LECT. I. Of the definition and parts of Chirurgerie.

MAny learned discourses have beene delivered out of this sear, of sun­dry points of the renowmed art of Chirurgerie by Master Doctor Gwyn of famous memorie, who by reason of his not vulgar learning, hath left an eternall memorie in the mindes of those who knew him in­wardly, to himselfe. God having called him out of this transitorie life, and vale of miserie, to rest from his labours, it seemed good to the Governors of this worshipfull Com­pany to have this exercise performed by the most able of the brethren as it should come to every one according to his place and dignitie. And undoubtedly this office hath [Page 2]beene performed by most, laudably, and f [...]itfully to the praise of the Hall, and mutuall communication of skill, for the better performing of duties which so high a calling doth require. And surely if this course had beene con­tinued, it had mightily encreased in readers the theoricall or contemplative part, which doth consist in the know­ledge of the precepts, had made them able to give greater contentment to their patients by their rationall discourses, and more emboldened them in particular operations, having sufficient warrant of Art for their practice, and abilitie to convince empyrickes and malitious calumniators. But see­ing (as I understand) the highest power of this Realm, from whom there is no appeale, hath decreed that this exercise shall be performed by a Doctor of Physicke, and that the worshipfull Company hath for the present made choise of mee, who professe my selfe to bee a member of the Com­pany; I shall labour by diligence to supply all defects in mee, which sundrie may find in mee, if they compare my weakenesse, with the ablenesse of my predecessor. Howso­ever the matter falleth out. I will endevour to deliver what is for the purpose of that subject whereof I reade, although not all peradventure which might bee alledged to the purpose. Neverthelesse I mean not to be so sparing in my discourses, as that you shall have occasion to thinke that any thing absolutely requisite hath beene kept backe. And if it fall out that at any time I checke or controule those authors, who by some are highly esteemed; I desire that none ascribe this to any ambition or vaine glorie in mee before thy weigh my reasons in the impartiall bal­lance of judgement. And as it is impossible for any man, who curiously and scrupulously treadeth in another mans footsteps, to compasse a long journey in a day: So let none thinke that ever hee shall bee famous in his art, if hee give himselfe only to imitation of others. The ancients have left not a little to bee found out by the diligence of poste­ritie. Whosoever is industrious and judicious shall find [Page 3]my words to bee an oracle. Many of them have set down sundrie things not tryed by experience, but imagined by their fancie, which the sickle of tryall will prune. Never­thelesse, in reprehension I will use them respectively, by reason of reverence, which is due to antiquitie. Besides this nothing can bee both invented and perfected. Now seeing in all the discourses and lectures which have beene delivered out of this place, only particular points of the Art have been handled, and none hath taken the paines to touch any Praecognita, or generall notions, which may be instead of an Introduction to the particulars, seeing no subject hath been delivered, or commended to mee, I will briefly though some Introductorie points, which will give no small light to the lectures, which hereafter shall bee read. The Praecogni­ta. The first shall bee of antiquitie and dignitie of Chi­rurgerie. The second shall be of most famous authors, who have taken the paines to illustrate it, by their wri­tings: The third shall be of its place in the course of Phi­losophie. The fourth of the definition of it: The fift of the division or parts of it. Which things when I have set downe, I shall shut up this lecture; permitting election to the Governours, whether they will have mee proceed methodically, through the whole course of Chirurgerie, or scatteredly to handle dispersed parts of the same as hi­therto hath beene done. My opinion is, The intention of the autor. that it will bee both more fruitfull and pleasing to intelligent hearers (if God will grant mee life and health) to passe through all the points of Chirurgerie methodically: for first the co­herence of the parts will help the memorie: And who shall bee assiduous hearers shall not by snatches take a hungrie morsell; but have a full banquet, fully to answer the ap­petite. When I come to particulars, I will not only deliver the principles of Hippocrates, and Galen, and their sectators the Arabians: but I will acquaint you with the theorems of the Chimists, and compare the opinions of both, that it may bee known who have beene most fami­liarly [Page 4]nursed in the bosome of nature. Of the Chymists Paracelsus is the Generall. The chiefe Chymists. He hath sundrie Colonels un­der him, as Petrus Severinus the Dane, Quercetan, Petrei­us, and sundrie others, who are oftentimes clouds with­out raine; more fraughted with bountifull promises, than reall performances. Now to come to touch the first generall point of Chirurgerie, The antiquity of Chirurgerie. which is the antiquitie of it, I dare bee bold to affirme, that of all arts liberall, it was the first which was invented after the fall: for as for A­gricultura and are pastoralis, husbandrie and grazing, they would have beene required of man, if hee had continued in the state of innocencie, to have furnished unto him nou­rishment, and other things requisite for the enjoying of this life contentedly, untill hee should have beene transla­ted from earth to heaven to enjoy the beatificall vision of his Creator. Now it is most probable, I may say demonstra­tive, that what strange event did first minister occasion to invent an art, that that art was first enquired for and found out. Such was the wounding and killing of Abel, by his brother Cain, by reason of emulation. This could not but move Adam, and Cain himselfe to studie how they might not only repell violence, but have in readinesse means to cure hurts also, if they should have beene woun­ded, and their lives spared. All things which were done before the floud are uncertaine and unknowne, if you except those things which that eminent Prophet Moses, by the inspiration of the Holy Ghost, hath recorded. You may reade of bragging Lamech, Genes 4 23 who boasted of murthering. B [...]sides this the wickednesse of man in­creased, Gen. 6.5. sufficient to set him on, and that there were before the floud, giants and mightie men, vers. 4. and so able to performe by violence of villanie. Shall any man thinke that men unable to resist, did not think upon remedies to cure their hurts, being endued with reason; but as dogges licked their own wounds, and provided no means for curing contusions, fractures, dislocations, and [Page 5]such accidents as follow after violence offered. As for in­ternall Physicke, being so neere to the creation, Physick not so ancient as Chi­rurgerie. living long even to 969 yeares, Gen. 6.27. as Methuselah did, it is like they used none, seeing they had no other sicknes but that of old age: which falleth out, the naturall and acci­dentall heat exhausting the radicall moysture, and was un­avoydable after that the sentence of mortalitie was pro­nounced against Adam and his posteritie, Gen. 3.10. Thus wee see that as the practice of Chirurgerie was necessarie before the floud, so wee cannot gather by any obscure conjectures, that that part of Physicke, which cureth by exhibiting internall medicaments, was in use. Yea untill the time of Hiprocrates. Physicke it selfe seemeth to have beene only a knowledge of simples, fit for curing of inter­nall diseases, and outward griefes found out by experience: and that there were but few precepts concerning the art, shewing either the knowledge of particular griefes, or the method of curing of them; They, who are accompted the autors and inventors of Physick, prove this to bee true: The inventors of Physick. Amongst the Grecians, Apollo the sonne of Iupiter and Lato­na, is accompted the first, which gave his mind to the studie of Physick and Chirurgery. Or him thus writeth Ovid. 1. Metamorph.

Physick is my invention & throughout the world (to me.

Helpfull I am said to be, & the faculty of h [...]rbs is subject Aesculapius his sonne followed his father, who added much to that which his father invented: wherefore he was accounted amongst the gods. His two sonnes Podalyrius, and Machaon accompanyed the Grecians to Troy, unto whom they did good service in curing the wounded per­sons. Chiron Achill [...]s his master is said by Plinie to have had great skill in the knowledge of simples, and that hee was skilfull in dressing of wounds: both his name she weth, (for it is likely hee was called Chiron, because hee was skilfull in [Page 6]the manuall part: [...] in Greeke is a hand) and Achilles his practice in curing wounded persons: for hee cured Tele­phus king of Mysia, whom he had overcome and hurt, and from him the herb Millefole is called Sideritis Achilaea. Of this, which hath beene spoken, wee may gather that these eminent and worthy men did more practise Chirur­gerie, than Physick. Hippocrates is the first wee have, who committed to writing precepts concerning the practice of Physick: Hee did not only practise Chirurgerie himselfe, but wrote sundrie treatises concerning sundrie operations of it: as of fractures, lib. 1. of joynts, lib. 1. of reducing bones by instruments, lib. 1. of ulcers lib. 1. of fistulaes, lib. 1. of wounds of the head, lib. 1. of drawing out of the womb a dead child, lib. 1. All these are in the sixt section of his workes. Galen succeeded him about six hundred years after, a man worthy of eternall memory, who did illu­strate Hippocrates with his learned commentaries, and by adding of those things, which were wanting, did perfect the art. In his workes are sundrie Treatises, concerning Chirurgicall subject. The rest of the Greeke writers fol­low him, as Paulus of Aegina, Aetius, Alex. Trallianus, Oribasius, Actuarius and the rest. Amongst the Latines Celsus excelleth, who hath written acurately of all Chi­rurgicall operations, whom all modern writers doe ex­ceedingly commend; as Fallopius de tumoribus praeter na­turam, cap. 1. And Fabricius ab aqua pendente in sundry pla­ces, and the rest. Of some, who went before him, thus he writeth: lib. 6. c. 1. And in Rome sundrie reasonable good professors (he meaneth of Chirurgerie, which hee calleth vetustissimam most ancient) But chiefly of late Triphon the father, and Euelpistus added somwhat to that discipline. The Arabians follow; amongst whom A­vicen is the chiefest, who lived 1100 yeares after Christ: of Chirurgicall matters hee discourseth in the third booke of his canon, and in the fourth part of his Canticles. Rases 2. Continent. Albucasis. Amongst our moderne writers [Page 7]these excell, Guido de Cauliaco, whom Tagaultius hath expressed in good Latine: Fallopius, with whom none is to bee compared: Ambrosius Paraeus, Iohannes de Vigo, Hie­ronynous Fabricius ab aqua pendente, Guilielmus Fabricius in his centuries & Master Gale, Master Banister, & Master Clowes, while they lived, brethren of this worshipfull companie, who by their writings have commended them­selves to all posteritie. So much I thought good to deli­ver of the antiquitie, dignitie, and of the chiefe professors of Chirurgerie; which ought to stirre up your diligence in labouring, to excell in the particular operations of it, and to resolve to contemne the obloquies and calum­nies of rude and ill bred persons, who shall seeme to slight this excellent art. If you inquire for the beginning of it, it is vetustissima most ancient, according to Celsus in the place above mentioned: If you require certaintie, it is grounded upon experience, and offereth it selfe to the eye: If you aske who did of old practise it, you shall finde that either they were numbred amongst the gods, or were re­nowmed persons, called heroes, as Hercules, Chiron, Achil­les, or men of eminent learning and worth, as Hippocrates, Galen, Avicen, and sundrie others. The subject of Chirurgerie. It hath for its subject the body of man, and in this point no whit inferiour to Physick it selfe. And whereas many will stick to take a dangerous medicament; yet they will not stick to admit Chirurgicall operations, although they bee full of perill, as incision for the stone, and dropsie, To what part of Philos phie Chirurgerie is to bee referred. dismembring and such like, as wee may see day by day. Now to know to what part of Philosophie Chirurgerie is to bee referred, wee must consider that there bee two parts of Philosophie: whereof the one is speculative, whose end is knowledge; Parts of Phi­losophie. The other practick, whose end is practice. Now practice hath two differences, Action, and Effection. Action lea­veth no worke behind it. Effection doth. Arist. 6 Ethic. c. [...] & li. 1 mag. moral. c. 35 [...] Of the active part of philosophie, there bee three parts; Ethick, which frameth the manners of a private person: Oeconomick, [Page 8]which sheweth how a family is to bee governed, and Policie, which teacheth how a Commonwealth is to bee ruled: These wee will leave, because they belong not to our purpose: as neither those arts, which are meerly factive, commonly called mechanicall, and so unworthy of a Philosopher. The speculative part of philosophie com­prehendeth under it the Metaphysicks, Arise. 6. Meta­phys c. 1. naturall philoso­phie, and the Mathematicks: Of the first and last we will speake nothing, because they belong nothing to that sub­ject which wee have in hand. The subject of naturall philosophie is corpus naturale, or a naturall body: Now of all naturall bodies, the body of man is the chiefest & most excellent, which moved the kingly Prophet to burst out into this resolution: Laudabo te, quia mirabiliter forma­tus sum: I will praise thee, because I am wonderfully fra­med: The admirable composition of the body of man drew from Galen himselfe, not the best master of pietie, a hymne to his Creator. Now naturall philosophie con­sidereth the body of man, The parts of Medicine. as it is a species or kinde of natu­rall body: but medicine as it is curable by art. Of Medi­cine there are two principle parts, [...], and [...]. The first teacheth the preservation of health by conveni­ent diet, exercises, and such like: I The second teacheth, how health lost may bee recovered: II There be two meanes to repaire health: for this is done either by medicaments, or manuall operation. The first is performed by that art, which here is called physick; the second by Chirurgerie. So that Chirurgerie is the second branch of the cura­tive part of medicine, without the which neither countrie, citie, towne, village, hamlet, yea no private familie can well continue or subsist. This wee must confesse, if we con­sider unto how many externall injuries the body of man is subject, as to scaldings, fractures, luxations, wounds, ulcers, ruptures, stone, and to what not: So that the use of Chirurgerie is by reason of absolute necessitie more often required, than the ministration of medicaments. [Page 9]And seeing the operation of a Chirurgion is more sub­ject to the eye and other senses, than the exhibition of medicaments is, it behoveth every one to bee well verst in that which he taketh in hand, seeing his practice is more subject to censure: There bee a number of empyricall knaves, filthie bands, and bold queanes, who daylie mi­nister medicaments boldly, who [...]twithstanding dare not meddle with any curious operation in Chirurgerie. Such impure hands dare not touch such a chaste and unde­filed Lady. Now it is time to come to the fourth point, IV. Point. which I intended in my proposition: which is to shew what Chirurgerie is: Now there is a double quid, or what, quid nominis, & quidrei: The first sheweth the reason why this tearme was found out to expresse this art: The se­cond delivereth the nature of the art it selfe. The Erymon. Chirurgia is a Greeke terme composed of [...] which signifieth a hand, and [...] to worke: Because it restoreth health to the bodies of men by manuall operation. The definition of Chirurgerie. Chirurgerie then may be thus defined: It is a branch of the curative part of medicine, which teacheth how sundrie diseases of the bo­dy of man are to bee cured by manuall operation. It is not a science properly, because it resteth not in only know­ledge; but an art as Physick it selfe is: for it leaveth an ef­fect after the operation, to wit, health: So that for the ge­nus, it hath the same with Physick it selfe: Both Physick and Chirurgerie propose to themselves one end: yet the meanes are divers. Physick restoreth health by ministrati­on of medicaments; but Chirurgerie by manuall operation: Seeing then the definition which I have assigned to Chirurgerie doth consist of genus and differentia, accor­ding to schoole termes, it must bee an essentiall defini­tion, fully expressing the nature of it. The fift point whereof I intended to speake of this lecture, V. The parts of Chirurgerie. was of the parts of Chirurgerie, which must bee assigned according to the maine differences of operations. Those are foure in number, and consequently so many parts: for either by [Page 10]Chirurgerie, solution of un [...]tie is removed, and union resto­red; or things unnaturally united are separated & disjoyned; or things superfl ous taken away: or last of all defects supplyed. The kindes of solution of uni­tie. Now solution of unitie is either gathered by rea­son, or deprehended by sense. In tumors although the parts seeme to the eye united; yet reason teacheth us, that there is a divulsion of [...]hem: The doctrine of tumors there­fore ought to bee the first particular treatise. Solution of unitie apparent to the senses, to wit, sight and touch, are either in the soft parts, or in the more solide and hard. In the soft or fleshie parts there bee two differences of soluti­on of unitie: vulnus & ulcus, awound, and an ulcer: In the hard parts there are found a fracture, and a luxation; two distinct sorts of solution of unitie to fill up the fourth and fift places. This part may bee called [...], or pars compositrix, 1. Part of Chi­rurgerie. the part joyning together. The second part of Chirurgerie opposite to the first, teacheth to separate parts unnaturally united: where either the comely composition of the body of man is defaced or empaired, or the actions of the same hindred. Sundrie have beene brought into the world with the anus and vulva quite shut up. The conside­ration of that membrane, which is found in the necke of the matrix of some women, is in this place to bee noted and considered: Seeing there have beene and yet are so many concertations amongst both skilfull Physitians and Chi­rurgeons. Here also is the cure of the wrie necke to bee set downe. In this griefe the head on the one side by reason of one or more tendons of the muscles of the neck shor­tened, the head is drawne towards the claves more than on the other wherby it commeth to passe that the face grow­eth awry and distorted: and so the beautie of the counte­nance is much impaired. To this part belonged the cu­ring of tongue-tyed children, in whom sucking and speech are hindered. Not only fingers and toes cleave together in the same person: but twinnes also, and double members of one person. The consideration of such doth belong to the [Page 11]historie of Monsters; not to any art: seeing such things are to bee ranged amongst rarò contingentia, and so belong not to art, which is of things necessarie. 2. Part of Chi­rurgerie. This part may bee tearmed [...], or separatrix pars, the separating part. 3. Part. Now followeth the third part of Chirurgerie, which shew­eth the meanes to remove from the body things superflu­ous, which may fitly bee called [...], or ablatrix pars, the nipping or removing part. Things superfluous are such, either by event, or by their own nature. Things su­perfluous by event are sundrie: And first a dead child in the womb, or staying too long to the prejudice of it own and the mothers life. Here shall bee set the manner how to bring women to bed (as wee terme it) artificially and safe­ly. Secondly, a falling of the small guts into the cod by enlarging or renting of the production of the Peri­tonaeum, which wee call a rupture. When I come to this point, I will set downe the diversities of ruptures, and the meanes of curing of each: which are either incision, or trusse, or application of medicaments, sometimes used so­litarie, sometimes concurring most or all together. Third­ly, the amputation of a limme by reason of a mortification, or some other accident. Here shall bee set downe the most accurate method of dismembring. Fourthly, the exstir­pation of any part, as the breast, when a cancerous either tumor or ulcer doth possesse it. Here you shall be acquain­ted with the safest way of exstirpating a cancer and a lupus. Fiftly, bloud offending either in quantitie, or qualitie is drawne by phlebotomie, leeches, ventoses, of all which I will particularly discourse. Things by their owne na­ture superfluous, are either somwhat familiar to nature, or altogether adverse: Of the first sort, are Wens, and Strumae: when I come to them I will set downe the diver­sities of them, and how they also are to bee cured. Second­ly, the couching of a cataract offereth it selfe. Here I mean to set downe the varietie of cataracts, the prognosticks of them, whereby it shall bee knowne which are curable and [Page 12]which not, and the most exquisite manner of couching of such as are curable. Things adverse to nature, are stones in s [...]dr [...] parts of the body; but chieflly in the bladder. The incision for extracting of it, is called [...]: of it I meane diligently to discourse, because it is a dangerous operation, and many times scandalous. Last of all, I come to the fourth and last principall part of Chirurgerie, IV. Part of Chirurgerie which is the supplying of the defects of the body, which may be called [...], or additrix the supplying or adding part. Now things which are added, are either of the body it selfe, as restoring of the Nose lost, or curing of the hare lip. Of the first, I will set down the method of the Bono­nian Physitians, and Chirurgeons: Of the second, my own and other famous mens experiments in curing both the sin­gle and the double hare-lip. The matter of things, which is used for repairing of the losses in other parts, as the eye, the eate, arme, and legge, is no wayes of the nature of the body. Neverthelesse when I am come so far, I will make an end of the course of Chirurgerie with touching these so much as shall seem sufficient, to instruct such as have not beene verst in these practices. I have run through those five introductorie points of Chirurgerie, to wit of the antiquitie and dignitie of it: of the professors of it, of its place amongst the liberall arts, of the definition and parts of the same. As concerning the two last points, I have varied from all who have written of this subject: Neverthelesse I have the light of nature on my side, and the experience of all skilfull practitioners. So that it is needlesse to take further paines, either to confirme those things which I have alleaged, or to refute that which hath been said by others; Seeing I intend rather to frame an able operating Chirurgeon, than to set out a contentions disputing theorician: Besides, reprehending of others doth not so much instruct the hearers in the knowledge of the truth, as sheweth that, which is not to bee learned, but shunned. Neither is a Chirurgeon contented to have [Page 13]performed so many duties to the body of man while it is a­live and the instrument of the soule, for performing acti­ons; but when it is dead the spirit returning to God, who gave it, hee ceaseth not to bee officious to it, in dissecting of it, for the instruction of himselfe and others, and pre­serving it from putrefaction and annoyance, untill time and place fit for burying of it bee offered: which hee com­passeth partly, by encearing of it, partly by embaulming: of the which two last, I meane also to discourse: That the Chirurgeon, which I meane to frame, may bee compleat. I have now presented to the view of the eyes of your understanding, this Chirurgicall Canaan: Into the which I meane to bring you, not to use the native inhabitants hardly, as Ioshua did the Canaanites and their things: but mutually to enjoy the use of those good things which you shall find with them. If I proceed orderly, I must enter into the doctrine of Tumors, which will bee both pleasing and profitable in my first lecture. It is a subject, which is most frequently offered, and from whence the meanest of all the brethren, which practiseth, is not exempted. Where­fore it behoveth every one to bee well grounded in this point: Howsoever I shall be willing that the Governours of the worshipfull Companie set downe the matter, whereof I shall reader:

• Generall to all Tumors, and those are in number three.
  • 1. The description of a Tumor.
  • 2. The causes of a Tu­mor according to the
    • Dogmatists.
    • Chymists.
  • 3. The differences of Tumors.
• Speciall, belon­ging to every Tumor parti­cularly. How all Tumors are either
  • Simple, and those are 6. which pro­ceed from either
    • Humors, and those are foure.
      • Phlegmone, caused of bloud.
      • Erysipelas, of cho­ler.
      • Oedema, of flegm.
      • Schirrus, of Me­lancholie.
    • Or from
      • Water, an aque­ous Tumor.
      • Flatuositie, a flatu­ous Tumor.
  • Compound Now the Combination of the Tu­mors proceeding from the mixture of the materiall causes, causing the simple, I have set downe in every particular Tumor.

LECT. II. The generall doctrine of Tumors.

SEeing according to Aristotle in cap. 1. lib. 1. physic. acro­as. in every methodicall tractation, that which is most generall ought first to bee set downe, then that which is more speciall; because the generall points being set down, they exceedingly further the knowledge of the particulars: I will begin from those things which are common to all speciall Tumors, and those I make in number three. First, I will declare what a Tumor is. Secondly, which are causes of Tumors: Thirdly, which are the maine differences of Tumors.

The appellati­ons of a Tumor.Before I come to the essentiall definition of a Tumor, I Will set down the denominations of it. A Tumor in Greeke is called [...], that is, a prominence or protube­rance in the bodie. And from hence the Latine words uncus a crooke or hooke, and aduncus bended or crooked, are derived: Because things bended cause a sticking out. The Arabians and barbarous Physitians, who follow them, call all Tumors unnaturall Apostemata, in Latine abscessus: this word is derived from the greeke verb [...], abscedere: Because in apostemes there is a collection of humors in any place, which have left their own proper seat &c. For hu­mors, which cause Apostemes, come from the veines, and so leaving ther own naturall receptacle, seat themselves in other parts of the body, being dependant and weake. And Chirurgeans commonly call Tumors wherein there is col­lection of matter Apostemes. Tumor, which is a Latine word, and by frequent use made familiar in English confe­rences and discourses, is derived from the Latine word Tumeo, to bee raised or puffed up: And from Tumor com­meth Tumulus a grave: because it is raised up higher than the ground adjacent to it. Now bunchings or stickings out of parts of the body, are threefold: Differences of Tumors [...] the body. for either they are naturall, and then they serve for the comelinesse of the [Page 16]body are threefold: for either they are naturall, and then they serve for the comelinesse of the body, 1 and further the actions, as we may see in the head, belly, joints; the thighs, calves of the legs, 2 and armes: or they only passe the ordina­ry dimensions of some parts, 3 such are the dugs full of milk, and the bellies of women which are with child: Or they are altogether unnaturall, not only marring the comely composition of that part of the body which they possesse; but hindering the actions also. Such a tumor, or eminence of the body, is called by Galen [...], id est, tumor praeter naturam, a Tumor contrary to nature. Having set downe the denominations of a Tumor, I must come to the definition of it. Seeing so many as have written of tu­mors have set down one definition, or another, if I should set downe all the severall definitions, which are by divers authors set downe, and insist in the refutation of such defi­nitions as offend against the conditions of a good defini­tion, I should rather seeme to the judicious, to make an o­stentation of reading, and wit, than a care of the profiting of the hearers. Of all the definitions, two are chiefly to bee noted: the one of Fallopius in his treatise of tumors: c. 3. The other of Hieron. Fabricius ab aqua pendent. in O­peribus Chirurgicis, part. 2. lib. 1. de tumorib. cap. 1. That of Fallopius is gathered out of Galen, cap. 1. lib. 13. de method. medendi: and it is thus. It is a disease, whereby the parts lose their naturall bignesse, exceeding it. So that exte­nuation is contrary to a tumor. Hee will have it to bee a disease of the instrumentorie parts: for quantity is only an instrument, whereby the organicall parts performe their actions, more strongly, or weakly, as wee may see in dwarfs, and tall men. Galen lib. 1. de tumorib praet. nat. c. 1. affirmeth that in tumors contrarie to nature, all dimensi­ons, that is, length, height and breadth are increased. But the former definition cannot bee ascribed to every particu­lar tumor, and so it is not large enough: for in an Erysipe­las extreme heat rather offendeth, than the bignes enlar­ged, [Page 17]which very often cannot bee deprehended by the sen­ses. The definition of Fabricius. The definition set downe by Fabricius ab aqua pendente is this: A Tumor against nature, is a disease for the most part compounded, which is to bee named of that thing, which hindereth the actions. And seeing to a crow, her own birds seem fairest, for if any one set under her, hens egges to bee hatched, that they may have cocks of the game, they must watch for the time of disclosing, lest shee kill them: So hee to make his definition plausible to his readers, will have all to mark some remarkable points in his definiti­on. And first of all, in that he calleth a Tumor against nature morbus, or a disease, he will not have pushes in the face, and such small eminences of the skin to be Tumors, because they hinder not the actions: hee cannot deny that the equalitie of the skin is altered, and besides this, the a­ction of the skin, which is perspiration, in that place is hindered. Let no man think it harsh, that I ascribe action unto the skin, being a simple and similary part of the bo­dy: it cannot bee denied that all similary parts have an use, which use sometimes is an action, as this of the skin; to send out by the pores of it fuliginous vapors, and super­fluous serositie of the bloud by insensible perspiration and sweat. And although such small eminences commonly are denied to bee diseases, because they hinder not the a­ctions; yet they be passions, and affections, which require the skill of the Physitian and Chirurgean: yea those pushes of the face are somtimes more hard to be cured than great Tumors, and Artists many times gaine more by those, than these: besides this, by reason of the matter they are to be re­ferred to one or other of the maine Tumors. Howsoever they are not to be neglected. According to Aristotle 1. Rhe­toric. c. 5. & Galen. ad Thrasibulum, Three gifts of the body. there be three gifts of the body, to wit, Health, Strength, and Beauty, all which medicine is to direct: Health is preserved by holesom nou­rishment, Strength by convenient exercises: of the which [...] intreateth, whereof Hieron. Mercurialis hath [Page 18]written a volume; [...] hath care of the beauty: now seeing by reason of the face, a man is called beauti­full or ugly, who can deny that they deserve the care of the Physitian, and Chirurgean. He addeth that a Tumor is a disease most commonly compounded; if hee had said ever compounded, hee had spoken a truth: for in every one of these Tumors, there is a Tumor conspicuous or latent; or a solution of unitie, either sensible or imaginary. In an Erysipelas it self, wherein there appeareth neither quan­tity of part increased, nor solution of unity procured; yet in it there are undoubtedly both: for the first, seeing there is so great a heat in the part possessed with this griefe, the Humors must bee rarified, and the part dilated, which will require a more spatious place than it had before, which is an evident argument, that the quantity is inlarged. As for the second, the parts before arctly united must be somwhat separated by stretching: Reason must teach us that which cannot bee deprehended by the senses. The last clause of the definition, That the Tumor is to bee named from that which hindereth the action, as Erysipelas a disease of distemperature, because heat doth most hinder the action of the part: this is frivolous, because not heat only, but the bedewing of the skin with choler, by the which it is stret­ched, hindered the contraction and extension of the skin, and so by a necessary consequence, the hindering of the motion of the part organicall, wherein it is seated. To conclude, this definition may bee applyed to other griefes than a Tumor, as to the head-ache, which is a disease most commonly compounded of distemperature of the hu­mors, and solution of unitie, and may have its denomina­tion from the diversity of the humor causing it. Where­fore, seeing neither the definition of Fallopius out of Ga­len, nor the definition of Fabricius ab aqua pendente, can abide the triall of the lawes of a good definition, wee must assay to give another, which shall be this: A Tumor against nature is most frequently a disease, somtimes a light [Page 19]affection, for the most part incident to the organicall parts, increasing their quantity above nature, by reason of receiving of superfluous humors sent from other parts. Here I will labour to yeeld a reason for every point of this definition. The genus is a griefe, The definition of the author. because it hindereth the actions, somtimes it is a passion or light affection, which hindereth not the action of the part, as appeareth in small adomatous Tumors, and scirrhosities: and therefore these modifications frequently, and somtimes are added. The subject of a Tumor is a part organicall, somtimes by its own nature organicall, as a finger or toe, somtimes organi­call only by office, as when the use of a similarie part is performed by an action: as it appeareth in the skin, one of the uses whereof, is to send forth by its pores insensible perspirations, fuliginous vapors, superfluous serosity of the bloud by sweat, and ichors of humors in the beginning of Tumors, and declination by discussive and resolutive medicaments. The forme of a Tumor is quantitie increa­sed, whereby it differeth from all other griefes. The cause of quantity in­creased. The cause of increase of quantitie, is receiving of superfluous hu­mors, which is done two manner of wayes, to wit, affluxi­on, and congestion. Affluxion is, Affluxion. when a humor offen­ding either in quantity or quality, suddenly with violence seizeth upon any member, either by reason of the weak­nesse of it, the rarity, loosenesse, dependancy, heat, or pain, or because the whole body is full, or cacochymicall, and the parts sending strong. Congestion is, Congestion when a humor is collected in any part by little and little, by reason of the weaknesse of the concocting and expelling faculty of the same: so that a Tumor against nature is a disease alwayes compounded, against Fallopius in his Treatise of Tumors, c. 3. For there is alwayes a solution of unity, either mani­fest, or latent and occult, and this hee granteth; for hee saith, & de hoc conveniemus: we shall agree concerning this. Besides this, the quantity is increased, and that al­wayes to reason and imagination, although not to the [Page 18] [...] [Page 19] [...] [Page 20]sense, as hath beene said of an Erysipelas. Moreover, you shall hardly finde a Tumor without some distemperature, either simple, or compounded. I have insisted somewhat too long in clearing the Probleme of the definition of a Tumor against nature, because there is great contention concern­ing it amongst Authors, both ancient and moderne.

Causes of Tu­mors.Now order of doctrine requireth, that we speake some­what of the causes of Tumors: these are either externall, or internall; Externall. The causes externall are in number eight. I. The aire, if it be contagious, it causeth Tumors, as Carbuncles, and Botches in the plague time. II. The touching of things exceeding temperature in the active qualities, as we see in the application of Veficatories, and sitting long upon any cold seat. III. Too hard binding of the part, which cau­seth sometimes Gangrenes. IV. The application of an at­tracting instrument to the body, as Cupping-glasses, and Hornes. V. Whatsoever may cause solution of unitie, as wound, fracture, luxation, or contusion. VI. Biting of beasts, whether they be venomous or no. VII. Taking in­wardly things offensive to nature, whether it be by the ex­cessive quantity, as when by too liberall drinking wine, an Erysipelas seazeth upon the head, or by a maligne qualitie, as we may see fall out after the taking of Arsenicke or Mer­cury sublimate. VIII. Immoderate motion, whereby im­moderate heat is procured, whereby the Humors become more subtill, and the passages to the weaker part more pa­tent.

Causes of the weaknesse of a part.Now the part is weake: First, by nature, and that either by reason of its substance, it being spungeous, and loose as Glandules: so wee see frequently Parotides behinde the eares, and Bubones in the groynes, or by reason of the na­turall humidity of the part; so Tumors more often appeare in the flesh than in the spermaticke parts. A part also na­turally is weake by reason of the situation, for the de­pendant parts are more apt to receive influence of humors, as the more high are to receive Halitus; so it is often seene, [Page 21]that it rising from the stomacke, or some inferiour part, causeth in some the falling sicknes. A part, secondly, is weak by accident, and that by reason of errours committed in the things not naturall, as aire, meat and drinke, exercise, and such like, whereof much is spoken in that part of Physicke which is called Physiologia. Things requi­red in a Tumor. So that to the causing of a Tu­mor in a part, there be required, the weaknesse of the part which receiveth, patent passages, preparation of the Hu­mor, and the strength of the part sending.

The internall, causes of Tumors are either Humors or Flatuosities: The Humors are either naturall or unnaturall: Internall The naturall are either sincere, as choler, flegme and melan­choly; or mingled, as some of these with blood, for blood is no where sincere, but according to the humor mingled with it, which is predominant, it is called cholericke, phleg­maticke, or melancholy blood. The Humor unnaturall is water, as in the dropsie, for it never can become nourish­ment. Of Tumors which are caused by reason of strange things, as wormes, lice, bones, nailes, haire, grissy substan­ces, and such like, I will speake when I come to the third part of Chirurgerie, called [...] or Ablatrix, which ta­keth away superfluities. But time admonisheth to come to the setting downe of the principall differences of Tumors. In this matter I will leave all needlesse and fruitlesse distin­ctions of Tumors, from time, as that some are new, some old, some short, some long enduring: from the quantity, as that some are small, some great, some of a meane big­nesse: from the condition of them, as that some are milde, some maligne, some curable, some uncurable, and such like; which either doe not greatly further the knowledge and curation of Tumors, or else are to bee set downe to some purpose in the explication of every particular Tumor. Onely now in my generall discourse of Tumors, which is to shew light unto that which shall hereafter be spoken in the speciall doctrine of each, I will meddle with the differences taken from the materiall cause of Tumors, from whence [Page 22]spring the maine principall Species of Tumors, unto which all other may be reduced.

The maine dif­ferences of Tumors.All Tumors then are either simple or compounded. The simple are caused either of Humors or Flatuosity: the hu­mors are either naturall, or unnaturall: the naturall Hu­mors are foure, Bloud, Choler, Flegme and Melancholy: If blood, which neither in the veines, nor without, is found sincere and unmixed (as hath beene said) cause a Tumor, it is called Phlegmone, or Inflamatio, according to Galen lib. 2. ad Glaucon. cap. 1. Of the divers kindes of it, which have their denominations from their places, and of the diversities which arise from the complication of it with other Humors, I meane to discourse when I come to the particular tracta­tion of it: for I meane not to confound particulars with ge­nerals, because this would breed confusion, and so deprive the memory of fruit of that which is delivered. Of all other Tumors a Phlegmone deserveth the first place, because it is caused of bloud, which is the son of nature, first begotten, and the treasure of life. If choler cause the Tumor, it is cal­led Erysipelas; these two are hot Tumors. If flegme cause a soft and white Tumor like it selfe, it is called Oedema, unto which divers pituitous Tumors are reduced, of the which I will speake in their proper places. If a Tumor very hard be produced of the melancholy juice, and without paine, it is called Scirrhus; these two last are cold Tumors. If a Tumor be caused of water contained in any part, it is called Tumor aquosus: If from flatuosity Emphysoma; these two last Tu­mors are the off-springs of crudity, caused by the weake­nesse and defect of the naturall heat. And seeing these have the materiall cause different from that of others, I will speak of these in severall Lectures, as was done in every other particular Tumor. Besides this, they require other medica­ments than the rest of the maine Tumors doe, as shall bee shewed when we come to the curation of them. Differing then from the rest, I see no reason why they may not bee accounted severall Tumors; one cannot truly say that ei­ther [Page 23] Hernia aqu [...]sa, or flatuous Tumors of the joynts, can bee reduced to the aforesaid foure principall Tumors, or that they can bee cured by the same indications of curing, and medicaments which are applied to the other. You see how I have set down six simple Tumors, for fewer I cannot, if you consider either the diversity of the materiall causes, or the diversity of the topicall applications, or the evidence of doctrine. The combination of these beget the compound Tumors; in these compound Tumors, Compound Tumors. what Humor is pre­dominant, that carrieth away the denomination: As for ex­ample, if bloud abound more than choler, the Tumor is cal­led [...]. If choler be predominant, it is called [...], and so in all other combinations of Humor in Tumors, which shall be presented to your view. When you have noted the Pathognomonical signes of each of the simple principall Tumors, it is an easie matter at the first sight to discerne the kinde of Tumor, and what compound medicaments are to be applied to it. Hitherto have I declared unto you the opinion of Hippocrates, Galen, and of the rest of the Grecians, as also of the Arabians con­cerning the materiall causes of Tumors. Now to fulfill my promise, I will shew you what Paracelsus and his followers thinke of this point: First then they acknowledge but two elements, water and earth; for if they should not grant so much, they could not be accounted in the number of the faithfull; for in the very first Verses of Genesis mention is made of both. Secondly, The Humors are not parts of the body. they account the Humors parts of the body, and so the causes of no griefes, but erroneously, for if they were parts, they would bee endued with life, which they are not. Thirdly, they would have some action, whereof they also are deprived: onely they have an use, which is to nourish the parts. Besides this, they maliciously dissemble the doctrine of the rationall Physitians and Chi­rurgeons, for they make each Humor, contained in the masse of bloud, either naturall, or against nature: the natu­rall they make, either alimentary, which nourisheth the [Page 24]parts, or superfluous, which nature reserveth for some o­ther uses: of this abounding, diseases proceeding of fulnesse are ingendred, called Plethora: of the Humor against na­ture, causing impurity, Cacochymia is caused; so choler in the veines and arteries is naturall, and alimentary. In the Cystis fellis, and in the Porus biliarius, the superfluous is contained: if it leave the appointed receptacles, and passe to the habit of the body, it causeth the yellow jaundize; if by adustion, it become Bilis atra, it procureth Cancers and Wolfes; What Humors cause diseases. so that they hold not the naturall, but those that are unnaturall to be causes of diseases.

The principles of all things according to Paracelsus and his followers.The Paracelsians appoint three principles of all things, Sal, Sulphur, and Mercurie, and not onely by resemblance, or allegorically, but really: By Sulphur, they understand the fattie substance; by Mercurie, the waterish substance; by salt, the earthy substance: Distill Cloaves, there come two humidities, the oile and spirit: in the bottome the earthy substance stayeth, which hath two parts, Terra repurgata, the crystalline salt, and Terra mortua, the blacke earth. The life of the salt is a strong water, The life of salt. which if it be by distillation drawne, it leaveth but a Terra damnata, onely fit for the dunghill. The effect and benefit of salt. This salt preserveth the body from putrifaction, wherefore Christ called his Disciples the salt of the earth, because by the preaching of the Gospell, and administration of the healthfull Sacraments, they procured to the unfaith­full the life of grace, who before were but Terra damnata; and by a wonderfull transmutation of terrestriall creatures, made them spirituall, representing the Angels, yea God himselfe, by restoring his image. From defects in these three, The causes of diseases accor­ding to the Chymists. they will have all diseases to proceed: and concern­ing Tumors against nature, the hot they will have to pro­ceed from Sulphur and Mercurie, and the hotter it is, the more Sulphur to concurre. The cold Tumors they will have to proceed from Mercury and Salt, and according to the loosenesse, or firmenesse of the Tumor, the more Salt or Mercurie to be required, as in Oedema more Mercurie, in [Page 25] Scirrbus more Salt. This is their doctrine concerning the materiall causes of Tumors, in my judgement it is the salfest course to insist in the foot-steps of the ancient, for their way is plain and easie; no man can deny that there are foure Humors in the masse of bloud, as may appeare when it is drawne out of the veines: Choler swimmeth about the bloud, which is known by its bright rednesse; Melancholy is in the bottome, which is deprehended by its grossenesse and blacknesse; now Flegme uniteth these two last Humors, and maketh them tough. The Paracelsian doctrine is full of difficulties, which hee maketh more obscure by coyning strange words, as his Reader will perceive; so that his dis­courses are but a kinde of canting Philosophie. Neverthe­lesse, I thought good in plaine termes to acquaint you with it, that when any Empericke shall make a shew of learning, by using these termes, you may finde him out, and esteeme of him as he is: that is, like that head which the Wolfe a­farre off espied, representing the head of a living man, but comming neere, and seeing it but curiously carved, affirmed it to be Pulchrum caput, sed sine scientia, A comely head, but without wit.

LECT. III. Of the generall Indications of curing Tumors.

OF the generall points whereof I intended to speake be­fore the handling of every particular Tumor, having set downe the definition, causes, and differences of Tu­mors, now I am called upon to set downe the generall indi­cations of curing Tumors.

Indication what it is,Now an indication is that which sheweth what course is to bee taken for the recovery of health: The gene­rall indications are taken either from the matter, or from the times of every Tumor; In the matter, we are to consi­der [Page 26]the motion of it, and its nature: As concerning the motion of the matter, it is either in flowing, or it is received already into the part. The causes of fluxion are two, Ple­thora, or fulnesse, and Cacochymia, an ill complexion: Plethora or fulnesse is twofold, Ad vasa, and Ad vires: Ad vasa is when the veines are onely full, and the body not­withstanding quicke and nimble [...] this is twofold, Pura, when there is a due proportion of the Humors of the body, and Impura, when there is an excesse of any of the three Humors besides bloud, as Choler Flegm, or Melancholy. Ad vires is when there is such a fulnesse, as causeth sluggishnesse of the body: this requireth evacuation of Phlebotomie, as Cacochymia by purgation. As for Phlebotomie, three things are to bee observed concerning it. I. The manner: In ful­nesse, Quoad vasa, at one time so much blood is to bee drawne as is requisite; but in fulnesse, Quoad vires, because strength is somewhat abated, you are to draw bloud by re­petition, and not all at one time. II. Is the quantity, how much then is to bee drawne, the weaknesse or strength of the party will informe you; for in a weake body you are to draw lesse, in a strong body more, strength and weaknesse are to bee discerned by the functions: the weakness of the naturall faculty is discerned by crudity of Urine, and excrements of the body: the weaknesse of the vitall, by a weake and small pulse, as also breathing weake and thicke: the weaknesse of the animall function is found out by de­fect in moving and feeling; by the integrity and perfection of these three faculties the strength of the party is percei­ved: But we must diligently distinguish beweene langui­shing and weaknesse indeed, Weaknesse and oppression dif­fer. and oppression of faculties by reason of fulnesse, making them dull and slow; for as in weaknesse, great moderation is to be used, so in oppression we may more bountifully and boldly suffer the veine to run. The third thing to bee observed in Phlebotomie is the end of it, whereof it is instituted; the scopes of bloud-letting are two, Derivation and Revulsion: Derivation is the draw­ing [Page 27]of the Humor to the part adiacent, or of the same side, by opening of that veine, or a branch of it, which is inserted into the part affected: as for example, if in diseases of the head or necke, we open the Cephalica in the same side: and even in this there is a kinde of opposition, to wit, high and low; or in Tumors of the groyne, we open Vena poplitis: this they doe also who open this veine in Podagra, if the gout invade the foot. This kinde of interception we use, not onely because there is a plentifull fluxion to the part affected, but because a speedy interception is required, lest the naturall heat of the part be oppressed, or the rupture of a vessell ensue: so in inflamation of the lungs, and side, wee open the liver veine of the same side, and draw bloud plen­tifully. Revulsion is a drawing of the Humor to a part op­posite: of this there be foure differences: I. From the higher to the lower parts, as from the head to the feet. II. From the right side to the left. III. From the fore part to the backe, which wee shall doe if we apply Leeches in diseases of the brest or belly. IV. Is when we draw from the center unto the circumference, as in applying Ventoses with Sca­rification to the necke in diseases of the braine, as in the A­poplexie, and Lethargie Vesicatories performe the same.

But one may aske which we to be accounted high, Quest. and which low.

I answer, That all those parts which are above the navell, Answ. including also the liver and stomacke, are accounted high; but the parts below the liver, are accounted low, as the kid­neys, and genitals in man and woman.

The ends of Revulsion.This kinde of interception we use in two cases: First, if the matter flow but flowly, and so a sudden interception is not required. Secondly, if we are to open a veine to prevent a disease, as Vena cubiti for to free one of a fit of the gout. But this kinde of drawing hath no place in contagious Tu­mors, if they appeare either in the upper or lower parts; for whether they appeare either behinde the eares, and arme-pits in the upper parts, or in the groynes in the lower, [Page 28]revulsion must be by the Vena cava, which is inserted into the right ventricle of the heart: now whether any conta­gious vapour or Humor can bee sent by this passage safely, let every judicious person consider.

Now there is a difference between Revulsion, Derivation, and Evacuation, for in the former two, motion is requi­red, as you have heard, but in vacuation the Humors must be quiet. In the translation of Humors flowing from any part, wee must marke according to Hippocrates, that it be done [...], Secundum rectitudinem, by observation of a straight course; and that is done two manner of wayes:

First, by the rectitude of the parts, as the left with the left, and right with the right, and the hinder with the fore parts. Secondly, by the rectitude of the vessels: as for ex­ample, The liver veine of the arme hath a kinde of strait­nesse with the veines ascending to the head: so if one bleed immoderately at the right nostrill, by applying a Ventose to the region of the liver, the flux ceaseth: if it flow from the left nostrill, it must be applied to the region of the spleene.

Having set downe how Plethora is to bee abated, if it cause fluxion, we are to shew how Cacochymia is to bee re­moved, which is not so much by reason of the quantity op­pressing, as by reason of an evill quality offending a part. Now this matter offending in quality, it either moveth from place to place, or it resteth where it had its first invasion; if it move from place to place, it is the safest course to abate the Humors wherein this quality is resident by Phleboto­mie, lest it seaze upon some principall part: if it be quiet, resting contented with the first place, then let us use by pur­ging, expelling the Humor, whether it be choler, flegme, or melancholy, with appropriate medicaments, which Physick prescribeth in that branch of the curative part of Physicke which restoreth health by the administration of inward me­dicaments. Having set downe the indications which are ta­ken from the motion of the Humor, wee must come to those which are taken from the nature of it.

Indications from the na­ture of the humor.Now the humor it selfe is either not contagious, or con­tagious: If it bee not contagious, the fluxion of it doth proceed from three causes: The first is the strength of the part sending the humor, which it doth, either because it is burdened with the quantity, or pricked on by the quality; wee have shewed what is to be done in these cases. The se­cond is the thinnesse of the humor. The third is the attra­ction of the affected part. If fluxion be caused by reason of the thinnesse of the humor, if we cannot use phlebotomie or purging, as in children, decrepit persons, and in wo­men with childe in the last moneth: then we must use revul­sion, and this is done six manner of wayes. I. By Ventoses region of the liver, when one bleedeth too much at the right nostrill. II. Painfull constriction, or binding of the parts, as armes, and legs: but wee must first rub hard the parts which are to be bound; and if we binde the arme, we must use a Ligature in three parts: 1. Neere the arme-pit. 2. A little above the elbow. 3. About the wrist. In the legs we must use a Ligature neere the groyne, a little above the knee, and neere the anckle. III. Painfull frications when wee meane to revell from the center to the circumference. IV. Bathing of the parts with very hot water: for first by reason of the paine it doth revell. Secondly, it doth discusse because it openeth the poores. And in fevers by bathing of the limmes sleepe is procured, the vapours ascending to the head. V. Vesicatories which are used in the Apoplexie, Le­thargie, and such like. VI. Fontanels, and they are in great use to be applied to divers parts, for the preventing and cu­ring sundry griefes. If the fluxion be procured by the attra­ction of the part affected, there be two causes of the attra­ction: First, the distemperature of the part. Secondly, paine. If distemperature of the part be the cause, it must be removed by its contrary: but seeing it is most commonly a hot distemperature, things cooling are to be applied, as by applying clothes moistened with oyle of Roses, or violets [Page 30]cold: but when the clouts become hot, the [...] are to be remo­ved, and cold to bee applied, or cloaths moystned in the juyces of cold herbs. If wee apply unguents, as infrigidans Galeni, Rosatum Mesuis, de cerussa Rasis, Populeon, wee must not apply the unguent immediately to the skin; but a thin linnen cloth: for it keepeth the unguent from drying, and doth not hinder the breathing out of the vapors, which the immediate application of the unguent would doe, and so by stopping of the pores, would increase both the heat and paine.

