittor flowing forth.

XXIII. If it is become putrid, it will be known by the grievous stinking smell, and the disco∣loured matter.

XIV. The Prognosticks. If by reason of the great abundance, and the thickness of the Sordes or Impurities, the transpiration is hindred, the Part soon after corrupts; and so of a sordid Ulcer, it afterwards becomes a putrid Ulcer, or depascent, which is an eating Ulcer.

XV. If the putridity is in∣creased, or be not checked in the Ʋlcer, at length a Gangren will succeed, and then a Sphacelation follows.

I. The Cure of a Sordid Ʋlcer.

XVI. In this kind of Ʋlcer, great care is to be taken in the course of Diet; and the Body must be first purged from vitious and corrupt Humors, with Our Family Pills, Pill. Catholicae, Pul. Cornachini, Syrupus Catharticus, Tinctura Purgans, &c. and then a Traumatick Decoction is con∣tinually to be exhibited.

XVII. Outwardly, you must cleanse with Abstersives; as juices of Smallage, and Wormwood, and Centory; and meals of Barley and Orobus, Myrrh, and Honey of Roses, juices of Li∣mons and Citrons, Aqua mulsa, and Salt-water: but more espe∣cially with Wine and S.V. which is of exceeding benefit in cleansing all sordid and pu∣trid Ulcers; and is therefore to be mixed with other Medica∣ments.

XVII. If the Ʋlcer is made sordid by the use of too strong Detergents, Wiseman commends Ʋng. Basilicon mixed with red Precipitate, also Vng. Diapom∣pholigos, as things proper to dress the Ulcer with: and some cooling Unguent or Cerat, as Refrigerans Galeni, may be ap∣plied over it, with a Compress wrung out of Oxycrate.

XIX. If it is become sordid by the use of Lenients, and is covered thick with the sordes or filth, you need not fear (says Wiseman) to fill the Ulcer with red Preci∣pitate, and apply some mild Abstersive on Pledgets of Lint over it, with a Compress wrung out of Aqua Calcis, or Aqua

Aluminosa, and not to dress it 'till the third day after.

XX. For thereby the pain will lessen, and the Sordes will come away in a Slough; after which, the Ulcer is to be digested, 'till it looks more fleshy and natural, and then you are to incarnate with Medicaments of a milder quality, &c.

XXI. In a common sordid Ulcer: ℞ Ʋng. Basilicon ℥ i. red Precipitate ʒiii. mix them. Or you may dress with Ʋng. Apostolorum, or with Mundifica∣tivum Paracelsi, mixed with Alumen ustum.

XXII. This Liniment is good. ℞ Roots of round Birthwort ℥i. Agrimony, Centory the less, Worm∣wood, A. M. i. boil them in Wine: to the straining add, rind of the Frankincense-tree, Scammony, A. ʒiv. boil in the Wine again, then strain out, and add meal of Oro∣bus ℥ss. pouders of Tobacco and of Myrrh, A. ʒii. S.V. ʒi. Honey of Roses ℥ii. Turpentine q.s. mix, and make a Liniment.

XXIV. Or you may wash the Ulcer with this. Take Barley-water lbi. Honey of Roses, S.V. A. ℥ii. mix them.

XXV. And you may dress it with this. Take Turpentine, Honey of Roses, A. ℥i. flowers of Barley and Orobus ʒii.A. pouders of Myrrh and of Tobacco, A. ʒi. mix them.

II. The Cure of a Putrid Ʋleer.

XXVI. If the Ʋlcer is putrid, you are to wash it with a good Lixivium of Pot-ashes, in which Centory, Southernwood, Worm∣wood, Carduus, &c. have been boiled, or with good Brandy, and Ʋng. Aegyptiacum.

XXVII. Sennertus advises to wash it with Oxycrate, Lye, Brine; upon which are to be imposed Medicaments made of meal of Orobus, and pouder of long or round Birthwort-roots, mixed with a Decoction of Squills, in Wine and Honey.

XXVIII. Or, Take Honey ℥ii. Turpentine ℥i. Scammony in fine pouder ʒvi. Tobacco in pouder ʒiii. mix them.

XXXIX. If the Ʋlcer is hol∣low, you must use some cooling Ointment; as of fine Bole, lest an afflux of Humors should be excited by hot and biting things.

XXX. If the Ʋlcer is corrosive, and undermines the lips, making the Flesh soft, or unfit for healing, you are to deal with it, as we shall shew in Phagedenick Ul∣cers.

XXXI. However, that which is corrupted must be taken quite away, either by Incision, or by Cautery, (whether Actual, or Potential, it matters not much) 'till at length we come to the sound and quick Flesh.

XXXII. If you fear it should degenerate into a Gangren, you must use stronger things; as Balsamum amarum, Oxymel of Squills, Lixivium of Quick-lime, round Birthwort-roots, Scammony, To∣bacco in ponder, Emphorbium, the Ablution of Mercurius dulcis in Lime-water, Flower, or volatil

Sal Armoniack, Butter of Anti∣mony, &c.

XXXIII. But if the Putrefacti∣on shall yet be encreased, and the Ʋlcer tends to a mortification, you must treat it as we have taught, in Our Discourse of Gangrene and Sphacelus.

CHAP. VIII. Of an ƲLCER with TƲMOR.

I. WHat the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 vel 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus cum Tumore, vel Ulcus Tumidum: we in English call, An Ulcer with Tumors, or a Tumid Ulcer.

II. The Cause. The cause of a Tumor in an Ulcer, is the same with that in the afflux of Humors; but according to the nature of the Humor, such is the variety of the Tumor, whether it be Phlegmon, Erysipelas, Oedema, or Cancer.

III. The Signs. The Tumor it self is known by sight; but the kind of the Tumor, you may know by the signs of each particular Tumor, which you may search out in their respective places.

IV. The Prognosticks. An Ʋl∣cer with Tumor is more difficult to cure, than one without: and a Phlegmon is more easily cured than any of the other kinds of Tumors: if it is a Cancerous Tu∣mor, it is rendred in the highest nature difficult, and is for the most part uncurable, and only admits of Palliation.

V. The Cure. These kinds of Tumors must be here cured, as we have declared in their several Chapters; but yet, nevertheless, they are so to be managed, that the Ulcer may not in the least be neglected.

VI. You must first have respect to the vitious Humors, then to the Part affected; you must apply Medicaments which may either discuss the Humor, which is the cause of the Tumor, or bring it to Suppuration.

I. An Ulcer, with a Phlegmon.

VII. In an Inflammation, you may apply a Cataplasm made of Quinces, boiled with the Pouder of Myrtle or Barley-meal, Pom∣granate-peels, and Red-roses.

VIII. In the Augmentation of the Ulcer, you may add pouder of Camomil-flowers and Bean-meal: but in the state, Mallows, Marsh∣mallows, Meal of Linseed, and Faenugreek-seed. As,

IX. ℞ Barley-flower ℥ii. pou∣der of Camomil-flowers ℥i. Meals of Linseed and Faenugreek-seed, A. ʒvi. Milk, q.s. mix, and make a Cataplasm.

X. If the Tumor tends towards a Suppuration, it is to be helpt for∣ward with Maturatives, as a Cataplasm of Mallows, Marsh∣mallows,

Linseed, Faenugreek-seed, Saffron, Wheat, &c. As,

XI. ℞ Mallows, Marsh-mal∣lows, A. M. j. Water, q.s. boil to softness, and bruise them well; to which, add Meals of Linseed and Faenugreek-seed, A. ℥i. Wheat-flower ℥ss. Colophony ʒii. Saffron ʒss. oil of Roses, or yellow Palm∣oil ℥ii. mix them.

II. An Ulcer with an Erysipelas.

XII. If an Erysipelas be in the near adjacent places, you must ap∣ply those things which we have di∣rected in the Chapter of an Erysi∣pelas, lib. 3. cap. 17. You may very profitably impose on the external Parts, Waters and Jui∣ces of Elder-flowers, and Night∣shade.

XIII. But if you should rashly impose things which stop the Pores, great Blisters would often be ex∣cited, with malign and long con∣tinuing Ʋlcers, especially in the Thighs, which many times (by suffocating the natural Heat) de∣generate into a Gangrene.

XIV. If it should so happen, it will be then requisite, to apply cooling things, Dryers, and A∣stringents together. As,

XV. ℞ Plantan-leaves, M. i. Red-Roses M. ss. boil in Water to softness: heat and pulp them, and add Barley-flower ℥iss. pouder of Balaustians ℥ss. oil of Roses, q.s. mix, and make a Cataplasm.

XVI. But that which is often used here, is Unguentum Diapom∣pholygos, unto which (if you please) you may add a little Saccharum Saturni.

III. An Ulcer with an Oedema.

XVII. If the Tumor is Oedema∣tous, you may apply this: ℞ Leaves of Althaea, of Mallows, A. M. j. boil them in Lye of Pot-ashes to softness; bruise or beat them well, and add pouder of Althea-roots ℥iss. pouder of Camomil-flowers ℥i. pou∣der of Wormwood ʒiii. and of Saf∣fron ʒi. oil of white Lillies, q.s. mix, and make a Cataplasm.

XVIII. Or this: ℞ Pulp of Juniper-berries, Mithridate, A. ℥ii. pouders of Camomil-flowers and of Orrice-root, A. ℥i. Colophony ℥ss. Zedoary in pouder ʒii. Saffron ʒi. oil of Roses, q.s. mix, and make a Cataplasm.

IV. An Ulcer with a Cancerous Tumor.

XIX. Tho' the hopes of the cure of this is but small, yet something is to be done; you may dress it with Empl. de Ranis, with treble Mercury, or our Empl. Mercuriale.

XX. Or you may apply over it, a thin Plate of Lead besmeared with Quick-silver, often to be re∣newed; and you may sometimes wash it with the Water of the Griffen; or a Lixivium of Quick∣lime, in which a little Sublimate; or at least Mercurius Dulcis has been dissolved.

XXI. As to the rest of the Cure, which we might speak to here, we shall refer you to the particular Chapter of Cancers, in lib. 3. cap. 36. where you will see the whole of the matter at large.

CHAP. IX. Of an ƲLCER with PROUD FLESH.

I. WHat the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus cum Hyper∣sarcosi; we in English call, An Ulcer with proud Flesh.

II. The Cause. It is said, to come from too much Blood or Hu∣mors flowing to the Part affected; or from weakness of the Sarco∣tick, not being so drying as it should be; in which latter case, the Flesh is loose and spongy.

III. The Signs. It is known by sight, the Flesh is Luxuriant, or higher and more in quantity than it should be, red, light, loose, and spongy, and withal very tender.

IV. The Cure. If it comes from too much Blood or Humors flowing to the Part, the Sick must then use Fasting and a spare Diet; and to the Ulcer, drying Medicaments are to be imposed.

V. In the Toes sometimes, by reason of the Nails growing in, there is often Luxuriant Flesh; so that a man can neither put on his Shoes, nor go without pain; in this case burnt Alum alone, will take away the said Flesh.

VI. If it proceeds from the use of weak Sarcoticks, you must use a stronger sort of Abstersives, and such as may (if need requires) produce a Cicatrice: even Sep∣ticks must be used sometimes, if occasion be.

VII. But if there is need but of a little Drying, let there then be imposed dry Lint, or Lint, or Lin∣nen Cloths, which have been well wet and soaked in the following Decoction.

VIII. ℞ Nut Galls, and Rinds of Frankincense, Mastich, A. ʒi. Balaustians, Red-Roses, Rue, A. M. ss. Alum ʒii. boil all in Red Port-wine. Or, you may use the first of the Pouders de∣scribed in lib. 4. cap. 9. sect. 129. aforegoing.

IX. Now the proud Flesh is ei∣ther but beginning, or else it is come to a great height: if it does only begin to increase, then strong Desiccatives or Dryers will serve. And such are these following:

X. First, Vegetable Desiccants. Aloes, Avens-roots, Balaustians, Bistort-roots, Birthwort-roots, Comfrey-roots, Frankincense rine, Herb Horse-tail in Pouder, Mastich, Myrttle-berries, Nut∣galls, Olibanum, Oak-bark, Pom∣granate-Peels, Rue in Pouder, Sanguis Draconis, Savin in Pou∣der, Spunge burnt, Scammony, Sumach, Tobacco in Pouder, Tormentil-roots, Yarrow.

XI. Secondly, Mineral Desic∣cants. Alum burnt, Aqua Calcis, (which dries much without pain) Aes ustum, Catechu, Caput mor∣tuum of Vitriol, Ce••use, Crocus Martis, Chalk, Cataminaris, Fine

Bole, Flowers of Sulphur, Lead calcin'd with Sulphur, Litharge both of Silver and Gold, Minium, Rust of Iron, Saccharum Saturni, Tutia, Terra Lemnia, Terra Sigil∣lata, Umber, Whiting.

XII. Some of these things, you may use either in Pouder or Deco∣ction; if in Pouder, you may mix with them Ashes of an old Hat, or of Leather burnt, and dryed Blood, also burnt Alum, and even red Praecipitate, which in a mixture, Wiseman says, may be reckon'd a∣mong the milder Medicaments.

XIII. If you use the most proper of them in Decoction, then you may add a convenient quantity of either Alum, or Roman Vitriol; by which means you will not on∣ly suppress the luxuriant or soft and spongy Flesh, which is bud∣ding forth, but shall incarnate the Ulcer, and bring it to a heal∣ing, and Cicatrization.

XIV. ℞ Roots of Bistort, Com∣fry, and Birthwort, Catechu, Nut∣galls, Oak-bark, and Pomgranate Peels, A. ℥i. Fair-water lbii ss. or q.s. boil to the one half, and strain out. If you add to the De∣coction, Roch-Alum ℥i. it will be of a deep Amber-colour; but if a little Roman-Vitriol, it will be blackish, and will stain the Clouts and Rowlers of an unpleasing dirty Colour.

XV. Yet with the Vitriol it will be more effectual than with the Alum, and chiefly in malign Ʋlcers. You may dip Pledgets of Tow or Lint in it being warm, and gently press it out, and so dress the Ulcer therewith mor∣ning and evening; you will find in your practice, such a Decocti∣on, much transcending either Ointments or Emplasters.

XVI. Tho' some of the Minerals may be used also in the form of a Decoction, yet other som, and the most of them, are used in the form of a Pouder: they are, it is true, more effectual than Vegetables, yet it is not so easy to clean the Sore after them; nor are they so plea∣sing to the Patient, as when they are made into Ointments or Emplasters.

XVII. An Ointment. ℞ Ce∣ruse, Litharge, Mininm, A. ℥ii. Burnt-brass, Crocus Martis, A. ℥iss. Tutiae, Caput mortuum, A. ℥i. Sac∣charum Saturni, Catechu, A. ℥ss. Camphir ʒii. Oil of Roses, ℥xxx. boil to the consistency of an Ointment, adding Wax ℥iv. This is of good use where the Ulcer is hollow.

XVIII. A Pouder, from Wise∣man. ℞ Nut-galls, Pomg••anate-peels, A. ʒiv. Balaustians, burnt Alum, A. ʒi. make a subtil Pou∣der, and mix them. This (says he) may be sprinkled on the Ul∣cer thick, and dry Pledgets, with Compress bound over it: or it may be boiled in Red-wine, and Pledgets dipt therein, and ap∣plyed.

XIX. If the Proud Flesh is grown to a height, so that it will not yield to Desiccatives, you must then come to stronger Medicaments, which are called Cathereticks, or yet stronger than those, which are called Septicks; or the strongest of all, which are Escaroticks: the difference of which, you may see in the Third Edition of Our Synopsis Medicinae, lib. 1. cap. 69. sect. 207.

XX. Where the Proud-Flesh is

soft and sp••ngy, 〈◊〉〈◊〉 •…•…he•• •…•…ichs will be of sufficient 〈◊〉〈◊〉, and such are Alum-stone, Alu•…•… •…•…nt, Aqua Lapidis Medicamentosi, Aqua Viridis Sennerti, (which see Lil 4. Cap. 9. Sect. 130. afore∣going) Chalcitis, p••uder of Hermodacts, Prince's ••ouder, red Precip••tate, seewing. of Brass, Turpethum 〈◊〉〈◊〉, Ver∣digrise, Vitriol whi••e, 〈◊〉〈◊〉 stone, Ʋnguentum Apof•…•…orum, Ʋnguentum Aegyptiacum, and a mixture of Apostolorum ℥i. or of Aegyptiacum ℥i. with Basilicon ℥ss. to which add the Pulvis Angelicus in the place afore∣cited, Sect. 129.

XXI. Cathereticks pierce not deep, by reason of their thick sub∣stance, as also for their rebated heat; but only superficially corrode the Flesh, and dry, and without any great pain; because their heat is not very intense, unless mixt with some other things.

XXII. Aqua Calcis is mode∣rately drying, but if a few grains of Sublimate corrosive is added to it, it is much more powerful. The Water of Lapis Medicamentosus and the Aqua Viridis are more strong, but they may be made milder by the addition of a small quantity of Plantan-water.

XXIII. Red Precipitate, or burnt Alum, do either of them by themselves cause no great pain; but if they be used being mixt with other things, they both cause Pain, and a small Escar: yet red Pre∣cipitate exceeds most other things, for it operates with small Pain, concocts and thickens Ichorous Humors; and being washed, and mixed in small quantity with Incarnative Oint∣ments, it advances their Ope∣ration; and Turpethum Minerale yet exceeds the red Precipitate.

XXIV. A compound Pouder. ℞ Balaustians, Catechu, Nut-galls, A. ʒii. burnt Alum ℥jss. Ceruss, Dragons-blood, Olibanum, Myrrh, A. ʒi. Verdigrise, Princes Pou∣der, A. ʒss. mix them.

XXV. The Vitriol and Alum stones will serve will (says Wise∣man) for this purpose, to keep down loose or proud Flesh, and to cicatrize these Ʋlcers which are most luxuriant; and if they be discrectly used, will perform the work with little pain, and pro∣duce a firm Cicatrice.

XXVI. Fallopius his Cathe∣retical Lint. ℞ Rose, Plantan, and Nightshade waters, A. ℥iv. Crums of Bread ℥ii. corrosive Sub∣limate in pouder ℈iv. Opium ℈i. boil to the consumption of one half, and strain thro' a thick Cloth. Take Lint and boil it therein for a little while, then take it out, press it, dry it, and keep it for use.

XXVII. Sennertus makes it thus. ℞ Plantan and Rose wa∣ters, A. ℥v. corrosive Sublimate ʒi. boil, and strain thro' a thick linnen Cloth: in the straining, let the Lint or pieces of linnen Cloth be laid to soak, then taken out, dried, and kept for use.

XXVIII. Of the Ung. Aposto∣lorum and Aegyptiacum, the latter is said to be strongest; but in plain Ʋlcers it is not so well to be used, because of its spreading, and by touching the sound Part, it causes great pain; but it is

good in fretting Sores of the Mouth and Sinuous Ulcers, being dissolved in proper Decoctions, fit for the same purpose.

XXIX. But the Ung. Aposto∣lorum, tho' it is a Catheretick in tender Bodies, yet it is only a Mundificative in such as are of a strong and firm habit of Body.

XXX. If the luxuriant or proud Flesh shall be so firm and com∣pact, as to contemn all Cathere∣ticks, you must then have recourse to such as are yet stronger, viz. either 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Septicks, putre∣fascientia, corrupting Medica∣ments; or 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Escha∣roticks, Medicaments producing an Eschar or Crust.

XXXI. Septicks are not so hot as Escharoticks, but of a more sub∣til and thin substance, not having so much earthiness and astriction: and so as they more easily pierce, they cause less pain; which is yet very sharp and prick∣ing, but of no long continu∣ance.

XXXII. These leave the cor∣rupted Part soft, moist, and of a blackish colour: of the liquid kind are, Aqua Fortis, Aqua Re∣gis, Oils of Vitriol, of Sulphur, and of Salt: of the solid kind are the white Arsenick or Rats∣bane, the yellow Arsenick: or Orpiment, the red Arsenick or Realger.

XXXIII. Unguentum Fallo∣pii. ℞ White and yellow Arse∣••iak, A. ʒjss. Opium ʒ ii. round Birthwort roots, Verdigrise, A.ʒiii. Hogs-lard ℥ivss. mix, and make an Ointment. This is effectual in correcting and taking away of stubborn proud Flesh; besides which, it is of extraordinary use in curing of Cancers.

XXXIV. Escharoticks, by reason of their extraordinary great Heat, cause vehement Pain 5 and the reason is, that being of a more earthy substance, they are longer in piercing thro' the Part; of this kind, these are the chief: 1. Lapis Infernalis. 2. The White Caustick, of Sope and Quick-lime. 3. The Silver Cau∣stick. 4. Corrosive Sublimate. 5. Turpethum Minerale, whilst white, before it is washed.

XXXV. Of all these the Lapis Infernalis is the most effectual, and operates the most speedily, where it can be applied to an upper Part, or can be hindred from spreading.

XXXVI. The White Caustick is to be applied to the under side of a Part, or a Part depending, and where there is fear of running; because this Escharotick is not so apt to run, as is the Lapis Infernalis. It does the work well enough, but is scarcely so quick in operation, as the Lapis Inf. now mentioned.

XXXVII. The Silver Caustick is harder, and less apt to spread; and therefore is most convenient for the Parts that are depen∣ding, and where the Escharo∣tick may be most apt to run.

XXXVIII. Corrosive Sublimate is by na••means to be used alone, but it may be mixt, and grownd with Roman-Vitriol, calcined 'till it becomes red, or like to red Terra Sigillata.

XXXIX. White, or unwashed Turpethum Minerale, is also to be

mixed with the same Roman Vitriol calcined: this does work more gently, if mixed with some Narcotick Liniment or Oint∣ment, than if applied without mixture: and it far exceeds corrosive Sublimate, for that it is more familiar to Nature, and causes less Pain: and as it is not so volatil and piercing as the Sublimate, so in tender Bodies it assaults not the Heart and Vitals, nor causes Symptomati∣cal Diaries, as the Sublimate is apt to do.

CHAP. X. Of a CALLOƲS ƲLCER.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, vel 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. the Latins, Ulcus callosum; we in English call, A Callous Ulcer, or, An Ulcer with a Callus.

II. The Causes. It is derived either from the defluxion of a hot Serum; which is condensed or hardned, either by the over∣coolness of the Air, or by Me∣dicaments which cool and dry overmuch.

III. The Signs. The lips of the Ʋlcer are hard, livid, and wan, and sometimes of a whitish colour: and they are generally Annual, and thro' length of time con∣tract this callosity or hardness, with a livid colour.

IV. The Prognosticks. From what cause so ever this Callosity happens, the Ʋlcer is not possible to be cured, or closed up with a Cicatrice; 'till the hardness is first taken away, and the Ulcer be reduced to its natural state.

V. If the hardness be not great, it may be removed by Emollients and Discussives, with good Compress and Bandage: first, foment with roots and leaves of Althea, of Lillies, and of Mallows, Linseed and Fenugreek-seed; flowers of Camomil, of Melilot, and of Elder; which rarifies the con∣densed Blood, and removes the lividness.

VI. Then embrocate the hard∣ned lips with Ung. Dialthaeae, Oils of sweet Almonds, of Lillios, and of Earthworms; and apply Ceratum Galeni, Emplastr. è Mucilaginibus, Diaehylon cum Gummi, or de Ranis cum Mercurio, or a Plate of Lead besmeared with Mercury, or a Paste of Ceruss and Calx lota, made into an Ointment with Hogs-lard; and over that, a good Compress and Bandage.

VII. Sennertus advises to the application of the Mucilages of Linseed and Fenugreek-seed, Oils of Almonds, Lillies, and Earth∣worms, Hens and Ducks fat, &c. Or this, Take Mucilages of Al∣thea-seed and Fenugreek, A. ʒiv. Oils of sweet Almonds and of white Lillies, A. ʒvi. Turpentine ℥ii. Wax q.s. mix, and make an

Ʋnguent; over which you may apply the simple Diachylon-Emplaster.

VIII. But as to the Bandage, Wiseman advises for the Leg, the laced Stocking, which being well made, preserves the other parts from fluxion, better than a Rowler can.

IX. If these things will not do, Galen, in Meth. Med. lib. 4. cap. 2. is to be advised with: When the lips of the Ʋlcer (says he) are somewhat discoloured, and made a little harder than ordinary, they are to be cut out, even to the sound Flesh.

X. Wiseman also says, If the edges of the lips are inverted and callous, or the Ʋlcer is in such a place, where you cannot make good Bandage; your best way will then be by Caustiek or Knife to remove it, and then to digest and heal the Ulcer.

XI. But if the Sick will endure neither Incision, nor Burning with an Actuàl Cautery; you must then use Corrosives, such as the Aqua Viridis, (in Lib. 4. Cap. 9. Sect. 130. aforegoing) or the Pulvis Angelicus, mentioned in Cap. 9. Sect. 20. but the strongest of Remedies are, the Oils of Vitriol and Sulphur.

XII. Yet nevertheless, whether the Work is done by Incision or Corrosion, you must be very cau∣tious in the Nervous Parts; and defensative Medicaments are to be applied to the places adja∣cent; lest Pain, or an Afflux of Humors be excited.

XIII. An Observation. One 18 Years old, of an ill habit, had an inveterate Ulcer on the in∣side of the Ancle, of a round figure, with thick callous lips, the parts about being livid. There was no hopes by Emol∣lients and Bandage; they were therefore rubbed round with a Caustiek-stone, the Ulcer drest with Basilicon mixt with Preci∣pitate, and Diachylon ireatum was laid over with Compress and Bandage, designing to dispose the lips to unite with the Ulcer. The Eschar separating slowly, the lips skin'd underneath, and so disappointed me: but the in∣verted parts being removed, with the Callus underneath, a Paste made with Calx lota and Lard, applied with good Compress, forced the lips with the Ulcer, and so it was healed with a smooth even Cicatrice. Wiseman, Liv. 2. Cap. 8.

XIV. Another. A Maid having such an Ulcer, with livid callous lips, but not inverted; it was digested with Basilicon and Pre∣cipitate, and fomented with a Decoction, as above mentioned; then Diachylòn ireatum applied over the parts about, and a Compress, with a laced Stock in, put on over it, thereby digesting the Ulcer, and flatting the lips; and in 3 Weeks time it was in∣carnated and cicatrized with Ʋng. Diapompholigos, tho' it had been more than 3 Years work in other Hands. This speedy Cure I imputed to the Laced-stockin, performing all the Intentions necessary to the curing of such like Ulcers. Wiseman, ibid.

CHAP. XI. Of an ƲLCER DISCOLOƲRED.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus malè coloratum, vel dis∣coloratum; we in English call, an Ulcer evil-coloured, or dis∣coloured.

II. The Cause. It proceds ei∣ther from an afflux of malign Humors; or for want of natural heat, or from too hard binding; or from the coldness of the Air, or Weather.

III. The Signs. It is known by sight, being discoloured, with a wan, livid, leaden colour, or black coloured; and sometimes with a yellowish colour, according to the nature of the Humors which most predominate.

IV. The Prognosticks. Disco∣louring of an Ʋlcer is an evil sign, and foreshews some other worse Symptoms suddenly to ensue, if the cause thereof be not re∣moved.

V. The Cure. If it is from an afflux of Humors in a cacochymick habit of Body, you must make Evacution by Purgation and Vo∣miting, as also by Diureticks.

VI. And in the intervals of Purging, a good Traumatick Drink is to be taken; which may alter the habit of the Body, and destroy the malignity of the Humor abounding.

VII. Outmardly, Interceptives and Defensatives are to be ap∣plied to the parts adjacent to the Ulcer.

VIII. And Scarification is to be made upon the very place where the Discolor is most manifest; that the vitious Blood may be drawn forth, which you may dry up with Spunges.

IX. Then in the next place, you must use strong Disiccatives, having but little sharpness: if these pre∣vail not, you must apply the Aqua viridis before-mentioned, in Lib. 4. Cap. 9. Sect. 130. or some such like Medicament, espe∣cially such as may have the power of Abstersion and Incar∣nating together.

X. Then with Pulvis Astrin∣gens, or with some drying Lini∣ment, Ointment, or Plaster, you must produce the Cicatrice, as in other Ulcers.

XI. If it proceeds from want of natural Heat, Attractives and Pyroticks are to be applied, and such things as have in them a comfortable and spirituous Heat; of which kind are Lixivium's, Spirit of Wine, Euphorbium, and the like.

XII. If it procceds from cold∣ness of Air or Weather, you must (besides the things named in the former Section) take care to keep it warm by Emplasters, Rowlers, and warm Cloathing.

CHAP. XII. Of an ƲLCER CAVERNOƲS, or HOLLOW.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the La∣tins, Ulcus sinuosum, and Ulcus cavernosum; we in English call An Ulcer sinuous, cavernous, or hollow.

II. A sinuous or cavernous Ʋlcer, is that which has its mouth streight, and its bottom broad, with many caverns therein, some right, and some oblique, without any hardness or callosity; and therein it chiefly differs from a Fistula. These Caverns, by help of a Wax-candle, are easily found out.

III. The Differences. These Ʋlcers differ one-from another; as the Caverns are either streight or crooked; deep, or lying only under the Skin; or having one, or more Sinus's.

IV. The Causes. They many times proceed from Apostems, wherein the Sanies or Pus, being long continued, either by his own nature, or by its long continuance becomes sharp and corrosive, whereby it makes or eats a hollowness, not much unlike to Coney-borows, which the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and the Latins, Sinus: of a Sinuous Ʋl∣cer, from this Cause, we have already treated at large, in Lib. 3. Cap. 4. aforegoing, of this Work.

V. But a sinuous Ʋlcer is not only bred from Apostems, but often∣times succeed Wounds, caused thicfly thro' the ignorance or negligence of the Chirurgeon: and these many times happen in Parts de∣scending; as in the Reins of the Back, Groin, Thighs, Legs, and Feet.

VI. For in such-like places, where the Muscles are large, if the Wound is not so ordered, that the Sanies or Pus may be evacuated by the Orifice of the Wound; it then by its weight descends, and according to the ductus or pro∣gress of the Muscles, and so makes Cavities, Furrows, and Coney-borows; and this more especially if it is long detained, whereby it becomes sharp and corroding.

VII. The Antecedent Cause is, a Ca••ochymy or evil habit of Body, in which many evil Hu∣mors do abound; occasion'd by evil Diet, Excess, Slothfulness, want of Exercise, and a dis∣contented fretful disposition; which sowr the Humors so, that when the Sanies or Pus pro∣ceeding from them is too long detained, as aforesaid, they be∣come corrosive, and render the Ulcer sinuous.

VIII. For unto the Part af∣fected, being now weakned, Excre∣mentitious Humors flow, not only from the Parts adjacent, but from the whole Body also, which

makes the Ulcer the more diffi∣cult to be cured.

IX. The Signs. They are known from the preceding Causes; whe∣ther it is a translation of Matter from within outwards, or from a Phlegmon, or other Abscess, or a Wound, &c.

X. It may also be known or found by searching with a Probe, or a Wax-candle, or a Plummet of Lead: and if there are more Orifices than one, they are dis∣covered by Injections; and the largeness may be known, by the quantity of Matter flowing forth.

XI. The Prognosticks. Sinuous Ʋlcers, if they have been of long continuance, they will be of diffi∣cult cure; because of the weak∣ness of the Native Heat of the Part, which makes it unable to assimulate its proper Nutriment, or to resist the afflux of Humors.

XII. If the Sinus runs upon. or under the Joints, Nerves, or Ten∣dons, where it cannot easily or safely be laid open, it will be of very difficult cure.

XIII. If it proceeds from a translation of Matter within the Body, the Cure cannot be ef∣fected 'till the diseased Viscera be healed; during which, the Patient will be in great danger of a Marasmos, or very deep Consumption.

XIV. But if the sinuous Ʋlcer discharges but little Pus or Matter, and that well digested, and in à place where it may safely and easily be kept open, the Cure will be in more hopes.

XV. Cure. There are two ways of curing a sinuous Ʋlcer: 1. By Injections, without laying them open. 2. By opening them, and dressing them as another Ulcer.

I. The Cure, without laying open the Sinus.

XVI. There are four Inten∣tions of Cure. 1. That a good Diet be instituted, which may be drying, and not generating a large quantity of Excrementitious Hu∣mors: and respect is to be had to the Regulation of all the other six Non-naturals, which are here in other places largely discoursed of.

XVII. 2. The Cacochymia is to be considered, and the super∣abundant or excrementitious Hu∣mors are to be evacuated, and contemperated: you may purge with Syrupus Cathartious, or an Infusion of Sena, Rhubarb, and Mechoacan; or with Pil. Cath∣articae, Panchymagogae, or Our Family Pills; or with Palvis Cornachini, which is no despica∣ble Medicament: and if the Stomach is foul, Evacuation must be made by Wine or Syr••p of Squills, or some proper Antimo∣nial.

XVIII. The Humor must be contemperated, by giving some proper Traumatick Diet-drink, and other Balsamick and Vulne∣rary Potions, as the nature of the thing requires.

XIX. 3. The Influx of the Humors into the Sinus is to be prevented; and this is to be done by Revulsion, Interception, and Repercussion; of all which we have discoursed in their proper places.

XX. The removing of the Con∣joined or Proximate Cause: this has respect immediately to the Cure of the Ulcer; by removing the Accidents which attend it, as Pain, Inflammation; Tumor, Sordes, &c. without which, there can be no hope of a Cure.

XXI. In order to do this, we shall observe the Method of doing it, out of the admirable Franciscus Valeri••la his Observations; who in Lib. 5. Obs. 1. & 7. has in a most excellent manner delivered the true Way and Method of Healing.

XXII. 1. You must consider the Sinus, how the Matter may be be best discharged; if the Orifice be in the declining part, it is to be inlarged; but if the Sinus runs beneath downwards, it will be necessary to open a Hole in the declining and lowest part of the cavity or hollowness, (either by the Incision-knife or Caustick) that a way and passage may be made in a depending place, for the issuing forth of the Sanies, Pus, or Matter.

XXIII. But if the Sinus does run under considerable Vessels, Ar∣teries, Veins, Nerves, or be in such a place where you cannot conve∣niently or safely lay it open; you must then (say 〈◊〉〈◊〉 •…•…man) in∣large the Orifice, 〈◊〉〈◊〉 put the Member in such a position, as may dispose the Matter to flow forth, and by Compress and Bandage, contribute your en∣deavours thereto.

XXIV. 2. That such a com∣pressive Ligature be used, (to pre∣vent the coming of a Fistula) which may begin from the bottom of the Wound or Ʋlcer, and end in the orifice thereof: this always provided, that by how much the nearer it comes to the Orifice, by so much the looser it may be.

XXV. 3. That, way being thus made for the discharge of the Mat∣ter, the Ʋlcer is to be cleansed with Abstersives, according to the degree of its impurity: and that by reason of the foulness of these Sinuous Ulcers, the Spirit of Wine is very fit to be mixed with other Medicaments, because it has an excellent property and virtue, to cleanse and purify in such like cases.

XXVI. For truly great and admirable is the power and force of Aqua Vitae or Spirit of Wine, in cleansing sordid and foul Ulcers, in resisting of a new Flux of Matter, by strengthning of the Part now weakned by the disaffection; in glewing together the parts of the Ulcer disjoined or separated; in producing a soundness and firmness of the Flesh; and in disposing to a speedy healing, especially if the Affect be in Parts nervous and tendinous: so that there is scarcely any thing better for that purpose in the World.

XXVII. First of all (says Va∣leriola) after Ʋniversals, and a special regard had to the whole Body, the Ʋlcer must be cleansed from its thin ichorous Excrements; without which it can neither be filled up with Flesh, nor agglu∣tinated.

XXVIII. ℞ Broth of whole Barley lbii. Honey of Roses ℥vi. mix, and inject with a Syringe: it cleanses, without any sharpness;

but if Spirit of Wine ℥iv. be ad∣ded to it, it will be so much the better.

XXIX. Wiseman says, the most usual Abstersives are, Ung. Apostolorum, Mundificativum Paracelsi, and Mund. ex Apio, especially being used with red Pre∣cipitate.

XXX. If there is a necessity for Injections, you may cast in with a Syringe (says he) some of the following Liquors; (having a care not to stop the Orifice, lest you dilate the Sinus.)

XXXI. A milder Injection is this. ℞ Decoction of Barley, which mix with Syrup of dried Roses, or else with Honey of Roses. Or this, which is stronger. Take tops of lesser Centory, Agrimony, Horstail, Burnet, A. M. i. roots of round Birthwort, of Orrice, A. ℥ii. Myrrh, Sarcocol, A. ʒiii. Water lbii. boil and strain, and add thereto S.V. ℥iv. Honey of Roses q.s. mix them.

XXXII. But if the Ʋlcer is very deep, you must use strong Cleansers, by mixing with some of the former Injection a fit proportion of Ʋnguentum Aegy∣ptiacum: and if then after 6. 8, or to days, these following things should do nothing, you may use this following of Vale∣riola.

XXXIII. ℞ Raspings, or ra∣ther the pouder of Guajacum, and and bark of the same in pouder, A. ℥ii. bark of Frankincense, Myrrh, Sarcocol, A. ℥ss. long Birthwort, Centory the less, Agrimony, Horse∣tuil, Pimpernel, Olive-leaves, the greater Consound, Wormwood, A. M.i. pure Rod-wine lbiv. clarified Honey ℥iv. mix, and make a De∣coction; and strain out for an Injection.

XXXIV. But at the very time of using it, add thereto of the best Aqua Vitae or S.V. ℥i. for every dose, or using, as oft as you administer the Decoction.

XXXV. But if together with the aforesaid Decoction, you add of the best Aqua Vitae, or S.V. lbii. and so distil them in a Glass-Alembick, in B.M. you will have from thence a most admirable Liquor; not only for cleansing all hollow and sordid Ulcers, but also for conglutinating, and closing them safely up; which we have frequently found (says Valeriola) by Experience.

XXXVI. So••ne cleanse with this. ℞ Wine (in which white Horehound, lesser Centory, flowers of Hypericon, Carduus Ben. Worm∣wood have been infused) lbss. Unguentum Aegyptiacum ʒ ii. Honey of Roses ℥ss. mix for an Insection. You can scarcely de∣vise more effectual Medicaments than these are, for the cleansing of a sinuous or cavernous Ulcer.

XXXVII. You may easily know when the Ʋlcer is sufficiently mun∣dified; and that it is not yet clean, if the Quittor or Matter is either stinking, reddish, pale, blackish, or thin and water ish.

XXXVIII. But when the time is come, that it is thought sit to sid the Ʋlcer with Flesh, you may then make use of this next following Injection; the Virtues and Facul∣ties of which are both mode∣rately to cleanse; and also to fill up the cavity with Flesh,

and therefore may deservedly be called a Sarcotick Remedy.

XXXIX. ℞ Leaves of Plan∣tan M. ••i. of Agrimony, Betony, Cinkfoil, Herb. Robert A. M. i. of both Consounds, Ceterach, Horstail, Hypericon, Wormwood, A. M. ss. Water q.s. make a Decoction: at the end of the Decoction, add red Astringent Wine lbii. Red-roses, Mrrtle-leaves, whole Barley, A. P.ii. boil a little, and strain, of which take lbiv. and add there∣to Bean-meal, Frankincense, Ma∣stich, Myrrh Pine-Rosin, Sarcocol, r••und Birthwort root, A. ℥i. meal of ••robus, Florentine-Orricè root, A. ℥ss. Honey of Roses ℥iv. mix, for an Injection.

XL. After the Injection, put in Tents (according to the hollow∣ness) dipt in some Sarcotick Oint∣ment, (as the Ointment of Lith∣arge) and within the Ulcer apply this Sarcotick Pouder.

LX. ℞ Fine Aloes ℥i. Floren∣tine-Orrice root, Frankincense, rind of the same Tree, Sarcocol, A. ℥ss. make a fine pouder, and mix them; with which fill up the hollow cavities of the Ulcer.

XLII. And withal, to encourage the Healing, you may foment the Ulcer and parts adjacent with the Decoction at Sect. 33. above; or with this, ℞ Cen∣tory the less, Red-roses, A. M. i. Myrrh in pouder, ʒiii. Roch-Alum ℥i. boil all together in Red-Wine, then strain out for a Fomen∣tātion.

XLIII. After these things are done, you may use this Epulotick-Injection following. ℞ Leaves of Plantan, green Pvy, Red-roses, A. P.i. Myrtle-berries, P.jss. leaves and flowers of Centory the less, A. M. ss. Roch-Alum ℥i. Pomgra∣nate-peels ℥jss. Red-wine q.s. mix, and make a Decoction.

XLIV. And over all, you may lay Emplastr. de Minio, or Dia∣palma, or Diapompholigos, or Our Emplastr. Album.

XLV. And lastly, in the curing of these great and hollow Ʋlcers, (says Valeriola) after the through cleansing of them, we found by good. Experience, that there was nothing better, nor more available for the Cure, than the applying of Pillows or Bolsters, a little thicker than ordinary, round about the said Ulcers; and so binding them hard on, strongly to press down upon the Flesh lying underneath, that the separated parts might touch one another: and Experience taught that agglutination was most ab∣solutely procured thereby.

II. Of Dressing of these Ulcers.

XLVI. First, lay over the whole compass of the cavity Emplastrum Album, and then inject with a proper Syringe, your Abstersive Medicament blood-warm; for for the cleansing the Sanies or Sordes, and making the Ulcer sweet.

XLVII. And if the Excrements or Impurities be ichorous and thin, you may put in this Ointment, which has an admirable and excellent virtue, in speedily cleansing the Ulcer. ℞ Juice of Smallage lbss. (which is a famous thing in cleansing of foul Ulcers) of the best Honey ℥iv. Barley-flower ℥ii. Turpentine ℥jss.

meal of Orobus ℥ss. choice Myrrh ʒii. mix, boil all together, and make an Ointment. Linnen rags may be dipt herein, and put in∣to the cavities of the Ulcer. It cleanses Ulcers excellently, with∣out any biting at all.

XLVIII. Then put into the Ori∣fice a Leaden Tent or Pipe; but let it be short, hollow, wider in the upper than in the lower part; and having broad lips turned out, that it may be kept from slipping in; and cover the Orifice and upper part of the Tent with Empl. Diapalm. cum Succis, or Empl. Album, or some such like, which let be snipt, to give way to the Matter which may flow out of the Ulcer.

XLIX. Above the Emplaster you may lay a piece of soft Spunge, moistned with the Decoction with which you dress the Ʋlcer, and wrung out, which will suck into it self the humidity, and keep the lips of the Orifice dry; and above the Spunge, you may lay a Pledget of fine Tow.

L. This done, Bolsters must be laid from the lower part of the cavity, or bottom of the Ʋlcer; over which a double soft linnen Cloth is to be put: and then you are to rowl it up, beginning the rowling at the bottom, where it must be somewhat streight, to press out the Pus or Matter, bring the Sides of the Ulcer to∣gether, and procure agglutina∣tion: but let not the Bandage be so hard as to be painful or trou••lesom, for that would dis∣temper the Part.

LI. As you draw near to the Orifice in rowling, it must be some∣what slack, that the Matter may have room easily to issue forth.

LII. You may dress it but every second or third day, unless much Sanies, Humidities and Impuri∣ties flow forth: and when you do come to the dressing of it, first, loose the Rowler, the turning of which is about the Orifice, and so take away the Spunge and Emplaster, that you may come to cleanse the Ulcer.

LIII. Then observe, whether Nature is yet intending to agglu∣tinate the parts; which you will easily know, by the Recrements issuing forth, their colour, con∣sistence, and smell: and by the Ulcer it self, whether it is with, or without Pain, or any re∣markable Tumor.

LIV. If the Matter is much, ill-colour'd, and stinking, and the Cavity is painful, and a manifest Tumor appears, you may be certain that there is no agglutination; then you must continue to dress the Ulcer in the following man∣ner, 'till a perfect Unition is accomplished, which you may know by the Signs.

LV. If the Pus or Matter is but little in the Orifice, there is no Pain selt, and the Cavity is equal without Tumor, then you may conclude that the Agglutination is induced; and now you must come to the use of Epuloticks.

LVI. If after some time of Dressing, a thin, gleeting Matter shall yet appear, especially when the Ulcer is in or near Parts nervous, tendinous, membranous, or glandulous, you are not to despair, but to continue the Dressings on, 'till the Tone of

the parts hurt are in some mea∣sure restored.

LVII. And as to the first Em∣plaster which is laid over the whole Cavity it self, it is so often to be renewed, as it is souled with the Quittor, or leaves off sticking to the part.

LVIII. You are also to dress the Ʋlcer as seldom as may be: for often dressing lets in the cold Air, which is prejudicial to Ulcers, and hinders their uni∣tion and healing.

LIX. And this is the manner of proceeding in these Sinuous Ʋlcers, if the Excrements have a way to flow from them: which will be, if the Orifice is in a depending Part, or lateral, the Cavity or Sinus being lateral also: for then, such a situation or posture may be ordered, as may farther the evacuation of the Excre∣ments.

LX. But if by reason of the situation and figure of the Cavi∣ty, the Ʋlcer cannot le dis∣charged of its filth, then no Abs∣tersion, Incarnation, or Agglu∣tination can be expected, till that hinderance is removed, which is only to be do••e either by Incision or Caustick.