And in application, of pulteses, they are to be spread be­tween the fouldings of a cloth, dipped in some convenient oyle or liniment; for so it doth not hinder perspiration, and the applications are removed more easily from the part. This in your pratice is to bee noted, and the inveto­rate error to bee shunned, if the wayes by the which the humor passeth, bee too ample and patent, and a hot distemperature joyned, then things astringent and cooling are to be applied, roulers and other cloaths being moystened in them. Wherefore in this case myrtils berries, red rose leaves dried, pomgranate rindes and flowers, sumach, sloes, oaken and owlar barke boyled in red astringent wine, or vineger and water, or new and fresh Tanners woose, and strained are effectuall. The parts therefore by the which the humor passeth, are to bee rouled somwhat strait with the rouler, cloaths, stupes, or pledgets and bowlsters be­ing moistned in this liquor, and wrung: you may also ap­ply astringent and defensive emplasters drawne upon leather; such an one is this, ℞ rad. torment. bistort. symphyti. ros. rub. gallar. balaust. malicor. sang. drac. boli. Armen. santal. rubr. cerass. an. ʒ j. cerae albae ℥ iij. ol. myrtill. ℥ j. mise. fiat ceratum. So much then shall bee sufficient to have been set downe, concerning the attraction of the affected part, by reason of the distemperature of it: now wee must come to the second cause of the attraction, which is paine or dolor. There are two causes of paine, solution of unitie, [Page 31]and a venomous quality: if the solution of unity proceed from the affluxion of Humors hot or sharpe distending the parts, the paine is to bee eased with medicaments conveni­ent: these are of two sorts, Anodine, and Narcoticall: Ano­dynes gently contemperate the part, by reason of the con­formity which they have with the nature of man. They are hot in the first degree, and of subtill parts; such are milk, old sallet-oyle, butter, the fat of swine, hens, ducks, geese, eeles, man, badger, beares: the oyle of camomil, lilies, earth-wormes, lineseed, dill, sweet almonds, egges, the pulp of Cassia tempered with the oyle of roses, the pulp of swect apples with the pouder of saffron. Narcoticks, are which deprive the part of the facultie of feeling, such are Opium, hemlocke, henbane, the deady night-shade, man­dragora, and the apple of Peru, or prickly apple: When narco­ticall meanes are to be used. these we are to use when the former will not prevaile, and when by reason of watching, a fever or faintnes is to be feared. Somtimes in extremities they are used solitary, som­times with their correctives, to wit, things hot, if we feare stupefaction of the part, unto the which they are to be ap­plied: such things are castoreum, saffron, cinamon, cloves, pepper, and such like. If the biting of a venomous beast, What is to bee done in biting of venomous beasts. as of a mad dogge, or a viper, or adder: or the stinging and pricking of any beast, as of a scorpion, or insect, as a hornet, bee the cause of a Tumor, wee must addresse our selves to meet speedily with the poyson. If therefore a venomous beast bite or sting, first, the part is to be scarified, and ventoses to bee applied: then the part is to be fomen­ted with Theriaca Andromachi, dissolved in strong wine vineger, and stupes moistned in the same, applied to the same; or it is to bee fomented with the oyle of scorpions, and a pledget wet in it to bee applied: and above the pled­get, this emplaster of Fallopius is to bee spread warme, De tumoribus c. 14. ℞ pic. naval. ℥ j. sal. nitri. ℥ ss. semen. synapi ʒ ij. cepar. allior. sub. prun. coctor. an. ʒ iij. assae foetid. sagapen. an. ʒ ij. stercor. columbini ʒ j ss. aristol. rotund dictamni albi an. ʒ j. ol. lil. al­bor. [Page 32]℥. ss. fiat emplastrum: pigeons also, and hens, and cockes divided in two parts, and applied hot are avallable. Som­times the actuall cauterie is to bee applied, to tame the malignitie of the poyson, if the poyson hath continued a­bove three dayes: Besides this, two things more are to bee done, first, according to Galen, the member is to bee bound hard, 3. de loc. affect. 7. three or foure inches above the part bitten or stung: secondly, Antidots inwardly are to bee given; but chiefly Theriaca Andromachi, for many dayes together in a liquor, fit for the constitution of the diseased person: now if the matter of a Tumor bee contagious, Indications in contagious Tumors. wee are by all meanes to draw it out of the body, lest if it goe in, it deprive the person of life, as in the plague, or infect the liver, as in the pox, wherefore ventoses are to bee applied, and medica­ments attractive to bee applyed: such is Fallopius his em­plaster set downe before, for the attraction of poyson. In the plague, wee must not faile to minister Antidots, even to three times in a day, and to procure sweat: such are Theriaca, Electuarium de ovo, Electuarium Orvietani, or this of Fallopius: De Tumor. c. 9. ℞ baccar. juniper. caryophyll. nuc. muscas. rad. enul. an. ʒ ij. rad. aristol. utriusque, gentian. an. ʒ vj. semen. portul. acetos. doron. been rub. an. ʒ j. spodii, oss. de corde cervi. ligni aloes. coralii albi & rubri, rasur. ebor. baccar. lauri, mastich croci. an. ℈ ij. rut. morsus diabol. au. ʒ j. pulp. ficuum & dactylor. an. ℥ j cinamoni liquirit. an. ℥ ss. tormentill. card. benedict. dictamni albi an. ʒ iij. amygdal. dulc. & pinear. excort. an. ℥ j. agaric. trochiscat. ʒ vj. rad. peu­ced. ʒ ij. terrae sigillat. & bol. erient. an ℥ j zedoar. ʒ ij. ca­phur. ʒ iij. spec. 3. santal. spec. diarrhod. abbat. an. ʒ ij, cort. citri, pulv. smaragdi an. ʒ j. moschi ℈ j. Theria [...]. Andromach. & Mithridat. an. ℥ j. fol. mali Arm [...]niaci ℥ ss. cum syrup. de cort. citri, & de acetositatecitri an. triplopondere ad pulveres fiat Electuarium. Coquendo em­ [...]ias [...]a. Vt Electuarium fiat magis efficax addi possunt cornu rhinocerotis ʒ iij, & cornu cervi praparat. ℥ ss. dos. a ʒ j ad ʒ ij, in convenience liquore.

The stinging of waspes or bees is cured with mallowes [Page 33]stamped and mingled with cold water, or chaulke applied with the same.

LECT. IIII. Of the foure times of a Tumor, and the Indications taken from them.

HAving spoken of the Indications curative, taken from the matter of a Tumor, now it followeth that wee speake of the Indications taken from the times of a Tumor: the times of a Tumor are foure, the beginning, the increase, The times of a Tumor. the state and declination. The beginning is thought to be, 1 when a part beginneth to swell, although the actions bee not hindered: in the beginning repelling medicaments are required: repelling medicaments are cold, and of grosse substance, for they are to thicken the part affected, and to coole the inner parts of it; such are the whites of egges, plantine, night-shade, house-leek, prick-madam, purselain, rose buds, drie roses, myrtil berries, pomgranate flowres, and rindes, gales, sumach, quinces, sloes, bole, sanguis draconis, terra sigillata, sowre wine, Tanners woose, which you may apply either single, or mingled according to your scope. When repel­ling medica­ments are not to bee used. But in six cases wee are not to use repelling topicks, first, if the matter bee venemous or maligne: least it being repelled, should assault some principall part. Se­condly, if the matter be critically turned to a part, so that it bee not a principall part by the error of nature: for then it ought to bee repelled, as when in a burning fever, the matter being sent to the meninges causeth raving. Thirdly, when the body is either plethorick, or of an ill habit. Fourthly, 6. a con p med. 2. m. loc a. 2. when the humor floweth to the emunsto­ries. Fiftly, if the part have but little naturall heat, wee are not to use repercussives, least the naturall heat bee ex­tinguished, and the part mortifie. Sixtly, when the dolor Id. tod. lib. c. 7. & 13 method. [Page 34]is vehement, 13. method. c. 16. and the part exceedingly pained, for then Anodyns are only to bee used. Wee are to thinke the Tu­mor to increase, when the part is stretched, and symptomes are increased, and seeing in the increase the matter partly floweth, and partly possesseth the part, you are partly to repell, and partly to discusse: but if the matter flow with such force and plenty of humor, that it threatneth corrup­tion of the part, (e) or if the humor which floweth bee thick, and so hot, that the part feeleth a burning, as in a carbuncle, then are you to use sensible evacuation by scari­fication; but where wee cannot conveniently scarifie, the leeches are to bee applied as in the hemorrhodes, and o­ther griefes of the anus. Discussion. Now discussion is an evacuation of a thin matter gathered in a part, by insensible evapora­tion, procured by the naturall heat increased by proportio­nate medicaments. In this description, insensible is added to distinguish it from evacuation by incision, scarification, or leeches, which evacuate sensibly to the eye: the princi­pall efficient cause is the naturall heat; the adjuvant dis­cussive medicaments, the matter which is to bee resolved must bee thin; for it is in vaine to goe about to discusse a thick substance: because it is not apt to yeeld vapors. In the description, The effects of discussive me­dicaments. discussive medicaments are said to helpe naturall heat by increasing of it, which being done: First, the humor is made thin: Secondly, it is resolved into a va­por: Thirdly, it is drawne from the center to the circum­ference, and lastly expelled by the pores of the skin. The qualities of these medi­caments. Such medicaments then must bee familiar to nature, and these performe their office, by consuming superfluous humiditie: and so they must be hot and drie. Degrees of them. Gal 6. de comp. medic. 2. in loca c. 1. They must then be subtil, that they penetrate to performe these offices. There bee three degrees of discussive medicaments, they in the first degree are hot and drie in the second, as drie figs, branne, camomil, I Ammoniatum, galbanum, leaven, lilie roots, me­lilot, the roots of the marshe mallow, goose grease, and old hens grease: and because such asswage paine, wee ought c Id 6. de com­pos med. 2. in. loc. c. 2 d Id. 2. ad Glau­con c. 9 Id. 14. method. 20. [Page 35]alwayes to begin with them. In the second degree, are cala­mint, II Isope, penniroyall, ments, cummin-seeds, and dill-seeds, bean floure, the floure of vetches, fenugreeke, hore­hound, the root of Peucedanum, the roots of both the birth woorthes, lyons fat, old bearer fat, old badgers, cats, dogs, and mans fat: these are somwhat drier, and hotter than those of the first. In the third degree, III are those which are drie and hot in the third degree, as nitor, unslaked lime, sulphur vive, assa foetida, &c. These are to bee applied ac­cording to the constitution of the partie, as the skilfull Chirurgean shall see cause. The state of a Tumor is, when it is come to such a degree, What is to be done in the state of a Tu­mor. Its signes. as that it can goe no further in bignesse, the signes of it are these: first all symptomes, as tension, paine, rednesse, and feaver symptomaticall are at the height, and remaine uniforme, neither increasing nor decreasing: secondly, the veines of the parts adjacent continue in this same fulnesse and dilation. In the state, wee are to use Anodyns with discussives by reason of the paine. Of the Decli­nation. Wee are to thinke that the declination of the Tu­mor beginneth, when the aforesaid symptomes begin to abate, and then strong discussives only are to bee applied, wherof we have spoken before. In necessitie we may use these which are found in the shops, diachylon cum gummis, diachylon magnum Mesuis, diachylon ireatum. The terminati­on of Tumors. Tumors end not only by resolution, but often by maturation; and somtimes by induration and corruption: and as discussion is better than apostemation; so induration is better than the corruption of the part: fiftly, Tumors doe end chang­ing the place, The matter. as when in a plurifie the matter falleth upon the midrife, and causeth Empyema.

LECT. V. Of curing of a Tumor come to suppuration.

HAving in my former Lecture set down, that all Tu­mors end in one of these five wayes, to wit, discussion, [Page 36]apostemation, induration, corruption of the part, and pas­sing from one part to another.

Having shewed the method how they are to be discussed: Now order requireth that the meanes be set downe, how a Tumor is to bee handled, if it tend to suppuration, or ma­turation: which by our usuall terme is called Apostemati­on. Thus we are inforced so to goe to work: When natura­tion of a [...]u­mor is to be procured. First, if the humor be too plentifull; for then the naturall heat cannot well rule it, and so it must bee seconded by forraine and ex­ternall heate, which working vpon superfluous humidity, causeth putrifaction according to the Philosopher. Se­condly, when it is crude; for then wee must labour to con­coct it with the medicaments, which are peptica or coquen­tia. Thirdly, when the matter is hard; and then we must use emollient medicaments. The medicaments which pro­cure quittour, they are temperately hot and most: and these help naturall heat, that it may the more easily elabo­rate the matter, and make it fit for expulsion, and this wee call concoction. Emollient topicks are used to soften any matter indurated, and such are drie in the first degree; and hot in the first, and in the beginning of the second. But it is to bee noted that there is a difference betweene tension and hardnes, and relaxation and softnes: a part stretched will yeeld to the finger pressing it; if it bee hard it will not: and where there is any tension, relaxing medi­caments are to bee applied, which attenuate and open the pores, and therefore they must more discusse than drie, and so be drying in the first degree, and hot in the second. A part indurated must have emollient means applied to it: whereof wee will speake, when wee come to discourse of a schirru. Indications in curing of Apo­stemes. In the curation of Apostemes, wee are to doe two things: first, wee are to prepare the matter, and make it fit for expulsion: secondly, wee are to evacuate it, when it is prepared. To accomplish the preparation of the mat­ter, first, Removing of accidents. wee are to remove accidents: secondly, to procure the maturation of the matter. The accidents are these, pain, [Page 37]tension of the part, hardnesse, and heat. Asswaging of paine. As for the as­swaging of paine, narcoticall or stupefactive medicaments have no place here: for first, they extinguish the naturall heat of the part, The inconveni­ences of narco­ticall medica­ments. which is the principall efficient cause of coction: secondly, by thickning of the matter, they make it more rebellious; wherefore wee are to use Anodine medi­caments, whereof wee have spoken already: you shall doe well to apply such a cataplasme as this. Take of white bread crums jiii ℥, of new milk three quarters of a pinte, of mallow and violet leaves pounded small of each an hand­full: boyle these to the consistence of a cataplasme; then adde to it of saffron a dramme, of unguentum populeum iij ℥: let the aposteme bee dressed with this, or such a medica­ment, morning and evening.

Against tensi­on. Simples.If the part bee stretched, use relaxing topicks, such are those which are temperately hot, not drying much, and of subtill parts, as white hore-hound, archangell red and white, mullen, dill, camomill, fenygreek, mercury, melilot, turneps, the leaves of the marsh mallow, the floure of barlie, beanes, and vetches; of these you may frame to your pur­pose such a cataplasme: Take of camomil-flowres beat to pouder ij pugils, of barlie, beane, and floure of vetches, of each ij ounces, of marsh mallow leaves and flowres pounded a handfull: boyle these in beefe, or mutton broth strai­ned, and the fat taken away, untill they come to the consistence of a poultice: Then adde to it of the oyle of dill, ca­momill and rape-seed, of each j. ounce: dresse the aposteme with this or the like, morning and evening.

Against hard­nes. Simples.If hardnesse hinder, use those things which are emolli­ent, as all manner of fats, the dregs of oyle, all sorts of mallowes, colts-foot, buglosse and burrage, quince seed, milk, the white lilie, linseed, figs, raisins, the marrow of beasts, the oyle of sweet almonds, march violets, Ammo­niacum, Bdellium: of some of these you may frame a ca­taplasme after this manner: Take of linseed meale or pow­der, Compounds. iiij. ℥, of marsh mallow roots, and white lilie roots [Page 38]boyled in water, and well bruised, of each ij. ℥, of the violet leaves, and flowres, and colts-foot leaves, of each an handfull; boyle these in new milk, untill they come to the consistence of a cataplasme: unto the which adde of ammoniacum dissolved in muscadine, of the pulp of figs and raisins, of each j. ounce;, and so make up your cataplasme.

Against heat.If immoderate heat trouble you, apply things cooling: but let them bee cold either in the second degree, or be­ginning of the third: for the reasons yeelded against narco­ticks, when I spake of paine, such are umbilicus veneris, or navell woort, prickmadam, singreene, barlie meale, endive, the pulp of the pumpeon, sea-tong lettice, ducks-meat, the water lilie, the water archer, plantine, garden night-shade: of these herbs with barlie meale boyled in faire spring water make a poultice; and to every lib. of the poul­tice, adde ij ℥. of populeum unguentum, and one ounce and an halfe of unguentum rosatum Mesuis.

You may demand of mee, Quest. how long the application of these topicks prescribed, for the removing of accidents, are to bee continued.

I answer, Answer. untill the accident bee almost gone, with the which you encountered, and then you may proceed to as­sist nature, by increasing naturall heat by ripening medi­cines, which was the second intention of curing apostemes set downe by mee. Maturation of apostemes. Now those medicaments which help nature, ought first to stop the pores reasonable, only suf­fering the sharp vapors to breath out, and to detaine those which are mild, and somwhat thick, which are the secon­dary cause of coction. In this respect, then they ought to be viscous and tough in substance, such are temperate oyles, and mucilages, Gal de simplic. [...]acult. which by Galen, are called Emplastica: secondly, they ought to be familiar to nature, and so tem­perately hot and moyst. One thing is to be noted, that hot­ter simples are to bee chosen, according to the temperature of the part, if the Tumor seeme somwhat cold: wherefore if the Tumor seeme hot, only maturatives in the first degree [Page 39]are to be used, and those of the second degree to be shun­ned: But if the matter be somewhat cold, then you are to use maturatives of the second, yet alwayes mingling with them some of the first degree. And the reason is this, be­cause the medicaments of the second degree dry too much, wherefore those of the first degree are to be added, in the which there is much moisture, which is requisite to coction and producing of quittor. These medicaments are called Concoquentia, and Pus moventia, and Suppurantia: such ought to be hot and moist, as the body of a temperate man is, and so they ought neither to dry or moisten, or to heat or coole immoderately, but onely to preserve and in­crease the naturall heat; for a suppurative medicament ought to answer the constitution of him unto whom it is applied.

Degrees of suppurative medicaments.Of these suppurative medicaments there be two rankes: In the first, are Mans-grease which asswageth paine also, Duckes-grease, Goose-grease, Hens-grease, oyle of sweet Almonds, sweet sallet Oyle, Mallowes, sweet Butter, Figs, Simples of the first degree. Fenugreeke, Lilly roots, Linseed, Wheat-flowre; a Cata­plasme made of Wheat-flowre, Water and Oyle, an Empla­ster made of yellow wax, and oyle called Cerelaeum, Violet leaves and flowers, saffron. For an example, Compound. I will set down the description of a suppurative Cataplasme compounded of some of these of the first rank: Take of Milke a pint, in the which boyle of Wheat-flowre a quartet of a pound, of Violet-leaves, and Mallow-leaves stamped, of each a handfull, of Lilly-roots, and Figs boyled in water, untill they be soft, of each two ounces; when they are come to the consistence of a Pultice, adde of Saffron beat to powder a dramme, of the oyle of Linseed, sweet Almonds, Lillies, and Mans-grease, of each one ounce; and so make up your medicament. If the Tumor be immoderatly hot, mingle al­wayes with your suppuratives those things which are cold and moist in the first degree, as Violet-leaves, Lettice, the pulp of Pompions, Grownfill, Succorie, Dandelion, and [Page 40]such like. If of a sudden you be called, and be required to dresse a Tumor tending to suppuration, you may have re­course to the Apothecaries shop, and with these things dresse it. First, beat some oyle of Violets and faire Spring water, together, taking two spoonfull of oyle, and one of water, with the which embrocat the Tumor, then apply a pledget moistened in this, upon the part which is like to breake, or be opened; and above the pledget, Diachylon simplex if the Tumor be hot, or Diachylon cum gummis if it be but a little exceeding the ordinary temperament.

Suppuratives of the second degree. Simples.Suppuratives of the second degree are these; Terebinthi­na, Ammoniacum, Galbanum sagapenum, Gummi elemni, Pix navalis, Burgundie pitch, Saffron, Leaven, Fenugreek, Onyons and Garlicke rosted under the imbers, old Butter, oyle of Camomill, and Dill, old Hens-grease, Badgers-grease, and Beares and Dogs-grease, Wheat-flowre, Flowre of Linseed. In the shops there are Emplastrum de mucilagi­nibus, Dialthaea cum gummis, Diachylon cum gummis, Di­achilon magnum. Compound.

As before I have done, so now I will set downe a com­pound medicament, framed of these Simples: Take of the roots of the white Lilies, of the roots of the marsh Mallow, of Onyons boyled and bruized, with the liquor of each iiij. ℥. of Leaven ij. ℥. of Linseedmaeale j. ℥. and a half, of Saf­fron beat to powder a dram, of Ammoniacum & Galbanum dissolved in Muscadine, and the pulp of Figs, of each j. ℥. of oyle of Camomill and Lilies so much as will make a Ca­taplasme of a good consistence.

In Strumes, and Bubos venereall, use this: take of Dia­chylon cum gummis, and Emplastrum de muci laginibus, of each j. ℥. of Garlicke and Onyons rosted under the imbers of each ij. drammes, of Dialthaea cum gummis, Mans-grease, and Beares-grease of each j. dramme, make a medicament. One thing I would have you to note, that suppuratives of this degree are fittest for all contagious Tumors, and that to all such, Onyons and Garlicke rosted, and mingled with [Page 41]other medicaments, are to be applied; for being thus prepared, they leese their sharpnesse, attract, and become fami­liar to the naturall heat.

How Apostemes are to be opened.

Hitherto you have heard how that Tumors that cannot be discussed are brought to suppuration: Now I am to de­liver unto you, how the matter, which is suppurated, is to be discharged. This is done by opening the part: Now some things are to be considered before the action, some in the action, and some after the action: Before we goe about to open an Aposteme, First, we must be certaine whether it be ripe enough; Secondly, we must resolve how to open it.

Signes of ma­turitie.The signes of maturation are; I. The Tumor, by con­tracting it selfe, seemeth lesse than it was in the state; for while the naturall doth concoct the matter, vapours are rai­sed by the heat, and so the part is distended; but when the matter is concocted, the elevation of vapours ceaseth, and the Tumor falleth somewhat. II. The Tumor draweth it selfe to a point, or prominence; because when nature over­commeth the matter, it draweth it together, and draweth it to the skin. III. Hardnesse and tension are much aba­ted; for maturation being procured, many vapours are dis­cussed, which before stretched; and made hard the skin. IV. By pressing the matter with the finger, wee finde a flu­ctuation, or comming and going of it: but we must be cir­cumspect when a Tumor in a great joynt is offered unto us, as in the knee; for if we presse laterall parts of it, a certaine undation will appeare. V. The party feeleth much ease in the part; partly, because some of the sharpe vapours are re­solved; partly, because the matter concocted doth make the parts more loose. VI. The vehement heat ceaseth; for the Humor being come to maturation, the unnaturall heat a­bateth, and the naturall heat resteth. VII. If the part in­flamed hath changed the colour, and of red is become white, and chiefly in the pointed place. VIII. The scarffe [Page 42]skin becommeth shriveled, and ruffled; and this is a good signe, for it sheweth that unnaturall heat hath left it.

[...]truments fit [...] [...]pening.The second thing which wee said was to bee resolved up­on, was the instruments with the which the Apostemes are to be opened. They are three; I. The lancet or incision-knife, of the which there be divers formes set downe by the ancients: of the which wee will speake, when wee come to discourse of particular operations for the which they are re­quired. II. Is the causticke or pyroticall medicament. III. The actuall cauterie, which we will leave willingly to horse Leeches, unlesse we be destitute of other meanes: and when we are to make a fontanell, or to stay a great flux of bloud, or to dry a carious bone, or to correct a cancerous part after that it is extirpate.

Steele instru­ments.As for steele instruments, wee are to use them, First, Apostemes bee in the face, to avoid the filthinesse of the scarre, after the curation. Secondly, in small Tumors: for so they will be the sooner whole.

As for the Causticke medicaments, Caustickes. wee use two sorts of them: the first is made of the strongest sope lees, boyled to the consistence of a soft stone. The second is made of the like lee, and unslaked lime, boyled to the forme of a firme unguent. The first is best in Tumors which possesse the convex part. The second is most convenient, if they be in parts concave or hollow.

These Pyroticall medicaments are most fit to be used in five cases: I. If we intend to keep the Tumor long open, as is requisit in all contagious Tumors, in the plague, & pox: for where the caustick is applied, there is alwaies losse of sub­stance, and by it we may make the orifice round, which of all other figures most slowly is cured. II. In large Apostemes causticks are fittest; for by them, making as large an orifice as we wil, we shal spare tenting and enlarging of it; besides, the stretched parts will the sooner bee contracted. III. They are to be used in deepe apostemations, such as happen in the belly and back, for so the matter shall have a readier way for [Page 43]evacuation. IV. They are best, when a flux of bloud may be expected. V. We apply them, when we will gratifie ti­morous persons.

Things to be done in the opening.When we are come to open the part, then these things are to be observed: I. The nature of the part: this teacheth us, to shun veines and arteries by reason of hemorrage, and nerves, tendons, and membranes by reason of the paine which ensueth. II. If the skin only be to be divided, then the apertion is to be made straight; but if a muscule also be to be incised, it must be done according to the fibres of it. III. Apertion must be made in the depending part, because the matter will be more readily so drawne out. IV. It must be done where the part is thinnest, for so lesse paine is caused. V. The apertion must be proportionate; for if it be too lit­tle, then the matter, especially if it bee thicke or grumous, cannot be well drawne without expression, which maketh way for callosity, and fistulation. If it be too large, first, the scar will be the more ugly. Secondly, the parts subjacent will be made more apt to be altered, by receiving the impression of the cold aire. VI. Wee are to know how much matter is to bee evacuate at one time: In great Tumors, and those which are in the joynts, great moderation is to bee u­sed; for with the matter many spirits breathe out, and so are spent: from whence extenuation of the body, yea and death sometimes ensueth. The Chirurgeon who is to doe this, ought to bee resolute, chearefull in countenance and speeches, and no wayes scrupulous: otherwise he shall make the Patient dismayed, and fearefull, Gal. 2. de Sympto caus. 2. which doth much weaken and abate the courage of the Patient.

Things to bee done after a­pertion.Things to be observed after the opening of an Aposteme, are these: First, the removing of accidents which most com­monly fall out. Secondly, the manner of dressing. The ac­cidents are most commonly three, fainting, chiefly if the parties be children, women, but above these, effeminate men. Secondly, paine. Thirdly, a flux of bloud.

Against fain­ting.As for fainting, we may labour to prevent it, by mini­string [Page 44]unto the Patient a Caudle, Aleberrie, or some stiptick wine with a toast, as Allegant, and tent; or if it be like to ensue, we may minister unto them some cordiall water with sugar, as Cinamome water, Triacle water, or Aqua coele­stis. If dolour and paine ensue, Against paine. let the part bee embrocat with oyle of Roses, and the third part of wine beaten toge­ther: yet the oyle is not to touch the brimmes, if apertion hath beene made by incision, lest it cause spungeous flesh to grow. Against blee­ding. As for staying of blood, I will set downe the sit­test, and most effectuall meanes to performe this, when I shall come to discourse of wounds, for in them it doth most commonly fall out.

Dressing after opening.As concerning the manner of dressing after opening: If this hath beene done by incision, either a tent, if it be small, or dosels with pledgets armed with some restringent pow­der, as bole, frankincense, and flowre tempered with the whites of egges, if it be large, are to be used: and so it is to remaine for the space of foure and twenty houres. If the caustick be applied, then Dialthea simplex, or sweet butter melted in a sawcer, are fit to be used untill the eschare fall; then the cavity is to bee incarnate: If in the meane time spungeous flesh appeare, it is to be removed with cathereti­call medicaments, as ☿ precipitate alone in gentle bodies, or mingled with alome, taking the third patt of this in har­der bodies: yea, you shall be enforced somtimes to use Pul­vis sine pari. & other Fistula powders with some medica­ments, which coole and asswageth paine, as Vnguentum populeum, and Rosatum Mesuis: take my word, Basilicum and Aureum are not so fit.

Last of all, it is to be sealed up with epuloticall medica­ments, as Diapalma, Emplastrum de minio, Vnguentum comi­tissae, and Desiccativum rubeum. If a Tumor end into an In­duration, it must bee cured as a Scirrhus, whereof I will speake in its proper place. If it end into the corruption of the part, the way of dressing this shall bee set downe in my discourses of and Gangraena and Spacelus. If a Tumor cease, [Page 45]because the matter removeth from one place to another, as when Pleuritis endeth in Empyema, neither doth this be­long to this place.

LECT. VI. Of a Phlegmon.

HItherto I have delivered a generall rule or method, common to the curation of all particular Tumors: Now it resteth, that the use of the generall documents bee shewed in every speciall Tumor. Of all which, Phlegmon. a Phlegmon doth first offer it selfe: First, because it is caused by the most excellent humor, to wit, blood; the matter of spirits, and the store-house of life. Secondly, because it is most fre­quent. Thirdly, because very often, as a Symptome, It ac­companieth other griefes, as wounds, contusions, ulcers, luxations, and fractures, as Galen noteth. a 2. ad Glau [...]. c. 1. & 13. me­thod c. 1.

The word [...] is drived from [...] from whence flagro, to burne, by reason of the heat of it.

A Phlegmon is a Tumor hot, proceeding from the afflu­xion of blood to any part. In this description, A description of it. where it is said to be hot, in this it is distinguished from Oedema and Schirrus; and in this that it is pronounced to proceed from blood, it is severed from Erysipelas of caused of choler: the differences are taken either from the materiall cause of it, or else from some parts which it possesseth. The diffe­rences of it taken from the matter are these: Differences from the mat­ter. It is either Legitima, or Notha, either truly bred, or else bastardly.

A proper Phlegmon, is caused of good blood, onely of­fending in quantity: Good blood is discerned by colour, Good blood. taste, and consistence: In colour it is red, in taste sweet, in consistence meane, betweene thicke and thin: of all other humors it is most plentifull in the body, because it affor­deth nourishment to all the fleshy parts, as they have their being by it. Next unto blood, More phlegme than choler or melancholie. there is more of sweet and alimentarie phlegme, than of choler and melancholy; because [Page 46]it is bloud halfe concocted, and in extreme hunger nature turneth it unto nourishment. But it is not so easie to de­termine of the other two humors, choler and melancholy; Alex. Aphrodisaeus thinketh that there is more choler than melancholy, a. 2. problemat. for by reason of choler being hot and thin, the bloud being made thin, doth passe the more readily, even by the capillar veines, to nourish the most outward parts: but in truth, More melan­cholie than choler. and by all likelihood, there is more melancholy than choler, if you take melancholy for the grosest part of the bloud: for first, seeing the bones which by ancient computation are 246. but more in number indeed are nou­rished by this humor, it being cold and dry, answerable to their temperature, it must bee more plentifull than choler. Secondly, because the spleene appointed to bee a re­ceptacle of melancholy, is larger than the gall. Thirdly, because choler is not so familiar to nature as melancholy is: for as by a small quantity of choler, a great deale of milke becommeth bitter, even so it is in blood. Now things bit­ter are unpleasant to nature; wherefore it is probable, that provident nature hath in the masse of bloud appointed more melancholy than choler. Lastly, if we diligently note bloud drawne out of the veines by phlebotomie, wee shall evidently see more feculent bloud in the bottome of the the sawcers, than yellow choler fleeting in the top.

Signes of a true phlegmon.The signes of a true Phlegmon are six. I. This Tumor beginneth suddenly, and encreaseth speedily, because the matter is plentiful, and the wayes by the which it is sent very patent and large. II. It is very hot in respect of Oede­ma and Schirrhus, but yet not so burning as Erysipelas. III. The colour of the part is of a fresh ruddy colour. IV. In this Tumor there is great paine with pulsation. V. There is a great tension in the part, because the unnatu­rall heat raiseth plenty of vapours which distend the part. VI. The veines which before lay hid become conspicuous, and appeare either ruddy or blackish.

Now as I said, there bee many differences of Phlegmons [Page 47]taken from the parts which they invade: for if it sease up­on the meninges or membranes of the braine, Differences of a phlegmon ta­ken from the parts. it if called [...], if the conjunctiva of the eye, then it is called [...], if the muscules of the throat, it is termed Angina, if the Pleura, it is named [...], if the lungs, [...], if the kidneys, [...], if the emunctorie of the heart and liver, Bubo, of the braine, Parotus, of the gums, Parulis, of the almonds, Paristhmia, Tonsillae: Phlegmons in other parts have no proper names, and even these I will referre to the particular practice of Physicke, wherein they are handled, and rest contented with the doctrine of externall Tumors.

These inflamations, if they possesse the externall parts, and be but moderate are healthfull; Prognosticks. as those which either by reason of the plenty, or malignity of the humor, I threa­ten a gangren, and mortification are to be suspected. A phlegmon which hapneth in a young body, II in a hot and thin part, III the body being not very plethoricke and in the summer time is more speedily cured; but quite contrarily if the conditions be opposite. The indications curative of a true phlegmon are taken from the times of it: The meanes by the which we cure are two, a convenient diet, and artificiall application of apt meanes for curing of the Tumor.

In the beginning therefore, we must prescribe such a diet as is able to hinder the increase of superfluous blood, and the fluxion of that which is already bred: wherefore the diet must be spare and slender, onely sufficient to sustaine nature, and withall cooling: the patient then shall rest con­tented with chicken, and veale broth with bread, calves-feet and trotters stewed, and seasoned with vineger, thin oat­meale-gruell, panadoes, sallets made of sorrell, spinage, purselaine boyled in thin chicken or veale broth, seasoned with some vineger, verjuice and sugar; let his drinke bee small beere or ale, altered in the summer with barrage, buglosse and burner; barley-water, faire spring-water, wherein the crust of a loafe hath beene boyled, and made [Page 48]pleasant with oxie saccharum, or oximel diureticum, ming­ling with a pint of the water, one ounce and an halfe of the sirrups. If the party be weake, Almond-milke made of barley-water, or the thin broth of a chicken may be per­mitted: If we intend to make the blood unapt to motion, and to detaine it in its owne receptacles, then we must in­stitute a diet, having these three qualities: For first, it must coole: Secondly, it must make a constriction, and pursing up of the vessels: Thirdly, it must be diureticall, or move urin; for much serosity being carried away by the passages of urine, the blood must be made thicker, and therfore not so apt to flow. But we must take heed, that such a diet be onely pre­scribed to such as are in their constant age, and have large veines; otherwise, we shall cause new obstructions, and mul­tiply griefs: now to this purpose, you may ordaine broths, wherein lettice, sorrell, spinage, purselain, marigold-flowers, and columbine-flowers and leaves have beene boyled, calves, sheeps, and lambs heads boyled, with greene-sawce made of sorrell, or alleluia, be ware of alliaria, jacke of the hedge, or those simples which are hot, young chickens with gooseber­ry-sawce, are good, and such like. We must forbid wine, flesh, egges, fat things, and such as breed too much blood; and spices, because they heat the blood; & piercing drinks, as stale beer or ale, Wardens and peares rested, stewed, or ba­ked are good. because they further the fluxion of blood. To procure urine, an almond-milke may be made of a pti­san, having the emulsion of the seeds of the pompion, gourd, musck-melon, cucumber, lettice, purselaine, and plantaine. Now the humor flowing immoderately, Evacuation. we must labour to stay by abetting of it, and that by two manner of wayes; by phlebotomie, and purgation.

As for phlebotomie, Phlebotomie. if the inflamation be great, the par­ty young and strong, and full of blood; in the spring time we may take a lib. at a time, yea more, and iterate it if oc­casion be offered: in others, moderation is to be used, ac­cording to the strength of the patients. Which veines are to bee opened. If a phlegmon pos­sesse the parts which are above the liver, then the veines of [Page 49]the armes and upper parts are to be opened: but if it invade the parts which are under the liver, as the kidnies & geni­tals, then the branches of the vena cava descending are to be opened in the hams or ancles. One thing is to be noted in Phlebotomie; that we open not veines too farre distant from the part affected, as Ʋena frontis in diseases of the feet: for we should evacuate too great a quantity of blood, before wee should intercept any tending to the part affected. If a Phlegmon hath succeeded the staying of the evacuation of blood from any part, as from the nose, the wombe, the he­morrhodes, meanes must be used to procure these accusto­med evacuations: but seeing these may be found in all who have set downe the manner how to cure particular dis­eases, I will leave them to diligence and industrie of your selves, being unwilling to mispend time.

As for Purgation, Purgation. one may doubt whether it can doe any good; seeing no blood, the matter of a Phlegmon, can be by this meane spent. I answer, that it helpeth by accident, and two manner of wayes: for first, purgation drieth the body, and so depriving the blood of moisture, maketh it more unapt to flow. Secondly, by purging sharpe humors, the part which sendeth the humor is not pricked forward. But in this case, lenitives are better than eradicatives, What purga­tives most sit, be­cause they rather coole than heat, and cause no ebullition in the humors: such are Diacatholicum, Electuarium leniti­vum, Electuarium de sebesten, or a bole, or cassia, tamarinds and sugar of violets.

Locall medica­ments.As for the Topicall meanes, which respect the part, and the humor, they are of three sorts: Revellentia, Defensiva or intercipientia, & Repellentia: now medicaments appoin­ted for revulsion, must be hot & attractive, Rep [...]en [...]ia. and applied to the parts opposite and remote, as I have set down in the generall method of curing of Tumors. Of this kind are fomentations, Fomentations. made of all sweet smelling and hot garden herbs boyled in strong wine, as calaminth, penniroyall, myntes, lavender, tansie, time, smallage, feverfew, sage, savorie, pellitorie of [Page 50]Spaine; the fomentation must be very hot, the use of them must be continued untill the part become red. Sometimes, if the as [...]laction of the humor be fiere, [...] and plentifull, we are to apply Vesicatories, as in inflamations of the eyes to the necke: but seeing there is none, who hath beene but ini­tiate in the practice of chirurgery, who is not fitted with a medicament for this purpose, I mean not to leese labour, and mispend time in setting downe any descriptions of them. [...]ut let me tell you, that some sorts of ranunculus, [...] in [...]se o [...] the [...]. or crow­foot greene beaten and applied to the part, are more secure than cantharides; but the bull-foot, which is found in most pooles by the high way, is most excellent, being beaten and applied in a wall [...]ut-shell, or muscles or cockle shels, chu­sing the amplenesse of the shels, according to your purpose. If in the winter time you apply cantharides, you must cor­rect them with Euphorbium, mustard seeds, and seeds of amie, or dill: for if a vesicatorie of them bee applied to thin and tender bodies, it will cause difficulty of urine, which will be removed speedily, if the party drinke of an almond-milke, made of barley-water, wherewith the emulsion of the great cold seeds hath beene drawne, and that warme. Besides these locall medicaments, we are to use Cupping-glasses, [...]pping g [...]s­ [...]. sometimes without sacrification, if the party be timorous, and not very plethoricke; but if the af­fluxion of humor be great, and the party strong and coura­gious, let scarification be used. [...]ctions. Frictions also are not to be omitted; but in this exercise we must begin at the extremi­ties, as hands and feet, and end at the trunke of the body, to move the humor, and then to labour againe from the trunk to the extremities, to bring it downewards.

As for Ligatures, in applying them, you must begin at the trunke, Ligatures. as about the shoulder, and articulation of the thigh, and end in the hands and feet, making three ligatures in each extremity; above the elbow, and about the wrest in the arme, and above the knee and anckle in the leg.

After revelling meanes, Defensives. Defensives succeed: These are [Page 51]applied to stay the humor from flowing to the part these must be cold, dry, and astringent, fit to purse in and contract the vessels: these are applied to the parts adjacent, and which have lesse flesh, as to the joynts, and parts above the joynts; for there the vessels are most conspicuous, and so are most apt to receive the impression of the medicament: so if the foot or hand be inflamed, let the defensives be appli­ed to the anckle and wrest, and so forth.

Of these defensives there be two sorts, for some are more milde, as Plantine, the whi [...]e Rose, Night-shade, The divers kindes of de­fensives. red Poppie or water of the spawne or Frogs, red wine, vineger and wa­ter, vineger and oyle beaten together called Oxylaeum, 1 ver­juice, and such like, and these are to be applied to tender bodies, and who have but small veines. Others are stron­ger as Bole, Sanguis draconis, Terra sigillata, 2 Pomgranet flowres and rindes, the decoction and pulp of Sloes, Su­mach, Myrtill berries. These are to bee applied to bodies or a strong constitution, of ripe age, and who have large veines, and in the summer time, and when the inflamation is fierce. Of such simples we may make composition fitting our purpose: as, mingling Masticke, and boyle with the oyle of Myrtils, and whites of Egges: The juyce of Hous­leeke with Milk is good, or a decoction made of red wine, and Tanners woose, wherein are boyled red Rose leaves, Myrtil berries, Sumach, and Pomgranate pills & rindes; Ce­ratum Santalinum is good. It is not amisse to have in readi­nesse, such a defensive as this: Take of white wax ten ounces, of the oyle of Myrtils, and Quinces of each one ounce, of Masticke powdered ʒ iij. of Bole, and Sanguis dra­conis beat to powder of each j. ounce and ij drams, make up an Emplaster: in the winter you may adde more oyle.

Last of all, Repellentia offer themselves, Repellentia. which beat back from the part affected, the humor: The differences of such medicaments, taken from their substance are these. Differences of repelling medicaments. Some are cold and moyst, as Housleekes, Lettice, Purselain, Suc­corie, Ducks meate, the white of an Egge, Navel woort, I [Page 52]Night-shade. These are milde, you may use either the juyce of these, or a Cataplasme made of barlie meale, and these juyces. II There bee some simples, which more strongly coole, as the Henbane, Mandrake, Hemlocke, the deadly Night shade, and the apple of Peru: but these are only to bee used, when the partie is of a flourishing age, in the summer, and the veines large.

Againe, some of these repelling medicaments are astrin­gent, cooling and drying: these repell more strongly, than the cold and moyst, for besides cooling, whereby the naturall heat flying its contrary, doth carry with it the blood, they draw together the part, and as it were wring out the humor: of these some are weaker, as. Vine leaves, Plantaine, Horse-taile, Perwinkle, buds of red Roses, oyle of Myrtils: others are stronger, as Bole, Pomgranate pills and rindes, the pulp of Sloes, Oaken and Owlar barke, red Wine with Alom, Galls, the huskes of greene nuts: these if they bee untimely used, wrinckle the skin, increase [...] paine, indurate the humor in the part, and somtimes returne the matter to some principall part.

Things to bee observed in the use of medica­ments.Wherefore if wee will use aright the simples, and make good compositions of them, wee must diligently consider the temperature of the partie and part, the measure of the inflamation, the quantitie of the humor flowing, the sense of the part, the passages, and aire. Wherefore the hot con­stitution of the party and part require gentler topicks, be­cause the excesse is not great, only heat being added to heat; but if the part bee cold, and lesse fleshie, it requireth stron­ger medicaments, because the cause must bee greater: so in children end women wee use milder than in aged and strong bodies: so the greater the inflamation is, the stronger ought the topick to bee: so if the part bee very sensible, gentle meanes will serve; but if it bee dull it will suffer stronger: so if the veines bee large, stronger medica­ments are to be applied; because plenty of blood must needs flow. Last of all according to the constitution of the [Page 53]aire the locall meanes must bee stronger or weaker.

Now it is time to determine, what medicaments are to bee used in the beginning of a phlegmon: Beginning of a phlegmon. If therefore the partie bee offered while the blood is wholly yet in the small veines: then repelling medicaments are to bee applied. I. Because the humor as yet is but little and thin. II. Because nature as yet is strong. III. Because the matter is not as yet setled or impacted: If some of the humor bee in the small veins, and some be without them in the distances of the musculs, and parts, or in the porosities of the similarie parts, wee are to apply medicaments partly repelling, part­ly discussing; but more of the repelling.

Neverthelesse, in cases repelling, medicaments are not to bee applied unto phlegmons beginning. I. If the parts bee weake, left their naturall heat bee quenched: such are glandulous parts, for they are loose, and flaggie. II. When there is intolerable pain: for then repelling medica­ments would cause greater paine, and so perhaps cause fainting and swouning. III. When the cause is externall, and causeth a malignitie, as the biting of a mad dogge, or of an adder: for so the matter should bee driven to the principall parts. IV. When the fluxion is vehement, and much matter floweth: for then repelling medicaments should bee fruitlesse, the part not being able to resist.

But seeing I have set downe both the simples, and some formes of compounded medicaments of the two kindes of Topicks, I will abstaine from all idle repetition, and passe to to the augmentum, or increase of a phlegmon. In it then wee are to apply discussing medicaments mingled with re­pelling, yet the repelling during the whole course of the augmentum, ought to have the dominion: Increase. because untill the latter end of the increase, the greatest part of the mat­ter is within the vessels, and may bee repelled; for when blood is once slipt out of the veines, it cannot bee evacuate by repelling, but discussing topicks: These are called also [...]: They ought to bee hot and dry in the third de­gree, [Page 54]and of piercing substance: For first, they must make the blood thin and fluxible: [...].8. Simpl. 5. [...].9 Simpli de paronych. [...]3. method. 16. Secondly, they must convert it into vapours: and thirdly, they must evacuate by the poores of the skin by insensible perspiration. In thin and tender bodies in the summer time, milde medicaments are most convenient, as camomill, dill, fenugreeke, beane­flowre, and such like. But in compact, and thick bodies, strong are required, as, Sulphur vivum, Opopanax, Galba­num, mints, hore-hound, worm-wood, calamint. &c.

When the phlegmon is come to the state, The state. or height of paine, tension, and heat; medicaments equally repelling, and discussing are to bee applied: because a great deale of the humor is yet in the veines, and much without them.

When a phlegmon is come to the declination where­in paine, The declination tension, and heat begin to abate, a discutient fo­mentation made of camomill leaves and flowres, melilot, dill, tansie, sage, lavander, mints, scordium, and such like, and the application of Diachylum cum gummis will serve, or a cataplasme of beane flowre, camomill, dill, me­lilot boyled in strong ale lees, adding to the cataplasme oyle of camomill, dill, and white lilies: but if the in­flamation bee great, the paine vehement, the heat intole­rable, the tension and swelling notwithstanding the fol­lowing of the former course, then suppuration or aposte­mation is to bee procured. Apostemation.

If the naturall heate in the body of man be prevalent, it turneth all things to nourishment, if they be familiar unto nature; if any excrementitious part be in them, it turneth that into vapours, and expelleth them by insensible perspira­tion; but if the naturall heat be inforced to enter in single combate with the unnaturall heat upon equall termes, then the naturall heat discusseth some part, and the unnatu­rall heat not able to corrupt the part, suffereth a meane to bee wrought, The signes of the dominion of naturall or unnaturall heat. that is, generation of quittour. Now unto which of them the victory inclineth, may bee gathered by the qualities of the quittour. If the quittour bee good, [Page 55]it is white, because it is caused by the coates of the veines, arteries, nerves, and membranes, which are in colour white, and t [...]asmute the water into the same colour. Secondly, The signes of laudable and ill quittour. thick, because concoction is performed by thickning. Thirdly uniforme, because the naturall heat hath an abso­lute dominion over every part of the quittour. Fourth­ly, not stinking, the naturall heat induring no putrifaction: If contrariwise the quittour bee pale, red, or blacke, thin, unequall, of divers substances, and stinking; then the unna­turall heat is prevalent. Now how a phlegmon, which must bee suppurate is to bee dressed, I have set downe at large in the former lecture of apostumations of hot Tumors: hi­therto I have spoken of a true bred phlegmon, engendred of sincere blood.

Now I am to give you notice of a bastard phlegmon, Of a bastard phlegmon. which is caused by the admixtion of some other humor with blood: If choler bee mingled, it is called [...]: If phlegme [...] If melancholie [...]. Seeing compounded diseases are to bee discer­ned, esteemed, and cured by the diseases and simples solita­rie, I shall not need to spend any time in discoursing of these: If choler abound, wee are to coole and moysten in a high­er measure than in a true phlegmon: If flegme bee joyned wee must heat more; if melancholie, wee are to use things warming and softning. They who have written of Tumors after a phlegmon, have set down discourses of a gangren, carbuncle, and a pestilentiall bubo, but a methodically: For a Gangren is an accident, which doth not only accom­pany Tumors, but wounds, ulcers, fractures and disloca­tions, and that more often; of it therefore I will discourse in its proper place. As for a schpacelus a mortification or a sideration of a part, it belongeth to the third part of chirurgerie called [...] which teacheth to take away superfluities: such as a member is by accident, when it is de­prived of life, and threatneth corruption to the whole, un­lesse it bee taken away.

A carbuncle and a pestilentiall bubo are symptomes of the Pest. as a venereall bubo of the Pox. Of these I shall bee willing to discourse, when occasion shall bee offered to reade of the griefes, unto the which they are to bee refer­red.

1 Tumors to be referred to a phlegmon.Vnto phlegmon [...] that Tumor which is cal­led Panus, Panis, or Panicula in Latine, from the figure in Greeke [...] is to bee referred: It is a Tumor most com­monly in the glandulous parts, Celsus li. 5. c. 25. somwhat flat, in the top whereof there is a representation of a pustle: It hath a grea­ter heat and paine, than the bignesse of the Tumor shew­eth, it is commonly most discussed without apostemation: because it hath more choler than blood. 2 But contrariwise [...] hath more blood than choler, for it quickly commeth to suppuration: In forme it is like to Panus a weavers roule or touch-wood, and hath this same seate, to wit, the glan­dules in the emunctories. 3 As for furunculus or [...], it is engendred of grosse humors mingled with blood in fleshie parts most commonly: See Galenti. 5. 2. in loca. If it bee milde and come to matu­ration without any great difficultie, it may bee referred to [...]. If it bee hard and stubborne to medica­ments, it is to bee referred to [...].

LECT. VII. Of an Erysipelas.

HAving in my former weekly lecture delivered what I thought pertinent concerning the first generall Tu­mor, a phlegmon, the cause whereof was said to bee blood without the vessels offending in quantitie or qualitie. Me­thod now warneth mee to discourse of the second generall Tumor called Erysipelas, proceeding for the most part from choler: not so much because it surpasseth either phlegme or melancholie, whereof Oedema and Schirrus are bred, in [Page 57]dignity or quantity, as that it more representeth a phleg­mon in accidents, to wit, heate and colour.

But before I enter into a particular discourse of an Ery­sipelas, give mee leave to touch three points briefly, which will make all things which I shall deliver, more plaine. The first, is the signification of this terme choler: The second shall bee of the divers kindes of choler: The third shall set downe the signes of a cholerick person: for such an one is most subject to this Tumor. Colera then in Latin, and [...] in Greeke signifieth not the humor, which in En­glish is called choler or the gall; but a disease, whereby this humor is expelled vehemently by vomit and siege. Never­thelesse in our vulgar speech, and with the barbarous late writers, it is taken for the humor it selfe, and so I shall bee inforced to use it. Thus much I thought to insinuate to you, that you should not bee ignorant of the proper and learned significations of the termes of Art.

Now Bilis or Fel in Latine, in [...] in Greeke, choler or gall in English is either alimentarie, or superfluous: the alimen­tarie is the fourth part of the masse of bloud dry and hot, which more property might bee called bilious bloud: the superfluous, which serveth not for the nourishing of the body, is either naturall, or unnaturall: the naturall is that, which in the liver is separated from the blood, and turned to vesicafellis. The unnaturall comprehendeth foure sorts. under it. I. is the Vitelline, like unto the yolkes of egges yellow; but thicker and hotter than that of the gall: II. is Potracea, which in colour representeth the leeke, it is engendered in the stomack by reason of cruditie, and eat­ing of such meats as engender it: as gartick, onions, leeks, and milkin Infants, who often by seege discharge such an humor: III. Aeruginosa, like verdigrece engendred of more vehement heat, and corrupt aliments in the stomack: IV. is [...], like unto woad; it is more greene, than that which resembleth the leeke: it is caused of the arugi­nosa more burned, and commeth neere to atrabilis.

Now, a man is thought to bee of a bilious constitution, if hee bee watchfull, nimble, hastie, angrie, and dreame of fire and thunder, his urine is thin and yellow, his pulse strong, swift, and hard, his veines are large, the habit of his body is leane, and dry, his colour yellowish: cold things refresh him.

These things being permitted, now I am to discourse of the Tumor Erysipelas it selfe, of it I will set downe five things: the Etymon of the word, the nature of the Tu­mor, the signes of it, the prognosticks of it, and last of all the indications of curing of it. i. As for the Etymon of the name of this Tumor, it is called [...] in Greeke quasi [...]: for the ancient for [...], which signifieth red, used and [...], and [...] signifieth neere: wherefore [...] is nothing else but a Tumor in colour, comming neere to red, and tainting often the adjacent parts: for thin and hot blood, or blood with the which yellow coler is mingled, dyeth the skin with the colour of a pale rose: the nature of Erysipelas is discovered by setting downe the description, and kindes of it.

An Erysipelas then is a hot Tumor proceeding from most of choler, in this description Tumor is the genus: for this is common to Erysipelas with all other Tumors. In that is said to bee hot, it differeth from Oedema and Schirrus: and whereas it is affirmed to proceed of most choler, it is distinguished from all the rest of the Tumors.

But here it may bee demanded, whether Erysipelas bee caused of alimentarie, or of superfluous choler: unto the which question I answer, that it is to bee thought that it is caused of the alimentarie choler, if it bee exquisit: other­wise how could the yellow jaundise, and Erysipelas so much differ, if they both did proceed from excrementitious cho­ler: for first the yellow jaundise possesseth the skin of the whole body; but Erysipelas one part only: secondly, an Erysipelas hath alwayes a symptomaticall feaver annexed to it; but the yellow jaundise is most commonly free from it: [Page 59]thirdly, in an Erysipelas there is alwayes paine; but in the jaundise none: fourthly, in the jaundise the skin is of a yellowish colour; but in an Erysipelas it is of a bright red colour.

There are two kindes of Erysipelas, for it is either exqui­sit, or not exquisit, or a true, and a bastard one: as for an exquisit Erysipelas it is a Tumor of a bright red tending to yellow, causing little swelling, very hot with a pricking paine, caused of alimentarie choler: this choler abounding in the body if part of it bee turned into any part, it causeth an exquisit Erysipelas. The parts which it most commonly invadeth, are the nose and face, for much thin blood flow­eth to these parts: secondly, the legges: for nature being moved by the plenty of this choler sendeth it first to the e­munctories of the groynes, and from thence it descendeth to the legs, it hapneth in the sommer; because then cho­ler is multiplied; but in the winter, because the pores of the skin are shut by cold, and so insensible perspiration hin­dered: and because this humor is thin, it spreadeth to a great part of the skin.

As for the signes of an exquisit Erysipelas, they are either taken from the qualities of the humor which causeth it, or from the differences betweene it and a phlegmon. The signes taken from the qualities of the humor are these: The paine is great and urgent, the heat notable, the colour a bright red tending to a yellownesse, the tumor is small, only possessing the skin, the pulsation is very small, and lesse than in a phlegmon. First, because the parts in a phleg­mon are more compressed, and it reacheth deeper: secondly, because in a phlegmon the humor is thicker, and cannot so easely bee breathed out as in an Erysipelas. The differences betweene a phlegmon and an Erysipelas are these. I. A phlegmon possesseth the skin, and the flesh lying under; but an Erysipelas the skin only: the cause in an Erysipelas is the thinnesse of the humor, which rather disperseth it selfe through the skin than heaveth it up. II. The heat in [Page 60]an Erysipelas is greater than in a Phlegmon: for somtimes the cuticula is blistered. III. The symptomaticall feaver is greater in an Erysipelas, than in a Phlegmon: because choler is hotter than blood. IIII. The paine in an Erysi­pelas is lesser; than in a Phlegmon: because in it there is only a hot distemperatute; but in this a solution of unity, be­sides the parts being stretched. V. In a Phlegmon, the co­lour is of a darke red, by reason of thick blood lying deepe; but in an Erysipelas the colour is a brighter red, tending to a yellownes. VI. In an Erysipelas there is a pricking paine but in a Phlegmon, a heavie & stretching. VII. The skin in an Erysipelas being pressed, yeeldeth; but in a Phlegmon it doth not: The causes are the thinnes and thicknes of the humor. VIII. In an Erysipelas the rednes vanisheth away from the skin, and it becommeth white if it bee presse with the singer; but in a Phlegmon it doth not so. IX. In an Erysipelas there is no stretching of the akin; but in a Phlegmon there is: Last of all, a Phlegmon setleth it selfe in one place; but an Erysipelas maketh the parts adjacent red by spreading. As for the Prognosticks of an Erysipelas: I. That which proceedeth from naturall yellow choler is mildest: for no vehement symptomes succeed: and besides seeing it appeareth in outward parts, it is to bee thought that the inner parts are discharged of this humor. II, As it is a good signe, if an Erysipelas bee driven to the out­ward parts, so it is fearefull, if it returne from the outward to the inward parts. Aphor. 25. sect 9. III. An Erysipelas appearing in the head is mote dangerous, than in other parts: because if the matter passe to the meninges, it cau­seth phrenitis or raving, if to the muscules of the neck, the Squinancie. IV. An Erysipelas appearing in wounds, ul­cers, fractures and dislocations, is commonly mortall: if it proceed not from the application of too hot locall medi­cines. V. If an Erysipelas tend to suppuration, it is not good: for then the humor must bee thicker than ordinarie, and the obstructions stronger, and so the solid parts are in [Page 61]danger to bee corrupted VI. If a bone being bare, the ad­jacent fleshie parts bee possessed with an Erysipelas, it is ill: for first, the body must bee troubled with sharpe humors, secondly, flesh cannot bee restored by such blood.

Now it is time to draw out our forces, to incounter with this griefe: wee are to meete with it with foure kindes of helps, dyet, chirurgeri [...], internall medicaments, and locall meanes. As for the dyet, our nourishment must be cooling and moystning. Let the patient then care thin chicken broths, altered with the cooling herbs, panadoes, thin oate­meale gruell, sallets of lettice, sor [...]ell, puishine, and spinage boiled. If the choler bee very thin, the partie may eate fresh fish, which live in cleere sandie, or rockie waters, as trouts, small pickrells, perches, and of sea fishes, the whi­ting-maps, and smelts, hee may eate also of the braine of a pig or it petittoes, or trotters with vineger, and sorrell, let him refraine from all meates which are fat and sweet: let his drinke bee spring-water, boyled with the bottome of a loafe, made pleasant with some Oxysacchar. or the distil­led waters of endive, or sorrell, hee may use a plaine ptisan: Galen permitteth the patient to drink as much cold water as hee will, for this cooleth the body, quencheth the thirst, Lib 9. method. c 5. abateth the heat of the choler, and cooleth the liver: but in this case the season must bee hot, and the stomack good: with us small beere bottelled is best, all forts of wine are forbidden. In the Summer, let the aire be coole and moyst, in Winter, let it bee rather hot :for in this season an Erysi­pelas is caused of the constriction of the pores of the skin, by reason of cold: let all perturbations of the minde bee banished, let sleepe bee procured; for watching drieth the body. But if an Erysipelas bee in die face, watching is best: for immoderate and long sleepe filleth the head full of va­pours, wherby the griefe is increased.

As for the chirurgicall helps, it may be doubted whither Phlebotomie bee necessarie or no, for the decision of this doubt, these propositions shall serve: I. If an Erysipelas [Page 62]invade the head, neck, or face, the Cephalica alwayes is to bee opened: lest a phrenitis or angina ensue. II. In an E­rysipelas Phlegmonodes wherein blood increaseth the heat in what part of the body soever it bee, a veine is to bee o­pened. III. In an exquisit Erysipelas in other parts of the body wee ought not to draw blood: for first, by drawing of blood, the bloud which remaineth, moveth more, and becommeth more subtill: Secondly, the stay of choler is taken away: Thirdly, by taking away both good and bad blood together, the party is weakned.

As for the internall medicaments, they ought alwayes to goe before the locall, if yon except two cases: I. If an Erysipelas bee procured by an outward cause, as a blow: II. If the heat bee vehement, and the Tumor bee far from any principall art. In these cases we may apply a medi­cant cooling and moystning, before wee minister any pur­ging medicament. If an Erysipelas appeare in the head or face, wee must open a veine, apply the Leeches, minister a purging medicament, prescribe a slender dyet, and use re­vulsions by frictions, ventoses, blisterings, and vomiting if it appeare in the legs.

As for locall medicaments, wee must looke about us, for if wee apply cold medicaments, the matter may bee repel­led to the braine, from whence Phrenitis may proceed, or to the throate, which may cause Angina: If you bee infor­ced by the importunitie of the patient, or standers by to apply a locall medicament. Aetius counselleth to apply a Swallowes nest beat to powder, lib. 14 c. 5.9. and tempered with hony, that it may represent a liniment with a feather. This is a safe medicament, for it only drieth and repelleth not: Wee may also apply the decoction of mallowes with some oyle of violets, or sweet Almonds. Now the purging medica­ments which discharge choler, these or such like will suffice, Rhewbarb, Tumarinds, Cassia extracted, Electuarium leniti­vum, Diacatholicon, Diaprunum solutivum, Electuarium de succorosar. Caricostinum. If it bee but a milde inflamati­on, [Page 63]s [...]arpe c [...]ysters made of the decoction of cooling herbs, with the aforesaid Electuaries will serve the turne.

Having set downe the helps taken from the diet, phle­botomy, and the ministration of internall purging medi­caments, I must hasten to set downe convenient locall me­dicaments: for in these you are most imployed and bu­sied: one thing is to bee observed, that wee must not in any case apply astringent medicaments, which are cooling and drying: For seeing the vapours in this Tumor are sharp, Gal. de comp. [...]ed f [...]genera [...]l. 1. c. 4. if they bee kept in, th [...] might erode and corrupt the part. Now as concerning locall medicaments, first, I will set downe which they are: Secondly, how long they are to bee applied. These medicaments ought to bee cooling, and moystning: but before I name them, let mee warne you, that first you refraine from narcoticall simples, unlesse ex­ceeding great paine, and in a part farre from a principall part call for them. Secondly, that you apply not unctuous and fat medicaments, for First, they most easily are infla­med: Secondly, they stop the pores. Now the medica­ments which are to bee imployed, are either simple or compound: The simples are Navel-woort, Horse taile, Knot-grasse, both the Plantines, Ducks meat, garden Night-shade, Lettice, Purselaine, the Poppies: First, the juyce of them expressed may be applied: Secondly, the distilled waters drawne from them, some powder of myrrhe having been infused in them. Wee may also apply clours wet in the juyces of the aforesaid herbes, being mingled with verjuyce or vineger. The compound medicaments are Ceratum infrigidans Galeni made of lb j. of oyle of Roses, and ℥ iiij. of white wax: i Simpl. 13. & 14. method 13. this is to bee washed with water and vineger. You may adde to it the juyce of Night-shade. He [...]r [...]ius hath three good medicaments, the first is Castle-soape dissolved in Spring water: The se­cond, is Bulls dunge boyled in a frying pan with vineger, and a few flowres of Cammomil, and Elder, untill it come to the consistence of a liniment: The third is made of two [Page 64]parts of aqua spermatis ranarum, and one part of Rose vine­ger, wherein some myrrhe must be infused: these may be safely applied to an Erysipelas of the head, neck, or face; the juyce of horse dung is not only good, being applied to this Tumor, but in sealdings and burnings also, if a little Camphyr bee added to it.

The medicaments which are to bee applied to an Erysi­pelas must bee very liquid, actually cold, and often chan­ged: for when then become hot, they will rather offend than profit, if they bee not removed. The last thing which I promised to set downe concerning the locall medica­ments was, how long they were to bee applied: this wee may find out by two signes. The first is, if the heate be alto­gether abated, or almost: the second is, if the skin hath re­covered it owne colour. When you perceive these two signes, you must desist from applying cooling topicks, lest the skin become livid, or black which threaten a gangren, and somtimes mortification. If this appeare, what then is to bee done? first, a fomentation is to bee used, made of Cala­mint, Scordium, Wormwood, Peniroyall, the lesser Cen­torie, and Betonie boyled in a weake lie made of ordinary ashes: after the part is sufficiently fomented, you are to apply Hippocrates cataplasme made of Barlie meale, vineger and oyle of Roses warme: or this, take of the floure of Barlie, Beans, and Vetches of each iiij ℥. of a weak lie iiij. lb. boyle these to the consistence of an emplaster, then put to it iiij ℥. of Oximel: if the discolouring of the part passe through the skin, and the part bee immoderately cooled, it will not bee amisse to scarifie the part which only remai­neth. I am but in a few words to discourse of a bastard or a spurious Erysipelas: such an one is to bee thought, when with alimentarie choler an other humor doth concur.

Now seeing foure other humors may associate them­selves to choler, so many kindes of a bastard Erysipelas may bee accounted. If therefore some blood bee mingled with choler predominant, then [...] is caused: in [Page 65]this kinde of Tumor the rednes is more dark, and the swel­ling not so spreading: If waterish phlegme bee mingled with choler, then [...] ariseth: If grosse blood or thick phlegme concurre with choler, then [...] is caused: lastly, if choler associate it selfe with the corrosive salts of the serositie of blood, it causeth Erysipelas ulcerosum, which breaketh the skin. But see­ing the compound Tumors are to bee discerned by the do­ctrine of the simple, and that the medicaments are accor­dingly to bee applied, not distrusting your observations or judgements, I will end.

Of that Erysipelas, which breaketh the skin, there are two kindes, Herpes miliaris, and Herpes exedens: Herpes milia­ris is caused of a salt waterish humor mingled with unna­turall sharpe choler: the signes of it are these. I. Many pustules rise in the skin like to millet seeds. II. When they breake, a matter issueth out representing quittour and sanies. III. The place hath a mingled colour be­tweene red and pale; this is without danger: the medica­ments which are to bee applied to this, ought to bee coo­ling and drying, as the Knot-grasse, Horse-taile, Plantaine, Owlar, Willow and Oaken barke, Pomgranate flowers and rindes, Myrtill berries, red Rose leaves boyled in Tan­ners woose, Vnguentum album rasis, de cerussa, de minio, Diapompholigos.

Herpes exedens, called by Celsui, ignis sacor, Lib. 5 [...].28. and by some ignis Sancti Antonti: it is caused of unnaturall choler, hot and sharpe, corroding the skin only, by the which signe it is discerned from Phagedoena, or [...]. Wherfore if many small ulcers appeare not passing deeper than the skin, you may pronounce this to bee Herpes exedens. In the curing of this, minister the decoction of Sarsa, and after the fo­mentation of it, with Tanners woose, wherein cooling and astringent simples above mentioned, have beene boyled; apply this locall medicament. ℞ cerae flavae ℥ ij. resinae pini ℥ j. ss. terebinth. ℥ j. ol. myrtini ʒ vj. sucei Nicotiana ℥ iij. [Page 66] Coq. in ceratum molle. But here a question may be mo­ved, why the choler which causeth the yellow jaundise doth not ulcerate the skin? This falleth out, first, because the choler which causeth the yellow jaundise is dispersed; but in Erysipelas united. Secondly, because the choler is naturall and only excrementitious in the jaundise, such as is contained in the Vesicula fellea, and discharged into the guts. Thirdly, because thin phlegme is mingled with cho­ler in the jaundise: for this disease endeth with much swea­ting.

LECT. VIII. Of an Oedema.

IN the subsequent discourse, which I am to deliver of an Oedema, the third generall Tumor caused of phlegme, I will use the same method which I did in the doctrine of an Erysipelas. First then, I will set downe what phlegm is. Secondly, the differences of it: and Thirdly, the signes of a phlegmaticke person: and then I will deliver the doctrine of Oedema, for such an one is most subject to this Tumor.

Phlegme then is the fourth part of the masse of blood, cold and moist: as concerning the sorts of it, it is either ali­mentary or excrementitious. The naturall, as it is cold and moist, so it is without any forraine taste: as oyle and but­ter are accounted sweete, when as they have no ranke taste. This humor by the naturall heat increased (as in famine) may become blood, and serve for the restoring of naturall humiditie: it ought rather to bee called pituitous blood, than phlegme.

Unnaturall phlegme is that which cannot bee turned into aliment: of it there are three kindes. The first is pi­tuita acida, sowre phlegme, so called from the taste which it leaveth in the mouth, when it is spit out: This is a raw [Page 67]phlegme and bred in the stomacke by reason of the defect of naturall heat: so that being drawn into veins, it hardly can be altered. The second is pituita salsa, salt phlegm, this is caused by the admistion of thin salt moisture: for of bit­ter things as Aloe, and Coloquint, mingle them with thin humors as you will, a salt taste never can bee procured. In sweat, teares, and urine this taste is manifestly deprehen­ded: a very novice in Alchymie is able to make the salt of urin, & one laboured to procure a Patent for making saltpe­ter of urine, in the time of the last Parliament: but I never heard that hee made any; being, as it is likely, deceived by his imagination. The third kinde of unnaturall or excre­mentitious phlegme, is pituita vitrea, representing in colour and substance, moulten glasse. This is very cold, thicke and tough, and causeth great paine, 2. de loc. affect. c. 5. if it bee detained in a­ny part. Galen affirmeth of himselfe, that being troubled with a vehement paine of the belly, by injection of the oyle of Rue, was discharged of such an humor, and so the paine ceased: whereas before hee thought that a stone had stuck in one of the ureters.

Phlegmaticke persons are slow and sluggish, their senses dull, they are sleepy, they dreame of waters, raine or snowe, they are not easely moved to anger, their pulse is soft, small and slow: their appetite is not great, they are seldome dry, they by the mouth and nose void many phlegmatick excre­ments: their urine is white or pale, sometimes thick; som­times thin, the sieges often are raw and flegmaticke: the blood by what means soever it flow from the body, is petui­tous: their body is whitish, soft and coldish, they are sub­ject to cold and long diseases, as the dropsie, letargie and such like, lastly they endure fasting well. These signes shew naturall and sweet phlegme to abound in the body.

Having set downe the description of phlegme, and the differences of it, as also the signes which discover a phleg­matick person, I am to discourse of Oedema, or a phleg­maticke Tumor, of it I will deliver these five points: first [Page 68]the signification of the terme Oedema: secondly, the diffe­rences of it: thirdly, the prognosticks of it: fourthly, the indications of curing of it: and lastly, what Tumors are to be reduced to it. As concerning the terme [...] in Greek, in Latine Oedema, with Hippocrates and all other ancients, it is the same with [...], which signifieth eminentia, emi­nence or bunching out: and so every particular Tumor may bee called Oedema. But with Galen and later authors it is taken more strictly for that Tumor which is caused of phlegm. Oedema is either exquisit or not exquisit: an ex­quisit is either primarie or symptomaticall: the primarie is caused of the naturall phlegme, Gal. li. de atra bile cap. 5. which is contained in the masse of blood, and by reason of the too great quan­titie of it, setteth to worke the expelling facultie to dis­charge it into the weaker and depending parts. Naturall phlegm is cold & moist, thin in consistence, in colour white, in taste sweetish or insipid. The signes of an exquisit Oede­ma are five. I. It is soft and loose, because it is caused of thin phlegme. Lib. 2. [...] 6.1. II. If it be pressed with the finger, it hath either no paine, or very little. III. If it be pressed down with the singer it yeeldeth and leaveth a pit, which is the most proper sign of an Oedema. IV. It is white, representing phlegme in colour, wherof it is bred. V. It is cold without heat, be­cause the pituitous humor is cold and moist. Avicen cal­leth this Tumor Vndimia. The materiall cause then of this Tumor is the pituitous humor redounding in the wholl body. This humor is caused either of externall, or inter­nall causes: the externall causes are aire cold and moist, phlegmaticke meats, idlenesse, too much sleepe, stinging of waspes, and such like: the internall are a cold and moist constitution of the head, stomacke; but chiefly of the liver. This Tumor invadeth not promiscuously all parts; but such as are cold, weake, and loose, such are the feet and hands, the cods, as in hernia aquosa, the eyelids: and then in them appeareth an outward Tumor loose, without pain, not altering the colour of them, which being pressed with [Page 69]the finger quickly yeeldeth and returneth, the matteriall cause is a waterish humor mingled with flatuositie: so the heart and liver cannot suffer any such Tumor, as neither the kidnies: because these parts are firme and hot. As for the presages, Oedema is a long continuing disease, because it is cold, and therefore the naturall heat of the parts affected, must bee weake. II. It is not very dangerous, because the paine is either none or very small. As concerning the cura­tion, it is performed either by diet, or internall medica­ments, or locall meanes: as for the diet of such as are sub­ject to an Oedema, if it proceed from externall causes they must bee removed: the aire which is to bee chosen must bee hot and dry, the foode must bee drying: wherefore roasted meat is better than boyled, fowles and birds which live in dry grounds; are better than water fowles, rabbets, chic­kens and veale are good, mutton is better than lamb, swines flesh and fishes are to bee shunned, as also heads, braines, and feete of beasts: sallets of cold herbs are hurtfull, use biscuit bread, or good houshold bread baked with Anise seedes, Fennill seedes, and Coriander seedes. Let the drink bee altered with the rasping of Quajack, Sarsaparilla, Radix chinae, Sassafras, yellow Sanders Cummin seedes, Coriander seedes, Fennill seedes, Anise seedes, Galingal, Nutmegs, Calamus aromaticus, some Ginger, Cinamon, Rosemarie and Sage. The drying diet made of these, especially in the summer time is good: sweating in this case is very effectu­all, every other morning after the taking of the diet: fasting is good as also watching, studying, and labouring: for all these dry the habite of the body.

If an Oedema possesse the hands, then walking is good; if the feet, then we are to praescribe sitting and working with the hands. Seeing then an exquisite diet will not serve to surprise this disease alone, we are to entertaine purging medicaments for the expugnation of it. We need not to trouble the patient with many preparative medicaments; seeing the pituitous humor which causeth this disease is [Page 70]thin, waterish and in motion; First of all, no medicaments internall are so effectuall in this griefe as Mercurius vitae, and safe medicaments of antimonie: for, First they discharge the stomack of crudities by vomiting, and so correct the cold and moyst distemperature of it: Secondly they dispatch the obstructions of the mesaraical veines and liver: Thirdly they mightily evacuate waterish and phlegmatick humors, and so correct the distemperature of the liver, and kidneyes.

As for ordinarie internall medicaments, pilulae de hiera cum agarico acuat, with a graine of Elaterium are good: diaphaenicon, diacarthamum, diaturbith, pilulae de hermodacly­lis, de aromatibus, cochiae. And the pilles of Galen made of coloquint aloe, and scammonie with syrupus Augustanus. As for the doses of these medicaments, and how they are to be exhibited I will refer you to those, who have diligent­ly handled these things, chiefly to the practice of Martinus Rulandus.

But here you may demand of me what is to be thought of phlebotomie? Quaest.

To this demand I answer, Answer. that in an exquisite Oedema opening of a veine is to be shunned. I. Because in a bodie cold and moist we open not a veine, such is that which is tainted with an Oedema. II. Because in this griefe there is alwayes cacochymia, seldome plethora: III. Because in an Oedema there is neither a maligne mat­ter, nor a horrible symptome and so it cannot be called m [...]r­bus magnus, or a fearefull disease: and so phlebotomie is not required. As for the locall medicaments, which are to be applyed, they ought by drying and strengthning to alter the part.

In the beginning then we are to apply such medicaments as repell, and digest: but more digesting than repelling be­cause the humor is cold: for in the beginning some part of the humor is in the small veines, some in the pores of the skin; but more in the cavities, and greater veines: towards the state of the griefe we are to use digesting meanes. Galen [Page 71]useth foure things, I. A rowlar with two ends, lib. 2. ad Glauc. c. 3. et 14. n. e­thod c 4, such as is used in fractures, first the rowler must bind the Tumor it selfe more straightly; but the parts on every side adjacent more slackly, for so the humor is wrung out from the part affected, to the parts adjacent above and below. II. Is a Sponge, but in the use of a sponge we must see that it cover all the affected part, otherwise at the next dressing we shall see that the humor hath flowed to the bare part: in steed of a sponge we may use pledgets of hemp-tow; yea and double cloathes. III. Vineger, for it doth consume phlegme, and because it is subtil it peirceth, IV. Some water to moderate the sharpnesse of the vinegor: If an Oedema be above sinews and tendons in a tender bodie lesse vineger is required. But in hard bodies and in other places more vineger is to be ap­plyed: if you mingle some allome with the vineger and wa­ter, the medicament wilbe the more effectuall. Avicen coun­selleth to apply lime water with the juice of mirtils: but instead of the juice we may boyle myrtle berries in lime water.

If you boyle scordium, myrtle berries, sumach, red rose flowers dried, calamint, wormewood and penyroyall, in equall quantitie of red astringent wine, vineger, tanners woose and lime water adding to every pint of the decocti­on strained 3. drammes of allome, you shall have an excellent medicament. You may apply also an unguent made of un­slaked lime, and old swines grease.

One thing is to be noted, that the Oedematous part is to be rubbed well with a cloth before the medicaments be applyed, that they may penetrate more easily, [...] If an Oedema in the belly according to Hippocrates after 60 dayes tend to suppuration: which commeth to passe because the phlegme by long staying in the part, is altered by heat, and turned to quittour: then we are to hasten suppuration by the application of Diachylon cum gummis: then to open it, Thirdly to mundifie it. Fourthly to incarnat it, and last of all to procure skinning. And seeing I spake of these [Page 72]things in the curing of a phlegmon tending to Apostema­tion, I will remit you to that discourse, because I distrust not your memories.

It falleth out many times that an Oedema, is a symptome of an other disease as I have said: but chiefely of the cough of the lungs, dropsie, and cachexia or ill habit of the body, and doth possesse the legs and hands: First because they are furthest from the heart, the wel spring of heat: Secondly, because they are framed of cold parts: seeing this acci­dent cannot be removed, unlesse the disease which is the cause of it be cured, and seeing these diseases are for the most part mortall, I will suffer such as are empyricks, and prodigall of their owne credits, to follow their owne cour­ses, and to undertake such cures.

An Oedema is thus engendred: when nature is troubled with phlegme the expelling facultie thrusteth the pituitous humor from the great vessels to the lesser, and being kept in by the densitie and coldnesse of the skin, is gathered in the musculous part, and so causeth this Tumor. Hitherto then I have discoursed of an exquisite Oedema. Now it remaineth that we briefly dispatch that Oedema which is not exquisit. This is caused when some other humor is joy­ned with the pituitous: if blood then be joyned with it, it causeth [...]: if choler concurre it procureth [...]: If melancholie, or thick and glutinous phlegme it causeth [...]. In all these kindes of a not exquisit Oedema the thin pituitous Tumor must be pre­dominant. The other humors concurring are found out by their owne proper signes which are set downe in the discourses of everie principall Tumor, so that I should mis­pend the time if I should goe about to set them downe here. Some things I would have you to note. The first is, a pri­marie Oedema is caused by congestion, for it creepeth on by degrees: But that which is Symptomaticall, an accident of other diseases, as tabes, asthma, cachexia and dropsie is pro­cured by fluxion: for it suddenly appeareth. The second is [Page 73]this: If by reason of long keeping bed, either because one hath had a long and lingring disease, or because he hath re­ceived a hurt in the leg, the feete swell and become Oede­matous, when by motion afterward the naturall heat is en­creased, this flatulent phlegme is discussed, and the Tumor ceaseth. Quest. One thing may be asked why Galen affirmeth that the liver may be possessed with a schyrrus, and not Oedema: To this it may be answered; Answ. that the liver by its paranchy­ma or propertie of substance turneth thin phlegme whereof an exquisite Oedema is caused, into blood; but if it receive any thick phlegme, of that then a schirrus, and not Oedema is caused. But it is time to adresse my selfe to set downe those Tumors which are referred to an Oedema: of those some are enclosed within a cystis or a membrane; and some have no proper membrane: those which have a proper membrane are in number 3. Atheroma, Steatoma, ma­liceuris. But it may be doubted from whence this cystis, Dub. membrane, or folliculus doth proceed. Sol. Undoubtedly it is framed of the teyes of the cutis and membrana carnosa: for seeing the naturall heat cannot concoct the matter of these abscesses, nature doth providently separate it by its proper cystis from the parts adjacent lest it should corrupt them.

The matter which causeth these abscesses and feedeth them, proceedeth from a veine, which is not accompanied with an arterie, and so being destitute of vitall heat, it is alto­gether unnaturall, and cannot be assimilat to the parts unto which it floweth. Atheroma then containeth a substance like unto rice▪ pottage, or curds: the matter of this Tu­mor is thick and grosse phlegme.

Steatoma is a Tumor not so high as Atheroma, contai­ning a matter like unto grease, or that which we call the sweet bread pancreas: blood flowing by the veine which hath no arterie, and so is destitute of vitall heat is easily turned into this fattie substance. Meliceris containeth a matter representing honey: so the phlegme which causeth [Page 74]this Tumor is thinner, than that which breedeth an athe­roma, and hath some choler mingled with it the heat whereof maketh the matter fluid, and liquid.

The Tumors reducible to Oedema which have no cystis, are three, psydracium, ficus, and talpa. Psydracium is a pointed white pustale containing in it a waterish humiditie. Ficus is a Tumor so called, First because it hath a roote like unto a fig: Secondly because it containeth small graines as a fig hath. It is a Tumor red, round, and somewhat hard and painfull; from whence issueth a matter, like unto the seedes of a fig, if it be broken and wrung. The matter of this Tumor is grosse blood, mingled with phlegme and some waterish moysture. Talpa or testudo is so called, be­cause as a mole heaveth up the ground, so this Tumor the skin from pericranium, this Tumor is larger than sicus, and is caused of more grosse humors; wherein there is little moysture.

So you have a briefe description of the Tumors which are reducible to Oedema: As for the cure of them I will reserve it untill I come to that part of chyrurgerie called [...], which sheweth how superfluities of the bodie are to be taken away. The moderne authors adde to these Nata, which is a large Tumor so called; because it repre­senteth the buttocks called nates, without paine, consisting of soft and pituitous flesh; caused of congestion of pitui­tous blood: it is seated most commonly in the neck, shoul­ders and back: it is onely cured by excision.

Ganglium and lupia are round Tumors of the nervous parts without paine: yet they differ; for Ganglium is hard, but Lupia soft: 2 Lupia may be moved every way, up­wards, downeward, and side wayes: but ganglium toward the sides only. Thirdly Ganglium is like to a knot of the sinew; but Lupia possesseth not the sinewie parts only, but other solid and hard-parts in hands and feet.

LECT. IX. Of a Schyrrus.

NOw are we to enter into the contemplation of a Schyr­rus, the ugly progenie of muddie melancholy, as we have discoursed of a phlegmon, Erysipelas and Oedema, who deduce their pettigree from blood, choler and phlegme and ascribe their being to them. But that you may heare­after discerne the better the nature of a Schyrrus, I will first set downe the description of melancholy: Secondly, the divers sorts of it: and thirdly the proper signes of a melan­choly person: which wil both lead you to the knowledge of the griefe, and open the way of curing the person posse­ssed with this griefe. Because the English tongue doth pro­miscuously use Melancholy, both for [...], me­lancholicus succus, and [...] atra bilis, I must give you warning, that these two doe much differ; for melancholi­cus succus is the feculent part of the blood like unto the lees of thick wines as Allegant, and is drawne from the purest part of the blood by the Spleene. It is neverthelesse one of the 4. nutritive humors naturall to the bodie, and gentle ha­ving no corrosive or stinking qualitie. But Bilis atra is cau­sed of immoderate heat, and is maligne: Bilis atra. for it burneth and corrupteth the flesh, it is sowre and sharpe, and being pow­red upon the ground it boyleth and raiseth it up, as leaven doth dough, and hath an unpleasant smell. The kindes of it. There be 3. sorts of this: the First is caused of blood burned, and of all others is the mildest: 1 the Second it is engendred of saccus melan­cholicus burned; 2 and it doth differ so much from the natu­rall black, as lees burned from the unburned: 3 the Third is caused of yellow or vitellin choler more burned, which of all others is the worst; because choller whereof it is bred is more hot and sharp: than melancolie juyce.

None of these are engendred in a sound and healthfull person, whereas the succus melancholicus is found in all per­sons of what temperature or estate soever they be. The descripti­on of succus melancholicus. Where­fore Melancholicus succus may be thus described: It is the fourth humor in the masse of blood black and thick, yet na­turall cold and dry. The differen­ces of it. This humor naturall is either alimen­tarie or excrementitious. The alimentarie nourisheth the melancholicke parts, which are cold and drie; as the bones, cartilages, and ligaments. The excrementitious or super­fluous is drawen by the Spleene.

Signes of a me­lancholicke person.Now these signes discover melancholie persons; they are silent, pensive, constant in ther purposes, slow to anger; but if they entertaine it, they turne it unto hatred: their sleepe is troublesome by reason of fearefull dreames, as of black things, dead bodies, death: they are sad and given to feare, without cause; their puls is small, slow and hard: their colour is dark, their apetite to meat and Ʋenus is more than ordinarie: they seldome thirst, because they abound with much superfluous phlegme, their blood is thicker and black­er than ordinarie, from what part soever of the body it flow, the urine is thin and whitest, if no melancholie be min­gled with it; but if Melancholie be mingled then it is thick, black, or of a leady colour, they sweat much in their sleepe; the habit of their body is leane, rough and hard: they are subject to varices and haemorrhoides: if such a one be pre­sented to you possessed with a Schirrus, it is easie to dis­cerne the disease, and of what humor it proceedeth, and how the party is to bee dealt withall. So you have the de­scription of melancholie, the divers sorts of it, and the markes of a melancholicke person: which things shew no small light to attaine to the knowledge of a Schirrus. In my discourse of a Schirrus, I will set downe first the descrip­tion of a Schirrus: Secondly the signes of it: Thirdly the differences betweene it and other Tumors: Fourthly the kinds of it: Fifthly, the prognosticks of it, and lastly the manner of curing of it.

The descripti­on of a Schir­rus.To begin then with the description of a Schirrus, it is a Tumor hard, and without paine, caused either of natu­rall melancholy, or thicke, tough, and cold phlegme. If the cause bee melancholie, it hath a leadie colour; if phlegme, it changeth not the colour of the skin: for phlegme is white; As for the signes of it; I. It is hard.

Now there are foure causes of hardnesse: the first is coldnesse, as appeareth in Ice; this is removed by moderate heat, as by the sunne. The second cause, is drynesse, as wee may plainly see in the hands of Sailers, and Felt-makers. The third cause, too great repletion, which doth appeare in the stomacks of gluttons. The fourth cause, may bee the combination of these, and indeed all these concurre to pro­cure hardnesse in a Schirrus. As for coldnesse, it may bee in­duced either by things externall, as cold aire, and narcoti­call medicaments: secondly, from the part affected, Because those parts are very thicke. 2. in. Gal. 1. simp. for schirrosities chiefly appeare in the beginnings of the mus­cules, ligaments, and tendons, and other cold parts: third­ly, from the humor: so the melancholick juyce, and thicke and viscous phlegme: the materiall causes of a Schirrus are very cold.

The second signe of a Schirrus is, that it is without pain: and this commeth to passe, either because the animall spi­rit cannot passe through an humor so thick and glutinous, as that is which causeth a Schirrus, or because it is benummed by the coldnesse of the humor. This is the third signe, that it is fixt, and as it were nayled to the part, and doth not move by pushing, as Scrophula or Ganglium.

Now I will shew you how it differeth from other Tu­mors. It differeth from a phlegmon, for in this, there is great paine: from Erysipelas, because this is not hard: from an Oedema, because this yeeldeth to the touch, and leaveth a pit. It is discerned from watrish and flatuous Tu­mors, because they have a thinner, and more cleere matter. The differences betweene it and a cancer are these. I. A cancer is alwayes painfull, because it is caused of bilis atra, [Page 78]or a dust choler; but a Schirrus is without paine. II. A Schirrus is cold, but a cancer hot: this is caused by reason of the humors whereof they are bred. III. A Schirrus in­vadeth the sollid and hard parts, as the joynts, tendens and ligaments; but a cancer the loose and flaggie parts, as the breasts, the privie parts, and such like. IV. In a cancer, not in a Schirrus, the veines appeare full of a blacke humor: which for the likenesse, one may call the legs of the crabbe, as the round Tumor the crabbe it selfe. It is high time to set downe the predictions of the successe of curing, which schirrosities are like to have, that when such Tumors are offered to you to bee cured, you may bee made circum­spect and wary in taking of them in hand: 1 an exquisite Schirrus is uncurable, for seeing it is senselesse, it is mani­fest that the part is deprived of the influence of the animall spirit; and seeing this humor doth distend the sinewes, veins, and arteries, the facultie it selfe is strangled and choa­ked, so that it neither can direct, nor help the naturall heat to concurre with the meanes, to bee applied for the dis­patching of this griefe. Secondly, this being a cold Tu­mor, and the naturall heat extremely weake, what hope can there bee, that it can at any time triumph over so great an infirmitie. A Schirrus not exquisit, although it bee not mortall, 2 unlesse it bee very great, yet it hardly admitteth any cure, 3 and by much difficultie. A Schirrus which is ex­treme hard is altogether uncurable: for gentle means a­vaile nothing, and those which are strong make it more hard: 4 a Schirrus from succus melancholicus is warely to bee delt withall: because it hath a great affinitie with a cancer, and so may degenerate into it, if improper medicaments be applied. 5 If a Schirrus bee caused of thicke and glutinons phlegme, you may be the more bold: for this cannot easely contract any malignitie. The differences and divers sorts of a Schirrus are to ensue: a Schirrus then is either prima­rie, or Epigenematicall. A primarie Schirrus is that, which is a griefe of it selfe, and not caused by reason of any infir­mitie [Page 79]preceding. This is twofold, for it is either exquisit or not exquisit: a primarie exquisit Schirrus is that which at the first, is caused by collection of the melancholie juyce in a part. A Schirrus is thought to bee not exquisit, when an other humor is joyned with melancholie. If therefore some laudable blood bee joyned with it, it cau­seth Schirrus phlegmonodes, if choler, Schirrus erysipela­todes: if phlegme Schirrus oedematodes. Neverthelesse, seeing these are compound Tumors, and are to bee dealt withall according to the doctrine delivered of the sim­ple Tumors, whereof they are bred: I will leave these to your owne considerations.

A Schirrus epigenematicall or Symptomaticall is that, which ensueth after an other Tumor, not handled accor­ding to art, as a phlegmon or an Erysipelas: this happe­neth two manner of wayes. I. It may fall out by the im­moderate use of locall medicaments too cold, and narco­ticall or stupefactive: for these condense, and as it were congeale the humor. Secondly, this may happen by the too continuall application of resolutive topicks: for so only the subtill and thin parts are breathed out, and the thick and glutinous remaine. The last point, which in the beginning I promised to deliver unto you concerning a Schirrus, was the manner of curing of it, receive it then, which I hope you will well like of.

The indications of curing are taken from three things, to wit the diet, internall medicaments and externall applica­tions. As for phlebotomie it is here fruitles, because the hu­mor is cold, unles the veins be very full, the blood black, and age and strength conspire: for then it is expedient, for so the humors in the masse of blood will bee more fluxible; and the quantitie being diminished, the naturall heat will the more easelie rule the residue. If a Schirrus bee caused in a man by reason of the hemorrhods stopped, then the lee­ches are to bee applied, if in a woman by reason of the men­strues supprest, then Saphena is to bee opened.

As for the diet then, the meat must bee of easie digestion, moistning, and affording a thin juyce: such are Chickens, young Pigeons and mountaine fowle, Lamb, Veale, young Pullets and Cockrells, fed Rabbets, poched Egs, asparagus sallet, Spinage, Burrage, Purselaine: bread of good wheat not too much leavened is convenient, let the drinke bee small white wine, or reasonable strong beere well boyled, cleere, and neither too old, nor too new, good Syder also with Rosemarie, Burrage, Buglosse burned, and Suger is good. Meats which afford a grosse juyce are to be shun­ned, as old beefe, all meats dried in the smoake, venison, fish living in muddie waters, all salt meats, course bread: the immoderate use of v [...]neger is hurtfull: apple tarts, and warden and peare pyes baked with Fennill-seeds and An­nise-seeds will serve instead of other sweet meats. Let the habitation of the diseased partie bee in a pure, hot and moist aire: too much sleepe, idlenesse, griefe and pensive­nesse are to bee shunned. As for internall medicaments, they ought to purge melancholy, and thick and glutinous phlegme: but both of these are to bee prepared before they bee evacuate. Those medicaments which prepare melancholie ought to attenuate or make thin, and moisten: such are the syrups of the juyce of Burrage, Buglosse, the sy [...]ups of Fumiterry, Hops, and Apples, with the deco­ction of Balme, Harts-tongue, Scolopendria, Tamariske, and such like. Those medicaments which prepare phlegme ought to bee of an attenuating, and mundifying qualitie, as the syrup of Isope, of Betonie, of Stechas, Oxymel, and Mel rosatum in the decoction of Calamint, Hore-hound, Penny-royall, and such like. The humors being prepared, then they are to bee purged: melancholy is to bee purged with confectio Hamech, Electuarium, Indum, pils de lapi­de lazuli, the extract of black Ellebor, Electuarium leniti­vum, and the like, which may bee ministred in the infusion of Sena-leaves and Polypodie. Phlegme is to bee purged with Diaphaenicum, Diacarthamum, Hiera Pachii, Pilulae [Page 81] de agarico, et hermodactilis, diaturbith and the like. The electuaries are to be ministred in a decoction of those sim­ples which prepare phlegme.

One thing is to be noted, that nothing is more effectuall in discussing these schirrosities, than the continuall taking of the decoction of sarsa parilla, and guajack instead of o­ther drink, using a convenient diet, and procuring everie other morning sweating: for lignum vitae warmeth, and sarsa dissolveth the hardnesse: if it performe this in nodes, which are farre harder than any Schirrus possibly can be; why should it not performe this office in a Schirrus?

Here it is no wonder if few be cured: for sundrie are im­patient if their expectation be not speedily answered, and besides this, they are unwilling to gaine the losse of their health by forgoing their sensualitie and pleasure, being ven­tris mancipia; more carefull of their tast than health.

But time calleth us to speak of externall applications, which are fit to be used in the cure of a schirrus. In these you are to consider three things, their faculties, their dif­ferences, and the right use of them. As for the faculties then of the locall medicaments they ought to be discussing and softning, emollientia and discutientia. Repelling medica­ments are not to be used, because the humor is thick, and hard, and so unapt to motion.

Of emollient medicaments there are foure degrees: in the first are those which are gentlest; such are mans grease, capons grease, the marrow of harts, and calves bones, ducks grease, swines grease, sweet butter. Li. 7. c. γ. Galen adviseth to apply to gentle Schirrosities, a medicament made of sweet butter, black rosin, and new wax, Dialthea simplex, is of this degree. In the second degree are these, goose grease, badgers grease, dogs grease, old ranck oyle, oyle of Lin­seed. In the third degree, are the fat of lions, beares, wolves, foxes, libards, and the marrow of horses, and mans bones. In the fourth degree, are Ammoniacum, galbanum, bdellium, caranna, tacamahaca, opopanax, of these simples you may [Page 82]frame unto your selves such compositions as the qualitie of the schirrus, 7. ad Almans. which you are to take in hand shall require. Rases in all schirrosites, commendeth a certaine cata­plasme and it is excellent indeed.

The description may thus be framed, take of bdellium, ammoniacum, and galbanum, of each 1. ounce, dissolve these in a hot martar with oyle of lilies, adde of the muci­lage or pulpe of rosted figs ij. ℥, of the mucilage of Linseed and Fenugreeke, vj. ℥, make up a cataplasme, dresse the schirrus with this cataplasme once a day. Diachilon cum gummis, and emplastrum de mucilaginibus are convenient. Riolan the father commendeth this medicament, take of unguentum de althaea, of diachylon cum gummis & emplastrū de mucilaginibus of each 1. ounce, of the oyle of Lilies vj. drammes: mingle these well together, you may adde to these medicaments some vineger to help penetration. If a Schirrus be above a nerve or a tendon, instead of vineger you may use the spirit of wine.

One thing is to be observed, that before you apply any me­dicament, the part affected is to be fomented with the de­coction of Mallowes, marsh-mallowes, Camomill, Melilot, and Cowslip flowers in vineger, unto which after it is boy­led, some spirit of wine is to be added.