III. The Cure, by Opening the Sinus.

LXI. The Opening of a sinuous Ʋlcer is confidered in a twofold respect: 1. In opening the bottom of the Sinus only, when in a depending Part, it is lower∣most. 2. The laying open all the whole cavity or cavities, when the nature and disposition of the Ulcer so requires it.

LXII. If the Cavity then is lower than the Orifice, whether directly or obliquely, tho' not very deep; or if it goes deep also, as it does in many sinuous Ulcers; or if it penetrates into the Brest, or Abdomen; or if the hollowness is very broad and capacious; or if it be in a great Joint; or where great Vessels, Nerves, and Tendons are: in all these cases, a new way must be made for the Matter, that it may be discharged downwards.

LXIII. This is done two ways: viz. either by Caustick, or In∣cision.

LXIV. The Caustick is of use, 1. When the Patient is timorous or fearful. 2. When the Cavity is in a Part, wherein a great Scar may cause deformity. 3. When there may be fear of a great Flux of Blood. 4. When the Patient is sick also and weak.

LV. If the Sinus is in the upper side of a Part, apply Lapis Infer∣nalis, for it mortifies soonest, deepest, and with the least pain; nor will it in such a place be so apt by running or spreading, to burn the adjacent parts, or cause a greater Wound than is intended.

LXVI. But if the Sinus is in the lower or under side of a Part, or in a Part depending; then use the white Caustick, made of strong Soap-Lye and unslaked Lime, which will not run.

LXVII. Some of our late Chir∣urgeons use the Caustick-stone, by constant rubbing it on the Part, 'till it is mortified, and then it is opened with an Incision-knife: but this is not to be done, but

when the Skin is thin; because this rubbing gives far greater pain, than the application of it to the Part, being defended.

LXVIII. When the Escharotick has mortified all to the cavity or Sinus, then you must cause the Eschar to fall, by applying to it Ʋnguent, Dialthaeae, fresh Butter, Hogs-lard, or some such like thing; and when it is come off, a passage in the lower part will be made for the Matter: after which, you must proceed in the former Methods to compleat the Cure.

LXiX. But if the Patient has courage enough to endure it, you may use Incision, which is soonest done, is leis painful, and will sooner be cured: it may be performed either with the Incision-Knife, or with a Syringot••mos, as your reason shall direct you.

LXX. When you have made Incision, you may arm Dossels and Pledgets, with mundifying and drying Medicaments, such as this. ℞ Ʋnslakt Lime ʒijss. Aloes ʒii. Amber, Colophony, Scam∣mony, A.℥jss. Catechu ʒi. make all into ••ine pouder; mix this with the while and yolk of an Egg beaten together; bringing them to the consistency of an Ointment; which apply to the Incision, or filling it well, that the lips may be kept asunder.

LXXI. Open it not, 'till the end of the second day; for it will both digest the Wound, and dry the superflous humidities of the Ul∣cer: after which you may go on with the Cure as before directed.

LXXII. But when the Sinus is near no great Joint, nor approximate to any great Arteries, Veins, Nerves, Tendons, or Glandules; or is not of an extravagant bigness, or like to bring a dangerous Hemorrhage, but lies on the middle of a Limb, or along a great Bone: in all these cases it will be the surest way to lay open the whole cavity the longest way, if it crosses not the Ductus of the Muscular Fibres: and this is done also, either by Caustick, or Incision, as is before declared.

LXXIII. The Cavities being laid open, the Ʋlcer is to be cleansed with Abstersives, as Oxymel∣simple, or with Squills, Unguen. Apostolorum, Nicotianae, Aegy∣ptiacum, or some of the other things before described in this Chapter: after which, you must apply Sarcoticks to Incarnate, and Epuloticks to compleat the Cicatrice.

LXXIV. If the Ʋlcer is from an Abscess within the Body, it will not be safe to use Injections, unless a way be found how to be let them out again: in such cases, you must see how you may give Vent to the Matter, for while that is wanting, there can be no hope of cleansing: but that being conveniently made, it may be kept open by a Cannula, or some such like thing; 'till Nature, thro' the help of Art, shall be disposed to heal the disaffected Viscera.

LXXV. But if these kinds of Ʋlcers prove-rebellious, and diffi∣cult to be cured, you must pre∣scribe some Traumatick Decoction, or some Decoction made of Guajacum and its bark, Sarsa∣parilla, S••ssafras, Chin•• root.

Burdock-roots, Agrimony, An∣gelina, Avens, Bistort, Borrage, Bugloss, Comfrey, Consound, Golden-round, Horehound, Hy∣pericon, Ladies-mantle, Sanicle, Solomons-seal, Tormentil, and other the like Vulnerary Herbs; the taking of which may be con∣tinued for three Weeks or a Months time.

LXXVI. And then wash seve∣ral times a day, with the Water of the Griffin, by injecting it in with a Syringe; and if the Ulcer is laid open, by washing it with a Spunge, and laying a piece of Sponge, or double Cloaths wet therewith, and keeping them still moist with the Water, this cures speedily, and it were to a Miracle when all other things fail.

CHAP. XIII. Of an ƲLCER with WORMS.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins Ul∣cus cum Verminibus; we in Eng∣lish call, An Ulcer with Worms.

II. The Causes. They are cau∣sed from great Putrifaction; and foreshew a great declension in the state of the Ulcer, from a healthful habit of the Flesh, and parts about it.

III. But in some nasty People, where Flesh-flies can come at the Sore, they may be caused from Fly∣blows, (which in the West Indies I have sometimes seen in Negroes Legs) if they proceed from this cause, the consequence is not so bad as the former.

IV. The Signs. As they are bred for the most part in Ʋlcers sordid, and foul; so if the Ulcer is large and wide, they are generally known by sight.

V. Or otherwise, if they cannot be seen, they are known by a biting pricking pain, and a sense of a kind of motion called motus undosus, a wave-like mo∣tion; with a certain filthy stink.

VI. The Prognosticks. If they proceed from Fly-blows, there is simply no danger in them; but if from Sanies or Sordes, by reason the Ulcer had not been purged or cleansed for a long time, as it shews a great corruption and putrifaction; so it also declares the Ulcer to be of difficult care; and that the Tone of the Part is much depraved.

VII. The Cure. The Indications of Cure are twofold: 1. To take away and destroy the Worms. 2. To prevent and hinder the putridity of the Ulcer.

VIII. If the Worms lye open, or in an open Ʋlcer, so as to be plainly seen, they may be taken forth with Instruments, fitted for the same purpose: but some Authors laugh at this, thinking the pain in doing it will be great, and the labour fruitless;

for that possibly you may not be able to take out all; and if you should, yet you leave the corrupt humor, and putridinous heat behind, which bred them, and may also breed more.

IX. But as these Worms or Maggots are for the most part bred in hollow and sinuous Ʋlcers, so they lye hid, and cannot be seen, and for the most part stick so fast, that they cannot be drawn forth. These Worms then are first to be killed with Medicaments, which may also have a faculty of taking away the putridity, the corruptive heat, and the over∣great humidity of the Part.

X. Such Simples as are good for killing Worms in Ʋlcers, we have enumerated in Chap. 2. Sect. 14. aforegoing of this Book; to which you may add these few fol∣lowing: Aron-roots, Bearsfoot, Fetherfew, Fern-roots, Hellebor white, Hellebor black, Lupins in meal or decoction, Mugwort, Peach leaves and flowers, Quitch∣grass, Scordium.

XI. All, or any of which you may use in Infusion, Decoction, Lixivium, Pouder, or Ointment, simple or compound, as the nature and quality of the Ʋlcer shall most require: among which, those things which shall be prepared from Bearsfoot, the Hellebors, To∣bacco, Aloes, and Scammony, may be superior to all other Vegetable-medicaments whatso∣ever.

XII. In the place afore-cited, from Sect. 15 to 20, we have given you several Compound-Medicaments for this purpose, of extraordinary effects: yet that we might not be wanting, you may also take these following Compounds; which have a power also of de∣stroying the putridity, and dry∣ing up the too great humidity.

XIII. To correct the Putri∣dity. ℞ Centory the less, Hore∣hound, Wormwood, A. M.i. Water q.s. boil and strain; and to lbi. add Honey, Aloes, A ℥ii. Ung. Aegyptiacum ʒiv.

XIV. Or this of Sennertus. ℞ Gentian-root ℥ss. white Helle∣bor ʒii. Dittany, Centory the less, Wormwood, A. M. ss. Water q.s. boil, and strain: to lbi. thereof add Elixir Proprietatis ℥i. mix them.

XV. Or this of Riolanus, in Chirurg. de Ʋlcerib. cap. 8. Take, roots of white Hellebor, of Capers, of Gentian, and of white Dittany, A. ʒii. Centory the less, Calamint, Horehound, Scordium, Wormwood, A. M. ss. Water q.s. boil, and strain: in lbi. thereof dissolve Honey ℥ii. Aegyptiacum ℥i. with this he washt the Ulcer, and over it he laid Ʋng. Apostolorum.

XVI. Or, ℞ Ʋnslaked Lime q.v. extinguish it with Wine-Vinegar; and afterwards mix it well with Oil of Roses q.s. and make a Cataplasm.

XVII. Fallopius in Lib. de Ʋl∣ceribus, cap. 2. advises to this, which may be used with a Tent that will reach the bottom. ℞ Ceruss, Polymountain, A. ℥ss. Tar q.s. mix, and make a Liniment.

XVIII. Or, ℞ Meal of Lu∣pins ℥i. Bulls-gall ʒ vi. Elixir Proprietatis ʒv. Honey q.s. mix, and make a Liniment.

XIX. Fallopius his Aqua Alu∣minis Magistralis is commended.

℞ Plantan and Rose waters, A. lbi. Alum, Mercury sublimate, A. ʒii. the Ingredients being in pouder, mix, and dissolve in a glass Vessel in a Sand-heat, evaporating away one half of the Water: let it settle a Week, and decant the clear for use: when it is to be used, it is to be mixed with a double, triple, or quadruple quantity of Rose-water.

XX. To these things add, the Infusions of Crocus Metallorum, or of Vitrum Antimonii; the Ab∣lution of Mercurius dulcis, and of Turpethum Minerale in Lime-water, or the Water of the Grissin, which is incomparable; so Vitriol of all sorts dissolved in fair Water, adding a little Spirit of Wine in which a little Cam∣phir is dissolved.

XXI. But among Vegetables, scarcely any thing exceeds Tobacco; the Juice of the green, or the Decoction or Infusion of the dry; used by Injection, or Pled∣gets dipt therein, and applied: to this add Ʋnguentum Nicotianae, either alone, or mixed with a little red Precipitate.

CHAP. XIV. Of an ƲLCER VARICOƲS.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus varicosum; we in English call, An Ulcer varicous, or, An Ulcer with a Varix.

II. We have already treated of Varix, as it is a Disease of it self, in Lib. 3. Cap. 16. of this Work aforegoing, so that no more need be said of that here: we are now only to consider an Ulcer, as being joined with it.

III. The Causes. What the causes of a Varix are, we have told you in the place cited; and also what the Causes of an Ulcer are, in Cap. 1. Sect. 24, ad 35; by joining of which together, you may find out the Cause of an Ulcer varicous.

IV. The Signs. They are also easily known by sight; by com∣paring the signs of a Varix with the Signs of an Ulcer, as they are delivered in Cap. 1. Sect. 36, ad 52, of the Book aforegoing.

V. The Prognosticks. A Vari∣cous Ʋlcer cannot be healed, unless the Varices be first of all healed; as Galen, Meth. Med. lib. 4. cap. 2. saith.

VI. And it is to be observed, that if the Varix be very great, that it is scarcely to be removed with the saving of Life; so very great is the danger of Death.

VII. And a Varix being ulce∣rated by the acrimony of the Humor, thro' some Accident or Bruise, Wound, &c. then Pain, Inflam∣mation, and Tumor may succeed.

VIII. The Cure. Wiseman says, The Cures of these Ʋlcers are

either Real, or Palliative; the Real or Perfect Cure is, the total cutting out of the Varix, as we have taught in Lib. 3. Chap. 16. Sect. 32, ad 44. from Paulus Aegineta, Cornelius Celsus, Avicen, and Wiseman.

IX. But this way (says Wise∣man) has not been admitted a∣mongst us; nor have I often seen a Varicous Ulcer could be cured by cutting off the Branch leading to the Ulcer, there being com∣monly more Veins concerned in it.

X. The Palliative Cure consists (the necessary Purging and Bleeding having gone before) in dressing the Ʋlcer with Digestives and Deter∣sives, according as the Ʋlcer is sanious or sordid: and while by good Bandage, or a laced Stockin, (if it is in the Leg) to repress the Humors impacted in the Part; by which Bandage, the lips of the Ulcer will be disposed to cicatrize with the Ulcer: but this lasts no longer than the laced Stockin shall be worn; from whence it is called a Palliative Cure.

XI. Some advise, that if a Varicous Ʋlcer contemns the ordi∣nary means, to take up the Varix both above and below, and to open it between the Deligations, according to the Method of Hil∣danus, in the place afore-cited, Sect. 45, ad 5., that the Blood may be discharged out of it; which is an Operation of no very great difficulty.

XII. And if in doing this there should be some unknown way (by some small branches of a Vein, which you had not before hand secured) for the Blood to fall into the Vein again, whereby an He∣morrhage does succeed, you must stop it with Pulvis Astringens and the white of an Egg, or Pulvis Stypticus, or some such like thing, with sitting Ban∣dage; the Swathband being also first wet in Oxycrate, or some Styptick Liquor; and then it is to be healed after the manner of an ordinary Wound.

XIII. An Observation. A Wo∣man 54 Years old, had a varicous Ʋlcer on her right Leg, which was much swelled, and somewhat in∣flamed. It was drest with Ʋng. Tutiae, and over it was applied Ʋnguent. Nutritum and Populeon mined together, which was rowled up with Compress and Bandage. A laced Stockin was provided against the next day, which was laced on, and the former Method of Dressing re∣peated: from that day the pain ceased, the Humors were repres∣sed by virtue of the Bandage, and the Ulceration cicatrized in ten or twelve days.

XIV. Another Man had Ʋlcers in the skin of his Legs in several places among Varices, without In∣flammation, but towards night they swelled, and were painful. The Ulcers were drest with Ʋng. Diapompholigos, and rowled up: within a day or two laced Stoc∣kins were put on, (the Ulcers being drest) with Compress un∣der them upon the Ulcers, and pieces of Vellum were laid be∣tween, to defend them from the wrincles of the Stockins: by wearing these, the Humors were restrained, and the Ulcers dis∣posed to Cure; which, with

Epuloticks, (an Issue being made in each Leg) was effected in few days.

XV. Another. A Woman that had a Varicous Ʋlcer in her Breast, which would not cure; the Varix lying under the skin felt like net∣work: it was hard, without inflama∣tion or discolouring, and discharged a well-digested Matter out of the Nipple, and some small openings near it. The Ulcer was drest sometimes with Ʋng. Basilicon, sometimes with Ʋng. Tutiae and Empl. è Bolo, applied over the Breast, with Bandage to support it; and fine Tow sprinkled with Ceruss, was worn under the Axilla: by which means it was cured in about a Months time.

XVI. Another. A Woman had a sordid Varicous Ʋlcer in one of her Legs. Her Leg was fo∣mented and drest, as in the former Observations, and by Bandage it was disposed for a laced Stockin. The Ulcers were dressed with Detersives, and with Compress and Bandage rowled moderately streight from the Foot to the Gartering: (for the Varix was from the Ham to the Ancle.) The Pituitous Humors impacted in the Part, thus rari∣fied, and the Ulcer cleansed, the laced Stockin was put on, with Compress upon the Ulcer; which streightned the Blood in its passage, and represt the Hu∣mors; and the lips of the Ulcer were made even, and cicatrized in a few Weeks, without either Purging or Bleeding, and the Leg reduced to its natural state. Wiseman, lib. 2. cap. 11. Ob∣servat. 1, 2, 4, 5.

CHAP. XV. Of an ƲLCER CARIOƲS.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus cariosus; we in English call, An Ulcer carious; or, An Ulcer with foul∣ness, or rottenness of the Bones.

II. The Causes. That the Bone which lyes underneath the Ʋlcer, is sometimes foul, and contracts a rottenness, Experience hath oftentimes confirmed: the cause, says Barbett) is either from a long flux of Humors, or from their acrimony and malignity, or from an occult quality, or from a contusion, some way hurting the Bone, or from the use of too sharp Medicines.

III. To these Causes, Sennertus adds, that it often happens from the French Disease, whose mali∣gnity and poison makes the very Bones to become carious, the Skin sometimes remaining whole and sound.

IV. He also adds, that this Cariosity sometimes proceeds also from the nature and quality of the ambient Air, especially when it is

too cold; and another cause from an Incision with a sharp Instru∣ment.

V. Other Authors resolve the Causes into External and Internal. The External Causes are, either too great Cold, which destroys the natural heat of the Bone; or too great Heat, which discus∣sing the natural humidities, drys and corrupts the Bone.

VI. The Internal Causes are threefold. 1. A glutinous and superfluous humidity, which first softens, and then corrupts the Bone; oftentimes causing a distorsion of the Member, and a protube∣rance of the Bone; and this many times not proceeding from any Venereal Cause.

VII. 2. A sharp and malign Humor or Matter, which by eroding the Periosteum, pierces the Bone, and presently corrupts it: and this happens most commonly in old and inveterate Ulcers. Nor is this a Wonder, since such a like sharp Humor, will corrupt and rot Teeth, and even eat them away, which are the hardest of all Bones.

VIII. 3. An occult quality in some particular Humor or Juice of a Part, as in the French Pox. For if it did with any manfest power corrupt the Bone, it would first have eroded the Flesh; as being most subject to, and sensible of any manifest quality: and operates here up∣on its subject the Bones; just with a hidden property as the Loadstone draws Iron, and Am∣ber Wheat-straws.

IX. Wiseman adds another Cause, which is from the mali∣gnity of strumous Ulcers, near the Bones, where the malignity begins in the Bone it self.

X. The Signs. We consider the Signs, 1. Where the Bone does appear, and are manifest by sight. 2. Where the Bone does not appear, and must be known by conjecture.

XI. Where the Bones do appear, and lye open to sight, they at first appear of the colour of Fat, then yellow, afterwards black, and unequal; as Celsus says, lib. 8. cap. 2.

XII. The Bone may be bare of Flesh, and yet covered with a Viscous Matter; this being rub∣bed off, the Bone appears either white, brown, or black: if the white is porous, the Caries may be deeper, and more dangerous, than if it were black and hard.

XIII. If also the Bone is felt with the Probe, it finds no re∣sistance; or does not appear smooth, but rugged; if the Probe slip not, being guided to the Bone, the Periosteum must be gone; and so the Bone must be more or less corrupted, both from the external Air, and from the Pus or Matter fixing upon the Bone.

XIV. Where the Bones appear not, but lye hid, the conjectu∣ral signs manifest the Cariosity. 1. If a Fistula, or cavernous Ʋlcer had preceded; or if the Ulcer had been of a long conti∣nuance, being rebellious to pro∣per Medicaments: for then the Bone may be thought to be carious, having been long, and much moistned, and made soft by the Matter.

XV. 2. If the ulcerated Flesh above, is loose, soft, and spongy, or

of a pale or livid colour: because when the Bone is carious, the Flesh is made soft and corrupt, that a Probe may be easily thrust thro' it.

XVI. 3. If a Tent or Pledget reaching to the Bone should stink the next day, when taken out, the Bone may well be suspected to be curious: so also if the Sanies or Matter flowing from the Ulcer be thin, and stinking, or much; being more than the largeness of the Ulcer should seem to afford.

XVII. 4. If the Ʋlcer will admit skinning, and often breaks out again, it is much feared that the Bone is foul: for an Humor still issuing from the cor∣rupt Bone, causes a fresh Inflam∣mation, which makes the Ulcer break out a new. Aegineta, lib. 4. cap. 10. and Galen, in Com. sect. 6. aph. 45.

XVIII. 5. If the Matter is very fetid, and the Probe will penetrate into the Bone, it is then very much corrupted; and if the Matter does stink much, or is oily, it is a certain sign of rottenness.

XIX. Hippocrates, sect. 6. aph. 45. says, Si Ʋlcera annua, aut etium diusurniora fiant, Ossa corrumpi necesse est: and this is so much the more true, if they be nearer to a Bone, and the Flesh is lax, and white; and it is so made, says Sennertus, by the Sanies that sweats as it were out the Bone.

XX. The Prognosticks. Ʋl∣cers with caries, or rottenness of the Bone, are of difficult cure; and are accounted by some, among the number of Ulcers cacoethick or malign.

XXI. No Ʋlcer can be cured, while the Bone remains foul; and if the Caries is near great Ar∣teries, or in or about the Joints, especially the greater Joints, as the Shoulders, Elbows, Wrists, Knees or Ancles; or in the heads of the Muscles, or in Parts Nervous or Tendinous, the Ul∣cer will not be easily cured.

XXII. Ʋlcers in the great Joints, as Elbow, Knees, Ancles, with cariosity of the Bone, and loss of the Cartilage, are for the most part incurable; because exciting vehement pain and watching, hurting the Stomach, and spoil∣ing the concoction and digestion of their Food, they generally bring with them an incurable Marasmos.

XXIII. If any of the Vertebrae of the Spina Dorsi prove foul, the Cure is to be doubted of: for the substance of the Vertebrae being spungy and hollow, it will be affected: and as it is a difficult matter to apply Medicaments thereto, by reason of the Mu∣scles placed above them; so it will be a hard matter to avoid the conjugations of Nerves, which spring from their trans∣verse processes.

XXIV. Hippocrates, sect. 7. aph. 2. says, That if by reason of the corrupt and rotten Bone, the Flesh becomes blackish, and of a leaden colour, it presages much evil: and Galen, in his Com∣ment on the same Aphorism, says, It signifies no small or mean distemper of the Bones, but an ex∣traordinary corruption of them.

XXV. If the Sternum or Ribs in Ʋlcers of the Brest are foal, be not too hasty to undertake the Gure;

for the acrimony of the Pus or Matter may easily corrode and pierce thro' the Intercostal Mu∣scles and the Pleura, and so lay the Vital Parts open to the Air; which in a short time will cause an extinction of the Natural Heat, and so induce Death.

XXVI. In either of the Bones above the Eyebrows, if the Cariosity passes the first Table, it will be very difficult to bring the Ʋlcer to a Ci∣catrice: this is true in Wounds, where Solution of Unity is from an external Cause; much more in Ulcers, where the parts are eroded by an internal Humor, which is supplied from the dis∣temperature of some Noble Part.

XXVII. The Cure. Besides the Indications of the Ʋlcer, the rot∣tenness of the Bone shews the cor∣rupted Part must be taken away, for what is dead, can by no means be again restored: in the Flesh it is called Sphacelus, Mortifica∣tion; in the Bone Sapros, Caries, Rottenness.

XXVIII. The Ʋlcer is first to be wiped clean, the Bone (if it be yet covered) to be made bare, by cutting off the Flesh, ac∣cording to the Part, and Ductus of the Fibres; not transverse, or cross-ways.

XXIX. But yet nevertheless, if there be the greater Arteries, or Veins, heads of Muscles, Nerves, or Tendons, Section or Cutting can∣not be admitted: but in this case, the way is to be made, as much as may be, with Gentian or Rape root, or prepared Spunge, or Elder-pith, tenderly conveyed into the Ulcer: and the Flesh likewise which lyes upon the Bone, may, where it is safe to be done, be consumed with a Caustick, or Potential Cautery, or Cathereticks, neatly conveyed to the Part, that so the Bone be made bare.

XXX. If the Caries lies just under some considerable Artery, Vein, or Tendon, you are to consider whether you can remove it, without laying the Bone bare; because Na∣ture, in some strong and health∣ful habits of Body, is so prompt in the work, that she will easily do it, with some little as∣sistance of Art.

XXXI. But if it is not well to be done, you are to consider the prejudice which may happen to the Patient in the Cutting of those Vessels, &c. comparing it with the good that may succeed thereupon, and so to proceed accordingly.

XXXII. Incision is not well to be made, if the Bones lye deep; or if not deep, if there are many Tendons above them; as in the Metacarpium, or upper distance between the Wrist and Fingers; and in the Metapedium, or Meta∣tarsus, which are articulate with the Toes.

XXXIII. Exesion is done with Cathereticks, of which red Pre∣cipitate and Turbith-mineral are best; and these are to be used where there is but little Flesh up∣on the Bones: or with Cauteries Potential, as Lapis Infernalis, the White Caustick, the Silver Cau∣stick, and other things of like nature, where the Flesh is thicker: they are of use in a Cariosity of the Cranium, Ʋlna, or Tibia; but they are not to

be applied where many Tendons or Nerves are, lest they should cause Convulsions thro' Pain, or deprive some Parts of their Motion.

XXXIV. The Bone being made bare, you must remove what is rotten of it, either by the help of Medicaments, or Chirurgery: and that by Chirurgery is perfor∣med, 1. By Scraping, Paring, Rasping, or Boreing the Bone. 2. By the Actual Cautery.

I. Of Scaling the Bone by Medicaments.

XXXV. Desquamatoria, Me∣dicaments Scaling the Bone, or which separate the corrupt part of it from the sound, ought to be very drying, and of a subtil and thin substance, that they may penetrate the Cariosity, and suck up the superfluous humidity in the corrupt Part, and dry the very Bone which is sound: that Nature being assisted and strengthned by such Desiccatives, she may cause the Bone to send forth of it self Flesh, or a Callus; which being increased, thrusts off the rotten Scales from the sound Bone, and so induces the Ulcer to a healing.

XXXVI. These Desquamatory Medicaments have three degrees of Strength: viz. 1. Mild, or gentle. 2. Stronger. 3. Strongest.

XXXVII. 1. Mild Desquama∣tories. Blood dried, Bole-armeny, Catechu, Hog-Fennel roots, Guaja∣cum Gum, Mummey, Myrrh, Orrice∣roots, Pinetree-bark, Pomgranate∣peels, Dragons-blood, Sarcocolla, Sumach, Sealed-earth, white Briony roots. These will serve, if the cariosity of the Bone is but su∣perficial; and are to be used, where the habit of the Sick is soft and tender.

XXXVIII. 2. Stronger De∣squamatories. Aloes, Alum, Aqua Vitae, Aron-roots, round Birthwort roots, Borax, Chrysocol mineral, Camphir, Dragon-roots, dross of Brass, Guajacum-bark; Oils Chy∣mical of Juniper, of Lavender, of Limons, of Marjoram, of Oranges, of Origanum, of Penniroyal, of Rosemary, of Sage, of Savin, of Sassafras, of Turpentine, Pumice∣stone burnt, Scammony, Spirit of Wine, Tobacco. These may be used when the Cariosity is some∣what deep, and the Patient of a reasonable strong constitution of Body.

XXXIX. Strongest Desqua∣matories. Euphorbium, Figtree∣ashes, Lime unwasht, Oil of Cloves, Oil of Camphir, Oil of Pepper, Oil of Petre with Camphir, Oil of Sulphur, Oil of Salt, Oil of Vi∣triol; Pastilli Andronis, Musae, & Polyidae, Salt of Tartar, Spirit of Nitre, Spirit of Salt, Sief de Plumbo, Tinctura exfolians; Vi∣triol common, Hungarian, and Ro∣man, calcin'd; Ung. Aegyptiacum, Verdigrise. These are to be used when the Cariosity is very deep, the Constitution very strong, and the Ulcer malign and rebel∣lious: and when these are ap∣plied, the fleshy Parts ought to be very well defended, lest much Pain, and Inflammation ensue.

XL. Of these last before-mentioned, Euphorbium is said to be chief, and is so accounted by Fallopius; and he writes, that

he himself never found any thing more excellent, or that would sooner take away the corrupted Bone; and Hildanus is of the same opinion.

XLI. Any of the former (which can be) may be reduced to pouder, and then mixed with Honey, Rosin, Wax, Ʋng. Aegyptiacum, or some such like, and so ap∣plied in the form of a Liniment. Or you may make Compounds of them, according to the fol∣lowing Examples.

XLII. Wiseman says, the Pou∣ders may be mixed with Syrup of dried Roses, or Mel Rosatum; or they may be laid dry upon the Bone, with Dossels of Lint over them, to keep the lips of the Wound distended; or they may be used with S.V. or in the form of Injections.

XLIII. Sennertus his Pouder. ℞ Euphorbium in pouder ʒi. Mum∣mey, Sarcocol, A. ʒss. each in pouder, mix them.

XLIV. An Injection, from Barbett. ℞ Juice of Celandine, S.V. A.℥ijss. Myrrh, Aloes, A. ʒii. white Vitriol ℈ii. mix, and make an Injection.

XLV. Another Pouder, from Sennertus. ℞ Roots of round Birthwort, of Briony, or Hog-fennel, of Florentine-Orrice, A. ʒi. Eu∣phorbium ℈i. make a Pouder; which strew on the Bone.

XLVI. Take roots of round Birthwort, of Hog-fennel, of Orrice, A. ʒiv. Aloes, Myrrh, bark of the Pine, pouder of Earthworms, Agarick, Scammony, A.ʒii. scales of Brass, Euphorbium, A. ʒi. all being in pouder, with Honey of Roses, q.s. make a Liniment.

XLVII. A Pouder. ℞ Scam∣mony, Tobacco, A. ʒii. Euphorbium ʒi. make each into a pouder, and mix them: or, ℞ Scammony, Tobacco, A.ʒii. Euphorbium ʒiss. Camphir ʒi. make a pouder, and mix them. Salmon.

XLVIII. ℞ Roots of Floren∣tine Orrice, bark of Opopanax, and of the Pine, Myrrh, Aloes, scales of Brass, A. ʒii. make a Pouder, which mix with Honey, to a Lini∣ment. Avicen.

XLIX. Wiseman's Injection. ℞ Roots of Comfrey, of Gentian, of the Birthworts, long and round, of Florentine-Orrice, A. ℥i. Balau∣stians, Red-roses, Sumach, A. ℥ss. White-wine q.s. boil & strain: to lbii. of the Decoction add S.V. ℥ii. Honey of Roses, or Ung. Aegy∣ptiacum q.s. mix them.

L. Sennertus his Oil. Take yellow Sulphur lbi. melt it by a gentle Fire, to which put pure Salt of Turtar lbss. in pouder: mix by continual stirring, 'till they are cold; then pouder, and put it into a Cellar or cold moist place, upon a Marble, to run per deliq. with this Oil you are to anoint the corrupted Bone.

LI. A Pouder of Fallopius. ℞ Roots of Hog-fennel, of Orrice, A. ℥ j. Euphorbium ʒ i. make a Pouder: it may be put upon the crums of new White-bread cut in thin pieces, and so applied to the corrupted Bone.

LII. A Tincture. ℞ Birthwort long and round, roots of Briony, of Hog-fennel, of Orrice A. ℥ss. Con∣tory the less, Camphir, A. ʒ ij. Aloes, Euphorbium, Verdigrise, A ʒiss. S.V. q.s. mix, and extract a Tincture.

LIII. A Cerat, from Sennertus. ℞ Roots of Hog-fennel, of round Birthwort, Euphorbium, Opopanax, A. ʒss. Wax ℥ss. Turpentine ℥i. mix, and make a Cerat.

LIV. If Medicaments will not do, (which you may know in the space of 40 or 45 days; for Na∣ture very slowly makes a separa∣tion of the corrupted Bones from the sound) you must then have re∣course unto Chirurgery; more especially if the corruption of the Bone is more deep, and not in the superficies.

II. Of Scaling the Bone by Scraping, Rasping, &c.

LV. If the Caries is in the greater Bones, and lyes deep, or is subject to the inflowing of Matter; the readiest way will be by Ma∣nual Operation, viz. either by Instrument, or the Actual Cautery.

LVI. If you can easily come at the Bone to scrape it, as in the Cranium, that way will be most proper: and you are to scrape 'till you find it firm, and that you discern ruddiness in the Bone, and not only 'till it looks white, for that is the natural colour of the outward Cortex or Shell.

LVII. Yet in some it is frequently found porous and carious, whil'st it retains that colour; and if you do not rasp, scrape, or pare that away, the Callus will be slow in thrusting out, and putting off the rotten part: and if you do scrape it, the deeper you enter into it, the browner and softer the Bone will be.

LVIII. But you ought to be cau∣tious in the Work, that you pene∣trate not to the Marrow of the Bone; when possibly you need not take away more than the external Shell of it.

LIX. The Bone is to be scraped, (if the corruption of it is small) with an Instrument for that purpose, called the Scraping-Instrument: or, (if the corru∣ption and foulness is great) by rasping it with a Raspatory, or by shaving, or paring it with a Chizel; or else by perforation of it with a Wimble, or Auger, or Terebellum.

LX. If you do it with the Chizel and Mallet (a Leaden one will be best) the Bone is then to be made smooth and even with a Raspa∣tory: this being done, some of the aforegoing Medicaments, or some drying Sarcotick must be applied, according to the Con∣stitution of the Patient, by which you ought to be guided.

III. Of Scaling the Bones by the Actual Cautery.

LXI. If the Caries is so deep, that it cannot be scrap'd, ra∣sped, &c. you must come to the use of the Actual Cautery, to consume the rottenness, which is the chiefest Remedy for con∣suming of all the excrementi∣tious Humidity.

LXII. In order to this Work, if the Ʋlcer is narrow, you must pass it thro' a Cannula, fitted to go down thro' the Ʋlcer to the Bone; which Cannula or Pipe is to be covered with an Emplaster, or a Linnen Cloth pasted on,

and oiled, that it may pass in the more easily.

LXIII. And indeed, in applying these Cauteries, you ought to be cautious, lest you burn the Flesh that lyes near it; and it ought to be defended some way or other from the heat of the Fire. And if you use these Cannulae or Pipes, you ought to have several of them in a readiness, because they are subject to heat; or you must have a Bason of cold Water, to cool the Pipe, &c.

LXIV. The carious Bone being first cleansed from the filth or matter which is upon it, with armed Probes you are to place the Cannula upon it; and then pass the Actual Cautery down, thro' the Pipe to the Bone, so often 'till you have dried it; pulling out the Cannula after each heat, to cool or change it: by this means you will perform the Ope∣ration, without burning the lips of the Ulcer.

LXV. According as the Bone is rotten, so the Humor will spurt out from it, upon the first application of the Cautery: but upon re∣peating it, the Bone will be so dry, that you shall not hear it hiss; and you will also feel it firm.

LXVI. The Actual Cautery is not to be applied to Bones of the Head, lest the Brain should be inflanied: besides, in Ulcers of the Head, it often falls out, that both Tables of the Scull are foul; so that you will be forced to remove a great piece of the Cranium; which is to be per∣formed with the Trepan, Head-law; &c.

LXVII. Nor is it to be applied to the Vertebrae of the Back (the Spine it self only excepted:) nor will the Sternon, or Ribs admit of the Cautery: the Heel-bone requires also great caution, be∣cause it is soft, and rarely ex∣foliates by rough handling.

LXVIII. The spongy Bones in Hands or Feet, are to be kept bare by Dossels, according to the length of the Caries: and if the whole Bone is corrupt, it will dry and separate from the Joints in time, and the Ulcer happily cure; but to hasten it, you may dry it with the Actual Cautery.

LXiX. But if the Bone be ca∣rious only in one part, as in the middle, or at one end, you may nip it there in pieces with a a pair of Pincers, (to hasten the Cure) and dress it lightly with some of the lighter Desicca∣tives; so in few days the Caries will cast off, and a Callus come on; and, (if the native heat is preserved) the two ends will be united, as in fractured Bones.

LXX. Now the chief Places to which the Actual Cautery may be applied, dre where Dilatation is only permitted, not Incision, or the Potential Cautery; and they are the back of the Hand, and top of the Foot, or Instep you may also safely apply it to the Ʋlna and Tibia, laid bare; and also to the Joints, if the Cartilages be foul, and way be made.

LXXI. This Practice Paraeus used, when he amputated one in the joint of the Elbow, and the Pa∣tient found great ease and com∣fort by the application of it See Paraeus, lib. 11. cap. 25.

LXXII. Lastly, this is to be observed, That the Actual Cautery is then chiefly required; 1. When a flux of superfluous Humors flow to the Bone, known in part by the moist and cold habit of the Body. 2. If after the ap∣plication of Desquamatories, the Bone still appear soft and moist, not changing its colour.

LXXIII. There is one passage in Celsus, lib. 8. cap. 2. worthy to be recited. Igitur si caries alti descendit, per Terebram urgenda crebris foraminibus est, quae altit•…•… dine ••itium; aquent. Tum inoea foramina demittenda candentia Ferramenta sunt, donec inde siccum Os ex: toto fiat. Simul enim post haec & resolvetur ab inferiore Osse quodcunque ••irtatum est, & is sinus: Carne replebitur; & Humor auts nullus passea feretur, aut mediocris. Sin autem nigritie est, aut si 〈◊〉〈◊〉 ries ad al••eram quoque parteni Ossis transit, oportet excidi. Atque idem in carie quoque ad alter a•…•… partem Ossis penetrante fieri potest•• Sed quod torum vitiatum, totum eximendum est. Si inferior pars integra••st, eatenus quod corruptum est, excidi debet. Item sive Ca∣piris, sive Pectoris Os, sive Costa cariosa est, inutilis vitio est, & excidendi necessitas est. If then the rottenness has descended deep, we ought with the Tere∣bel or Wimble to make many holes, as deep as what is cor∣rupted in the Bone. And then red-hot Irons are to be let down into those holes, so long 'till by this means the Bone is whole∣ly dried. For withal, after this, both whatsoever is vitiated and corrupted will be loosned from the lower part of the Bone; and that Sinus or hollowness will be either none at all, or but very little. But if there is any blackness, or if the rottenness tuns, or spreads to some other part of the Bone, it ought then to be cut out. And this same thing may be done in a rotten∣ness penetrating into some other part of the Bone. But that which is wholly vitiated, is all of it to be taken forth. If the inferior or lower part is whole and sound, then only so far as is corrupted, is to be cut off. Again, whether it be the Cra∣nium, or the Sternum, or a Rib which is rotten, it will be made thereby totally uncapable to be restored to its soundness; for which reason, there will be a necessity of cutting it out.

IV. Of Dressing and Healing the Ulcer.

LXXIV. After the Scraping, Rasping, &c. of the Bone, Wise∣man advises to the application of the milder sort of Sarcoticks, as this: ℞ Pure Turpentine ℥iv. Gum Elemi ℥ii. Pine-Rosin, Ma∣stich, A. ʒvj. Frankincense, Sarco∣col, A. ʒiij. mix them over the Fire. Apply it warm upon Lint, and in few days you will see the Flesh thrust forth in small Grains, which is Callus; and in a few days more, it will thrust off small Spells from the Bone you scraped.

LXXV. Where you can safely dilate the Ʋlcer, you ought to do it; and keep the Bone bare and dry, by filling it up with Dossels;

that the lips of the Ulcer grow not upon your Work; lest the Matter dropping from thence, should corrupt the sound Bone under them: for the Work of Exfoliation always begins from the sound edges.

LXXVI. After Cauterizing the Bone, Sennertus in the first place applies Rose-water in the white of an Egg, to prevent Inflamma∣tion, and lessen the Pain: after∣wards he applies Oil of Roses with the yolk of an Egg: and then after that, Butter with Mel Rosatum: but to the Bone it self, pouder of roots of Birth∣wort and Hog-fennel mixt with Eupphorbium, or some other of the former Desquamatories, 'till the Bone scales.

LXXVII. Fallopius uses Pled∣gets, moistned with Rose-water and the white of an Egg; to hinder Inflammation for some few Dressings: and he applies to the Bone Exfoliating Medicaments.

LXXVIII. Guido à Canliaco applies after the Cautery, Oil of Roses mixed with the white of an Egg for three days: and the same mixed with the yolk of an Egg for three other days: and after∣wards Butter, mixed with Mel Rosatum; and above these some Abstersive, 'till the Bone scales. After which, he incamates and consolidates with Avicen's Pou∣der, at Sect. 48. above.

LXXIX. Wiseman dresses (af∣ter Cauterization) with the writes of Eggs, beaten with the mucilage of Quince-seeds; and the Ulcer and its lips with Ʋng. Refrigerans Galeni; over which and the neighbouring parts, he lays a Cerat of the same; and conti∣nues this way of dressing, 'till the heat of Urine is mitiga∣ted.

LXXX. Then if the lips are vesicated, he dresses them with Ʋng. Alhum, ••riae, &c. and the Bone with milder Desquamato∣ries or Exfoliatives, keeping the Ulcer open 'till the caute∣rized Bones are cut off; after which he casts away ••he Dossels, and with Incarnatives and Epu∣loticks compleats the Cure.

CHAP. XVI. Of an ƲLCER CACOETHICK, or MALIGN.

I. WHAT the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus cacoethe, & Ulcus malignum; we in English call, An Ulcer evilly disposed, or malignant.

II. This kind of Ʋlcer the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins from them, Dysepulote; viz. an Ʋlcer, hard or difficult to be healed.

III. By some Authors, as Celsus, lib. 6. cap. 28. it is called Chironium; so also Aegineta, lib. 4. cap. 26. calls this Ulcer both

Chironium, and Telephium: and these Terms are derived from Chiron, who first found out or instituted the way and method of Curing it; and from Tele∣phus, the Person who was long affected or troubled with such an Ulcer.

IV. The Causes. The Antece∣dent Cause Sennertus will have to be from Atra Bilis; or Melan∣choly, having some Black Choler mixed with it. Others will have it to be from one or both those Humors, joined with malignity and virulency.

V. The Conjoined Cause of this rebellious Ʋlcer, is from the dis∣temper of the ulcerated Part, or from an afflux of Humors flowing in: the afflux of Humors is also considered in a twofold re∣spect: 1. As they are bad, and depraved in their quality. 2. As they are excessive in their quantity.

VI. The Signs. Such-like Ʋl∣cers are known; for that they have their lips ill-coloured, and for the most part, they are red and itching; and altho' the Ulcer is never so gently wiped, it is with pain.

VII. The parts also round about it swell up, and the Ʋlcer is from day to day dilated, or grows wider: and not only the Skin, but the Flesh which lies under it, is eaten through.

VIII. The Prognosticks. This kind of Ʋlcer is always contuma∣cious and rebellious; being very difficult to be cured, unless it be with extraordinary Medica∣ments.

IX. And if the Humor which feeds or vexes the Ʋlcer, has got∣ten into the habit of the Body, or that there is a habit of Breeding it; it will be difficult without regeneration, or totally altering of it, to reduce it to its natural constitution or state, or to hin∣der or prevent its increase.

X. The Cure. This is scarcely to be accomplished, except the Cause be first removed, and the whole mass of Blood purified: (this more especially if the Ulcer has been of some years standing, or of a very long continuance.)

XI. And this must be done by manifold and continued Purging, continued Sweating, and a constant taking of some; traumatick Diet∣drink; that so the Body may be emptied of all its vitious Humors, the Tone of the Viscera rectified, and the whole habit changed.

XII. Ʋniversals being thus pre∣mised, Sennertus advises to things cooling, drying, and astringent; yet withal discussive, or mixt with Discussives: as Balaustians, Bram∣ble-tops, Bistort, Cyprus-nuts, Cinkfoil, Frankincense-bark, Ma∣stich, Nightshade, Plantan, Pom∣granat-Peels, Ceruss, Lead burnt, Litharge, Minium, Mercury, or Quicksilver, Sulphur, Vermilion, Vitriol, Vitriol calcin'd.

XIII. To these may be added; Ʋng. Aegyptiacum, Fuscum Wur∣tzii, Nicotian••e, Diapompholigos.; Empl. de Plumbo, de Min••o, Gri∣seum, de Ranis cum Mercurio, vel Merculiale.

XIV. You may therefore first foment the Ulcer with this De∣coction. Take Plantan-leaves M. i. Balaustians, Rea-rises,

Pomgranate-peels, A. ℥i. Myrtle∣berries, Sumach, burnt Alum, A. ℥ss. Red-wine q.s. boil, and wash also the Ʋlcer therewith.

XV. The Ʋlcer being washed, lay over it Ung. Diapompholigos, or Ung. Album Camphoratum: or this, ℞ Tutty prepared, fine Bole, A. ℥ss. burnt Lead washed, Ceruss, A.℥i. juice of Plantan ℥jss. grind all in a leaden Mortar to to a Mass, adding Oil of Roses and Wax, as much as suffices to make it into an Ointment.

XVI. A Decoction of Oak-leaves, Alum, Frankincense, and Myrrh, is commended; imposing over all Empl. de Ranis cum Mercurio, in double or treble quantity: but nothing is equal to the Water of the Griffin.

XVII Other Authors, for dimi∣nishing the Humor impacted in the Part, advise to do it by catheretick Medicaments; as the Pastilli or Trochisci Andronis, Polyidae, & Musae; the Preparations of which you may see in my Pharmacopoeia Londinensis, lib. 4. cap. 34. sect. 23.38. & 39. which being in pou∣der may be mixed with Ʋng. Populeon, or some such-like Ointment.