As concerning the right use of the locall meanes, these observations following are worth the noting, the first is, If a Schirrus be caused of the melancholie humor which is cold, thick, and drie, you are to apply a medicament which warmeth, attenuateth, and moysteneth, II. If the Schirrus be engendred of cold, thick, and tough phlegme, then the medicament ought to be warming, attenuating, cutting, and mundifying. III. Tender persons and parts require milder; but partes and persons harder and stronger, require more forcible meanes. IV. If a Schirrus hath beene procu­red, because an unskilfull person hath applyed medicaments too much repelling, or discussing to an inflamation: then apply this mollifying liniment. take of yellow wax, and [Page 83]ducks grease tryed, of each j. ℥. of oyle of Lilies ij ℥. of the marrow of oxes bones ij ℥. mingle them wel together. V. If immoderate use of drying topick hath procured hard­nesse, then medicaments moystning are to be used: such is a catapsalme made of mallowes boyled and capons grease, or swines grease.

Unto a Schirrus these tumors may be referred strumae, wartes, cornes, leprosie. As for Strumae and the leprosie, they will require severall tractats.

Wartes, if the root be small and the top broad, may be ta­ken away by ligature; if the root be broad they must be ex­terpate with medicaments. There I commend unto you, strong aqua fortis, or lapis infernal [...]s relenred, these must bee applyed to the wartes with a rush or a straw. The third is an experiment of Faebricius, ab aqua pendente, and that is this; of Purselaine bruised, and the powder of Savin make a cataplasme and apply it.

Cornes first must be artificially cut, and then one of these medicaments which I shall name, must be applyed: Ammo­naicum disolved in vineger, and brought to the consistence of cerot, emplastorum de mucilaginibus, and diachylon cum gummis.

LECT. X. Of aqueous Tumor.

I Have delivered in my Lectures penned before the last Ea­ster holydayes what I thought most materiall concerning the foure principall Tumors, Phlegmon, Erysipelas, Oede­ma and Schirrus, which are caused of the foure humors in the masse of blood; to wit blood properly so called, choler, phlegme and melancholy, and so might have concluded the doctrine concerning the differences of Tumors, as sundry others have done who have written of this subject.

Neverthelesse seeing aqueous or waterie and flatuous Tu­mors are often presented to you to be cured, I thinke it ex­pedient to discourse of these, that the doctrine of Tumors may be compleat.

First then I will discourse of the Aqueous, and then of the flatuous Tumor. The materiall cause of the Aqueous Tumor by the Physitians is called serum or serosus humor. Of this humor there is but a small quantitie in a healthfull person; no more than is fit to make the blood thin, that it may be the more readily caried unto all the parts of the body to afford them nourishment. This being done it is dischar­ged through the pores of the skin, either by sweat or insensi­ble perspiration.

Wherefore Galen not without reason affirmeth all se­rositie to be an excrement. [...]. d [...]nat. sa­ [...]tat. c. 9.

This serosity is not only of a moist and waterish sub­stance; but of a salt qualitie in like manner, yea, this serosi­tie, urine and sweat have the same matter: The difference of mine, sweat, and the wate­rish humor. yet they differ, for Serum is that aqueous humiditie, which is contained in the blood: and although blood bee drawne, yet it cannot bee discerned unlesse the blood grow cold and congeale, and this thin part by the concretion of the blood bee sepa­rated from the thicker. Urine. But urine is nothing else but the superfluitie of this serositie of the blood mingled with the waterish humiditie of meat and drinke, and neere the root of Ʋena cava separated from the masse of blood and drawne by the attractive facultie of the emulgent veines & kidnies, and by the ureters sent to the bladder, there to bee detained untill the convenient time of excretion. So that this kind of excretion purgeth the blood from waterish humidity, wher­by it is made more firme, & so more fit to nourish the parts. As for sweat and insensible perspiration, Sweat. they are nothing else but the excrements of the solid parts. Neverthelesse, they carrie with them some obscure signes of the constitu­tion and temperature of the body: hence it is that a dogge can finde out his master, and discerne the tract of the Hare, [Page 85]from that of a Fox, and of one fowle from another. The causes of the increase of the waterish humor. Some preternaturall causes will encrease the serositie of blood: as meats affording plentie of waterish humiditie, as most fruits, cold herbs, and immoderate use of water, 1 and other drinks: for although some drinks bee hotter than others, yet all of them have more waterish humiditie than spirit: and by reason of the distemperature and obstruction of the parts appointed for sanguification, 2 often times this serositie is not separated from the alimentarie humors; but is detai­ned and increased, and not expelled by urine and sweat: from whence the dropsie, fevers and pustules of the skin doe proceed.

The causes of an aqueous Tumor.An aqueous or waterish Tumor then is caused of the su­perfluitie of this serositie detained in the body, after that it hath performed its office, which if, when it hath carried the nourishment through the narrow passages: 1 such are the me­saraicall veines, and those which are dispersed through the substance of the liver. Wherefore when the liver sendeth the blood by the branches of the vena cava to the parts of the body, it hath not need of such store of humiditie. If too much of this waterish humiditie be sent to the habit of the body, & move the expelling facultie, then part of it is sent to the skin, which causeth waterish Tumors. Those which heave up the Cuticula are called Sudamina. Sundry diffe­rences of wa­terish Tumors. Those which arise in the night time are called Epinyctides. If wa­terish humiditie be gathered in the codde, it causeth [...], if in the navell [...], if in the head, [...]. And although neither Fallopius nor Tagaultius have made any mention of waterish Tumors, thinking perhaps, that they may bee reduced to pituitous Tumors, yet these Tumors wherin nothing else but waterish humiditie is con­tained, doe plainely evince, that an aqueous Tumor is one distinct from all others. What causes move the sen­ding of this hu­mor to the cir­cumference of the body. Superfluitie of this serositie is sent to the habite of the body: partly because the weaknesse of of the kidnies doth not suffer them sufficiently to draw it: partly, because the liver is too cold, and lastly, by reason of [Page 86]some error committed in the use of the things not naturall, as immoderate taking of water, and other drinks, as Wine, Ale, Beere, Syder.

The signes. The signes of a waterish Tumor are these: First, it is somtimes more, 1 sometimes lesse swollen: yet it yeeldeth when it is pressed hard, whereby it is discerned from Schir­rus. It is distinguished from a phlegmon, 2 and Erysipelas, because these are painefull; 3 but it not. It is discerned from an Oedema by this, that it being pressed, it admitteth no pit as Oedema doth. 4 It being beaten, it yeeldeth no noyse, as a flatuous Tumor doth, 5 as appeareth in a tympanic. Last of all when it breedeth, there is alwayes an itching in the part, by reason of the saltnesse, which is in the waterish hu­miditie. These Tumors appeare in the navell, The places most subject to this Tumor▪ cods, and the habite or compasse of the body; yet most frequently in the joynts of the armes and legs: because these parts be­ing weake, cold, and thick, are aptest to admit such waterish Tumors. The predicti­ons. As for the Prognosticks, that waterish Tumor which happeneth by reason of any imperfection of the liver is dangerous: 1 not so much in consideration of the Tumor it selfe, as of the infirmitie of the liver. Other waterish Tu­mors although they bee not so dangerous, 2 yet by reason of the weakenesse, couldnesse, and thicknesse of the skin are not so easely cured. 3 As for those Tumors which rise in the compasse of the body, like to blisters or small bladders and are called sudamina, as they are no wayes dangerous, so they are easely cured. The indicati­ons of curing this Tumor. As for the curation of this griefe, reason and experience have found out five means to meete with it, to wit, a convenient diet, internall medicaments, exter­nall applications, and manuall operation. If then an vni­versall humiditie possesse the whole body, D [...]et. the diet must bee drying: wherefore roasted meat is better than boyled. Im­moderation in drink is by all means to bee shunned: for,

And as temperance and sobriety have a promise of pro­longing our temporall lives, so are they powerfull helps in curing diseases: but chiefly those which are caused by the su­perfluitie of moist and waterish humors. Flesh then is better than fish, and of flesh meats, those are best which are driest: Kid then is better than Lamb, Veale than Mutton, Rabbets and Conies are good, land fowle are better than water fowle. Hippocrates himselfe commendeth Porke above Pigs flesh: but neither of both is good: for Pigs flesh is ex­ceeding moist, and in Porke the fat is moist, and dissolveth the stomack; but the leane is hard, and not easely conco­cted. All supping meats are to bee shunned, for they mul­tiply moisture. Ludovicus Cornarus his diet recorded by Lessius in his Hygiasticon or treatise concerning preservation of health, is fit for such persons. For above the space of fortie yeares, hee rested contented every day with xij ℥. of bread and meat, and xiiij ℥. of drink: when hee was eightie yeares of age, so able hee was by the observation of this moderate diet, that without any advantage of ground, hee usually backt the fairest Italian horses. How the liver and kidnies af­fected are to be cured. One thing is to bee noted, that seeing superfluous humiditie seldome possesseth the body, unlesse there bee some fault in the liver and kid­nies, you must by all means labour to reduce them to their natural temperature. The means to compasse this, are set down by every one, who hath penned the practice of physick, unto whom I remit you, being unwilling to trouble you with impertinent discourses.

Internall medi­caments.The internall medicaments appointed for the expugnati­on of this griefe, are of three sorts: for either they purge by stoole, or by urine, or by sweat, and insensible perspiration. To touch the Catharticke medicaments, Catharticall medicaments. such are one graine of El [...]terium which a scruple of pilulae coehiae, or de Euphorbio, or Alepha [...]gmce: two drams of the seed of the dwarfe Elder, or Ebulu [...] beaten to powder, and ministred in white wine, & a spoonfull of the juice of Ebulu [...], the flower deluce, of s [...]ldanella mingled with ij ℥. of the syrup of damask [Page 88]Roses dissolved in ij ℥. if white wine. The purging diet is excellent if you adde to the ordinary purgatives in it, the rootes of Esula major, the berries of the bucke-thorne, and Carthamus seeds. Amongst all the simples Mechoacan and Jalop are most commended, both for their efficacie in wor­king, and safety in ministring. Diureticall me­dicaments. As for diureticall means, I commend unto you this medicament: take of the ashes of Broome, and Beane-straw burned, of each a good handfull: straine through those ashes iiij pintes of Rhenish wine three times: then infuse in this wine of the roote of Sassafras sli­ced ij ℥. of Nutmegs and Cinamon, of each two drammes, of Bay berries, and Juniper berries of each six in number, of Cummin-seeds ij ʒ, of Fennil-seeds and Annise-seeds of each one dram and an halfe, of Sugar iiij ℥, of the spirit of Salt j ʒ. Minister every morning iiij ℥. of this wine strained, and so much about foure of the clocke in the after-noone: the decoction also of Penniroyall, Time, Calamint, with seeds of the Melon, Pompion, Cucumber and Purselaine made pleasant with the syrup of Althea, de quinque radici­bus, and of I sope ministredas the former, is good.

As for diaphoreticke medicines, the decoction of Gua­jacke, Sarsaparilla, Diaphoretick medicaments, Sassafras, and the China roote with Agrimonie, Betony & Coriander, sweet Fennil-seeds, & An­nise-seeds carrie away the bell. How effectuall these me­dicaments are, being judiciously used, not in this griefe on­ly; but in moist ulcers also, and other diseases contagious, I need not to labour to perswade, seeing there are few of this company, who have not often made triall of them: when these decoctions are ministred, a strict diet must bee enjoyned, and plentifull sweat procured, according to the tolerance of the diseased partie.

The locall ap­plications.The topicall remedies ought not to bee repercussives, although the humor bee thin, because seeing nature can make no use of it, it is to bee evacuated: wherefore the re­medies ought to discusse, and rarifie the skin, that vent may bee given to the humor. Fabricius ab aqua pendente [Page 89]commendeth this medicament, De Tum p. n. p. 2. lib. 1 c. [...]0. take of Mallow leaves on handfull and an halfe, of the meale of Lupines j ℥. of the oyle of Dill and Camomill of each ij ℥. with s. q. of white wine make up a cataplasme. The Ice of unstaked Lime, and branches of the vine are good. Avicen out of Galen, against waterish Tumors describeth thus the emplaster of Mustard, & affirmeth, that if this medicament prevaile not, that there is but small hope that any other will. Take of Mustard-seed, Nettle-seed, Brimstone, Aristolochia rotunda, of the fome of the sea, or Brine and Bdellium of each j ℥. of Am­moniacum, old Oyle, and Wax, of each j ℥. make a cerot according to art. Let me advertise you of one thing, that the part is to bee fomented before either cataplasme or empla­ster bee applied. The fomentation is to bee made of a lee made of Beane-straw, Broome, and twigs of the vine bur­ned, with some ordinarie ashes, wherein you are to boyle common Wormewood, sea Wormewood, the lesser Cento­rie, Calamint, Cummin-seeds, Bay berries, Juniper berries, Scor [...]m, Camomill flowers, Melilot flowers, and tops of Dill: unto the decoction strained, adde the sixt part of sheres Sack. But seeing I have discoursed sufficiently of all degrees of discutient remedies in my lectures of other Tumors: I will cease to trouble your patience with idle re­petitions, commending unto you only these few specificall remedies before mentioned. Now to come to the last re­medie appointed for rebellious waterish Tumors, to wit, manuall operation: If they cannot bee discussed, as often­times Hydrocephalos and Herria aquosa: then the humor is to bee let out, sometimes by incision, sometimes by a can­stick medicament: then the part is to be mundified, thirdly it is to bee incarnat, and last of all cicatrized. But seeing I have handled these points, when I discoursed of an apo­steme, and that I am to set downe what is singular in every Chirurgicall operation, wherby superfluities are taken from the body, in that part of Chirurgerie, which is called [...], here I desist, referring every thing to its pro­per place.

LECT. XI. Of a flatulent Tumor.

HAving set downe the doctrine of a waterish Tumor, I am to fulfill promise, to speake of a flatulent Tu­mor: In Latine it is called Tumor flatulentus, The names of it. in Greeke [...], or [...], for the Grecians call flatuositie sometimes [...], sometimes [...].

Persons most subject to this griefe.The person in whose bodie flatuosities are multiplied, is often troubled with gudlings in his sides, he belcheth of­ten, he is troubled with singing of the eares, his excrements come forth with flatuosity, his urine is frothie, he findeth a stretching of his belly, yet without any heavinesse.

The causes of this griefe. Differences of weake heat.The causes of flatuosity are crudity and weake heat. The heat may be accounted weake two manner of wayes. I. Of it own nature, & so it hath some power and do [...]ion over the humor, and doth in some sort dissolve it, but im­perfectly; and so it produceth halituous vapours, which are called flatuosities, but is not able to discusse them, and so they remaine in the part, and distend it, and that because the flatuosities are grosse, and the part thicke: this appea­reth often in the knees, and troubleth Chirurgeons and Phy­sicians much. II. Heat may be accounted weak by reason of the matter it selfe; when as the matter is so plentifull, that the heat cannot wholly overcome it, but leaveth some vapours undiscussed.

The differen­ces between a water [...]sh and flatuous TumorThe causes of crudity are ebriety, gluttony, a sedentary life, and flatuous drink and meats; such are beere or ale not well boyled, pease, beanes, chesnuts, turneps, radices, greene fruit, swines flesh, water fowle, salt fish, and such like. I It is discerned from a waterish Tumor, whereof we have spoken, by the lightnesse of it; for an aqueous Tumor is heavy, II but this not. Secondly, by distending the mem­branes, [Page 91]and stretching of them, it causeth often intolerable paine, whereas in waterish no paine is felt. It is discerned from an Oedema by this, that it admitteth no pitting, al­though it be pressed: it is distinguished from Schirrus, be­cause this is hard, but it not: it is discerned from a Phleg­mon and Erysipelas, for in it the skin is not discoloured, neither is there any extraordinary heat felt; but in those both appeare.

The progno­stickes.As for the Prognosticks, receive these; If these flatuo­sities possesse parts very sensible, as great joynts, such are the elbowes, or knees, I which are compassed with thicke membranes, they are hardly cured, and will busie the most skilfull.

II As for those which invade other parts, they are not very easily cured. First, Why those T [...] ­mors are hard to be cured. because these halituous spirits are grosse. Secondly, because the parts thorow which they are to be discussed are thicke. Thirdly, because the naturall heat is weak. The indicati­ons of cu [...]ing. Whosoever goeth about to cure these flatu­ous Tumors; First, he must prescribe a strict diet to the Pa­tient, such as I have set downe in the cure of a waterish Tu­mor. I Secondly, II he must bar him of the use of all flatuous ali­ments, whereof I have made mention, and prescribe unto him meats of easie concoction, and which afford a lauda­ble juyce. After meales let him eat a slice of the marmalad of quinces, with some coriander, and anniseeds comfits, ha­ving but one covering of sugar. The stomack a little before bed time is to be embrocated with the oyle of masticke, woormewood and rue.

As for the Topicall remedies, the part first is to be fomen­ted with Sheres sacke, wherein Dil, Rue, Bay-leaves, The topicall remedies. Ca­momill; and Melilot-flowers, Cummin-seeds, Annis-seeds, Fennill-seeds, and Bay-berries have beene infused. I Then the part is to be embrocated with the oyle of Camomill, II Lillies, Dill, Rue, Bayes mingled with Aqua vitae. III Third­ly, apply to the part the Cummin emplaster, or that of Bay-berries: if the Patient doe feele inflation in his sto­macke, [Page 92]or in region of the spleen, minister unto him of the confection of Bay-berries ʒ. ii. in iii. ℥. either good Hip­pocras, or Canarie wine, wherein Cinamon hath been infused two houres before supper. iij. or iiij. drops of the oyle of Pepper, or vj. of Fenill-seeds oyle in the wig of a Sacke-posset are good. Digestion is furthered in such per­sons, if they take a cup of Sacke having a toast in it, and af­terward eat the toast, being first besprinkled with sugar. To such a remedy the meanest may attaine unto: you and they will better like of it, than of an [...] [...]emedy sold in the Apo­thecaries shop. The Sacke is to be taken two houres be­fore supper.

LECT. I. Wherein the Authors, and Definition of Vlcers are set downe.

BEfore I addressed my selfe to discourse of any particular matter belonging to the course of Chirurgerie, I allotted in my first Lecture, foure parts to Chirurgerie: whereof the first was [...], which teacheth to unite parts disjoyned. The differen­ces of the solu­tion of unity. Solution of unity I made two fold: either intelligible, to bee apprehended by reason or understanding, or sen­sible, which may be perceived by the very senses. The intel­ligible I named a Tumor, in the which very often no so­lution of unity doth offer it selfe, either to the sight or [Page 96]touch, as in many cholericke Tumors, and others in their beginning. Sensible solution of unity, I affirmed either to be in the soft parts, or in hard. As for the solution of unity in the soft parts, I appointed two differences of it; to wit, Vlcus and Vulnus, and ulcer and a wound.

But here, Quest. not without a cause, a question may be moved, which of those two, in methodicall proceeding, ought to have precedencie. It is an undoubted truth, that the first man that lost his life was Abel, and that by wounds; so that by all likelihood, men first of all bent their wits to finde out meanes to cure hurts received by externall violence: for the neerer they lived to the creation, the more pure their bodies were, no hereditary diseases being left by parents, if you except mortality by reason of old age, which no man could escape by reason of the sentence of death pronounced for the sinne of disobedience against Adam and his posteri­ty by Gods owne mouth: and so being little troubled with either inward griefes, or outward sores, they troubled not themselves about the invention of medicaments to cure these; so that by the right of time, the treating of wounds ought to precede the handling of ulcers. Answ. Neverthelesse, in our times my opinion is, that the discourse of ulcers, for sun­dry reasons, I ought to goe before. For first of all, an ulcer doth proceed from an inward Humor corroding, but a wound from an outward instrument dividing: so that a silly Empirick, yea a doting old woman, may go about the curing of wounds in fleshie parts, and compasse it; but to the cura­tion of ulcers, the knowledge of Humors, and the constitu­tion of the bodies affected are required, which require a man well versed in that part of Physicke called Physiologia. Secondly, II greater variety of medicaments is required in the curing of ulcers, than there is in the curing of wounds, & so still greater skill is required in the curing of the one than of the other. III Thirdly, greater estimation doth acrew unto those who take upon them the curing of ulcers, than unto those who deale with wounds, and that by all sorts and degrees [Page 97]of persons, whether they be rich or poore, rude or civill, learned or Ideots; so that I need not to retract my opinion in ascribing unto the tractation of ulcers the precedencie, before the discourse of wounds.

The scope.In my proceeding, I will handle these ten points: First, I will point out the Authors who have written laudably of this subject. II. I will set downe the definition of an ulcer. III. The causes of an ulcer. IV. The differences of ulcers. V. The generall signes of ulcers. VI. The generall progno­stickes of ulcers. VII. I will set downe such medicaments as are fit for all ulcers in generall. VIII. Of the generall indications of curing of ulcers. IX. Of their times. X. I will discourse of every particular sort of ulcers.

I To make the tractation of ulcers perfect and compleat; First then to come to the Authors, Point. I meane not to name all who are come to our hands, and have written of this subject; but such as are famous for their skill and experience. Hippocrates and Galen, although they have not left to poste­rity particular large monuments of this matter, yet when occasion is offered, they omit not to set downe both the in­dications of curing, and medicaments effectuall to cure. Hippoc. in his 6. Sect. of ulcers and fistulaes. Galen in those excellent bookes of his which he penned, De methodo me­dendi, Lib. 3. of a simple ulcer, Lib. 4. or an ulcer with ac­cidents; of the orderly way to cure diseases, for the most part doth illustrate his precepts by examples borrowed from the Practice of Chirurgerie.

If you demand why he did so? Quest.

I will tell you the cause in Fallopius his words, Answ. in his first Chapter of ulcers, Quoniam ut ait Celsus, lib. 7. c. 1. Quum eadem est. Seeing according to Celsus, the meanes which Physicians use in curing, sometimes take effect, sometimes availe not, it may be doubted whether health may be ascri­bed to the good constitution of the body, or to the meanes applied, but the effect of Chirurgerie is most evident. O pregnant testimony to evince the certainty and excellencie [Page 98]of Chirurgerie. Let those Physicians who slight the pra­ctice of Chirurgerie, thinking themselves to be chicks of the white hen only, consider and weigh the weight of this testi­mony of Celsus and Fallupius in the impartiall ballance of reason. Avicen the chiefe of the Arabick Physicians, hand­leth this matter in the fourth Booke of his Canon, and the third Treatise: although he doth write confusedly, yet the reading of him will profit such as understand him, and will not be fruitlesse. Albucasis hath some good things, but the number of the trifles are many moe. Paulus Aegineta in his fixth Booke of the Art of curing, onely toucheth some points of this matter, as a dog doth Nilus when he drinketh. Gabriel Fallopius followeth, who hath written an excellent Treatise of this matter; but whosoever shall peruse him, shall finde him in sundry things intricate enough: I will bring him a new companion, but farre surpassing all other moderne Writers, Minadou [...], one of the famous professors of that renowned University of Padua, in his three Bookes w ^ch he penned of the curing of the deformities of the body of man: whosoever he be who shall go about to make a pa­rity between these two and others of the late Writers, I shal judge him worthy of Midas his eares, and after that hee hath proceeded, & been promoted in Germany, to be saluted a Doctor with foure feet. To these two Italians, I joyne the German Samuel Hafenrefferus, in his foure Books of the af­fections of the skin, in whom there are many varities, if one with judgement discerne them. The rest that can be named are of the lower bench, as Guido a Cauliaco, and he who hath onely taught him to speake a little more eloquently, Ioannes Tagaultius, in the third [...]ooke of his Institutions of Chirurgerie. Ioannes de Vico accounted the father of Em­perickes. Marianus Sanctus in the third Treatise of his com­pend of Chirurgeric, and Angelus Bologuinus in his two Bookes of ulcers, shall beare him company. I must not o­mit that painful and judicious Chirurgeon Ambrose Parrey, unto whom Chirurgerie is much beholding. Vesalius also [Page 99]deserveth praise. The two latest who have written are the two Fabricii, Ierome and William: Hieronymus Fabricius in the third Booke of the second Part of his Chirurgicall workes: Guiliel [...] Fabricius in his learned Chirurgicall observations, who in this course out-strip all their fellowes. These Authors of all others are most to be perused, for in reading of them one shall become both more understan­ding, and more able to performe the cures which shall be committed to his care and skill. As for the rest, I leave them unto those who rather chuse to feed upon ackornes, than pure manchet. Riola [...] the father, Iaques Guilmeau, Pec­cetius and Pigra [...], although they deserve their owne praise, yet in my opinion they are to give place to those whom I have named. If any one would mispend good houres, let him read Paracelsus his great and little Chirurgerie, which are like clouds without raine. If you would be furnished with forrests of Chirurgecall medicaments, peruse the Trea­tise of the learned Hollerius de materia Chirurgica, of Chi­rurgicall meanes, and Iacobus Dondus in his enumeration of Chirurgicall remedies, both simple and compound.

As for those medicaments which in my proceedings I shall from time to time set downe, they shall not be a con­fused heape, but a choice of the best approved, to ease you of the labour of election.

II Now are wee to descend to the definition of an ulcer, which was the second point: Point. I will not stand upon the set­ting downe of sundry descriptions of sundry Authors, and the examination of them, because this labour would take up too much time, and little edifie you, which was appoin­ted the end and scope of these Lectures. An ulcer in English is deriued from the Latine ulcus, and this from the Greeke [...], because it disjoyneth the part which it possesseth, and so this tearme, in its generall signification, comprehendeth every solution of unity: and so Hippocra­tes in his Treatise concerning wounds of the head doth en­title it.

But seeing solution of unity may proceed from two causes, to wit, an externall instrument dividing, and a sharpe humor eroding, De caus morb. cap. ult. according to Galen: there must be two differences of solution of unity likewise according to the same Author, de constit. art. c. 6. Ʋulnus, a wound, procured by an externall instrument, and ulcus, an ulcer, caused of an inward cause eroding. Thus then an ulcer is to be descri­bed: It is a solution of unity proceeding from an inward cause eroding the part. The descrip­tion. The subject of an ulcer, I make not onely the fleshy part, (whereby I understand, not onely all the parts which cover the bones) but the bone it selfe also. Unto the ulcer of a bone the Author of the book de constit. art. cap. 6. giveth a peculiar name, calling it Teredo, [...], which properly signifieth the little worme which pierceth wood, and consumeth it. I see no reason why the name of an ulcer may not be ascribed to the solution of unity in a bone, if it proceed from an inward cause eroding, as the terme of a wound is, if it bee divided by an externall in­strument, as a sword or hatchet. An ulcer then is a compound disease: for in it there is both solution of continuity, and losse of substance.

LECT. II. Of the causes of ulcers.

III IN the third generall point concerning ulcers is set downe by me the causes of ulcers. Point. These are either an­tecedent or conjunct: The antecedent causes may be redu­ced to foure, to wit, Cacochymia, or the evill habit of the body, Contagium, or the communication or imparting of an infecting quality, vapour or humor, by the which an ulcer is caused in any part; a venomous moisture, as in biting and stinging of serpents.

I As for Cacochymia, the speculation of it doth belong un­to Or lastly the distemperature of the part it selfe. [Page 101]the practice of Physicke: yet in my discourses of Tu­mors I set downe the signes of every humor, redounding as much as was requisite for any to know, who onely medleth with the practice of Chirurgerie. While any of the three humors (bloud being excepted) in the masse of bloud con­tained in the veines, is faulty and peccant in quality, it is accounted the cause antecedent of an ulcer. Somtimes these humors are solitary, somtimes they are associate together.

II Contagium, or infection, it is communicated sometimes by a rotten and corroding vapour, and so very often, if one visit often one having Pthysis, such vapours being mingled with the aire, infect the party who visiteth, especially if he draw too neere to the diseased party. So ulcers of the yard come from dealing with women whose secret parts are tou­ched with venereall ulcers: yea the itch it selfe, and scabbed­nesse, is gotten by either lying with one troubled with it, or sleeping in a bed where a scabbed person hath rested.

III As for the distemperature of the part, it may be procured either by cold, as appeareth in kibes, or by heat, as we may see in a gangren; because the bloud flowing copiously to the part pained, and not being concocted, it putrifieth and erodeth the part. Last of all, by biting or stinging, as of a mad dog, or a venomous serpent, a corruption of the hu­mors may be caused, the conjunct cause of an ulcer: so that e­very humor that is changed from it owne naturall tempera­ture, whether it be by putrefaction, adustion, or commix­tion of any thing unnaturall, may procure an ulcer in what­soever part it seateth it selfe.

The opinion of dogmaticall Physicians concerning hu­mors.But the followers of Hippocrates and Galen, speake o­therwise of these humors than the Chymists doe. The Ga­lenists, make the three humors of the masse of bloud, to wit, choler, flegme, and melancholy, to be the causes both antecedent and conjunct of all ulcers, if they become con­trary to nature. So they will have rheumaticke ulcers to be caused of salt flegme, Herpis exedens to be caused of erugi­nous choler; cancerous ulcers of Bilis atra, which are the worst and most deplorable of all others.

The opinion of Chymists.The Chymists on the other part, affirme that the dis­course of humors doth not manifest unto us the essence, and proper nature of any disease. So Quercetan in his ad­vise of curing the gout, bringeth in the stone, which he af­firmeth not to be ingendred of the Galenicall humors. Pe­trus Severinus the Dane in his Idaea medicina philosophicae, or Pourtrature of the philosophicall Physick, wondreth at the folly of those, who make those fantasticall humors, bloud, choler, flegme, and melancholy the causes of diseases: wherefore they out of minerals, salt, sulphure, and mercu­rie, fetch out the causes of all griefes. Although Galen call sometimes humors salt, nitrous, and eruginous, yet the Chy­mists have no reason to reject the ordinary names of humors, and to call contumeliously dogmaticall Physicians Humo­rists, and to deny any disease to proceed from the ordinary humors of the body becomming unnaturall: for seeing that according to Galen 1. de loc. affect. c. 2. that is to be accoun­ted the cause of a griefe, That the ordi­nary humors of the body are causes of disea­ses. which being present the disease continueth, and which being removed the griefe ceaseth: and seeing we perceive diseases to be caused of vitious hu­mors abounding, and these being expelled the griefe to vanish, I see no reason why these humors may not be ac­counted the true causes of griefes; and that it is a meere folly, and an affection of novelty, to baptize these by names of minerals farre fetched; as to call that which in fevers is cast up by vomit, rather sulphure than choler. Besides this, the Chymists are injurious to dogmaticall Physicians, in la­bouring to perswade men that they by the name of a hu­mor understand nothing else, but a waterish substance void of all other faculty, which should be the principles of all bodies, What a Humor is. and the causes of all diseases: whereas every ratio­nall Physician, by the terme of a humor, understandeth a liquid body mixed with bloud: which seeing it is a seve­rall body of its owne kinde, and is more compound than water, so it hath farre more excellent qualities than water. The Physicians their owne selves have set the Alchymists at [Page 103]worke, while talking of humors, and the causes of diseases, so much talke of the first qualities, heat, cold, moisture, and drynesse. For although sundry diseases are caused of heat, The first quali­ties are not the only causes of diseases. cold, moisture, and drynesse, yet we shall finde other quali­ties in the Humor, which may as well hurt the body as these: for Hippocrates in his booke de prisca medicina, or ancient physicke affirmeth, not that which is hot, cold, moist, or soft, to be most powerfull, but that which is bitter, salt, sweet and sowre, unsavourie, and sharpe with some sowre­nesse; these and a thousand such, [...] being exalted in their faculties, he will have to bee the causes of diseases, and not the first qualities onely: and from these the diffe­rences of symptomes in fevers of this same kinde doe de­pend. These whilest they are exquisitely mixed in the bo­dy are harmelesse, yet when one of these is severed from the rest, and is exalted in its quality, it manifesteth it selfe, and annoyeth man; so the corrosive salt doth bewray it selfe in cancers, and corrosive ulcers. Minerals are in the body of man. Neither is it to be thought absurd, that minerals are in the body of man, for seeing man is fed by plan [...]s, and beasts, which feed also up­on the plants; seeing also the herbs have their aliment from the ground, which is not alike in all places, but often is min­gled with a salt juyce, and other minerall spirits, which the beasts and herbs cannot perfectly convert into their owne substance; one can hardly thinke that a man can live upon these, & have no such thing participate. So we see what va­riety of wines the diversity of the soiles bring forth; & that in every wine there is tartar or argol, which appeareth also very often in podagricall persons. In vomiting, sundry times substances like to leekes, green, and eruginous, exceeding hot and sharpe are throwne up, which being received into ba­sins, dry them with a bright eruginous colour. See histo­ries in Shenki [...] [...]ed. obser. lib. 3. ob. 62. in the third booke of his physicall observations, the 62. observation. Michael Dor [...]gius lib. 1. de [...]edico & [...]ci [...]a, in his first booke of the Physician and physick reporteth, that a certaine Lawyer [Page 104]made such urine, as did fret the linings, as if it had beene the spirit of vitrioll; such humors appeare plainly in scabbed­nesse, fretting ulcers, but specially in a cancer. Wherefore Bertinus is his third booke and eleventh of his Physicke, doth rashly and inconsiderately affirme, that not one whit of mercurie, salt or sulphure, lieth hid in the body; for in the itch, scabbinesse, some catarrhes, inflammations of the eyes, and fretting ulcers it may be perceived; but in urine, which is also an excrementitious humor, the salt may be se­parate, & presented to the sight: yea, besides the salt in urine, another substance the cause of diseases may be marked: for if you take a cleare urine, and suffer it to settle, a matter like unto the powder of bricke, and sometimes a white muddie substance will so cleave to the sides of the chamber­pot or urinall, that it can hardly be sometimes washed away; of such a matter tophes in gouty persons, and stones in the bladder, are ingendred.

The ordinary humors are not the causes of all diseases.Whosoever shall goe about to reduce the causes of all diseases to bloud, choler, melancholy and flegme, shall wrap himselfe into a number of difficulties: I will desire him to yeeld me a reason, why he calleth salt flegme so, seeing flegme is said tobe cold, but this hot? Why is Atrabilis comprehended under melancholy, seeing it is very hot, but this cold? Besides this, if any Physician goe about to cure diseases procured either by contagion, or poison, without any great respect to the humors, he presently goeth about to minister either a Lexipharmaca, as in the plague which is gotten by contagion, to abate the force of it, and then he addresseth himselfe to the preparation and evacuation of the humors. If poison be ministred to any one in meat or drink, which according to Cardan, commenting upon the 62. aphor. of the 4. sect. may be suspected, if he finde gri­ping in his stomacke, if he vomit and goe to stoole, if with­in six houres the akin become greenish or spotted, then An­tidotes are ministred, and not such as respect choler, melan­choly or flegme. Let the Humors then which are ingende­red [Page 105]in the body retaine the accustomed names, but if an ex­ternall cause make them degenerate from their nature, let these be distinguished from the ordinary, and have their denomination from that which altereth them. If salt, niter, alome, vitrioll, verdigrease be mingled with any humor, let it be called from the minerall mingled with it, salt, ni­trous, alominous, vitriolate or eruginous. And for this cause some late judicious Physicians writing of maligne and pestilent fevers, and considering their notable differences, have affirmed some to participate the nature of arsenick, some of mercurie, some of hellebore, some of opium, some of the leopards bane, some of the hemlock, some to partici­pate of the poison of a viper, scorpion, mad dog and such like, noting the variety of symptomes in sundry per­sons.

Of the super­fluous melan­choly Humor.One doubt doth remaine concerning the melancholy humor, whether it be onely thin and waterish, as Reusnerus affirmeth in his booke of the Scurvie, exercit. 4. out of sun­dry places of Hippocrates, who calleth melancholy [...], as in his booke [...], in his booke de worh is, and in his first booke de worh is mulierum, or whether it be thick and ear­thie, according to the vulgar and received opinion. Before this doubt be solved, some propositions are to be permitted. I. In the Chylus there are two substances, one liquid and thin, the other thick and terrestriall, which can no more nourish than ashes. II. Nature doth mingle these which are not sent away by stoole, with part of the aqueous and super­fluous humidity caused of drink and liquid meats. So in a lie the falt and some adust parts are so mingled, that they are not discerned before separation.

That the spleene draw­eth superfluous melancholy.I say then, that this thick and feculent humor tempered with much moisture, is to be accounted the superfluous me­lancholy humor, and that it is attracted by the spleene. For firt, seeing this feculent humor is altogetherunapt to nou­rish, it must be separate from the Chylus, which cannot bee performed by any other part befides the spleene. Secondly, [Page 106]the spleene is of a darker red colour than the liver is, which proceedeth from the thick, feculent, and terrestriall humor which it imbibeth. Thirdily, Hippocrates de aere, aq. & loc. affirmeth, that such persons as dwell in fenny places are sub­ject to passions of the spleene. The cause is, because the wa­ters are not pure, but muddie. Fourthly, if the spleene did draw onely thin and waterish humors, it could not bee so subject to obstructions as it is. The feculent humor mixed with much humidity, is the cause of sundry diseases: the thin part sometimes ascendeth to the upper parts, the grosse to the lower parts of the body, as wee see in the scurvie, wherein the gummes are ulcerated, and the legs tumifie. The spleene being spungeous draweth much humidity to it, wherefore spleenetick persons ought to drink sparingly, for if they bib too much, the naturall heat of the part is easily oppressed, The qualities of the waterish Humor of the spleene. and so they become hydropick. The waterish hu­mor of the spleene is not insipid, but sharpe and biting, and copious: so we see those who are troubled with quartanes, about the end of each fit to sweat plentifully; and those who are oppressed with melancholy to spit much. In the thick, feculent, & terrestriall blackish matter, somtimes there is no excesse of the spleene: in qualities, sometimes there is, and those are two: Acerbitas, an astringent sharpnesse, such as appeareth in greene unripe fruits; and Aciditas, sowrnesse: from these qualities intended and exalted, atra bilis becommeth so corrosive. So much I thought good to set downe of melancholy, to cleare the doubts which are moved of it, and to shew one use of the spleene.

To returne then to the carbonary crue of unlearned Al­chymists, Object. They object thus, The rationall Physicians af­firme the body to be nourished by the foure humors, how can they then be causes of the diseases?

It is strange that any men should wilfully shut the eye of the mind, Answ. understanding I meane, that they may not see the truth, seeing man, as Aristotle in the very first words of the booke of his Metaphysicks affirmeth, naturally coveteth [Page 107]knowledge, and witnesses are our first parents to their owne and our losse. No dogmaticall Physician ever affirmed any disease to be caused of any humor of the body, as long as it continueth in its owne naturall estate; but then to stir up griefes, when it is separate from the rest, when it doth putri­fie, when forraigne substances and qualities are added, which make it of a familiar humor, a prosessed enemy to health, consisting of the natural constitution of the body, resulting of the laudable commixtion of the foure humors naturall. I have insisted somwhat long in the setting down of the cau­ses of ulcers, because he (whosoever he be) that goeth about to cure ulcers without the knowledge of the causes, is like one, who being blindfolded, is set to thrash a cocke.

LECT. III. Of the generall differences and signes of ulcers.

OF the ten Points, within the limits of which I resolved to include all my discourses of ulcers, in my former Lecture I dispatched three; in the first I nominated the prime Authors, who have written of this subject: in the se­cond, I set downe the description of an ulcer: in the third, I discoursed somewhat largely of the causes of ulcers in ge­nerall.

Now the fourth Point, concerning the differences, IV. Point. and sundry sorts of ulcers, offereth it selfe to be handled, and in truth the course of nature so requireth: for the forme of every particular ulcer doth spring from the cause conjunct of the same: for example, a cancer ulcerate is discerned from all other ulcers by its proper and pathognomonicall signes, all which as effects, are ascribed to Atra bilis, im­pacted in the part the cause conjunct of the same.

Here of purpose I omit the idle and fruitlesse distinctions of ulcers, Differences of uncers. set downe by sundry Authors, which neither bet­ter [Page 108]the understanding, nor further the curation. These on­ly I will set downe, I. From their na­ture which are matteriall. The matteriall differences then of ulcers are taken either from the nature or constitution of an ulcer, or from the subject or part af­fected. From the nature and constitution, an ulcer is either simple or compounded.

In a simple ulcer, nothing is offered which may stay the Chirurgeon from going about the consolidation of it, as the cause conjunct, a cruell symptome, adjuncts, or some disease.

Differences of a compound ulcer.A compound ulcer wherein either some of these, or all are found, which must be removed before unition be procu­red, is either of the milder sort, or maligne.

The more milder sort of ulcers yeeld to ordinary and usu­all medicaments, if they be judiciously applied.

The maligne yeeld not, and besides have fearefull symp­tomes: those maligne ulcers proceed either from inward, or outward causes.

From internall causes spring a cancer ulcerate, Phageda­na, Nome, fretting ulcers, and others which are called Chi­ronia, or Telephia, which denominations insinuate nothing unto us concerning the nature or curation of an ulcer, but bring onely unto our memory the names of these who are celebrated by Poets, which belong more to Grammarians than Physicians or Chirurgeons to be knowne.

The externall causes which procure ulcers are two, to wit, Contagium, contagion, or a venomous quatity, vapour, or humor, comprehended under the name of Venenum, or poison.

II. From the partsThe differences taken from the subjects or parts affected are two, for either an ulcer possesseth the outward part, and is called Externum, or outward, or it afflicteth the inner parts, and is named Internum, or inward. Other differences are taken from the continuance, figure and quantity, are here impertinent, and further only predictions, of the which I will speake in the prognosticks of ulcers.

V. The signes of ulcers.As concerning the signes of ulcers, an internall ulcer is found out and discerned by the excretion or matter expel­led. As for example, if the urine be purulent we conjecture the kidneyes or bladder to be ulcerate. Signes of the lungs ulcerated If purulent matter be voided by coughing, it is like that the lungs are ulcerate; if much of such matter be rejected, and signes of an apo­steme have gone before, it is an apostematous ulcer; if the purulent matter be but little, and no signes of an inflam­mation have beene noted, then it is but a primarie ulcer proceeding of erosion, by reason of a sharpe humor separa­ting the unity of the substance of the lungs. These internall ulcers I will leave to the consideration of Physicians, unto whom they are most commonly presented to be cured, who very often purchase fees with no small discredit to the Art and themselves. Onely I will set downe such things as tend to the curation of ulcers of the externall parts. I need not to busie my selfe about the setting downe of the generall signes of such, seeing they are presented to the view of the Chirurgeon by the parties grieved. Onely let me give you warning, that you mistake not a wound for an ulcer: into this errour you may easily fall, if you admit the most ordi­nary description of an ulcer, set downe even by judicious Physicians and Chirurgeons; which is, Riolan. Chiru [...]. sect. 2. that it is a solution of continuity in a fleshy part, yeelding quittor; it skilleth not, they think; Whether it be laudable or illaudable. It is strange that there should be set downe no other difference between a wound & an ulcer, than this, that the one is blou­dy, and the other purulent. Doth not, I pray you, a wound become purulent of it selfe, although no Chirurge on deale with it, and may not an ulcer become bloudy if incision be used, as it may dayly be seene? Frivolous it is also in my judgment, that a solution of unity inflicted by an instrument that woundeth in a bone, as a sword, may be caned a wound, and that a solution of unity in a bone, procured by an ero­ding humor, may not be termed an ulcer.

Seeing the causes conjunct make the true differences of [Page 110]an ulcer and wound: The causes conjunct of wounds and ulcers. which are an externall instrument divi­ding, & a sharp humor eroding the parts. Who can imagine that in a venereall ulcer, wherein these is corruption of the bone, there should be two sorts of ulcers specifically diffe­ring, to wit, one in the fleshy part, and another in the bone, the same humor causing both.

But a solution of unity in the bone by a corroding is cal­led Teredo, say they.

What then? Object. Must a maligne ulcer in the face, because it is called Noli me tangere, be exempted out of the list of can­cerous ulcers?

No. Sol. Let this then be accounted an undoubted truth, that a solution of unity procured in the body by a humor e­roding, whether it be in the flesh or bone, may be, yea ought to be called an ulcer, as a solution by an instrument separa­ting, is called a wound in both.

LECT. IV. Of the generall prognisticks of Ʋleers.

NOw I am to descend to the sixt point touching Ul­cers, VI. Point. proposed by mee in the beginning, which is of their generall prognosticks. The presages. The consideration of these will make one circumspect, when an ulcer is offered to him to be cured, in the election of his cures: for whosoever ta­keth in hand a griefe uncurable, hee discrediteth himselfe, and causeth the art to be contemned by those, who are sim­ple and ignorant, imputing the error of the practicer to the insufficiencie of the art. 1 Let this be the I. praediction: an ulcer in a body of an evill complexion which may bee con­jectured by the colour of the skin, if it bee of a tallowie whitenesse, yellow or swartish is not easely cured: for it is likely, that corrupt phlegme, vitellin choler, and feculent melancholie doe abound, which humors hinder the rege­neration [Page 111]of flesh: but by the contrarie, an ulcer is easily cured in a person of a good complexion, who digesteth well and doth not increase superfluous moisture. 2 II. ulcers in bodies, which are either very moist or drie are hardly cu­red. This is plaine in the bodies of hydropicall persons, and those which ars aged, for as superfluous humiditie con­trarie to desiccation hindereth the healing in those: so in these the defect of radicall moisture. 3 III. ulcers in chil­dren by reason of their excessive humiditie, and in women with child, because the most laudable part of the blood is turned to the nourishment of the child, are not easely cu­red. IV. ulcers which fall out after criticall apostemes in the spondils of the back, 4 or great joynts of the body, for the most part are mortall: because after sicknesse, and aposte­mation, nature must be exceedingly weakened, the naturall heat much abated, and the radicall moisture almost spent. Such apostemes doe fall out when as sharpe fevers end not crittically in the decretory daies by some evacuation, as blee­ding at the nose, vomiting, sweating, purging by stoole and urine, but extend themselves to the fortieth day. 5 V. If the place wherein the ulcer is seared be blackish, blowish, or greenish, it hardly can bet cured: for the bloud must bee naughty, and the flesh corrupt. 6 VI. Ulcers of around fi­gure are cured with difficulty, the reason is this, Consoli­dation is procured by unition of the parts; now the farther the parts are asunder, the more slowly it is procured: but a round figure, of all other within the same bounds, is most ample. VII. Painfull ulcers in children are dangerous, 7 because their bodies being raw, and the spirits subtill, they are easily spent, which is the cause that they are much wea­kened, and so disposed for death it selfe. 8 VIII. If an ulcer become either blewish or pale, the party being ill, death is not farre off; for these colours shew the mortification of the part; and drynesse sheweth that the naturall moisture is gone. 9 IX. If an ulcer be cōplicat with a disease which main­taineth it, the ulcer, according to the nature of the disease, [Page 112]is either of easie or hard curation. So a venereall ulcer in a succulent and strong body is easily cured, but if the party be in a Marasmus, neither the ulcer nor the disease can be cured; because the use of desiccatives, which onely availe in these infirmities, will onely hasten death increasing the ex­tenuation of the body: in like manner ulcers in hectick and hydropick persons are hardly cured; in these because super­fluous humidity hindereth desiccation of the ulcer; in those because laudable juyce floweth not to the part ulce­rate. X. If tumors in ulcers suddenly vanish without any evident and manifest cause, 10 as bleeding, or application of a discussive medicament, they portend no good: but convul­sions; if they appeare in the hinder parts, because the Spins is very nervous: and madnesse, pleurisie or suppuration if they were red, 11 and in the forepart. XI. Soft tumors in ul­cers are laudable, because they will yeeld to medicaments, but hard, not easie to be cured, because the humor is more rebellious. 12 XII. If the haires fall in places of the body about the ulcer, it is an evill signe: for then there must be great a­crimonie, and corruption of the humors, as in quartane a­gue [...], the pox, and leprosie. 13 XIII. If in an ulcer where there is cariosity of the bone, the colour of the flesh be of a livid colour, the party must be in danger: for it is a signe of the extinction of the naturall heat. 14 XIV. Ulcers which afford quittor, which is white, smooth, and uniforme, and not stinking, promise an easie cure, for these qualities in the quittor, shew the dominion of the naturall heat, and the soundnesse of the solide parts. 15 XV. A flux of bloud com­ming in an ulcer after strong pulsation is ominous, accor­ding to Hippocrates Sect. 7. aph. 21. for there must bee a strong phlegmon, and the arteries must be much pressed, so that a gangren may be expected: howsoever of such furious bloud no flesh can be regenerate. 16 XVI. If an Erysipelas ap­peare, the bone being bare, it is no good signe, Hipp. Sect. 7. aphor. 19. for neither can flesh be regenerate by such a sharp humor as this, 17 that causeth so hot a tumor. XVII. From [Page 113]maligne ulcers two forts of quittor flow; One thin, and it is called Ichor, or Sanies; such a virulent matter issueth also from the pricking of the nerves, and corruption of the pe­riostion. The other sort of quittor is thick, and is called Sordes. 18 XVIII. In ulcers which have continued a twelve­moneth or longer, the bone must be scaled, and the skinning be hollow, Hipp. lib. 6. aph. 45. But to make good this Apho­risme of Hippocrates, some conditions are required: The first is, that much flesh above the bone be not in the part ulcerate. Secondly, the humor which floweth to the part must be very corrasive. Thirdly, it must not have beene dealt withall by any Physician or Chirurgeon. If one or more of these conditions faile, the Aphorisme must misse of its pre­diction. What Galen and late Writers have set downe in the explication of this Aphorisme, cleare not the truth of this Aphorisme: onely these conditions set downe by me doe. The signes which leade you to the knowledge of a bone corrupted are these: 1. If the ulcer having beene skinned, Signes of a corrupt bone. breaketh out again, for it is likely that the bone casteth out an ichorous substance, which is the cause of this recidivation, 2. If the ulcer yeeld more and thinner matter then the big­nesse of it requireth. 3. If the brims of the ulcer will not come in. 4. If the brims become reddish. 5. If the bone, being presented to the sight, it appeare rugged, and of a blackish colour, not smooth, or a ruddy white colour. XIX. Whatsoever ulcers cast out much Sanies or Ichorous matter, 19 which is too thin, of a leady, pale, or black colour; or glutinous, or stinking, and which fretteth the skin adjacent, are hard to be cured, for this humor keepeth the ulcer moist, and cannot easily be dryed, even if you apply powerfull Topicks. XX. Inveterate ulcers which cast out a quittor, 20 called by the Grecians [...], like unto white oyle, are hardly cured: for this signifieth a colliquation of the part, and an extenuation of the rest of the body.