XVIII. Or yon may use red Pre∣cipitate, grownd and washed in a Lixivium of Pot-ashes; or the Princes Pouder; either of which may be mixed with some Sarco∣tick Oiniment, to be used in Rheumatick Ulcers, and in ten∣der Persons.

XIX. Or in stronger Bodies, you may take red Precipitate ℥ii. unwashed, and mixt with burnt Alum ʒi. it is fit to be applied in foul and stinking Ulcers; such as Herpes exedens, Phagedaena, and Nomae.

XX. Turpethum Minerale, while white and unmixt, is to be preferred before them all; yea if washt, it exceeds them; and is of mighty use in Vene∣real and Malign Ulcers, as also in a Venereal Headach; it may be mixt with Paracelsus his Mun∣dificative, ʒi. of the Turpethum, to ℥i. of the Ointment, and so applied: it may be used unwasht to strong Constitutions, but washt to such as are tender and delicate.

XXI. This Turpethum far sur∣passeth corrosive Sublimate, or Arsenick; being more safe, and not so painful, or apt to cause Inflam∣mations, or Symptomatick-Fevers. It may also be mixed, ʒii. with Alumen ustum ʒi. to evacuate the peccant Humor out of the Part affected, in such as have a firm and able Habit of Body: it may be mixed with Ʋnguentum Nicotianae.

XXII. The next Indication, is the Healing-up of the Ʋlcer; which has two Intentions: 1. To to fill up the Flesh, with proper Sarcotioks. 2. To cicatrize it with Epuloticks.

XXIII. As to the Sarcoticks, they should be such as dry strongly, but have no•• Corrosive faculty; this of Paraeus, lib. 6. cap. 84. is good. ℞ Pine-bark ℥ss. Ce∣russ, Tutty prepared, A.℥i. Oil of Roses, Sheeps-suet, A. ℥ii. Wax q.s. mix, and make and intment: if a little Saccharum Sarurm, or Minium, or Cinnabat be added, it will be more effectual.

XXIV. Or, ℞ Ʋag. Enulatum

cum Mercurio ℥i. flowers of Sul∣phur ʒi. mix them. This Paraeus commends as a thing infalli∣ble: but if you find the lips of the Ulcer to be more and eroded, you must be obliged to touch them with Spirit of Nitre, Spirit of Salt, Oil of Vitriol, or Oil of Sulphur; by which means, these Ulcers which seem incurable, are often cu∣red.

XXV. Or you may use this. ℞ Juice of Tobacco ℥iv. yellow Wax, Gum Elemi, A. ℥ii. Turpen∣tine, Pine-Rosin, Oil of Myrtles, A. ℥jss. boil to the consumption of the Juice, then add pouder of Tobacco ℥i and where occasion is, you may add to ℥i. of it, of red Precipitate, or yellow Turpethum Minerale ʒi.

XXVI. The Ʋlcer being filled up with Flesh, you must produce the Cicatrice with Epuloticks; among which Desiccativum Ru∣brum, and Ʋng. de Minio, are commended.

XXVII. Lastly, Aquapendens, part. 2. lib. 1. cap. 28. advises to drinks every day Goats-milk; more especially if the Party is of a thin habit of Body, and in a Hectick-Fever or Consumption: or otherwise, a Decoction of Sursa∣parillu; the Faculties of which, very few of the Chirurgick-Tribe are ignorant of, especially in the curing of malignant and creeping Ulcers.

CHAP. XVII. Of an ƲLCER PHAGEDENICK.

I. WHAT the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus Phagedae∣nicum; we in English call, A Pagedenick Uler, or, An Eating Ulcer.

II. The Kinds. This Ʋlcer is twofold: 1. That which the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; and the Latins, in imitation of them, Phagedaena; also Ʋlcus exedens: and we in English, The Eating, or Sprealing Ʋlcer. 2. Nomae, also Ʋlcus depascens, or the Can∣cerous Ʋlcer; of which we shall treat in the next Chapter. This Phagedaena is derived 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; ab Edendo, à 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, to Eat: so that it may well be called, An Eating Ʋlcer.

III. It is an Ʋlcer with a Tumor; for which reason, some Authors have accounted and treated of it among Tumors, as Galen de Tumoribus, cap. 14. But whereas there is always an Ul∣cer joined with it, the more modern Authors (whom we here follow) think it more reasonable to be handled in the Discourse of Ulcers.

IV. The Differences. It dif∣frain Herpes exedens; for that corrodes and eats up the Parts lying near round about it; but it corrodes and eats thro' the Skin

only: whereas Phagedaena is a deep and profound Ulcer; and does not eat only thro' the Skin, but even to the parts under∣neath; eating thro' the Flesh also.

V. It differs also from Nomae, or the Cancerous Ʋlcer: for tho' that is an eating Ʋlcer also, yet it is an Ʋlcer with an eating or devouring putridness, creeping but slowly, and without any Tumor: whereas a Phagedaena is an Ulcer without any putridness, tho' abounding with matter; eating profoundly thro' the Flesh, and creeping to the parts adjacent lying round about it; and is always accompanied with a tu∣mor about its lips, by which it is distinguished from Nomae.

VI. The Cause. It is caused generally from adust Choler or Melancholy, or else from yellow Choler with salt Phlegm, and a serous or wheyish Humor, mixt therewith: which Humor is not so thin, as to produce only an Herpes; nor yet so thick and malign, as to produce a Cancer.

VII. Now this Humor comes either from some Part affected with a hot and dry Distemper; or else it is made adust, by some pre∣ternatural heat and driness in the Part affected.

VIII. Wiseman says, in a Caco∣chimick Habit, an Herpes exe∣dens often arises on the Nose and Face, from a small Pimple, or fiery Pustle; which being heated by scratching, or picking with their Nails, becomes at length corrosive; and from a Herpes exedens, becomes phagedenical: this by a farther exasperation, becomes cancerous: these (says he) differing, but only as the Humor becomes less or more sierce.

IX. The Signs. They are known by what was said in the Differences, at Sect. 4. and 5 above: but some∣times the Ulcer takes its original from an Abscess in the Flesh; and sometimes it begins in the Skin, and after eats into the Flesh, spreading into the parts round about, and dissolving the Flesh in the bottom of the Ulcer.

X. And the Humor causing this Ʋlcer, by reason of its great abun∣dance, fills the lips of the Ʋlcer, and causes a swelling to appear: but by reason of its acrimony and malignity, it frets, gnaws, or eats the parts adjacent which are sound.

XI. The Prognosticks. All these kinds of eating Ʋlcers are difficult to be cured; and if they happen in a Body of a hot and dry tem∣perature, where the Aliment sent to the Part, (tho' it be good) is made sharp and corro∣sive; they are so much the more hard of cure.

XII. They resist the force of ordinary Medicaments; which tho' they are applied to other Ulcers with good success, yet in this kind of Ulcer they be∣come utterly ineffectual.

XIII. If this Ʋlcer happens in a cacochyn ick habit habit of Body, it is yet more rebellious: and here the Constitution of the Body must be altered, before this Evil can be cured, which is a matter of very great difficulty.

XIV. If it happens in decrepit Age, or in such as are in a Hectick

Consumption, where the natural heat, and radical moisture are almost spent, and only acrid and salt Humors abound, the Ulcer then will scarcely admit of any cure at all.

XV. If it happens from the French-Pox, it is cured by Speci∣ficks for that Disease: but if it comes from either Causes, so (says Wiseman) it is extream difficult, and does frequently terminate Cancerous.

XVI. The Cure. There are two chief Indications of Cure: 1. To remove the Antecedent Cause. 2. To destroy the Con∣joined Cause.

XVII. The Cause Antecedent is removed, 1. By Purging; which you may do, first, by Emeticks, if the Stomach is foul, and the strength of the Body will bear it; and that may be done with Wine-Vinegar, or Honey, or Oxymel of Squills, or with Tartar Emetick, or Infusion of Crocus Metall. or Vinum Antimoniale, or some other Antimonial Emetick.

XVIII. Secondly, by Purgation, which may be done with an Infu∣sion of Sena and Rubarb, Syrupus Catharticus, Pulvis Catharticus, Tinctura Purgans, Pilulae Cathar∣ticae, Family Pills, Pulvis Corna∣chini; or some Mercurial Purge made with up Princes Pouder, white Precipitate, Turbith Mine∣ral, &c. suited according to the Constitution.

XIX. 2. By Diet or Wound Drinks, which are to be made of Decoction; of Guajacum, Sarsa, China, Tormentil, Bistort, Bur∣dock, and Comfrey roots; to which Vulneraries, as Agrimony Angelica, Avens, Betony, Bawm Hypericon, Ladies-mantle, Sani∣cle, Solomons-seal, Wound∣wort, &c. may be added.

XX. If the Humor flows to the Ʋlcer in any great quantity, it is to be diverted by Revulsion, Deri∣vation, and Interception, if it is possible. Some commend the Pur∣ging with Confectio Hamech, à ℈i. ad ʒss. mixed with Mercurius dulcis, à gr. 12 ad 24. and this to be repeated twice a Week.

XXI. The second Indication of Cure is to destroy the Conjoined Cause, which is done by Topicks. The virulent Humor affecting the Ulcer requires (says Wise∣man) to be dried up; and the Intemperies to be corrected. But because these Ulcers differ much one from another in their cor∣rosive qualities, according to the different habits of Body, the Medicaments therefore must accordingly vary.

XXI. If the Ʋlcer wants Dige∣stion, Digestives must be applied, before any thing else can possibly be done: for Digestion has a kind of Fermentative Power, by which it alters and changes the nature of the acrimonious and corrosive Humor, destroying its property, at least making it more mild and gentle.

XXIII. Then, if the Intempe∣ries is hot, your applications are to be cold, with some little Astringency, as Ung. Tutiae, è Plumbo, de Calce, de Lithargyro: or you may apply Ung. Populeon, mixed with Album Camphora∣tum, in equal quantities.

XXIV. If these things will not do, or answer expectation, you

must proceed to stronger: but by the Authority of the Ancients, you ought to scarify these Ul∣ters, or some-ways provoke them to bleed; that the sharp Blood and Humors may be there∣by discharged.

XXV. Aegineta has this Pou∣der. ℞ Ʋnslakt Lime, Chalci∣tis, or Vitriol, A. ʒii. Auripig∣mentum ʒ i. make all into a pouder. ℞ Unguen. Nicotianae (of Our Prescription) ℥i. of the former Pouder ℥ii. mix them, and apply it.

XXVI. You may wash with the Water of the Griffin, which is a most admirable thing; or with some drying Medicaments, which may repress the afflux of Humors; as Aqua Calcis, Aeruginosa, Alu∣minosa, or a Decoction of Plan∣tan, Horstail, Bramble-tops, Ba∣laustians, Red-roses, Cyprus-Nuts, Galls, &c. made in Smiths-Forge-Water, or Red-wine, q.s.

XXVII. After which, the Ulcer may be sprinkled with pouders of Tutia, burnt Harts-horn, burnt Ivory, and Oister-shells, Pom∣granate-peels, Catechu: or they may be mixed with Ointments.

XXVIII. ℞ Ung. Diapom∣pholigos ℥iii. fine Bole, Sanguis draconis, Balaustians, A.℥ss. Oil of Roses, q.s. mix, and make an Ointment; which apply with Compress wet, and wrung out of some Astringent Decoction, over all.

XXIX. The Ʋlcer thus drest, is not to be opened again in three or four days: for the tempera∣ment of the Part being weak, the frequent exposing it to the Air, renders it more weak, and the Medicaments less ef∣fectual.

XXX. To this purpose Galen, Comp. Med. cap. 4. upon the Me∣dicament of Asclepiades, has these words: For unless the Me∣dicament shall stick somewhat long upon the Skin, it effects but little or nothing; which most Physi∣cians are ignorant of.

XXXI. And the truth is (says Sennertus) there is commonly a great Error committed in this very point, whilst they think that to be the best course, to wash the Ʋlcer three or four times a day; when that the Medicament does act nothing at all, unless by the native Heat it is drawn forth into act: and in regard that in long continued Ulcers, the heat of the affected Part is very weak, it needs much time therefore to excite and draw forth the strength and virtue of the Me∣dicine.

XXXII. For which reason, the Medicament ought to be kept sticking upon the Part for a long while; nor is its action to be disturbed, for that the virtue and strength thereof is not in a little while to be drawn forth by the heat of the Part af∣fected; for which reason, no new or fresh Medicament is pre∣sently to be applied: yet if the Humor is very sharp, it is the oftner to be wiped away; lest lying in the ulcerated Part, it should more and more corrupt the same.

XXXIII. Or you may apply Ung. Fascum Wurtzii, Ung. Ni∣cotianae Nostr. or some such like; 'till the Ʋlcer ceases sprending,

appears red, is cleansed, and is in a good condition; then you may heal it up with Sarcoticks and Epuloticks, as is usual in other Ulcers.

CHAP. XVIII. Of an ƲLCER CANCEROVS.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, (Ulcus & Ulcera quae in Cancrum ver∣gunt:) also 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, (Ulcus, & Ulcera serpentia, quae depascunt:) and 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉; (Ul∣cus & Ulcera, quae sunt ejusdem naturae seu qualitatis, ut depa∣scunt;) and the Latins Nome, pl. Nomae; also Ulcus depascens, pl. Ulcera depascentia: we in English call, Consuming, feeding, or cating Ulcer or Ulcers; also Cancerous Ulcer or Ulcers; be∣cause they eat like a Cancer ul∣cerated.

II. The Kinds. Some Authors will have Nome to be the only Cancerous Ʋlcer; others add also Lupus, the Wolf; and Noli me tangere.

III. Nome is a corrosive or eating Ʋlcer, without any tumor in the lips; conjoined with ma∣lignity, and putrefaction of the Part, and feeding deeply upon the adjacent sound parts, almost after the manner of a Cancer ulcerated.

IV. Lupus is a most stinking, malign, putrid, and cancerous Ʋlcer; in the Arms, Sides, Loins, Hips, Thighs, Legs, or any brawny, or very fleshy Part.

V. Noli me tangere, is a ma∣lign, putrid, and cancerous Ʋlcer in the Nose and Face, rebellious, and many times very painful, not much differing from Lupus, but in the place or situation thereof: of these two latter, as they are Tumors, we have already treated in Lib. 3. cap. 34. sect. 31. ad 53. Here we shall a little more consider them, as special kinds of Ulcers.

VI. The Differences. Nome is an eating or devouring putrid∣ness, yet an Ʋlcer which creeps but slowly; and differs from Pha∣gedaena, because it eats with great putrefaction, moving for∣wards from the diseased and unsound parts, to those which are whole and sound; adding to them malign matter, from the unsound: so that its nature arises not from the substance of the thing declared, but from the matter accessary, which is to feed; as Galen, Meth. Med. lib. 5. cap. 4. does demonstrate.

VII. It is distinguished also from Phagedaena; for that as Phage∣daena is always with a Tumor, and the corrosion is only from a a malign quality, and acrimony of Humors; whereby it eats thro' the

parts and flesh lying underneath, and that are about it: so Nome is always without a tumor, and the corrosion which eats deeply and profoundly, (tho' slowly) is from a certain putrified Hu∣mor, &c.

VIII. It differs also from Her∣pes exedens; for as that is only a corrosion in the Skin, without putrifaction; so this is a cor∣rosion in and thro' the Skin, but deeply into the substance of the Flesh also, with putrifaction.

IX. The Causes. The Causes of all these proceed from vitious and malign Humors abounding in the Body, exalted to such a de∣gree of acrimony as may cause putrefaction; partly from sim∣ple Choler or salt Phlegm mixed with Atra Bilis, and so dispersed thro' the whole habit of the Body.

X. Chymists will have them to proceed from an Arsenical Sulphur, separated from the Natural Bal∣sam, or Juices replenishing the Body, and sent or directed to the Part affected. And indeed, an Arsenical quality best represents the nature of these kinds of Ul∣cers: for truly like Arsenick, the Humors here protruded, are of a putrifactive quality.

XI. The Signs. These Ʋlcers are known by sight; partly from their kinds and differences, and partly from the situation, or place which they affect, being accompanied with putrifaction and eating.

XII. Nome eats deepest into the Flesh; the other are more superficial, and are sometimes Ulcers upon a Sarcoma, or ex∣crescence of superfluous Flesh, which sometimes eat more, some∣times less.

XIII. The Prognosticks. These, like all other eating Ʋlcers, are very hard to be cured: and if they happen in a Body Cacochymi∣cal, they are seldom healed, but last for the most part during the Patient's whole life.

XIV. If they be with an afflux of Humors, or near any principal Vein, Artery, Nerve, or Tendon, they are not only so much the more difficult to cure, but also so much the more dangerous.

XV. If they happen to such as are in Consumptions, or are He∣ctick, or Asthmatical, they are of evil consequence, and for the most part kill the Patient; by draining away the remaining part of the Radical Moisture which ought to support Nature.

XVI. The Cure. All these re∣ceive much one and the same Me∣thod of Cure; and the same Medicines which are generally good for one, good for the other also.

XVII. The gentler means, and such as we have prescribed in the former Chapter, are first to be at∣tempted, because sometimes they may prevail: but if those things do no good, as it oftentimes falls out, we must be constrained to come to the use of stronger Remedies.

XVIII. This Pouder is com∣mended in a Nome. ℞ White Vitriol ℥jss. Crocus Martis ℥vj. Galls ℥ix. make all into a fine pouder, which mix with some convenient Ointment, as Ʋng-Nicotianae.

XIX. Or this. ℞ Ʋnslakt

Lime, Orpiment; white Vitriol, A. ℥i. Catechu, Galls, Pomgra∣nate-peels, round Birthwort roots, Tobacco, Alum burnt, Saccharum Saturni, A. ℥ ss. burnt Brass, Crocus Martis, Lead calcin'd, A. ʒvi. make all into a fine pouder, and mix it with clarified Honey q.s. and make a Liniment.

XX. Or, ℞ An Infusion (of Balaustians, Birthwort-roots, Car∣dus Ben. Centory the less, Cate∣chu, Galls, Germander, Pomgra∣nate-peels, Scordium, Southern∣wood, Wormwood) in Vinegar ℥viii. purified Verdigrise ℥iv. Honey ℥xiv. mix, and boil to a consistency.

XXI. Wiseman says, you must use Detersives made of Ʋnguen. Aeg••ptiacum, red Precipitate, Troch. Andronis, Musae; also Causticks, and sometimes the Actual Cautery.

XXII. To these Applications, Objections (says he) have been made: but if drying Medica∣ments without erosion will do no good, you must then come to stronger: and where the putrefaction is great, you will find it necessary to use the strongest kinds, as the Actual Cautery, it not being only of use to remove the corrosive Flesh, but to check the mali∣gnity, and strengthen the weak∣ned part.

XXIII. But where the Patient will not admit of that, you must use Causticks, the parts about being in the mean season defended with Refrigerants: after sepa∣ration of the Eschar, and cor∣rupt Flesh, the Ulcer is to be healed up with Sarcoticks and Epuloticks, as is usual.

II. Of Lupus, the Wolf.

XXIV. Tho' when other things fail, the former Directions may serve in the Cure of this Ʋlcer; yet some things Country-people have observed; that the appli∣cation of raw Flesh, as of Hen, Chicken, Pigeon, Dog, Whelp, Kitling; raw Beef, Mutton, Lamb, or Veal, being laid to in slices, allays the fury of the Difease, abates the malignty, and stops the eating quality.

XXV. Others apply this up∣on Pledgets of Lint. Take burnt Lead, Tutty, Prankincense, A.℥iv. Wormwood in pouder, Wax, A.℥jss. Oil of Roses ℥vi. juice of Night∣shade q.s. mix, and grind in a leaden Mortar, to the consistence of an Ointment.

XXVI. Juice of Nightshade is wonderfully commended; and it will be so much the more powerful, if Catechu and Saccharum Saturni be dissolved in it; the juice of Tobacco has also the same effect: a double or fourfold linnen Cloth may be dipt in them, and applied, and over that a Pledget of Tow, or piece of Spunge dipt in the same Liquor: Camphir dissolved in a little S.V. may also be mixt with them.

XXVII. Or you may lay over a green Tobacco-leaf, two or three of them, one over another; be∣cause they may be apt to dry; and dress it with them twice a day.

XXVIII. Or, Take Honey of Mullein ℥ii. Oil of Mace or Nut∣megs ℥i. Catechu ℥ss. Pomgranate∣peels

ʒii. Minium ʒi. mix them.

XXIX. Or this of Fallopius. Take Oil of Roses, Oil-omphacin, A. ℥vi. Oil of Myrtles, Ung. Po∣puleum, A. ℥iii. leaves of Night∣shade and Plantan, A. M.ii. beat them well; boil all with a gentle Fire to the consumption of the Juice: strain, and add thereto Wax ℥iv. which melt, and taking it from the Fire, whilst hot, add moreover, Litharge ℥vi. Ceruss ℥ii. burnt Lead, Tutty, A. ʒijss. grind all together in a leaden Mortar for two Hours.

III. Of Noli me tangere.

XXX. Some commend the Sub∣limate of white Arsenick, because it mortifies in one day Can∣cers, Fistula's, Nomae, and other strange and malign Ulcers, ap∣plying round about Defensatives.

XXXI. Some commend this Experiment. Take Salt M. i. Sorrel M. viii. beat them well together in a Mortar, to which put Water enough to cover it three Inches over; boil to the consum∣ption of half: strain, and add thereto burnt Alum ʒiii. white Vitrol in pouder ʒi. dissolve, and wash there-with, twice a day.

XXXII. Or you may apply Ʋng. de Lithargyro, de Minio, de Tutia, Desiccativum, and other things of like nature, which are only to be used as Palliatives; tho' yet sometimes they have cured.

XXXIII. I commend upon my Own knowledge, Ung. Nicotianae made after my Prescription: the juice of Tobacco, Scammony in pouder, and Euphorbium, which scarcely bites at all in an Ulcer.

XXXIV. This is commended by some. Take Cow-dung lbiv. green Tobacco, or the dry; Housleek, Henbane, Hemlock, Mandrake, Nightshade, Plantan, Purslan, A. M.i. beat all together, with twenty River-crabs; which done, either press out the Juice and use it; or distil a Water there-from in a Pewter Still, mixing there∣with Camphir ʒiii. dissolved in S.V. dip Cloths therein, and frequently apply them.

XXXV. And not only in Noli me tangere, but also in Lupus and Nome, and indeed in all kinds of malign and inveterate Vlcers, we commend the use of the Water of the Griffin; than which possibly there is nothing more excellent in Nature, it being able to do more than all other things.

XXXVI. Lastly, this following Diet, to be given inwardly (is not to be forgotten) in all these kinds of Ulcers, since Ex∣perience has confirmed its effi∣cacy and power. ℞ Betony, Fennel, Sanicle, Wintergreen, A. M. iii. Fluellin or Pauls Betony, M. vi. Album Graecum ℥iv. cut, bruise, and put them into a Bag with a Stone in it, which put into four Gallons of new Ale or Beer; let them stand three or four days, and then add volatil Sal Armo∣niack ℥iv. of this let the Patient take a Draught, Morning, Noon, and Night.

XXXVII. If Noli me tan∣gere be in the Lip, and it has not eroded very wide, or spread much, it may be cured by

cutting out, after the manner of a Hare-lip, and that with very little deformity. See Lib. 3. Cap. 34. Sect. 31. ad 53. of this Work aforeging.

CHAP. XIX. Of an ƲLCER by BƲRNING or SCALDIING.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus ab ustione, vel Ulcus perustum; we in Eng∣lish call, An Ulcer by Burning; whether it is made by the naked Fire, or by Scalding with Water, Oil, Pitch, Tar, Lead, &c.

II. It is an ulcerated solution of Continuity made by Fire, or other very hot things; wherein the Skin is sometimes burnt and exulcerated, and sometimes the Flesh, with the Vessels, Nerves, Tendons, &c.

III. The Causes are manifest; the Signs by which it is known are; 1. An Eschar, where it is not faln off. 2. An Ʋlcer aboun∣ding with Matter, where it is faln off.

IV. The Prognosticks. If it is small, and in a bealthy body, it is easily cured: if great and deep, it commonly leaves Scars behind it.

V. If it penetrates into the great Vessels, it generally produces a Gangren: if it pierces to the Intestines, it is incurable: if it is from Lightning, it is for the most part mortal.

VI. If it is in the Groins; or the Eyes, it is very dangerous: and if a hairy part is burnt, the Hair never grows again there, but the place remains bald:

VII. The Cure. If the Fire is not out, you must endeavour to take that out; which done, you may come to the cleansing and healing of the Ulcer by Topicks.

VIII. Our Ointment of Tobacco, we commend as most admirable thing: it is excellent in the greatest and a most desperate Burnings.

IX. If there are Blisters, they must be cut and opened, that the hot and sharp Humor may flow forth; and then this Ointment may be applied. ℞ Ung. Basi∣licon, Oil of Roses, or of Hyperi∣con, A. ℥i. yolks of Eggs N^o ii. mix them.

X. Or this: ℞ Fresh Butter, Hens-grease, A. ℥i. Oil of Lil∣lies, Mucilages of Fleawort and Quince-seeds, Wax, A. ℥ss. Cam∣phir ʒ ii. Saccharum Saturni, Saffron, A. ʒi. mix them.

XI. If you please, instead of the mucilages of Fleawort and of Quince-seeds; you may use Barley, or Wheat, or Oatmeal flower.

XII. If the Pain be very great, you must alleviate it with this Defensative. Take Oil of Roses ℥ii. white Wax ℥i. Camphir ʒi. Barley meal or flower, q.s. mix them.

XIII. Or this. Take fine Bole, Terra Sigillata, Ceruss, Catechu, Pomgranate-peels, Red-roses, A. ℥ss. Wax ℥ii. Oil of Roses ℥iv. in which let Camphir ʒii. be dis∣solved: moisten the Pouder with â little Vinegar, then mix with them the melted Wax and Oil of Roses.

XIV. To take out the Fire, and ease the Pain, a Cataplasm made of Onions, Rue, and Mithridate, is much is commended.

XV. If the Patient is in such violent pain that he cannot sleep, add to either of the former Ointments Opium, à ʒss. ad ʒi. dissolved in S.V. or Vinegar: and use Rowlers dipt in Oxy∣crate, or in a Pickle made with Water, Vinegar, and Salt, (if the Part is capable of Bandage) it will excellently repress the flux of Humors, ease the Pain, and draw out the Fire.

XVI. If there is an Eschar, it is speedily to be removed with an Incision-knife; and this Oint∣ment following may be applied. Take Oil of Roses, fresh Butter, Hogs-lard, A. ℥i. yolks of two Eggs: mix them.

XVII. Defensatives are not here so convenient, especially, if there is danger of a Gangrene, because they are apt to hinder tran∣spiration.

XVIII. This of Guilielmus Fa∣bricius, is good. Take Diachal∣citeos ℥ii. Hens and Goose grease, A. ℥ss. melt them together, and and add burnt Alum, burnt Lead, Litharge, Lapis Calaminaris, A. ʒi. grind all together in a Leaden Mortar: add mucilages of Flea∣wort and Fenugreek seed, A. q.s. mix, and make an Ointment.

XIX. You must labour that the Eschar may be removed the first or second day: if it cannot be by the former Applications, then you must cut it in divers places, with an Incision-knife, that so a passage may be made for the issuing forth of the Humor, and admission of Medicaments to the Affect, such as those at Sect. 15. and 17. aforegoing.

XX. Now when the Eschar which was burnt shall be separated, the Ʋlcer is to be cleansed; and after that, you are with Sarco∣ticks to incarnate, and with Epuloticks to cicatrize; as we have before directed, in the Cure of other Ulcers.

XXI. Yet you are to take care, that those things which you order in respect of skinning the Sore, be not over-dry; lest the Cicatrice be rough, deformed, or unsightly.

XXII. Some will have Burn∣ings, &c. to be Ʋlcers; others, (because of their immediate Con∣stitution) to be Wounds: the matter is not great which you take them to be; at first doubt∣less they are Wounds, after∣wards they prove Ulcers: so in respect of the first Consideration we handled them under the Title of Wounds; where we have largely considered them under many Heads; for which Reason we have been very brief

here: and therefore request you to supply what is wanting in this place, from the Matter declared there; which you may find in Lib: 4. Cap. 24. afore∣going.

CHAP. XX. Of an ƲLCER FISTƲLOƲS, or, of a FISTƲLA.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Fistula ille morbus, & Ulcus fistulosum we in English call purely, A Fistula, Fistulous Ulcer, or, An Ulcer fistulated.

II. The Definition. It is a sinuous or hollow Ʋlcer, which is narrow, with a callosity or bardness in the inner side of the parts; suffering a solution of Ʋnity, and yielding a stinking and virulent Humor.

III. The Differences. It dif∣fers from a sinuous Ʋlcer only in this, that the sides are callous: whereas a sinuous Ulcer is totally without callosity.

IV. This Callus, is a thick and infensible heaviness; and it many times becomes so hard, that the sides can by no manner of means be agglutinated or united.

V. Fistula's also differ among themselves; some of them proceed from an Apostem, some from a simple Ʋlcer, from the Parts af∣fected: some are in Fleshy Parts, others in Tendinous, or in the Bones or Joints: and some enter into the Cavities of the Brest or Belly.

VI. They differ also in their magnitude; for some are greater, some lesser: in their Conti∣nuance; for some are inveterate, others recent: in their Figure; for some are streight and nar∣row, and some deep or shallow; others are winding, or capa∣cious: in the Number of their Sinus's; for some have but one Sinus; others two, or three, or more; which are also either strait or winding, and many times penetrate to the Bone.

VII. The Causes. Wiseman says, the Callus is hastned, (or made) by the transpiration and resolution of the thin and subtil Humors, and the incrassation of the more pituitous: by the con∣gestion of which, a long Pipe of (hardned or brawny) Skin is made, which branches it self inwards from the Orifice, quite thro' all the Cavities of the Ulcer.

VIII. Sennertus says, that Fi∣stula's have their original Causes for the most part from Apostems; in which, either by the impurity of the Body, or the too great abundance of the evil Humor, being long contained, a Callus is bred.

IX. Or, they may be caused from the unkilfulness of the Artist, not applying proper Medicaments, or delaying the Cure; whereby the Pus, from its corrosiveness, and long detention, makes as it were Coney-burrows, 'till they become at length very deep, and withal callous, of an insen∣sible brawney hardness.

X. They are said to proceed also from Flegm, or adust Melancholy, degenerating into a fetid and virulent Humor.

XI. The Signs. The edges of a Fistula are white and hard, having little or no pain; and in∣deed the whole Fistula is gene∣rally void of pain, unless it be in a Joint, or near to, or touches a Nerve, Tendon, or Membrane.

XII. The Pathognomick Signs of a Fistula are taken from its essence; being of a Pipe-like figure, with callosity.

XIII. The Accidental Signs are taken from the differences: if the Orifice and Sinus is but one, or single, the Quittor is less; but if the Sinus's are manifold, the Pus or Quittor is more in quan∣tity; and it is ever filthy, viru∣lent and stinking, and sometimes may be prest out thro' the Ori∣fice of the Fistula: the changing also the position of the Body, or part will shew them: for the flowing of the Matter having ceased, if after the changing the position, it runs out again, it shews that there are more Si∣nuosities.

XIV. By a Probe you may search the cavity of a Fistula; but in an oblique, crooked or winding, you must use a Wax-candle, which is best also to be used when the Fistula is in the fleshy and sensible Parts: the Probe is most convenient, when it pene∣trates to the Bone.

XV. If the Fistula is only in the fleshy Parts, that which is touched by the Probe, is soft; and the matter which comes out, is white, equal, and in great quan∣tity.

XVI. If it penetrates an Arte∣ry, that which comes forth is thin, and shining, and comes forth with leaping: but if the cavity joins to a Vein, the matter is like dregs of Claret-wine, but red∣der and thicker, where the Vein is eroded.

XVII. If it touches a Nerve, there is puin in probing it to the bottom; and the Pus is as it were fat and oily, but less in quantity; and the action of the Part is made uneasy, causing a pricking pain, with a certain numbness.

XVIII. If it extends to a Bone, what the Probe touches is hard, not yielding, and painful, while the Periosteum is not corroded, not if it is corroded, or consumed, and the Bone is foul, you will find it rough and unequal to the touch, with a thin, stinking, and black matter, and void of pain.

XIX. If the Probe being pressed slip, no cariosity has seized upon the Bone, for a sound Bone is smooth and slippery: but if the Probe stay upon it, appearing smooth, it is disposed to cariosity; and if the Bone feel unequal and rough, it is carious.

XX. If there are more Orifices than one, you may know whether

there be more Fistula's than one, by injecting a Liquor with a Sy∣ringe into one of the Orifices: for if the Liquor flow forth again by all the Orifices, then it is all but one Fistula; but if it comes not forth at the other Orifices, then there are more Fistula's than one.

XXI. And this is likewise dis∣covered in part, by the colour of that which comes forth: for if that which flows forth by all the Orifices is of one colour, it is a sign that the Fistula is but one; but if of a different colour, it shews that there are more than one.

XXII. If by searching, the parts are pained, or if Blood follows your Probe, the Fistula is not confirmed; but if neither happens, 'tis a Fistula beyond all dispute.

XXIII. The Prognosticks. All Fistula's are hard of cure, and some incurable: and it is parti∣cularly to be observed, that some certain Fistula's ought not to be cured, viz. such as are old and inveterate, by which the superfluous Humors have for a long time been vented: for such Fistula's as these (in regard they preserve Men from divers Diseases) are by no means to be closed up; because, as Hippocra∣tes, Epidem. lib. 6. sect. 3. saith, that when they are shut up, they cause many Maladies. And there∣fore, on the contrary, if at any time such should chance to be healed, they ought to be opened again.

XXIV. A recent Fistula in the fleshy parts alone, and not deep, in 〈◊〉〈◊〉 y••ung Body of a good constitution, is more easily cured: but an old, deep Fistula, having many Si∣nus's, or being near any noble or principal Member, or being in an old, or cacochymick, or he∣ctick, or emaciated Body, is of very difficult cure.

XXV. If the edges are not very hard, but somewhat soft and mat∣tery, they promise a more speedy cure: but coming in those places where Nature is accustomed to discharge her self of vitious Humors; as the Abdomen, Groins, Buttocks, Cods, Perinaeum, and Fundament, they are of much more difficult cure.

XXVI. They are also difficultly cured, and for the most part incu∣rable, which touch the Arteries, Veins, Nerves, Tendons; and those which are in the heads of the Muscles, or in the Joints, Vertebrae, cavity of the Thorax, Abdomen, Womb, Bladder, or Guts.

XXVII. Those among the Bones and great Joints, are very difficult to cure; by reason of the sensi∣bility of the parts, which for the most part admit neither of In∣cision nor Dilatation.

XXVIII. Those which are in such places, where you may safely lay them open, or remove the Cal∣lus, are more easy of cure: so also such as are shallow, passing no deeper than the Membrana car∣nosa, or at the farthest, than the Membrane of the Muscles or Muscle; because by incision they may easily be cured.

XXIX. Fistula's winding and turning, and with many Coney∣burrows or cavities, require Incision, that Medicaments may be con∣veyed

to other parts; otherwise they admit not of cure: and these are of more difficult cure, than those which have but one Sinus.

XXX. But indeed no Fistula is of easy cure, because of the un∣aptness of the Part for conveniently applying of Medicaments: for un∣less they reach to the very bot∣tom of the Fistula; (which is not easily to be done) no cure succeeds. Besides, the Medica∣ments which are able to remove a Callosity, are vehemently sharp and biting; causing Pain, sym∣ptomatical Fevers, Fainting, &c. and the Humor which causes the Fistula, is oftentimes malign and stubborn, not easily yielding to Medicines; for which reasons the Cure many times succeeds slowly, and ill.

XXXI. Fistula's ending in the Tunicles of Arteries and Veins, are thought to be incurable, because of Hemorrhages: for if you en∣large the Orifice, or take away the Callosity by sharp Medica∣ments, the flux of Blood will be renewed or increased. This hap∣pens most commonly in Bubo's of the Groin, not speedily cured, and Parotides under the Ear, and in Phlegmons in the Arm∣pits: because these Parts being Emunctories, are near to the divarication of the great Ves∣sels, viz. the Aorta and Vena cava, descending and ascen∣ding.

XXXII. If in a Fistula in the Back, the Spine be carious, 'tis 'tis no prudence to undertake a Cure; for at length an exte∣nuation of the Body will be induced, and the Animal Spirits diminished; and withal they will not be communicated (as they ought to be) to the extre∣mities of the Body, whereby Death will not long after suc∣ceed.

XXXIII. Fistula's in the Joints are dangerous; (for even great Wounds in the Joints in Bodies of a good habit, are pronounced by Hippocrates to be mortal.) For seeing the Joints are framed of very sensible parts, as Nerves, Tendons, Membranes, and Liga∣ments; and that Corrosives must be applied to remove the Callus, great pain will ensue, which may endanger a Flux of Humors, Inflammation, &c. all which will detard the Cure. Be∣sides, these being depending Parts, and not fleshy, they are less able to discuss a Flux of Humors received, by reason of the weakness of the Natural Heat of the Parts.

I. The true or absolute Cure of a Fistula,

XXXIV. The Cure of a Fi∣stula, is either Real, or Pallia∣tive.

XXXV. The real and true Cure, is that which removes the Callus, and compleats the Cure, as in other Ulcers.

XXXVI. The Palliative Cure, is that which meddles not with the Callus, but only dries the Fistula within, and skins it without, the hollowness never∣theless remaining, commonly continuing some little while closed, but easily breaks forth

again, being to be kept under by a regular Diet, Purging, and taking good Wound-drinks.

XXXVII. In order to the real and true Cure, there are several Indications: 1. To abate the Humor which flows. 2. To cor∣rect the vitious Habit of the Body, by Traumaticks. 3. To remove the Callus. 4. To heal up the Ulcer, with Sarcoticks and Epuloticks.

XXXVIII. As to the first Indi∣cation, which is to abate the Humor that flows, there are several In∣tentions: 1. That the Patient keeps a regular and good Diet; eating things sweetning the Juices and Humors of the Bo∣dy, or at least breeding sweet Juices, and of a sparing nou∣rishment, (unless the Sick be in a Hectick, or Consumption) that the Sore may not be supplied with a superfluity of Humors: such are Bilket, Meats roasted, (not boiled or baked) Fowls or Birds of Mountain-places, Par∣tridges, &c. of which we have spoken plentifully in other places: he may eat also every Morning fasting, an ounce or better of Green-ginger, which strengthens the Stomach, corrects in some measure the evil Ha∣bit, and drys up superfluous Humors.

XXXIX. 2. To evacuate the evil Humors contained in the Body, which supply the Fistula with Matter and Humor: this is done by Universals; as general Purges and Vomits, which carry off and diminish the Humors, and cause a Revulsion of the same.

XL. For this purpose, you may use Emeticks, which empty the Stomach, and cause a Revulsion upwards; the chief of which are from Antimonials; as the Infu∣sion of Crocus Metallortun, Vinum Benedictum, Vinum Antimoniale, Tartar Emetick, Pulvis Antimonii, Pulvis Rheumaticus, Mercurius Vitae: and among Vegetables, we commend Oxymel Scilliticum; than which there are not many better things: but in using these things, you must consider the strength and habit of the Bo∣dy, and accordingly make your choice, and pursue them.

XLI. Emeticks having been used their due course, you are next to cleanse the Bowels by proper Cath∣articks; such as Tinctura Par∣gans, Sal Mirabile, Mercurius praecipitatus Principis, Aurum Vitae, Syrupus Catharticus, Pulvis Catharticus, Pulvis Cornachini, Electuarium Catharticum, Pilulae Catharticae, Pilulae Mirabiles, and Our Family-Pills; choosing out of all these things, those which may most agree with the Humors of the Body, and comport with the strength or weakness of the Sick.

XLII. And these things are to be continued for some time; or are to be constantly resumed and made use of, at due intervals of time; as the nature of the Disease requires, and the Body of the Sick can bear.

LXIII. The second Indication requires to correct the evil Habit of the Body, by Traumatick Diet-Drinks. Now altho' we have, in Lib. 4. Cap. 30. given you ma∣ny and various Prescriptions of Diet-drinks, out of which you

may choose what most agrees with your present occasion; yet we shall for order sake, give you some other Examples in this place, which Authors have very much commended.

XLIV. Tagaultius prescribes this Diet-drink. ℞ Agrimony M.iii. Plantane M. ii. Olive-leaves M. i. cut, bruise, and boil in Canary-Wine, q.s. of which let the Sick drink ℥iii. or iv. every day.

XLV. Or this: ℞ Osmund∣royal P. iii. Centory the less P. i. Wine q.s. boil, and make a De∣coction: it corrects the Humors, makes a good Habit of Body, expels and drives forth broken Bones: add in its use, a little Spirit of Wine.

XLVI. Or this: ℞ Sanicle, Mugwort, Speedwel, Saracens-Consound, Wintergrcen, A. ℥ iv. Horstail ℥ii. Canary-Wine q.s. boil, and make a Decoction.

LXVII. This, if you would have its Operation yet stronger, you may in drinking of it, add to each Dose, of levigated Crabs-eyes ℈ i. for Crabs-eyes and Savin are of sin∣gular use, in expelling Pus, and other putrified Matter, in con∣suming and removing a Callus, and driving forth corrupted Bones.

XLVIII. Another Dict-drink. ℞ Avens, Carduus ben. Savin, A. ℥iii. Sanicle, Saracens-Consound, Speedwel, A. ℥ii. Tormentil-roots ℥i. Wine q.s. boil, and make a Decoction.

XLIX. Authors mightily com∣mend the roots of Gentian and round Birthwort; ʒi. of either of them being taken in White-Wine in the Morning, either every day, or every other day, fasting two Hours after it.

L. The juices also of Agrimony, roots of Bistort, of Borrage, of Comfrey, of Tormentil, and of Osmund-royal; the juices of Cen∣tory the less, Golden-rod, and white Horehound, and of Plantane, Periwincle, and Horstail, being mixed with Ale and drank every day; sweetned with Sac∣charum Rosatum, wonderfully contribute towards the healing: so also the Decoction of Gua∣jacum, Sarsaparilla, and Burdock-roots, being given morning and evening for a Month or two together.

LI. ℞ Raspings of Guajacum ℥vi. Sarsaparilla split ℥iv. Rai∣sons stoned ℥iii. Liquorice bruised ℥ii. roots of Tormentil, Osmond∣royal, Bistort, Comfrey, Coriander and sweet Fennel seeds, A. ℥i. Agrimony, Golden-rod, tops of Hypericon, Solomons-seal, A. M.i. boiling Water ten quarts: infuse for 24 hours, then boil with a gentle Fire, 'till a Gallon is eva∣porated; strain, and keep it for use. Dose, half a pint in the Morning fasting, a pint at Din∣ner-time, half a pint at 4 in the Afternoon, and a pint at Supper∣time: if the Patient cannot drink this quantity, let him drink as much as he convenient∣ly can.

LII. The third Indication of Cure, is the removing of the Cal∣lus; which how that is to be performed, and whether by Me∣dicaments or Instrument, or both, we shall anon shew un∣der the next Head, where

we shall treat of it at large.

LIII. The fourth Indication of Cure, is the healing-up of the Ʋl∣cer. The Callus being removed, or dissolved into a slough, and cast off, you may deterge with this. ℞ Turpentine washt in Aq. Vitae ℥iii. juices of Smallage and of Hounds-tongue, A. ʒvi. Honey of Roses strained ℥jss. boil to the consumption of the Juice; and add to it pouder of round Birthwort root, of Tobacco, Myrrh, meal of Lupins, A.ʒii. Scammony ʒi. mix.

LIV. And if you add to the former, pouder of Orrice, of Frankincense, of Myrrh, and Sar∣cocol, it will become incarnative; and then you may cicatrize with Ʋnguentum desiccativum rubrum, &c.

LV. Or you may wash and cleanse with this. ℞ Plantane and Rose water, A. lbi. Ung. Aegyptiacum ℥i. white Vitriol ℥ss. Syrup of dried Roses ℥v. mix, and dissolve for an Injection.

LVI. Or: ℞ Plantane-water, or rather Lime-water, which is better, lbi. white Vitriol calcin'd ℥ii. fine Bole ℥i, S.V. ℥j ss. in which let Camphir ʒvi. be dis∣solved, mix them. With these, you may wash and cleanse the Fistula; more especially, those into whose bottoms you cannot easily convey other Medica∣ments.

LVII. Sennertus also says, you may inject by a Syringe Lixivium, (not very strong) Aqua mulsa, Sea-water, Lime-water, and Wa∣ter of the bot Baths, and Aqua Vitae, or S.V.

LVIII. Now of how great Vir∣tues Spirit of Wine is, in these kinds of Cures, we have already declared in Cap. 12. Sect. 15. and 16, aforegoing: and here again, we cannot but by the way observe, That if it is mixed with other convenient Medica∣ments, it is then of admirable use and benefit in cleansing and drying sordid and filthy Ulcers; and will perform ten times more, being mixed with other Medicaments, than they could do, if used alone without it, or if used alone with them; which the industrious Artist, if he pleases to try, may easily prove.

LIX. If you use cleansing Pou∣ders, you may blow them into the Ʋlcer by a Pipe, its end being put into the Sinus of the Fistula, the Fistula being but a little way within the Flesh: but if it is long, it may be opened on the opposit part, and so on both sides the Medicaments may be cast in.

LX. And here likewise we can∣not but intimate, what we have before said, in the Cure of a Sinus, and of a Cavernous Ʋlcer; that we must use our utmost endea∣vour, that the orifice of the Fistula may be open downwards, that so the Humors may the more freely flow forth; or if it be not open, then in that very place it is to be opened, unless there be some weighty reason which may hinder it.

LXI. Some inject Lime-water, in which Mercurius dulcis levi∣gated has been put, and shaken together: or the Ablution of Turpethum Minerale; but scarce∣ly any thing exceeds the Water

of the Griffin, which in healing Ulcers does Wonders.

LXII. Some deterge with this. ℞ White-wine ℥viii. Ung. Aegyptiacum ℥ss. S.V. ℥i. mix them; with which you may in∣ject warm once a day, or oftner, if you see occasion.

LXIII. You may know when the Fistula is sufficiently cleansed, if the Pus or Matter is uniform, equal, smooth, thick, white, and without any ill or stinking smell.

LXIV. If the Bone be carious, you must consider how far the caries has entred into it, and endeavour the removal of it either by Actual Cautery, or boring with the Trepan, or rasping, shaving, or scraping; then by Desquamatories hasten the exfoliation of the Bone; and so proceed in the rest of the Cure, with Sarcoticks and Epuloticks.

LXV. But if the Fistula is near, or over some noble Part; or if there is a Nerve, Tendon, or Artery near; or if it is deep in the great Bones, or in the Joints, where you cannot proceed by the actual or potential Cautery, and it will not yield to milder Medicaments; you must then come to the palliative Cure, by gentle Purgings, Diet-Drinks, Waters, Balsams, and Ointments; which may give a quietness and ease to the Part affected, as we shall anon de∣clare.

LXVI. The second Intention of this fourth Indication, is to unite and consolidate the Parts dis∣joined: this is done in part, by continuing the use of traumatick Diet-drinks, or some such Li∣quor as this. ℞ Angelica, Avens, Bawm, Hyssop, Fetherfew, Mint, Marjoram, Savory, Tyme, Peni∣royal, Savin, A. M. ii. Burnet, Centory, Sanicle, Plantane, Knot∣grass, Yarrow, Solomons-seàl, A. M. i. roots of round Birthwort, of Bistort, Comfrey, Gentian, Tormen∣til, Zedoary, A.℥ii. Wine a gallon: put all into a glass Alembick, and draw off in B.M. a quart or three pints of Spirit: the dregs strain out, and the straining clarify with whites of Eggs: to this clarified Liquor put a quarter or more of its weight in Honey, which dis∣solve, and then add the distilled Spirit to it, and keep it for use. It may be given inwardly, ℥iii. at a time, Morning and Night; and also injected into the Ulcer, to incarnate it; applying in∣carnative Balsams or Ointments after it.

LXVII. The third Intention of the fourth Indication is, to produce the Cicatrice; of which we need not say much here, considering we have said so much of it in former places: only this you may note, that you may know when the Ulcer is near whole, and sit for cicatrizing; for that the Humor which flows from it, will be little, thick, and concocted, and the place will be void of pain and tumor; and when you find it altogether dry and skinned, you may then say that the Fistula is perfectly cured.

II. The Way of removing the Callus.

LXVIII. We are first to consider whether the Callus can be removed by Medicaments, or not; if it can,

whether it can be taken away with∣out laying the Sinus open, or not: if it can, then the first thing to be done; is to widen the mouth thereof, for the better and more easy application of Medicaments thereto.

LXiX. The Callus in the Orifice may be perceived at sight, but the Callus in the Sinus it self, is to be discovered by Instrument: for the Instrument or Probe being put in, if there is little or no pain, and it bleeds not, but a certain hardness it self, there is a Callus.

LXX. In those who are young, whose Flesh is soft and tender, Emollients and Digestives are sufficient, to dissolve or dis∣sipate the Callus; with which, as you see occasion, you may mix Abstersives.

LXXI. But the narrow Orifice is first to be dilated, (if it is too straight) which is performed four several ways: 1. By Incision; which is to be used to strong Bodies, if the Fistula is not deep, and runs along only under the Skin, no deeper than the Membrane of a Muscle, and if it is in a fleshy Part.

LXXII. 2. By things which swell; and these are to be used before Inci∣sion, if the Fistula has many sinuo∣sities: of this kind are roots of Briony, wild Rape, Birthwort, Gentian-roots, Elder-pith, Puff∣balls prepared and prest; Sponge twisted, and bound about with Thread very hard, and then kept in a Press for some time: this dilates more than the other things, and imbibes more moi∣sture.

LXXIII. Some prepare the Spunge by dipping it in simple Melilot-Emplaster, when very hot, the•• put between two Trenchers, and prest strongly in a Press, and after an hour or two, when it is cold, to be taken out; it will be firm, and almost resemble green Sage-Cheese.

LXXIV. Others dip the Spunge into Glair or Whites of Eggs, and then in like manner, keeping them in the Press' till they are dry, and so taking them out. Either the former or this may be cut out into Tents, of what form, or fashion, or bigness you please; which being put into the Fistu∣la, will exceedingly dilate it, by sucking to it the humidity.

LXXV. 3. By the Fistula-Tent: which your may make of fine downy Lint (the Threads being all taken away,) with this doun, and the Glair of Eggs, you may make Tents of what bigness and length you please, even to the depth of the sinuosicy. You may do it on piece of Deal-board.

LXXVI. And you may enlarge the bigness of the Tents, to dilate the Fi∣slula as much as you please: for these Tents being dried, will pierce into any cavity, like a Probe, without bending, (if they are well made) by reason of their stiffness.

LXXVII. 4. The fourth and last way, is by Hellebor-root; which opens by a kind of Ca∣theretick, or Caustick Property, and is to be prudently used: but is, in truth none of the worser means.

LXXVIII. The Orifice being thus widened, we may proceed to the removing of the Callus, as directed

at Sect. 70. above, with this Ointment. ℞ Juices of Smal∣lage ℥ii, of Celandine ʒii. of Onions ʒi. Honey of Roses ℥ii. Turpentiue, q.s. mix, and make an Ointment.

LXXIX. ℞ Our Ung. Nico∣tianae ℥i. Turpethum Minerale ʒi. mix them: and in some very tender Bodies, Ʋng. Nicotianae may do it alone: if you have not Turpethum Minerale, you may use instead thereof so much red Precipitate.

LXXX. And of this nature are, Ashes of Fig-branches, mixt with Goose-fat; Pot-ashes or Salt of Tartar, mixt with Veal-fat; decoction of Fern-roots, deco∣ction and pouder of Tobacco, and Euphorbium, Diachylon mixt with Precipitate, Ʋnguen∣tum Apostolorum.

LXXXI. Amongst the Emol∣lients and Digestives, for resolving and dissipating a Callus, Wiseman enumerates these, viz. roots of Althea, of Lillies, of Elecam∣pane, of Solomons-seal, wild Cucumbers, seeds•• of Line and Fenugreek, all sorts of Marrows, Fats of Hogs, Geese, Cocks and Hens, Mans-grease, Ʋng. Althaeae cum Ammoniaco & Galbano; of which, says he, you may make Fomentations, Cataplasms, Oint∣ments, Cerats, &c.

LXXXII. To this purpose also, he recommends Empl. de Ranis, fine, & cum Mercurio, (for Mer∣cury has a mighty power in softning Bones, and Ivory it self) Empl. è Mucilaginibus, Dia∣chylon cum Gummi.

LXXXIII. But for the most part, stronger Medicaments, to consume and remove the Callus, are requisite: as, the Roots of Spon∣dylium, viz. Meadow or Cow Parsnip, roots of Asphodel, Snakeweed, Briony, decoction of Lupins; but the best of all, are the lesser Centory, and the roots of black Hellebor, put in for 3 days into the Sinus: yet this last will be dangerous, if the Fistula be in any part of the Tho∣rax, or Abdomen.

LXXXIV. Or, ℞ Honey ℥iv. juice of blue Flower-de-luce roots, Red-wine, A. ℥i. juice of Celan∣dine ℥ss. boil a little; then add Scammony in pouder, Litharge, A. ʒii. white Vitriol, Tobacco in pouder, Aloes, Myrrh, A.ʒi. Turpentine ℥ss. mix them.

LXXXV. Take Frankincense, Myrrh, Scammony, A.ʒii. roots of Briony, of round Birthwort, To∣bacco, A. ʒi. Verdigrise ʒss. Sal Armoniack ℈ i. Hogs-lard, Oil-Olives, A.q.s. mix them.

LXXXVI. If the Callus is somewhat hard, and the Patient in years, you must use things more harsh, and which mundify strongly: as, Take Ung. Apo∣stolorum ℥i. red Precipitate ʒi. burnt Alum ℈ii. or instead of red Precipitate, you may use Turbith Mineral, in the same quantity; mix them well together.

LXXXVII. Or you may use Ʋnguent. Aegyptiacum, with the Precipitate and Alum: as it is stronger, so it causes more pain than the Ʋng. Apostolorum, but it procures not so good a kind of Pus.

LXXXVIII. Aegineta, lib. 4. cap. 49. commends the juice of the roots of Laserpitium,

or Elaterium mixed with Tur∣pentine.

LXXXIX. Ʋng. Fuscum Wur∣tzii is a famous thing in this case, if it is reduced by boiling into the form of a Suppository or Tent, and so put into the Fistula.

XC. Or this of Barbett. Take Agrimony Mss. Scordium, flowers of Hypericon, A. P.ii. French Bar∣ley ℥i. White-wine q.s. boil, and strain; add Virgin-Honey ℥iv. boil to a thickness, then add Sarcocol ʒiii. Olibanum, Mastich, A.ʒii. Myrrh ʒiss. white Vitriol ʒi. mix them: of this make Supposito∣ries or Tents; he says it is pre∣valent also against Fistula in Ano.

XCI. But if the Callus is inve∣terate, and grown to a very great hardness, so that the former things will do nothing, you must then come to the stronger Remedies, and such as are Caustick; of which also, some are more gentle, others more vehemently fierce.

XCII. The more gentle are these. ℞ Strong Vinegar ℥vi. white Vitriol ℥iv. Alum, Verdigrise, A. ℥ss. boil, and calcine in a luted Vessel; then make it into a fine pouder, and mix it with Ung. Aegyptiacum, with which arm the Tents. Barbett.

XCIII. The Aqua Viridis, or Green Water, (which we have formerly described) is an excel∣lent thing; being oftentimes cast into the Fistula, with a Syringe.

XCIV. Aegineta, lib. 4. cap. 49. has this: Take Verdigrise ʒxii. Ammoniacum ʒii. dissolve the Ammoniacum in Vinegar, and then mix the Verdigrise with it.

XCV. Wiseman says, he com∣monly uses Lapis Causticus, Tro∣chisci de Minio, Arsenick, and Oil of Vitriol: or this: Take Wax, Rosin, A. ℥i. corrosive Sub∣limate ℈ii. more or less; mix them upon a Fire, and dip a Spunge in it, but not too hot, lest you burn it; then press it out, and cut it out into such a form as may serve your purpose.

XCVI. Guido commends Aqua fortis, some Spirit of Nitre, which is better than A••. fortis, because A.F. is apt to black and foul the Bones, if it should touch them: others commend Oil of Vitriol, others Oil of Sulphur, and some Spirit of Salt.

XCVII. If you desire rather an Injection, Wiseman says you may make this, or some such∣like. Take Ung. Aegyptiacum ℥ss. Soap-lees ℥i. Rose-water ℥ii. Plantane-water ℥iv. Sublimate ʒss, Arsenick ℈i. mix, and boil to the consumption, of a third part; of which cast a little of it in with a Syringe for three days toge∣ther, shutting the Orifice up with Wax, of some Emplaster; so shall you consume all the Callus.

XCVIII. But, says he, you must consider well the situation of the Fistula; lest by its too far pene∣trating, it should hurt the Bone, or parts underneath.

XCIX. Take strong Lye ℥iv. Honey of Roses strained ℥jss. De∣coction of Lupins ℥i. Alum ℥ss. mix them: if you would have it yet stronger, you may add thereto red Precipitate ʒss.

C. Or, Take Orpiment, Sulphur

vive and Calx vive, Ana; make them into a fine pouder, and mix them. Or, Take burnt Alum ℥ii. Vitriol calcin'd ℥i. Orpiment, Ver∣digrise, A. ℥ss. make all into a fine pouder. Or, Take Turbith Mine∣ral not washed, Vitriol calcin'd, fine Bole, Ana; make all into a fine pouder.

CI. The strongest of all are these. Take corrosive Sublimate, Vitriol calcin'd, fine Bole, Ana; make them into a fine pouder. Or, Take white Arsenick, Orpiment, Calx vive, Ana; make them into a fine pouder: or, (if the Fistula is laid open, so that you can easily come to the Callus) you may with a Feather touch it gently with the Butter of An∣timony.

CII. As to the use of the sormer Pouders: if you have dilated the Fistula by Incision, you may sprinkle the Callus with them; but if it is dilated by any other means, then you may mix the Pouders with Ʋnguent. Populeum, wherewith a Tent may be armed, and so applied: or you may make Troches of those Pouders, which being made into form and dried, may be put in.

CIII. But this you must observe, that you must not force out either the armed Tent, or Troches, before they force out of their own accord: for so they will bring out the Callus with them whole, the Tent being within the Callus.

CIV. If there are many Sinuo∣sities, so as that no Tent can pierce to their bottoms: it will be best then to mix these Pouders with some Liquor, as Aqua Calcis, a small Lixivium, Alum-water, Vitriol-water, or White-wine, and so inject with a Syringe.

CV. But by reason of the Ap∣plication of these Medicaments, there is usually much pain, and sometimes Inflammation; it will be good to provide against it by some proper Defensative: as, Take Oil of Roses, Whites of Eggs, Ana; mix them well together, and apply it over the Part affected.

CVI. Or, Take Cows-milk lbi. crums of White-bread ℥vi. boil to thickness of a Pultiss; then add Ung. Populeon ℥ii. Henbane-seeds, ℥ss. Saffron in pouder ʒjss. Opium in pouder ʒss. mix, and make a Cataplasm, which apply Mor∣ning and Evening.

CVII. And round the adjacent parts, you may apply this cor∣roborating Emplaster. ℞ Pou∣ders of Red-roses, of Myrtle∣berries, A.ʒi. Mastich, Olibanum, Pomgranate-peels, A. ʒii. Orrice∣root ʒiii. yellow Wax, Pine-rosin, Oil of Hypericon, A. ℥i. mix, and make an Emplaster.

CVIII. Wiseman, to ease the Pain, and defend the Part, uses these Lenients; Decoctions of Mallows, Marsh-mallows, Violet-leaves, Mullein, Henbane, Quince-seeds, Barley; or Oil of Eggs, fresh Butter, Lard, Ʋng. Basili∣con, with Oil of Lillies, Dial∣thaea, &c. and over them he applies Refrigerants, as Empl. è Bolo, Oxylaeum, Emplast. Album, with Juices.

CVIX. But if notwithstanding all that has been said, the Fistula will give place to no Reme∣medies, that have or can be applied; we must betake our selves to the Incision-knife,

or the Actual Cautery it self.

CX. The whole Sinus is to be laid open; (unless it be in those Fistula's which reach unto the great Arteries, Nerves, Tendons, Membranes, which gird in the Ribs, or other parts of like nature:) which is to be done with the Incision-knife, ac∣cording to its position and form; or else with the Syringo∣tomus of Fabricius Aquapendens, which is very useful in this cause.

CXI. The Fistula being laid open, the Callus is to be removed by some of the Medicaments before de∣scribed; or with the edge of a Pen-knife or Razor; cutting so far, 'till you come to the good and sound Flesh; which you may perceive, not only by the colour, but by the Blood, and sense of Pain.

CXII. If the Callus is extraor∣dinary hard, it will be the best way to remove it with the Actual Cautery, or red-hot Iron; which is done, not only with most speed, but also with least pain, or sense of feeling; yet this Remedy, by reason of the ter∣ror thereof, few People will admit of it.

CXIII. In the mean while that these things are doing, whether by Caustick Medicaments, the Knife, or red-hot Iron) the Part it self is to be well guarded with some cooling Defenfative and Repel∣ler; lest the great pain should cause an Inflammation.

CXVI. The Callus being thus burnt throughly, you must then apply things to remove the Eschar or Crust; as Oily things, fresh Butter, Hogs-lard, Palm-Oil, Ʋng. Populeon mixed with Ʋng. Basilicon; to which you may if you please add a little Precipitate.

CXV. If the Fistula ends in a Bone, you must (so soon as it is discovered by Section) diligently scrape and pare away whatever is black and corrupted in the Bone, which must be in the surface there∣of. If the rottenness has cor∣rupted farther, then the scaly part is to be cut forth with some proper Instrument, unless it comes forth of its own accord.

CXVI. If the rottenness has pe∣netrated to the Marrow, then that which is corrupted is to be taken forth; but if the Bone is wholly putrified, it must be all of it taken out; which may be well enough done in small Bones, but not so in others.

CXVII. The Bone being now cleansed, you are immediately to apply Incarnatives, and then to heal it after the manner of a simple Ʋlcer: if the Fistula does not give place to healing, it is a certain sign, that all the cor∣rupted part was not taken away: for which reason, the Fistula is to be opened, and the Bone to be farther scraped and cleansed with all the care imagi∣nable.

CXVIII. If yet after all this, it will not heal, you may then con∣clude, that it has penetrated so deep, as it will be scarcely possible to find out its end and bottom; and is then to be left unto Na∣ture, whom we are yet to assist and help with Medicaments: and for this purpose, this Pouder of

Nicholas the Florentine, is much commended.

CXIX. ℞ Salt decrepitated, Tartar, Agarick, A. q.s. let them be made into fine pouder: this is said to draw forth the Bones which are broken and corrupted, cats thro' the putrified Flesh, and heals the Ulcer.

CXX. But this following Pouder is better. ℞ Salt de∣crepitated, Tartar calcined, Scam∣mony, Tobacco, all in fine pouder, A.℥i. Euphorbium ℥ss. mix them.

CXXI. The Callus being remo∣ved and quite taken away, if there be any thing sordid and foul yet remaining, you must make use of detersive and sarcotick Medica∣ments, such as that at Sect. 53. aforegoing: and for which pur∣pose Centory the less, Birthwort-roots, Golden-rod, Pimpernel, and the like are to be used: and then lastly, with Sarcoticks and Epuloticks you must com∣pleat the Cure.

III. The Palliative Cure of a Fistula.

CXXII. When the Palliative Cure is to be used, we have partly shewed at Sect. 65. aforegoing: to which we add, that in what part soever it be, and how simple soever, if it proves re∣bellious, and resists all sorts of Medicaments, as it oftentimes does, in scorbutick, strumatick, and cacochymick Bodies, you must then apply your self to this Method, as the ultimate of all that is to be done.

CXXIII. For it drys, and shuts it up for a time with a thin Skin, which so remains, 'till more Humors are generated, and heaped up in the Part affected, and then it breaks out again.

CXXIV. The Body is to be well cleansed and evacuated (at due intervals of time) with pro∣per Emeticks and Catharticks, such as we have enumerated be∣fore at Sect. 40 and 41. above: but as the Purging must be con∣tinual, it may be for many Months, or some Years: so a Purging-drink may be thought more expedient; such as this following.

CXXV. Take fine soft Ra∣spings of Guajacum, mealy Sarfa bruised, choice Sena, Mechoacan bruised, Hermodacts, Carthamus-seeds, A. ℥vi. Rhubarb, Liquorice, Fennel and Coriander seeds, A. ℥iii. Scammony, Anniseeds, Winters Ci∣namon, Virginian Snake-root, A.℥i. Agrimony, Angelica, Avens, Bawm, Ladies-mantle, Sanicle, Winter∣green, A. M. i. all being grossly bruised, put them into a Bag, with a Stone in it, which put into three gallons of new Ale; of which after the second or third day, the Pa∣tient may begin to drink; half a Pint fasting every day, and if it is a Body hard to work upon, as much at 4 in the Afternoon.

CXXVI. And for his constant Drink, he may take this. Take Guajacum rasped, Sassafros ra∣sped, mealy Sarsa, China, Juniper-berries, Burdock-roots, A. ℥x. round Birthwort root, Zedoary, Winters Cinamon, A. ℥v. Aniseed, Coriander and Fennel seed, Ginger. A. ℥ii. Agrimony, Angelica, Avens, Bawm, Clowns-woundwort, Albeal, Betony, Sage, Hyssop, A. M. i. all

being grossly bruised, put them into a Bag with a Stone in it; which put into four gallons of new Ale, letting them work together for two days: after which, the Pa∣tient may drink it as his ordi∣nary Drink.

CXXVII. Let his Diet be drying, and very strengthning; because this continual running of the Ʋlcer will drain the whole Body, and be in danger to induce a Consumption: white Ship-bisket is good, and ought to be his only Bread; his Meat ought to be roasted; and for Restoratives, strong Broths and Gellies are often to be given him.

CXXVIII. Let the Orifice of the Fistula be open downwards; if it is not so, let it be made by Inci∣sion or Cautery, or by the help of the Syringotomos, so that the Humors may freely pass out.

CXXIX. Then as for Topicks, Lime-water is good to wash, or inject withal, and sometimes Red-wine, or Red-wine mixed with S.V. or Lime-water with S.V.

CXXX. ℞ Aqua Calcis (in which Litharge has been boiled) ℥i. Spirit of dried Roses, or of Myrtle-berries ℥ii. mix them. Or, Take Plantane or Rose water ℥vi. Spirit of Wine ℥ii. Roman Vitriol in fine pouder ʒii. mix, and dis∣solve. Or, you may inject and and wash daily with the Water of the Griffin, which exceeds all other things in Nature; for that by long using of it, it has many times dissolved the Callus it self.

CXXXI. In some of these Li∣quors a Pledget of Lint, or a new Spunge may be dipt, or throughly soaked, and applied to the Fistula, and bound to the place: and over the Lint or Spunge Empl. Album, or Diapalma may be put, to keep it fast on: and it needs to be drest but every other day only, unless very much Matter flows forth; for then it will require a daily dressing and looking after.

CHAP. XXI. Of an ƲLCER GANGRENOƲS.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus Gangraena∣tum, or Gangraenosum; we in English call, A Gangrenous Ulcer.

II. It is a notable and extraor∣dinary Distemper, tending to a Mortification, which may invade an Ʋlcer, without any Tumor at all. Yet because it often follows up∣on Tumors, especially a Phle∣gmon, we have amply treated thereof in the Book of Tumors, viz. Lib. 3. Cap. 11. aforegoing; in which place you have its va∣rious Causes, Signs, Progno∣sticks, and Methods of Curing: here we shall only give you a few words concerning an Ulcer gangrenated, or sphacelated.

III. The Cause. It is whatso∣ever destroys the Native Heat of the Part; for as much as the Life thereof depends solely thereupon.

IV. The Native Heat is de∣stroyed, 1. By vehement Cold. 2. By extream outward Heat. 3. By defect of Nutriment. 4. By Suffocation; the Transpiration being hindred by stopping the Pores, which is many times by too strict Bandage. 5. By a Venemous Quality; as is evi∣dent in a Carbuncle, Bitings of Vipers, Rattle-snakes, &c. 6. By Septick Medicaments, not pru∣dently and carefully applied.

V. The Signs. There are va∣riety of Signs and Symptoms, according to the variety of its seve∣ral Causes: however, there is a Pustle or Pustles appear, with a spot in the middle; and if it proceeds from cold, there is a great pricking, and the Part is first pale, then red, then black. If from heat, or stop∣page of the Pores, the Pustules yield a gleety Humor, and the redness turns to whiteness. If from too hard Ligature, the Pustules are greater, and full of a thin reddish Humor: if from Poison, &c. under the Pustule a black Spot appears, spreading it self over the whole Part.

VI. If it becomes a perfect Sphacelus or Mortification, the Part looks first pallid, after livid, then black, the Flesh is loose and stinking; the sense, heat, and pulsation is vanisht; and the life of the Part is wholly abolished, so that if cut or burnt, it is insen∣sible of pain: the Flesh seems cold, and becomes soft and flaggy; which afterwards dies, and becomes black, hard, and wholly dead, and yields a stink like to that of a dead Carcas.

VII. The Prognosticks. All Gangrens are dangerous, if they be in moist parts; because that the innate Heat in those Parts is sooner suffocated, from the great store of humidity.

VIII. But a Sphacelus it far more dangerous; because it can no more be restored to life again, but the Part sphacelated must be cut off, to save the Life of the Patient.

IX. The Cure. Tho' we have so largely handled the Cure in the place afore-cited, yet these things following in an Ulcer gangre∣nated, are farther to be observed.

I. The Cure of an Ulcer Gangrenated.

X. If it proceeds from Cold, bathe the Part in very cold, or almost frozen Water, so will the inward Heat be rouzed up, diffuse it self, and be brought again into play: and give inwardly Powers of Rosemary, Juniper, Limons or Sassafras, in a Glass of Canary: after which, you may give a Dose of Our New London-Treacle; then being in Bed, induce Sweat, by applying glass or stone Bottles to the sides, full of boiling-hot Water.

XI. Also let Warming-stones or Bricks be heated, and wrapped up in Napkins, and applied to the soles of the Feet: and if the Gangrene goes on, you must immediately scarify, and foment the Part

either with Lixivium of Pot-Ashes, or with Powers of Am∣ber, or camphorated S.V.

XII. If it proceeds from Suffo∣cation of the Natural Heat, ex∣hibit often volatil Sal Armoniack in a Glass of good Wine, let the place be scarified deep, and emptied by Cupping-glasses, and then Defensatives to be applied to the Part, to which add con∣venient Purging.

XIII. The Incision being made, the Part is to be washt with Brine, or Lixivium of Salt of Tartar, boiled with meal of Lupins, or Aloes; adding after boiling, a quarter-part of S.V. and a tenth part of Spirit of Sal Armoniack: when the Part is washt, lay on Ʋng. Aegyptiacum; which here is reputed to be the best of all other things, being a most effi∣cacious Remedy for taking away putridness, and separating the dead Flesh from the sound.

XIV. If the putridity be more than ordinary, use this. Take Syrup of Wormwood and Scordium lbi. Vinegar of Squills ℥vi. Verdi∣grise ℥iii. juices of Rue and Cen∣tory the less, A. ℥ii. Alum, Sal Armoniack, A. ℥ss. boil to a good thickness, then add of Treacle and Mithriddle, A. ℥ss. Camphir ʒi. mix them.

XV. Or this Water, which has been used with success. Take fresh Ʋrine lbii. Oil of Tartar per Deliquium lbss. Oak-buds, Centory the less, A. M. ss. Vitriol ℥i. boil to the Consumption of a third: then add S.V.℥iii. strain, and add S.V. ℥iii. in which Camphir ʒii. has been dissolved. All these things are to be applied blood warm, and continued 'till the Putri∣dity is removed.

XVI. If these things do not, you must proceed to Causticks; as the Princes Pouder, red Pre∣cipitate, Turbith-mineral, and such other like.

XVII. The Crust, in what way soever it is produced, must be taken away, as we have formerly taught; not waiting 'till Nature will do the work: but the highest part of the Crust is with the edge of a Pen-knife to be cut, even to the sound part, to make way for Medicines; lest waiting 'till it falls of its own accord, a new Putridity under the Crust should be contracted.

XVIII. If it be from Malignity or Poison, you must take care to defend the Heart; and expel the Poison by things Expulsive, Su∣dorisick, and Alexipharmick; as Medicins made of Angelica, Avens, Bawm, Carduus bened. Citron-juice, Dittany of Crèet, Lavender, Mint, Origanum, Pep∣per, Roses, Rosemary, Rue, Sorel, Wood-sorel, Scordium, Swallowort, Mithridate, Venice-Treacle, Our Theriaca Chymica; but principally with volatil Salts, as of Vipers, of Harts-horn, of Urine, and of Sal Armo∣niack, &c. by which procuring Sweat, the malignity will be driven forth, from the noble Members to the exterior Parts.

XIX. If the Poison sticks out∣wardly, you must apply strong At∣tractives, that it may not spread abroad: and if it is inward, the Matter is to be called forth by Scarifications on the Part affected, Cupping-glasses, &c. washing

the Part afterward with a De∣coction of Angelica, Centory the less, Dittany, Rue, Scordium, Southernwood, Swallowort, and Wormwood, made either in Wine, or Lixivium, or equal parts of both.

XX. Or, you may attract it, and consume it; by applying a Cataplasm of Garlick, Onions, &c. roasted, mixed with Leven, Tur∣pentine, and other strong drawers: or the Actual Cautery (which is the most effectual of all) may be applied.

XXI. The Gangrene being in a fair way of recovery, cleanse the Ʋlcer with Detersives; made of juice of Smallage and Honey of Roses, mixed (if need be) with a little Spirit of Wine.

II. The Cure, when Sphacelated.

XXII. But if there is an absolute Sphacelus, you are to consider whether the Member be sphacelated wholly, or in part. If it is totally sphacelated, it is to be ordered as we have directed, Lib. 1. Cap. 32. and Lib. 3. Cap. 11. Sect. 100, to 125.

XXIII. But if the Sphacela∣tion is in part only, first apply Defensatives upon the sound places adjacent, then make many streight and oblique Sections, scarify the dead Flesh which lies near the sound; and do this very deep, even to the Bone: and strew upon the Wound burnt Alum, Pot-ashes, and unslackt Lime, (avoiding Arse∣nick, which melts, corrupts, and putrifies the Flesh.)

XXIV. And the Crust which is over the Part affected, is to be taken away with the Incision-Knife, or a Razor; not waiting 'till it falls of its own accord: for the dead part will be dried, and so will easily be separated from the sound.

XXV. Some use the Actual Cautery, burning the putrified Flesh, 'till pain is perceived in the Part, after which they remove the Eschar: and then they deterge, incarnate, and cicatrize it, in all respects as a simple Ulcer. But Fallopius likes not the Actual Cautery, where there is much Flesh, because the Burning makes a most abominable stink.

XXVI. If upon removing of the Eschar, any principal Artery or Vein should be hurt, you may stop the Bleeding with such things as we have delivered in Lib. 4. Cap. 4. aforegoing; or with this. ℞ White Starch ℥iii. Ca∣techu ℥ii. Aloes, pouder of Toads∣flesh, A.℥i. Dragons-blood, Frank∣incense, fine Bole, A.℥ss. downe of a Hare cut small, Spunge torrified, A.ʒii. make all into a pouder, and mix them.

XXVII. Or with this Our Spe∣cifick. ℞ Pouder of Mans-blood, ℥iii. pouder of dried Toads, Cate∣chu, A. ℥ii. burnt Alum, ashes of an old Hat, A. ℥i. Salt of Vitriol, Dragons-blood, Sealed-earth, fine Bole, A. ʒv. make of all a fine Pouder.

XXVIII. And over the Pou∣der, you may lay this Emplaster. ℞ Fine Bole, Sealed-earth, Dra∣gons-blood, white Starch, A. ℥i. Fitch, q.s. mix, and make an Emplaster.

XXIX. Or you may lay on

this Sparadrap of Fallopius. ℞ Acacia, Aloes, Aloe-wood, Alipta Moschata, Alum, Cuminseed, Gal∣lia Moschata, Myrrh, red Sanders, yellow and white Ana, make a pouder. ℞ Ship-Pitch, Pine Ro∣sin, colophony, A. ℥ii. Mastick, liquid Storax, A. ℥jss. of the for∣mer Pouder ℥i. Gum Arabick, Tragacauth, A. ℥ss. let all be melted, and therein dip a Lin∣nen Cloth to make a Sparadrap.

XXX. All things being thus done, cleanse the Ʋlcer with ab∣stersives, incarnate it with Sar∣coticks, and Cicatrize it with Epuloticks, and heal it up in all respects as another Ulcer.

CHAP. XXII. Of an ƲLCER of the HEAD.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and the Latins, Ʋlcus Capitis: we in English call an Ʋlcer of the Head.

II. The Kinds. There are four several kinds of Ʋlcers of the Head: 1. Tinea, The Dry Scald Head. 2. Achores, the moist Scald Head with a thin Humor. 3. Favus, the moist Scald Head with a thick or Honey-like Hu∣mor. 4. Ʋleus Simplex, from an Apostem, Tumor or Contu∣sion.

I. Of the Dry Scald Head.

III. It is called by the Greeks (as Aristotle) 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉: and by the Latins Tinea, or Tineae, but this is while it affects the Hair chiefly; and of which we have said something already in Lib. 2. Cap. 5. aforegoing: but when it once comes to affect the Skin and Flesh, it may be called Tinea Ʋlcerosa, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ʋlcus aridum, the Dry •…•…ald: and of this it is we shall speak here.

IV. It is a Crusty Ʋlcer fret∣ting, the Skin like a Moth, with but very little moisture, Corrupt∣ing the Roots of the Hair, and making a dry filthy Scab.

V. But Petrus Johannes Fa∣ber in Chirurgica Spagyrica, Cap. 15. will have it to be, A peculiar Phagedaenical and Cancerous Ʋlcer of the Head, arising from a Vi∣triolick Salt in the Body of Man, which fretting the Skin, pro∣duces the Scall, sometimes white, sometimes yellow.

VI The Causes. And (says he) as Vitriol in the Great World, while it is calcining in the Fire, does coagulate into a Mass, either white, if the calcination is but moderate; or yellow if the Fire is augmented: so Vitriol in the lit∣tle World, when it is separated from the Balsam of the Body, makes its way towards the Skin of the Head, which it corrodes, and produces a Crusty and Scaly Matter. So that this Ʋlcus ari∣dum

may properly be said to be caused from Rhlegma Vitriolatum, a Vitriolated Phlegma.

VII. But Avicen, Mercurialis and many others of the Gaienists will have the material cause from Me∣lancholy joined with some acrid Humor, which provoking the Expulsive faculty, is thereby driven out at the Skin of the Head, and so causes this Ulcer; in which opinion there is very little appearance of Truth.

VIII. The Procatartick causes are: 1. From being Hereditary. 2. Or a fault in the course of the things Nonnatural. 3. Or from the Nurses Milk. 4. Or from Contagion and Infection.

IX. The Signs. It is known by a filthy dry Crusty Scab, some∣times white, sometimes yel∣lowish, or of an Ash-colour or greenish.

X. The Prognosticks. It is a malign Ʋlcer difficult to be cured; and the more inveterate, the more malign and hard of Cure; and when cured, many times leaves behind it an Alopecia, or Ophiasis; or the Humor being diverted to some other parts, produces a Morphew or Leprosy.

XI. And it is yet harder to cure, if the Skin is hard, or of a shelly substance sending forth many Scales or dry Scabs, or makes the Hair fall, by reason of the Acri∣mony of the Humor vitiating their roots; so if it has been once cured and returns again; for that it seems a seed of the Dis∣ease, remains fixed in the part affected.

XII. The Cure. There are two Indications of Cure: 1. To re∣move the Causes, Procatartick and Antecedent. 2. To remove the Causes Proximate, by application of proper Topicks.

XIII. The Procatartick causes are removed by rightly ordering the things Nonnatural; in which a good and regular Diet is chiefly to be minded.

XIV. The Antecedent cause is removed by due purgation, and that is perform'd: 1. By gentle Emeticks, which may empty the Stomach without much Violence. 2. By Catharticks, which ought to be Antimonial, but chiefly Mercurial.

XV. Paraeus thinks that the meanes used in curing the French-Pox, are effectual in curing of this Disease; and therefore Mercuri∣us dulcis, Red Precipitate, white Precipitate, the Princes pouder, and Turpethum minerale are com∣mended: also Aurum Vitae.

XVI. The second Indication has respect to the Proximate or conjoin'd cause, which has three Intentions: 1. To separate the Scall or Scab. 2. To take away the Hair by the roots. 3. To heal the Ulcer.

XVII. To cause a falling of the Scabs, you may anoint with Oil of Eggs, or of Myrrh, or of Sheeps Trotters, and the mucilages of Althea-roots, Linseed, and Fe∣nugreek, addding some proper Catheretick; but to young and tender Children, you must use soft means only.

XVIII. To take away the Hair by the roots, you must apply some sticking Emplaster or Paste, as a Plaster made of red or green Wax spread upon Leather, and laid on for 15 or 16 hours, or

the Cataplasm ad Porriginem, de∣scribed in our Doron Medicum, Lib. 3. Cap. 7. Sect. 1. which when it is fastned to the Hairs, is to be forcibly pull'd off, all at once, and therewith the Hairs will all come forth by the roots.

XIX. Then to heal the Ʋlcers, first foment with a decoction of Centory, Colocynthis, Gentian, Southernwood, and Wormwood; made in red Wine: and anoint with Vnguentum Enulatum cum Mercurio duplicato, or with Va∣lentia Scabiosa, and over it lay Empl. de Ranis cum Mercurio Tri∣plicato, or our Emplastrum Mer∣curiale.

XX. But Mercurialis applys this Cerate to the part affected. ℞ Juices of Fumitory, of Scabious, of Borrage and sharp pointed Dock, Vinegar, A. ℥iii. Old Oil lbi. Boil to the Consumption of the Juices: then strew in this Pouder. ℞ roots of white and black Hel∣lebor, Sulphur Vive, Vitriol, Auripigment, Calx Vive, Alum, Nut-galls, A. ʒss. Verdigrise ʒii. Make all into a pouder, and with Tar ℥jss. Wax, q.s. make a Cerate: where note, that if instead of juice of Borrage, juice of Tobacco had been put, the Medi∣cament had yet been the bet∣ter.

XXI. I have known this cured only with Ointment of Tobacco, and green Tobacco-leaves, laid over the part affected.

II. The Moist Scald Head, with a thin Humor.

XXII. This Disease is called by the Greeks 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉: and by the Latins Achor, and Achores; and by Ʋs, the moist Scald Head with a thin Humor: because a sanious matter called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ichor, does flow from it. See Lib. 2. Cap. 11. aforegoing.

XXIII. Galen, libro de Tumori∣bus, says, Achor is a small Ulcer in the Skin, which may be cau∣sed of a Salt and Nitrous Flegm, out of which flows a sanious matter, not altogether waterish, nor so Viscous and thick as Ho∣ney: and in another place, he says the holes in this Ulcer are less than those in Favus, out of which flows a thin Humor with clamminess.

XXIV. Oribasius ad Eunap. Lib. 4. Cap. 4. say also, that Achor is seated in the Skin of the Head, having but small holes, out of which a thin, and somewhat viscous Sanies does flow.

XXV. Aetius Lib. 6. Cap. 68. says that Achor is seated in the Skin of the Head, having but small holes, out of which a thin viscous Sanies does flow: and to this description Actuarius de dignosc. Morb. Lib. 2. Cap. 5. and Aegi∣neta Lib. 3. Cap. 3. assent.

XXVI. The Causes. The Procatartick or remote causes are evil Nutriment, and Contagion: the Antecedent cause is Atra bilis made sharp, or a sharp Excremen∣titious Humor, made so either by nature or accident: the proxi∣mate or conjoined Cause, is the same Humor impacted in the part affected.

XXVII. The Signs. They are in part discovered in the descripti∣on of the Ʋlcer, which is always

with an Itching, and a little Tu∣mor or swelling.

XXVIII. The Prognosticks. This Disease is most incident to Children and Youth, many of whom receive the Original Cause from the Mothers Womb, or the Nurses Milk.

XXIX. If it has continued long, and has much altered and corro∣ded the Skin, tho' it be cured, yet it leaves baldness behind it: but if it is hereditary, it is scarcely ever cured.

XXX. Happening to Children it frees them from the Epilepsy, as Hippocrates says; for the Hu∣mor which might cause that Disease, is derived from the inner to the outward Parts. The Cure is the same with the next following, and therefore we shall Treat of it under that Ti∣tle.

III. The Moist Scald Head with a thick Humor.

XXXI. This is called by the Greeks 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and by the Latins, Favus or Favi: and by Us, the moist Scald Head, with a thick Humor.

XXXII. Galen (in loco cita∣to) speaking of these Ʋlcers called Favi, says, that it is a certain Tumor or Ʋlcer having several holes, out of which Matter flows like unto Honey; and in another place, he say that the holes in this Ulcer, or Favi, are larger than these in Achor.

XXXIII. Oribasius saith, that Favus is like to Achor, but that it has greater holes, which con∣tain a Matter like Honey.

XXXIV. Trallianus, Lib. 1. Cap. 9. says, that Cerion, or Favus, is a Grief like to Achor, yet differing in magnitude, for the holes out of which the Hu∣mor issues, represent an Honey-Comb, for which reason it was called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Favus, an Honey Comb.

XXXV. Aetius (in the place aforementioned) says, that the Malady 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, or Favus, is like to Achor, save that in this there are large holes, out of which is∣sues a thick Matter, like unto that which comes out of Honey-Combs, from whence came the Name.

XXXVI. And-Actuarius, says, that Cerion, or Favus has greater holes than Achor, which contain an Humor like to Honey: from whence it appears, that Favus is like to Achor, saving that the holes are much larger, and the Humor much thicker.

XXXVII. The Causes are the same with the former to which, you are referred; save that in this, as the Humor is thicker, so it is derived from an abundant much grosser Matter, and at∣tended with lesser acrimony, which always thins the Humors.

XXXVIII. The Signs. They are contained chiefly in the Descrip∣tion of the Disease, to which add, Tumor, and much Itching.

XXXIX. The Prognosticks. They also are the same as in the former: but Favus as it seems more digested, and has less acri∣mony in it, so it more easily yeelds to Remedies.

XL. The Cure of both these Evils. This we have pretty

largely shewn in Lib. 2. Cap. 11. Sect. 12. ad 23. aforegoing; however these following things we think necessary to be said. 1. As to Diet, strong sweet Wines, and surfeiting Food is to be avoided; as also salt and sharp things, and Fry'd Meats, and what ever creates a gross and impure Juice.

XLI. 2. That in case of Purg∣ing, a purging Diet Drink, where∣in Raspings of Guajacum, and Sassafrass, also crude Antimony are put, is chiefly to be chosen.

XLII. 3. That the Head may externally be purged with Errhins and Sternutatories: some make choise of juice of Primrose roots: others of pouder of white Hellebor; but Tobacco is accounted the best of them all.

XLIII. 4. That you endeavour the falling of the Scabs or Scall, and the taking off the Hair (if it cannot be done without it) by some proper depilatory, at least∣wise; by the Means directed in Sect. 18. above.

XLIV. 5. This done, to Kill or Destroy the Humor impacted in the Part, you may apply the Remedies directed in the places afore cited, of this work, or some of these following.

XLV. Take fresh Butter ℥vi. Palm Oil ℥iv. Oil of Scorpions ℥ii. Mercury Coagulate ℥jss. pou∣ders of white and black Hellebor roots, of Elecampane, unslaked Lime, Sulphur Vive, A. ℥ss. mix, and make an Ointment.

XLVI. Or, ℞ pouder of white and black Hellebor, Soot, Pot Ashes, Galls, Alum, Auripigment, Calx Vive, Litharge, Sulphur Vive, A. ℥ss. Sulphur of Antimo∣ny, white Precipitate, Mercury coagulate, Verdigrise, A. ʒii. pouder and boil all in juice of To∣bacco ℥xiv. then add Palm Oil lbi. Tar, Turpentine, A. ℥i. Wax, q.s. mix and make a Liniment.

XLVII. 6. That in Children and tender Bodies, you use the more gentle Medicaments, as this. ℞ Sulphur Vive of our Hercules, A. ℥i. Alum, Catechu, A. ℥ss. Juice of Limons ℥jss. Turpentine ʒvi. Oil of Scorpions q.s. mix, and make a Liniment.

XLVIII. Or if they be rebel∣lious, ℞ Sulphur Vive, Hercules, A. ℥i. Scammony Stavesacre, Tobacco both in fine pouder, A. ℥ss. Sulphur of Antimony, Alum: Tur∣pentine, A. ʒii. Oil of Scorpions, q.s. mix, and make a Lini∣ment.

XLIX. 7. That before the Ointments are applyed, the part affected be fomented with Tanners Woose, or red Wine, with Balaust∣ians, Catechu, Myrtle-berries, Pomgranate-peels, and Sumach have been for some hours in∣fused over a gentle Fire.

L. 8. That the Ʋlcers be dres∣sed but once in 24 hours (unless they be exceeding moist) with the Ointments; and that over them, some Cerate made chiefly of Wax, be applyed.

LI. 9. That if there should be any danger of an Inflammation, in∣stead of Oily and Greasy Bodies, you are to mix the pouders of both Hellebors, Stavesacre, Birthwort and Orrice roots, Sulphur Vive, Scammony, Tobacco, &c. with Oxymel Simplex, making it of the consistency of an Electuary, and

so to apply it to the Ulcers, in∣stead of the Ointments or Lini∣ments.

IV. Of an Ʋlcer of the Head, from Apostemation, Contusion, &c.

LII. This is that which is purely called by the Greeks, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and by the Latins, Ʋlcus Capitis; which is a mani∣fest and open Ulcer, like Ulcers in other parts.