LECT. V. Of the generall curation of ulcers and their times.

HAving set downe the generall prognosticks of ulcers in the sixth Point, now the seventh Point concerning the generall method of curing of all ulcers doth offer it selfe.

The universall curation of ulcers is comprised in this one proposition: All ulcers ever desire desiccation, so Hippoc. in princ. Lib. De ulcer. & Galas. Lib. 3. method. c. 3. for whether we goe about to ingender flesh, or to seale up an ulcer by cica­trization, desiccative medicaments are still required.

Foure times of ulcers.There are foure times to be observed in ulcers.

• I I. Principium, the beginning; In it the quittor is thin and waterish.
• II II. Augmentum, the proceeding; In it the quittor flow­eth more sparingly, and thicker.
• III III. Status, the consistence; In it there is no ichorous matter, but [...], yet somewhat thinner it appeareth.
• IV IV. Declinatio, when the ulcer is in the mending hand, then laudable Pus sheweth it selfe.
  The qualities of laudable qu [...]ttour.
  It is white, being altered by the naturall temperature of the veines, arteries, nerves and membranes, whose substance is white. Secondly, it is uniforme, not grumous or cruddy, naturall heat working equally upon every part of it. Thirdly, it is without all ill smell, seeing the naturall heat hath corrected all the evill qualities of it.

The meanes of curing of ul­cers.The curation of ulcers is performed by two meanes: The 1. is the removing of the causes antecedent. The se­cond, is the artificiall dressing of them.

Causes antece­dent.The causes antecedent are foure: Cacochymia, Conta­gium, Venenum, and the distemperature of the purt.

I The ill habit of the body is to be removed by alteration and evacuation, if the humor abound.

II Contagion is to be overcome by Alexipharma.

III Poison is to be contemperate by Aeidota.

IIII The distemperature of the part is to be removed by things contrary unto it. And that we may the more easily attaine to these scopes, a convenient order of diet must ever be pre­scribed.

The cause conjunct, which is the eroding humor, The cause con­junct. that is setled in the part, is surprised by such medicaments as sute for the foure times of an ulcer before mentioned by.

The use of sup­purative me­dicaments.In the beginning then Suppuratives or Digestives are to bee applied. First, because the matter which hath left the vessels, and hath insinued it selfe within the porosities, putrifieth: wherefore it ought to be concocted, that it may become laudable quittor.

Secondly, good flesh cannot be procured by sarcoticall medicaments, unlesse the matter be concocted; for so the ulcer is made apt to admit the generation of flesh. These Suppuratives ought in the first qualities to be proportio­nate to the temperature of the part unto the which they are to be applied, so to parts hot in the first or second degree Suppuratives hot in the same degrees are to be applied: for if they exceed, they are so farre from strengthening the na­turall heat, that they rather pervert it, making it aguish and unnaturall: if the part be temperate let temperate Suppura­tives be applied.

In what ulcers Digestives are unfit.But Digestives ought not to be applied, First, to putride ulcers; for seeing Suppuratives are hot and moist, if they should bee applied, I they would cause the greater putrifa­ction.

II Secondly, they are not fit for rheumatick ulcers, for such medicaments relax the part, and make it more subject to re­ceive the matter that floweth, and so a tumor might bee caused. And as Suppuratives are to be applied to the parts ulcerate, because the humor which is hot and sharp would inflame the part if it were not suppurared and cleansed. The uses of re­pelling medi­cines.

Sorepelling Topicks are to be applied to the parts about [Page 116]the ulcer to repell the matter which floweth. I I. That the heat of the Suppurative medicament draw nothing from the parts adjacent.

II II. To strengthen the parts that they may resist fluxion.

III III. Because by the repelling of the humor, the desicca­tion of the ulcer is furthered.

IV IV. Because the heat of the part ulcerate is intended and strengthened, it being kept in by the coldnesse of the repelling medicament.

The mixtion of medicaments when profita­ble.And for as much as I affirmed that ulcers alwayes require desiccation, it is not amisse to mix with the Suppuratives some driers, yet that in the beginning the Suppuratives have the upper hand, but in the end the desiccatives.

After that the ulcer is well digested, and yeeldeth lauda­ble quittor, Mundificatives Mundificatives are to be applied: for if you ap­ply farcoticall medicaments, before the ulcer is well dige­sted, spungeous and naughty flesh will grow, which will admit no cicatrization. In mundifying we must not use too sharp medicaments, for these may cause an unskilfull Phy­sician or Chirurgeon to beleeve that it is a corrosive ulcer. The paine which the Patient feeleth in the part ulcerate wil bewray this errour. These three scopes being compassed to overcome the cause conjunct, nothing remaineth, but to seale up the cure by cicatrization.

How fluxion is stayed Revulsion.Seeing most ordinary ulcers proceed from fluxion, it is to be withstood, First, by Revulsion. Secondly, by Repul­sion. In Revulsion, wherein the matter is drawne to parts farre distant, the rectitude of the part, and vessels is to bee observed. So if the ulcer be in the right leg, Revulsion is to bee procured in the right arme, if you respect the rectitude of the part; but if you consider the rectitude of the vessels, Revulsion is to be used in the left leg, if the ulcer be in the right: for so the communion of vessels is kept.

How revulsion is to be procu­red.Revulsion is performed by attractives, and these are three; Heat, paine, and the shunning of vacuity. Hot thing which procure attraction, are hot inunctions, and baths: straight [Page 117]ligatures cause paine; but both paine and heat are caused, Ventoses, and Vesicatories. Fontanels attract by reason of the shunning of vacuity; for they sending out sill some sub­stance, some other must bee drawne to fill up the place of that.

Repulsion, wherein the humor is stayed in its passage, Repulsion. is performed by applying those medicaments, which common­ly are called Defensives: Defensives. these medicaments are astringent and cold, and rather dry than moist in ulcers. Now that you may know whether you proceed according to Art in the curing of ulcers, receive this Aphorisme: To know good medicaments. When medica­ments applied to ulcers doe good, or at least hurt not, it is a signe that they are convenient; but if they doe harme, by making the ulcer hotter or colder, drier or moister than is fit, then you may gather that such are to be changed, Albucasis. and their contraries applied.

Things which make ulcers long in curing.To conclude this Point, nine things make ulcers hard to be cured.

• I. The defect of good bloud in bodies extenuate.
• II. The impurity of bloud in cacochymicall persons.
• III. Is the filthinesse of the ulcer.
• IV. Soft and cadaverous flesh about the ulcer.
• V. The malignity of the humor.
• VI. The hardnesse of the brims of the ulcer.
• VII. A secret cause in the aire of some places, they be­ing hot and moist.
• VIII. When the bone is corrupted.
• IX. The application of unfit medicaments.

LECT. VI. Of the medicaments be fitting ulcers in generall, and first of repelling medicaments.

NOw at the last I am come to the last generall Point, set downe by me in the first Lecture concerning ul­cers, of the which I intended to discourse, which is, of the medicaments befitting ulcers in generall. I meane to spend this Lecture upon this subject, to the end that you may be so furnished with good and approved medicaments, as that you shall not need either to envie or wonder at such as brag of secrets.

It is not unknowne to your selves how many sawcie and malepert Empiricks there are here in London, who basely and irreverently speak of those who are skilfull indeed, and deserve well of the Art of Chirurgerie, (purchasing unto it credit, and to their owne selves profit and renowne, by their methodicall and successefull practice) and so impu­dently boast of their secrets, and exalt themselves as if they had no forehead. But surely it is to be thought, that there is too great a distance betweene it and their tongue, that the forehead cannot stop the tongue from uttering Thraso­nicall speeches of themselves: it is great pity such are so countenanced as they are. The Magistrates let them pro­ceed in their extravagant courses, thinking it not fit for an Eagle to stoope to a gnat. The ruder and ignorant sort, ra­ther consider the promise, than the performance, thinking that there can be no cloud without raine.

That you may be the more able, not only to encounter with these confident cowards, but to overthrow them also; I will endevour, according to that talent of skill which I have, to furnish you with competent both Theorie and Practice. It is a shame for a Chirurgeon not to be furnished with admira­ble [Page 119]variety of medicament, seeing nature hath beene so pro­vident for him. Turne your eyes whither you will, and be­hold the fertility of nature, and you shall see and finde that in her works she hath not beene unmindfull of you. As for plants, you have Dioscorsdes and Galen, yea all who have written of them, witnesses; that the greatest part of them have fallen to your share. As for the things which lie hid in the bowels of the earth, as metals, spirits, marcafites, doe they not serve your turne? The metals for your instru­ments, the rest for your medicaments. Let no man think then, that a skilfull and industrious Chirurgeon can by his Art performe no other cures, but such as may be compassed by the compositions in his Salvatory. These he must have in readinesse, other medicaments he is able to fetch out of the treasure of nature, which he hath at his command. This I will make good by the setting downe onely those medica­ments which are known to belong to the curation of ulcers. Of these there are two orders or rankes: for some serve for ordinary ulcers, some for those who have a malignity an­nexed. Those that serve for ordinary ulcers are of five sorts, for some are Repelling, some Digesting, some Mundifying, some incarnating, and some Cicatrizing, and the Medica­ments which performe these offices, are either simple or compound.

LECT. VII. Of the curing of a plaine and hollow ulcor, being Simple.

HAving passed thorow the ten points whereof I inten­ded to speake, before I was to meddle with the curing of any particular ulcer, now it is time to deseend to the set­ting downe the method of curing of ulcers in particular. I would have you to call to remembrance the materiall dif­ferences of ulcers delivered by me in the third Chapter, which were taken either from the nature and constitution of an ulcer, or from the parts affected: from the nature of [Page 131]the ulcer I deduced two sorts of them: some I called sim­ple, some compounded. Now the simple ulcer is to bee ac­counted such an one, as hath neither a disease, cause, or symptome annexed to it, or complicate, besides the solution of unitie caused by crosion. Of these simple ulcers there are two kindes: for some are plaine, and equall to the naturall skin, wherein only the Cuticula and Cutis are lost. Galen. lib. 3. meth. c. 3. Some are hollow, cav [...], wherein besides the Cuticula and the Cu­tis, a part of the flesh is lost. It is not needfull severally to set downe the curation of ulcur planum, or aequale, a plaine, or even ulcer; because in prosecuting the indications of cu­ring of ulcur cavum, a hollow ulcer, I must set downe the meanes of curing a plaine one: for this is contained as a part in the other.

Seeing then there are two affections in a hollow ulcer, Indications of curing an hol­low ulcer. to wit, solution of unitie; and cavitie, three scopes of curing offer themselves, unition, incarnation, and cicatrization. Wherefore if the quittour be white, smooth, Secundum. Gal. comm. ult lib. Prognost. 10. small in quan­titie, reasonable thicke, and not evill smelling: If besides the ulcer it selfe be red, and sensible, then we may goe about to gender flesh, by applying sarcoticall medicaments: But by the contrarie, if the Pu [...] bee blacke, uneven, grumous, rough and stinking, and if the ulcer it selfe bee not red and sensible, the ulcer cannot be incarnate, before it be prepared by suppuratives and mundificatives. Excrements in ulcers. Besides Pu [...] which is reasonable thick, three sorts of excrements appeare in ulcers.

The first is thin, watrish, I like to water wherein flesh hath beene washed: this hath received no alteration, but hath flowed pure, as it is in the veines and flesh; this is called Ichor. The second is thin too, II but it hath received some al­teration by the temperature of the part, this is called Sanies, or Virus. The third is verie thicke and glutinous, III and is called Sordes.

Now the excrements which are thin moysten the part ulcerate, that it cannot sufficiently discharge it selfe by breathing out the humiditie. Wherefore Desiccatives are [Page 132]to be used to consume this superfluous moysture: but the excrements which are thick cleave to the part, and hinder the addition of flesh. After Mundisi­cation, Incar­nation These are met withall by abstersives or mundificatives. The ulcer being prepared by suppura­tives and mundificatives, you are to ingender flesh by inca­nating medicaments. Two causes of the sleshingen [...]. There are two causes of this flesh which is to bee procured: 1. Is the efficient cause: This is nature it selfe not onely of the whole body; but of the part it selfe also, which is called Temperies, the naturall tempe­rature or constitution of it: whereby it attracteth, conco­cteth, applyeth and assimilateth the nourishment to it selfe. 2. Is the materiall cause: this is sincere and pure bloud. If the part ulcerate enjoy such, then nothing remaineth but to maintain it: If the bloud be not pure, [...]hen it is to be altered, if it be too hot it is to be cooled, if too cold it is to bee war­med, if it be too thin it is to be thickened, if it be too thick it is to be attenuate; if there be too great plentie of it, it is to be diminished; if it be too little, then it is to be encrea­sed by convenient order of diet.

The Indicati­ons of curing a simple ulcer.To come necrer to the curarion of a simple ulcer: First, we must discreetly order those things which are called not naturall: seeing a convenient diet preserveth and maintai­neth the good constitution of the whole body, and tempe­rature of the part: Diet. Wherefore all those meats and drinke which make the bloud too hot, too sharp, too thin, or too thicke, are to be shunned, and those onely to be permitted which afford good juyce, and are of easie concoction, espe­cially if the diseased partie be tender and weake. Besides this they must be taken moderately, and at convenient times. The part it selfe must bee kept quiet: Quietnesse. for motion hea­teth the part. Care also is to bee had of sleeping and wat­ching: for as watching dryeth the body, and consumeth superfluous humiditie, so sleeping moysteneth the parts; but those chiefly which are nervous or sinewie, as mem­branes, tendons, ligaments. If then the ulcer be humid, en­joyne watching; if it be drie, command sleeping. As con­cerning [Page 133]vacuation of the excrements, let it bee appointed that they may answer in quantitie the food which the dis­eased partie taketh. If he prove costive, either minister unto him a glyster, or give him an ounce of Electuarium leniti­vum in chicken broth. As perturbations of the minde change the state of the whole body, so the tranquillitie of it maintaineth the same. A speciall care is to be had of the aire; for it wonderfully preserveth the temperature of the part. Southerly and Northerly winds or not fit for ulcers: for as the first moysteneth and heateth, so the second doth much coole and dry: but cold is an enemy to ulcers. So it is observed that the aire in Angieu is hurtfull to ulcers in the legs, but in Paris good. So in Pise and Ferrara it is hurt­full; but in Florence wholsome. Prognosticks. As for the prognosticks of simple ulcers: If I should set downe any, you might justly thinke I did abuse the time: for there is none so sim­ple, who may not gather out of the verie denomination of them, that they are most easie to bee cured, and that great skill is not required to compasse the same: onely let mee give you warning that the cure may be either more easie, or hard, according to the nature of the part ulcerate, and the diet of the patient. So simple ulcers are more easily cured in a fleshy part, than in the joynt or a nervous part; for in these stronger desiccatives are required, and in them the na­turall heat is not so powerfull to make use of the medica­ments applyed. In like manner a simple ulcer is more easily cured in the body of a temperate person, than it is in the bo­dy of one given to deboshry. Having set downe the right use of the things not naturall, as diet, sleeping and watch­ing, evacuation of the excrements, the perturbations of the minde and aire, I am to deliver unto you some locall medi­caments for the accomplishing of the curation of these ul­cers, according to the generall indications of curing set downe in the fifth Chapter.

As for the digesting, mundifying, and incarnating of a simple ulcer if it bee hollow, Digesting, Mundifying, Incarnating. these intentions and scopes [Page 134]shall be performed by the application of my Basilicum: The description of it is this: ℞ Cera & resin. an. ℥vj. picis nava­lis ℥iiij. gummi Elemni ℥ij. Ol. Olivar. ℥v. & semiss. vernicis clare ℥iiij. Seviovill. ℥ij. Terebinth. ℥iiss. Olib. mirrh. pultae an ℥j. fiat unguentum ex l. a. If you make triall of this you shall finde it not a little better than the ordinarie two bea­ring this name, to wit, Basilicum magnum and parvum: If an hollow simple ulcer prove sordid, mingle with an ounce of this my Basilicum two scuruples of the cathereticall power made of Precipitate and Allom calcined: or if you apply Paracelsus mundificative tempered with the same, you shall haply mundifie it; but if a plaine or equall ulcer be uncleane, the yellow Turbith or Precipitate washed, be­sprinckled, and covered with a pleadget of lint will serve. A­bove these medicaments apply Diapalma cum succis, and above this a double cloth moystened in red astringe wine, having some Allome dissolved in it. If you be in the coun­trey, apply to the parts adjacent to the ulcer, clouts moyste­ned in the juyces of cooling and astringent herbs, as Plan­tane, Garden Night-shade, Knot-grasse, Purselaine: If you a [...]bint these parts with: Triapharmacum, and Vuguentum po­puleam mingled to gether, you shall prevent fluxion and in­stammation.

When you have filled an hollow simple ulcer with flesh, Cicatrization. nothing remaineth but to cover it. Now the cover of the flesh is the skin it selfe: and as the flesh lost is to bee repai­red, so that which covereth it. But seeing the skin is framed in the womb of a seminall matter, it being lost it cannot be restored by reason of the defects of matter: Wherefore we must finde out another cover. This cover is called by Artists Cicatrix: This is nothing else but the uppermost Superfi­cies of the flesh so dried, that it doth represent the skin. And as in ingendring of good flesh in the ulcer, laudable bloud was the materiall cause of it, so good flesh is the materiall cause of the Cicatrix. How the Cica­trix is procu­red.

This Cicatrix is procured by three meanes, by nature it [Page 135]selfe, the aire, and epuloticall medicament. I That nature hath an hand in this businesse it doth appeare many wayes: for we may see daily ulcers skinned with these same medica­ments by Empiricks, which they used in incarnating: so that nature must bee the chiefe efficient cause. Secondly, many times a scab covereth such ulcers being incarnate, which being removed, or falling away of it selfe, the place appeareth skinned: onely nature is the cause of this: for no medicament was applyed. Thirdly, if nature had not a hand in this businesse, such an order would not be observed, that the brims of the ulcer should first be skinned, and then the middle. Fourthly, nature worketh in her actions to the period appointed: so in an ulcer shee not being hindred fil­leth the ulcer with flesh even unto the uppermost Superfi­cies, which being done she ceaseth from affording any more matter of flesh, whereby it commeth to passe that the upper Superficies being deprived of further nourishment must be­come dry.

II What power the aire hath, doth manifestly appeare in the bodies of infants newly borne, their whole skin is soft and red: the cold aire afterward doth repell the bloud, drieth the skin, and maketh it more hard.

III But seeing nature verie often in such an action proveth slow, so that if you should wholly rely upon her, and expect her leasure, you should seeme of purpose to protract time, & be indanger to lose your patient, it is the safest & best course to aid nature by bringing to aid convenient & good epuloti­call or skinning medicaments. In the monuments both of ancient and moderne writers one shall finde great varietie, whereof notwithstanding a discreet and judicious choyse must be had, if hee meane to make good use of them; for I dare bee bold to affirme, that there are almost infinite de­scriptions of medicaments, where of the: first describers ne­ver made any triall, but set them downe, being inducell onely by imagination. And amongst these medicaments, you shall finde not a small number, which are either [...]idicu­lous [Page 136]or superstitious, Epuloticall medicaments. or both. Seeing then the case so stan­deth, I will onely commend unto you three medicaments fit for [...]kinning of simple ulcers: The first is, Diapalma cumsuccis. The second my Epuloticum, which I described in my former Lecture. The third shall be Heuruius Spara­drop. The description of it is this, taken out of his Method to Practise Lib. 1. pag. 81. of the Leyden edition. ℞ ol. om­phacin. & axung. porcin. an. ℥iij. lythargyr. auri vel argent. ℥iiij. cerussae ℥j. Goq. ista lento igne ad emplastri consisten­tiam: tum: adde cerae, picis an. ℥i ss. colophon. ℥ij. plumbi pul­verizati ℥i ss. fiat emplast. see. art. Sparadrops made of this, not onely simple ulcers, but parts of the body excoriat by reason of long lying in bed caused of weaknesse brought by chronicall diseases.

LECT. VIII. Of the Compound, but milder ulcers, in generall

IN my former Lecture, I set down what did belong to the curation of simple ulcers, as well plain, as cave or hollow, wherein no other offence besides the losse of the skin and flesh is found. Hereafter I am in like manner to discourse of ulcers compounded, What a com­pound ulcer is. wherein besides solution of unitie, caused by erosion, there is somewhat else that hindereth the consolidation of the ulcerated part.

The differen­ces of com­pound ulcers.These compounded ulcers are either of the milder sort, or else maligne. Those of the milder sort, have annexed either a disease, or a cause, or symptomes, which hinder the Chirurgeon from going about the unition of the part ulcerate. Diseases com­plicate with ulcers. Sundry diseases in the body of man may keepe ul­cers from healing: some from corrupting the humors, as the leprosie & pox. I meane the French: some hindering of laudable bloud in sufficient quantity to be sent, as Pthysis, and a Hectick f [...]ver: some by sending too much waterish [Page 137]humidity with bloud, hinder the unition of the part ulcera­ted. If ulcers in such persons be presented to you to be cu­red, you are seriously to ponder in your minde, how hard a taske is put upon you, if any of the former diseases be com­plicat with the ulcers, if you onely except the French-pox in a reasonable strong body: but if the body of one troubled with the French-pox be extenuate much, then permit the cure of him also amongst the rest, to the charge of such as are onely [...], or citizens of the world, having no permanent habitation; and resting contented at the first with halfe of the bargaine made for the cure, willingly, al­though nor honestly, commit the second paiment to the ar­bitration of fortune. They during their life time, continu­ing scandals to Art and Artists, it is strange, if at the houre of their death, their consciences for the present seared, grow not tender, and fearefully accuse them. Seeing the practice of Physick and Chirurgery are severed within the Liberties of the city of London, I hold it to be the safest course for you to leave the cure of the diseases to learned Physicians, and to assume onely to your selves, the methodicall dres­sing of the ulcers: for so the whole discredit, (if any re­dound) will fall to the Physicians share, who cured not the griefe, the onely stay of the curing of the ulcer. This is my advice, if an ulcer complicat with a dangerous disease, come at any time to your handling: (It is not your desire (I know) that I should set downe the manner of curing of any inward disease: for then I should be bu [...]ie with my siccle in the harvest fields of other men) that then in this case, you have recourse unto some Author, who hath written most lear­nedly of the manner of curing that disease which is an­nexed to the ulcer, and follow his indications in dealing with the disease, if you have not the opportunity of a Physi­cian, whose advice you may follow.

Authors to bee followed in cu­ring the French-pox.In the cure of the French-pox, if you int end to use the unction, be directed by Ambrese Parrey, or Master Clowes, who, while he lived, was a famous member of this Compa­ny [Page 138]If you resolve to insist the kingly, and cleanly way of curing this disease by dyet, then follow renowned Fallo­pius or Capivaccius. There is a Volume in foli [...] wherein are contained the monuments of such as have written of this disease, according to the talent of skill granted unto them: I rather would have you acquainted with these, than to range much, and imitate the swallow, which flyeth much, but prayeth onely upon flies.

As concerning the Dropsie, the Cough of the Lungs, the Hectick fever, or Maras [...]us, the extenuation of the body: if these being complicat with an ulcer, hinder the curation of it, have recourse to the learned Works of the famous moderne Writer, Daniel Sennertus, the late Professour of Physick in Wittenberg, who hath couched in his learned bookes, what almost can be spoken, either by Galenists, or Chymists, concerning these and other diseases. The Plagi­ary Barow in his Method of Physick, and Bruel, are but like unto rotten reeds, appointed for the ruine of impotent, and lame persons, if they relie upon them.

II From a disease joyned to an ulcer, Of the causes annexed. I will descend to the causes hindering the cure of an ulcer. These are two, the humors that flow, and the distemperature of the part.

As for the humor, How causes in flowing are to be met withall. if it be in flowing, then you are to meet with it with the ordering the things called, not natu­rall; as aire, meat and drink, sleeping & watching, evacua­tion and such like, and by purging of the humor offending: whereof I spake sufficiently in the doctrine concerning Tu­mors. How humours flowing are re­moved. Gal. 4. me­thod. 2. If it hath flowed to the part, and be impacted in it, then it is to be removed by three meanes: to wit, by drying, expressing, and removing of the causes of the fluxion.

You shall dry the humor, if you use sarcoticall medica­ments, I drying at the least in the third degree, as Bones cal­cined, Harts-hornes calcined, and made up in Trochisces with Plantane, and Rose-water, Aesustum, the Pumick­stone calcined, Calaminaris, Borax, the powders of Tor­mentill, Bistorts, Comfrey, and such like; whereof I have [Page 139]spoken sufficiently before: yet Nunquam satis dicitur quod nunquam satis discitur, a thing remarkable can never be too much pointed at; so fluxible and gliding are the objects of our memory.

You shall expresse the humors: First, II by using such re­pelling medicaments as I have often spoken of, which are to be applied to the parts adjacent to the ulcers.

Secondly, by rowling the ulcer, as Hippocrates prescribeth in his Treatise of Fractures, that it begin about the ulcer, using so many revolutions, or windings of the rowler, as are fit, and ending in the sound part.

As for the causes of fluxion they are three; transmission, III attraction, and the furious motion of the humnor it selfe. Galen. 2. de dif­fer. feb. 11. & 12. method. 3, 4, 5. A part sendeth either moved by the superfluity of the humor, or urged by the offending quality, or both. If the humor of­fend in quantity abounding, then it is to be abated by phle­botomie, purging, slender diet, and such meanes as have been delivered by me in the Treatise of Tumors, to lessen pleni­tude, or Plethora, the signes whereof I delivered there al­so, so that I need not to repeat them here. If the humor offend in quality, urging and pricking the part to the ex­pulsion of it, as the liver, which being tainted with the French-pox, sendeth the humor to the groynes, yard, ma­trix, the fundament and throat. When wee have observed and noted the quality and nature of the humor, then wee are to goe about the expulsion, or alteration of it, or both.

If the humor offend both in quantity and quality, then are we to use both purging and altering. Now to finde out the humors in quality offending, seeing I have set downe their pathognomonicall, & proper fignes, when I discoursed of every speciall Turnor, I will remit you, at this time, to the places where they were set downe. If humors doe flow by reason of the attraction of the part; it is procured either by the heat, or the paine of the part. Gal. 4. meth. 2. & 13. meth. 13. If a humor flow to the ulcer, neither being sent from a part, nor received by a part; but because the humor it selfe is eliquat, either by the [Page 140]vehement perturbations of the minde, or an aguish consti­tution, or the exhibition of an eradicative, or strong medi­cament: then the tranquility of the minde is to be procu­red, the aguish heat to be abated, and the exhibition of such medicaments to be stayed. Having spoken of the fluxi­on of humors so much as is fit for our present purpose, now I am to touch briefly the other cause of milde, yet com­pound ulcers: to wit, the distemperature of the part.

The distempe­rature of the part. The single distemperatures are in number foure: to wit, toodry, too moist, too hot, too cold. A dry distemperature is found out by these signes: the colour of the ulcerate part is ill-favoured, not lively, little or no matter floweth from it, in touching it seemeth hard and dry.

This distemperature is removed by two meanes: First, by drawing out the naturall humidity to the part affected, by opening the passages, which before by reason of immo­derate drynesse were drawne together. In this case friction is excellent.

Secondly, drynesse is removed by the application of hu­mecting medicaments. Two such are commended by the Ancients, pure Spring-water, and Water and Oyle mingled together.

As for the use of Spring or River-water, it must bee ap­plied luke warme, not very hot; for if it be very hot, it dis­cusseth; because the humors having beene attenuate by it, they are turned into vapours, and so resolved: but if it be temperately hot, and the part fomented by it, it moi­steneth.

The second medicament composed of Water and Oyle, by the Ancients is called [...]. The ulcerate part im­moderately dry, is to be fomented with this medicament warme: Take either two parts of Water, and one of Oyle, or equall; warme them in a single Viall-glasse, then shake them well together, that they may be mingled, and apply the medicament. This is a convenient Topick in the win­ter, for although warme water warmeth the part during [Page 141]the time of fomentation, yet after fomentation it leaveth the part cold, because it drew out the heat to the Superfi­cies of the body: wherefore oyle is excellent, for it stop­peth the pores and keepeth in the heat. These two medi­caments are to bee applyed to the ulcerate part by [...]upes, spunges, or pledgets.

An observa­tion.One thing you are to looke unto you, and to provide be­fore fomentation, that the body of the partie unto which they are to be applyed bee neither plethorick, for then too much moysture may bee attracted; nor cacochymicall, for then corrupt humours may be drawne, both which will hin­der the curation of the ulcer: use therefore first of all phle­botomie, or purgation, according as you shall see cause.

Quest.But you may not without cause aske, When fomentation Quefl. is to be left?

Answ.I answer, that two things shall declare unto you the pe­riod of fomenting: the first is the substance of the part, the second is the colour: wherefore when you see the part a little tumified, soft and moyst, and of a ruddy colour, desist from fomentation, otherwayes the humour attracted will be discussed.

The curation of a moyst di­stemperature.If a moyst distemperature hath possessed the part, then the flesh of the part will be moyst, spungeous flesh will bee apt to grow, and plentie of excrements will flow from the ul­cer: In this case strong Desiccatives, or Sarcoticks mingled with Basilicum aureum, or Arcaeasliniment are to be used: with an ounce of any of these unguents you may use one dram and an halfe of these Desiccatives: such are the Regulus of Antimony, Lead calcined, Calaminaris, Bones and Hornes calcined, the powder of the root of Iris, Mastick, Olibanum, and such like. Aes ustum, the Pumick stone calcined, and Henricus rubeus are excellent. The curation of n hot di­stemperature. If the part bee distempered with heat, then the part ulcerate will bee somewhat tumi­fied, hard and red, and befides the relation of the diseased partie, your owne feeling will assure you. In this case use Aqua calcis viva, so called; but more properly Lixivium [Page 142]calcis vive, wherein some litharge of silver hath beene boy­led: you may use also snow water, wherein some of your Vitriolum album or white Copperas hath beened dissolved: In a quart of Apsame water dissolve two drams of Roman Vitri [...]l, you shall have a water of the colour of a light Emerauld colour fit for your purpose. In a pint of Plan­tan [...] water dissolve two drams of ordinarie Vitriol or Al­lome, and this also is a fit medicament. Let mee acquaint you with one thing, that in Redriffe a Copperas is made of Mars or Iron, which is most sit in the cure not onely of or­dinarie ulcers, but of those also which are in the eyes, blad­der, throat, and the Intestinum rectum. Make triall as I have done, and you shall finde that true which I say. You see how plaine I am with you concealing nothing, which may purchase unto you credit and gaine.

The curation of a cold di­stemperature.If cold distemper the part, which you shall discerne by its colour, hardnesse, sense of the patient, and your owne fee­ling, then apply to the ulcerate part Basilicum magnum, my Basilicum, Arcaeas his liniment upon pledgets, and above these Diachyl [...]n cum gummis, Emplastrum de mucilaginibus, or Paracelsus his Stictick Emplaster. But before the appli­cation of these, foment the part with, a fomentation made of Sacke and March-Beere, wherein Calamint, Centorie, Wormewood, Spike, Camomil, Tansey, Scordium, Rue, and Bay-leaves have beene infused and boyled.

III The third thing which wee affirmed to make up a com­pound ulcer was a symptome annexed to an ulcer. Of an ulcer witlrasymp­rome. Now of all other, Paine is the cheifest: for first, paine by attraction bringeth much moysture to the part, and so hindreth the curation: Of paine. Secondly, it inflameth the parts: Thirdly, it cau­seth watching, fainting, and oftentimes convulsions. How it is cea­sed. Paine is removed two manner of wayes: First, by raking away the cause of paine, which is affluxion of humors: How this is to bee done wee have spoken already: Secondly, by application of Anodine medicaments. These ought to bee temperately hot, & subtill. Simples of this kind are the wa­ters [Page 143]of warme baths, Camomil, Dill, Millet, Linseed, Fe­nugreeke, the marish Mallow, the pulp of Cassia, Raisins, sweet Apples, and Turneps, with a little Saffron they are effectuall, Milke, Butter, Oesypum, or the greasinesse of wooll, Sapa, new wine boyled to the third part, Swines, Hens, and Mans grease, the fat of Ecles and Calves, Oyle of Egges, Earth-wormes, Foxes, Swallowes, Rue and El­der: the oyle of Wax, & Sallet oyle, wherein Sulphurvivum hath beene boyled, are excellent in painfull ulcers of the joynts, Oyle of Camomil, Dill, and Roses: Of these you may frame unto your selves compositions, as occasion shall require. Take this for an example; ℞ Farin. hord. Milis, Furfur. an. ℥ij. Lact. recent. lb. ss. coq. ad consistentiam cata­plasmatis, tumadde Pulp. Cass. & Passul. major. an. ʒvj. Pulp. Pomor. redol. ℥j. Ol. ℞ of. Lumbric. aneth. Cam [...]wil. & Overum an. ℥j. O [...]sypi ℥j ss. Croci ʒj. Make a Caraplasme. Sometimes the paine will bee so great that you shall bee en­forced to use narcoticall medicaments: Narcoticall medicaments. The simples are Opium, Henbane, Hemlock, the Apple of Peru, Mandrake: Of these adding white Bread crums, Milke and Saffron, you may make Pultices: I will set one downe as an example, after which you may frame others: ℞ Lact. rocent. lb. ss. Mic. pax. albiss. ℥iiij. Fol. Hyosciami, Solani, Cicut. Contus. an. man. 1. [...] ista ad cataplaswatis consistentiam: tum adde ung [...]. popul. ℥ij. Dresse the ulcer with Plantane water, wherein some Allome is dissolved, or Roman Vi­triol. Then apply Diap [...]cumsuccis, and above it this Cataplasine. Dresse this ulcer at the least morning and eve­ning untill the paine be gone.

LECT. IX. Of the Differences of the milder sort of compound ulcers, and first of a sinewous ulcer without any callositie.

HAving discoursed in my former Lecture of those things which make the milder sort of ulcers to be accompted compound, to wit, a sicknesse, cause, or symptome compli­cate with an ulcer. In this Lecture I will set downe the dif­ferences of milder ulcers, and the curation of them. These differences are taken either from the figure or adjuncts: from the figure these. Of the milder compound ulcers some are plaine, some sinewous. I call that a plaine ulcer, wherein the skin is eroded, and the subjacent flesh, and the whole ulcer is presented to the sight, being bare and unco­vered. No compound ulcer is to bee accompted of an easie curation: because both skill and experience are required in performing this.

And although these plaine ulcers be subject wholly to the sight, yet let no man imagine that all of them are of equall facilitie to be cured; for according to the nature of the griefe, the qualitie of the cause, and the invasion of the symptomes, the ulcers with the which these things are com­plicate, are either of more easie or difficult curation. A plaine compound ulcer hath three scopes in curation of it: for first, Indications of [...]uring a plaine compound ulcer. that must be removed which maketh it compound, whether it be a disease, cause, or symptome: secondly, that which is by erosion lost must be repaired: and thirdly, the part must be cicatrized: How all these three indications are performed, I have set downe at large in the former chapter, so that I need not to repeat any thing.

A sinewous ulcer. Sinus. Vleus sinuosum, or a sinewous ulcer, I call that which is like to a Cony-burrow; for sinus, or sinuositie, is a cavitie or [Page 145]hollownesse of parts under the skin, seperate by afflux of an eroding humour, which according to nature were uni­ted. There bee two causes of these sinuous ulcers, to wit, The causes of it. Apostemes lying deepe along time, or not timely opened, although they be not so deepe: and wounds not well cured: for quittour lurking a long time, either in a tumour suppu­rate, or in a deepe wound not well cleansed, must needs cor­rupt and get a sharp qualitie, which maketh to it selfe these cavities, which are not so easily filled with flesh and united: for unto the part affected, now weakened, excrementi­tious humours flow, not onely from the parts adjacent, but from the whole body also, which make the ulcer hard to be cured. These burrowes are found out by probes of silver, or lead, & wax-candles: If there be more orifices than one, by injections. They sometimes are superficiall, Their figures. sometimes deepe, sometimes straight, sometimes oblique, sometimes there is but one caverne, sometimes there be more.

The differen­ces of sinuous ulcers.Of these sinuous or cuniculous ulcers, some have either hardnesse nor callositie, such I will terme Vlcera cavernosa, hollow ulcers; some have both hardnesse and callositie, these are termed Fistulae. The manner of curing caver­nous ulcers without ope­ning. First then I will shew you how cavernous ulcers are to bee cured, and then how Fistula's. There are two waies of curing of a cavernous ulcer: the first is by injection of medicaments: the second is by opening & dressing, according to Art. If you goe about to cure such an ulcer by medicaments, without opening, then two scopes offer themselves, to wit, the filling of the cavitie with flesh, and the agglutination of the parts disjoyned. The Incarna­tives must be drying without erosion, and the Glutinatives must have astriction, besides desiccation. Both these inten­tions you may performe with the injection of this medica­ment following, ℞ Aq. decoct. hord. lb j. Mollis rosat. ℥iij. Sarcocoll. ʒijss. Mirrh. Thur. an. ʒij. Rad. Tormentill. Locall medica­ments. Bi­stort. Symphyt. a [...]. ʒjss. Balaust. ʒj. Baccar myrt. ʒijss. I Su­mach, ʒjss. Vini od [...]rifer. ℥vj. Bulliant ad consumptionem tres partes, ac coletur decoctum, cui adde Spirit. vini ℥j. If you [Page 146]perceive that the ulcer is not sufficiently mundified, which you may conjecture if the quittour be either stinking, red­dish, pale, blackish, or thin and warrish; then apply this medicament: II ℞ Vini in quo infusa fint marrhubium album, Centaurium minus, Absynthium, Flores Hyperici, & Carduus Benedictus lb. ss. Ʋnguenti Aegyptiaci ʒij. Mol ros. ℥ss. misc. inject this. You can hardly devise more effectuall me­dicaments than these are for agglutination of a cavernous ulcer: The manner of dressing. Yet whosoever shall apply them, not dressing and binding the ulcer artificially, shall hardly cure any such ul­cer: wherefore I thinke expedient that I shew you the way of dressing: First, lay upon the whole processe of the cavitie Diapalma cum succis, or, Emplastrum album coctum, or Em­plastrum contra rupturam: Then inject your medicament warme. Thirdly, in the orifice put in a leaden tent, or pipe; but short, hollow, wider in the upper than lower part, & having the brims of the upper part turned, that it may be kept from slipping in, shut the orifice and the upper part of the tent or pipe with an emplaster; let it be one of those named before: the emplaster must bee snipt, that it may give way to the quittour which floweth out of the cavitie: above the emplaster apply a peece of a spunge, which must be soft, moystned with the medicament with the which you dresse the ulcer, and wrung out: for the spunge sucketh in­to it selfe the quittour, keepeth the brims of the orifice dry, and preserveth them from excoriations: above the spunge lay a pledget of tow: the lower cavitie, or from the bottome of the ulcer to the orifice it must be bonistered. Above all lay a double soft linnen cloth. Begin your rowling at the bottome, where it must bee somewhat strait, to bring the sides of the ulcer together, both to expresse the quittour, and to procure agglutination, but let it cause no paine; for it would distemper the part: towards the orifice the row­ling must bee somewhat slacke, that the quittour may have way to issue out. Everie third day (if much matter doth not flow) dresse it, loose first the rowler, the turnings whereof [Page 147]are about the orifice, take away the spunge and emplaster; first, that you may come to cleanse the ulcer; secondly, that you may make triall whether nature doth goe about to ag­glutinate the parts: which you shall discerne, Signes of ag­glutination. if the excre­mentitious matter abate, bee laudable in colour and consi­stence, and have no ill smell, and if the cavitie bee without paine, and without any remarkable tumor: By the contra­rie, if the quittour be plentifull, ill-coloured and stinking, if the cavitie be painfull, and a conspicuous tumor appeare, you may perswade your selves that no unition is procured. Dresse the ulcer according to this manner, untill perfect ag­glutination be caused, which you shall know by the signes aforesaid going before, if no quittour or verie little appeare in the orifice, if the cavitie be equall without tumour, and no paine be felt: when you perceive these signes, then ad­dresse your selves for the cicatrizing of the ulcer. If after a dressing or two, thin gleeting matter appeare, yet despaire not; for often times such matter is wrung out of the parts by reason of the medicament drying: the nature of the part, as being nervous, membranous, or glandulous; or lastly, by compressing of the ulcer by bolstering and row­ling. As for the emplaster applyed to the cavitie it selfe, it is to be renewed when it is defiled with quittour, or leaveth cleaving. Dresse the ulcer as seldome as you can, Why such an ulcer is not to bee dressed often. contrarie to the practice of Empyricks; for often dressing doth give way to cold aire, which is hurtfull to ulcers, and hindreth unition. Thus you may proceed in curing of cavernous ulcers, if the excrementitious matter have way to flow from them freely, which will be if the orifice be in a depending part, or late­rall, the cavitie or sinus being laterall also; for then, such a posture may be appointed, as will further the evacuation of the matter: But if by reason of other figures of the cavitie, the cavitie cannot discharge it selfe of the filth of the ulcer, The manner of curing of these ulcers by ope­ning. then untill this impediment be removed, no expurgation, in­carnation, or agglutination can bee expected: wherefore way is to be made by incision or caustick.

In what cases you are to use these meanes.This you must doe, first, if the cavitie bee lower than the orifice, either directly or obliquely; but not verie deepe. Secondly, if it goe verie deepe also, as in fistula's, and such ulcers penetrating in the brest, where the cavitie most com­monly is lower than the orifice. Thirdly, if the hollownesse be verie broad. In these cases way must bee made by these meanes for the matter, that it may bee expurged; other­wayes if it be kept in, it will erode the parts adjacent, and no incarnation or consolidation can bee looked for. Wee may make way for the quittour two manner of wayes: first, by opening the lower end of the sinus only; Secondly, by opening the whole cavitie.

When the ul­cer is to bee opened onely in the depen­ding part.The first course we are to take, if the sinus be of an enorme businesse, or if it be in a great joynt; for great wounds in such joynts are mortall, according to Hippocrates: or if there bee great vessels, nerves or tendons of muscules in the way, which are like to bring fearefull fluxes of bloud, or lamenesse: which things skill in the Anatomie will teach you. If none of these cases hinder you, then it is the surest way to lay open the whole cavitie, which is the second way. These two scopes wee may attaine unto by two meanes, to wit, by causticke and incision.

When the cau­stick is to bee used.The causticke wee are to use, first, if the partie be timo­rous, and will not admit section: Secondly, if the cavitie be in a part, wherein a great scarre may cause deformitie: Thirdly, if there be feare of a great flux of bloud: Fourth­ly, if the diseased partie be sicke and weake.

The manner of applying cau­sticks.If the causticke be to bee applyed, if the situation of the part wherein the sinus is bee in the upper side, then apply your Lapis infernalis: for it corrodeth soonest, deepest, with lesse paine, and will not bee so apt by running and spreading to burne the parts adjacent, or to cause a greater solution of unitie than wee intended. But if the sinus be in the lower fide, as in the sole of the foot, or in a part verie depending; then I advise you to use the causticke made of strong sope lees, and unslaked lime, which will not run. It is [Page 149]an ordinarie practice of some to rub the part with the Cau­sticke stone, and when the part is mortified then to open it: First, this is not to be done, but when the skin is verie thin; besides this, this rubbing causeth farre greater paine, than the application of it to the part being defended: Be ever of this minde in your practice, to use the mildest meanes; the fruits which you reape by so doing will be respect, love, cre­dit and gaine. When you have perceived that the force of your corrosive medicament hath mortified all to the verie cavitie, then procure the fall of the eschar, with the applica­tion either of Dialthaea simplex, or Butter without salt: there is no substance comparable to this in this purpose. When the eschar is gone then proceed in curing of the ulcer, as hath beene said, by mundificative, incarnative, and cicatrizing medicaments.

when Incision is to be used.If the partie be couragious and strong use incision: this is sooner performed, hath lesse paine, and sooner will bee cured. When you have made incision, arme dosils and pled­gets with a medicament which strongly dryeth and mundi­fieth; such is this: Take of Aloe Hepatica two drams, of blacke Rosin and Amber, of each a dram and an halfe, of Mill-dust two drams, of unslaked Lime two drams and an halfe; with this powder, and the white of an Egge, and the yolke beaten together, make a medicament in consistence representing an unguent: then apply the medicament to the Sinus incised, filling it well that the brims may bee kept asunder. Open not the sore till the end of the second day, at the least; for this medicament will both dry the superflu­our humiditie of the ulcer, and will excellently digest it. Af­terward dresse the ulcer as the methodicall indications of curing shall move.

Internall medi­caments.If you finde these ulcers thus handled not to heale to your minde, then hold your patient to the decoctions of Sarsapa­rilla, Guajacke, and the China root, with the which mingle some of your most effectuall Vulneraries, as Agrimonie, S. Iohns woort, Sanicle, Avens, our Ladies mantle, Virga [Page 150]aurea, Salomons seale, the roots of Comfrey, Tormentill, Bistort, Horehound, Borrage and Buglosse. I will not con­ceale from you the description of a decoction, whereof I have made often proofe in ulcers of the brest, joynts and belly: ℞ Sols. parill. ℥vj. Rad. Sassafrus ℥jss. Scob. Guajac. ℥iij. Eupator. Scahies Tussilugin. Sanicul. Hyper. an. man. 1. Rad. Syn phyt. Tormentill. Bistort. an. ℥ss. Rad. Borrag. Bu­gloss. an. ℥j. Passul. major. enucleatar. ℥iij. Liquirit. ℥ij. In­fundantur infundenda per noct. in aq. font. fervent. lb. xxiv. se­quente die coquantur lento igne cum reliquis ad consumpt. lb. viij. Bibat aeger singul. dieb. lb. iiij. hujus decocti: Hauriat lb. ss. mane, ac tantundem hor. quarta pomeridiana: In prandio bibat lb. j. ac tantundem in coena: Quum sitit super­est lb. j. haurienda. The simples of this composition may plead for the efficacie of it. Let him continue the taking of this decoction for the space of 21. dayes: during which time hee is to use a spare diet, and to eat flesh affording a good juyce, and of an easie concoction. As for the locall medicaments which are to be applyed to the ulcer, I have spoken of them already: too much repetition will breed loathing.