LIII. If it is foul, it must be cleansed with Abstersives, made of the juice of Smallage: or with this. ℞ Honey ℥iv. Gum Elemi ℥ii. fine Aloes ʒii. mix them.

LIV. Or you may wash with this. ℞ Canary, white Port-Wine, A. ℥ii. S.V.℥jss. Honey ℥i. mix them. Or, ℞ White Port-Wine, juice of Centory, S.V. A. ℥ii. Honey of Roses, Syrup of Mulber∣ries, A. ℥i. mix them, to wash with.

LV. If the Ʋlcer is very foul, and runs much, you may dis∣solve in the aforesaid Liquors, Aloes Succotrina ʒiii.

LVI. After the Ʋlcer is washed, dress it with the Abstersive; and lay over it Emplastrum de Me∣liloto.

LVII. Purge with some Cath∣artick Diet-drink, or with an Infusion of Sena and Rhubarb in White-wine, or with Our Fa∣mily Pills, or Pilulae Catharticae; which may be taken twice a Week, or oftner, if occasion requires.

LVIII. When you see that the Ʋlcer is throughly cleansed, per∣fect the Cure, by dressing it once a day with Arcaeus his Liniment, or with Flos Ʋnguen∣torum.

LIX. But if the Ʋlcer proves rebellious, and will not easily heal, apply the Seton to the nape of the Neck: for by this means the Humor will be diverted or de∣rived, and the cure will succeed in a short time, without danger of returning again.

LX. Postscript. In the Cure of Achor and Favus, (which happen as well in old as young People) the general Method (says Barbett) is by strong Purging, Bleeding, Sweating, Salivation, Unction, and Pulling-out of the Hairs: but (says he) without using any of those ways, I have often cured these Diseases, with this only Decoction.

LXI. ℞ Pot-ashes, and with Whitewine make a Lixivium, of a moderate acrimony; in a quart of which boil leaves of Marjoram, Southernwood, A. M. ii. Maiden∣hair M. jss. Rose-leaves M. i. and therewith let the Head be well washed and bathed, twice or thrice a Week, very hot: and then let it be dried with hot linnen Cloths; thus doing for a few Weeks, the Patient will be cured: but gentle Purging may sometimes be used.

CHAP. XXIII. Of an ƲLCER of the EYE.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus Oculi, vel Oculorum; we in English call, An Ulcer of the Eye, or Eyes.

II. The Kinds. They are consi∣dered; 1. In respect to the Part. 2. In respect to their Qualities, Natures, or Accidents.

III. In respect to the Part af∣flicted: the Ulcer possesses either the Coats of the Eyes, as the Adnata or Conjunctiva, Cornea, Ʋvea; of which those in the Conjunctiva or Cornea, are chief: or the fleshy Corner next the Nose. Those of the Cornea are either superficial, or deep.

IV. In respect to their Natures: some are mild, and these chiefly possess the Tunicles of the Eye; or malign, and they possess the fleshy part.

V. The malign are also twofold; viz. either not contagious, or contagious: the not contagious are twofold, viz. Ʋlcus depa∣scens, or Ʋlcus cancrosum: the contagious are threefold, viz. Carbunculosum, Venereum, and Morbillosum.

VI. So that out of what has been said, we must treat of Ʋlcers of the Eyes, 1. As they affect the Adnata or Conjunctiva. 2. As they affect the Cornea superfi∣cially. 3. As they affect the Cornea deeply. 4. As they af∣fect the fleshy part with Ʋlcus depascens. 5. As they affect the fleshy part with Ʋlcus Cancro∣sum. 6. As they are contagious in the Small Pox. 7. As they are contagious, in the Venereal Disease. 8. And as they are contagious, from a Pestilential Anthrax, or Carbuncle.

VII. The Causes. The Proca∣ctartick Causes, are from Blows, Contusion, or some external Vio∣lence. The Antecedent Causes are from a Cacochymy of evil Humors, or a Plethory, if such a thing is in Nature. The Pro∣ximate or Conjoined Cause is an Inflammation, or Ophthalmy, or sharp corrosive Humors lodged in the Part.

VIII. The Signs. These Ʋlcers are known by sight; from the Part they affect, and the nature and quality of the Ulcer.

IX. The Prognosticks. They are dangerous, and difficult in the Cure; especially those in the Cornea, and Pupilla, where for the most part, they leave Blind∣ness.

X. If the Cornea is wholly eroded, the Aqueous Humor is let forth; and many times also the Crystalline.

XI. If there is an Inflamma∣tion withal, it is generally very painful; and ought forthwith to be removed, by those things prescribed in an Ophthalmy.

XII. Ʋlcers of the Eyes in Per

sons of a Cacochymick Habit of Body, if they are cured, (which is always with difficulty) yet they generally leave some ble∣mish, or other weakness upon the Part.

XIII. If they happen in Chil∣dren, they are always of difficult cure; because of their froward and untoward, or fearful and uneasy disposition.

XIV. The Indications of Cure are threefold. 1. By Ʋniversals, as by proper Catharticks. 2. By Revulsion and Derivation. 3. By Vulneraries, as Abstersives, In∣carnatives, and Cicatrizers.

XV. An Abstersive Collyrium, from Barbett. ℞ White Amber, red Myrrh, A. ℈ss. Sugarcandy ʒi. Saffron gr. vi. Eyebright-water ℥ijss. white of one Egg, mix them.

XVI. Another. ℞ Red Coral prepared, Frankincense, A. ʒss. crude Antimony, Harts-horn burnt, white Troches of Rhasis, A. ℈i. burnt Lead, gr. xv. Honey of Roses, q.s. make a Liniment.

XVII. An Incarnative. Take Celandine-water ℥iii. Gum-tra∣gacanth ℈i. Aloes, Frankincense, Tutty prepared, A. ℈ss. Glass of Antimony levigated gr. vi. mix them.

XVIII. A Cicatrizing Colly∣rium. ℞ Rofe-water ℥iv. Sac∣charum Saturni, Sarcocol, white Troches of Rhasis, burnt Lead, A. ℈ss. mix them, to wash with.

I. Ʋlcers of the Eye, affecting the Conjunctiva.

XIX. The Tunica adnata, or Conjunctiva, is derived from the Pericranium, and is common to the Eyelids: and therefore an Ulcer in that is the most simple, and easy of cure; and proceeds (as has been said) mostly from an Ophthalmia.

XX. An Ophthalmia is said to proceed from two Causes. 1. It may proceed from Inward Causes. 2. From Outward; and then it is either mild, when the Conjunctiva is only inflamed; or vehement, making red, and turning up the Eyelid, wherein the Humor is so sharp, as to cause an erosion, or ulceration.

XXI. First, cleanse with this. ℞ Honey of Roses strained ℥ss. Goats-milk ℥ijss. fine Aloes ℈ss. mix them.

XXII. Or with this. Take Goats-milk ℥iii. yolk of one Egg, Sugarcandy, Honey, A. ʒi. Myrrh, Aloes, A. ℈ss. mix them.

XXIII. Consolidate with this. ℞ Rose-water ℥iii. Gum-traga∣canth ℈i. red Coral prepared, burnt Harts-horn, Sarcocol, Dragons∣blood, burnt Lead, white Starch, A. ℈ss. Crocus Metallorum, Sac∣charum Saturni, A. gr. v. mix, and make a Collyrium.

II. Ʋlcers of the Cornea, superficial.

XXIV. Some Authors make the superficiary Ʋlcer to be fourfold. 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Caligo, a Misti∣ness and Dimness of the Sight. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Nubecula, a little Cloud; which is deeper than the former. 3. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ʋl∣cus ad Iridem, an Ulcer grow∣ing about the Iris, posses∣sing part of the white, and part

of the black of the Eye; by some said to be Albugo, a Pearl in the Eye; which in the Iris appears white, but without it is reddish. 4. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ʋlcus simplex Cculi, a simple Ulcer or Erosion of the Cornea in the Eye, which makes it ragged, and of an ash-colour.

XXV. But of all these, the last, which is a Sore of the Eye caused by Erosion, can only be called an Ʋlcer; the Cure of which only we shall here treat of; for that those things which cure or help the latter, will certainly cure the former.

XXVI. A Collyrium, to wash with. ℞ Juices of Celandine, of Fennel, of Rue, of Southern-wood, white Port-wine, A. ℥iv. Bnlls-gall ℥ii. Aloes, Sarcocol, A. ℥ss. distil in a Glass-body in B.M. in which infuse Crocus Metallo∣rum levigated ℥i.

XXVII. ℞ Juices of Fennel and Rue, A. ℥iv. Honey of Roses strained ℥i. choice Brandy ʒii. mix them.

XXVIII. ℞ Honey of Roses strained ℥i. Rose-water ℥iv. Aloes finely poudered, Tutty prepared, Saccharum Saturni, A. ℈i. mix; with this or the former, let the Ulcer be drest daily twice a day, and it will quickly be well.

III. Ʋlcers deep, or piercing the Cornea.

XXIX. Of the deep Ʋlcers some Authors make four sorts: 1. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Fossula; a hollow, narrow Ulcer of the Eye, with∣out filth, like a round Puncture. 2. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Ʋlcus cavum; a hollow Ulcer, wider than the former, but not so deep. 3. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Inustio; which is yet deeper, made by Burning; being an impure crusty Ulcer, thro' which the Humors sometimes come, when cleansed by Abs∣tersive Medicaments. 4. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Pro∣cidentia Ʋveae Tunicae; which is, when the Cornea is corroded quite thro', and falls down.

XXX. This last or fourth kind, which properly is also fourfold: 1. Very small, like the head of a Fly or Pismire. 2. Bigger, being faln down more, and is equal in bigness to a small Grape. 3. Larger, hanging or sticking forth like a little Ap∣ple. 4. When it is grown hard, brawny, and flat, almost nail∣like.

XXXI. These Ʋlcers of the Cornea, viz. the three first kinds, are not to be slighted, for that they have deeply seized upon the substance of the Membrane; lest corroding thro' the whole Mem∣brane, the Humor should issue out, and so the Eye sink, causing an incurable Blindness.

XXXII. The fourth kind, where∣in the Cornea is eaten quite thro', having four several species, they are all of them said to be incu∣rable: but the grape-like and apple-like, may (if their roots be small) have their deformities in a great measure abated, by binding them: but this deliga∣tion will no more restore the Sight, already lost, than it can make a new Eye.

XXXIII. The Causes. The Ma∣terial Causes of all these Ʋlcers,

is a Salt and Nitrous Humor, as Aegineta, lib. 3. cap. 22. will have it, which is sharp and cor∣roding; which being in a Ca∣cochymical Habit of Body, ren∣ders them always of difficult cure.

XXXIV. The Cure. This has relation only to the three first kinds, in which Emeticks are to be avoided, and such Catharticks as are apt to work upwards, which are always prejudicial to weak Eyes: you are only to use such as are gentle and lenient, by which you may gradually, or by little and little discharge the Humor offending; that that which is good may succeed in its place.

XXXV. The Body then being gently purged, Nature oftentimes corrects and amends the remaining part of the Juices; by converting that which is benign into Nou∣rishment; and expelling the superfluous, by Stool, Urine, and Sweat.

XXXVI. To these things add, the right Ʋse of the seven Non-naturals: otherwise, tho' you may fail of the Cure, yet it may be very much prolonged.

XXXVII. Renodaeus, Pharm. lib. 5. cap. 11. has this Topick. ℞ Burnt Lead, Antimony, Tutty washed, burnt Brass, Gum Ara∣bick and Tragacanth, A. ℥i. Opium ʒss. make all into a pouder, which with Rose-water form into Troches. Dissolve one of them in Cucumber, Plantane, or Purslane water, and dress the Eye there∣with.

XXXVIII. Heurnius, Meth. ad Praxim, lib. 1. pag. 141. (in the Roterdam Edition in 8^o. Printed 1650.) has this: ℞ Calamina∣ris thrice burnt, and twice quenched in White-wine, ℈ii. burnt Brass ℈iv. burnt Lead washed, Myrrh, A. ℈ss. Saffron gr. v. Opium gr. ii. Decoction of Fenu∣greek ℥i. grind all upon a Porphyry∣stone, and make a Collyrium. Make the Eyes first clean with a Spunge dipt in Decoction of Fenugreek and Linseed; then with a Pencil dress the Eyes, five or six times a day.

XXXIX. The same Heurnius, in the place cited has this also. ℞ The Gall of Partridges, or of a Hare, or of Fishes ʒss. juice of Fennel ʒss. Sugarcandy ʒii. Syrup of Roses q.s. make a Collyrium. The hard whites of Eggs also beaten with a little Vitriol, and and the Liquor dropping there∣from thro' a linnen Cloth, being anointed on the Ulcer, won∣derfully cleanses it: the Body in the mean while is to be kept soluble with Lenitive Clysters.

XL. It has been observed also, that Sows or Wood Lice, being bruised, and infused in Rhenish Wine, N^o. 200. to a quart of Wine; and the Liquor drank every Morning fasting to ℥iii. is excellent to heal Ulcers of all kinds, tho' malign, as Depascent and Cancerous, and to help dimness of Sight, and cure most Diseases of the Eyes.

IV. Of the Depaseent, or Eating Ʋlcer.

XLI. This is a malign Ʋleer, which begins at the corners of the Eyes, and sometimes at the

white of the Eye, seizing many times, even upon the Horney-Tunicle.

XLII. The Prognosticks. In Cacochymick habits it frets and eats very much, and runs on in such sort, that oftentimes it consumes the adjacent parts, as the Muscles and Lids of the Eye.

XLIII. It is dangerous, and seldom cured without deformity, and loss of Sight; for which rea∣son the Patient ought to be in∣form'd of the event or danger, before the Cure is undertaken.

XLIV. The Signs. It is known by sight: but it yeelds a stinking slimy Matter, the pain is vehe∣ment, and there is commonly a Symptomatical Fever,

XLV. The Cure. You may dress the Ʋlcer with this. ℞ juices of Henbane, Nightshade, To∣bacco, and Tarrow, A. ℥i. Honey ℥iii. mix them over a gentle heat. Or, ℞ Juice of Mandrakes, of Nightshades, of Plantane and Pur∣slane, A. ℥i. Honey of Roses strain'd ℥iv. mix them over a gentle heat, adding Sacchurum Saturni ℥i.

XLVI. The Ʋlcer being drost with the former things, apply over it, this Cataplasm. ℞ Pulp of boil'd Quinces ℥iv. Barley Flower ℥ii. Unguentum, Rosa∣tum ℥i. Saccharum Saturni, Hen∣bone-seeds in pouder, A. ℥ss. Oil of Poppies, q.s. mix them.

XLVII. If the Ʋlcer proves ve∣ry malign and corroding, it must be corrected, by dropping into it some of this mixture. Take Rosewater, Henbane, Housleek, and Nightshade waters, Oil of Vitriol or Sulphur, A. ʒii. mix them,

XLVIII. And if by the use of it the pain is very great, you may appy this Anodyn Cataplasm to it. ℞ Pulp of Quinces ℥vi. Hen∣bane, Housleek, Mandrake, Night∣shade, A. M. i. juice of Night∣shade lbi. boil till the Quince Flesh is soft: then add, Barley Flower ℥ii. Oil of Poppies ℥i. Saccharum Saturni ℥ss. Opium ℥i. mix, and boil to a Consistency.

V. Of a Cancerous Ʋlcer.

XLIX. This is that which is said to be caused of an Arsenical Salt, wherein, besides the Corro∣sion, there is a Septick, or putre∣factive quality, which alters the form of the Part after a very strange manner.

L. The Signs. It begins in the black of the Eye; and in it the black and white of the Eye are reddish: the pain is almost con∣tinual, and vehement, and a dark-coloured, sharp, corrod∣ing, putrefactive, stinking Hu∣mor flows from it: and it is the more exasperated by the appli∣cation of sharp Medicines to it.

LI. The Prognosticks. Aegi∣nera, Lib. 3. Cap. 22. says, that this is an Incurable Ʋlcer: and indeed nothing but a Palliation can be promised, because it re∣sists the most probable Reme∣dies.

LII. The Cure. Let the Pa∣tients Food be Milk, and Milk∣meats, Curds and Whey, Milk∣pottage, Custards, Panado's, and Milk boild thick with Oatmeal, which sweetens the Juices of the Body, nourishes, and is of good Juice, and easy concocti∣on:

to which add other Food of easy digestion.

LIII. As to Topicks, you may apply this. ℞ Burnt Lead ℥ii. red Lead, Cinnabar levigated, A. ℥i. Mercury coagulated ℥ss. Palm Oil of a Golden colour, q.s. mix, and make an Ointment.

LIV. Or, ℞ Mucilages of Line and Fenugreek seeds, extracted with Poppy-water ℥i. white Troches of Rhasis with Opium ʒi. mix them, which apply warm, renewing it morning and even∣ing.

LV. And over all you may ap∣ply this Cataplasm. ℞ Rotten Apples, or Pulp of baked Apples ℥vi. Cassia newly Extracted, Barley Flower, A. ℥ii. Burnt Lead ℥jss. white of one Egg: juice of Nightshade, q.s. mix them.

VI. Ʋlcers in the Eyes, from the Small-Pox.

LVI. They generally follow an Inflammation of the Eye, or when any of the Small-Pox break out in the Eye, as I have sometimes seen.

LVII. They are known by either Tumor, or Crust, or erosion with matter issuing out, and much pain.

LVIII. Let the Eyes be fomen∣ted with warm Breast-Milk, or with warm juice of Fennel, or with a Mucilage made of Quince, Fleawort, Fenugreek, or Lin∣seed, with juice of Fennel.

LIX. After which, anoint them with this gentle Abstersive. ℞ Honey of Roses strained, juice of Smallage, A. ℥i. Breast Milk ℥ss. Saffron in pouder ℈ss. mix them, and anoint therewith: this Medicament alone will be enough to heal them.

VII. Ʋlcers in the Eye, from the French-Pox.

LX. When these Ʋlcers proceed from the French-pox, you will find the Cure of them very difficult, unless the Cure of the Disease causing them be attempted at the same time.

LXI. However outwardly you may apply this. ℞ Honey of Roses strain'd ℥i. of our Hercules, Cin∣nabar levigated, A. ʒii. Aloes ʒss. mix them.

LXII. Renodaeus in Pharm. Lib. 5. Cap. 11. has this. ℞ white Wine lbi. Plantane and Rose wa∣ter, A. ℥iii. Auripigment ʒii. Verdigrise ʒi. Aloes, Myrrh, A. ℈i. make the dry ingredients into fine pouders, and mix them with the Wines and Waters.

LXIII. This is yet a more ex∣cellent thing. ℞ White-wine lbi. Honey of Roses strain'd, Bul∣locks, Gall, A. ℥iss. Nightshade, Plantane and Rose waters, A. ℥i. juice of Centory the less, of Smallage, of Scordium and of To∣bacco, A. ℥ss. Cinnabar leviga∣ted Vitrum Antimonij, Aloes, Myrrh, A. ʒii. mix. digest two days, then use them.

VIII. Ʋlcers caused from a Pesti∣lential Carbuncle.

LXIV. If it is caused from any Pestilential Ʋenom, there arises first a small Tumor in the Eye, which is hot, hard, painful and con∣tagious;

arising from a thick, black, burnt and venomous Hu∣mor.

LXV. The heat causes the Burning and fermentation of the Humor; and it is contagious by reason of its Poyson and Malignity, which it emits constantly in fumes or vapors: and when it comes to yield matter it stinks, by rea∣son of its putrefaction.

LXVI. It is accompanied with great thirst, heat, especially inter∣nal, watching, and raving: and the Urine is sometimes very red, thick, and troubled.

LXVII. The Cure. These Symptoms appearing, you are first to give inwardly Antidotes, and Alexipharmicks: the vulgar Phy∣sicians give Venice Treacle, Mi∣thridate, and Elect. de Ovo: but we commend our Theriaca Chymica, above all other things in the World.

LXVIII. For it overturnes the Venom, destroys the Poyson, abates upon the spot all the vebement Symptoms, and secures the Life of the Patient.

LXiX. If you perceive a small Pustule on the top of it, open it with a Lancet or Incision Knife, and nbate the vehement heat with Aqua Spermatis Ranarum, or Aqua Solani mix'd with a little S.V. in which Camphir is dissol∣ved; or you may do it with Pop∣py water in which Saccharum Sa∣turni is dissolved, adding a little Camphir in pouder, laying a Cloth moistned in the same over it to the Eye.

LXX. And above it apply this Cataplasm. ℞ Goats or, Cows Milk, or rather juice of Nightshade lbss. Barley Flower, q.s. mix them.

LXXI. When the Crust is fal∣len, Mundifie with this. Take Honey of Roses, juice of Fennel, Ana, mix them: then incarnate by adding thereto Colophony in pouder, a third part.

LXXII. Lastly, cicatrize the Ulcer with this. ℞ white Port Wine lbi. Aloes, Tutia prepared, Ceruse, A. ℥ss. Honey, Sugar Candy, A. ℥iss. Alum, Sacchar∣um Saturni, A. ʒi. mix: digest in a gentle sand-heat, for 48 hours; then keep it upon the Faeces for use.

CHAP. XXIV. Of a FISTƲLA of the EYE.

I. WHat the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Fistula Lachry∣malis: we in English call the Weeping Fistula, or Fistula of the Eye. I know some will have this Ulcer to be called 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Aegilops, because it is a hollow or cavernous Ʋlcer in the Fleshy, or great Corner of the Eye; but Aegilops is no more Fistula La∣chrymalis, than a cavernous Ʋlcer not callous, is a Fistula.

II. The Place. It is seated in the great or innercorner of the Eye, near the Nose: or according to to Barbett, in the Punctum La∣chrymale, from which (a hollow Ulcer therein becoming callous) comes the Name of Fistula La∣chrymalis.

III. The Causes. It sometimes is caused from Anchylops, or Aegylops, or what produces the like Tumors in other places: some∣times it is made by Fluxion, and appears at first very small, like a Phlegmon or Inflammation.

IV. Sometimes, and that fre∣quently, it is caused by the French-Pox; and many times from a strumous Humor, in such as are affected with the Kings-Evil. Barbett says, it becomes callous, or degenerates into a Fistula, from a continual flux of Hu∣mors.

V. The Signs. It is manifest at sight: for first, the Orifice offers it self to view; then, by com∣pression of the Finger upon the Canthus, the matter issues out; sometimes a mixt matter is discharged, sometimes in a smal∣ler quanrity, and sometimes in a larger; and sometimes it is not unlike to the white of an Egg: also, you may run a Probe to the bottom of the Sinus.

VI. If it is from a Strumous Cause, it is made by Congestion, and the Tubercle is round, without dis∣colouring the Skin: if it is made by Fluxion, there is pain and redness accompanying it, and inflammation all over the Eye.

VII. The Prognosticks, Some∣times this Matter will be so sharp and malign, as to penetrate, rot, and eat quite thro' the Bone; so that it will discarge it self down∣wards thro' the Nose, with a fetid smell.

VIII. All these kinds of Fistu∣la's of the Eye, are of difficult cure, let them be from what cause soever: for the Part being loose and spungy, the Eye very sensi∣ble, and the Part very lax, it makes the Humors apt to soak into it, and penetrate even the Bone it self.

IX. That which is recent, if it is well opened, is easiest of cure; that which is inveterate, or of long continuance, is for the most part accompanied with an Ul∣ceration of the Gland, and a Caries in the Bone, which makes them subject to a weeping, after they are cured.

X. The sensibility of the Eye, makes it subject to pain and fluxion; and also unfit to be drest with sharp Medicaments, such as a Fistula usually requires.

XI. And if the Ʋlcer is accom∣panied with Erosion, it will be apt to terminate Cancerous; (as I once saw one) in which case, the Patient is deplorable.

XII. If it is become Cancerous, (known by its hard and livid lips, sharp pain, and fetid virulent mat∣ter) you are only to use a Palliative Cure, (as in Cancerous Ulcers) for an Absolute Cure will never succeed.

XIII. If the acrimonious mat∣ter has penetrated the Nose, to make a way thro' the Bone of the Nose from the corner; then the upper Orifice is only to be shut up, without scaling of the Bone; which will be a

abour both very painful, and fruitless.

XIV. If the Fistula continues long, as a Year, &c. and the Pus passes thro' the Bone to the Nos∣tril, it will cause 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, Oculi Atrophia, a Consumption of the Eye, which will be incurable.

XV. The Cure. The Indications of Cure are threefold: 1. To cause an evacuation, alteration, diversion, or revulsion of the Humor. 2. To remove the Cal∣lus, without which the Cure cannot succeed. 3. To heal up the Ulcer, by Incarnatives and Epuloticks.

XVI. Due Purging ought to pre∣cede, by such things as are most universal, and least apt to cause Vomiting; Syrupus Catharticus, an Infusion of Sena, and Pulvis Cornachini are commendable: to which you may add, Pilulae Catharticae, Tinctura Purgans, and Pulvis Catharticus.

XVII. An alteration of the Hu∣mor is to be endeavoured, by such Alteratives as are prescribed in the Cure of Strumae, French-Pox, Scurvy, &c. using a Decoction of Guajacum, Sarsa, &c. for many days, with other Altera∣tive and Vulnerary Diets.

XVIII. The Matter also ought to be derived from the Head by Errhins, applied to the Nostrils: as, Take Scammony, Guttae Gam∣bae, A. ʒii. Confectio Hamech q.s. mix, and make long Rolls for Errhines.

XIX. And a diversion of the Humor is to be made, by applying Cupping-glasses, Vesicatories, and Causticks to their proper places: Fabricius Hildanus, Cent. 1. Obs. 41. says, that instead of a Cautery, he applied a Seton to the Neck, by which means alone he has performed the Cure.

XX. And some Authors will have a Revulsion to be made by Bleeding; where there is (as they say) a Plethory, or platitude of Blood.

XXI. Externally, Repellents (says Wiseman) are to be applied to the diseased Part, to prevent Fluxion; made of distilled Wa∣ters, or Juices of Horstail, Let∣tice, Plantane, Purslane, Night∣shade, Frog-spawn, &c. with whites of Eggs, Bole-Armeny, Sealed-Earth, &c.

XXII. And to intercept the Matter, (says he) we apply to the Temples Gum-mastich, Ta∣camahacca, Empl. ad Herniam.

XXIII. But if the Tumor in∣creases with tension and pain, it will then be fit to endeavour a Discussion, by such things as are prescribed in an Ophthalmia; as Elder-flowers, Hypericon, Len∣tils, Orobus, Rue, Southernwood, Wormwood, Melilot-flowers, Camomil, &c. boiled in Wme, or some weak Lixivium.

XXIV. The second Indication is, to remove the Callus; in order to which, the Orifice (because it is generally narrow) ought to be dilated with a Tent made of Elder-pith, Gentian-roots, Rope-root, Spunge pressed, &c. ac∣cording to the proportion of the sinuosity in the beginning.

XXV. Then you shall yet more enlarge it, by Spunge prepared with Melilot-Emplaster, or Glair of Eggs; as we have formerly

taught; by which means you will discern all the corners of the sinuosity.

XXVI. The Fistula being thus dilated, we must now apply our selves to the removing of the Cal∣lus: Barbett has Phlegm and Spirit of Vitriol, Aqua fortis, Mercury-water, Ʋng. Aegyptia∣cum, burnt Alum, blue Vitriol, Verdigrise; but Ʋng. Fuscum Wurtzii, boiled to the consisten∣cy of a Suppository, to be put into the Fistula, he commends above all.

XXVII. Riverius advises to wash the Ʋlcer every day with Rue-water, applying after Ung. Apostolorum, which is to be con∣tinued for three Weeks; laying over it some convenient Em∣plaster, and defending the Eye with Rose-water. ℞ Rue-water ℥iv. Honey ℥ii. Verdigrise ʒi. mix them. Inject it warm, with a Syringe.

XXVIII. If the Callus does not yet waste, use this following Injection. ℞ Rue, Pilewort, Agrimony, A. M. ss. S.V. lbss. juice of Tobacco ℥iv. infuse twenty-four Hours, then strain out.

XXIX. After the use of which, apply this following upon Dos∣sels. ℞ Wine-Vinegar ℥iv. Ho∣ney of Roses strained ℥iij. Ginger ʒii. Verdigrise ℈ii. mix, and boil to a thickness.

XXX. But in application of Medicaments this Part, you have not so great a liberty, as in other Fistula's: for fluid and running things, having a great acrimony, are not safe; for passing unto the Adnata, and from thence to the Cornea, they may possibly erode it, whence a new Ulcer may be made, and so the Grief may be doubled.

XXXI. And even solid things themselves, must be very carefully applied; that they go no farther, nor spread beyond the sinuosity, lest horrible Symptoms be in∣duced, by means of a fluxion, and increase of the acrimony of the Humor, which may hurt the Membranes of the Eye, ad∣jacent to the Part affected.

XXXII. Some use this. Take water of Elder, or Dwarf-elder flowers lbj. corrosive Sublimate ʒii. or better; according to the hardness of the Callus: the proportion you must guess at by the continuance of the Fi∣stula, Habit of Body, and Age of the Patient, making it either weaker or stronger.

XXXIII. Others use this. Take Plantane or Rose water ℥vi. Spirit of Nitre ℥iii. mix them. This they account excellent, but 'tis very sharp, and must be used with caution, and sparingly applied to the sinuosity, so that no part of them touch the Membranes, lest they should excite vehement Accidents.

XXXIV. Others like solid Me∣dicaments better; because the force of their operation is more durable, and they are more secure, as being not so apt to spread. In a young, tender, and delicate Body use this. Take red Precipi∣tate, or Turbith-mineral ʒii. burnt, Alum ℥i. mix them very well.

XXXV. Afterwards, take Ung. Populeon ℥i. of the former Pouder more or less, mix them: with this Mixture arm a Tent, which put

into the dilated Fistula, which let remain 'till it slips out of it self; and continue the use of it, 'till the Callus is removed: which you may know, if the sinuosity appears soft, and the Pus sticking upon the Tent be laudable.

XXXVI. If there is a Caries, Wiseman proposes this. Take Vi∣triol calcin'd, Cantharides (their heads and wings cut off) Quick∣lime, Sal Armoniack, R•…•…-alum, Ana: mix, and bring them to a body with Boys Ʋrine.

XXXVII. In applying of these things, the parts about must be defended, and the Fluxion hin∣dred by application of Refrige∣rants; yet after all, it is a most painful and tedious ways.

XXXVIII Wiseman proposes the use of the Actual Cautery, which being applied thro' a Can∣nula will with one touch waste the Callosity, and destroy the Caries: after which, it is to be drest up with a Dossel dipt in a mixture of Oil of Roses and the white of an Egg, and a Compress in the same over all: then it is to be digested, and deterged with milder Prescriptions, keeping the Orifice dilated with a Dossel dipt in Tinctura Myrrhae, &c. 'till the Bone exfoliates.

XXXIX. And so Barbett: If (says he) the Os lachrymale, or Zygomaticum be foul, the Skin being divided, an Actual (or Po∣tential) Cautery must be applied, that the Caries may be removed; otherwise, (if that be not ta∣ken away) it will be impossi∣ble to cure the Fistula.

XL. All Authors, as with one Voice, subscribe to the Actual Cautery, which must represent in figure an Olive-stone: the parts adjacent must be defended from the Fire, by a Cannula, or hollow Pipe, as Aquapendens and Wise∣man direct: you must effectually impress it, to dry the humidity, the sooner to procure the sca∣ling of the Bone.

XLI. 'Tis true, some Authors prescribe fatty things, to hasten the separation of the Eschar; yet it is better not to use them, be∣cause the Part is moist of it self; and so the application of such Medicaments might induce a sordid Ulcer.

XLII. What I shall advise to, is a Tent dipt into Red-wine, or Tincture of Euphorbium; or a Pledget dipt in the same, lay∣ing above all Empl. Album, or Diapalma, or Empl. de Minio simplex, or cum Sapone; the use of these things is to be conti∣nued, 'till the Scaling of the Bone.

XLIII. But because many People (by reason of the terror) will not admit of the Actual Cautery, it may be performed be Incision, &c. after this manner: first, with a bended Probe, find out the cavity every way, both upwards and downwards; and draw a Line with Ink, between the Glandule of the Eye, and the Trochlea or Pulley; thro' which the first oblique Muscle, called superior or major, passes, ending obliquely in the uppermost part of the Cornea.

XLIV. Then divide the fleshy or membranous parts, making In∣cision to the Os lachrymale or

Zygomaticum: the Part incised divide with the Nails of your Forefingers, until the Incision is so much dilated, that it may without any difficulty admit of an indifferent Pledget or Tent.

XLV. This done, put in a Tent made of Ʋng. Fuscum Wurtzii; or a small Pastil made of unwashed Turbith-mineral, Vitriol cal∣cin'd, Sealed-earth, and Ʋng. Populeon; mixt, and wrought up into a stiff Paste, and dried.

XLVI. About the Tent or Pastil, apply a Pledget armed with Populeon, over which lay Empl. Album, or Diapalma malaxed with Oil of Poppies or of Hen∣bane, or of Hypericon; then defend the orbit of the Eye with little Bolsters or Pledgets, wet in Frogspawn-water camphora∣ted, and so bind it up; dressing it twice a day with the Tents or Pastils, viz. Morning and Eve∣ning, 'till the Callus falls out of its own accord.

XLVII. Then view the Bone, and see how much is carious; and thereto apply this, or some such like. Take roots of round Birth∣wort, of Orrice, of Hog-fennel, Myrrh, Euphorbium, A. ℥ss. make all into a fine pouder, and apply it: this may serve in such as are young, and of a tender habit of Body.

XLVIII. But if they be of good years, or middle-aged, and of a strong constitution, you may apply the pouder of Euphorbium; after the application of which, or of the former Pouder, you may fill up the cavity of the Part incised with prepared Sponge, as aforesaid; and about it apply a Pledget armed with Ʋng. Po∣puleon, which hold fast down with Empl. Album, Bolsters, and Bandage.

XLIX. This manner of Dressing you must continue 'till the Scale falls off, or the carious part is separated, which will be in about 20 days, or very little more: then mundify with Mel Rosatum, or Mel Rutaceum, or Syrup of dried Roses, or with this. Take Spirit of Wine ℥ iv. Honey ℥ ii. Verdigrise ʒi. boil to the consum∣ption of a third part.

L. Then endeavour the Consoli∣dation, with Syrup of Myrtles, or Syrup of Comfrey: or with this. Take roots of round Birthwort, of Orrice, bark of Frankincense, A. ʒiss. Aloes, Cadmia fossilis, Ma∣stich, Myrrh, Sarcocol, A. ʒi. Honey q.s. mix, and make a Li∣niment. Or: Take Alum, Anti∣mony, Aloes, Balaustians, Frank∣incense, Dragons-blood, A ʒi. Verdi∣grise ℈ ss. make a fine pouder, which mix with Rue-water q.s. and make a Collyrium, to drop into the Eye, thrice a day, &c. and last of all, cicatrize with some Epulotick Ointment, Cerat, or Emplaster.

LI. If it so chance, that the whole substance of the Bone of the Nose subjacent to the Fistula is carious or corrupted, and a Catarrh be also attending, so that it seems to be often cured, and breaks out again. In this case, you must first dilate again the sinuosity, 'till the corrupt Bone appears; then you must pierce the Bone of the Nose with a Gimblet, that so the Pus or Matter may flow inward, to the Nostrils; and

then cure up the Ulcer or Fi∣stula, as we have taught in other places.

LII. This, tho' it is no real Cure, yet outwardly no deformity can be seen, nor shall the Patient himself be able to discern the turning of the Pus, from the out∣ward Glandule to the Nostril in∣wardly; nor shall he himself perceive any smell which shall offend him: as he who smells continually to a Damask-Rose, shall in a little time perceive no smell at all in it.

LIII. If you perceive the Fi∣stula to be malign, or seems to degenerate into a Cancer, (known by the Signs at Sect. 12. afore∣going) you must only use a pal∣liative Cure: for which purpose, apply this Medicament of Heur∣nius. ℞ Lapis Calaminaris thrice heated red-hot, and quenched in Vinegar ℥i. burnt Brass ℥iv. burnt Lead washed, Myrrh, A. ℥ss. Saffron ʒii. Opium ʒi. mucilage of Fenugreek ℥xxiv. mix them well by grinding together.

LIV. If you intend to keep it for any time, it will be best to mix it with Sheeps-suet, Oil of Ben, A. ℥xii. instead of the Mucilage of Fenugreek, because thereby it will be better preserved. It is an excellent Eye-salve, in all Ulcers and Fistula's of the Eyes, whether simple, malign, or can∣cerous.

LV. Fabricius Hildanus, Cen∣tur. 5. Obs. 23. has this notable Example. A Boy 13 years of age had a Fistula lachrymalis 4 years together in his left Eye, the Bone being carious; the Gland was so eroded, that when he cried, tears trickled out of the Fistula. The Actual Cautery was the best Re∣medy, yet the Boy refused it: therefore having ordered his Diet, he was Purged, and a Seton was made in his Neck: when the Seton ran, the Poten∣tial Cautery was applied, which causes no pain: when the Eschar was fallen, the Fistula was dila∣ted to the Bone, with an esca∣rotick Ointment and prepared Sponge: afterwards good store of Euphorbium in pouder was strewed upon it; and upon that a Plaster of Gum Elemi was applied. When these things had been used for some Weeks, the Bone scaled; after the Scale was taken away, half a drop of Balsam of Tolu was applied once a day to the Ulcer, which soon healed up, and continued per∣fectly well; and a little after the Seton was removed, and the Fistula healed up. In this Cure, Hildanus ascribed most to the E p or bium.

CHAP. XXV. Of an ƲLCER of the NOSE.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉: and the Latins, Ulcus Narium; we in English call

An Ulcer of the Nose: but the Greeks also call it 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, and and the Latins Ozaena, Narium Ʋlcus putridum, (ab humorum acrium defluxu:) a putrid Ulcer of the Nose. It is called Ozaena, from the ill scent thereof.

II. The Cause. It is from a de∣fluxion of sharp, salt, bilious, putrid, and eroding Humors, which some∣times corrupts the Bone it self, but chiefly the Cartilage or Gristle, whereby the Nose is many times made flat, and the Face deformed.

III. These Humors, if they be only sharp, they produce Ʋlcers bard to be cured, but not of a vehement smell: but if the Hu∣mor is putrid and corruptive, then the Ulcer stinks much.

IV. The Kinds. It is clear, out of what has been said, that Ozaena is twofold. 1. That which pro∣ceeds from a sharp Humor only, and stinks not. 2. That which proceeds from a putrid Humor, having a corrosive faculty; of which Actuarius, lib. 2. cap. 10. speaks.

V. The Signs. The Breath of the Patient always stinks, but more especially, in a strong expi∣ration: and this proceeds from rotten and corrupt Humors gathered together about the Meatus colatorii, or Passages of the Os Ethmoides; whence com∣municating their malignity and putridity to the adjacent parts, they cause an ill smell.

VI. There is also a flux, more or less, of a sharp or putrid matter; sometimes, as Celsus says, it is covered with a Crust.

VII. The Ozaena of the Ancients, was only a malign Ʋlcer; but most of the Ulcers of the Nose seen with us, are Symptoms of the Pox, and are contagious, and by contact may infect others.

VIII. For which reason it is, (as I believe) that Gorraeus, Definit. Med. lib. 13. affirms, that this Disease is more fre∣quent now in our times, than it was when the ancient Authors lived and practised.

IX. Aegineta, lib. 3. cap. 24. says, that Ozaena is a carious and rotten Ʋlcer; bred of sharp Humors flowing to the Nostrils, and eroding them.

X. Barbett says, that it some∣times spreads it self within the Nose, to the Palate; and then there is great pain, and a sordid Crust; more especially if it proceeds from the French-Pox.

XI. The Prognosticks. If it is recent and simple, there is little or no pain: and if when it is toucht it bleeds, and has a black Crust upon it, 'twill be easily cured.

XII. If it is inveterate or old, it is hard to cure: so also if it proceeds from Polypus, or the French Disease: but if it dege∣nerates into a Cancer, it is incurable.

XIII. If it proceeds from any other, or precedent Disease, that Disease (what-ever it be) must be first removed, or cured, before the Ozaena can be cured.

XIV. Celsus, lib. 6. cap. 6. says, If the Ʋlcers be about the Nostril, which have Crusts, and an evil Smell, (which the Greeks call Ozena) you are to know, they will be difficultly cured.

XV. All these kinds of Ʋlcers are of difficult cure: 1. Because of the proximity of the Brain, which affords plenty of Humors. 2. Because the Part affected is of a moist temperature. 3. Be∣cause Internals being given, lose much of their force and virtue, before they come at the Head.

XVI. That which is apparent, is easier to be cured, than that which is latent; and if this kind of Ulcer continues long, it takes away the Sense of Smelling.

XVII. If it is a Symptom of the French-Pox, it is easier cured, than if it is originally of it self: 1. Because when it is of it self, it comes nearer to a cancerous quality, than otherwise. 2. Be∣cause we have more certain Medicaments for the cure of the Pox, than for the cure of any thing cancerous.

XVIII. The Cure. There are three Indications of Cure. 1. That which has respect to the pro∣catartick cause. 2. That which relates to the antecedent cause. 3. That which belongs to the proximate or conjoined cause.

XIX. The removal of the pro∣catarctick cause, here most respects the Diet: let the Patient avoid all sorts of Meats which are salt, acid, sharp, windy, or hard of digestion, yielding a corrupt or evil juice; and that he feeds very moderately and sparingly, upon that which is good and proper for him.

XX. A sparing Diet at least, and sometimes fasting is necessary for the Cure; for it hinders the generation of many ill Humors, especially in cacochymick habits of Body; as it helps conco∣ction and digestion, and causes an appetite, so it also very much dries the habit of the Body.

XXI. The removal of the ante∣cedent cause is done by purging. Emeticks are not so good here, as Catharticks; unless the Sto∣mach is foul, and replenished with corrupt Humors.

XXII. The Catharticks which we shall make use of it in this Cure, are either vegetable, or mineral: the vegetable may do well enough, where it proceeds from the lesser and milder Causes: but mineral are to be chosen, when it proceeds from the more vehement and rebel∣lious.

XXIII. Among the vegetable Simples, these are chief; Agarick, Aloes, Cambogia, Colocynthis, Hellebor black, Hemodacts, sal∣lap, Mechoacan, Scammony, and Sena. These may either be used singly, or compounds may be made of them.

XXIV. Such are, Our Syrupus Catharticus, Pilulae Catharticae, Pulvis Cornachini, Tinctura pur∣gans, &c. and among the Shop-Medicaments, Pilulae ex duobus, sine quibus; Cochiae minores, de Agarico, Trochisci Athandal, Dia∣catholicon, Diacarthamum, Caryo∣costinum, Confectio Hamech, &c.

XXV. Among Minerals, the chief Preparations are taken from Antimony and Mercury: from An∣timony, you have, 1. Pulvis Antimonii. 2. Pulvis Catharticus: both which are very great Medi∣cines, and very extrordinary things; and may be prepared as directed in Lib. 1 ca. 68. s. 1. and 5.

XXVI. The Preparations of Mer∣cury are more effectual; much more if it proceeds from any Venereal Cause, or if there is any fear of its becoming Cancerous: those which are most convenient for this purpose, are Mercur. dulcis, white Precipitate, the Princes Pouder, Turpethum minerale, Arcanum Coralinum, &c.

XXVII. The removal of the proximate or conjoined Cause, which is directed by the third Indi∣cation of Cure, and whereby the Ʋlcer comes to be healed up. And here you are first to remove the Scab, which fixes it self in the fore or lower part of the Os Ethmoides, or Os Cribriforme, which hinders the Brain from discharging of the malign Hu∣mor which causes the Ulcer, and also hinders Medicaments from coming to to Part affected.

XXVIII. ℞ Oil of sweet Al∣monds ℥ii. Sperma Ceti ℥ss. mix them well over a very gentle Fire. Or, ℞ Neats-foot-oil ℥ii. pure Bears-grease, or Oil ℥i. mix them. Turn the Face upwards, and bend the Head down backwards, and drop it into the Nostrils, 'till the Patient feels it by the taste in his Throat and Palate.

XXIX. Or, Take Neats-foot-Oil, or Linseed-oil, and cast it upon the Nostrils with a Syringe; re∣peating it four or five times a day, 'till the Crust is loosned; then moisten with this. Take juice of Endive or Smallage ℥iv. Honey ℥i. mix, and cast it up with a Syringe.

XXX. Or you may inject this, which is stronger. ℞ Rhenish Wine ℥vi. juice of Pomgranates ℥ii. Honey ℥i. Litharge ʒii. Red-lead ʒi. Mercury dulcified ʒss. burnt Alum ℈i. boil a little, and strain.

XXXI. After which, he may snuff up of this Sternutatory. ℞ Tobacco ʒi. roots of white Hel∣lebor, Nigella, A. ʒss. Rosemary, Sage, A. ℈ii. Musk gr. iii. make all into a subtil pouder.

XXXII. The crusty Substance or Scab being faln, you may dress it with this Water. ℞ Waters of black Cherries, Plantane, and of Roses, A. ℥iv. Spirit of Vitriol ℈j. or ʒss. mix them. Or, Take Smiths-forge-water ℥viii. Alum ʒii. mix them well. Or, Take Phlegm or Spirit of Alum, Plan∣tane-water, A.℥iv. Mercury dulci∣fied ʒii. mix them. Or, Take Fallopius his Magistral Alum-Water ℥iv. Plantane and Rose Waters, A. q.s. to weaken it.

XXXIII. Or you may wash, and inject with the Ablution of dulci∣fied Mercury in Lime-water: or, wash and inject daily the Water of the Griffin, than which few things are better.

XXXIV. You may also of∣ten in the day-time inject some such drying, astringent, and abstersive Decoction: as, Take Red-roses M. i. Plantane, Knot∣grass, Perwinkle, A. M. ss. Bis∣tort, Tormentil, A.ʒi. Balaustians, unripe Bramble-berries, A. ʒ ss. Water q.s. boil and strain, and to every three ounces, add Mel Ro∣satum ℥i.

XXXV. Then anoint with this of Barbett. ℞ Ung. fu∣scum Wurtzii ℥i. burnt Lead, Ceruse, Tutia prepared, Litharge, bark of Frankincense, Myrrh, round Birthwort roots, Mercurius dulcis,

A. ʒjss. Ung. Album Camphora∣tum, q.s. mix, for a Liniment.

XXXVI. Or this of Sennertus, in Med. Pract. lib. 1. part. 3. sect. 4. cap. 1. ℞ Burnt Lead, Litharge, Wax, A. ʒi. Oils of Roses and Myrtles, A. ʒjss. Ceruss, fine Bole, Balaustians, A. ʒss. grind them all in a Leaden Mortar, to an Oint∣ment.

XXXVII. Or, ℞ Unguent. Album, & de Tutia, A. ℥i. Oil of Myrtles ℥ss. Scammony, Tobacco in pouder, A. ʒi. dulcified Mer∣cury ʒj ss. mix, and make an Ointment.

XXXVIII. If none of the former things prevail, you must use this. ℞ Rose or Plantane water, or choice white Port-wine, ℥viii. Powers of Mercury ℥ss. or ʒvi. mix them; and therewith wash, and inject up the Nostrils.

XXXIX. This cleanses and dries, without biting, and often∣times performs all the Intentions of Healing: it is a Medicine beyond comparison.

XL. Then heal, and consum∣mate the Cure with Ung. Mira∣bile; the composition and prepara∣tion of which, see in Our Doron Medicum, lib. 3. cap. 4. sect. 〈◊〉〈◊〉 for it is a singular thing in the cure of the Ulcer, tho' it be malign, or should proceed from the French Disease: you may dip Tents into it, and put them up the Nose.

XLI. Or you may fume the Ulcer (if it yet proves rebel∣lious) with this of Barbett. ℞ Amber, Benjamin, Gum San∣darach, Frankincense, Storax, A. ʒi. Artificial Cinnabar ʒiv. make a Pouder or Troches, for Fumes. As much as Nutmeg, is enough at a time; which is to be put upon live Coals, and the Fume is to be received up the Nostrils by a Funnel: but it must be cautiously used, as once a day, or not above twice a day at most, lest a Salivation be raised.

XLII. If the Ʋlcer proves can∣cerous, tho' it is judged uncurable, yet you may dress and palliate it, either with the former Fume of Barbett, or with this Water, or you may make use of both. ℞ Frog-spawn, Snails, A lbii. Oak∣buds, Ground-Ivy, A. ℥vi. mix, and distil a Water like Rose-water; to which add Camphir calcin'd, (being mixed with fine Bole, and so put into a Crucible) ʒi. wash and inject with this, and put up Tents of Lint, or Spunge moistned therewith.

XLIII. If the Ʋlcer proves yet rebellious, and will yield to none of the Remedies, you must come to the use of the Actual Caute∣ry: for according to Hippocra∣tes, lib. 1. aph. 6. extream Remedies must be applied to extream Griefs or Diseases.

XLIV. The Intention of apply-the Actual Cautery is, 1. To cause an Eschar, by impressing upon the Ulcer: or, 2. To dry the Ulcer by often applying it; but always giving off, before the Patient feels any pain.

XLV. If you design an Eschar, both ••ends of the Pipe thro which the Cautery is to pass, must be open: and when the Eschar is produced, the fall of it must be procured by the means directed at Section 28, ad 31. and then you must proceed

in curing the Ulcer, as is there∣after taught.

XLVI. But if you intend only desiccation, then the end of the Pipe which you apply to the Ʋlcer must be shut or closed; and the desiccation will be accomplished by a manifold iteration of the same; after which, you must pursue the Cure as is before directed. See more hereof in the Third Edition of Our Syn∣opsis Medicinae, Lib. 3. Cap. 35. Pag. 505.

CHAP. XXVI. Of an ƲLCER of the EAR.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus Auris; we in English call An Ulcer of the Ear.

II. The Causes. It is caused either by external Force or Vio∣lence; as of a Fall, Blow, Stab, &c. which may hurt and contuse the Part; and from whence Pus, or other sharp Excrements may be bred, which may erode the cavities of the Ear.

III. Or from an antecedent Cause; as sharp Humors, sent from the Brain to the cavity of the Ear, causing Apostems, Ulcers, &c.

IV. The Signs. It is known by Blood and Matter flowing out, and may be discerned also by pain, noise, and trouble in the Ear; and some∣times if Worms are there, there is felt an intollerable itching, not easy to be abated.

V. The Kinds. These Ʋlcers are either without an Excrescence of Flesh, or they are with an Excrescence.

VI. The Prognosticks. If the Matter is white, and without any ill scent, and the Ear itches much, it is without danger; yet it be∣speaks Worms, as aforesaid.

VII. If the Matter comes out of the Ear, and Pulsation is felt with great Pain; you may judge that a Phlegmon, Abscess, or In∣flammation is present.

VIII. If the cure of these Ʋlcers is long deferred, there is much danger of Deafness to ensue.

IX. If a great quantity of Pus comes forth of the Ear, you may safely judge, that it proceeds from a fluxion of Humors from the Brain.

X. The Cure. The Antecedent Cause is first to be removed by proper Purging; for which we commend the Arcanum Jovis, Pulvis Antimonii, Pulvis Cathar∣ticus, and Pulvis Cornachini: and in some Constitutions, the Electuarium Catharticum, which makes a good Revulsion.

XI. As to the Conjoined Cause, if any thing is gotten into Ear, it is to be taken out: and if Hu∣mors abound in the Part, a deri∣vation is to be made, by appli∣cation of Vesicatories, the Seton: or, making an Issue.

XII. The next thing to be done,

is to cleanse the Part with Abs∣tersives: as, ℞ Hydromel lbi. Honey of Roses strained ℥iv. mix; and inject with a Syringe very warm, then dry it with the Probe armed with Lint.

XIII. But the Medicaments which are put into the Ear, ought to be neither too hot, nor too cold; for that Part can ill endure any excess, in any of these two qua∣lities.

XIV. Put no fat or greasy Medicines into the Ear; for as it is composed of Spermatick∣parts, (as Physicians speak) so they will be apt to induce a sordid Ulcer.

XV. Nor let any sharp Medica∣ment be put into the Ear, before the Body is well purged; lest a Fever be procured, and a flux of Humors be moved to the Part.

XVI. Let all the Medicaments which are put into the Ear, be of a thin and liquid substance; that they may sink down the deeper.

XVII. And after dressing, let the Patient lye upon the whole Ear, the disaffected Ear being uppermost, and stopt with some fine Cotton, or Lint, for a pretty while.

XVIII. Trochisci Andronis dis∣solved in Elder-Vinegar, are commended for cleansing; so also Crocus Martis boiled in strong Wine-Vinegar, 'till the Tincture is extracted.

XIX. The Ulcer being cleansed, you must consolidate and heal with this. ℞ Scurvi∣grass M. i. round Birthwort roots ℥i. Canary-Wine lbss. boil, strain, and add thereto Spirit of Wine ℥ii. inject it warm into the Ear.

XX. Or you may inject into it a Sanative Synup, made of the Vulnerary Herbs; as of Agrimo∣ny, Angelica, Avens, Bawm, Comfrey, Horstail, Knotgrass, Ladies-mantle, Mint, Plantane, Scordium, Sanicle, Solomons-seal, Self-heal, Winter-green, Yarrow, &c. which is not only good in Ulcers of the Ears, but in all other cavernous or hollow Ulcers.

XXI. And to these Vulneraries, some few Astringents may be ad∣ded; as Bistort, Balaustians, Catechu, Myrtle-berries, Pom∣granate-peels, Oak bark and buds, Red-roses, Sumach, &c.

XXII. If the Ʋlcer is foul, or has Worms in it, a Decoction of dry Tobacco in Ale or Wine, will be found an incomparable thing: after injecting, you may dress it with this Liniment. Take Ung. Diapompholigos ℥i. distilled Balsani of Myrrh ʒiii. Honey of Roses ʒii. mix, and apply it with Lint.

XXIII. If these Ʋlcers yield much pus, or filth, they must be drest once every day: but if they yield but little matter, it will be enough to dress them once in two days.

XXIV. If the Ulcer is ma∣lign or inveterate, you must cleanse with this. Take Rhenish-Wine lbi. Honey of Roses strained ℥iii. Vinegar ℥i. Verdigrise ʒi. burnt Alum ʒss. boil, strain, and inject warm to cleanse: then afterwards heal the Ulcer, as directed at Sect. 9, 10, 11 above.

XXV. But withal, it will be necessary to divert or derive the Humor, by Errhines applied to the

Nostrils, and Masticatorics to the Mouth; and the Patient must use a Diet drink made of Gua∣jacum and Sarfa, &c.

XXVI. If an excrescence of superfluous Flesh does grow in the Ear, (which is many times does, so as to fill up all the cavities of the Ear, and cause Deafness) you must first purge the Patient very well, as before directed.

XXVII. Then consume the spongy Flesh or Excrescence, by injecting the Composition at Sect. 14. above, and strewing upon it this fol∣lowing Pouder. Take Vitriol cal∣cin'd, Alum burnt, A. ʒi. Auri∣pigment, Verdigrise, A. ʒss. mix them. Or, Take Alum burnt, Vi∣triol calcin'd, A. ʒss. red Precipi∣tate, Turbith-mineral not washe, A. ℈ii. fine Bole, Aloes, A.ʒi. mix them.

XXVIII. And upon every dressing, wash out the Pouders with this Injection. Take White-Wine ℥iii. Honey of Roses strained ℥ss. Ung. Aegyptiacum ʒi. mix them: after injection, strew in some of the former Pouders again, and continue this course 'till the whole Excrescence is wasted.

XXIX. Which done, heal and cicatrize with the Vulnerary-Syrup, or some such-like thing, dissolved in Plantane or Rose Water.

CHAP. XXVII. Of an ƲLCER of the MOƲTH.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins Ulcus Oris; we in English call, An Ulcer of the Mouth: under which the Lips, and insides of the Cheeks and Tongue are comprehended.

II. The Causes. They are either Primary, proceeding either from some external Violence, or a Flux of sharp Humors: or Symptomati∣cal, caused from some malign or contagious Disease; as the Small-Pox, French-Pox, Kings-Evil, malign burning Fevers, &c.

III. The Signs. They are known by sight; the Ulcer has gene∣rally a whiteness upon it, and is the same with that which the Country People call the Canker.

IV. The Prognosticks. If they be recent, they are the more easily cured: so also if they proceed from the Small-pox, or some malign Fever.

V. Those which are Symptoma∣tical from the French-pox or Kings-Evil, are only to be cured, by curing those Diseases.

VI. If they be malign, or seem to be of a Cancerous nature, they will be of difficult cure, and sometimes prove to be incurable.

VII. The Cure. There are breakings-out after Fevers and Colds, and Fissurae Labiorum, Chaps of the Lips; which are

caused from a salt, sharp, drying Humor; which Ulcers are hot and painful, especially if the Patient speaks, eats, or laughs.

VIII. These are easily cured by anointing with Ʋng. Album, or with this. Take Beef or Mut∣ton suet ℥iv. Oil of Ben, or Oil-Olive ℥iii. white Wax ℥jss. Sper∣ma Ceti ℥i. Camphir ʒii. mix, and make an Ointment; with which anoint Morning and Eve∣ning: it will not fail.

IX. Or, Take Veal-suet from the Kidneys ℥iv. Oil of Ben ℥ii. white Wax, Rose-water, A.℥i. Saccharum Saturni ʒvi. Sperma Ceti ʒiii. Camphir ʒi. mix them. It heals wonderfully, and if con∣stantly used every Night, pre∣serves the Skin as plump, smooth, full, and fair, (free from all Wrinckles or other Deformi∣ties) even to Old-age, if the Party was not much above twenty.

X. If the Ʋlcer of the Lips is benign or mild, it may be cured with Ung de Minio, or Desicca∣tivum Rubrum camphuratum; which is effectual even against inveterate or old Ulcers, in what part of the Body soever they be: nor does the Ʋng. è Solano come much behind it.

XI. If the Ʋlcer of the Lips is malign or cancerous, (which you may perceive by its colour, being blackish or livid, and its brims hard, its pain and heat much, and almost continual, and its yielding an ill-smelling Sanies:) or if it is from any strumatick or venereal Cause, you must then purge often, and cleanse the Body with proper Catharticks; and use Sudorifick, Antistru∣matick, and Antivenereal Medi∣caments.

XII. You must wash it with the Ablution of Mercurius dul∣cis in Lime-water, or with the Juice of Tobacco, or with the Water of the Griffin, which is a most excellent thing; or with this. Take Henbane, Hemlock; Housleek, Nightshade, Plantane, Speedwel or Fluellin, A. M. iii. Stramonium M.ii. whites of Eggs N^o. xii. Alum in pouder ℥vi. Cam∣phir ʒii. dissolved in S.V. ℥iv. put all into a Glass-body, and distil in B.M. in the distilled Water dis∣solve Saccharum Saturni ℥ss.

XIII. Afterwards anoint with Ʋng. Nicotianae, or ad Scabiem; or de Tutia, or with this. Take coagulated Mercury in fine pouder ʒvi. Ung. Tutiae ʒiv. Wax, Oil of Ben, or of Poppies, A. ʒii. Turpen∣tine ʒi. mix them.

XIV. If the Ʋlcer is rebellious; and will not yield to these Medi∣cines; you must have recourse to more effectual Means, such as we have prescribed in the Cure of Cacoethick, Phagede∣nick, and Cancerous Ulcers.

XV. If the Gums, and insides of the Cheeks or Lips are ulcera∣ted, with such an Ʋlcer as the Common-people call the Cankers; it is to be cured by Abstersives and Driers: for which pur∣pose, Barbett commends this fol∣lowing.

XVI. Take Oak leaves or buds M. i. Balaustians, Roses, A. P.i. Pomgranate-peels ʒii. burnt Alum ℈ii. white Vitriol ℈ss. Red-wine q.s. boil and strain. To half a Pint of the Liquor, add Honey

of Roses, Rob Diamoron, A. ℥i. mix, for a Gargarism.

XVII. Or, Take common Chalk, fine Bole, A.ʒii. red Lead, burnt Alum, Catechu, A. ʒi. Mercurius dulcis levigated ʒss. Vitriol. ℈i. Whitewine q.s. boil; and to lbj. of the Liquor, add of Fernelius his Syrup of Comfrey ℥iv. mix them.

XVIII. Or, Take Scurvigrass M. iii. bruise gently, and boil in Rhenish Wine lbii. strain, and sweeten with Syrup of Mulberries: with which wash the Ulcers daily oftentimes, and keep the Herb Night and Day in the Mouth, upon or against the place affected.

XIX. If all these things will do no good, you must touch the Ulcers with Oil of Vitriol or Sulphur, 'till they are overcome; then cleanse and heal with this Gargarism. Take Plantane or Rose Water, lbii. Saccharum Saturni ʒii. white Vitriol ʒi. Honey ℥iv. mix, for a Lotion or Gargarism.

XX. If the Roof of the Mouth is ulcerated, you must take care that your Applications be not loathsom or distastful, lest the Parts abhor them.

XXI. If the Skin which co∣vers the Roof is ulcerated, first, (if it is foul) touch it with Aqua Fallopii, allayed with Plantane or Rose Water: or, Take Water of the Griffin, Honey of Roses, A. ℥ ii. Frogspawn-water ℥i. Oil of Sulphur or Vitriol ʒii. mix them.

XXII. The Ulcer being touched with the former things, you may dress it with this. Take Syrup of dried Roses, of Myrtle-berries, and of juice of Pomgranates, A. ℥i. Syrup of Mulberries ℥ss. Oil of Vitriol ℈ ss. or gut. xii. mix them: or you may wash it with the Water of the Griffin alone, or dulcified with Honey of Roses: dressing it often in a day.

XXIII. If the Bone of the Mouth is bare, you must dress it with this. Take Barley-flower, roots of Comfrey, of Orrice, and of Tormentil in pouder, A. ℥ss. Mastich, Olibanum, Sarcocol, Bo∣rax, A.ʒss. Syrup of Red-roses, of Mulberries, A.℥v. mix them: and if the rough Skin grows again, or unites, you obtain your end.

XXIV. If the Tongue is ulce∣rated, and it is benign or mild, let be often drest or washt with this. Take Pearl-barley ℥iv. roots of Althaea, Liquorice bruised, A. ℥ii. Water lbvi. boil to one half; strain, and add thereto Honey of Roses, Syrup of Mulberries, A.℥ii. mix, and keep it for use.

XXV. If the Ʋlcer proves malign, cacoethick, phagedenick, or cancerous, you must dress it with Aurum Vitae, or the Princes Pouder, or native Cinnabar mixed with Saccharum Saturni; or those things which we have enumerated and declared in those places, where we have treated of the curing of those Ulcers.

CHAP. XXVIII. Of an ƲLCER of the THROAT.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus Gutturis, seu Laryngis, vel Gurgulionis, vel Gulae; we in English call, An Ulcer of the Throat.

II. And here under this Title, we comprehend, 1. The Ulcers of the Ʋvula, or Gargareon. 2. The Ulcers of the Amygdalae, or Tonsillae. 3. The Ulcers of the Throat, beyond the Ʋvula.

I. Of the Ʋlcers of the Uvula.

III. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Ulcus Uvulae, an Ʋlcer of the Ʋvula, is caused either prima∣rily from a Flux of sharp Hu∣mors, occasioned thro' cold, or some external violence; or sym∣ptomatically, from the French-Pox.

IV. The Signs. It is known by sight, an eating or corroding Humor appearing upon the Part; and some∣times also, an Inflammation: if it is from the French-Pox, the Breath stinks, and the Patient has a great difficulty in swal∣lowing.

V. If the Ʋvula is wholly away, it for the most part causeth an impediment in the Speech; but more especially while the Ʋlcer is present: but I know a Patient of mine who has wholly lost it, without the least hurt or defect to their Voice: and the same thing Guil. Fabricius Hildanus, Cent. 2. Obs. 21. affirms.

VI. The Prognosticks. If it is benign or gentle, it is of easy cure; but if malign, or accompanied with a Catarrh, it will be cured with much difficulty: if it is caused from the French-Pox, it is not to be cured, but with the cure of this Disease.

VII. The Cure. If the Ʋlcer is benign, it may be cured with some of the milder Medicaments in the former Chapter: or you may first wash the Ulcer with this Gargarism. Take Agrimony, Avens, Centory the less, Fluellin, Marjoram, Plantane, Scordium, Solomons-seal, A. M. i. Whitewine lbii. Water lbi. boil 'till lbss. is consumed: strain, and dissolve therein Oxymel simple ℥iv. and keep it for use.

VIII. Then touch it with this Liniment. Take Honey of Roses strained ℥jss. Ung. Aegyptiacum ℥ss. Alum in pouder ʒss. mix them, and apply it Morning and Evening.

IX. If it proceeds from the French-Pox, you may use the Ablution of dulcified Mercury, or Turbith-mineral, or red Precipitate, in Lime-water; or, the Water of the Griffin, inferior to none of them.

X. But if with the Ʋlcer, it is much tumified, or inflamed; or

the Patient has a vehement Catarrh, and a tickling Cough, and that it proves rebellious to all the things prescribed; it will then be necessary to cut it wholly off.

XI. Let the Body be first well purged; and then take notice how much is necessary to be cut off, which is at least all that is ulce∣rated. The Operation may be done according to the Exam∣ples in Lib. 3. cap. 26. sect. 57, 58, and 59. aforegoing; which are extracted from Wiseman.

XII. If after cutting off, an Hemorrhage should accidentally happen; you may stop it with some styptick Pouders, or a Gargle made of Alum, and Catechu, in Red-wine.

II. Of Ʋlcers of the Almonds.

XIII. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, plur. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. Ulcus Amygdali, vel Tonsillarum, an Ʋlcer of the Almonds of the Ear; may arise from the same Causes, that an Ulcer of the Ʋvula arises from.

XIV. The Signs. It is known by sight, the Tongue being pres∣sed down with the Spatula. There is in this case, always a difficulty in swallowing, and for the most part the Gland is very much swelled, and many times out of its place.

XV. The Prognosticks. If it is only from a Cold, and without a Fever, there is the more safety: if it happens in Summer-time, it is more apt to spread; if it is inveterate, it is with much diffi∣culty cured; and if it becomes scirrhous, it is scarcely ever cu∣red, but with cutting off, or out.

XVI. The Cure. These Ʋlcers, as also every Ʋlcer of the Mouth, require stronger Desiccatives than the Ʋlcers of other Parts; be∣cause they are always kept moist with Spittle, and are very apt to spread.

XVII. You may use the Medica∣ments described in the former Chapter, as also in the Cure of the Ʋvula, to which you may add these following: let the Patient gargarize with a Deco∣ction of Devil-bit; or with this Take Tinctura mirabilis ℥ii. red Port-wine ℥vi. mix them.

XVIII. After gargarizing, anoint them with this Liniment of Sennertus, in Med. Pract. lib. 2. cap. 22. Take the lesser Centory, roots of Florentine Orrice, white Dogs-turd, A. ℥i. Honey q.s. mix, and make an Electuary.

XIX. If these things do no good, gargarize it only with the Water of the Griffin; for if there is any hope or possibility of curing it by Medicaments, this will do it, yea tho' it proceeds from the French-Pox.

XX. But yet at last, after all, if it resists all Local Medicaments, you must come to Incision, the manner of doing it we have taught at large, in Lib. 3. Cap. 26. Sect. 45. ad 56. of this Work aforegoing, to which you are referred.

III. Of an Ʋlcer of the Throat, be∣low the Uvula and Tonsillae.

XXI. Causes. It arises either from a Flux of sharp Humors, or from

some Stramatick or Venereal Cause, the which you may discern and distinguish by the Discourse of the Patient.

XXII. The Signs. It is known by sight, pressing down the Tongue with a Spatula; by pain and dif∣ficulty in swallowing, narrow∣ness of the Throat, and (if it comes from the Pox) a vehement stinking Breath.

XXIII. The Prognosticks. If it comes firm the Kings-evil, or French Disease, it is cured by curing them: if it is recent, it is easily cured; if inveterate, with much difficulty: if the Ulcer has eaten and spread largely, and very deep, or if any large Ves∣sels are gnawn asunder, it is for the most part mortal.

XXIV. The Cure. The Patient may gargarize with this. Take Plantane-water lbi. Waters of the flowers of Oranges, Red-roses, A.℥i. corrosive Sublimate in fine pouder, ʒii. digest in a Sand-heat for an Hour; strain, and keep it in a Glass for for use.

XXV. If the Patient cannot swallow any solid Food, give this four Mornings together, and you will see a wouderful effect. Take dulcified Mercury levigated, à ℈i. ad ʒss. Syrup of Clove-Gilly-flowers, or Honey of Roses ℥ss. mix them. Or you may give the dulcified Mercury in new Milk.

XXVI. If these things do not, you must come to the Water of the Griffin, which is admirable, and will cure it (if curable) in a Week or ten Days time: if this does nothing, the Patient must submit to his Fate.

CHAP. XXIX. Of an ƲLCER of the NECK.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus Colli, vel Cervicis, vel Juguli; we in Eng∣lish call, An Ulcer of the Neck.

II. The Causes, It may be pro∣duced from some external violence, as a Wound ill managed, or a Con∣tusion: or it may proceed from a Phlegmon, or an Apostem: or it may be caused from Venereal Contagion, or Poison, or stru∣matick Tumors, by degenera∣tion.

III. The Signs. The Ʋlcer it self is manifest at sight; but the Signs of the various Causes, must be learnt from the relation or discourse of the Sick, or some who belongs to them.

IV. The Prognosticks. If re∣cent, and not near any of the prin∣cipal Vessels, or the Spina, it will be the more easily cured.

V. If it is in the Neck behind, and has corrupted the Vertebrae; the Patient is then in a dangerous condition; if it has pierced to the Medulla, Death only can

put a period to the poor Patient's misery.

VI. If the Ʋlcer spreads, and creeps near to the Jugular Veins, or Soporal Arteries, there is great danger: if they once come to be corroded, nothing but a Miracle can preserve Life.

VII. If it is inveterate, and has otherwise eaten deep, or taken possession of the Glandules, (of which that Part is full) tho' it touches none of the great Ves∣sels, or recurrent Nerves, yet it will be of very difficult cure.

VIII. If it becomes fistulous, nothing but a palliative Cure can be expected; and in this last case, keeping the mouth of the Ulcer open, and the Ulcer it self al∣ways clean, it may prove (in Strumous cases) an advantage to the Sick.

IX. If being near the Spina, it should affect some of the conjuga∣tions or pairs of Nerves, proceeding from those Vertebrae; the Parts which are replenished with Branches from those pairs of Nerves, will be apt to suffer an incurable Palsy.

X. The Cure. Let it proceed from what cause soever, it is neces∣sary that Purging precede, or goes hand in hand with the other Ope∣rations of the Cure; that the su∣perabundance of the Morbifick-Matter may, as much as possible, be carried off.

XI. In all the common cases, and where it is primary, vegetable Catharticks may do, or those mixed with dulcified Mercury, or white Precipitate; but if it proceeds from a Strumous or Venereal Cause, (being Symptomatical) it will be necessary to add to them Mercurials; as red Preci∣pitate, the Prince's Pouder, Arcanum Corallinum, Turpethum Minerale, Aurum Vitae, Praecipi∣tatum per se, &c.

XII. This Purging is to be done at first every third or fourth day, for eighteen or twenty days: af∣terwards for a Month or six Weeks, only twice a Week: and after that time, only once a Week, 'till the Ulcer is healed up.

XIII. If it proves inveterate and rebellious, you must in the inter∣vals of Purging give constantly a Diet or Wound Drink, made of Guajacum, Winter's Cinamon, Sarsa, Sassafras, with addition of the principal Wound-Herbs, and and every Night at Bed-time this following Pouder.

XIV. ℞ Turpentine reduced to pouder by boiling, Crabs-eyes levi∣gated, Goats-blood dried; Ana; make all into a fine pouder; of which give ʒss. or ℈ii. going to Bed, in any proper Vehicle. This will cause a great part of the Morbisick Matter to be carried off by Urine.

XV. As to Topicks, if it wants digestion, (as Ʋlcers in this Part very often do) you must then dress it with Medicaments proper there∣to. This following is good. Take Venice or Strasburgh Turpentine, Honey, A.℥i. yolk of 1 Egg, Mastich in pouder ʒii. mix them.

XVI. After you find the Ʋlcer is well digested, (which you may know by the kindness of the Ulcer; not being full of pain, red, fretful, or eating, and the good condition of the Pus) you must then cleanse it with

Abstersives, as Ʋng. Nicotianae, Basilicon; or Basilicon mixed with a little Precipitate: or with this. ℞ Ʋnguent. Nicotianae ℥ii. Basilicon ℥i. Aegyptiacum ʒiii. mix them; and over all apply Empl. Album, or Diachylum cum Gummi, or Emplastr. Mercuriale, according as the Cause may be.

XVII. The Ʋlcer being suffi∣ciently cleansed, you may incar∣nate with Sarcoticks, as the Linimentum Arcaei, or this. Take Linimentum Arcaei ℥iii. Ʋnguent. Nicotianae ℥ii. Basilicon ℥i. mix them. And if the Ulcer is apt to be over-moist, you may add a little Precipitate thereto; which in this case will keep the Ulcer clean, and also help to incarnate.

XVIII. And now being filled up with Flesh, you have nothing more to do, but with some proper styptick Water, or astringent and desicca∣tive Pouders, Ointments, or Em∣plasters; to induce the Cicatrice, and perfect Healing.

XIX. If it is malign, you must often wash it with the Water of the Griffin; and apply such things, as we have directed in cacoethick and malign Ulcers.

XX. If it is from a Strumatick or Venereal Cause, it will scarcely be perfectly cured, but with such a course as may possibly cure those Diseases.

XXI. If it seems to be very habitual, or is become fistulous, you will do well to apply your self to the palliative Cure, (which we have in a former place already delivered:) because Ulcers and Fistula's in this Part cannot be laid open, but with much cau∣tion; lest the recurrent Nerves, or the other great Vessels should be hurt, or suffer in the Ope∣ration.

CHAP. XXX. Of an ƲLCER of the STOMACH.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus Stomachi, vel Ventriculi; we in English call, An Ulcer of the Stomach.

II. The Stomach is said to be the Shop or Work-house of Nature, where the Chylus is prepared; and it is composed of three Tuni∣cles. The outermost is common from the Reritonaeum, and is the thickest; the middlemost is pro∣per to it self, and is fleshy; the innermost is from the Dura Meninx, and is wrinkled.

III. It has Fibres of all sorts, and is crusted over with spongy Flesh; and it is situated in the middle of the Hypogastrium, resting upon the Vertebrae of the Loins: its left or highest Ori∣fice is called Os, also Stomachus; and its right Orifice, Pylorus; which is joined to the Guts, to convey the Chylous Juice to them.

IV. The Causes. It may be caused either from a sharp and acrimonious Humor, corroding the Tunicles of the Stomach; or from the breaking out of the ulcerous Pustules of the Small-pox, when they break out inwardly, and then break, or ulcerate.

V. Or it may be caused from a vehement intemperate Heat: by which the Coats of the Ven∣tricle seem as if they were par∣boiled; after which they break, and the Part becomes raw.

VI. Or it may be caused from the long taking of very acid things; as Juice of Limons with∣out allay: or from the taking inwardly Oils of Vitriol, Sulphur, or Salt or Aqua fortis, Aqua Regis, or Spirit of Nitre without mix∣ture: or the taking of eroding Poisons, or Causticks, such as Vitriol calcined, Arsenick, corro∣sive Sublimate, &c.

VII. The Signs. It is known by the exceeding pain and torment the Sick is almost always in, especially after eating and drinking, and for some hours after, 'till the Meat or Drink is gone off the Stomach; at what time there is some relaxa∣tion of their pain, and they seem to be a little at ease again; but immediately after eating and drinking, the pain is renewed, and comes on afresh, as before.

VIII. The continuation of the Pain, and vehemency of it, makes the Patient almost afraid either to eat or drink, and in a manner destroys the Appetite: by which the Patient looks pale and wan, as if in the Green-sickness; and wastes away, as in a deep Con∣sumption.

IX. Sometimes, by reason of the vehemency of the pain, (it being a nervous Part, as the Tunicles of the Ventricles are,) the Patient faints, and swoons away, some∣times vomits up his Food again for ease and relief; and by the constancy and conti∣nuance of it, is brought into a very faint and feeble condi∣tion, as being scarce able to go alone, and they look even like the very Picture of Death.

X. By reason of this disorder of the Stomach, the Concoction is weakned, the Food not well di∣gested; and the Excrements of the Body, as Ordure and Ʋrine, are crude and raw, looking of a very ill and pale colour.

XI. The Prognosticks. It is a very pernicious Disease, and without timely help, many times kills the Patient: if it is caused by sharp or acrid Humors, it is more easily cured than other∣wise.

XII. If it proceeds from the Small-pox, or the violent heat of a malignant and burning Fever, (known by the great burning in the Stomach, vehement desire of drinking) it is for the most part deadly.

XIII. If it is caused from ta∣king any quantity of Oils of Vitriol or Sulphur, Spirit of Ni∣tre, &c. it is for the most part mortal: because those vehement things in a very short time bring a mortification upon the Part, and assault and empoison the Vital Spirits.

XIV. The Cure. In this Dis∣ease the Symptom of Pain is some∣times so vehement, that respect

must be had to it, before we at∣tempt to attack the Disease it self. And altho' there may be a foulness in the Ulcer, which ought to be cleansed and taken away; yet sometimes we are forced to do that, after we have first abated the pain.

XV. If it is such a kind of anguish or dolour, that neither Cordials, Aromaticks, nor Anti∣dotes; things hot, or cold, or temperate; things sweet, as Su∣gar, Honey, or Liquorice; nor things sowr, do any good at all; no nor Opiates, or any kind of Narcotick or Anodyn whatsoever, do give any relief in the least measure.

XVI. What is then to be done? truly since the Disease generally proceeds from an over-great acidity and acrimony of the Juices; it follows, that it can be only ab∣ated by things opposite to that quality, to wit, things of an absorbent and alcalious nature.

XVII. And therefore we ad∣vise, that this Medicament be given for four days. ℞ Fine Bole, Terra Sigillata, fine Chalk, A.ʒiii. Crabs-eyes levigated, Pearl prepared, Orient part of Oyster, shells, A. ʒi. make all into fine pouder. Dose, ʒss. or ℈ii. Mor∣ning and Evening in Goats-Whey, or other Whey, if that be wanting, or in Barley-water.

XVIII. Then proceed to the cleansing of the Ʋlter, and evacua∣tion of the peccant Matter, by Le∣nitives only: for which purpose, Hydromel may be given alone, or mixt with Manna of Frank∣incense, as Galen advises; or you may give Barley-water with Ho∣ney of Roses, or Sugar of Roses, in the beginning in the Morning fasting: avoiding all manner of Vomits, lest they dilacerate the Ulcer more.

XIX. And giving those things in the Morning, let the aforegoing Pouder be constantly given every day, or night going to Bed.

XX. And if the Ʋlcer is inve∣terate or old, you must use Barley∣broth, Decoctions of cooling Herbs, Almond-milk, Sugar of Roses: or new Milk, with Sugar, and a little Honey: not forgetting to give every Night a Dose of the aforegoing Pouder; without which the Cure will not well succeed.

XXI. Afterwards you may give Chalybeat-Milk and Iron-Waters, or Smiths-forge-water filtred, for ordinary Drink: or Water in which fine Bole or Terra Sigillata has been infused, which is ex∣cellent: adding (in a great debility of the Stomach) a little rough or austere Wine, for that the heat of the Part may be weak.

XXII. Give often also some good Tramatick Decoction, as De∣coctum Traumaticum Vulnerarium, Cancri, &c. or this: Take juices of Agrimony, Avens, Bugle, Burnet, Sanicle, Scabious, A. ℥iii. clarify, and sweeten with Syrup of dried Roses ℥iv. give it for five Doses, often to be repeated.

XXIII. Decoction of Sarsa and China, with Burdock and Comfrey roots, in Chicken-broth, given for twenty or thirty days together, is very good; so also the Mineral-Waters of Vitriol, Alum, or

Iron; or Tincture of Iron extra∣cted with Whitewine.

XXIV. During the whole Cure, keep the Stomach clean, with gentle Purges of Sena, Rhubarb, Mechocan, Myrobalans, Syrup of Roses, Tamarinds, Diacatholi∣con, &c.

XXV. Lastly, to heal up the Ʋlcer, give Pulvis Haly, or this: ℞ Pulvis Haly ℥ii. fine Bole, Terra Sigillata, red. Coral, Crabs-eyes, and claws, Bloodstone, Pearl, Oister-shells, (all levigated) Crocus Martis, A. ℥ss. native Cinnabar, Sar••ocol, Hypocistis, A. ʒii. make all into a fine pouder. Dose, ℈ii. with Sugar of Roses, in Poppy-Water.

XXVI. Or you may give it with Conserve, or rather Blood of Com∣frey roots; or in a weak Tincture of Catechu, with Syrup of Quinces. You may keep or preserve it, by making it up into Troches, with mucilage of Fleawort-seeds, or rather with that of Gum-Tragacanth. Thus have we here given you the Theory and Praxis of a Disease, from our own Expe∣rience, in which, we have fol∣lowed the Footsteps of no Man living.

CHAP. XXXI. Of an FISTƲLA of the BREST.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Fistula Thoracis, vel Pectoris; we in English call, A Fistula of the Brest.

II. The Causes. It is either from an External Cause, as from a Wound penetrating into the Brest: or from an internal Cause, from a Phlegmon possessing the In∣tercostal Muscles, and the Pleura.

III. The Signs. It is discovered at sight, having present the Signs of the other Fistula's: and if the Matter flows into the cavity of the Thorax, there will be short∣ness of breathing, and a slower motion of the Brest.

IV. The Difference. It is either with one Orifice, as when it pro∣ceeds from a Wound penetrating into the Brest: or with more Orifi∣ces than one, when it follows after an Apostem.

V. The Prognosticks. If the Patient has an Hectick, or is fallen into a Marasmos, (which this Fi∣stula is apt to induce) the Body growing very thin, and being in an absolute Consumption, the Disease is for the most part incurable: for the drying means which are absolutely necessary for the curing of Ulcers, increase those Diseases, and so hasten on Death.

VI. Celsus also says, that these Fistula's when they have passed the Ribs, sometimes corrupt the Dia∣phragma or Midriff; (which may be known by the place affected,

and the greatness of the Pain:) in which case they are ever uncura∣ble.

VII. And indeed all Fistula's of the Brest are hard to be cured, 1. Because the parts are in con∣tinual motion, by reason of its dilatation and contraction, caus∣ed by the intercostal Muscles. 2. Because the Virus of the Fi∣stula does often corrupt the Rib, whose internal substance (being spongy) is apt to lodg the Cor∣rupt or Virulent matter. 3. Because the sinuosity (extending it self between the Pleura and up∣per Rib, to the distance between it and the lower Rib) is very difficult to be cleansed. 4. Be∣cause it is apt to induce a He∣ctick or Marasinos, which ren∣ders it uncurable. 5. Because the Pleura in this case is always Ulcerate, which being membra∣nous, thin, and without Blood, does (like the Bladder) very hardly admit of consolidation. 6. Because the farther end of the Fistula is for the most part lower than the Orifice, which hinders the expurgation of the Pus or matter. 7. Because Medica∣ments cannot be so well apply'd in this case, as in Ulcers and Fistula's of other Parts. 8 Be∣cause of its proximity to the noble Parts, as the Heart and Lungs, upon which the Life of the Patient depends.

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.

II. Of an Ʋlcer in the Lungs.

XLVIII. Because the Lungs are contained in the Cavity of the Thorax, or Brest, and that they

being sometimes externally Wound∣ed, are affected with an Ʋlcer, we thought good to add as an Appendix to this Chapter, a Discourse of the Ulcers of the Lungs.

XLIX. The Greeks call this Discase, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, pl. 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. vel, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. And the La∣tins, Ʋlcus Pulmonum: And we in English, an Ʋlcer of the Lungs. But if an Ulcer proceeds from an inward Cause, then both Greeks and Latins call that 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉 Phthisis, which is a Con∣sumption of the Lungs, of which we shall speak nothing in this place.

L. The Causes. The Causes of such Ʋlcers, after a Wound in∣flicted into the Lungs, may be, 1. A solution of unity in the Substance and Vessels of the Lungs, viz. the Arteria Pulmonaris, and Vena Pulmonaria. 2. An Effusion of Blood into the Cavity of the Tho∣rax, which corrupting, ulce∣rates the substance of the Lungs.

LI. The Signs, The Wounds of the Lungs, and of its Vessels, are known, 1. By a great diffi∣culty of breathing, and a vehe∣ment pain of the sides, not feit before.

LII. 2. By frathy Blood coming forth of the Wound, and also com∣ing forth of the Mouth by Coughing; for this shews that fome of the Vessels must be wounded.

LIII. 3. The Patient lies easier upon the wounded th•…•… whole side, so that many times he can easily speak so lying, whereas being turned on the whole side, he speaks with pain and difficulty.

LIV. When Blood is poured forth into the Cavity of the Thorax, you may know it, 1. By the hea∣vy weight which seems to press down the Midriff. 2. By the Increase of a Fever. 3. By the stinking of the Breath after a while, the Blood being corrup∣ted. 4. By a desire to Vomit, with Fainting and Swooning Fits, from the Blood's putrefy∣ing and turning into Pus. 5. From the difficulty of Breathing. 6. From the voiding of Blood by the Mouth. 7. From the Patients being only able to lye upon his Back.

LV. Now that there is an Ʋlcer of the Lungs, it is manifest from the length of time, since the in∣flicting of the Wound: For having dressed the Wound so long a time, as it is reasonable such a Wound may take in Curing, and it is not yet healed, you may then prudently fear that a putrid Ulcer of the Lungs is in∣duced; more especially if no laudable Pus, but a thin Sanies flows out, in very great quan∣tities, exceeding the magnitude of the Wound.

LVI. The Prognosticks. Al Ʋlcers of the Lungs are Cured with great difficulty, 1. Because the Orifice is not depending al∣ways, but for the most part higher than the Ulcer. 2. Be∣cause the lungs are encompassed with the Pleura, (a Membrane inwardly investing the Ribs) which being accounted a Sper∣matick Part, and endowed with but little Blood, is not easily u∣nited. 3. Because the Muscles of the Brest, Heart, and Lungs,

are always in motion, which hinders consolidation. 4. Be∣cause Topicks cannot easily be applied, and kept to these Ul∣cers, by Bandage, Bolsters and Emplasters, as they can to Ul∣cers of the External Parts.

LVII. If the Patient has no Cough, a sweet Breath, Expecto∣rates easily, Sleeps comfortably, his the Bowels soluble, digests his Food well, the Ʋlcer yielding a good sort of Pus, or Matter, and his Body wastes or pines not a∣way, nor usually accosted with Sick or Fainting Fits, you may conceive good hopes of Cure.

LVIII. But if a Cough be pre∣sent, or a stinking Breath, or the Pus flowing from the Ʋlcer stinks; if there is a difficulty of Breath∣ing, a lingering putrid Fever, exasperated mostly at Night, with Watchings, Costiveness of Body, want of Appetite or Di∣gestion; if putrid pieces of the Lungs, or of the Branches of the Windpipe, be expelled thro' the Mouth, and the Voice is shrill and whistling, as if he spoke thro' a Pipe, and the whole Bo∣dy pines and consumes away, the danger of Death is not small.

LIX. So also if the Hair fall, which is caused by reason of the want of Nourishment, or of the Corruption of it; if the Cheeks and Face comes to be of a leaden Colour, yet after eating seem to be ruddy, and Vapours ascend∣ing thither; if the Flesh on the tops or ends of the Fingers seems wasted or consumed, the Nails grow crooked, the Feet begin to swell, the Natural Heat de∣cayed, and Lice increase by reason of the Corruption of the Humors, Death is not far off.

LX. The Cure. The Indica∣tions of Cure are Threefold. 1. The Directing of a proper Diet. 2. The Correcting the Humor, to induce Cleansing and Healing. 3. The Application of proper Topicks.

LXI. As to the Diet, it ought to he of good Juice, nutritive, and easie of Digestion, because the Body it apt to be extenuated and consu∣med in this Disease. Crabs are much commended in this Mala∣dy: So also Snails, but they are of a thick and slimy Substance, and so apt to breed an Excre∣mentitious Juice: However, their Broth boiled in Milk, and sweetned with Sugar, or min∣gled with other strong Broths, may breed a good Nourishment.

LXII. But nothing seems better than Gelly of Sheeps-Trotters made by boiling in Milk, and then sweetned with white Sugar-candy: Gelly of Hartshorn is an Incompa∣rable thing; so also Gelly made of Calves and Neats Feet, of Knuckles of Veal, and Knuckles of Pork. To these things add the Gravies of Buttocks of Beef, of Legs of Mutton, of Fillets of Veal, and of other Meats which yield a plenty of that Li∣quor.

LXIII. Milk also is an admi∣rable thing, (if there is no Fever) for it nourishes the Body, gene∣rates Blood, and Lympha, and corrects the actimony and sharpness of corrupt Humors: The wheyish part cleanses the Ulcer, cools, and keeps the Body soluble; the curdy part breeds good Blood

and Humors, strengthens the whole Body, and consolidates; and the buttery or oily part, moistens, smooth, and makes easie, hindering the desiccation of the Body.

LXIV. Womens Breast-milk is the best; many have been Cured of a Phthisis, who have been given over as incurable, meerly by suck∣ing of it: Asses Milk is thinner, and so more apt to absterge: Goats Milk is an incomparable thing; because of their Food: And Cows Milk obtains in the last place; but that they may not corrupt in the Stomach, they ought to be sweetned with Sugar of Roses.

LXV. Milk is only to be given when the Stomach is empty, and no other Food is to be taken, 'till that is digested, lest it curdle, and becomes sowr or corrupted: let the Patient begin with a little at first, and so increase it gra∣dually every day, according as he finds his Stomach can bear and digest it.