LECT. X. Of the palliative cure of a sinuous ulcer with callositie in generall.

IN my last Lecture which I delivered from this place, the vacation from these exercises being at hand, I spake of a sinuous or hollow ulcer, without a callositie or hardnesse of the inner Superficies of the parts disoyned: Now the or­der of doctrine requireth that I discourse of a sinuous ulcer, which hath a callositie in these same parts. In times past it hath been accompted a master-peece in the practice of Chi­rurgerie to cure such: In so much that Master Boovie the [Page 151]Counsellors father, a brother of this Companie while hee lived, dwelling in Tower-street, set up above his doore a new signe with this inscription; Here dwelleth one who can cure a Fistula: young Hall having acquainted him with his fathers practice. And in truth not a small skill, or ordi­narie proceeding is required to effect this matter: for the greatest part of such an ulcer lyeth hid, and little is offered to the eye. Besides this, ordinarie meanes are for the most part here ineffectuall, and so magistrall meanes are required. Wherefore I have diligently laboured to couch in this my discourse whatsoever can be required in the curing of such an ulcer, as you shall perceive in my proceeding.

First then, I will deliver the generall doctrine of this kinde of ulcer: then I will set downe the manner of cu­ring of such in some particular parts of the body. A sinu­ous or hollow ulcer with a callositie or hardnesse in the in­ner superficies of the parts disjoyned and separated is called in Greeke [...], from the similitude which it hath with the long and hollow windie instruments of Musicians: in Latine it is called Fistula, and so in the English tongue for this same cause.

The definition.A Fistula then is a sinuous ulcer, narrow and long with callositie. Here you are to observe, that a Fistula besides si­nuositie, must have callositie and narrownesse. It happe­neth most commonly, when apostemes having been opened, The cause materiall. the inner Superficies of the parts kept asunder by a sharp hu­mour, become in progresse of time callous. The humour which causeth this callositie must bee more astringent than sharp; for it rather tanneth the part by reason of its acer­bitie, than erodeth by reason of its acrimonie: besides this, Fistula's are for the most part indolent, unlesse they end in parts verie sensible, as nerves, tendons, membranes and joynts. Wherefore the Chymists will have this humour to be the Salpeter of the little world, or man, separate from the naturall salt of the Balsame, or radicall moysture of the body: that this salt is cooling and anodine, the Practicers [Page 152]of Physick doe beare witnesse: for in burning fevers it is added to Juleps, which are appointed for cooling, and as­swaging of paine under the name of Sal prunellae: It doth also, by reason of its stipticitie unite the spirits, and stay the immoderate exhalation of them.

The signes.The signes are taken either from the essence of a Fistula, or from the accidents. Callositie then with a Fistula, or whistle-like figure, is the pathognomonicall signe of a Fi­stula. The signes taken from the accidents are two-fold: for they are taken either from the quittour, or the manner of paine. In a Fistula the quittour is ever virulent, ugly and stinking; as for the manner of paine it is but small, unlesse it be by reason of the sensiblenesse of the parts named by me before.

The differen­ces.As for the differences, or divers kindes of Fistula's, I will onely set downe those, which further either curation, or prediction. Let this then bee the first difference: Fistula's either goe shallowly alongst under the skin, or they passe deeper to the subjacent parts. Secondly, Fistula's end ei­ther in the fleshy parts, or they passe to the bones, or to the cavities themselves. Thirdly, some are straight, some croo­ked. Fourthly, some are single, some manyfold, yet pro­ceeding from one orifice. These are the materiall, or pro­fitable differences of Fistula's.

The signes of the differen­ces.Now followeth that I speake of the signes of these dif­ferences. 1. Whether there be more callous sinuofities than one, you may conjecture by the quantitie of the quittour; for if more copious quittour flow from a Fistula than can be expected from one Sinus, it not passing to any remarka­ble cavitie, it is likely that there are more than one. The changing also of the position of the body, and compression of the part will shew this; for the flowing of the matter having ceased, if after the changing of the position of the whole body, or one member, it run out againe, it is proba­ble that there are more sinuosities. Moreover, if varietie of quittour flow, it is an argument that sundry parts are [Page 153]affected, and more sinuosities like to be. But to what parts the Fistula passeth, receive these signes: If it passe to the fleshy parts, the quittour appeareth white, smooth & plen­tifull; besides this, the part whereon the end of the probe stayeth seemeth soft. If it passe to a nerve, a fattie & oleous matter doth issue out, the motion which is caused by that sinew is impaired, and the Fistula is more painfull than o­thers are; besides, the probe touching the sinew, causeth a pricking paine, with a certaine numnesse. If the Fistula passe to the veines and arteries, yet so that the coats of them be not eroded, then the matter which it yeeldeth is like un­to the lees of Claret wine; for bloud swearing thorow the coats of porosities of the vessels mingled with the quittour, causeth such a substance.

If the coat of a veine bee corroded, bloud issueth thick, of a dark colour, and without quavering and leaping; but if the tunicles of an arterie bee pierced, then the bloud is redder, of a more bright colour, and commeth forth with ejaculation. If a Fistula reach to the bone, that which the end of the probe toucheth appeareth hard, and yeeldeth not to the probe, neither is any paine felt. If the probe being pressed slip, no cariositie hath seised upon the bone; for a sound bone is smooth and slipperie: If the probe stay upon it appearing smooth, it is disposed to cariositie; but if the bone appeare unequall and rough, then it is undoubtedly carious. Besides this, the quittour which floweth from a corrupt bone is thin, yellow, and ill-smelling. So much then concerning the signes, which shew us the divers kindes of Fistula's.

Now let me deliver unto you some remarkable presages or predictions, touching the curing of them, that you may become circumspect in undertaking the curation of such as shall be presented to you. Let this then be the first:

No Fistula is of easie curation. First, I by reason of the unaptnesse of the part to admit the convenient application of medicaments: for unlesse they reach to the verie extre­mitie [Page 154]of the Fistula, which is not so easie a matter, as you shall finde by practice no good can be done. Secondly, by reason of the qualitie of the medicaments, which are able to remove the callositie; for these must be sharp and biting, and so cause paine: from whence come symptomaticall fe­vers, and fainting verie often, especially in tender and young bodies. And thirdly, by reason of the humour, which cau­seth a Fistula, which yeeldeth not to ordinarie and vulgar medicaments. Let this be the second.

II Fistula's which are shallow, passing no deeper than the Membrana carnosa, or at the furthest than the membrane of the muscules, or muscule subjacent, are more easily cu­red than those which pierce deeper; for those by incision may easily be cured, but these not so.

III The third shall be this: Fistula's wreathed, or with mul­tiplicitie of sinuosities, require incision, that medicaments may be conveyed to all the parts.

The fourth: If a Fistula no passing further than the fleshy parts, bee not of a long continuance, and that in a young and a strong body, it affordeth good hope of curing: Imagine the contrarie event, if contrarie circumstances bee accompanied.

IV Receive this as the fourth: If the extremitie of a Fistula end in the tunicles of veines or arteries, or both, (the signes whereof I have delivered, when I spake of the differences of Fistula's) then you are to meet with the symptome of hemorrage, the coats being eroded: for if you labour ei­ther to enlarge the orifice, or to take away the callositie by sharp medicaments, the flux will bee encreased. This acci­dent happeneth most commonly in Bubo's of the groyne not speedily cured, and Parotides under the eare, and Phleg­mons in the arme-pits: These parts being emunctorous, and nere to the divarication of the great vessels, to wit, the Vena cava, and the Aorta descending and ascending.

V Fistula's ending in verie sensible parts, as nerves, tendons, the bladder, the Intestinum rectum, and the like, are care­fully [Page 155]and mildly to be handled, by reason of the symptomes which often ensue, as accidentall fevers, Lipothimies, losse of appetite and sleepe: all which are apt to bring an exte­nuation unto the whole body, and so to defraud the part of more than requisite nourishment, without the which con­solidation cannot be effected.

VI Fistula's in remarkable cavities, as the throat, brest, belly, are hard to be cured, because the end is more dependant than the orifice, which hindreth exceedingly consolidation.

VII If in Fistula's of the back the Spina be carious, shun the care; for these at the length bring an extenuation of the body, the animal spirits not being with requisite plentie communicate to the extremities of the body.

Fistula's in the joynts are dangerous; for if great wounds of the joynts, even in bodies of a good habit, bee pronoun­ced by Hippocrates to be mortall: what shall wee deeme of Fistula's in these parts, where besides the enorme dilatation that must be procured in curation, there is of a necessitie an ill complexion of the body. Secondly, seeing the joynts are framed of parts verie sensible, as tendons, nerves, membranes and ligaments, exceeding great paine must be caused by the application of corrosive medicaments, without the which a Fistula cannot be cured, and so the partie exceedingly bee troubled and perplexed. Thirdly, seeing the joynts are sea­ted in depending parts, and are not fleshy: and so as they are apt to receive humours attracted by paine, they are lesse able to discusse the humours received, partly by reason of the thicknesse of the membranes, partly by reason of the weaknesse of the naturall heat: who may not easily perceive the difficultie of curing of Fistula's in these parts?

VIII Fistula's having sund y sinuosities are more hardly cured than those which have but one, both because the labour is the greater, and the medicaments cannot so conveniently be applyed.

IX Fistula's which have continued a long time seated in a depending part, remote from any principall, by the which [Page 156]nature hath beene accustomed to discharge superfluities of the whole body, and not painfull, but rather slovenly or sluttish, are rather to be kept open than cured; for they pre­serve the health of the body, and hinder the assault of other diseases.

An H [...]storie.I knew a Gentleman who had a Fistula in ano about 20. yeares, yet unknowne to his wife, who lived notwithstan­ding verie healthfull to the last period of his life: having sent for me a few dayes before his death, he acquainted me with it: having taken a view of it, and perceived that it was dry, and of a livid colour, I pronounced his end to be at hand, which accordingly fell out.

Indications of curing.Now it is time to hasten to the setting downe of the cu­ration of Fistula's in generall. In the sixth Section of the Treatises ascribed to Hippocrates, there is one of Fistula's: In it he doth speake somewhat particularly of a Fistula in ano, and of the curing of it by ligation. Whatsoever is deli­vered in that Treatise, seemeth to be an exscription of notes out of his Adversaria or Note-booke, rather than a delibe­rate or methodicall discourse of the subject. Howsoever, it is to be embraced rather as a pledge and signe of his willing minde to pleasure his posteritie, than a patrimonie to en­rich the knowledge, and further the practice of any one, who shall goe about to cure any meane Fistula. Peruse the Treatise, and you shall finde me to speake a truth, if you shew your selves impartiall censurers. Seing I have delive­red unto you in the presages of Fistula's, that sometimes it is most expedient to leave some Fistula's uncured, I must make mention of a two-fold manner of curing of them: The one shall be called palliative or cloaked; Two kindes of curation. the other true and reall. The first affordeth some consolation and ease to the patient; but the second procureth perfectest health. A palliative cure, I would have you to understand, to be when sinuositie is inwardly dryed for a time, and the orifice see­meth to be shut up by a thin skin, untill fresh and new hu­miditie bedew the inward sinuositie, and open the orifice [Page 157]againe. This kinde of curation is most fit to bee used to­wards those, in whose bodies a Fistula supplyeth the place of a fontanell, to discharge superfluous humours, which nature turneth out from the principall parts, for the preservation of the health of the body.

You shall know this manner of curing to be used, if the partie immediately before the opening of the orifice finde some distemperature, and afterward the orifice being ope­ned, ease. To compasse this manner of cure three intentions are required.

First, convenient diet must be observed: This is perfor­med by feeding upon such meats as are of easie concoction, and afford good juyce, and in such measure as Leonardus Lessius in his [...] prescribeth, and Ludovicus Cornarus observed from his constant to his decrepit age. They advise moderation both in meat and drinke. Patients now adayes would thinke themselves hardly dealt with, if they should be stinted everie day to eat no more bread and meat than a pound, and to drinke no more drink than fourteene ounces. It is an easier matter to satisfie nature, than the appetite.

Secondly, the body is to bee purged not by any eradica­tive medicament, wherein Scammonie, Ellebore, or Colo­cynth entreth; but a purging diet, or a purging Ale; I will deliver unto you a patterne of both. Let your purging diet be thus dispensed: ℞ Sars. ℥iij. Rad. Tormentillae, Bistortae, & Symphyti, an. ℥j. Polypod. querc. ℥iij. Hermodactyl. fol. Sen. & Semin. Carthami, an. ℥ij. Rhab. ℥j. Semin. Anisi, Coriandri, & faenicul. dulc. an. ℥iiij. Glycyrrhiz. ℥jss. In­fundantur infundanda in aq. font. fervent. lb. x. per noctem: deinde additis reliquis lento igne coq. ad med. atque aromati­zetur decoctum cinam. ℥j. ac coletur: Stumat ager mane. lb. ss. calid. hyeme, ac tantundem hor. quarta pomeridiana. As for the purging Ale receive this description. ℞ Scob. Guajaci & Sars. parill. an. ℥iiij. Rad. Tormentill. Bistort. & Symphyti, an. ℥jss. Polypod. ℥iij. Eupat. Sanicul. Alchymill. an. man. j. Fol. Sen. Hermodactyl. an. ℥v. Rhab. ℥j. Semin. [Page 158]Anisi, Coriand. & Fenicul. dulc. an. ʒvj. Glycyrrhiz. ℥ij. fiat ex omnibus pulvis crassiuscalus indendus sacculo lan [...]o ra­ra texturae, qui suspendatur in gallon. duobu [...] Zythi non lupu­lati recentis & fortis. Let the Patient begin to drinke of this Ale the fourth day. Hee is to take halfe a pint in the mor­ning, and to sleepe upon it; and so much about foure a clock in the after-noone. When either of these purgatives are ministred, let the Patient about ten a clock in the fore­noone take some broth without bread, made of a Chicken, Mutton, or Veale, wherein Mallow, Parsley, Fennill, and Succorie roots, with some Raisins, Prunes and Dates have beene boyled. Let him dine on the boyled meat; but sup with rost meat. The purging Ale is more convenient for aged persons, than the decoction, and for such as have a weake stomack.

Thirdly, convenient locall medicaments are to bee ap­plyed, to further the drying of the sinuositie, and skinning of the orifice. I will onely set downe two injections for the first. The one is this: Take of Aqua calcis, wherein some Litharge either of gold or silver hath beene boyled iij. o℥. and of the Syrup of red Rose leaves dried, or of the Mirtill berries one ounce: mingle these together. The other is this: Take of Plantane water iij. o℥. of Roman Vitriol beat to powder, a dram and an halfe: let the Vitriol dis­solve in the water: inject these medicaments warme; apply to the orifice a pledget of lint wet in either of these medi­caments, and above the lint Diapalma cum suceis. Dresse the Fistula everie other day only, unlesse the quittour which floweth from the Fistula be plentifull. So you have the palliative cure of a Fistula. In the next Lecture I will deli­ver the true and reall curation of Fistula's in generall, wher­in you shall heare sundrie things worth the noting.

LECT. XI. Of the true curation of Fistula's in generall.

NOw am I to accomplish and performe my former pro­mise in setting downe the method of curing truly and really Fistula's in generall, and the practice of the same in the curing of some Fistula's of some speciall places of the body, which require some extraordinarie confiderations. Such are Fistula's in the great corners of the eyes, Fistula's in the brest, Fistula's in ano, and Fistula's in the joynts.

The meanes to cure Fistula's.The meanes to attaine to this manner of curation are three-fold; Dieteticall, Pharmaceuticall, and Chirurgicall.

Dieteticall meanes.As for the Dieteticall, I have set it downe amongst other points, which are required in the curation of an ulcer in generall. It shall be sufficient to insinuate now onely, that the diet of those who are troubled with Fistula's must bee verie sparing, and of meats and drinks which afford a lauda­ble juyce, and are of easie concoction, that crudities and sharp humours flowing to the affected part, hinder not the euration. And undoubtedly too liberall a diet, unto the which the Inhabitants of these parts are too much accusto­med, is the cause of the recidivation of these, and other griefes.

Pharmaceuti­call meanes.As for the Pharm [...]ceuticall meanes, they are of two sorts, to wit, Purgative and Consolidative.

I If the body of the diseased partie be cacochymicall, with some Plethora, minister the purging decoction, Purgatives. or Ale for the space of a weeke, described by me in my former Lecture. And while these are in preparing, you may make for the better operation of these, minister this or such like a por­tion: ℞ caric [...]stin. & Electuarii de succ [...]of. an. ʒiij. Syrup. [...]os. solut. cum Agari [...]o ℥j. Aq. cichor. ℥iij. mise. ut fiat po­tio, sumenda cum cerp [...]ri [...] custodi [...]. These two Electuaries [Page 160]purge the body of thin, hot, and sharp humours; the syrup and water correst the malignitie of the humours.

II The Consolidatives are either Rsimple or compound. The principall simples set downe by most authentike Authors, 1. Consolida­tives. and tried by practice are these; Gentian and the roots of the round Birthwort, a dram of either of these mingled with iij. ℥. Of white wine, and ministred everie other day in the morning, and fasting three houres after the taking of the medicament. The lesser Centorie, Osmunda regalis the root of it, Agrimonie, Virga aurea, the white Hore-hound, the roots of Borrage, Tormentil, Bistort, and Comfrey, Sarsa­parilla, the rasping of Guajack, Plantane, Vinca, Pervinca, and Equisetum. Of the juyces of these herbs mingled with Ale, you may make possets; the wig whereof strained and sweetned with some Saccharum rosatum, or the Conserve of red Roses, you may minister morning and evening to young persons, and those who are either weake, or abhorre all physicall meanes, whereof there is no small number now adayes, who hasten by their owne misdemeanour to bring on griefes; but when they are to use meanes, esteeme them harsh: not knowing that God of his infinite goodnesse and providence towards mankinde, hath appointed the meanes of recovering of health to be unpleasant to nature, that man should refraine from sin, the primitive cause of griefes.

2. Compound consolidatives.Of these simples afore-named, you may frame unto your selves sundrie compositions: for a patterne I will set downe one decoction: ℞ Sars. parill. ℥iiij. Scobis. Guajaci. ℥vj. Rad. Tormentill. Osmund. Regal. Bistor. Symphyt. an. ℥j. Eu­pat. Ʋirga aur. & si uil reslat prater consolidationem & cica­trizationem, Summitat. Hyperic. & Sigill. Salomon. an. man. j. Passular. Major. Exacinat. ℥iij. Liquirit. ℥ij. Semin. Coriand. & Fenicul. duleis, an. ʒv. Infundantur infundenda in aq. font. fervent. lb. xx. deinde coq. Lento igne additis reliquis ad con­sumptionem lb. viij. ac coletur decoctum. If the partie bee strong, let him drinke three pints a day: One halfe pint in the morning, and another about foure a clock in the after­noone, [Page 161]for dinner and supper there remaineth a quart. If the partie be young, or cannot take such a quantitie, by rea­son of the weaknesse of the stomach, make halfe of this quantitie, which being vj. lb. adde to the decoction of Su­gar and Honey, of each lb. j. and by gentle vaporing away some humiditie, bring the decoction to the consistence and taste of a pleasant Julep, which minister according to the to­leration of the partie. This Pharmaceuticall course you shall (I dare assure you) finde effectuall to your owne cre­dit, and comfort of the patient.

Chirurgicall meanes to cure a Fistula.The Chirurgicall meanes afford unto us five intentions.

First of all then the Fistula is to be dilated; for seldome doth it fall out otherwayes, that this indication is not re­quisite, unlesse it be in a Fistula in the cheeke, I which was caused and maintained by a corrupt tooth, which being drawne, the Fistula will heale of it selfe, a consolidative em­plaster being applyed to keepe out the aire.

How to dilate a Fistula.The Fistula may bee dilated three manner of wayes, by Incision, by putting in tents framed of such things as swell, after they have imbibed the humiditie of the Fistula; I and last of all by the Fistula tent.

Incision when it is to be used.As for Incision, it is to bee used in strong bodies, if the Fistula be not deepe and onely runneth alongst under the skin, no deeper than the membrane of a muscule, if it be in a fleshy part. Secondly, if the Fistula have many sinuosi­ties: before the Incision is made, the Fistula is to be dilated by some of the three other meanes, which I will deliver pre­sently: secondly, the medicaments which remove the cal­lositie (whereof anon must be applyed) both these intenti­ons must bee performed before Incision, otherwayes you shall hardly know how far your Incision is to bee extended, and shall leave some part of the Callus still, which will make way for recidivation and relapse.

II The second way to dilate a Fistula, is to use instead of tents such things as swell, whereof there bee sundrie, as the Gentian root, the pith of the Elder, or Dane-woort; but [Page 162]the spunge twisted with threed, The use of the spunge. after that it is wrung hard and wrea [...]hed, far exceedeth all these; for it both imbibeth more moysture, and dilateth much more. I will acquaint you with a preparation of the spunge, which is excellent, and this is it: Melt a rowle of your simple Melilot empla­ster; when it is yet verie hot, let a thick spunge imbibe it. This spunge having so drawne unto it selfe the emplaster, put betweene two trenchers, which trenchers with the spunge put into a strong presse, and presse them hard. Af­ter an houre or two, when you thinke the spunge to bee cold, unscrue the presse, and take out the trenchers with the spunge, you shall finde the spunge become a firme sub­stance, resembling greene cheese. Of this substance you may cut out tents of what fashion you will: This will not onely exceedingly dilate the Fistula, by sucking unto it the humiditie; but will also digest the callositie.

III The third way of dilating a Fistula, I set downe to bee by the Fistula tent. It is this way to bee made; Make good store of fine lint, from the which draw away all the threeds, that nothing remaine but the fluet, or the soft downe of it; of this downe with the white of an egge beaten, make your tents of what thicknesse or length the sinuositie of the Fistula requireth, by adding still some of downe: doe this upon a peece of a Deale-board smooth and even: If you still enlarge the quantitie of the tents, you may dilate the Fistula as much as you will; for these tents being dried, will pierce unto any cavititie as a probe without bending (if they bee well made) by reason of their stiffnesse. Of this manner of tent there is great use, in taking away the callo­sities of some Fistula's, and in healing of them, besides this use, as you shall heare anon.

The second Chirurgicall attention.The second Chirurgicall intention is to remove the Cal­lus: this is bred by reason of the influxion of an humor, not of an uniforme substance; for besides the thin parts, which are discussed or dryed, The matteriall cause of a Cal­lus. by both naturall and extraneous heat, it must have a thick substance to cause this callus, it being [Page 163]indurated: this must bee either flegme, if the callus bee white, or melancholy if it be livid, according to the dog­maticall Physicians, the Chymists appoint it to be Salt-peter, as I have said.

Why the ori­fice first con­tracteth a Cal­lus.In the beginning this callositie is bred rather in the ex­ternall orifice, than in the inner sinuositie: for first, the skin which is thick of it selfe, sooner groweth hard than the flesh which is soft: Secondly, because nature still laboureth to thrust out excrements to the skin. In progresse of time Fistula's having become inveterate, the whole passage con­tracteth callositie.

To know wher the passage hath also a Callus.You shall know by this, whether the passage be fistulated or no: If by the intrusion of the probe great paine is felt, and bloud issueth out, the Callus is not confirmed; but if no bloud follow, an little paine be felt, bee sure then that it is confirmed.

How the callo­sity is to be re­moved by me­dicaments.The callositie is removed either by medicaments, or the actuall Cauterie. The medicaments are of three degrees: for some are more milde, and these are of an emolliating and digesting qualitie, fit if the callositie bee but small in a fleshy part and a young body: such are Diolthaea cum gum­mis, and Vnguentum de poeto. Everie ounce of either of them having a dram of the Turbith minerall, or Precipitate mingled with Allome with it, is effectuall.

Secondly, some are more harsh; for they must mundifie strongly, if the Callus bee somewhat hard, and the partie somewhat aged: such are Vnguentum Apostolorum, Avicen. having Precipitate and Allome, or the Turbith with Al­lome mingled with it, Aegyptiacum is stronger than this; but I should rather use the Vnguentum Apostolorum than it, adding more of the aforenamed cathaereticall powder to it; for it causeth greater paine, and procureth not so good quit­tour as the Apostolorum.

Last of all, the medicaments which are to remove an in­veterate Callus are Caustick: and even of these some are more gentle, some exceeding fierce. The more gentle are [Page 164]these. I. ℞ Auripigment. Sulphur. vivi, & Calcis vivae, an. ℥j. fiat pulvis-subtilis. II. is Pulvis sine pari, cujus haec est de­scriptio. ℞ Auripigmenti, & virid. Aeris, an. ℥ss. Vitriol. calcinat. ℥j. Alumin. usti, ℥ij. fiat pulvis subtilis. III. ℞ Turbith. mineralis non loti, V [...]trioli v [...]mitivi, & Boli orient. optimi. an. partes aequales.

Of the strongest of all I will deliver unto you two magi­strall descriptions only, farre surpassing all others. I. is M. Hale his powder, who was famous in his time for curing of Fistula's: this is the composition of it, ℞ Aquil. mineral. Vitrioli vomitivi, & Terraerubr. oriental. an. part. aequales. II. is this which Iuse in Fistula's and Struma's: ℞ Realgar. albi, Auripigment. & Calcis vivae, an. part. aequales.

You may enquire how these are to be used: If you have dilated the Fistula by incision, besprinkle the Callus with some of the powders; but if you have done it by the second way set downe by me, then use the powders mingled with Vnguentum Populeon, wherewith arme your Fistula tent: or apply a Trochisk made of these powders and Populeum, and afterwards dryed.

After the application either of the Fistula tent armed with the unguent, or of the Trochisk, two things you are to observe: I. That you apply an anodine caraplasme, the fellow to this which I shall now deliver unto you shall not be found. It is also matchlesse in raging paines of the Gout: ℞ Lact. Vaccin. lb. j. Mic. Pan. albi, ℥vj. coq. ad cata­plasmat. consist. tum adde Vuguent, popul. ℥ij. Gummi Hyose. ℥ss. Croci pulti ʒjss. fiat cataplasma, quod applicetur parti affectae mane & vesperi. IJ. You must not force out either the tent armed, or the Trochisk, before they pop out of their owne accord: for so they bring the Callus out with them, and the tent with the Callus will represent a finger within a glove. If there bee many sinuofities, yet doe not pierce to any remarkable cavitie, as of the brest and belly, then you are to dissolve these powders in some liquor, as in Aqua calcis, Plantane water, Metheglin, a gentle Lee, Allome [Page 165]water, or Vitriol water. Alchymists exceedingly commend in this case the spirit of Niter.

The second way to remove a Callus by an actuall Caute­rie is an invention of ab Aquapendente: He will have an in­strument like to a setting Iron to bee made, the case to an­swer the widenesse and length of the Fistula, and to bee thrust into the bottome of the Fistula, then must the other round Iron fill the cavitie of this, toward the point onely, and be round an inch long, and bee put in red hot. It is not to stay long where paine is caused, because there is no Cal­lus; but to be rubbed up and downe where the place is in­dolent, untill paine be caused by reason of the removing of the Callus by the fire. And although hee highly commend actuall sire, and discommend the potentiall; yet I am not of his minde in sundrie cases: As for this invention, whosoe­ver shall goe about to practise it, I shall hold him much like to him who is to throw at a Cock blind-folded.

The third Chirurgicall Intention is, to mundifie the part: 3. Intention. this medicament will performs this: ℞ Vini albi. lb. ss. Vnguent. Aegyptiaci ℥ ss. Spirit. vini, ʒvj. misc. Inject this this warme, but once a day. You shall conjecture that the Fistula is sufficiently mundified, if the quittour have no ill smell, if it be uniforme, thick, and white.

Then you are to addresse your selves to the fourth Inten­tion Chirurgicall, 4. Intention. which is to unite and consolidate the parts disjoyned. To accomplish this: The descripti­on of the con­solidative Sy­rup. first draw first draw by an Alembick the spirit of these herbs following, putting so much spring­water as will bee three inches above the simples to them: the roots of Aristolochia rotunda, Tormentil, Bistort, Com­frey, the lesser Centorie, Ʋirga aurea, Burnet, Plantane, Knot-grasse, Yarrow, and Salomons seale. Reserve the spi­rit by it selfe: take the decoction remaining in the pot from the herbs by straining; for everie quart of this decoction take halfe a lb. of Honey, and so much Sugar: This mixture being clarified with the whites of Egges, and strained a­gaine, let it bee boyled by a soft fire to the consistence of a [Page 166]Syrup. The use of it. Take two ounces of the spirit, and one ounce of the Syrup, which mingle, and inject into the sinuositie, and deale with it as I prescribed, when I delivered the manner of dressing a sinuous ulcer. If any man deliver a more pro­bable way than this to consolidate a Fistula after the extir­pation of the Callus, I shall willingly lend him mine eares.

The last intention chirurgicall is to skin the orifice, 5. Intention. which requireth no new directions. You shall know a Fistula to bee neere whole, when the humour which floweth is little, thick, concocted, and the place voyd of paine and tumour: If it be altogether dry, you may pronounce the orifice to be skinned, and the Fistula perfectly cared.

From the premisses you may gather that foure things hinder the curation of a Fistula. I. Is the afflux of a vitious humour. II. Is the narrownesse of it, which hardly admit­teth the application of convenient medicaments. III. Is the deepnesse which hindreth the conveighing the medica­ments to the bottome. IV. The callositie which contem­neth ordinarie medicaments. Seeing I have shewed you the way to remove these lets and impediments; I hope you will give me leave to conclude this point, of the curation of Fi­stulas in generall. In the next Lecture I shall discourse of the curation of Fistula's in particular places, which when I have done, I will put an end to this Treatise of Fistula's.

LECT. XII. Of Fistula lachrymalis.

IN my two last Lectures I discoursed amply enough of the nature of a Fistula, by setting downe its description and pathognomonicall or proper signes, and the generall me­thod of curing all Fistula's indifferently. This only resteth to be done before I put an end to this point, to set downe the curation of some particular Fistula's differing onely in [Page 167]subjects, which are the parts wherein they are seated, where­in some speciall directions are required. I will onely speake of three, to wit, of Aegylops in the great comer of the eye, of a Fistula in the brest, and last of all of a Fistula in ano.

First then I will deale with Fistula lachrymalis, the Fi­stula in the great corner of the eye. In Paulus Aegineta, De Arte medendi, lib. 3. c. 22. there are words in sound much like [...], and [...]; but in signification different: He will have [...] to be a tumour or Aposteme before it is opened; but [...] he affirmeth to be when the tumour is opened, whether it bee fistulated or no: his words are these: Aegilops abscessus est, qui inter majorem oculi angu­lum & nares fit: qui ruptu [...] si negligatur, usque ad os Fistu­lam aperit. I demprinsquam ruptum exulceretur apostema an­chilops appellatur. So according to the version of Albanus Torinus, Thus it may bee Englished: Aegilops is an Apo­steme betweene the great corner of the eye and the nose: which if it be neglected, it maketh way to a Fistula, even to the bone: this aposteme is called Anchilops before it is bro­ken. All moderne Authors, who left any monument of Chirurgerie, follow him. This kinde of Fistula is called by the neoterick Chirurgeons, Fistula lachrymalic. Because it doth happen in the place from whence teares flow. By A­vicen lib. 3. can. fen. 3. tract. 2. c. 14. the aposteme is called Kakilus, or Akilus, and the Fistula it selfe, Garab, or Alga­rab. Fabriciu [...] ab aquapendente, de operat. chirurg. part. 1. c. 21. purposely handleth this matter, and Ambrose Parrey, lib. 16. c. 15. and Taliacotius in chirurg. curt [...]r. lib. 1. c. 21. The place then wherein this kinde of Fistula is seated, is the inner corner of the eye: although it beginneth first at the holes of the upper and low eye-lid, from whence the teares flow.

The signes.The signes are manifest to the senses: for first, the orifice doth offer it selfe to the view: secondly, by compression the quittour issueth out: thirdly, a small probe may bee thrust within the cavitie to the very end of the Sinus.

The Progno. sticks.As for the Prognosticks: First then, all these Fistulas are of [Page 168]hard curation, for the moystnesse of the place much hin­dreth desiccation, which is required in the curation of ul­cers. Secondly, the part (while one is awake) is in conti­nuall motion. Thirdly, by reason of the nicenesse of the part, choyse of medicaments must be had. II. If the quit­tour hath made way for it selfe to the inner passage of the nose, by that hole which passeth thorow the bone of the nose from the corner, then we are only to procure the shut­ting up of the upper orifice, and not to goe about the sca­ling of the bone by a fruitlesse labour, which will notwith­standing cost the patient great paine and griefe. III. If a Fistula in this place become cancerous, which you shall con­jecture by the hard and livid brims, a stinging paine, and stinking virulent matter, you arc onely to use a palliative cure, applying those medicaments which are fit for a cance­rous ulcer, whereof in the curation of a cancer I will speake at large. IV. If this continue long, it causeth a consump­tion of the eye, called [...], sometimes blind­nesse of that eye, and corruption of the aire, which we draw by the nosthrils, if the quittour passe from the glandule, tho­row the bone of the nose to the nosthrill.

The diversities of these Fistu­la's.Now to come to the differences of these Fistula's: Some are maligne, the signes whereof I have delivered in the Prognosticks: Some are not maligne. Of these wherein there is no malignitie, some are without cariositie of the bone, and some with cariositie of the bone: you shall know that there is no cariositie of bone: First, if the aposteme was not long continuing before it brake; for if the tumor was first an Oedema Scirrhodes, and continued a long time so before it brake, then it is likly that the humor corrupted the bone before it brake. Secondly, if the probe rest not upon a part hard and rugged. Thirdly, if after dilation of the Fistula, the cariositie bee not presented to the sight. If circumstances contrarie to these be offered, you may con­jecture that there is a cariositie in the bone.

The curation.To hasten to the curation of these Fistula's: If a Fistula [Page 169]lachrymalis, without corruption of the bone, bee offered to you to be cured, proceed after this manner. First of all, you are to dilate it: secondly, you are to remove the callositie: thirdly, you are to mundifie it: fourthly, you are to conso­lidate it: and lastly, to cicatrize it.

The manner of dilatation.You shall dilate it by the Fistula tent framed (as I taught in my former Lecture) according to the proportion of the sinuositie in the beginning: then you shall enlarge it more by spunges prepared with the Melilot Emplaster, which I likewayes set downe, when I taught here last. This manner of dressing will discover all corners of the sinuositie. The Fistula having beene thus dilated, you are to goe about the removing of the Callus. Now in performing this there is not so great libertie granted, as is in Fistula's of other parts. For first, fluid and running meanes having a remarkable acrimonie are not safe: for passing unto the Conjunctiva, and from thence to Cornea, they are able to erode it, from whence an ulcer may ensue, and so the griefe bee doubled. Secondly, even meanes solid carefully must be applyed, that they goe no further than the sinuositie of the Fistula. It is not unknowne unto you, what horrible symptomes often­times afflict the eye, by reason of a familiar humor only ex­alted in degrees of acrimonie: What mischiefe then is to be expected, if heterogeneall bodies, endued with extraor­dinarie sharpnesse, as these must be which remove a Callus, doe seise upon the membranes of the eye, adjacent unto the part affected.

Some there are who cure these lachrymall Fistula's with liquid medicaments, as with the water of Elder, or Wall­woort flowers; in everie pint of these dissolving two drams of Mercurie sublimate, or more, according to the hardnesse of the callositie. The proportion of mixture you must con­jecture by the continuance of the Fistula, by the age of the partie, and constitution of the body. If therefore a Fistula be offered to be cured in a body young, of a short continu­ance, and of a tender constitution, then the water is to bee [Page 170]mild; if contrarie conditions doe offer themselves, then you are to make it more strong, according to discretion. If you take two parts of Plantane water, and one part of the spirit of Niter, you shall have an excellent Topick according to the principles of the Chymists.

One thing is to bee observed, Observation. that these liquid medica­ments bee sparingly applyed to the sinuositie, that no part of them touch the membranes, to avoyd the accidents whereof I spake before.

Why solid me­dicaments are better than liquid.As for mine owne part, I more commend the solid medi­ments than these fluid: for first, their facultie is more du­rable: secondly, they are more secure, because they are not so apt to spread. If the body be young and tender, this me­dicament will serve: Take Mercur. Praecipitati, aut Tur­bith loti ʒij. Aluminis calcin. ℥j. Exquisite misceantur. postea ℞ Vnguent. popul. ℥j. Pulveris praedicti ʒij. Misceantur ut resuliet unguentum. When you apply this medicament, ar­ming a tent with it: pull it not out forcibly; but suffer it to pop out of it selfe. Continue the application of this me­dicament untill the Callus bee removed, which you may ghesse if the processe of the sinuositie appeare soft, and the quittour which cleaveth to the tent appeare laudable.

The Callus being thus removed, Mundification. you must mundifie it: To this purpose you shall use this locall medicament: ℞ Aq. Chelidoniae aut Rutae, ℥ij. Syrupi è succorutae, aut Mellis rosati ℥j. Misc. applicetur calefactum. Dresse the Fistula but once a day.

The part being mundified, Consolidation. which you shall know by the rednesse and tendernesse of it: Then goe about the conso­lidation. This you shall procure by this medicament: ℞ Aq. Plantag. ℥ij. Syrupi Mirtillorum, aut Ros. rub. siccat. ℥j. Misceantur. Apply this, and renew it but everie other day; Cicatrization. How an Aegi­lops, with cari­ositie of the bone, is to be cured. if no remarkable store of quittour flow.

As for the skinning: Diapalma cum succis, de minio, or Emplastrum rubrum astringens will serve.

If in an Aegilops or lachrymal Fistula the bone of the [Page 171]nose be corrupted by the humor staying in the embosment, then two wayes of curing are offered unto you: The first is by actuall cauterie, the second is by Incision. Peruse all who have written of the curing of this kinde of Fistula, and you shall finde that all with one accord subscribe to the a­ctuall cauterie.

The actuall cauterie must represent in figure the stone of an Olive: The parts adjacent must bee defended from the fire, either by an hollow plate according to Parrey, or a cane according to Ab aqua pendente: you may make choyse of which you will: you must effectually impresse it, to drie the humiditie, and the sooner to procure the scaling of the bone. And although Authors, after the application of the actuall cauterie, prescribe fattie things to hasten the separa­tion of the eschar, yet I advise you not to use them; for the part is moyst of it selfe, and so the application of such me­dicaments would procure a sordid ulcer: Apply therefore onely pledgets, or tents dipped in red wine, and above all Diapalma, or Emplastrum de Minio, or de Smegmate. When the bone hath cast a scale, then consolidate and skin it, as I have set downe before.

It is not unknowne unto you, with what difficultie pa­tients admit the application of an actuall cauterie, to a part much distant from any of the principall, and wherein there is but small sensibilitie. What will a patient troubled with this griefe doe, if you make mention of cauterization to be made in this place, so neere the eye and the braine it selfe? If at any time you make mention of such a kinde of curati­on to a patient, to try how hee doth stand affected to this operation; let me entreat you not to urge it too much, as if the cure of the Fistula could not otherwayes bee compas­sed, if you finde the patient averse, lest you drive him away, and so you lose both credit and gaine. When in the Coun­trey I practised Chirurgerie, sundrie times this kinde of griefe having beene presented unto me, I ever found the pa­tients strucken into a terrour and amasement, as soone as [Page 172]mention was made of cauterization; wherefore I set my imagination at worke, to finde out a way to cure a Fistula lachrymalis, lesse, terrible, but more sure and effectuall, which I will not conceale from you, because this griefe doth often come to your hands, and both great credit and gaine is pur­chased by performing the curation.

My manner of curing Aegi­logs.My manner of curation is this: First of all, having with a small probe bended, found out the cavitie both upwards and downewards, I draw a line with inke betweene the Glandule of the eye, & the Trochlea or the pulley, through which the small tendon of the first oblique muscule called superior, or major, the uppermost and greatest passeth, and endeth obliquely in the uppermost part of Cornea: then I make incision to the bone; the part incised I divide with the nailes of the fore-fingers, untill the incised bee so much dilated, that it will without difficultie admit a prettie pled­get: this being done, I thrust in a small Trochiske made of the Turbith minerall before it be washed, the vomitive Vitriol, and the best Terra sigillata wrought with Populeum to the forme of a stiffe paste, and afterward dried. About the Trochisk I apply a pledget armed with Populeum, which I keepe to the Fistula by an Emplaster of Diapalma cum succis, malaxed with the oyle of Henbane. Afterward fil­ling the orbit of the eye with little bolsters made of soft lin­nen-cloth folded, and moystened in Aqua spermati [...] ranarum caphurata, I rowle up the eye. These same dressings I use morning and evening, untill the Trochisk with the Callus fall out of it owne accord: which when I perceive, I dili­gently view the bone, to see how much is carious: unto it I apply the powder of Euphorbium, if the diseased partie be aged, and of a firme constitution of body; but if the partie be young, and of a tender constitution, I besprinkle the bone with Pulvis Cephalicus. The cavitie of the part inci­sed I fill up with a peece of the spunge dressed with the Me­lilot Emplaster, as I delivered in my former Lecture: about it I apply a pledget armed with Populeum, all which I couch [Page 173]downe close, with the emplaster and bolsters kept to the eye with a rowler.

This manner of dressing I continue untill the scale of the carious bone cast, which most commonly falleth out about the twentieth day. When the scale is removed, I mundifie the part with Mel rosatum, or Melrutaceum, then I pro­cure consolidation by the Syrup of Mirtles, or of the red Roses dried. And last of all I cicatrize the part affected with some epuloticall Emplaster, whereof I have set downe suf­ficient store heretofore, and shall hereafter when I shall dis­course of an ulcer which hardly admitteth skinning. I have made sufficient experiment of this manner of curing an Ae­gilops in sundrie persons. And I truly affirme, that I never miffed of the cure of any one with whom I thus dealt: nei­ther shall you (I hope) if punctually you observe these ob­servations in your proceedings.

When the bone of the nose is to be pierced.It may fall out that the whole substance of the bone of the nose subjacent to the Fistula may be carious, being of it owne nature thin, and the head of the partie besides verie rheumatick, so that being often cured in the opinion both of the Chirurgeon and discased partie, yet it doth breake out againe. In such a case you may demand of mee, how you shall fall off from such a cure with your owne credit. To this I answer, that there is yet a Subterfuge, and a way left to give contentment to the afflicted patient: To com­passe this, first dilate againe the sinuositie, untill the corrupt bone appeare, as hath beene shewed heretofore: Secondly, pierce the bone of the nose with a gimlet, that the quittor may have recourse to the nosthrils, which are appointed as shoares to discharge the flegmatike excrements of the braine, and to draw in fresh aire for the refrigeration of the lungs: & then cure the superjacent fleshie and skinnie parts, as I taught you, when I set downe the palliative manner to cure a Fistula. This manner of curation being the last re­fuge, it will undoubtedly give contentment to the patient: for the eyes of the beholders shall observe no deformitie [Page 174]externall in him, and he himselfe shall not be able to dis­cerne the turning of the quittor from the glandule out­wardly, to the nostrill inwardly: besides this, he himselfe shall perceive no smell that shall offend him; the smell of Garlick is not offensive to those who have eaten of it.

Now to conclude this my discourse of a Fistula lachry­malis, if you perceive any such Fistula maligne, or to tend to a cancrosity, which you shall discerne by the signes set downe, when I delivered unto you the Prognosticks: then use this medicament of Heurnius the father, set downe in methodo ad praxin. lib. 1. pa. 106. which he purchased both with money and entreaty, of one who got much money by it.

This is the description of it: ℞ calaminanter usti, atque in vini aceto extincti ℈ j. myrrha, plumbi usti ac loti an. ℈ss. croci gr. v. opii gr. ij. aeris usti ℈ iiij. decocti fenugraeci ℥ j. Misecantur exquisite omnia super lapidem pictorum. If you meane to make an oinement to continue long, instead of the mucilage of Fenugreeke, use new Swines-grease washed in Rose-water. This is admirable eie-salve in all ulcers of the eyes: (whereof I have made often triall) whether they be maligne or no.

LECT. XIII. Of Fistula's of the Brest.

HAving spoken in my former Lecture of Fistula Lachry­malis, I am now to set downe the method of curing other particular Fistula's, according to my promise. Of these, Fistula Thoraeis, a Fistula of the brest doth fist offer it selfe. Of the which Cornelius Celsus l. 7. Ambrosius Param l. 9. ca. 31. and Fabricius ab aqua pendente de operat. Chirurgic. part. 1. c. 47. have written.

How it happe­neth.This kinde of Fistula happeneth by two manner of [Page 175]wayes: First, by reason of a penetrating wound of the brest.

Secondly, by a Phlegmon possessing the intercostall Mus­cules, and the Pleura.

It is a superfluous matter to set downe any signes, seeing they appeare to the eye, and are easily found out by apply­ing the signes set downe in the generall method of curing of Fistula's, to every Fistula in particular.

The differen­ces.As for the differences, a Fistula ensuing a wound pene­trating to the cavity of the brest, hath but one orifice, the passage and sinewosity whereof is according to the penetra­tion of the wound; but a Fistula following after an Apo­steme hath frequently more orifices than one, whereof some passe to the cavity of the brest directly, some windingly.

The Progno­sticks.To come to the Presages. All Fistula's of the brest are hard to be cured, and that for seven reasons; I for first, the brest is in continuall motion by reason of its dilatation and contraction caused by the intercostall Muscules: now that motion hindereth the curation of any sore, it is so manifest, and confirmed by experience, that it needeth no probation.

II Secondly, because in penetrating Fistula's of the brest, the Pleura is alwayes ulcerate; which being thin, without bloud, and membranous, as the bladder hardly admitteth any consolidation.

III Thirdly, seeing the Virus of the Fistula doth often cor­rupt the rib; and seeing the internall substance of the rib is cavernous, and so apt to lodge corrupt matter, the difficulty of curing is increased.

IV Fourthly, in Fistula's of the brest, the end of the Fistula is often lower than the orifice, which hindereth the expur­gation of the superfluous matter.

V Fifthly, the sinewosity within, in penetrating Fistula's doth frequently extend it selfe betweene the Pleura and the upper rib, to the distance betweene it and the lower rib. Now how hard a matter it is to cleanse this cavity, I referre it to your owne consideration.

VI Sixthly, that liberty of applying of medicaments, which is permitted in sundry other parts of the body, is here de­nied; the lungs and heart being lodged in this cavity, whereof speciall regard is to be had, seeing from the safety of these parts the life of the Individuum dependeth.

VII Seventhly, because these Fistula's bring an extenuation of the body, and a Hectick fever.

Let this be the second Prognostick: If the party afflicted with a Fistula in the brest be fallen unto a Hectick fever, 2. Prognostick. and his body begin to be extenuate, pronounce the griefe to be incurable: for if you use deficcative meanes, which are required in curing of ulcers, you shall increase these symp­tomaticall griefes, and hasten death.

III The third Prediction Celsus delivereth unto us in these words, Solent quoque, &c. Fistula's use sometimes, when they have passed by the ribs, to corrupt the midriffe; which may be gathered by the place affected, and the greatnesse of paine, in this case there is no hope of cure.

The curation. As for the curation of a Fistula of the brest; to it three meanes are required, a convenient diet, pectorall decocti­ons, and locall applications. The diet. In a Fistula, which hath cau­sed neither a Hectick fever, nor extenuation of the body, a greater variety of meats is permitted, than when these symptomes are annexed. Howsoever meats of easie conco­ction, and which afford laudable nourishment, are to bee appointed for the Patient, and a moderate use of them is to be prescribed: of these two meanes I have spoken amply e­nough, when I set downe the generall curation of ulcers.

Pectorall de­coctions.As for pectorall decoctions, upon the use of which, the greatest part of the cure of such Fistula's dependeth, you shall finde divers descriptions of them in divers Authors. The Simples whereof these Decoctions are made are these; The Simples of them. The flowers & leaves of Colts-foot, Maiden-haire, the white Horehound, Comfrey, Tormentill, & Bistort-roots, Violet-flowers, Borrage-roots & flowers, Ellacāpane-roots, Hyssope, Germander, the flowers and roots of Mallowes, the roots of [Page 177]Parsley and Fenell, Liquorice, Scabious, Valerian, Burnet, Sarsaparilla, Guajak, the China root, Raisins of the Sun, and blew figs: of these Simples you shall finde sundry decoctions set down by Authors who have written of wounds and Fi­stula's of the brest.