LXVI. To correct the Humors, and induce a cleansing and healing, good Pectoral Diet-Drinks are to be prescribed. ℞ Roots of Alkanet, Bistort, Burdock, China, Cinkfoil, Comfrey, Guaja∣cum rasped, Liquorice, Orrice, Sar∣saparilla, Sassafras rasped, Tor∣mentil, Zedoary, A.℥iii. leaves of Agrimony, Alheal, Angelica, Avens, Bawni, Bramble-tops, Coltsfoot, Fluellin, Fumitory, Hyssop, Mint, Plantane, Sage, Sanicle, Tansy, Yarrow, A. Mj. seeds of Anise, Ca∣raways, Coriander, Cumin, Fennel, Jumiper-berries A. ℥iss. Curants, Figs, Raisons stoned, A. ℥iv. Rain or Spring Water, Wine, A. lbxii infuse in almost a boiling heat for 24 hours; then boil 'till a third part is consumed, strain, clarily, and with Honey q.s. dulcisie, and bottle it up for use.

LXVII. Or, ℞ Roots of Al∣kanet, China, Comfrey, Elecam∣pane, Guajacum rasped, Liquorice, Orrice, Sarsaparilla, A. ℥iii. Agri∣mony, Angelica, Avens, Costmary, Coltsfoot, Hyssop, Horehound, Speedwel, Sage, Sanicle, Savory, A. M.i. seeds of Anise, Caraways, Coriander, Fennel, A. ℥i. Juniper∣berries, Winter's Cinamon, A.℥ii. Figs, Raisons stoned, A. ℥iv. Water, Wine, A. lbx. infuse in a scalding heat 24 hours; boil 'till a third is consumed, then strain, and cla∣rify, and sweeten with Honey q.s. and bottle it up.

LXVIII. Every morning fasting, and at night going to Bed, let the Patient drink half a pint of one of the former Diet-drinks warm; and afterwards in the day-time, let them drink it as their ordi∣nary Drink, as they are a-thirst, or stand in need of it; and let it be given also at Meals, using no other during the Cure.

LXiX. We come now to the last Indication, which is the application of proper Topicks, which are chiefly Injections, but made of such things as are not bitter, for the Reason urged in Sect. 26. afore∣going.

LXX. ℞ Barley-water ℥viii. white Port-wine ℥iv. Honey of Roses ℥iv. mix them. Or, Take Decoction of Parsley ℥viii. White-Wine ℥iv. Honey ℥vi. mix them. Or, Take ctarisied juice of Smal∣lage ℥x. Whitewine. ℥iii. Honey of

Scordium ℥iv. mix them for an Injection.

LXXI. If the Ʋlcer is sordid, and yields much matter, you must add to every ℥iii. of the Injection, Ʋng. Aegyptiacum, à ʒss. ad ʒi.

LXXII. When you find the Ʋl∣cer sufficiently absterged or cleansed, which you may know by the smalness of the quantity of the Matter is∣suing forth, then you must hasten the Consolidation with all the convenient speed that may be; which may be performed with the following Medicament.

LXXIII. ℞ Decoctum Pecto∣rale, clarified juice of Comfrey, a. ℥ijss. Syrup of dried Red-roses ℥i. red Port-Wine ʒvi. mix, for an Injection:

LXXIV. Or, Take Comfrey, Ground-Ivy, Sanicle, Plantane, Solomons-seal, Perwinkle, Adders∣tongue, Hypericon, Betony, Bugle, Valerian, Yarrow, A. q.v. beat all together, and express the juice, which clarify: take of this clari∣fied Juice ℥viii. red Port-wine ℥iv. flegm of Alum ℥ii. Syrup of dried Red-roses, of Myrtles, of Pomgranates, and of Clove-gilly∣flowers, A. ℥jss. mix them, and inject warm.

LXXV. The Orifice is to be kept open, either with a Tent, or a Silver Pipe: the Tent may be made of fine Tow, (which is bet∣ter than some other things) be∣cause it will stick fast together; or of prepared Sponge, which is best of all; because it not only dilates, and sticks firmly toge∣ther, but it draws also the Pus, and imbibes it: let it be so made, that it may not slip in; for then it would fall upon the Diaphragma, and putrify there; causing Faintings, Swoonings, and at last Death: for which reason, it would be good to tye a Thread to the end of it, to prevent the worst.

LXXVI. But a Silver Pipe (made with stays or ears, to hinder its slipping in) is much better: it ought to have (besides the hole at the farther end) several large holes in the sides, near to the end, to make way for the more easy running forth of the Pus or Matter: it ought to be thick, and roundish on the sides at the end; that the Lungs, if they should butt against it, might not be hurt: and its out∣ward end ought to be stopt with a piece of Sponge dipt in Brandy; over which you may apply Emplastrum Album, or de Minio.

LXXVII. If it runs much, dress it twice a day; if little, but once a day: and when the Ʋlcer yields but little, or almost nothing of Pus or Matter, remove the Tent or Pipe, and cicatrize with all the speed that may be: for if an Orifice of the Thorax is kept open too long, it will be apt to degenerate into a Fistula.

LXXVIII. Lastly, if you be so happy as to perform the Cure, cause your Patient, that he be circumspect in all his motions; whether walk∣ing, leaping, running, or otherwise moving, and that thro' the course of his whole Life: for tho' an Ulcer of the Lungs be cured, yet the Cicatrice may be apt to behurt, and rent again from

the whole part of the Lungs, by irregular or violent motions, which then may be the cause of an untimely end.

CHAP. XXXII. Of an ƲLCER of the BACK.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ulcus Dorsi, vel Tergi; we in English call, An Ulcer of the Back.

II. The Causes. It is caused either from sharp Humors flowing down upon the Part; or from an Apostem, which follows some other Disease, by translation of the Matter to that Part; or from Struma, or some Tumor not well cured in a superior Part, or from external Violence.

III. The Signs. It is known by sight; being either a plain Ex∣ulceration, cavous, cavernous, or apostemous.

IV. The Prognostick. That in the upper Parts, is mo•…•… easily cured, than that in the Loins; and that which is recent, than that which is inveterate or old.

V. If it has been of a long standing, and has Coney-borows, as it were, with many turnings and windings, it will be of difficult cure: so also if it proceeded from an Apostem, or Tumor, which had been of a long con∣tinuance in the Part, before it broke forth into an Ulcer; for then it may be feared, that the Musculous and Nervous Parts are corrupted, or the Vertebrae hurt.

VI. If the Patient is extenua∣ted, or there seems to be an Atrophia or Consumption; it is manifest that the principal Parts are weakned, and that the Pa∣tient is in great danger.

VII. If the Vertebrae be cor∣rupted or foul, which you may easily discern by your Finger, or the Probe, the Patient is very desperate, if not incurable; but if the Mar∣row is touched, all hopes of Recovery are past.

VIII. The Cure. The Cure is to be considered according to the Causes and Symptoms present, or which do appear; you must first order a good Diet, and such as may be restorative, because these Patients always seem to be in a wasting condition: among Re∣storatives, volatil-mimal Salts have not the lowest place.

IX. I commend volatil Salt of Beef or Pork, or of Sal Armo∣niack, to be dissolved in Rhenish-Wine, or in a Decoction of Sarza and Burdock-roots: or in a De∣coction of Guajacum very thin rasped ℥ss. to a Gallon of Li∣quor, with addition of Resto∣ratives.

X. If an Atrophia is present, a De∣coction of Sarsa must be used, Choco∣let, or strong Cock-broth, Gelly of Harts-horn, and other Gellies,

with Goats and Cows Milk, all which abound with Volatil A∣nimal Salts.

XI. Let the Patient now and then Purge with gentle Medica∣ments; as with Sena infused in Wine; or the Infusion of the Species Hiera picra in half Wine, half Water: Or this, ℞ Ele∣ctuary Lenitive ℥ss. Elect. of the Juice of Roses ʒii. Syrup of Roses solutive ℥i. Barley-water ℥iii. mix for a Dose.

XII. Then if the bottom of the Sinus is lower than the Orifice, open it below either by Incision or Caustick, as that of Lapis Infer∣nalis, the white Caustick, the Silver Caustick, &c. and make an Orifice thro' the Eschar.

XIII. Then use an abstersive Injection, till you perceive the Ulcer to be clean, as, ℞ White∣wine lbi. Honey of Roses ℥iii. Ʋng. Aegyptiacum ℥ss. mix, and use it warm.

XIV. Or if it be only caveous, apply this mundifying Ointment. ℞ Juice of Smallage, Honey, A. ℥iii. Juices of Endive, Hops, El∣der, Centory, Scordium, A. ℥ii. Turpentine ℥iss. mix, and boil to the thickness of an Ointment.

XV. If any dead Flesh is pre∣sent, it is to be taken away with the Incision-knife, or Scissars, or with some proper Caustick.

XVI. The Ulcer being clean∣sed, you must Incarnate with this, or some such like. Take Rose-water ℥i. Syrup of dried Roses ʒiii. Olibanum, Mastich in pouder, A. ʒi. Trochisci albi Rha∣sis ʒi. mix, and inject warm.

XVII. Or in a caveous Ʋlcer, dressit with Ung. Nicotianae, or with Arcaeus his Liniment; and apply over all, Empl. de Meli∣loto, or Diachylon cum Gummi; after which Cicatrize, as is usual in other Ulcers.

CHAP. XXXIII. Of an ƲLCER of the WOMB, and its NECK.

I. WHat the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the La∣tins, Ʋlcus Matricis, we in Eng∣lish call, an Ʋlcer of the Womb.

II. And what the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ʋlcus Vulvae, vel Colli Matricis, we in English call, an Ʋlcer of the Neck of the Womb.

I. Of an Ʋlcer of the Womb.

III. The Causes. It is either caused from a flux of Humors to the Womb, an Apostem of the Womb, being broken; or from the Pox, where, in Coition, the Pocky Seed is cast into the Womb, and ulcerates it.

IV. Or it may be caused from External Violence, or too sharp and corrosive Medicines injected into the Womb, or taken at the Mouth.

V. The Sighs. It is known by the pain and pricking which is felt in the Part, as also by voiding of Sanies, Pus, or filthy stink∣ing Excrements, or a virulent Gonorrhaea, an impure Coition go∣ing before.

VI. The Differences. It is either, 1. Simple, wherein the Matter is little, white, and not stinking. 2. Or Malign, where∣in the Matter will be greenish, yellowish, livid, and party-co∣loured, coming away with Pain and Stink. 3. Or Venereal, at∣tended with other Symptoms of the Pox. 4. Or Cancerous, at∣tended with a great Tumor, Hardness, continual Pain, and either a bloody, or black stink∣ing Running.

VII. The Prognosticks. All Ʋlcers of the Womb are Cured with some difficulty; nor, accor∣ding to Hippocrates, is any Ul∣cer of that Part to be Highted, because the Womb is a Part very sensible, and as it were the Sink of the Body, to which a Flood of Excrements perpetually flow.

VIII. If it proceeds from a Ve∣nereal Cause, it is not to be per∣fectly Cured, but by the Me∣thods which are taken for the Cure of that Disease.

IX. If it is Phagedenick, or Cancerous, it is for the most part incurable, and vexes the Sick all her Life long.

X. Also, most Ʋlcers of the Womb, if they be carelesly hand∣led, produce grievous Symp∣toms, and sometimes a Gan∣grene.

II. Of an Ʋlcer of the Neck of the Womb.

XI. The Causes. It is caused either from a flux of sharp Humors, or from Pustules breaking out; or from impure Coition, the Pocky Venom of the Man hanging or sticking to the Part, and ero∣ding the Cutis: Or from over∣heating the Part, from too vio∣lent and insatiable Coition: Or lastly, from corrosive and eating Medicaments unskilfully applied.

XII. The Signs. It is known by sight; the Ʋlcer abounding with Matter sanious or purulent, and sometimes bloody: There is a Running, with great pain and pricking, both within, and up∣on the Lips of the Privity.

XIII. Sometimes the Ʋlter is with Tumor or Swelling, and some∣times it eats caveous holes, big enough to lay a long Nutmeg in: And it is for the most part ac∣companied with a heat and scalding of Uring, and a great pain, and sometimes a stoppage in making Water, the Bladder for the most part being drawn into Consent.

XIV. The Differences. Some are benign and gentle, yielding lit∣tle Matter, thick, and not stink∣ing: Others are sordid and ma∣lign, yielding much Matter, ill coloured, and with pain.

XV. Some also are superficial, yielding but little Matter; others are profound, abounding with much filth, and stinking: Some

are with Tumor or Swelling, o∣thers without.

XVI. The Prognosticks. These are more easily Cured than Ʋlcers of the Womb, because we can come more easily to apply Medicines to them; and the benign and mild are more easily Cured than those which are putrid and malign.

XVII. If they proceed from the Pox, or impure Coition, they are Cured with some difficulty; and in this Case, it will be prudent for the Patient to go thro' the Course of that Cure, especially if they be inveterate.

XVIII. If they proceed from Condylomata, which have been of long standing, or often returning, they will be of difficult Cure; and when Cured, will be in great hazard of breaking out again, unless a preventive Course be used for some time.

XIX. If they be with a viru∣lent Gonorrhaea, or an evil-con∣ditioned flux of the Whites, being corrosive, it will be impossible that they should be Cured, un∣less those Diseases be first taken away. See the Third Edition of Our Synopsis Medicinae, lib. 5. cap. 75, and 89.

III. The Method of Curing these Ʋlcers of the Womb, and of its Neck.

XX. Since they are so nearly related one to another, both in re∣spect to the Parts they affect, and the Causes they proceed from, we shall give you but one singular and direct way of Curing them. Now because these Ulcers are many times crude, undigested, and full of pain, they are first of al to be drest with Digestives, that they may be made easie, and brought to a good kind of Mat∣ter.

XXI. For the Womb you may make this Digestive Injecti∣on. ℞ Turpentine ℥ss. yolk of one large Egg, grinde them toge∣ther till they are well mixed, then add to them new Milk warm from the Cow lbi mix, and make an Injection, which with a Womb-Syringe cast or inject into the Womb, 3, 4, or 6 time a day: Before you Syringe with the In∣jection, be sure that you put in first a Syringe full or two of warm Water.

XXII. But to the Ʋlcer in the Neck of the Womb, you may ap∣ply this. ℞ Turpentine ℥ss. yolk of one Egg, grinde them toge∣ther, then add thereto Olibanum in pouder ʒii. mix them. Warm it, and anoint the Ulcer there∣with with a Feather or a Pencil, and apply a Pledget dipt in the same upon the Ulcer, dressing it twice a day.

XXIII. These things are to be continued so long, till the Patient has some ease, and the Ulcer yields a laudable or good Mat∣ter.

XXIV. Mean season while this is doing, the Antecedent Cause is to be removed by proper Emeticks and Catharticks: You may make Revulsion with a Dose or two of Tartar Emetick, or with Wine or Vinegar of Squills, or Infusion of Crocus Metallorum.

XXV. And you may Purge with an Infusion of Sena and Rhubarb in Wine and Water ana: Or with

Our Tinctura Purgans, or Pulvis Cornachini, or Pulvis Catharticus, or some other Medicament pro∣per to the Constitution of the Body.

XXVI. And by reason of the moistness of the Parts, and their aptness to receive a flux of Humors, and the humid nature of Ʋlcers, it will be necessary that a drying Diet-drink be prepared and ta∣ken daily for some time, made of Guajacum, &c. as we have directed, Cap. 31. Sect. 16, and 66. and in several other places.

XXVII. The Ʋlcer being di∣gested, you must cleanse it with Abstersives, such as this. Take Hydromel ℥x. Honey ℥iii. mix them. Or, ℞ Turpentine, Ho∣ney, A. ℥ss. yolk of one Egg, grind them together, and then add to them Hydromel, or white Port∣wine lbi. mix, and make an In∣jection.

XXVIII. ℞ Juice of Smallage and Pellitory of the Wall, A. ℥vi. Honey of Roses ℥iv. White-wine ℥ii. mix them for an Injection. If the Ulcer is foul and putrid, dissolve in the Liquor Ʋng. Aegy∣ptiacum ℥ss.

XXIX. But to Ʋlcers in the Neck of the Womb, besides the In∣jection, you may anoint with Ʋnguentum Nicotianae, or Ʋng. fuscum Wurtzii: Or apply this following Liniment of Barbett. ℞ Mercurius dulcis levigated ʒiv. Orrice-roots, Litharge of Gold, Flowers of Sulphur, Ʋng. Fuscum Wurtzii, A. ʒii. Honey of Roses q.s. mix, and make a Liniment.

XXX. Or you may inject with this. ℞ Damask Rose-water lbii. Powers of Mercury ℥iss. mix them; it cleanses pow∣erfully and safely.

XXXI. The Ulcer being cleansed you may heal with this. ℞ Rose-water lbi. red Wine lbss. Roch Alum in fine pouder ʒiii. white Vitriol ʒiss. Saccharum Saturni ʒi. mix, and inject warm.

XXXII. Or you may inject with Our Aqua Regulata, or with Aqua Ophthalmica, or with the Water of the Griffin, which is beaten, and not inferior to any other Wash.

XXXIII. And the Vulva, or Neck of the Womb, may be anoin∣ted with this Ointment. Take Ʋng. Nicotiang, Diapomp holigo, & Populeon, A. ℥i. Mercurius dulcis levigated ℥ss. Cinnabar le∣vigated ʒi. mix, and apply it.

XXXIV. If these things do not so perfectly as they should do, you must fume the Womb with these Troches: ℞ Gum of Juniper ℥i. Mastich, Myrrh, Olibanum, Ain∣ber, A. ʒii. Cinnabar levigated ʒiv. make all into fine pouder; and with Mucilage of Gum Tra∣gacanth make Troches, weighing each ʒi. One or two of these Troches will be enough for a fuming.

XXXV. The Fume may be re∣ceived up into the Privity, by help of a Funnel; and it may be re∣peated once every day, till Health is recovered: But in case of the French Disease, it may be used sometimes twice a day.

CHAP. XXXIV. Of an ƲLCER of the BLADDER.

I. WHat the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ʋlcus Vesicae, we in English call, an Ʋlter of the Bladder; in which we include an Ulcer also of its Neck.

II. The Causes. It is caused either from a Wound, or the Stone, or sharp Humors, or Diuretick Medicaments, as Cantharides, or from sharp Urine, caused by drinking much Wine, or stale Beer, and eating hot Meats.

III. The Signs. It is known by the continual or constant pain a∣bout the Bladder and Pubes; and in the Perinaeum and Ʋrethra; which pain is most vehement at the beginning and ending of Pissing.

IV. The Ʋrine also is thick with Matter, and sometimes with Blood, and sometimes with both mixt together, and comes forth many times with an ill smell; however, it stinks much, after it has stood a little while.

V. And whereas in an Ʋlcer of the Urethra or Perinaeum, the Pus or Matter comes forth first, or before the Ʋrine: In an Ulcer of the Bladder, or its Neck, it comes forth last, or at least mixt with the Urine, which makes the passage of the Urine diffi∣cult, and very hot, sharp, and painful.

VI. The Differences. The chief differences of these Ʋlcers which we shall observe here, are, 1. In respect to the Cause, as be∣ing from the Stone, Sand or Gravel, or from Humors, or Cantharides. 2. In respect to the Place, as being either in the Bladder it self, or in the Neck of the Bladder.

VII. The Prognosticks. These Ʋlcers, as they are very trouble∣som and painful, so they are very difficult to be Cured, and for the most part Incurable, because it is a part Membranous, having but little Blood in it, which causes ••nition and consolidation; and withal constantly washt with the Urine, whose saline Particles are a perpetual Cause of irrita∣tion, pain, and corrosion.

VIII. An Ʋlcer in the Neck of the Bladder, tho' it is also very difficult to be Cured, yet sometimes does admit of Healing, because it is more fleshy, and bloody, and less, or not simply Membra∣nous, as the Bladder is.

IX. If recent, and in young Peo∣ple, they are easier Cured than when inveterate, and in old: If they proceed from the Stone, they are impossible to be Cured till the Stone is taken away: If the Ulcer con∣tinues long, as it causes vehe∣ment pain, so also it causes watchings, and wastings, and at length brings the Body into a deep Consumption.

X. The Cure. The Medica∣ments to be used in order to this Cure, are either Internals or Ex∣ternals. The Internals are such things as may be first, Anodyn and Cleansing; secondly, such things as may conglutinate and heal the Ulcer.

XI. The White Potion is a good Abstersive, thus made: ℞ Strasburgh Turpentine ℥i. yolks of two Eggs, grinde all together till the Turpentine is perfectly dis∣solved; then take new Goats or Cows Milk lbiv. white Sugar ℥viii. mix and dissolve; mix this sweetned with Sugar with the mixture now made, and keep it for use. It cleanses admirably.

XII. If the Pain is very great, you may use instead of the Milk, as much Poppy-water: Of this white Potion the Sick may take ℥iii, or iv. Morning, Noon, and Night.

XIII. You may also give things smooth, slippery, oleaginous and bealing, as Goats and Cows Milk, Cream with Sugar, Almond Milk, Mucilage of Quince, and Fleawort, and Faenugreek-seed: Milk mixed with Plantane, Pop∣py or Rose Water, Emulsions made with Poppy-water, of which the Patient may continu∣ally drink, abstaining all the while from all things salt, acid, or any wise sharp.

XIV. Chio Turpentine made into Pills with pouder of Liquorice, and a little Honey, is an admira∣ble cleanser; so also Balsam of Tolu; also Balsam of Chili, or Peru, made into Pills, or a Bo∣lus with Catechu and pouder of Liquorice; and inferior to none of them is Gum Elemi, or Bal∣sam Capivii.

XV. Or you may take their Tinctures, extracted with S.V. in a gentle Sand-heat, which may be given à ʒii. ad ʒiv. at a time in White-wine, or in Milk.

XVI. Paracelsus commends Praecipitatus cum Aqua Ovorum, given à gr. iij. ad vij. and says, that it facilitates the Cure of Fi∣stula's and Ʋlcers in the Neck of the Bladder, even of such as are accounted uncurable, if injected into the Bladder with a proper Vehitle.

XVII. If the Pain is violent, you must mix with you Medicines, (whether given by the Mouth, or cast in by Injection) a propor∣tional quantity of Opium correct∣ed by some Months digestion in rectified S.V. or extracted with Our Spiritus Ʋniversalis.

XVIII. No Man can tell the Excellency of Opium, thus prepa∣red; for so it becomes as it were another thing; it is not only al∣tered from its pernicious quali∣ties, wherein it did formerly very much abound; but its Sa∣native Property is very much augmented and exalted.

XIX. And if the Body is hot and costive, it will be good to open it with gentle Purgers, such as Cassia new drawn, Manna, Sy∣rup of Roses, Agarick, Rhubarb, Mechoacan, &c. mixt with Mer∣curius dulcis; or rather with the Princes Pouder, not inferior to any other thing.

XX. The Ʋlcer being thus cleansed, you must agglutinate dry, and heal with this. ℞ pouder of Turpentine (made by loiling in

Water) Catechu, A. ℥i. Crabs Eyes levigated, fine Bole, A. ℥ss. Alum ʒii. Saccharum Saturni ʒi. all being in fine pouder, with li∣quid Storax q.s. make Pills, Dose ℈ii. ad ʒi. every Night at Bed-time: Or you may give the Pouder à ʒss. ad ℈ii. mixt with Milk.

XXI. Barbett commends this, as a thing often experienced. ℞ Spanish Juice of Liquorice, Roots of round Birthwort, Com∣frey, Osmund-Royal, A. ʒss. Frankincense, Myrrh, Mastich, white Poppy-seeds, Henbane-seeds, A. ℈i. Venice Turpentine, q.s. mix, and make Pills.

XXII. Or ℞ Troches of Win∣ter Cherries, of Amber, burnt Talck, A. ʒss. fine Bole, Terra Sigillata, Mans Skull, A. ʒi. Venice Turpentine, q.s. mix, and make a mass of Pills, which make as big as Pease; of ei∣ther of these Compositions, the Sick may take •• every Morning and Evening.

XXIII. Blood of Comfrey given in Tinctura Martis made with White-wine, for several days to∣gether, is an Excellent thing: So also Tincture of Catechu given in Poppy-water, and sweetned with Syrup of Comfrey.

XXIV. As for Externals, you may use this Injection. Take Lime-water (but not made too strong) ℥iii. Plantane or Poppy Water ℥ii. white Troches of Rha∣sis ʒi. mix them, and inject twice or thrice a day with a Ca∣theter-Syringe.

XXV. You may cleanse by an Injection made of Juice of Parsly, or Smallage clarisied; to ℥viii. of which Mel Rosatum ℥ii. may be added: But for this purpose no∣thing exceeds Our Aqua Regu∣lata, or Aq. Ophthalmica; to ℥viii. of which you may add Honey of Roses ℥ii. Spirit of Wine ℥i. which may be injected into the Bladder 3 or 4 times a day. See more hereof in the Third Edition of Our Synopsis Medicinae, lib. 5. cap. 38, & 42.

CHAP. XXXV. Of an ƲLCER of the GROIN.

I. WHat the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ʋlcus Inguinis, vel In∣guinale, & Fistula Inguinis; we in English call, an Ʋlcer of the Groin, and a Fistula of the Groin.

I. Of an Ʋlcer in the Groin, not Fistulated.

II. The Causes. An Ʋlcer may be caused, 1. From a Wound made by External Violence. 2. From a Bubo, Phlegmon, or Apostem, being broken or open∣ed.

3. From a Flux of sharp Humors. 4. Symptomatically, or from a Crisis, Nature expelling the Morbifick Matter that way.

III. The Signs. An Ʋlcer is manifest at sight: It many times penetrates deep, thro' the ob∣lique and transverse Muscles of the Abdomen, and yields for the most part a stinking sort of Quittor.

IV. The Prognosticks. If you perceive such an Ʋlcer as aforesaid, you may judge it not to be easily Cured, more especially if it falls out after a Venereal Bubo: For, 1. There is a Disease with its Cause joined to it. 2. It cor∣rupts the Fibres of the Muscles. 3. It sometimes corrupts the Vertebrae of the Loins, in which last case, the Disease is Mortal.

V. If it is recent it is more ea∣sily Cured than if it is inveterate; and if benign, more easie than if it were malign; and if it continues long, it for the most part in∣duces a Marasmus, or a deep Con∣sumption; because those Parts being as it were the Sink of the Body, are apt to drain all the Juices, even the Radical Moi∣sture out that way.

VI. The Cure. Let the Ʋlcer come from what Cause soever, upon its first appearing it generally wants digestion, and therefore Digestives ought to be applied for sometime, but not too long, (because of the over-great moi∣sture of those Parts) for that they are apt to produce a pu∣tridity.

VII. The next thing is to de∣terge the Ʋloer with proper Ab∣stersives: Ʋng. Nicorianae is a good thing, with which if the Ulcer is very foul, you must mix a little Ʋng. Aegyptiacum: Some use Ʋng. Apostolorum; but Ʋng. Fuscum Wurtzii is inferior to none of them.

VIII. If it is recent, it may be drest with this. Take Juices of Smallage and of Scordium, A. ℥iv. Honey of Roses ℥ii. mix for a Po∣tion; after which dress it up with Ʋng. Nicotianae mixed with equal parts of Apostolorum: If it is very putrid you must dress it with Basilicon mixed with Praeci∣pitate.

IX. The Ʋlcer being cleansed, you must induce the healing with proper Incarnatives and Epulo∣ticks, which by reason of the moisture of the Part, are to be drier than ordinary.

X. If it proceeds from a Vene∣rial or Pestilential Bubo, after they are brought to maturation, you must use the general Means prescribed in the Cure of those Diseases.

II. Of a Fistula in the Groin.

XI. The Cause. It is for the most part caused from an Ʋlcer be∣ing continued, or from the ill ma∣nagement of its Cure, by applica∣tion of improper things.

XII. The Signs. They are known by sight, and proceed for the most part from Venereal Bubo's ei∣ther neglected, or ill handled: Sometimes they happen in the Emunctories themselves, and sometimes somewhat above the Emunctory, the Matter not reaching it.

XIII. The reason in this last

Case is, either the weakness of the Expulsive Faculty, or the crossing of the Muscles oblique and transverse, in those Parts.

XIV. Nor is it any wonder that Abscesses, vlcers, and Fistula's, often fall out in those places, for that they are the sink, as it were, of the Body, where almost all the impurities flow; so that a perfo∣ration of the Guts is sometimes caused, that the Excrements come out at the Orifice of the Fistula.

XV. And sometimee it so falls out, that the Fistula penetrates many ways, even to the corrup∣ting of the Vertebrae of the Spina, making the Patient very uneasie.

XVI. The Prognosticks. All Fistula's in these Parts, which pierce into the Cavity of the Abdo∣men, are Cured with much diffi∣culty; 1. Because the sink os the Body is as it were there, a continual flux of Matter is apt to ensue, either from the Liver, or some other Parts. 2. Be∣cause that if Incision or Corro∣sive Medicaments are used, the Fibres of the Muscles, and Branches of the Vena Cava, and Aorta, are in great danger to be hurt.

XVII. If the Guts are eroded, and the Excrements come out at the Orifice of the Fistula, there is great danger of Death, 1. Be∣cause Topicks can scarcely be applied to them to induce the Consolidation. 2. Because the Guts are membranous, thin, and have but little blood, which is the medium of Unition. 3. Be∣cause we can have but little assi∣stance, either from Hand, or Eye. 4. Because the Fistula is apt to creep between the Mus∣cles, (which in those places are many) viz. the oblique and transverse, which are placed one above another.

XVIII. If the Vertebrae of the Spine be corrupted, the Fistula is incurable: And you may easily know when it is foul by the great quantity of stinking Sanies flowing from the same: The Patient also grows daily weaker and weaker, whatever Means is used, and being wonderfully extenua∣ted, at length Dies of a Maras∣mus, or deep Consumption.

XIX. The Cure. If the Fi∣stula is not deep, but superficial, make Incision, and remove the Callus by the help of some Ca∣theretick Pouder, or by the ways and means which we have pre∣scribed in Cap. 20. Sect. 78. ad 103. and in Cap. 24. Sect. 26. ad 35.

XX. Then Absterge the Ʋlcer, Consolidate and Cicatrize, accord∣ing to the Prescriptions delivered in the general Method of Cure, ap∣plying proper Abstersives, Sarco∣ticks, and Epuloticks; all which in Ulcers of these Parts ought to exceed the ordinary Medica∣ments of these kinds, as to their desiccative or drying Qualities, by reason of the very great moi∣sture of these Parts.

XXI. If the Guts are perfora∣ted, you ought to acquaint the Friends and Relations of the Pa∣tient with the Danger; but in your own Brest not to Despair, but to proceed on with Courage, for that Nature does some things (even in this case) almost Mi∣raculous,

and many times won∣derfully beyond our utmost Ex∣pectation.

XXII. Let his Food be made of things glutinous and consolida∣tive, as Meat prepared of Sheeps and Calves Feet, Neats Feet, Knuckles of Veal, and Knuckles of Pork, Jellies of Hartshorn, and Jellies made of the Guts of Calves, Sheep, and Hogs, which Cure by a Specifick Virtue.

XXIII. Rice boiled in Milk is very good; so also Frumety made of Wheat, having plenty of Raisons, and blue Curants in it: Thick Milk made with Wheat-flower, or white Starch, is proper; and very Excellent is Milk boil'd thick with Oatmeal, which nou∣rishes much, consolidates, and yet cleanses.

XXIV. Every Morning and E∣vening he may drink a good Draught of Alicant, or Spanish red Wine warmed with a Toasted Bisket sopt in it, eating the Bis∣ket; for the Spirit of the Wine, and its Styptick Property helps on the Consolidation, and Heal∣ing.

XXV. And inwardly you may give, Morning, Noon, and Night, the Pouder of Ox Guts à ʒss. ad ʒi. mixt with Blood of Comfrey, or Syrup of Comfrey ʒiv. or ʒvi. and then given with a Glass of warm Alicant. It is a Speci∣fick.

XXVI. Outwardly inject some Styptick Liquor, or this Mixture. Take Smiths Forge-water filtred ℥viii. Syrup of Myrtle-berries, or of red Roses dried ℥ii. Alum (dissolved in a little Rose-water) ʒii. mix them; and keep the Orifice open with a Sponge till the Gut is consolidated.

XXVII. The Gut being healed, you must then proceed to the remo∣ving of the Callus, after which by Abstersives, Incarnatives, and Cicatrizers, compleat and per∣fect the Cure.

XXVIII. If the Vertebrae of the Spine are foul, undertake no Cure, but if upon Consideration they will entertain you to dress them, you may inject into the Fistula the following Sanative Potion.

XXIX. Take Meadow-sweet Water, or rather Smiths Forge-water filtred lbi. Juice of Scor∣dium clarified ℥vi. Syrup of dried red Roses ℥iv. Tincture of Aloes, Myrrh, and Saffron, made with S.V. ℥ii. Tincture of Euphorbium ℥i. mix them, and over all lay Our Empl. Album, Diachylon cum Gummi, or Stypticum Paracelsi.

CHAP. XXXVI. Of an ƲLCER of the YARD.

I. Of an Ulcer External.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ʋlcus Penis, vel Virgae, we in English call, an Ʋlcer of the Yard.

II. The Causes. It may be caused either from external Vio∣lence, as Wounds, Bruises, &c. Or, application of Corrosive Medi∣caments; or, from the Poyson, Malignity, and Infection of the French Pox.

III. The Signs. It is known by sight, being a solution of Conti∣nuity with Putrefaction: If the Ulcer is sordid, foul, or putrid, it stinks much.

IV. The Kinds. It is either External, of which we speak here, or Internal, with Caruncles or Carnosities, which are fleshy Excrescencies.

V. The Prognosticks. If re∣cent they are easily Cured, if inve∣terate with more difficulty, espe∣cially if they are sordid, malign, virulent, or callous.

VI. If they proceed from the French Pox, they are much more difficult, and sometimes by ill Management degenerate into Gangrene or Sphacelus.

VII. The Cure. First inward∣ly take (to purge with) Pilulae Holagogae, or Our Pil. Cathar∣ticae, or Panchymagogae, or Our Family Pills: Or you may purge with Tinctura purgans, or Syrupus Catharticus, Electuarium Catharticum, or with Pulvis An∣timonii, or Pulvis Catharticus.

VIII. Then exhibit a Vulnerary Diet, or, if it proceeds from the French Pox, a Diet of Guajacum and Sarsa, whose use is to be con∣tinued for at least thirty days; for as much as these kinds of Ulcers are stubborn and rebelli∣ous, and oftentimes return a∣gain, or are otherwise apt to degenerate into a Cancerous Ul∣cer, and sometimes to Sphace∣late.

IX. Outwardly you must for some time apply Digestives, till they yield a good and laudable Quittor, after which they are to be cleansed with Mundificati∣vum Paracelsi, or Ʋnguentum Fuscum Wurtzii, or Ʋng. Nico∣tianae mixt with a little white or red Precipitate.

X. Then anoint with Ʋng. Mirabile, or Diapampholigos mix∣ed with a little white, Precipitate, or with this. ℞ Litharge ʒiv. burnt Lead, Oil of Roses, Quick∣silver, A. ʒiii. Tutia prepared ʒii. Aloes ʒiss. Pomgranate-peels ʒi. Load-stone, Saccharum Satur∣ni, A. ℈ii. Wax, q.s. mix, and make an Ointment.

XI. If this prevails not, by reason of the foulness of the Ʋlcer, you may use this. ℞ Rhenish Wine ℥vi. Plantane Water ℥iv. Spirit of Wine ℥i. burnt Alum ʒi. Verdigrise ʒss. mix, and boil a little; to which if the occasion yet require, you may add a lit∣tle Precipitate, or Mercurius dul∣cis levigated, or Powers of Mer∣cury ʒvi.

XII. Or you may wash with Our Aqua Regulata, or Aqua Ophthalmica, or which is better, and transcends all others, with the Water of the Griffin, for that these things very much hasten the Cure; and if the Ulcer has gotten within the Ʋrethra, they may be injected with a Syringe.

XIII. If the Ʋlcer is Cance∣rous, you may use this. Take Juice of Bramble tops, or Juice of the Fruit, Vinegar of Roses, A.℥ii. Juices of Housleek and of Night∣shade,

A. ℥iii. Aqua Vitae ℥iv. Malaga Wine, Oil of Roses, A.℥vi. Litharge of Gold ℥i. Frankin∣cense, Mastick, A. ℥ss. Verdi∣guise ʒiiss. Vitriol, Alum burnt, A. ʒiss. Camphir ʒi. pouder what are to be poudred, &c. and boil all together (except the Camphir) with a gentle Fire to the Consump∣tion of the Juices, then put in the Camphir, and with Wax q.s. make an Ointment.

XIV. If a Sphacelus attends the Part, the only Cure is by cut∣ting off, lest it creep inwards, and perforates either the Bladder or Perinaeum, and so kills the Pa∣tient. See more hereof in the Third Edition of Our Synopsis Medicinae, lib. 5. cap. 44.

II. Of an Ʋlcer Internal, with Caruncles.

XV. This the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Carnositas, Caruncula; and we in English, a Carnosity, or fleshly Excrescence within the Ʋrethra.

XVI. The Cause. Tho' it is possible they may be caused from an Ʋlcer of the Part, yet they pro∣ceed for the most part from a virulent Gonorrhaea, or the French Pox.

XVII. The Signs. They are known by the stoppage of the Ʋrine, or a great difficulty in pissing, with heat and pain; as also by search∣ing with the Probe, Catheter, or a Wax Candle, for that the Caruncle will stop their passage into the vrethra, and the Urine many times as it comes in small quantity, so it comes forth in a forked stream.

XVIII. The Prognosticks. They are Cured with some difficul∣ty, and scarcely without very dry∣ing and Catheretick Medicaments, assiduously applied for some con∣siderable time.

XIX. The Cure. It is per∣formed by removing the Caruncle, cleansing the Ulcer with Abster∣sives, consolidating and healing with Epuloticks.

XX. To remove the Callus you may often inject with this. Take Lime Water ℥viii. Mercurius du••∣cis levigated, or rather the Princes Pouder, or Turpethum Minerale, or white Precipitate ℥ss. Syrup of Roses ℥i. mix them for an In∣jection.

XXI. And by the help of a Pipe you may put in upon this Carnosity this Catheretick Pouder. Take burnt Alum ʒii. red Precipitate, Turpethum Mineraele, white Pre∣cipitate, pouder of the Griffin, A. ʒss. all being levigated very small, mix them together first by themselves, and then with vng. Basilicon, or Nicotianae, ℥iss. make an Ointment thereof.

XXII. The Carnosity being re∣moved, wash with the Water of the Griffin, which will alone heal the Ulcer, without any other Medicament. See more of this Cure in lib. 1. cap. 37. of this Work, where we have handled it more at large; as also in Our said Synopsis Medicinae, lib. 5. cap. 44.

CHAP. XXXVII. Of a FISTƲLA of the ANUS.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Fistula in Ano; we in English call, A Fistula in the Funda∣ment.

II. The Causes. They mostly proceed from Phlegmons, Phymata, and Hemorrhoids, broken, and ill cured, or not cured in a long time; as also from the Wounds made with Horsleeches, not well cu∣red, or leaving some Venom behind in them; which creating a malign and corrosive Juice, insinuates its self farther and farther, making a long Sinus, which in process of time be∣comes callous.

III. The Signs. Those which are caused by the inward Piles, are made gradually, and pass their Matter, (says Wiseman) which is a thin Gleet, between the Tu∣nicles of the Intestinum rectum, making their way out, near the Verge of the Anus, thro' a small Pin-hole, as it were.

IV. These are discovered by the issuing out of a thin Humor, staining the Shirt or Shift, rather than by any Pain they cause; which Discharge is thought to be ra∣ther a kind of Sweating than otherwise; yet it is not a sweating, but a real issue of thin Matter.

V. This in process of time is accompanied with itching, and is subject to excoriation or galling; from whence sometimes several kinds of Pimples or Pustles do break out; and sometimes Rha∣gades, Fissurae, or Chaps; and at length the Sinus spreads out∣wards, and grows callous, and the Orifice hard, and so con∣tracted, that a small Probe will hardly go in.

VI. Those Ʋlcers which are caused by Phymata, cause their Matter to pass deep among the Interstitia of the Muscles, (as other Abscesses in fleshy parts do) according as they can make their way: sometimes they pe∣netrate through the Intestinum rectum, to the very neck of the Bladder, yea into the Pelvis; or at best, insinuate their Gleet amongst the Musculi glutaei, &c.

VII. These are very painful, and send forth a sanious or purulent Matter, proportionable to their hollowness: and in length of time, they make as it were Coney-burrows, and grow cal∣lous; being of the worst sort of these Fistula's.

VIII. If a search is made with a Probe into the Sinus which comes from the Piles, and the while you press your Finger into the Anus, you may feel the Probe run all along between the Tuni∣cles of the Intestine; and it may pass thro' the Pile which gave it its original.

IX. Whereas the Sinus's which proceed from another root or spring, have outwardly no external Ori∣fice, but an Orifice inwardly, and discharge their Pus or Matter by Stool: yet possibly in length of time they may make a way ex∣ternally, and pass their Matter thro' one or more Orifices out∣wardly, at a farther or nearer distance from the Anus, ac∣cording as the Apostem lay in the Intestine.

X. You may easily find out, whe∣ther the Fistula does pass thro' the Intestinum rectum, or not: for, the Intestine or Gut is penetrated, if an Injection being made by the outward Orifice of the Fistula, it passes within the Anus: or, if after breaking of Wind, part of it makes its way thro' the Sinus: or, if putting your Forefinger into the Anus, you feel the naked Probe, it being thrust thro' the Sinus of the Fistula, by the outward Orifice: or, lastly, if the Excrements appear to be mingled with the Pus or Quit∣tor, or if the Quittor smells like the Excrements.

XI. The Prognosticks. No Fi∣stula in Ano is easy to be cured, because this place is as it were the Sink of the Body; and so abounds with plenty of impurities, and much superfluous moisture, which alwas hinder the Cure.

XII. Those Fistula's which pe∣netrates deep, beyond the Musculi Ani, if they be cured by laying open, the Patient will scarcely after retain their Excrements, but with much difficulty; and if they reach beyond the Sphin∣cter, the retention will be im∣possible.

XIII. Simous Ʋlcers arising from Phymata, if they have been of long continuance, are dangerous, and of difficult cure: Ulcers in Ano, are also hard to be cured, if they discharge a large quantity of Pus, by an opening so far distant, that you cannot safely lay it open; but the nearer to the Anus, the more easy the Cure.

XIV. If it proceeds from a Ca∣cochymical Constitution, where the Lungs or any Viscera are weak; it ought never to be healed, but kept open as a Fontanel or Issue, for discharge of Morbifick Hu∣mors.

XV. But if it cannot be kept open, with ease to the Patient, a good and sparing Diet is to be pre∣scribed; and the Humors are to be carried off some other way, before the absolute Cure is at∣tempted.

XVI. In like manner, sinuous Ʋlcers arising from the Piles, ought to be kept open, so long as they can be continued without pain trouble, or disturbance to the Pa∣tient: for by this means the Body will be discharged of ma∣ny superfluous Humors, and the whole Man kept in health.

XVII. Sinuous Ʋlcers in length of time grow callous, and so be∣come Fistulae; and they only differ from sinuous Ʋlcers as they are callous, which being in the Fundament, are more te∣dious than in other parts.

XVIII. If the Fistula does run superficially upwards by the Inte∣stinum rectum, whether it pene∣trates the Anus, or not, it is without danger, and may easily be cured.

XIX. But if the Fistula runs higher up, than you can reach it with your Fingers, it will be of difficult cure, because you can∣not lay it open the whole length: and if the Humor issues from the remaining Sinus, upon the Part which is opened, it will hinder cicatrizing.

XX. If the Fistula is become inveterate, runs much, and the Patient is much extenuated, strength decayed, Stomach lost, or debilitated, with faintness, and faint cold Sweats; let the state and condition of the Fistula be what it will, pierce the Intestine, or pierce it not, runs deep or superficial, it signifies not much; for it is to be feared, the hopes of Cure are past.

XXI. The Cure. It is twofold, viz. 1. Real. 2. Palliative. As to the Real Cure: a good Diet being instituted, and Universals prescribed, as in other Fistula's, we shall come immediately to the Chirurgick Part, which is performed by Deligation, or In∣cision, and the application of Topicks.

I. By Deligation.

XXII. The Cure by Deligation or Ligature, which was the Opera∣tion of the Ancients: but here is to be noted, that Deligation and Incision have place only when the Fistula is shallow; if it be deep, it cannot well be attem∣pted by any of these means.

XXIII. If therefore the Fistula penetrates into the Intestinum rectum, first, dilate it with a Fistula-Tent or Sponge, and remove the external callus as we have formerly taught; for so the Part which is to be bound will be more thin, and so more easily cut asunder by the Ligature.

XXIV. Let the Ligature be made of twisted brown Thread, or fine stitching-Silk, to which some put a Horse-hair, whereby they are made to do the work the quicker; a twist of three Threads of stitching-Silk may be enough; for if the Ligature is made too thick, it will too much bruise the Flesh in cutting it.