Amongst all others, the Pectorall Decoction of Francis­cus Arcae [...] you may most safely and securely trust unto: He white he lived, was so fortunate in the practice of Chi­rurgerie, that he drew that eminent Linguist and Divine, Arrias Montanus, very often to be a spectator of his opera­tions. The Decoction I need not to set downe, because you may fetch it out of the Author himselfe, who is translated into the English tongue.

My owne.I will not stick to commend unto you one of my owne, whereof I have sundry times made experiment. This is the Composition of it: ℞ Sars. parill. ℥ vj. scob. guajac. ℥ v. rad. Chin. ℥iij. rad. enuh. campan. ℥ j. capill. ve [...]r. scabios. fol. tussilag. scolop [...]nd. sumitat. hyper. an. man. 1. f [...]or. borrag. buglos. viol. beton. an. pug. 1. polypod. ℥ iij. liqu [...] it. ℥ ij. pas­sul. major. exacinat. & ficu [...] pinguinu [...] incisar. an. ℥ii ss. In­funde [...]tur ista per noct. i [...]aq. font. f [...]rventis lib. 24. deinde lento ig [...] coq. ad consu [...]p. lib. viij. a [...] col [...]tur decoctum. Bi­bat ager singulis di [...]bu [...]lib. iiij. Let the Patient every mor­ning about five a clock drink halfe a pint of this Decoction warme, and so much about foure a clock in the afternoone: at dinner let him take a pint, and at his Supper another: the third pint he may drink between meales, The reason of the quantity of the decoction to be taken. Marvell at not this quantity, for a lesse will little availe; for strong desiccation is required in this cure.

I Three things vehemently hinder the curation of these Fistula's: The first, is the inconvenient situation of the o­rifice, Things which hinder the cure when it is higher than the ending of the Fistula.

II The second extenuation of the boyd.

III And the third is a Hectick fever: of these in order.

The manner of incision.If then the ending of the Fistula be lower than the exter­nall orifice, a lower orifice is to be made by incision. In this incision. [Page 178]operation two things are to be diligently noted: The first is the place. The second, the cautions to be observed in the section.

The region of the brest fittest [...] incision.As for the regions of the brest: The left side is more safe than the right: for in this side the liver by its gibbosity bea­reth up the Diaphragma, and doth insinuate it selfe to the cavity of the brest: If then either one of these, or both should be wounded imprudently, it is an easie matter to prognosticate the tragicall event of this operation.

The place.As for the determinate part of the brest, which is to bee opened, let it be about the beginning of the next rib, and not at the lower end of that rib, above the which the orifice of the Fistula sheweth it selfe; for under it are couched a veine, a nerve, and an artery.

The manner of section.In your Section proceed thus: First, divide the skin to­wards the upper part of the lower rib, then make way tho­rowout the incostall muscules: These things being done, dry all things with a spunge, and put into the new orifice a swelling spunge, both to dilate it, and to draw to it selfe the quittor. If you goe thus to work, you need not feare any danger, if you passe no farther than the division of the Pleura: so that neither the Diaphragma, nor the lungs, or the Pericardium be touched.

What is to bee done if a Ma­rasmus or He­ctick fever be complicate with a Fistula of the brest. If with a Fistula of the brest, a Marasmus or Hectick fe­ver complicat, the difficulty of curing is exceedingly in­creased; two diseases joyntly conspiring to the ruine of the diseased party, which notwithstanding for their curation require advers indications, the Fistula requiring desiccati­on; and Marasmus and the Hectick fever craving humectati­on. If then a Fistula of the brest be offred to any one of you, first of all be sparing in your promises, lest you be accounted clouds without raine: who but an ignorant will give free raines to liberall promises to cure a Fistula of the brest complicat with other Deutoropatheticall greefes of their owne nature hard to be cured; when as it is a difficult mat­ter to cure a solitary Fistula of the part?

What a Maras­mus is.Marasmus, in Latin [...] Authors Marcor, is an immoderate drynesse and consumption of the whole body, by reason of the defect of the substantiall humidity, according to Trallia­nus. According to Galen li. de marc. Lib. 12. cap. 4. there are two degrees of it: The degrees of Marasmus. The one is when this extenuation of the body is in Fieri, in consuming; The other is, when it is in Facto effe, or consummate.

Signes of it in fieri.If it be in Fieri onely; the muscules begin to fall, the skin becommeth flaggie and loose, strength and agility de­cay, and the party findeth a manifest defect, and impotencie in all the actions of the body, whether they be animall, vi­tall, or naturall. Againt this degree, you may contend by instituting a diet moistening.

The curation of this degree.If a Marasmus be in Facto esse, or consummate; then the eyes grow hollow, and seeme to bee hid in pits▪ the live­ly colour of the skin fadeth, The signes of a Marasmus consummate. the skin of the forehead seemeth dry, and stretched like the head of a drum; the eye-lids seeme heavy, and scarse able to lift themselves up, as it hap­peneth to those who are wearied by reason of watching; the temples are hollow: in the cavities of the brest and belly, one would think, that there neither Viscera members con­tained, or guts: for the muscules are so consumed, and the cavities so drawne in, that nothing seemeth to remaine be­sides the fibra and the skin. To conclude, one having a con­summate Marasmus, seemeth to be nothing else, but a wal­king scel [...]t [...]s. Whosoever shall undertake the curation of such a one, and performe it, I will give him leave to give himselfe out for another Saviour, and to publish a fifth Go­spell, which the itching cares of our age would willingly perhaps entertaine.

2. Differences of a Marasmus.A Marasmus is two-fold: For one is accompained with heat, and may be called a dry Marasmus, I and this is nothing else but a Hectick fever, which hath consumed the radicall moisture of the solid parts, and it is called [...], or an extenuating fever.

The other is accompanied with cold. II This is two-fold: [Page 180]The one is naturall, The differen­ces of a Maras­mus caused of cold. and it is decrepit old age: for old age is defined by drynesse, and coldnesse.

The other is unnaturall, and it is called Senium ex m [...]rb [...], a decay by reason of sicknesse: old age commeth by the course of time.

This last of a violent cause, for it followeth after a bur­ning or a Hectick fever; and that by reason of the sicknesse it sefe, or by reason of the medicaments used in the curing of the aforenamed griefes: for a Hectick fever doth not onely waste the naturall humidity, but the naturall heat also seated in the humidity: wherfore the heart it selfe, the well­spring of this heat must become colder than it ought to bee. In this case the pulse is small & weak, and slow: in like man­ner the breathing is weak, slow, & cold. By reason of the use of refrigerating medicaments appointed by the Physician in curing of a Hectick, or a Febris Morasmodes, many times Senium ex morbo succeedeth: and this is more tolerable, be­cause the heart being somewhat immoderately cooled, the lesse of the radicall moisture is spent, than would be if the Hectick had its full course.

What a Hectick fever is.A Hectick fever, is an unnaturall heat which hath seized upon the solid parts, and wasteth the moisture of them: But seeing there is a three-fold moisture in the body: to wit, bloud in the small veines and arteries of every part, a dewy substance in every part, by the which it is nourished; and gluten, which keepeth together the terrestriall substance of each part, moisteneth it, and keepeth it from falling to dust.

The degrees of a Hectick.There are also three degrees of a Hectick. In the begin­ning, when the two first humidities begin to faile, the He­ctick fever is not easily discerned, although it may be with­out great difficulty cured: But if the radical moisture be consumed, as it is easily discerned▪ so it is hardly cured. As long as this moisture is somewhat plentifull, sufficient to [...]ntertaine the naturall heat, the body feemeth well colou­red, of a comely figure, and of a decent quantity.

What [...] to b [...] done in [...] suma [...] co [...] ­sumpti [...].If therefore you perceive the body of any one having a Fistula in the brest, by reason of the defect of this gluten, orradicall moisture to become discoloured, the figure to be altered, some parts bunching out, some growing hollow and the thicknesse of the members to become slenderer, the flesh colliquating; leave such a one to himselfe, that he may march peaceably to the period of his life. Having deli­vered unto you of a Marasmus or extenuation of the body, and a Hectick fever, so much as is expedient for you to know in your chirurgicall practices; without the knowledge of which, you cannot possibly proceed, warily and cir­cumspectively, in curing Fistulaes of the brest. I am to shew you what uses you may make of what hath beene deli­vered.

The uses of the discourse of a Marasmus, and a Hectick fever.If therefore one having a Fistula in the brest be brought unto you, whose body seemeth to be nothing else but skin and bone, (as the vulgar proverbe is) acquaint him with the danger wherein he is, lest death seize upon him unprepared. Neverthelesse, if he implore your aid, of Christian charity withdraw not what comfort you are able to procure unto him: appoint then a diet moistening and nourishing, if no Physician be at hand, which I will set down anon; and dresse him with those medicaments which are anodyne & healing. Inject into the Fistula Plantane-water, having some of the syrup of red Rose-leaves dryed, mingled with it; cover your tent and pledget with Diachylon simplex. If you per­ceive that there is so much of the radicall moisture remai­ning as is able to cherish the naturall heat, which you shall discerne, if the colour of the body be fresh, if the figure be decent, if the proportion of the parts be according to na­ture, and the diseased party can In some good measure per­forme all actions; you may conceive some hope of his re­coverie.

Remedice a­gainst a Maras­mus.Wherefore if a Marasmus hath extenuate his body, appoint for him a diet, which is likely to repaire the natural moisture impaired. Let him then take broths made of Mutton, Veale, [Page 182]or Chickens, wherein Damaske Prunes, Raisins of the Sun stoned, Currans washed and bruised, Mallow-flowers and roots, Marigold-flowers, Cinquefoile, Cowslip flowers, and Colts-foot leaves and flowers have beene boyled: Gel­lies are good, made of young Cockrels, and a knuckle of Veale; use no other spice to it than a little Mace, and Nut­meg. Let him betweene meales take Almond-milks, made of the broth of a Chicken boyled with French-Barley. It is good for him also every morning and evening, to take a draught of Asses or Goats-milke; or in want of these, of Cowes-milk, milked thorow the Conserves of Borrage, and Buglosse-flowers; Calves and Sheeps-feet stewed with Curranes are good: sometimes let him eat Pigs-flesh. If he have a minde to fish, grant unto him Whiting-mops, Smelts, Perches, young Pickerels, Trowts, yea sometimes Eeles: the Sole, Flownder and Plaice, may also be permitted; poched Egges, and sweet Butter without any Salt, or Almond-But­ter, are good for break fast.

Remedies a­gainst a He­ctick fever.If an extenuation of the body doe proceed from a He­ctick fever, then you must not onely moisten the body; but coole it also. In the broths then-boyle Borrage, and Succo­rie-roots, common Sorrell, wood Sorrell, Primrose, Violet, Borrage and Buglosse-flowers▪ let his Sallets be Lettice, Spi­nage, & Purselane, boiled in Chicken-broth. An Almond-milk made of the Decoction of French-Barley, wherewith the e­mulsion of the seeds of the Pompion, Musk-melon, Cucum­ber, Purselane, and white Poppie hath been drawne, is excel­lent taken morning and evening. Permit no Milke but But­ter-milke, and that when it beginneth to be a little sowrish, with a little of Sugar, of Borrage, or Buglosse. If the disea­sed party complaine of immoderate heat, and watching, minister unto him twice a weeke Philonium Persicum, with the syrupe of white Poppie, red Poppie, Gillie-flowers, Maiden-haire, Colts-foot, or of the juyce of Limons, or Citrons, in Aqua Spermatis Ranarum, or red Poppie. If you perceive that by the following of these courses, the party [Page 183]hath recovered his strength, and a good habit of body, then you may conceive a good hope of his recovery, and put him in good comfort: and so boldly proceed in the Cure, still endevouring by following the indications (as Theseus did the threed of Ariadne to come out of the La­byrinth) to restore perfect health to the Patient. In the be­ginning of the Lecture, Lappointed three indications for the curing of Fistula's in the brest; to wit, a convenient diet, pectorall decoctions, and locall applications: I have suffici­ently discoursed of the first two; the third then remaineth of locall applications.

Locall applica­tions.In setting downe of these I will be briefe, because they little differ from the generall, if you except a few observa­tions. You may safely dilate a Fistula of the brest, with the Fistula tent and spnnge; but in removing of the Callus you be wary, for if you apply the Trochisck, it must not reach to the cavity the brest, for the point of it will re­lent, breake, and fall upon the Septum transversum, which undoubtedly will crode it, cause an inflammation, procure a sharpe fever, a P [...]raphre [...]i [...]is, and at last death it selfe. Ap­ply then a tent armed with Populeon, wherewith the Fistu­la powder must he mingled, as hath beene taught: The Cal­us being removed mundifie the ulcer with Aqua calcis, and Mel rosatum mingled together: Take heed that you inject no better medicament, for such medicamen [...] are easily suc­ked in by the lungs, from whence by the Tracha [...] Arteria, they easily passe to the throat and mouth, from whence there is felt a horrible bitternesse, a desire to vomit, and an overthrow of the appetite. Para [...] lib. 9. c. 31. affirmeth this to have happened unto him twice t [...] be you ware by the ex­ample ample of others. The ulcer having beene mundified, pro­ceed to consolidation, for sores in this part are not to bee long kept open. This you shall procure by injecting two or three dayes the syrupe of red Rose leaves d [...]yes, mingled with Plantane-water; and then onely moistening a pledget wet in this syrupe, or the syrupe of Mirtles. Above the [Page 184]pledget apply Paracelsus his Stictick Emplastrum, for in this case it exceedeth all others; for it doth not onely draw the brims together, but it skinneth also.

LECT. XIV. Of Fistula's of the belly and joynts.

Having infisted so long in discoursing of the nature and curation of Fistula's, you may think, not without cause, that I ought to hasten to an end. In this Lecture I will set downe the indications of curing Fistula's of the belly and joynts, and so I will conclude this point.

The differen­ces of Fistula's of the belly.The Fistulaes of the belly are two-fold: for they are ei­ther in the Iuguinal parts, or else in An [...].

I Of these in the groynes I will discourse; because they most frequently fall out, being accidents, for the most part, which ensue after Ʋenereall Bub [...]'s, either neglected, or ill cured: yea, they fall out in plethorick and cacochymicall bodies very often, wherein there is no Neapolitane seed: and that somewhat above the emunctorie it selfe; the mat­ter not comming to the emunctories themselves, which re­ceive the excrements of the liver; but being hindered, ei­ther by reason of the weaknesse of the expulfive faculty, or by the crossing and thwarting of the muscules, oblique and transvers in those places, as you, who are skilfull in the Anatomie, well know. It is no wonder that both Abscesses, and Fistula's often fall out in these places, seeing the belly is as a draught or a sinke in a house, or a keele in a ship, whi­ther all imparities flow. Yea, such plenty of sharpe humors sometimes floweth to these parts, that perforation of the guts is caused, and that the excrements come out at the ori­fice of the Fistula; a lamentable case, noisome to the disea­sed party, and intolerable to the company. It falleth out [Page 185]sometimes that some of the Vertebra of the Spina are cor­rupted.

As for the Presages: The Fistula's in these places, which passe not to the cavity of the Abdomen, are hardly cured.

I First, because the liver is still apt to afford new matter.

Secondly, because great circumspection is to be used if you shall use either incision, or corrosive medicaments, by reason of the fibra of the muscules, and the branches of the Vena cava, and Aorta descending.

A historie.I visited once in Smithfield, a Preacher who had a Fistula by reason of a Venereall b [...]be ill cured, who entertained for his Chirurgeons Master William Clowes of famous memory, Master Authony Spademan, & William Bray, brothers of this worshipfull company while they lived. Although no con­venient meanes were omitted, yet the Cure came but slow­ly on. The diseased party impatient of delay, and not being comforted by any certaine hope of recovery, addressed him­selfe to one in the countrey, who was accounted famous for curing of Fistula's: for Master Hall at that time had ac­quainted sundry with his practice of curing of Fistula's. After the Chirurgeon had applyed his corrosive to remove the Callus, it corroding, the tunicles of the great vessels de­scending, the eschare parting from the sound parts, in the night a strong flux of blond ensued, which deprived him of life before the curer c [...] come. Wherefore let me advise you, diligently to obs [...] whether the bottome of the Fi­stula doth reach as deepe as the great vessels, that you may avoid the like fatall event.

II The second Presage is this: If the Vertebra of the Spina be corrupted, pronounce the Fistula to be incurable: you shall conjecture the Vertebra to be soule, if extraordinary store of stinking sanies issue out of the Fistula, and the party daily grow weaker, and more extenuate, notwithstanding that you use all convenient both internall and externall meanes.

III The third Presage shall be this: If the guts be eroded, & the excrements come out at the orifice of the Fistula, the life of [Page 186]the diseased party is in great hazard, because the guts are thin, membranous, and destitute of store of bloud.

Secondly, because the Fistula is apt to ereepe thorow the distances betweene the muscules, which in those places are many; to wit, the oblique and transvers, one placed a­bove another.

Thirdly, because in curing such Fistula's, we finde little helpe of hand and eye.

Fourthly, because topicall meanes can hardly be kept to the guts to helpe consolidation.

The cure.As for the curation of these Fistula's: If they be not deepe, The removing of the Callus. but run alongst superficially, the best course is to make incision, and then to apply one of the Fistula pow­ders described by me, care had of the age and constitution of the party.

The mundifi­cation.As for the mundification, consolidation, and cicatrizati­on of such, seeing no speciall observation is required, you are to have recourse to that, what I have copiously delivered heretofore. If the Vertebrae of the Spina be foule, you are to promise no cure.

Neverthelesse, if persons of worth will (upon good consideration) entertaine you to dresse them, they find­ing a comfort by your pains: Make an injection of Plantane, or Carduus Benedictus water, adding some fragrant water of Medow-sweet, the syrupe o [...] Rose leaves dryed, and the spirit of Wine, having the tr [...]ture of Aloe, Myrrhe, Mastick, and some Saffron. Let your emplaster be Diachy­lon cum gummis, or Paracelsus his Stictick. If the guts fall out to be perforated, having acquainted the friends of the party with the danger, yet despaire not, but goe on, and use methodicall meanes. Let the party eat Calves and Sheeps▪ feet stewed, Sheeps and Calves heads, for they afford a gluti­nous juyce; Rice boyled in Milke, wherein steele hath beene often quenched, is also good. Every morning and evening let the party take a draught of Allagant, warmed with a wheat tost, when he hath drunke off the wine, let [Page 187]him eat the toast. Make injection of red Wine, having a little Alome dissolved in it, & some of the syrup of the Mir­tles-berries: keepe the orifice open with a spunge, untill the gut be consolidate; then proceed to the extirpation of the Callus, mundification, consolidation, and cicatrization, as hath beene often heretofore taught. Event oftentimes falleth out above expectation.

A historie.Not long agoe a countrey youth, who had an Enterocele, was bound to a Barber in Aldersgate street; one applying to the Rupture a Trusse somewhat strait, caused and sideration or mortification of the part, so that the excrements came out plentifully, with much stinking matter, out of the ca­vity of the belly. Notwithstanding, by diligence, and ap­plication of convenient meanes, the gut was consolidate, and the youth kept alive. So much I thought good to deli­ver concerning the curation of Fistula's which happen in the inguinall region.

Of the Fistula an [...].Now it followeth, that I speak of Fistula's in An [...], which was said to be the second kinde of Fistula's invading and possessing of the Abdomen; or the lower belly.

This kinde of Fistula very often followeth after a Phleg­mon in the Anus, broken and ill cured.

There be two sorts of these Fistula's, for some pierce not the Intestinum rect [...], and some doe: and both these are ei­ther shallow or deepe.

Signes of a Fi­stula piercing the gut.You shall conjecture the Fistula to passe thorow the In­testinum rectum: First, if after breaking of wind, part of it make way thorow the sinus of the Fistula.

Secondly, if the excrements appeare mingled with the quittor, or if the quittor smell as the excrements use.

Thirdly, if injection being made at the outer orifice of the Fistula, part of it passe within the Anus.

Fourthly, the forefinger being put into the Anus, if you feele the probe bare it being thrust thorow the sinnus of the Fistula, this is an infallible and certaine signe.

As for the Presages of these Fistula's: Presages. First, no Fistula [Page 188]ani is of an easie curation: for this part being the jax of the body, it affordeth great plenty of impurities, and much su­perfluous moisture, which hinder the curation.

Secondly, if a Fistula in this place be not very painfull, and noisome, by reason of much & stinking quittor, but shut­teth and openeth it selfe sundry times, it is expedient for the health of the Patient, if such a one be left uncured; for by this meanes the body is discharged of superfluous hu­mors, and the body kept in health. I have knowne this accident to have happened to sundry, and to have conti­nued to the end of their lives. Some I know yet living thus affected, neither doe I doubt, but that sundry of this wor­shipfull Company have observed the like.

The curation.Now to come to the curation of these Fistula's: The meanes to attaine to this are sive: to wit, Diet, Internall medicaments, Incision. Deligation, and Topicall meanes.

As for the Diet and Internall medicaments, I have dis­coursed sufficiently heretofore, so that I need not, distrust­ing your memories, to repeat any thing.

As for Incision and Deligation; they have place when the Fistula is shallow, but if the Fistula be deepe, neither of these meanes are to be attempted.

The curing of Fistula's not passing to the gut.If therefore the Fistula be shallow, and passe not to the Intestinum rectum, after you have dilated it, and removed the Callus, upon a tent incise all the hollownesse: then fill it with dosels, armed with a medicament made of a restrictive powder, and the white of an egge, to keepe the brims of the incised parts asunder; for if you goe about to unite the parts too soone, it may be feared that a cavity will still re­maine, and make way for recidivation: wherefore it be­hooveth you, to see that sound and laudable flesh be ingen­dered in the bottome. Let not your incarnative medica­ments be fatty, for such will cause loose and spungeous flesh: use therefore the sanative syrup made of the vulne­rary plants, having some Pulvis cephalicus mingled with it. If the Fistula goe deepe inwardly, so that you cannot use [Page 189]conveniently incision, dilate the Fistula with the Fistula tent, and the spunge; then remove the Callus with a Fistu­la trochisk: the trochisk being come out, and the Callus quite spent, mundifie it with Mel rosatum, mingled with Aqua calcis: when you perceive laudable quittor, ende­vour to consolidate the part, by applying die sanative sy­rup, and Pulvi [...] cephalicu [...] upon the tents, which you must day by day shorten, until at the last the whole sinus of the Fi­stula is shut up; which you shall conjecture by the little and laudable quittor which the Fistula yeeldeth. Then nothing else remaineth, but to cicatrize the part with your Dia [...]al­ma, or Vuguentum de minio. The cure of a Fistula pier­cing the gu [...]. If the Fistula penetrate to the Intestinum rectum, then cutting asunder of the whole sinus of the Fistula by deligation is most sit. But first of all, you you must dilate the sinus, and remove the Callus, (as hath beene said) for so the part which is to be bound will be more thin, and so more easily cut asunder. As for the threed wherewith you are to binde the sinus, two I commend un­to you; first, sealing threed, which is made of the best hemp, unboyled, and unwhitned: for it is exceeding strong, and will not rot before it hath wrought its effect. The second, is a strong threed of silke, twisted; there is no great matter in the colour, whatsoever scrupulous Authors affirme: you may use either of these as opportunity shall be offered.

The manner: of binding.When you goe about to binde the sinus, put in one end of the threed in the eye of a small and flexible probe, then thrust the eye with the threed thorow the sinus into Intesti­num rectum: this being done, put into the Anus your fin­ger, and with it pull the threed 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 threed into the eye, draw that end thorow the outer ori­fice of the Fistula, If the sinus be not very thick and long, you may by one strong deligation binde off all the sinus, but if the sinus be thick and long, you must use sundry constri­ctions, tying still the ends of the threed with a running [Page 190]knot, that it may be the more readily loosed. Some after one deligation onely, more and more draw in the ends of the threed, with a round piece of a sticke turned about. When all the sinus after division, by deligation, lieth open, goe forward in the cure, as hath beene set downe when the sinus was incised. Now nothing remaineth to conclude these discourses of Fistula's, but to speake somewhat of the curing of the Fistula's in the joynts. These griefes, what paines they procure to the Patients, and troubles to the Chirurgeons who dresse them, it is so well knowne to those who have beene imployed in such businesses, that I need not to use many words to perswade any to beleeve this: ex­perience bearing witnesse.

1 The differences of these Fistula's are these. Some are without corruption of the bones and cartilages, and some have these annexed.

2 Againe, some of these are without any tumor of the ad­jacent parts, and in some there is a remarkable swelling of the parts adjacent; so that the skin it selfe is either brawny and hard, or loose and oedematus; and some of the tendons of the muscules are foule, and corrupted very often: such tumors often fall out, when Fistula's happen in the wrists and anckles.

3 Thirdly, in some of these Fistula's the joynt abideth firme, but in some it becommeth loose and weake, by rea­son of the relaxation of the membrane which covereth it, and the ligament by the which it is strengthened.

The manner of searching.Before I come to prognosticate of the events, let me ac­quaint you with one thing, and that is this; that if you bee called to children or young persons troubled with a Fistula, or Fistula's in the joynt or joynts, that you make triall of the sinus with a Mallow stalke answerable to it: for this kinde of probation is of all others lesse painfull, and will in­courage the diseased persons to commit themselves to you care, when they perceive that you searched the sores so easir hoping that your proceedings will be according to you-beginning. [Page 191]The small stalke of the Mallow next to the leafe is alwayes slimie and flexible, and so is apt to slip into the sinus, causing ei [...]her no paine, or very little.

The presage.As for the presages: I. No Fistula of the joynt, although it be without corruption of the cartilages or bones, is of an easie curation: for first by reason of the paine which is cau­sed by reason of sensiblenesse of the part, and the increase of it by reason of the sharpe medicaments which must be applied to remove the Callus, symptomaticall severs, losse of appetite, watching, and at last extenuation of the body; and at last a Hectick fever may be procured.

II. If a Fistula of the elbow or knee, have corruption, either of the cartilages or bones annexed, it will require a long time to have it cured: for the joynts themselves being very sensible, it must be gently dressed.

III. If in Fistula's of the wrist, the bones of it, or of the backe of the hand, be carious, you shall finde the cure to be difficult: for these bones are very spungeous, apt to receive superfluous humidity, and so are hard to be scaled.

IV. For these same reasons, the bones of the joynt of the foot and the instep are hard to be cured.

V. If Fistula's in the wrist or instep be accompanied with large and hard tumors of the hands and feet, pronounce the cure to be uncurable: for then the membranes, tendons of the muscules, and bones most commonly are corrupt.

VI. If an extenuation of the body, or a Hectick fever doe accompany Fistula's in the great joynts, shun the cure: for the indications of curing, which prescribe drying and cooling, in drying increase these griefes. Besides this, com­plicate diseases are more hardly cured than those which are solitary.

If you shall demand of mee, Object. what course is to be taken with those who are possessed with such uncurable Fistula's, if you bee intreated of the diseased party, or the parties friends to doe your best?

I answer, that if after some triall, Answ. you perceive the party [Page 192]to be uncurable, you ought to move the party to suffer ex­stirpation, and dismembring of the limme, whether it bee foot or arme, before he grow weake, and become unable to endure any such operation. In young persons you may at­tempt this operation; for I have adventured it with good successe; but in aged and crazie persons be not too bold: for the losse of the radicall moisture is more easily, by diet and medicaments, restored in those, than these: the other may, but these must die.

The topicall meanes.Now to come to the Topicall meanes, which are conve­nient for the curing of Fistula's in the joynts, (for as concer­ning the diet, and internall medicaments, I have spoken of them sufficiently already) you must note that you must have good anodine Cataplasmes to asswage paine, and good, ea­sie, and effectuall meanes to remove the Callus. If you ap­ply Mercurie sublimate, or Arsenick to remove the callosi­tie of Fistulaes in the great joynts, you shall alwayes cause a symptomaticall fever, and sometimes a mortification of the part, if the party be of a cacochymicall constitution.

Anodine meanes.As for the meanes which mitigate paine, I commend un­to you Fallopius his Cataplasme which he describeth in his Treatise of Ulcers, cap. 17. And it is this: ℞ ol. [...]umbrie. chamemel. & aneth. an. ℥ ij. furfur. flor. chamem. farin. hor. esypi. an. ℥ ii ss, vius allagant. ʒ x. fiat cataplasma. Renew it every twelfth houre.

How the Callus is removed.As for the removing of the callosity, no medicament is comparable in parity with the powder of Turbith minerall, before it be washed, being mingled with Terra Lemnia, si­gillata, Orientall bole, and the vomitive Vitrioll; this com­position may bee applied, being made up in forme of a trochisk, or mingled with populeon, and applied upon a tent. This medicament neither procureth extraordinary inflammation, or any horrible symptome.

As for the mundification, consolidation, and cicatrization of any Fistula in the joynt, after the removing of the Cal­lus, seeing these intentions may be compassed by the meanes [Page 193]which I delivered in my former Lecture, I will cease to trouble you with the repetition of them, and so will con­clude this Treatise concerning Fistula's.

If in Fistula's of the joints there be carosity of the bones, I will deliver the meanes to meet with this accident, when I shall discourse of the accidents of ulcers, before I make an end of this subject.

LECT. XV. Of Herpes Exedens.

HAving delivered unto you, what I thought pertinent of compound ulcers without malignity, method doth require, that I speake fully in like manner of maligne ul­cers.

What a ma­ligne ulcer is.Maligne is that, which differing from ordinary ulcers is not easily cured. By Gal. de erisib. l. 1. c. 3. not ulcers only, but all diseases which have a malignity annexed to them, all cal­led [...], and [...]. As a milde griefe hath a mild cause, and no horrible, or extraordinary symptomes, and yeeldeth to ordinary medicaments: so that which is maligne hath a fierce cause, extraordinary symptomes, and yeeldeth not to ordinary medicaments. These maligne ulcers doc happen, when such a [...] hath possessed the ulcerate part, that it doth corrupt the good nourishment which is sent to the part affected. The aliment sent to the part is corrupted, How the ali­ment of the part is corrup­ted. either by putrefaction, or a venomous quality communicated.

Then the signes of a maligne ulcer are three: First, it corrupteth the part which it invadeth, either by putrefacti­on, I or a maligne fretting quality.

II Secondly, It causeth extraordinary symptomes, as paine, and plentie of virulent and stinking matter.

III Thirdly, It yeeldeth not to ordinary medicaments.

Differences of [...]lig [...] ulcers.The differences of maligne ulcers are these: First, these ulcers are either ancient or moderne. I call those ancient, whereof mention is made by the ancient Authors: those I call moderne, which were onely knowne to late Writers: such are those ulcers which appeare in scorbuticall, and poc­kie persons, whereof I meane not to speake in this doctrine of ulcers, because they are symptomes of the scurvie and pocks, which cannot be cured unlesse the griefes themselves be cured. Now the setting downe of the curation of these diseases, will require large and particular Treatises.

Of maligne ulcers knowne to the ancients, some are lesse maligne, some more maligne. Of the lesse maligne there are three sorts: Herpes exedens, Phagedana, and No­me. Herpes exedens [...] in Greek, [...] being caused of thick and sharp choler, it corrodeth the skin even to the subjacent musculous flesh. It differeth from Phagedaena, because it erodeth the skin onely; but Phagedaena, both the skin and subjacent flesh. Celsus lib. 5. cap. 28. thus descri­beth it: Herpes fit cum cutis exulceratione, & est sine alti­tudine, latus, sublividus, inaequalis tamen, medium que sanescit extremis affectis, &c That is, a Herpes is caused when the skin is ulcerate. It is not deepe, but broad, of a livid colour, uneven; notwithstanding, the middle doth heale, the brims remaining sore. Wherefore if you perceive an ulcer to spread, and cause sundry other small ulcers, which reach no deeper than the skin, you may pronounce it to be Herpes exedens, or Formica ambulativa, or Corrosiva.

One thing is to be noted in the words of Celfu [...], [...]o [...]a. that a Herpes exedens may be of a livid colour; & so with thick and corrupt choler, that melancholy must be joyned, w ^ch is bred of Bilis atra, and so it must somewhat participate with a cancerous ulcer. And in truth, such ulcers often shew themselves in old persons about the beginning of the tailes of the muscules of the legs; and from these a moist noisome and stinking virulent matter will flow, and the ulcer it selfe will be very painfull, and rebellions.

The signesThe signes then of a Formica corrosiva are these: It onely corrodeth the skin, and so is not deepe, but broad; uneven it is, and sometimes of a livid or leady colour, if melancho­ly caused of Bilis atra be joyned with thick and putrid cho­ler: otherwise the brims of this ulcer, and the parts adjacent are of a yellowish colour, bewraying the humor, which is the materiall cause of this kinde of ulcer.

The Proguo­sticks.As for the Prognosticks: First, that Herpes exedens, which is caused onely of thick and putrid choler, is not ea­sily cured. I For first, the body which is troubled with such an ulcer, is not so soone altered; for the liver, the gall it selfe, and the Porus biliarius must be much out of frame, when they cannot make shift to dispatch this humor by the passages appointed for the evacuations of it; to wit, by the guts, and passages of the urine; but suffer it to passe to the habit of the body by the vessels which carry nourishment; to wit, veines and arteries.

II Secondly, because this humor being altogether contrary to nature, it causeth a [...], or ill constitution of the part; by the which the profitable nourishment which is sent to the part, for preservation of it, is corrupted: and so not onely the part affected is defrauded of aliment, but the parts adja­cent also are drawne to the same society of corruption.

III Let this be the third Prognostick: If a sincere Herpes exedens, proceeding onely of thick putrid choler be hardly cured, as hath beene proved; then if Bilis atra be annexed, surely the curation must be much more hard; for this is a humor which causeth more fearfull symptomes; as extreme paine, greater corrosion, and rebellion to ordinary medica­ments: and if the body hath gotten a habit of breeding of it, it is hard, without regeneration, to reduce it to its naturall constitution, and to hinder the provent and increase of it. Alchymists promise much, but for the most part they prove clouds without raine.

The causes of ulcers accor­ding to the Spagyricks.The Alchymists will have the efficient and materiall causes of all ulcers, to be the superfluity of the salt of the naturall [Page 196]balsome of the body, consisting of a due proportion of salt, sulphur, & Mercury. This superfluous salt being separate from the natural balsom by the expelling faculty, it is turned som­times to one, & somtimes to another part of the body, accor­ding as it is apt to be moved, according to its thinnesse or thicknesse, volatility or fixation. It setling in the part, it is more coagulate and calcined (the expelling faculty not be­ing able to expell it by the pores of the skin) and so it acqui­reth able to expell it by the pores of the skin) and so it acqui­reth a certaine corrosion, and is the cause of those ulcers, which luxe no maligne quality accompanying the salt. They will have a volatill and subtill salt, such as is in the nettle, and crowfoot to be the cause of an Erisypelas, and Herpes milia­ris; but a thicker and more fixed salt, such as that is of the Vitrioll, to be the causes of these ulcers, which corrode the parts adjacent: such a salt then as it, not very thicke, and throughly fixed, they will have to be the cause of Herpes ex­edens: but such a salt as is dense and thick, and throughly fixed, having some malignity, to be the efficient cause of a Phagedaena and Nome. This is their Philosophy of the ef­ficient, and materiall causes of these ulcers. And in truth it doth fitly represent to the eye of the understanding the na­ture of the humor, which dogmaticall Physicians will have to be the causes of ulcers. It is no herefie to maintaine ei­ther opinion; but he deserveth both credit and gaine, who shall performe the curation of those ulcers which the taketh in hand. Most Patients require rather speedy and easie cu­ration of their griefes, than learned discourses of them. Howsoever, these discourses are requisite for you, who meeting sometimes with scrupulous Physicians and Pati­ents, shall be drawn to shew your Theoricall as well as your Practicall part.

The curation of Herpes exedens.As for the curation: Three intentions ar required to cure a Herpes exedens: The first is, that the humor which floweth to the part be stayed. The second is, that the humor which is impacted in the part, be evacuate. The third is, the curation of the ulcer it selfe by convenient meanes.

1. Intention purging of the body.The first intention, which is the staying of the humor from flowing to the part affected, is performed by purging of the body from thick choler, and Bilis atra, if the Formica corro siva be of livid colour. To this purpose prescribe such a Potion ℞ electuar. lenit. ʒ vj. pulver. sancti ʒ j. aq. endi­viae ℥ iij. Misc. ut fiat potie. Or if the Patient be of a dain­ty taste, and loath electuaries and powders, then such a po­tion as this which I will set downe will be convenient: ℞ rhab. ʒ j. fol. sen. ʒ iij. ziij. zinzib. ʒ ss. spicae ℈ ss. Infundantur istaper hor. 2. in aq. font. serventis ℥ vj. deinde lento igne ex­halent ℥ iij. ac coletur decoctum, in quo dissolve mannae, & syru­pi decichor. cumrhab. aut syrup. Augustan. an. ℥ j. Misc. [...]t fiat potie. If the body of the party troubled with the ulcer, be plethorick and cacochymicall, it is convenient that hee take a purgative decoction for sundry dayes together. I will set downe such a one as a patterne; according to which you may frame unto your selves others like unto it in effi­cacie. ℞ rad. eichor. malvar. horrag. an. ℥ i ss. polypod. querc. The d [...] tion of a dec [...] ­ction purga­tive. ℥ ij. flor. borrag. bugloss. viol. an. pug. 1. fol. sen. & hermodactyl. an. ℥ ij. semin, anisi & faenicul. dulc. an. ʒ vj. rhab. ʒ vj. liqui­rit. ℥ i ss. Infundantur infundenda per noctens: in aq. font. fer­vent. lib. viij. sequente die adjectis reliqui [...] coq. ad medias ac coletur decoctum, quod aromatizetur cinan: ʒ vj. sumat ager mane lib. ss. ac tantundem hor. quarta pomeridiana. Between ten and eleven a clock in the morning, let the patient take some broth without bread, or a caudle, or aleberrie. These medicaments must be ministred cold in the summer time, and warme in the winter.

The second intention in curing of Herpes exedens, [...]. Intention was said to be the vacuation of the humor impacted in the part. This is effected by cathaereticall medicaments, or such as correct spungeous flesh: they are sharper than the strongest mun­dificatives.

The [...]ing di [...]ents of the [...]In the momuments of the Ancients, we finde the tro­chisks of Audron, Polyides, and Musa, exceedingly com­mended in such fretting and creeping ulcers: which I will [Page 198]set downe both to case you of the enquiring of them, and the better to apprehend and understand them. The Tro­chisci Andronis are thus deseribed: ℞ malicorii ʒx. alu­min. ʒiiij. vitriol. ʒxij. mirrh. ʒiiij. thur. aristol. rot. gal­lar. an. ʒviij. sal. armoniac. ʒiiij. fiat ex omnibus pulvis. Trochises Polyida are thus set downe: ℞ malicor. ʒvj. myrrh. ʒviij. alumin. ʒv. thur. ʒiiij. vitriol. ʒiij. The Tro­chisci Musae receive these things: ℞ alum. aloes, myrrh. vi­triol. an. ʒvj. croci ʒiij. malicor. ʒiiij. I should advise to cal­cine both the Alome and Vitrioll, which enter into these Trochisks, because they more strongly drie than those which are uncalcined. No substance is so fit as Vnguentu [...] populaeum to make up the Trochisks. When you are to use these Trochisks, you are to beat some of them to a subtill powder, and to mingle some of the powder with some con­venient unguent, taking a dramme of the powder for every ounce of the unguent: but what unguents are most fit you shall heare anon. These are the magistrall meanes, which the Ancients used in curing spreading ulcers.

The Topicall meanes of the moderne Chi­rurgeons.The moderne and neoterick Chirurgeons, not conten­ted with these, have found out other meanes not inferiour to these: The one is Mercuric precipitate, first nobilitate by Iohn de Vico, and fithence his time much used by all fa­mous Chirurgeons. This powder being washed with Plan­tane and Rose-water, and mingled with sarcoticall un­guents, doth admirably heale rheumatick ulcers in tender persons. If it being unwashed be mingled with alome cal­cined, taking ʒ ij. of it, and ʒ j. of Alome, it is a cathereti­call medicament, and fit to be applied to foule and spreading ulcers, such as Herpes exedens, Phagedaena, and Nome are. The other medicament invented by the late Chymists, is the Turbith minerall precipitate by the oyle of sulphur, or Vitrioll; it is now much used both in the practice of Phy­sick & Chirurgeric; it is ministred with good successe to per­sons infected with the Neapolitane lues; if they have either Cephalas Gallica, extreme paines in their heads, or venereall [Page 199]ulcers. As for the use of it in the practice of Chirurgery, I dare ascribe to my selfe the invention of it (in these parts) without suspition of any arrogancie. After that is precipi­tate and calcined, it is very white, and is an excellent escha­rioticall medicament, farre surpassing either Mercurie sub­limate or Arsenick: for it is more safe, and is not so painfull: besides this, it doth not cause such inflammations as these do, neither doth it procure so promptly symptomaticall fe­vers. Being washed, it is used to work these effefts which Mercurie precipitate doth, but much more effectually. To cause these medicaments to evacuate the peccant humors out of the parts affected, you are to mingle these with Para­celsus his mundificative; taking for every ounce of the un­guent, a dram either of the Mercurie precipitate, or of the Turbith minerall washed, if the parties grieved be of a ten­der constitution: or a dram of either, washed and mingled with Alumen ustum, in that quantity as hath beene said, if the bodies of the persons who are troubled with the ulcers be firme and hard, such as labouring men have. You are to continue the use of these topicall meanes, untill the ulcer spread no more, and be red, and very cleane. Having the two first indications required in curing of Herpes exedens, the third indication so followeth: which is the curation of the ul­cer it selfe.

To effect this, two scopes are required: The first, is to fill up the cavity caused by the losse of the skin. The se­cond, is to cicatrize the ulcers.

How the cavity in such ulcers is filled up. As for the first scope, those medicaments are to bee used which drie strongly, yet have no corrosive facultie. Paulus Aeginet. de art. wedond. lib. 4. cap. 20. hath sundry medi­caments for this griefe: if you peruse the Author, and con­fider the descriptions, you will esteem them but sorry ones. Tagaultius in institut. Chirurgicis lib. 1. de tumoribus praet. naturam, cap. 8. hath transcribed them, whom you may see: he hath done this, for no other cause (as I suppose) than this, that he had no better of his owne. Ambros. Para [...] lib. 6. c. 14. [Page 200]hath some medicaments for this griefe, which are not to be contemned. The first is this: ℞ ceruss. & tut. praepar. an. ℥ j. ol. ros. & adipis caprae an ℥ ij. cort. pini ℥ ss. cer. q. s. fiat unguen­tum. If you adde to these things some lead calcined, Pome­granate-rindes and flowers beat to powder, the unguent will be more effectuall. The second is, unguentum enulatum Mercurio, which he commendeth as an infallible medi­cament: if to every ounce of it you adde ʒ j. of the flowers of brimstone, you shall not misse of your purpose. He doth give one good note, that if you perceive the brims of the ulcer more and more to be eroded, you touch them with Aqua fortis, Oleum vitrioli, or Sulphuris, for by these meanes, sores which seeme uncurable are often healed. Hie­ron. Fabric. ab aq pendent. part. 2. lib. 1. cap. 28. adviseth to minister inwardly either Goats-milke, or the decoction of Sarsa pariglia, and without all doubt both are good; but there is no parity betweene the Goats-milk, and the decocti­on of Sarsa: there is none of this company, who is igno­rant of the faculty of Sarsa in curing all maligne, and cree­ping ulcers: Goats-milke may have some place, if the party be extenuare, and a Hectick fever feared.

As for the locall medicaments, he commendeth this ce­rat. ℞ succi depaeto ℥iij. cera citrinae ℥ ij. rosin. pini ℥ ss. ol. myr­tini ℥ ss. terebinthin. ℥ j. Bulliant ista donec consumptus sit succus tabaccae, ae fiat coratum molle. I will not stick to com­municat with you the description of an unguent of Tabac­ca which I use mine owne selfe, neithe [...] [...]m I ashamed to preferre it before all others of this kinde: the descriptions whereof I have seene. Thus then it is to be made: ℞ axung. porcin. ℥ viij colophon. ℥ iiij. cer. ℥ iij. succi de pato lib. 1. pae­ti contus. man. ij. coq. haec ad succi consumpt: tum adde gani­ [...]i Elemni, vernicis alb terebinthin. an. ℥ j. ac coletur un­guentum. It is an excellent incarnative in wounds as well as ulcers: besides this, no better mundificative can be devised in tender bodies, if one dramme of Mercurie precipitate washed, or of the yellow Turbith be mingled with an ounce [Page 201]of it. When you perceive the ulcers to bee filled up; How [...] ul­cers are skin­ned. then skin them with this Desiccative of mine: ℞ Sevi dmar. lb. ss. Axung. porcin. ℥iij. Cer. veruic. colophon. an. ℥ij. hisce ab [...]gne amot is insperge calaminar. in vino albo ter extinct. ℥j. Lythargyr. Plumbi calcin. Aeris usti, Henrici rub. an. ℥ ss. fiat ceratum. The two prime medicaments which are set downe in Anndotaries to effect this, are Deficativum ru­brum, and Ʋnguentum de minio, otherwayes called Vuguen­tum rubrum caphuratum. Your Emplaster de Minio doth not come neere to these in efficacie. Let this which I have delivered serve for the discerning and curing of Herpes mi­liaris, or Formica ambulativa, or corrosiva.

LECT. XVI. Of Phagedena end Nome.

HAving discoursed in the former Lecture of the first kind of the lesse maligne ulcers, which were said to be Herpes exedens, or Formica ambulativa, or corrosiva, I am to procced to the other two, to wit, Phagedaena and Nome and because they have not a small resemblance, by reason of the similitude of Symptomes, I will joyntly speake of both: and because what latter barbarous writers have delivered of them is confused, I wil labor diligently to distinguish them, that you shall not need to feare to talke of them before the most learned, if occasion shall be offered. These late writers, in the number of whom are Gordonius, Buyrus, Ʋalescus de Taranta, Ioannes de Vigo, Petrus de Argelata, Guido de Cau­liaco, and sundrie others, who lived in our fore-fathers times, when barbarousnesse had exiled eloquence, and ig­norance learning: and when all liberall Arts and Sciences had suffered a strange and fearefull eclips, although they set downe sometimes medicaments not to bee rejected; yet I would not have you to trust much to their discourses, or to [Page 202]labour to imitate their phrases. And as the Arabian Physi­cians doe farre exceed these, so the Grecians are to bee pre­ferred unto the Arabians in their discourses, although they come not neere unto the Arabians in seeting downe reme­dies for the griefes.

If you consider either the varietie or pleasantnesse of them: for many ages together here in the West, Hippe­crates, Galen, Paulus Aegineta, Oribasins, Alexander Trallianus, and the rest of the Greeke Authors lay unrespe­cted, and the Arabians only were in request, although most rudely and barbarously translated; which no judicious and impartiall Preader of their monuments will or can deny. Wherefore concerning these griefes, I will deliver unto you what the Grecians, the parents of Physicke, and all other liberall Arts and Sciences, have delivered methodi­cally: As for the medicaments which are to be applyed, I will pick out the best, which either the ancient or the moderne writers have revealed to us: neither will I conceale from you what I have found effectuall in mine owne practice.

The Etymon of the name. [...] then is a Greeke denomination, derived from [...], which is edo, to eat: so that [...] may be called in Latine Vlcus exedens: in English an eating ulcer.

The significa­tions of it.It signifieth two things: First, it is taken for all manner of corroding ulcers, which seize not upon the skin onely, but upon the subjacent flesh also: In this signification it is taken by the ancient Physicians, who flourished before Ga­len [...] time. Secondly, it is taken for a speciall kinde of ulcer by the later Physicians, as Galen. Comment. In aphor. 45. lib. 6. aphor. Hippoc. witnesseth. And it is fit that in discourses and writings all things bee set downe distinctly; for this much helpeth the memorie.