XXV. Others make it of fine sealing-Thread, which is made of the best Hemp, unboiled and un∣whitened; which is exceeding strong, and will not rot before it has done the work a either of these may do, you need not be very curious about the choice.

XXVI. Where the Fistula has penetrated put one end of the Thread or Ligature into the eye of a small and flexible Probe, made of sina and pliant Silver, or of Lead; then thrust the eye with the Thread thro' the Sinus into the Intestinum rectum; which done, put into the Anus your Finger, and with it pull the Thread out of the eye of the Probe, and draw it out at the Anus: or having bent the eye of the Probe, bring it without the Anus, and then putting the Thread into the eye, draw that end thro' the narrow Orifice of the Fistula.

XXVII. If the Sinus is not very thick and long, you may by one strong deligation bind up all the Sinus: but if the Sinus is thick and long •• you must use several

constrictions, tying the ends of the Thread with a running∣knot, that it may be the more easily loosed: but some, after one deligation only, more and more draw in the ends of the Thread, with a round piece of a Stick turned about.

XXVIII. Where the Fistula has not penetrated the Gut, you may make use of a short Probe, making the point sharp, to pass thro' the Intestine; but it must be very pliant, that it may be the fitter for the work.

XXIX. And in some cases, where the Fistula lies high, and the Sinus is crooked, you may make use of a fit Cannula, for the con∣veying the Needle up; and to strengthen it in its work, that it does not bend in perforating of the Intestine.

XXX. When all the Sinus after division by deligatiou, lies open, go forwards in the Cure, as if it had been opened by Incision; by removing the Callus, Abs∣tersion, Incarnating, &c.

II. The Method by Incision.

XXXI. The laying it open by Incision is thus. The Mouth of the Sinus is to be dilated by a Tent of Sponge, &c. and the exterior Callus is to be removed; if it be troublesom: otherwise immo∣diately go to the Work, and divide the Sinus with a pair of Scissars; which some Artists approve of, for the speedy division it makes; and indeed, if the Sinus is short, it is the Best way.

XXXII. But in doing this, you must be careful, lest the folds of the rugous Coat should fall between; for so you may chance to make two Wounds of one.

XXXIII. But if the Fistula penetrates the Intestine very deep, the work will be more difficult and bazardous, not only in the cutting, but in the progress of the Cure: for the newly-divided lips will be apt to fall one upon another, and so unite again; which if they do, the Fistula is renewed: and a Dossel or Tent put up the Sinus, will not continue in it, but lye as a Suppository, conti∣nually stimulating the Intestine to thrust it forth.

XXXIV. Whereas the Ligature contuses in some measure the lips, in cutting them; so that they re∣quire to be digested before they can unite, in which the Sinus fills up with Flesh, and heals within; so that the Fistula seems to heal, or be cured above, as the Liga∣ture divides below.

XXXV. The Fistula being thus opened, whether by Deligation or Incision, the Callus is to be removed by Cathereticks, as we have taught in the Cure of a Fistula in general, then to be digested, cleansed, incarnated, and cicatrized.

III. The Application of Topicks.

XXXVI. The Callus being re∣moved by Cathereticks, or Incision, or Canteries, fill up the hollowness with Dossels armed with an astrin∣gent Pouder, and the white of an Egg, to keep the lips of the in∣cised parts asunder: for if you should endeavour an unition too

soon, the cavity may possibly still remain, and induce a Reci∣divation.

XXXVII. For which reason, it is necessary that with Incarnatives (not fat or greasy) you should en∣deavour to engender good and sound Flesh in the bottom: if it is fatty it will generate loose and spon∣gy Flesh, which will put you to more trouble.

XXXVIII. For this purpose you may make use of this. Take Syrup of dry'd red Roses, or Syrup of Myrtles, or some other Ʋulne∣rary and Sanative Syrup ℥iv. Pulvis Cephalicus ℥i. mix them.

XXXIX. In opening the Fistu∣la by Ligature, there is wont to be sometimes heat and Inflammation: in this case, it is usual to apply a Stuph of Tow dipt in austere Red-wine, and Oil of Roses to al∣lay the heat of the Part.

XL. And every day (whilst the Ligature is doing its work) after going to Stool, it may be drest: and if need requires, you may inject a Decoction of hull'd Bar∣ley with Quince or Fleawort∣seeds, and then apply some Lenient or Auodyn, as Ʋng. Populeon, Rosatum, &c.

XLI, It is also to be noted, that in opening it by Ligature, the third or fourth day, the knot is to be ty'd streighter: and so in twice or thrice tying the Liga∣ture, it will cut its way out: or when it is almost through, the remaming part may be cut with a pair of Probe Scissurs.

XLII. If you use the Cannula, you must first pass it up the Orifice of the Fistula, and place the end of it against your Finger, which (be∣ing first anointed with a little fresh Butter) you have put into the Intestinum Rectum; then ano∣ther holding the Cannula, you may pass your Needle thro' it into the Gut; and as it is brought out by your Finger there, slip off the Cannula, and hasten the Needle forwards on its way, till you have brought it out with the Ligature: then cutting off the Needle, make the knot upon a bit of Emplaster, to prevent the Ligatures cutting the oute side, tying it as strait as the Patient can bear it, and making the second knot with a bow, and place the ends thereof so, as it may not be fouled in going to Stool.

XLIII. If there are shrivell a Piles or Condylomata, &c. about the Verge of the Anus, cut them off at the same time, or before you make the Ligature or Inci∣sion, to prevent the Inflamma∣tion, they might be subject to from the pain, which may be caused by the Operation.

XLIV. If the Sinus runs deep under the Verge of the Anus, so that the Lips are like to lie high, to make as it were a Gutter; it will be best to take them down by application of a Caustick, for it will much hasten the Cure, and make the Cicatrice smooth.

XLV. But if the Fistula goes so deep inwardly that you cannot con∣venlently open it, neither by Liga∣ture, nor Incision, you must in this case, dilate the Fistula with a Fistula Tent, and the Sponge: then remove the Callus with some proper Catheretick, as the Fistula Trochisk; the Trochisk

being come out, and the Callus wasted away, deterge it with Mel Rosatum mixed with Aqua Calcis, &c.

XLVI. When it is well digested, and cleansed, and a good Pus comes forth, you must incarnate with some choice Sarcoticks, or with that at Sect. 38. above; which you must put into the Sinus up∣on Tents, which Tents you are day by day to shorten, till at last the whole Sinus of the Fi∣stula is closed; then cicatrize with Ʋng. de Minio, Empl. Al∣bum, &c.

IV. The Palliative Cure.

XLVII. Where Fistulae in Ano cannot be Cured, or are not safe to be Cured, but it is more health∣ful to keep them open, to help Na∣ture in the discharge of the Morbisick or Superfluous Humors, descending by the Haemorrhoidal Vessels, espe∣cially when they are without pain, or any great trouble, are small, and terminate in the Orisice of the Anus; in all these Cases, the Palliative Cure is to be chosen.

XLVIII. If you see that the Orifice of the Fistula swells, and will not keep open; or that by rea∣son of the Contraction of the Callus, the Matter may be straightned; so that it may be in danger of insinuating it self deeper, and make the evacuation trouble∣som; it will be good to apply a small Caustick upon the Orifice, to remove the Callus.

XLIX. And after the separa∣tion of the Slough, the Orifice may be kept open with much ease, as if it were a Fontanel or Issue: And for receiving the Matter, and preventing Excoriation, the Patient may wear a Pledget of fine Tow, which will sit close without Bandage.

L. Or it may be spread thin with some softning Ointment, as the ne∣cessity may require, and be kept clean without any very great trou∣ble, till some ensuing Symptom shall indicate what is more to be done in it; or till length of time may happily Cureit.

LI. An Observation. A recent Fistula in Ano, coming upon Piles ill Cured, I perfectly Cured by a good Diet drink made of Guajacum, Sarsa, &c. and sitting many times on a Close-stool over the Fumes of Amber.

LII. Another Patient I had who had a Fistula in Ano, which proceeded from the applying of Leeches; it was a young Woman who had it above Five Years, and was very troublesom to her. I Cured her by a Salivation of 24 days, and a Guajacum Diet-drink, causing her for a considerable time to sit every day on a Close∣stool over the Fumes of Am∣ber.

LIII. Another Patient I had, which I Cured only by sitting for some days, half an Hour, and fometimes an Hour in a day, on a Close-stool, and receiving up his Fundament the Fumes of Cin∣nabar Artificial, made up into Troches in this manner. Take Winters Cinnamon in pouder, Am∣ber in fine pouder, A. ℥iss. Gum of Juniper, Mastich, Myrrh, A. ℥i. Artificial Cinnabar ʒvi. all being in fine pouder, with Mucilage of Gum Tragacanth, make Troches,

each weighing ʒss. of which he used 4 or 5 at a time. See the Third Edition of Our Synopsis Medicinae, lib. 5. cap. 57.

CHAP. XXXVIII. Of an ULCER and FISTƲLA in the JOINTS.

I. WHAT the Greeks call 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the La∣tins, Ʋlcus, & Fistula Artus vel Articuli, we in English call, an Ʋlcer, and a Fistula of a Joint.

I. Of an Ʋlcer of the Joints.

II. The Cause. It is often∣times caused by Wounds ill•• mana∣ged, Contusions, external Violence, defluxions of sharp Humors, Apo∣stems, Kings-Evil, French-Pox; &c.

III. The Signs. It is known by sight; if it is malign, the Sa∣nies running from it will be thin, and evil-coloured, and of no good smell; also the Patient will be in much paln.

IV. The Prognosticks. An Ʋlcer of the Joints is not very ea∣sily Cured; and if it is not well managed at first, it quickly be∣comes sordid, or malign.

V. If it once becomes inveterate, either a flux of Humors, (which some call the Joint-water) fol∣lows it, or it becomes a Fistula.

VI. The Cure. As these Ʋl∣cers are commonly very painful, and sometimes vitiated with a flux of thin Humors, or a running Water, so greater Care than ordi∣nary ought to be taken in their Cure: You ought often to purge with Tinctura purgans, or an In∣fusion in Wine, of Sena and Rhubarb.

VII. Or, the Patient may purge with Our Panchymagogue Pills, or with Pil. Catharticae, or Pulvis Cornachini, or Pulvis Antimonii, or Pulvis Catharticus Antimonii.

VIII. During the whole Cure, a drying Diet-drink ought to be taken, made of Guajacum, Sassafras, Sarsa, China, Mechoacan, and Burdock Roots, with the Vulne∣rary Herbs; without which, and often purging, it will not be easie to stop the flux of sharp Humors: Those who cannot take Pills, may take Our Electua∣rium Catharticum.

IX. Then to strengthen the Tone of the Parts affected, the Patient between purging ought to take every Night of Our Volatile or Specijick Laudanum, à gr. ij. ad iv. or vi.

X. And outwardly, tho' the Cure differs but very little from the Cure of Ʋlcers in other Parts, yet the Medicaments to be applied, ought to be much more desiccative, and with as little sharpness as may

be; and more powerful Anodyn Cataplasms, for alleviating of the pain, are to be used; be∣cause Pain is an inseparable Ac∣cident of the Ulcers of these Parts.

XI. If the Ʋlcer is without a flux of Humors, you may apply Deficcativum rubrhm, and anoint the Lips with this Ointment, ℞ Ʋng. Populeon, Album Cam∣pheratum, A. ℥i. Oils of Quinces and Poppies, A. ℥ss. mix them.

XII. But before you apply the Medicaments, foment the Part with a Decoction made of Balau∣stians, Pomgranate-peels, red Roses dried, Myrtle-berries, and Sumach, in red Astringent Wine.

XIII. But if the Joint-water is present, you must pour warm into the vlcer Our Unguentum Nico∣tianae, or, Ung. Fuscum Wurt∣zii, and then lay upon it, Lint dipt in the same, over which lay Emplastrum Paracelfi.

XIV. When the flux of Humors is stayed, and the vlcer clean, you must use Incarnatives of the dri∣er sort, as; ℞ Ʋng. Diapompho∣ligns, Desiccativum rubrum, Ana. mix, and apply it; or you may use that at Sect. 11. aforegoing.

XV. If any Tumor is approach∣ing, foment with the Tincture of Balaustians, Pomgranate-peels, Myrtle-berries, Sumach, and Ca∣techu, made in Spirit of Wine.

XVI. If the vlcer is very deep, so that the Ung. Fuscum cannot come to the bottom of it, make Tents of the Body of the Ointment, being boiled to a thickness, which put into the bottom of the Ul∣cer, and cover it so, that it may not get out again, over which lay Sticticum Paracelsi, as aforesaid.

XVII. The Tent will melt in the vlcer, cleanse powerfully, and repercuss any Water or Humor flow∣ing into it; being cleansed, you may perfect the Cure with Bal∣sam of Chili, or Peru, or some Artificial Balsam, with the Em∣plaster aforenamed.

II. Of a Fistula in the Joints.

XVIII. These are caused for the most part, either from a flux of Humors falling down from the Part, or from an Apostem, or from an vlcer ill managed, or ill cured; or from the Kings-Evil.

XIX. The Differences. Some are without Corruption of Bones and Cartilages, and some are with them: Some are without any Tu∣mor of the adjacent Parts, and some are with such a Swelling; so that the Swelling is either hard, or soft, in which some of the Tendons of the Muscles are very often corrupted, as in Fistula's of the Wrists and Ancles.

XX. In some of these Fistula's, the Joint remains firm and strong; in others it becomes loose and weak, by reason of the relaxa∣tion of the Membrane which covers it, and of the Ligaments which confirm and strengthen it.

XXI. The Prognosticks. If in a Fistula of the Instep or Wrist, there be large and hard Tumors in the Feet or Hands, it is said to be incurable; for that the Mem∣branes and Tendons of the Mus∣cies and Bones, are for the most part corrupted.

XXII. In a Fistula of the Wrist, if the Bones of it, or of the back of the Hand, be carious, the Cure will be very bard to be performed, because these Bones are spongy, and so apt to receive superflu∣ous Humidities, and withal, are not easie to be scaled.

XXIII. But indeed there is not any Fistula of the Joints, tho' it is without Corruption of the Carti∣lages or Bones, easie to be Cured; partly by reason of the pain from the sensibleness of the Part; and partly by reason of the sharpness of those Medica∣ments, which must be applied to remove the Callus, which al∣ways increase that pain, and so are apt to induce Symptomati∣cal Fevers, loss' of Appetite, Watchings, Restlesness, Exte∣nuation or Wasting of the Body, and at last a Hectick and Ma∣rasmus.

XXIV. If one of these Fistula's in the great Joints, is accompa∣nied with an extenuation, or pi∣ning, or Hectick Fever, the Case is desperate; for drying things which ought to be exhibited in the Cure, do add infallibly to the Consumption.

XXV. And for the same Rea∣sons that a Fistula in the Wrist is bard to be Cured, is a Fistula in the Ankle or Instep yet harder; for besides the Cariosity of the Bones, and their sponginess, here is withal a greater danger of a flux of Humors, because it is a more depending Part.

XXVI. A Fistula in the Elbow or Knee, if it is with Corruption of either Cartilages or Bones, since they are very sensible Parts, there will be a very great pain, and a mighty difficulty in the Cure; and if ever it is performed, it will not be done, but through a great length of time.

XXVII. The Cure. Ʋniver∣sals, and a proper Diet, with Wound-drinks being prescribed, as is usual in other Fistula's, we will come immediately to the Topi∣cal Cure.

XXVIII. 1. By reason of the Pain, Anodyn Cataplasms, are to be applied to alleviate it: This of Fallopius is commended. Take Bran, Flowers of Camomil, Bar∣ley Meal, Oesipus, A. ℥iiss. Oils of Earthworms, of Camomil, and of Dill, A. ℥ii. Alicant Wine ℥iss. mix, and make a Cataplasm.

XXIX. 2. Toremove the Cal∣sus, we commend, Arcanum Co∣rallinum, red Precipitate, or un∣washed Turpethum-Minerale, as the most Excellent things, and the latter of them as the best: You may mix it (or the others) with fine Bole, or Terra Sigil∣lata, and Vitriol calcin'd, which Compositum may be applied in form of Troches, or mixed with Ʋng. Populeon, and so appli∣ed upon a Tent; it produces no vehement Pain, nor inflamma∣tion, or other vehement Symp∣tom.

XXX. But beware that you apply not Arsenick, or Corrosive Sublimate, to remove the Callosi∣ty; for they always cause vehement Pain, Symptomatick Fevers, and (if the Patient be of a Cacochy∣mick habit of Body) many times a Mortification of the Part: I once saw the application of the latter to a Fistula in the Instep,

but it was with a great deal of Horror.

XXXI. 3. The Callus being, removed either by what is already said, or by Ung. Fuscum Wurtzii, boiled up to a Consistency, so as to be formed into Tents; you must mundifie, incarnate, and cica∣trize, as we have taught in the Cure of other Fistula's; but with this Observation, that here, all your Applications ought to be more desiceative, than in the Fistula's of other Parts.

XXXII. 4. If there is a Cario∣sity of the Bones, you must dress them with Tincture of Euphorbium, or with the Pouder of the same, it is safe, and without danger.

XXXIII. 5. If after some trial you perceive the Disease to be incurable, you must come to Am∣putation or Extirpation, be it Foot or Arm; and this must be, be∣fore the Patient grows too weak, or becomes unable to bear it: And this you may more safely do in a young Person, than in such as are aged, or decayed in their Strength; because in the former, the humidum Radicale is more easily restored by a good Diet, than in the latter.

CHAP. XXXIX. Of an ƲLCER of ARMS, and HANDS.

I. WHAT the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins; Ʋlcus Manûs; Ʋlcus Cubiti; & Ʋlcus Brachii; we in English call, an Ʋlcer of the Hand; or of the Elbow; or of the Arm.

II. The Causes. They often proceed from External Violence, Contusions, Tumors, Apostems, Kings-Evil, French Pox, &c.

III. The Prognosticks. They are either easie, or difficult of Cure; according as they are either re∣cent or inveterate, simple, or complicated with Symptoms, benign, or malign, &c.

IV. The Cure. Convenient purging, and often is to be prescri∣bed, with Our Family Pill, Pi∣lulae Catharticae, or Panchyma∣gogae, or Pulvis Cornachini, Pul∣vis Antimonii, or Pulvis Cathar∣ticus.

V. Or you may give Tincture of Sena and Rhubarb, made with White-wine; or an Infusion of Mechoacan in White-Port-Wine; or Rosin of Jallap, mixed with Mercurius dulcis, and pouder of Aniseeds or Caraways, or pouder of Liquorice, and so exhibited in a little Syrup of Roses.

VI. A good Traumatick Diet∣drink is also to be ordered, made of the Famous Vulneraries; and withal, a drying 〈◊〉〈◊〉 drink of Guajacum Sassafras, Sarsa, Anti∣mony crude, &c. as we have in many places taught.

VII. Then for Topical Applica∣tions,

if there is a vehemency of Pain, you must apply Anodyns, which may sometimes (as your Prudence shall direct you) be mixt with Narcoticks.

VIII. Then if the Ʋlcer is crude, with an undigested Sanies or Mat∣ter, you must apply Digestives, or Suppuratives, till such time as the Patient has ease, and the Pus is such as they call laudable.

IX. The Ʋlcer being digested, you must cleanse with Abstersives; but you must be cautious that they be not too strong, by rea∣son of the many Tendons, Nerves, &c.

X. The Juice of Smallage with Honey, or with Honey and Turpen∣tine is excellent; so the Mundi∣ficativum Paracelsi, and no ways inferior is Our Ʋng. Nicotianae, or the Ʋng. Fuscum Wurtzii, which is admirable, yea, tho' it be strumous: And some commend Ʋnguentum Bryoniae.

XI. If there is a great Tumor withal, you may apply this Dis∣cussive Cataplasm. ℞ Wine Vi∣negar, or Lime-juice ℥iv. Bean Meal or Flower ℥ii. fine Bole, Dra∣gons-blood, A. ℥ss. Orrice-root, pouder of Tobacco, A. ʒii. boil, and at the end add Oil of Roses ℥ss. and the yolk of one Egg, mix, and make a Cataplasm.

XII. If there is proud Flesh, you may take it away with Basili∣con, mixed with red Precipi∣tate, or with burnt Alum; or with this. ℞ The strongest white Wine Vinegar ℥iii. burnt Alum ℥ii. boil to driness, and calcine it again.

XIII. The Ʋlcer being cleansed, you must Incarnate with Sarco∣ticks, and then it must be cica∣trized with some Styptick Water, or with burnt Alum dissolved in red Wine, which wonderfully dries all sorts of Ulcers; or with proper Epuloticks, Ointments, Cerates, and Emplasters.

XIV. If the Ʋlcer is inveterate or malign, or proceeds from some strumous Cause, there is nothing equal to the Water of the Grif∣fin for the healing thereof; for being cleansed of its filth, you may wash the Sore with it 2 or 3 times a day, and keep Linnen Cloths 4, 6, or 8 times double, dipt in the same, and laid upon it, keeping them constantly wet, by often dropping the Wa∣ter thereon, which sinking thro' the folded Cloth, will penetrate to the Ulcer, and heal it, yea, in a very short time.

XV. Sometimes a laced Com∣press may be of great use in these Ʋlcers, especially if they be caver∣nous or hollow; but you must take heed, that you lace it not so hard as to extinguish the Natural Heat, for so a Gangrene and Mortification will be indu∣ced; and withal, take heed that you probe not too deep, nor where Tents are needful, that you make them not too long, lest you prolong the Cure, and put the Patient to much Pain.

CHAP. XL. Of an ƲLCER of the THIGHS, LEGS, or FEET.

I. WHAT the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, vel, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Ʋlcus Femoris; Ʋlcus Cruris vel Tibiae; and Ʋlcus Pe∣dis; we in English call, an Ʋl∣cer of the Thighs; or of the Legs or Shins; or of the Feet.

II. The Causes. They may proceed from the same Causes which Ʋlcers in the Arms, Hands, or other places, may proceed from: Sometimes they may proceed from the Itch, or a great flux of Humors, because they are de∣pending Parts; as also from long and daily standing, in Bo∣dies Cacochymick, where the Patient is of such a Profession, as requires standing for the most part of the time they are exer∣cising it.

III. The Prognosticks. Ʋl∣cers in these Parts are more diffi∣cult to Cure than in the Hands, Arms, or other upper Parts; be∣cause they are depending Parts, and therefore the Humors of the Body are more apt, and more easily flow to them than to other Parts.

IV. If they are recent and be∣nign, without evil Symptoms, they are easie of Cure; but if they are inveterate, malign, or accom∣panied with evil Symptoms, chiefly in Bodies Cacochymick, Scorbutick, Strumatick or Poc∣ky, they will be Cured with much difficulty.

V. And those in the Ankles, Insteps, and Feet, are more diffi∣cult to be Cured, than those in the Legs or Thighs; because of their being repleat with Vessels, Nerves, Tendons, and Bones grisly, or porous, more than the other Parts.

VI. The Cure. In order to the Cure, such Internal Medica∣ments as are of general tendency, are to be exhibited here, as we have formerly prescribed in simple Ʋlcers, as also in such as are sor∣did, malign, carious, or fistulous, or accompanied with other Symp∣toms; as you see the Nature of the Ulcer shall require, both as to make proper Evacuations by Vomit and Stool; as also for Traumatick and Drying Diet∣drinks, for the healing of the Ulcer.

VII. But in the Cure of the Ʋl∣cers in these Parts, besides the Topical application of Digestives, Abstersives, Incarnatives and E∣puloticks, there ought to be some∣thing more; the Thigh, or Leg is to be rowled from the Foot upwards; and in many Cases a laced Stocking is of extraordi∣nary Service.

VIII. And the Body ought to be well purged twice a week, which

is often to be iterated, but yet al∣ways with this caution, not to over-do it, but as you find the Body can bear it: For as the conti∣nuation of the Ulcer may con∣sume the Juices of the Body, and produce a Tabes, or Con∣sumption, which is often seen; so also too much Purging may help to induce a Tabisick habit of Body, to the Fatal Damage of the Sick.

IX. And for change of the Course of Physick, (which is also very ne∣cessary) Sweating ought to be in∣stituted, and to be alternately used, if the Body is strong, and able to bear it, which may be promoted by giving inwardly sudorifick Volatile Salts, and other things of like Nature; for that these Operations very much conduce to the drying up of the Ulcer, and wasting of those Humidi∣ties, which otherwise might be apt to fall down, and hinder the healing of the Ulcer.

X. If the Ʋlcer is crude and undigested, Maturatives and Sup∣puratives are to be applied for some time; then you may cleanse with Ʋng. Nicotianae of Our Pre∣scription, or with Apostolorum, or Ʋnguentum Fuscum Wurtzii, which last, (and indeed all of them do in some measure) not only cleanse but incarnate with∣al, not suffering any proud Flesh or ill Symptom to follow.

XI. You may incarnate with Li∣nimentum Arcaei, if it is in the Leg or Thigh, or with that Lini∣ment mixed with a little white or red Precipitate; after which you may skin with Ʋnguentum Dia∣pompholigos, simple or mixt with burnt Alum, or which is better, with Ʋng. Mirabile, or some Styptick Water, Our Aqua Regu∣lata, or Water of the Griffin, which consummates the Cure to all Intentions.

CHAP. XLI. Of ƲLCERATED PILES, or HE∣MORRHOIDS.

I. WHAT the Greeks call, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. vel, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, & 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉, vel, 〈 in non-Latin alphabet 〉〈 in non-Latin alphabet 〉. and the Latins, Haemorrhoides Ʋlcerosae, & Ʋlcus fici in Ano, vel Ficus Ʋlcerosa; we in Eng∣lish call, Ʋlcerated Piles or Hae∣morrhoids, or an Ʋlcerated Fig in the Fundament.

II. The Differences. These Humors are sometimes Phlegmo∣nous, sometimes Scirrhous, some∣times Cancerous; and many times they are Varicous, Ʋlce∣rous, or Fistulons.

III. The Part affected. This is chiefly the Anus, which is the exterior part of the Intestinum Rectum; in which place it is

bound about with a Sphincter-Muscle, which has a contraction and dilatation within it self; by the first of which, it keeps all the Excrements which fall down thither within the Guts, till such time as Nature is excited, by either fulness, sharpness, or some other Accident to expel them; and by the latter of which it voluntarily relaxes, and by the help of several pairs of Muscles, dilates it self, so as to make way for their Excretion.

IV. These Mascles, and especi∣ally the Intestinum Rectum it self, are fed and replenished with several Arteries, as, 1. The Arteria Mesenterica inferior, which (mostly designed for the Intesti∣num Rectum,) does disperse Branches in a plentiful manner, all over it, and particularly to the Anus. 2. The Arteria Hypo∣gastrica, which also sends Bran∣ches to the Anus, but chiefly to the Muscles belonging to it.

V. These Arteries conveying Blood thither, have a correspon∣dent or fit number of Veins provi∣ded for its return, viz. 1. The Haemorrhoidalis externa, which is a Hranch of the Hypogastrick Vein, corresponding with its name-sake Artery. 2. The Hae∣morrhoidalis interna (which is indeed the more principal Ves∣sel) that receives the Blood from all the parts of the Rectum, but more especially about the Anus, unites into a slender Arm or Trunk; and so passing along the Gut, runs by degrees into the Mesentery, and is inserted between the Mesenterical Bran∣ches of the Vena Portae, some∣times into the Right, sometimes into the Left, and sometimes into the Trunk of the Portae it self; yet sometimes accidental∣ly, (tho' rarely) it leaves this Course, and is inserted into the Splenetick Branch, sometimes without, and sometimes within the Spleen.

VI. The Blood then descends hi∣ther to the Part affected, chiefly by the Arteria Mesenterica infe∣rior; by which being let into the middle and inward Tunicles of the Intestinum Rectum, it is car∣ried back, chiefly by the Vena Haemorrhoidalis interna.

VII. The Causes. The Proca∣tactick or External Causerie may be from sitting upon cold places, upon Stones, Earth, Snow, &c. bitings of Leeches, Blows, Bruises, Priction, or Puncture, application of sh•…•…p Medicines, &c. taking of Albes, &c.

VIII. The Antecedent Cause, may be from a Cacochymy, where the shirpness of Humors falling down upon the Part, weakens it, and passing by or near that place from the Guts, do by their acri∣mony induce the Piles; which Humors, tho' they may be from Internal Causes in the Blood, yet they externally affect the Anus, in passing out at the same, not much unlike to that of a sharp Clyster.

IX. So that according to the variety and degeneration of the Humor, variety of Tumors do arise, making several Differences, of which we have spoken a little above.

X. The Proximate or Conjoined Cause is from the Blood in the Part

affected, which easily flows thither, 1. Because it is a depending part. 2. From the weakness of the part, being made so by an afflux of sharp Humors, which prompting Nature to an expulsion, stirs up a Fermentation and boiling in the Blood of the Part, and so causes it to swell. 3. Because the Veins hereabouts being small, and without Valves, and the Blood by its heat and fermentation swel∣ling, it is deteined there and stag∣nates, and by reason of the laxi∣ty of the part causes that Tumor which we call the Piles; which still increasing, and the Veins not being sufficient or large enough for its discharge, so as to be taken in by the Arteries, and the Skin thin, at length they break, and so bleed.

XI. These Tumors being very great (in respect to the part) and very painful with Inflammation, there is many times a Flux of sharp Humors, which cither thrust out spongy Flesh, as Morus, Fi∣cus, Condyloma, Crista, Phyma; or else by their Acrimony erode, and so create an Ʋlcer, which is either simple, benign, sordid, malign, Cancerous, Cavernous, or Fistulous.

XII. If it is demanded, why the Blood cannot so easily circulate in this Part, as in others, but must stagnate, and produce the Piles: it is answered, that by the sharp∣ness and thinness of the Humor attendent, Nature is provoked, and the Intestinum Rectum is sti∣mulated to make an Excretion, and is always offering to press or squeez, and contract it self, and so binds up the Vein, that the Blood cannot ascend, but is by the Violence of the motion kept back, even to the breaking many times of the Vessel.

XIII. The Morbifick Humor is generally lodged within the en∣trance into the Anus: and very of∣ten also on the Muscles near it, where the Piles are hidden, and seldom discover themselves, but only an outward Humor appears, which in length of time, many times apostemates, and at last ends in a Cavernous or Fistu∣lous Ulcer; penetrating (accor∣ding to the duct of the Vessels which seed it) sometimes into the Gut, and sometimes with∣out it.

XIV. The Signs. Your Eye will tell you, whether it is a Vein, i. e. the Piles or Hemorroids, or it be some other Tumor: whether it bleeds, or bleeds not; and whether they are Ulcerated, or not Ulcerated.

XV. In other Tumors, the Fi∣gure will discover what it is: if it is Condyloma, it is like a Pen∣sil-wart with a narrow Neck: if it is Ficus, it is flat, almost like a Fig: if it is Morus, it is a rough protuberance, much like that kind of Fruit: if it is Phy∣ma, it is a full red smooth Tu∣mor with heat and pain, like a Phlegmon: if it is Crista, it has a broad Basis: if it is Phlegmo∣nous, Scirrhous, or Cancerous, it is known by their proper Signs.

XVI. If the Tunicles are thick, or apt to be spongy, then the Parts swell, and the Vessels appear them∣selves blewish, and in cluster's like a small bunch of Grapes; or else Flesh grows about them, ma∣king

Ficus, Condyloma, &c. but if the Humor is of a Saline na∣ture, it makes Rhagades or Fis∣surae, which are Ulcers very common.

XVII. The Kinds, respect, I. The Part. It is either, 1. Of the Veins only, and so they are either Haemorrhoides coecae, blind, internal, and which bleed not; Or Haemorrhoides apertae, which are open, external, and bleed∣ing. 2. Or of the Veins with the Muscles of the Anus, generating Phlegmonous, Scirrhous, and Cancerous Tumors.

XVIII. They respect, II. The substance and Figure, and so it is either Blood alone, or a Fleshy matter, called according to its Figure, Morus, Ficus, Condylo∣ma, Crista, as aforesaid.

XIX. They respect, III. The Accidents, and so they are, 1. Not Ʋlcerated, or Ʋlcerated. 2. with little pain, or with much pain. 3. They are small or great, and with a narrow or broad basis. 4. They are either Temporary and Symptomatical, or Periodical.

XX. The Prognosticks. Those Haemorrhoids which are the Ʋvales are the mildest, and more gentle: The Morales, are worser, or in a mean between the former, and the next: the Verrucales, are the worst of all.

XXI. Those Piles which affect that part next the Neck of the Bladder, are more troublesom and painful, because of the consent they have with it; whence Inflamma∣tion, Phyma, and Strangury many times happen.

XXII. If the Haemorrhoides ••oecae be very painful, and not timely remedied, there will be great danger of a Flux of Humors, which may induce Inflammati∣ons, Apostems, Erosions, Ulce∣rations, &c.

XXIII. If they bleed seasonably and moderately, they ease and purge the Body of gross, and faecu∣lent Blood; and so thereby free it from many and dangerous diseases, as Pleurisies, Peripneumonies, Quinsies, Phlegmons, Apople∣xies, Epilepsies, pissing Blood, Quartans, &c.

XXIV. If they bleed immode∣rately, they cause Weakness, Faint∣ings, Cachexia's, Dropsies, Pining, Consumptions, and the like; it their Flux is unadvisedly up∣pressed, after a long course thereof.

XXV, If their Ʋlceration it plain, benign, and recent, it may easily be cured; but if cavous, sordid, malign or inveterate, they will be cured with very much difficulty.

XXVI. If they continue long, are painful, with a Flux of acri∣monious or sharp Humors atten∣ding them, they will be in dan∣ger of growing Cavernous, if not Fistulous.

I. The Cure of Blind Haemorrhoids.

XXVII The Body if accustomed to be costive, ought always to be kept soluble, with some Lenitive, as Extract of Cassia mixt with Cremor, Tartari, or Extract of Tamarinds: and the Patients Diet must also be such as may keep it in such a condition, be∣cause in this disease they are generally costive, and so avoid

their Excrements with much Pain.

XXVIII. Their Food may be Barley-gruel, Water-gruel boil'd full with blue Currants, hull'd Barley boil'd and buttered, or ea∣ten with new Milk or Cream, and a little Sugar, Pannado, Milk∣porrage, Milk thickned with Oat∣meal, Butter-milk, Whey-porrage made with Oatmeal, Outmeal Caudle, Veal and Chicken broths boiled with Beets, Borage, Bu∣gloss, Endive, Succory, Spi∣nage, &c. And their Drink may be a middling sort of Ale or Beer, but always new, or Wa∣ter sweetned with Sugar, or Ptisan, or Wine mixt with Water.

XXIX. Also now and then the Belly may be made soluble with Clysters made of fat Broth, Emol∣lient Decoctions, or new Milk with Sugar, or Posset-drink with Su∣gar, which may be cast in with a Clyster-syringe, made with a short thick Pipe taper-wise.

XXX. If they be very great, and the Patient in vehement pain, the only Remedy is to discharge the Blood by application of Leeches, which I have oftentimes done, suc∣cessfully; but then presently upon their removal, the Part ought to be fomented with red Wine, as hot as can be conve∣niently endured with Sponges, or double Flanels, and that for half an Hour, or neatly for an Hour together, by which means they are made to bleed the more plentifully.

XXXI. For want of doing this immediately after the application of Leeches, it has been many times very prejudicial to the Patient, because sometimes they leave a Venom behind them, which of∣tentimes creates an Ulcer, and sometimes a fistulous Ulcer, by attraction of Humors, which by these means is avoided.

XXXII. If they be not very great, or the pain not vehement, or if they are but in their beginning I have (I believe) more than five hundred times Cured them by anointing with Oil of Amber, or Powers of Aniseeds. It is a Dis∣ease I have been often subject to my self, and it used to afflict me vehemently; but after I had once found out the way of anointing them with Oil of Am∣ber, I soon Cured my self of them; and if I find upon ta∣king cold that they are coming upon me, by their being a little swell'd, I immediately apply my self to that Remedy, and so pre∣vent them, by which means I have been kept free from them, for more than these 20 Years last past.

XXXIII. But if the Piles are broke or ulcerated, these Medica∣caments are by no means to beused; for by reason of their heat, they mightily inflame the raw part, and afflict the Patient with ve∣hement pain.

XXXIV. Authors use other Medicaments, as this Fomentati∣on, to discuss and dry them up, where they thrust forth with great pain, and are subject to Inflammation. Take Plantane, Bramble-tops, Horsetail, A. M. is. Flowers of Mullein, M.ii. Line∣seed ℥ii. Catechu ℥i. Balaustians, red Roses, Pomgranate-peels,

Myrtle-berries, A. ʒvi. Wine, Water, A. q.s. mix, boil, and make a Fomentation.

XXXV. Having fomented them, apply a Mixture of Ung. Popu∣leon, and burnt Cork, upon Pledgets of soft Tow, Morning and Evening.

XXXVI. If the Disease is in its state, and the Inflammation and Pain vehement, either apply Leeches, or foment with this. ℞ Mallows, Mullein, A. M. j. Flowers of Hypericon, M. ss. Root of Hounds-tongue, and of Henbane, A. ℥iss. Linseed, Fenugreek-seed, A. ʒvi. Seeds of Althaea, and of Quinces, A. ʒiii. boil them in Mutton-broth, for a Fomentation.

XXXVII. Or, ℞ Barley-meal, Juices of Endive and Lettice, A. ℥iii. Fleawort-seeds ℥ss. Oil of Water-lillies ℥iiss. yolks of Eggs, N^o ii. Saffron ℈ii. mix, and make a Cataplasm; but in extremity of pain, anoint with this. Take Oit of Eggs ℥i. Opium gr. x. which dissolve in a little Water or Wine, and mix with the Oil.

XXXVIII. In the Cure of the Internal Piles, the same Emol∣lient Decoctions, and Anodyns, before-proposed, will be of good use, to be injected by a Clyster∣syringe.

XXXIX. If the pain proceeds from Cold, or a gross viscid Matter distending them, you must apply things beating and resolving; as Roots of Pilewort, Onions, Gar∣lick, Squills, Figwort, and Ointments made of them; a∣noint also with Balsam of Sul∣phur, of Rulandus, or the Tere∣binthinated, or Anisated Balsam of Sulphur, or sit over the Fumes of Frankincense, or Amber, which is better, often repeating it.

XI. When you find the Disease in its declination, you must apply things powerfully drying, as Tin∣ctura Mirabilis; or Crocus Mar∣tis astringens, Saccharum Satur∣ni, Ceruse, Litharge, burnt Lead, Minium, Chalk, fine Bole, Terra Sigillata, Aerugo, Catechu, all of them in fine pouder, which you may apply either alone, or mixt with a little Honey, or Hogs-lard; washing beforehand with Aqua Calcis, or Alumniosa, or some other Styptick Water; if they yield not to these Ap∣plications, but are pendent like a Grape, they are usually cut off; because otherwise, upon every little disorder, or taking cold, they will be apt to swell.

II. The Cure of the Bleeding Hemorrhoids.

XLI. Whilst they discharge gross and vitious Blood, or are be∣neficial in removing other Diseases, and withal, that the Patient has strength of Body to bear the Eva∣cuation, they ought not to be stopt, or heal'd; and so much the more, if they have appeared Monthly, or have been of some Years con∣tinuance.

XLII. In these Cases, they ought rather to be continued in their usual flux, or if stopt, to be pro∣voked thereto; which may be done with Aloes, and Aloetick Medicaments, as Pilulae Ruffi, &c. Scammony, Colocynthis, &c. given inwardly.

XLIII. But where the Bleeding is recent, or of young standing, espe∣cially

if it is over-abundant, to the weakening of the Sick, and abate∣ment of their usual Health; or if it induces paleness of Counte∣nance, pining, or a consump∣tive habit of Body, you ought to use the best means that may be to stop it.

XLIV. Inwardly you must give such things (whether as Food, or as Medicine) as may Incrassate, and Contemperate the Fermenta∣tion of the Blood. As for Food, things temperate, and not salt, so••re, or spicey; all picquant Sawces, Pickles, &c. are to be avoided; Food made of Fruits, Gelly and Conserve of Quinces, baked Wardens and Pe••rs, Pur∣slane, Lettice, Spinnage, Pom∣pions, Melons, Cowcummers, (not pickled) may be eaten with freedom; Milk-meats, Oatmeal-milk, Milk-porrage, and the like, are of Service in this Case.

XLV. As for Medicaments, you may give inwardly Syrups made of the Juices of Quinces, Purslane, Lettice, Plantane, Wood-sorrel, of dried Roses, and of Myrtles mixed with some proper Distilled Water, as of Alum, Poppies, &c.

XLVI. Profitable also in this Case are, fine Bole, Bistort, Ca∣techu, Crocus Martis, Harts-horn burnt, Lapis Haematitis, Sanguis Draconis, Spodium Terra Lem∣nia, Pomgranate Peels, Troches of Amber, Mithridate, Venice Trea∣cle, Diascordium, Our New Lon∣don Treacle, Out Volatil and Spe∣cifick Laudanum, Dr. Gardner's Laudanum Samech, Tinctura Mirabilis, &c. for that these things thicken the Blood and Juices, and so put a stop to the Career of the Flux.

XLVII. ℞ Catechu, Crocus Martis astringent, A. ʒi. Lapis Haematitis, Terra Lemnia, A.ʒss. Cochinele, dried Blood, (either of Man, or Beast) Saccharum Satur∣ni, A. ℈i. Of Our Specifick Lau∣danum gr. 5. with Syrup of white Poppies, make an Electuary for Four Doses.

XLVIII. Outwardly, Catechu, dried Blood, Pomgranate Peels, Cyprus Nuts, Galls, Hypocistis, burnt Lead, Ceruse, Litharge, Saccharum Saturni, Olibanum, Mastich, Sanguis Draconis, &c. may be all made into Pouder, and mixed with some proper Ointment, as Ʋng. Populeon, and applied upon Pledgets of Tow; or with Mucilage of Gum Traga∣canth, they may be either made into Suppositories, and so used; or else mixed with whites of Eggs, and spread upon Pledgets, and so applied.

XLIX. Or you may foment, if they are External, with the Royal Styptick, or Dr. Gardner's Styp∣tick, or other proper Styptick Water, as you see convement; or you may cast these Stypticks in with a Syringe, applying af∣terwards upon a Pledget Ʋng. Diapompholigos.

III. The Cure of ulcerated Hemor∣rhoids, Ficus, &c.

L. If the Ʋlcer is recent, it may be Cured by applying Balsam de Chili, or de Peru, upon Pledgets of Tow, to the Part; first of all anointing it well

with a Feather, with the same.

LI. But if the Ʋlcer is invete∣rate, Digestives are first to be ap∣plied, because there are many crude and unconcocted Humors many times in these Ʋlcers; afterwards you must deterge with Juice of Smal∣lage boiled up with Honey, or with the Mundificativum Para∣celsi.

LII. If the Ʋlcer is foul or sor∣did, you must continue the use of Abstersives the longer, forbearing such as are over sharp; lest they should induce by their sharp∣ness, a great flux of Humors up∣on the Part, to which it is very subject upon the least occasion.

LIII. Every time when you dress it, as soon as you have taken off the former Application, you must fo∣ment it with this following Mix∣ture. ℞ Juice of Scordium, and of Parsly clarified, A. ℥iv. red Port-Wine ℥viii. mix them, and foment therewith warm for almost half an Hour.

LIV. Which dane, then dress it up with the Mundificative or Ab∣stersive; and continue this course of fomenting and dressing, till you find the Ulcer to be very well cleaused.

LV. The Ʋlcer being cleansed, you must incarnate, if need be, with Sarcoticks: This is good; Take Ung. Diapompholigos ℥ii. Ung. Nicotiana ℥i. Mastich, and Olibanum in pouder, A.ʒiii. Bal∣sam of Peru ʒii. mix, and ap∣ply it.

LVI. The Ʋlcer being incarned, you must produce the Cicatrice by anointing with Ung. Diapompho∣ligos alone, or Ung. de Minio, or some other drying Ointment, or strewing the Sore over with pou∣der of fine Bole, or Terra Sigil∣lata, or some proper Styptick as pouder of Catecha, or Caput Mort. of Vitriol.

LVII. But before applying these Ointments, or Pouders, or upon every dressing, it will be good to wash the Sore with some Styp∣tick Waters, as the Aqua Alumi∣nosa, the Royal Styptick, Doctor Gardner's Styptick, or some o∣ther, as you shall see fit; not omitting the Water of the Griffin.

LVIII. But if notwithstanding all that can be done, the Ʋlcer proves rebellious and malign, you must make the Patient fit once or twice a day upon a Close∣stool over a Chafing-dish of Coals, to receive from the same the Fumes of these following Troches.

LIX. The Troches. Take Winters Cinnamon, Amber, both in fine pouder, A. ℥iss. Aloes, Myrrh, Sarcocol, A. ℥i. Zedoary in pou∣der, Bayberries in pouder, A.ʒvi. Artificial Cinnabar ground fine or levigated ℥i. all being in fine pou∣der, with Mucilage of Gum Tra∣gacanth, make Troches, each weighing ʒss. of which (being through dry) use 3.4. or 5 at a time. See the Third Edition of Our Synopsis Medicine, lib 5. cap. 54.

Explicit Liber Quintus.