The descrip­ion of it.It being taken thus for a particular kinde of ulcer, it may be described an ulcer tumified without putrefaction, deepe and corroding the parts adjacent: In that it is said to bee an ulcer tumified, it is distinguished from [...], the third kinde of eating ulcers, which corrodeth the sound [Page 203]parts neere unto it, without any remarkable tumor, as mor­at large you shall heare anon. It is said to be deepe, becaus It fretreth not onely the skin, but the fleshy part also unde the skin. And by this circumstance it is distinguished from Herpos exedens, which is an exulceration of the skin only. So this kinde of ulcer is not without cause called [...], or ulcus exedens, because it eateth and fretteth the sound parts neere unto it, making them of this fame condition with the diseased.

The mater [...] cause of it.It is caused of the bilious humor adust inclining to that melancholy humor, which is superfluous and not naturall; yet it is not to bee thought that it it very thicke, as is that which procureth a cancer: or so thin as that which causeth Erisypelas and Herpes. This humor, by reason of the plentifulnes of it, doth fill the brims of the ulcer, and causeth a swelling to appeare; but by reason of its malignitie and acrimonie, it fretteth the parts adjacent which are sound. Neverthelesse this humor is without putrefaction, which is alwaies in the ulcer called [...], or ulcus depascens, an ul­cer which feedeth upon the parts adjacent that are sound; for in Phagedaena there is erosion proceeding of a ma­ligne qualitie without putrefaction, or corruption of the whole substance, which is alwayes joyned with malignitie in a [...].

The signes.Then the pathognomonicall signes of a Phagedaena are these: First, it corrodeth not the skin onely, as Herpes ex­edens doth, but the subjacent flesh also: The second is this, that in Phagedaemicall ulcers the brims are tumified: The third is, that although there is erosion of the sound parts adjacent, yet there is no putrefaction: And by these two last signes it is distinguis [...]ed from [...], ulcus depascens, a consuming ulcer.

[...] in Greeke, in Latine Vleus depascens, [...]. in English a feeding or consuming ulcer. It is derived from [...], The Etymon, Depas­cor, I feed upon: for it passing from the diseased parts, it seizeth upon the sound and whole parts, and feedeth up­on [Page 204]them by communicating unto them both malignitie and putrefaction. It may be thus described.

[...], it is a corrosive ulcer; without any tumor in the brims, The [...] indued not onely with malignitie, but putrefaction, or corruption of the part, also feeding upon the adjacent sound parts, and that deeply. In that it is termed a corrosive ulcer or maligne, it agroeth in this with Herpes miliaris and Phagedaena. But whereas it is said to bee without any tu­mor in the brims, I meane remarkable, and to have putrefa­ction annexed, by these two signes it is distinguished from Phagedaena, or Vlcus oxedens, an eating ulcer: for so I think fit to name it; that in denomination also it may bee knowne from [...] ulcus depascens, a consuming or feeding ulcer. Last of all, where it is affirmed that it doth corrode not superficially onely the skin, but the subjacent fleshy parts also: as it hath this common with Phagedaena, so by this it is knowne from Herpes exedens; for this causeth ex­ulceration onely in the skin.

[...] and [...]lephian ul­ce [...];But seeing there is often mention made in the monuments of the ancient Physicians, of [...], and [...], of Chironian and Telephian ulcers, as of Galen, Paulus Aegi­neta, and others who follow them, it will not bee amisse to discourse a little of such ulcers: that you may know what is meant by these denominations, and bee able to answer any, if you be demanded what is meant by these termes.

Of these ulcers thus speaketh Galen. de tumorib. praeter nat. c. 13. [...], &c. whose discourse may bee thus Englished: Those ulcers which consume, and meddle with the sound parts adjacent, or about, corroding them; all these are called Phagedaenica. So that Phagedaena is framed of the ulcer and the tumor. Herpes in like manner doth erode the parts about it; but it resteth in the skin onely: but Phage­daena doth extend it selfe as well to the subjacent parts as to the skin. But it is to no purpose to call ulcers Chironian, or Telephian. It is sufficient to call all such ulcers [...], Ma­ligna: that is, of an ill condition or qualitie. By this pas­sage [Page 205]of Galen translated by mee, you may gather three con­clusions.

The first is, that in a Phagedaena there is an erosion not onely of the skin; but of the fleshy parts subjacent also, by the which it is distinguished from Herpes exedens, or For­mica ambulativa, whereof I discoursed in my former Lecture.

The second is, that in a Phagedaena there is a tumor in the brims of the ulcer, whereas there is none in a [...], or a consuming ulcer, called by Latine Authors Vlcus depascens, to distinguish it from Vlcus exedens, an eating ulcer.

The third is, that the denomination of Chironian and Telephian ulcers, doe onely signifie maligne ulcers in gene­rall; but no speciall kinde of ulcer in particular. In Paulus Aegineta de art. medend. lib. 4. c. 46. bearing this inscrip­tion of ulcers of an evill condition, which are called Chiro­nian and Telephian by Physicians: these words are read as I have translated them. Old and inveterate ulcers, which hardly admit skinning, which are named [...], or ma­ligne, some call Chironian, as if they did require the hand of the Centaure Chiron, the most excellent in the Art of curing: others call them Telephian, such as Telephus was troubled with, which require the helpfull hand of Achilles, who cured him. So hee jumpeth with Galen, that these ti­tles were ascribed to all maligne ulcers; but did point at no particular kinde of ulcer.

Now it cannot be amisse briefly to shew unto you what men Chiron and Telephus were, seeing they are so famously recorded by the Poets: They who are Scholers amongst you, cannot but be delighted when the studies of the youth are brought to remembrance. Chiron. Chiron then was one of the Centaures, which were a people who inhabited the places neere to Pelion, the hill of Thessaly. These first began to breake great horses, and to fight on horse-back: wherefore the neighbouring people, when it first saw them, belee­ved them to bee strange creatures, composed and framed [Page 206]partly of humane, partly of horses members: O strange simplicitie [...] This Chiron was the sonne of Sa [...]ne and Phillyra. It seemeth that he was called Chiron, because hee had a singular dexteritie in the manuall operations of Chi­rurgerie: for [...], in Greeke is an hand. He taught Aesculapius the Art of curing: Pelcus, Achilles his fa­ther, was his sonne in law, of whose daughter Thetis he be­gat Achilles, so much commended for valour and strength by the Heathen Poets. He taught Achilles being his grand­child, Chirurgerie, playing upon the Citherne, and horse­manship. The two kindes of Centorie, the greater and the lesser, Centaurium majus & minus, are named of him, where­of there is great use in the practice both of Physick and Chirurgerie. It is like that hee was fortunate in the curing of maligne ulcers, by reason of the great skill which he had in the knowledge of the facultie of plants. Hee lived but 2690. yeares after the creation of the world, that is, 77. yeares before the destruction of Troy, which fell out Anno mundi 2767. Then 2685. yeares are expired sithence fa­mous Chiron lived. This may serve to prove the antiquitie of Chirurgerie. Posteritie for his worth named the ninth signe of the Zodiack Sagittarius, who ruleth the thighs, from him: From whence Ʋirgil of the twelve Signes:

By this we may gather how vertue and learning were regar­ded in the rude and simple ages, which are verie little estee­med in these civill times, wherein most men are given to en­joy their pleasures, which will cost them too deare, when the generall accompt shall be made.

Telephus was one of Hercules his sonnes, Telephus. who being a­dopted by the King of Mysia who then reigned, after his death succeeded him in government. When he would have hindred the Grecians marching towards Troy, from passing [Page 207]thorow his countrey, in combat he was wounded by Achil­les; but afterward being reconciled to Achilles, he was cu­red by him, hee mingling with either an unguent or a cata­plasme, (for Malagma signifieth both) the rust of his speare, and it is not unlikely; for there is none here (as I suppose) who knoweth not the facultie of Crocus Martis in cicatri­zing of rheumatike ulcers, it drying strongly without any sharpnesse; unto which the rust of old iron washed and pre­pared commeth verie neere. So Achilles made sufficient proofe of his skill in the Art of Chirurgerie, which he lear­ned of his grand-father Chiron. Goe to then, let effeminate Hind-calves despise the Art of Chirurgerie, which so emi­nent a person as Achilles was, was not ashamed to practise. From Achilles Millefole is called Sideritis Achillea, Achilles his Star-woort: and it may bee that it was one of the chie­fest ingredients of the cataplasme: surely it is an excellent healing plant. To conclude then this point: maligne ul­cers who are not easily cured, are called Chironia, because Chiron was able to cure them, and Telephia because Tele­phus was troubled long with such an one.

Now time calleth to goe forward in the handling of these corrosive ulcers: but before I set downe the manner of cu­ring, the predictions of the events which are like to fall out in the course of curation are first to be set downe. I. Presages. Neither of both these corrosive ulcers are of easie curation, what body soever they light upon; and for three causes: for first, there is a [...], an ill constitution and temperature of the part, by the which the aliment which is sent to the part, al­though it be good, is corrupted. Secondly, a fresh supply of noxious humors is sent most commonly to maintaine the griefe. Thirdly, because the ordinarie medicaments which are applyed with good successe most commonly to other ul­cers, in these ulcers are ineffectuall. II. If these ulcers light upon a cacochymicall body, the case is yet worse: for the constitution of the body must be altered before these griefes can be cured, which is a matter of no small difficultie. III. If [Page 208]these seize upon decrepit persons, the case is in a manner de­sperate: for in such the naturall heat is weake, and the radi­call moysture almost spent: so that great store of corrupt and saltish humors are bred in the bodies of such, which being sent to the weak parts ulcerate, increase these griefes.

The intentions of curing.The curation is performed by three meanes: to wit, a convenient diet, internall medicaments, and locall applica­tions: As for the diet, Dict. those meats and drinks must be used which afford a laudable juyce; whereof I have spoken be­fore: and in that measure that the naturall heat may bee able to concoct them, that no superfluities be bred. Besides this, meats which are easily corrupted in the stomack are to be shunned, as milk meats, summer fruits, and salt meats: slimie fishes, and Swines flesh are to be shunned, because they afford no good nourishment.

Internall me­dicaments.Of internall medicaments I meane not to speake much, because this would require a longer time than now can be permitted. If a person be troubled with an ordinarie Phagedaena or Nome, be of strong constitution and pletho­rick, you may minister unto such Hiera Diacolocynthidos magistralis, Apud Rinedaeum de hieris cap. 4. or Pilulae aggregativae majores: If the partie be weake, you may minister Piluae stomachicae: Those which I use are these: ℞ Aloes ʒij. Rhab. Agar. Trochiscat. an. ʒj. Mirrhae, ℈ij. Mastich. ℈j. Syrup. Augustani, q. s. ut fiat massula. dos. Pilul. 2. pond. ʒss. à primo somno: vel sumat unam paulo ante coenam, alteram paulo antequam ineatur som­nus. Whether the parties be strong or weake, who are trou­bled with these corrosive ulcers, they are to use decoctions made of Sarsaparilla, Guajack, Radix Chinae, Tormentil, Bistort and Comfrey roots, with the which you are to joyne some Vulneraries, as Agrimony, the tops of S. Iohns woort, Sanicle, our Ladies mantle, mountaine and garden Avens, Salomons seale.

Nomae verende­rum. Nomae of the privie parts were knowne to the ancient writers, as we may perceive by Paulus Aeginetae de Art. med. lib. 4. c. 44. sub finem. In our times they seldome are seene [Page 209]to proceed from any other cause, than impure copulation. Such are often seene, in the which the whole Praepatium doth sometimes rot away. These corroding venereall ulcers require the generall cure of the Neopolitan disease, besides effectuall Topicks.

The applica­tion of Topi­call meanes.Now followeth the last indication of curing these cor­rosive ulcers, which is the application of locall medica­ments. In a Phagedaena wherein there is a tumor of the brims, you are to apply Vuguentum populeum, and Vnguentum album caphuratum, mixed together in equall quantitie to them. The second thing which I would have you to observe is this, that Nome, or ulcus depascens doth require stronger Topicks than Phagedaena, or ulcus exedens. Marke then these medicaments which I have picked out of Aegineta: I. ℞ Calcis viva, Vitriol. Vomit. an. ʒij. Auripigmenti ʒj. fiat pulvis subtili [...] ex his. For a Phagedaena apply the un­guent of Tobacco, having some of this powder mingled with it, as ʒij. for an ounce of the unguent. If you have to doe with a Nome, make a liniment of this powder and Oxymel, and apply it to the ulcer. II. ℞ Vitriol. albi ℥jss. Croci Martis, ʒvj. Gahar. ʒviij. Crocus Martis well prepa­red farre exceedeth their Squamae ferri, the scales of iron. Receive this medicament of my description: ℞ Calc. viv. Vitriol. albi, Auripigmenti, an ℥j. Malicor. Balanstior. cornu Cervi ust. Gallar. Pumicis calcinati, Alum. usti, rad. Aristol. rot. an. ℥ss. Croci Martis, Plumbi calcinati, aris usti, an. ʒvj. Cum melle despumate fiat Electuarium. Let mee commend unto you an Aegyptiacum which is not the vulgar: Primo infundantur absynthium, Cardum benedictus, Centanrium mi­nus, Scordium, Chamaedrys, Malicorium, Balaustia, Gallae, & rad. Aristol. rot. in aceto fortiffimo: ℞ hujus Aceti colati ℥vij. Aerug. ℥v. Mell. ℥xiiij. coq. lento igne ad unguenti con­sistentiam. This medicament is effectuall in venereall ulcers of the throat, and privie parts, and in all sordid ulcers.

How long you are to use these medicaments.You are to continue the application of these medica­ments untill you see the corrosion stayed, and the ulcers red [Page 210]and well mundified. When you have perceived this, incar­nate the ulcers with some of the consolidatives before set downe by me. Last of all, cicatrize the sores with such epu­loticall meanes as I set downe in my former Lecture.

In admoni­tion.But to shut up the delivery of these ulcers, which are of the mildest sort of the maligne, so much as concerneth the knowing and curing of them: let mee advise you that you promise no sudden cure of any ulcer, if it hath continued but one moneth: for the bodies of the inhabitants of this Iland, are for the most part plethorick, they will observe no good diet, and will not bee estranged from the sacrifice of Ʋenus. It is a strange thing to see what corrupt and ugly stuffe is covered by the curtaines of a beautifull skin, in a number of them. I make no doubt but many amongst you, who are least employed in practice, have had sundrie pati­ents, who have come to you pretending that they were only troubled with a pimple of the forehead, a red eye, a diffi­cultie of swallowing, shedding of the haire, watching in the night time, and paines betweene and in the joynts: whereas indeed these griefes were venereall pustules, the Neapolitan Opthalmia, virulent ulcers of the throat, Alope­cia Gallica, the vigils of Venus, & last of all the pockie joynt ague. It is no hard matter to those who are judicious, to finde out the symptomes of that griefe, which Vigo, the fa­ther of Empyricks, doth affirme to be able to bring the ac­cidents of all diseases in particular, according to the diver­sitie of the constitution of the bodies upon the which it sei­zeth. If therefore you see any ulcers, in what part soever, more painfull than the solution of such an unitie requireth, that it yeeldeth not to ordinarie medicaments appoyn­ted for ulcers, than suspect that there is a latent malig­nitie. Value not therefore your credit at a trifle, bee not too bountifull in promises, lest they bee required at your hands: suspect and pronounce in doubtfull cases alwayes the worst; for the best will save it selfe. Thus doing, you shall bring in no new practice. Many practicers there be, it [Page 211]is uncertaine whether of ignorance or policie, who aggra­vate the griefe of those who wholly commit themselves to them, that the greater credit and gaine may redound unto themselves, if the persons diseased escape, and the lesse blame may be laid to their charge if they die. In these proceedings there are two excellent teachers, Skill and Conscience: The first is to enable, the second is to direct practice. So much I thought good to deliver unto you of the three mildest kinds of maligne ulcers, to wit, Herpes exedens, Phagedaena, and Nome.

LECT. XVII. Of a Cancer and a cancerous ulcer.

WHen I ceased from reading last, I put an end to the doctrine of ulcers lesse maligne. Now am I to discourse of these ulcers which are accompted most maligne, and are to indeed. Of these there are two sorts, a cancerous ulcer, and a leprous ulcer: of purpose I referred the hand­ling of a Cancer and a cancerous ulcer to this place, because it fitteth them best, as you may perceive anon. First then, I will discourse of a cancerous tumor, and then of a cance­rous ulcer. A cancerous tumor is called by Galen, de tumor. praet. nat. c. 12. [...], in Latine Cancrosus tumor; It may be thus defined:

The descripti­on of a cance­rous tumor.It is a tumor proceeding of Bilis atra, round, hard, un­equall, of a leady colour, hot, verie painfull to the patient, and having full veines implanted in the adjacent parts. For as a crab, in Latine Cancer, The cause of the name. hath a body and feet of a livid colour, and whatsoever it claspeth with the clawes, it hol­deth it firmly, so this griefe is of a livid colour, and so gir­deth the part which it possesseth, that it seemeth to bee nai­led to the part, and about it the full veines exquisitely imi­tate [Page 212]the feet of a crab: and from these similitudes the tumor hath its name.

In the description the tumor is said to proceed from Atra bilis, or melancholy, or choler adust; for it signified both: The differen­ces of atra bilis. for there are two sorts of Atra bilis: the one is caused of naturall melancholy adust: the other is caused of yellow choler burned, and it is much more maligne than the former. See Galen, lib. 3. de atra bile.

The efficient causes.There are sundry efficient causes which ingender these humors in our bodies: First, a strong hot distemperature of the liver, which burneth the naturall melancholy and yel­low choler, and so hatcheth this Bilis atra. Secondly, accor­ding to Galen, c. 10. lib. 2. ad Glaucon. the spleene by reason of its weaknesse and distemperature, doth not draw unto it selfe the superfluous naturall melancholy, and so staying long without it owne proper place it is inflamed and burned. Thirdly, sometimes this humor is caused of the menstruall courses, and Hemorrhodes stopped. Fourthly, verie often an ill diet breedeth this humor, as when one useth meats of an ill juyce, and of a thick substance and hot qualitie, as gar­lick, onions, leekes, snailes, venison, pease and beanes, and such like. But there is nothing more pernicious than the immoderate use of potent and strong wines, such are all kindes of Sacks, and Greeke wines, which exceedingly burne the humors in the masse of the bloud. An hot aire and perturbations of the minde set forward also this hu­mor. But seeing there are degrees of malignitie in Atra bilis; The cause of a Cancer not ul­cerate and ul­cerate. the cancerous tumor, or Cancer not ulcerate, is cau­sed of the milder sort of it; but a Cancer ulcerate is procu­red of that kinde which is most maligne.

Why a Cancer is not bred of naturall me­lancholy.Take heed that you imagine not any sort of Cancer to be engendred of natural melancholy, which Galen, de art. curat. ad Glaucon. c. 10. lib. 2. affirmeth to be that part of the bloud which representeth the wine lees, when it is made by the li­ver, which is drawne by the spleen, wherwith it is nourished: for superfluous naturall melancholy causeth only Scyrrhus.

The materiall cause of a Can­cer.Of the materiall cause of a Cancer thus speaketh Galen, De tumor. praet. nat, c. 12. When Bilis atra seateth it selfe in the flesh, if it bee sharp it corrodeth the adjacent flesh, and doth cause an ulcer; but if it be milder, it procureth a Can­cer without ulceration. Aeginet. lib. 6. c. 45. hath these words: A Cancer is a tumor unequall, with tumified brims, ugly to behold, of a leady colour, indolent, sometimes not ulcerate, which Hippocrates calleth [...], or hidden; sometimes ulcerate: And seeing it hath it beginning from Atra bilis, for the most part it becommeth ulcerate: So he.

That a Cancer can hardly bee without paine.Where you are to note, that he affirmeth a Cancer to be indolent, or without paine, which is contrarie both to ex­perience and reason: Celsus also, lib. 5. c. 28. seemeth to grant some Cancers to be without paine. For first, I there is a solution of unitie, by reason of plentifull matter stretch­ing the parts, and pressing the sensible parts. Secondly, II there is a verie hot distemperature, by reason of the humor which cannot be discussed, which of a necessitie must cause paine. The explication of the rest of the particles set downe in the description, shall be set downe in the deliverie of the signes, to avoyd tedious repetition of the same things.

The signes of a Cancer.The signes then of a cancerous tumor are these. I. Ac­cording to Galen, lib. 14. method. c. 9. A Cancer in the be­ginning is hardly discerned: for the symptomes are but mild, and sometimes it is no bigger than a pease, or a beane, or a filbert-nut. II. It is hard, by reason of the thicknesse of the humor, which withstandeth the touch. III. It is of a leady colour, representing the colour of the humor where­of it is bred, yea the more maligne it is, the more livid and black it appeareth. IV. The tumor is verie painfull: First, because Atra bilis the materiall cause of it is hot: Secondly, because no heat can breath out, the substance of the Cancer being so compact. V. It is round, because the matter being thick, is not so apt to fleet abroad. VI. It is unequall, by reason of the ebullition of the humor, which notwithstan­ding is not equally active in all parts of the tumor. Last of [Page 214]all, a Cancer bath black or livid veines extended to the ad­jacent parts; for this atrabilious humor cannot sweat out of the veines, which is the cause that they appeare verie full.

What parts a Cancer may possesse.As for the parts which a Cancer invadeth, although it may breed in all parts of the body, yet it is most often seene in the brests and matrices of women, and in the lips and nose of the face. I have seene it also in ano, and in the top of the yard.

Why it doth possesse the brest.The brests most promptly receive this atrabilious humor, because they are of glandulous and loose substance: Besides, the Mammariae veines meet with the Vterinae under the straight muscules of the belly; so that the matrix may dis­charge it selfe of adust and feculent melancholy bloud by regurgitation, which may cause a Cancer if it passe to the dugs.

Why the ma­trix.A Cancer in like manner doth appeare verie often in the matrix, by reason of the detention of the menstruous bloud, which staying above the ordinarie time is burned. The lips also are spungeous & soft, and so apt to receive atra bilis, the materiall cause of a Cancer. Galen, de art. curat. ad Glauco­nem, lib. 2. c. 10. hath these words: Cancerous tumors may bee in all parts of the body, but chiefly in the paps of women, which have not their purgation according to na­ture. Aeginet. lib. 6. c. 45. saith; A Cancer doth happen to sundry places of the body, but chiefly to the matrix and paps of women.

As for the predictions before curing, Prognosticks. receive these: I. Al­though Cancers may appeare in all the quarters of the yeare, yet most commonly they shew themselves about the ending of the summer, and during the whole time of the harvest: because in these seasons, the melancholick exceedingly in­creaseth, and humors become adust. II. No Cancer is easi­ly cured; for if all ulcerate Cancers be incurable, according to Galen, c. 5. lib. de atra bile: no cancerous tumor can easily bee cured, it having the same efficient cause. III. A [Page 215]Cancer not ulcerate, if it hath possessed any deepe cavitie of the body, as the matrix or anus, it is not to bee dealt withall, according to Hippoc. lib. 6. aphor. 38.

The explica­tion of Hippo­crates.You must understand that hee meaneth the curing by ex­cision, causticall meanes, or ustion: for the ulcer will not admit cicatrization, and so the diseased parties live in conti­nuall paine and filthinesse, and at the last die miserably. But hee forbiddeth not the application of locall meanes, which asswage paine and gently mundifie. IV. Cancerous tumors in the outward parts, and onely superficiall in the begin­ning, may be cured according to Galen, lib. 2. c. 10. ad Glau­con. V. When cancerous tumors are come to a remarkable bignesse, they onely can bee cured by extirpation. VI. If a Cancer not ulcerate hath possessed the matrix, the partie fee­leth great paine in the groines, and hath often a difficultie in making of water: If the Cancer be ulcerate, it sendeth out a loathsome and cadaverous smell, the vapor whereof ascen­ding to the heart and braine, causeth sometimes fainting. VII. If the afflicted partie be weake, and the cancerous tu­mor be inveterate, or of along continuance, it is not to bee dealt withall with excision, adustion, or potentiall cauterie: onely lenitives are to bee used to procure a palliative cure: for sundry have continued even to their decrepit old age, with a Cancer not ulcerate.

The curation of a cancerous tumor.Now it is time to addresse my selfe to the setting downe of the curation of a cancerous tumor: The meanes appoin­ted for it are three, Dieteticall, Pharmaceuticall, and Chi­rurgicall.

I As for the Dieteticall meanes, all thick and strong wines are to be shunned, course bread, Cabbage, and Colwoort, Cheese, old and salt flesh, old Hares, and Venison: Watch­ing, immoderate labour and griefe are to be shunned; as also all other things, which thicken the bloud, and inflame the humors. Let the diet bee cooling and moystning. Barley creame is good, and Ptisan, Mallow flowers and roots, Succorie flowers and roots, Borrage, Buglosse, Violet [...] [Page 218]vineger. Many commend a cataplasme of Raisms stoned, Rue, and the leaves of Night-shade. This Fabricius, ab a­qua pendent. commendeth: ℞ Solan. hort. virg. aureae, son­chi, an. man. ij. coctis in aqua & contusis adde far. siligin. lb. j. Ol. ros. ℥v. fiat cataplasma. The Chirurgeons in Italy had in Fabricius his time, a medicament of greene Frogs effectuall against a Cancer, and in the Gout: thus it is made; Take a good number of greene Frogs, whose mouths fill with sweet butter, afterward put these Frogs in an earthen pot well glazed, having a cover, and the bottome full of holes: place this pot in the mouth of another earthen pot placed in the ground; lute these well together, and the cover of the upper pot: then for the space of three houres, let a gentle fire of Charcole bee set about the upper pot, to drive downe all moysture and fat to the lower: when the pots are cold, take out the Frogs out of the upper pot, and beat them untill you feele no roughnesse betweene your fingers: Last of all, mingle the fat and moysture in the lower pot, with this substance, and keepe this mixture in a cleane gal­ley-pot. Receive also this medicament from Parrey. Lib. 6. de tumor. praet. nat. c. xxx. ℞ Theriac. veter. Succi lactuc. & o. Ros. an. ℥j. Succi cancrorum ℥ss. Vitellos ovorum indu­ratos numero 2. Ducantur in mortario plumbeo ad unguenti consistentiam. Hee also in this same chapter commendeth a thin plate of reed anointed with quick-silver. How often the Cancer is to be dressed. The Cancer is to be dressed morning and evening. So much then of a cancerous tumor, or a Cancer not ulcerate, now am I to de­liver unto you the curation of a Cancer ulcerate.

Of a cancerous ulcer.A cancerous ulcer is an ugly ulcer, having a most stinking smell, thick lips, and turned outward, greenish and fretted, which yeeldeth a Sanies black, or of a dark yellow colour, and is exceeding painfull Riolan the father in his Chirurge­rie, in the second Section of ulcers, c. 13. affirmeth this sa­nious matter to be a strong poyson. No death could be de­vised too cruell for such an one as should give it to a man.

The signes.The partials of the definition containe the signes of a [Page 219]Cancel ulcerate, so that I need not to insist longer in the explication of this point.

The differen­ces.Of a cancerous ulcer there are two meane differences, Lupus and Noli me tangere: that is in the thigh or leg, this in the face. A Cancer in other parts of the body hath no particular denomination; but doth retaine the generall ap­pellation, with addition of the part affected, as a Cancer of the brest.

A Note.One thing is to bee noted, that in other countries, if a Lupus be troublesome, they apply the flesh of an hen, chic­ken, pigeon, whelp, or kitling cut asunder, according to the length: for so the furie of the disease ceaseth, the malignitie of the sanies is eased, and the corrosion is stayd: Sec Riolan and Ambrose Parrey in the places before cited.

The Progno­sticks.As for the prognosticks: First, if a Cancer not ulcerate be of hard curation, an ulcerate must bee of an harder: Se­condly, if the partie bee weake and feverish, I the matter is desperate. II

The curation.As for the curation, the diet, phlebotomie and purging, which I have set downe for the curing of a cancerous tumor will serve here also: wherefore this onely remaineth to set downe the locall medicaments.

Locall meanes.This then shall be the first: ℞ Plumbi usti & loti, Tutiae & Thuris, an. ℥v. Absynthii. ℥j. ol Ros. lb. ss. Cerae, ℥jss. I Succi Solani, q.s. Ducantur in mortario plumbeo ad unguenti consi­stentiam. Apply this upon pledgets of lint, or fine tow: a­bove this, to asswage paine, apply a cataplasme of the leaves of Succorie, marish-Mallow, and the white Poppie bea­ten, and tempered with oyle of Roses.

II The second shall bee the application of the juyce of Night-shade out of Tagaultiut, tractat. de ulcer, c. 19. Moysten a double cloath in the juyce of the Night-shade, and apply it to the ulcer; then apply above this cloath a pledget of tow or wooll moystened in this same liquor. You may keepe the juyces of herbs all the yeare long, How the juyce of herbs is to be kept. by putting them in a glasse, having a fosset in the bottome, and [Page 220]powring oyle upon the juyce, that it may bee three inches thick above the juyce.

III You may also use the juyce of our English Tobacco, and those which I named in curing of a Cancer not ulcerate.

IV The distilled water of the herbs with Camphir, applyed after this manner is effectuall.

V If you dissolve the Camphir first in the spirit of wine, it will mingle the better with the waters: ℞ Mellis verbascini, ℥ij. pulv. Malicor. ʒiij. ol. Nuc. ℥j. Misc.

VI This medicament of Fallopius is excellent: ℞ ol. Ros. & Omphacini, De ulcerib. c. 12. an. ℥vj. ol. Myrtini & unguent. popul. an. ℥iij. fol. Solan. & Plantag. an. man. ij. Bulliant lentissimo igne ad Succorum consumptionem, tum colentur: colatura adde cera ℥iiij. hac eliquata omnia amoveantur ab igne: Quum adhue tepent adde lithargyr. ℥vj. Cerussae. ℥ij. Tutiae, ʒij. Plumbi usti ʒijss. Ducantur in mortario plumbeo per duas horas. All these medicaments which I have set downe only are to stay the increase of a Cancer, and to abate the raging paine in those Cancers which are large and deepe.

The use of cor­rosives.If a Cancer be but superficiall, it may bee eaten out with Arsenick sublimed: The manner of the sublimation of it and use I did shew, when I discoursed of Fistula's.

The curation of a Noli me tangere.A Noli me tangere in the lip, if it hath not eroded a great quantitie, it may bee cured as an hare-lip, with little de­formitie.

For a Cancer in the matrix or anus.As for a Cancer in the matrix or anus, use this medica­ment: ℞ Stercor. bubul. lb. iiij. herb. Robert. Plantag. Sem­pervivi, Hyoscyami, Portular. Lacturend. an. man. j. Canc. fluviat. numero 12. Contundantur omnia, ac distillentur in Alembico plumbeo, imbuatur caphura, ac frequentèr injicia­tur aut sola, aut cum aqua spermat. ranar. As for the method of the extirpation of a Cancer, I will reserve it to that part of Chirurgerie which teacheth the way to remove things inconvenient to nature, called [...].

Medicaments in the shops.The medicaments in the Apothecaries shops fit for Can­cers are, Vnguentum de tutia, de lithargyr. de minio, De sicca­tivum [Page 221]rubrum. Empyricall meanes. Fabricius ab aq. pendent. de tumor. c. 3. set­teth downe a method whereby an Empyrick cured sundry Noli me tangeres, and Cancers in other places: and it is this, ℞ Vitriol. lb. jss. Auripigment. Sulphur. vivi, an. ℥iiij. Sal. gemm. ℥iij. cum aceto fiat pasta. In ollaterrea probè lutata sic­cetur in furne. With this powder he consumed the Cancer, but by divers applications.

How we shall know a Cancer to be exstir­pate.You shall know that the Cancer is quite extirpate, if laudable flesh appeare, like to the seeds of the Pomegranate, if it yeeld good quittor, and no sanious and stinking matter: then he healed it with this unguent: ℞ Mell. despumat. ℥iiij. Sevi hircin. limatur. capri, an. ℥jss. Litharg. auri, ℥j. Misc. Another in Essex about thirtie yeares agoe, in curing of Cancers, used onely the greene Treat, and white Vitriol, for everie ounce of the Treat taking ℥j. of the Vitriol: and by all likelyhood the medicament of Payne the Smith, with the which he went about to cure Noli me tangeres, was but a medicament composed of Arsenick, Orpiment, unslaked Lime, Bole and sweet Butter. You see how I conceale no­thing from you.

The cause of Cancers accor­ding to Chy­mists.The Chymists will have arsenicall, realgarian, and orpi­mentall substances separated from the naturall balsome, or composition of the body, to bee the causes of these cance­rous tumors and ulcers, when they settle in the parts, and cannot bee discussed: howsoever, they represent fitly the nature of a Cancer: for as it is, so are they of a putrefa­ctive qualitie. Let no man marvell, that sundry minerals may be in the body, seeing we see stones in the gall, kid­neyes, and bladder

The manner how to cure Cancers accor­ding to Alchy­mists.For the curing of Cancers they commend Antimony so prepared, as it doth not vomit, or trouble they body; but ei­ther procureth sweat, or purgeth downward: and indeed it is an excellent medicament: for it changeth the constitu­tion of the body, and mundifieth the masse of bloud.

Their Topicks.As for the Topicks, use the oyle of Arsenick, or whereof Mercuries vitae is made, mixed with oyle of Roses in due [Page 222]proportion, and these two have no fellowes; for I protest, I have often made experiment of both. If any the desirous to know, and make use of any thing which I have delivered, I will not be nice to impart it.

LECT. XVIII. Of the Leprosie and a leprous ulcer.

NOw followeth the second kinde of ulcers most ma­ligne; to wit, a leprous ulcer. But first of all, I will discourse of the Leprosie it selfe, and then of the nature of a leprous ulcer.

The names of it.The Leprosie in the Greeke and Latine tongue is called [...], from [...], scaber, rough: for it maketh the skin rough and uneven: or from [...], squama, or cortex, a scale or bark, because it sendeth our scales, & maketh the skin rough like to the bark of a tree. The divers kindes of le­prosity. There be two sorts of leprosity: to wit, the Grecian and Arabian Leprosie.

The Grecian leprosity may be thus described: It is a tu­mor with a confirmed hot any dry distemperature of the skin, both in the outer and inner part of it, wherein scales, like those of fishes, are sent out: so that Pruritus, Scabies, and Lepra Graecorum, the itch, scabbinesse, and the Graecian leprosity differ onely in degrees of tumifaction, and distem­perature.

The difference between itch­ing, scabbines, and the Greeke leprosie.In itching there is no remarkable tumor, neither doth a­ny thing fall away from the Cuticula, unlesse it be fetched away by hard scratching. In scabbinesse there is a remarka­ble tumor, and whether we scartch or no, both sanious mat­ter, and scales like to the cast skin of a snake. In the Graecian Leprosie, there are greater tumors than in scabbines, and bo­dies like unto the scales of fishes, fall from such as are pos­sessed with this griefe: so that Avenzoar fitly calleth scabbi­nesse Pruritum vesicalem, a blistery or powckie itching, but [Page 223]the Graecian leprosity Pruritum squamosum, a scaly itching.

The signes.The signes of this Leprosie are these: the skin is dry, rough, and full of small knobs, which itch exceedingly, and sendeth out bodies like to the scales of fishes.

The causes.The causes of it, are either the externall efficient causes, or the internall materiall.

The efficient.The externall efficient, are I. unwholesome meats and drinks.

II. Slovenlinesse, sluttishnesse, and filthinesse. Serenus the poeticall Physician hath comprised these two causes learnedly in two Hexameter verses thus:

Sweat not washed away, and want of good food, often doe make rough the lims, being taken with noi­some scabbinesse.

III. The menstruall courses, or hemorrhodes which were wont to flow, being suppressed, may cause this dis­ease.

IV. Fontanells which have long beene kept open, being shut up may procure the same.

V. Varices, the veines tumified by reason of melancholy bloud, being cured, sometimes are the causes of this griefe.

The materiall cause.The materiall causes are discerned by the colour of the griefe: for if the knobs bee of a livid or leady colour, superfluous impure melancholy is the cause; if they be white, or of a grayish colour, then salt flegme is predomi­nant, which is mingled with melancholy: and because aged persons multiply salt flegme, they are often troubled with this griefe.

The presages,As for the Presages, let this be the first: this griefe if it be habituall, and of a long continuance, it is not easily cured.

Secondly, if it be neglected, it may turne to the Leprosie of the Arabians.

pointed for them: for thorowout the whole yeere they eat cabbage salted, much cheese, old butter, and flesh dryed in the smoke, but most of all bacon. In like manner it is fami­liar to Aegypt: because there they eat much asses-flesh, and drink standing and corrupt waters, if you except those who inhabit places neere to Nilus. Lucretius learnedly expres­seth this, lib. 6. de natur. rerum.

The Leprosie is a disease which is bred by the River of Nilus, in the middle of Aegypt, and no where else.

Hence it is that Moses threateneth the disobedient Iewes thus, Deut. 28. vers. 27. The Lord will smite thee with the botch of Aegypt, and with the emerods, and with the scab, and with the itch, whereof thou canst not be healed. In the He­brew Text, it is with the ulcer of Aegypt, whereby is meant the Leprosie; by the scab, he meaneth the Greeke Leprosie, whereof I have spoken. In Spaine and Africk it is more common than any where else. In the Province of France, Delphinat, Languedock, and in Aquitane it is more fre­quent than in other parts of the countrey, Paraeus l. 19. ca. 6. Before the time of Pompey it was not seene in Italy, as wit­nesseth Plin. nat. hist. l. 26. c. 1.

Secondly, the Leprosie may be taken by having carnall co­pulation with an infected person, see Gordon. l. wed. particul. 1. ca. 22. and Philippus Schopfius in his Treatise of the Le­prosie.

Thirdly, the Arabians, Avicen, Albucasis, and Averoes, think that if a woman conceive while her courses flow, the childe will prove leprous, but it is not likely: for that bloud in sound women is good, and after conception it is retai­ned to nourish the childe: so that if that bloud were vero­mous (as some think) no man or woman could be sound.

Fourthly, this disease being often heredetary, it is pro­pagate from the parents to the children.

Fifthly, continuall conversation with leprous persons cannot be but very dangerous, for if one may become Pthi­sick, by often receiving the breath of one who is troubled with that griefe, according to Glassick Authors, much more may one be infected by receiving the aire infected with the breath of a leprous person, which is most corrupt and stin­king: wherefore lazarous persons, in every well ordered place, dwell by themselves, that they infect not others; and so God himselfe commaded, Levit. 13.4. and Numb. 12.14.

The materiall cause and dif­ferences of the Leprosie.The internall materiall cause, by all is concluded to be Bilis atra. Now seeing this humor is caused of three seve­rall humors altered from their naturall qualities, three kindes of Leprosie doe spring.

First, it is caused of the superfluous melancholy juyce burned; this Leprosie causeth the skin to be of a ruddie black colour: this kinde of leprosity commeth on but slowly, and hath milder symptomes.

The second is of yellow vitelline choler adust: This speedily corrupteth the inner parts, chiefly the liver and spleene, and from thence palling furiously to the habit of the body, produceth horrible symptomes: in this kinde of Leprosie the skin is of a yellowish colour, tending to greene.

The third is caused of salt or nitrous flegme burned: In this the colour is a palish white colour, the Leprosie which is caused of this humor, is not so fierce as the former. There be two other differences taken from the progression of the disease: for a Leprosie is either in the beginning, or consummate.

The signes of the Leprosie beginning.The signes of a Leprosie beginning, are these: The face seemeth to be of a livid reddish colour, the breathing is with some difficulty, the voyce seemeth to be somewhat hoarse, livid spots appeare in sundry parts of the body, the skin beginneth to loose its exquisite feeling, the urine is muddy [Page 228]and thick. Nat. hist. l. 26. cap. 1. Plinie affirmeth, that it was not seene in Rome before the time of Pompey, and began first in the nosthrill, not exceeding the bignesse of a lentill, and from thence pas­sed to the whole body, producing spots of divers colours, making the skin unequall, and raising scurses, and hard scabs.

The signes of the Leprosie confirmed.The signes of a confirmed Leprosie are these: I. The skin loseth altogether its feeling, so that you may thrust a needle thorow it, without any offence to the diseased party; I this happeneth because the humor, by reason of its thicknesse, stoppeth the sinewes, and so hindereth the ani­mall spirit to passe. Neverthelesse, the muscules move, al­though sluggishly; because they have veines and arteries, by whose bloud and spirit they are fed.

II II. Knobs appeare in sundry parts of the body, but chiefly in the face, about the forehead; the eares become thin, the nose flat upward, the lips thick.

III III. The face is of a leady reddishnesse.

IV IV. The voyce becommeth very hoarse, the lungs and wind-pipe being affected.

V V. The eyes become round, the thicknesse of the hu­mor bearing in the corners.

VI VI. When the griefe is consummate, warts very often doe appeare thorowout the whole body, like to haile-stones, as we see in measly hogs.

VII VII. Levinus Lemnius affirmeth, that the powder of lead calcined will swim in the urine of leprous persons, De occult. nat. mirac. l. 2. c. 52. but sink in the urines of all others.

VIII VIII. They are troubled with much belching.

IX IX. Their sweat and breath is most stinking; their brea­thing is with difficulty and stinking, by reason of the con­striction of the brest.

X X. The haire of the head beginneth to fall, that of the beard to grow thinner, and those of the eye-browes and eye-lids to fall also: this falleth out, because corrupt nou­rishment is sent to the haire, for if you pull out a few of [Page 229]their haires, you shall also pull out with the roots a fleshie substance.

XI XI. The nosthrils without are tumified, but within they are narrow, and ulcerate.

XII XII. The veines under the tongue seeme varicous, small knobs also like to haile-stones appeare there.

XIII XIII. The skin is unctuous, and will not admit water.

XIV XIV. The skin is wrinkled, and full of wrinkles and chops, as an Elephants skin is.

XV XV. The Muscules of the thumbe waste.

XVI XVI. If the body, the fingers, and toes have stinking ul­cers, and chops, you need not much to doubt.

XVII XVII. If you open a veine, it will be thick, burned, feculent, and have as it were fat upon the top, and it being strained thorow a cloth, leaveth a greety substance behinde it.

Now it is time to addresse my selfe to the Prognosticks, I wherof this shal be the first: A leprosie in the very beginning is hardly cured, for the materiall cause of it is Atrabilis: now all disease? of Bili [...] atra are of hard curation.

Secondly, a Leprosie consummate is altogether incura­ble by Art.

Now the meanes of curing a Leprosie beginning, The meanes of curing. are three: Dieteticall, Pharmaceuticall, and Chirurgicall.

As for the diet: The diet. That which I delivered for a cancerous tumor and ulcer, in the former Lecture, in this griefe is also effectuall, so that I need not idly to spend the time. It is fit that leprous persons eat of the biggest Snailes dressed as Wilks, or Perwinkles; and Frogs, and that for a moneth together; for this food doth exceedingly contemperate the heat of the bloud: the water also distilled of them is good to be drunk. Rodericus Fonseca commendeth this drink: Consult. 66. ℞ rad. chin. ℥j. succi limon. ℥ iij. aq. cichor. lib. vj. Infund. per diem natural. deinde coq. in B. M. per hor. iiij. vase be­ne clauso, decoctum postquam refrixit coletur: This same China will serve the second time, but to the third decoction [Page 230]you must have new China. The flesh of Vipers or Adders eaten, is good: let them be boiled in water, with some salt and oile; eat both the flesh and broth, but the heads, tailes, and intrals must be taken away: the trochisks of the Vipers or Adders are good, being ministred in Succory water: Poul­try also fed with paste made with the flesh of these, and Bar­ley-flowre is good, if it be used a long time; Corall and Pearle prepared, ministred in broths, are excellent; young Hares in March are good. Isagog. c. 12. Galen commendeth the Viper wine, and setteth downe the histories of sundry who were cured by the use of it. And Aretaeus lib. 4. cap. 12. de signis ac causis acutorum: but that preparations of vipers ministred in a confirmed Leprosie, Erust. part. 4. disput. cont. Paracel and Palmarius lib. de morbis contag. witnesse to be ineffe­ctuall, for they made triall of them.

The Pharmaceuticall meanes are of two sorts: for either they are Catharticall, or Specificall. Amongst the Catharti­call means, ℈j. of the extract of black Ellebore is excellent: the next is the purgative, or Diaphoretick Antimonie: the third is the flowers of the Regulus, ministring gr. viij. in conserve of Roses: the fourth is the infusion of the glasse it selfe, mingling with it a spoonefull of the syrup of Vio­lets; Mercurie precipitate with gold is admirable, gr. iij. are enough for a dose.

As for Specificall meanes, these are commended: the de­coctions of the Elme, Larix-tree, the roots of Tamarisk, Caterach, Fumiterrie, and Juniper-berries, boyled as Gua­jack is, and drunken for a long time; three ounces of Straw­berry water, or of the Cuscuta, Dodder taken morning and evening. Crollius commendeth ℈j. or ℈ij. Spiritus tartari in aqua conveniente, or gr. 7. of the spirit of salt ministred af­ter the same manner, gr. vj. Bezoar similiter laudantur, for it withstandeth malignity.

Chirurgicall meanes.As for Chirugicall meanes, they are two; Phlebotomie, & locall applications: If Phlebotomie be required, open the Saphena about the change, or the Hemorrhodes, but take not [Page 231]much bloud at a time, for leprous persons are weak.

As for the locall meanes, they are either baths or lini­ments; this bath is commended, Take of Crow-foot ten Baths. handfuls, of Colts-foot five handfull, of Tabacca two hand­full and a halfe; boyle these in a sufficient quantity of spring water: use this morning and evening, untill the body yeel­deth no filth.

Of all other liniments, Roderic. Fonsec. consult. 1. Liniments. com­mendeth this: ℞ viperas duas quas nulla parte rejecta inde phialae vitrea continent. lb. ij. Ol. ol. veter. exponatur rubru [...] & fatens, hoc [...]leo inunguentur axillae, inguina, car­pi. Intu [...] autem exhibeatur ʒj. Trochis. Exviperis, velcolubr. in ℥iij. aq. card. benedict. & ℥j. syrup. aceto fit curi, per dies 14. To these ulcers apply a linement made of this oyle, and Goats-suet, taking eqnall quantity of both. Wee may make an effectuall Oyle of our Adders to this same purpose. Oyle of Ad­ders. Gardanus used to anoint the Spina, Joynts, and Pulses of hands and feet with the fat of Vipers, for the space of seven dayes in a hot-house, & affirmeth, that be not only did mi­tigate the Leprosie, but did cure also consumptions of the body, and the Pthysis it selfe. If you have not these medica­ments at hand, you may apply such as I set downe for the curing of a cancer, in my former Lecture: which require no repetition.

LECT. XIX. Of the abating of superfluous flesh.

HAving set downe the maine differences of ulcers, and the method and meanes how to cure them, I must dis­course in like manner of the accidents of ulcers, which may hinder the prime intentions of curing of them, and so prove a let and impediment to you in your proceedings.

to those medicaments which are called Cathaeretica, The nature of cathaereticall medicaments. Aufe­rentia, which take away the superfluous fungous flesh. These are not so hot as either escatoricall, or septick medicants, and those which blister: yet hot they are, and burne, al­though gently; being then hot and dry in the fourth de­gree, they are of a thick and astringent substance: wherefore such medicaments pierce not deepe, partly by reason of their thick substance, partly by reason of their rebated heat; wherefore these onely superficially dry and corrode the flesh. Neither doe they cause any great paine, because their heat is not very Intense, unlesse they be graduate by the ad­mixtion of some other things. So we see Mercurie preci­pitate, or burned Alome, if either of them be applied to any sore, to cause no great paine; but if they be used being mixed, both to cause paine, and a small eschar. Such are Alome calcined, Shels burned, the powder of Hermodactils, Asphodill, Vergidrasse, but Mercurie precipitate excelleth, and exceedeth all these: for it doth work with small paine, and doth by concoction make thick, thin, and ichorous quittor: yea it being washed, and mingled in small quanti­ty with incarnative unguents, furthereth their operation. The yellow Turbith minerall exceedeth it in faculty, for the oyle of Vitrioll or Sulphur, whereof the Turbith mi­nerall is precipitate, is more familiar to nature, and astrin­gent, than the Aqua fortis, or Aqua regis, whereof the pre­cipitate is made.

Two Cathereticall unguents are much used, Ʋnguentum Apostolorum, and Ʋnguentum Aegyptiacum.

Of these two, the Aegyptiacum is the strongest: Vnguentum Aegyptiacum. In plaine ulcers I would not advise you to use it, for it spreadeth, and by touching the sound part causeth great paine. It is effe­ctuall in fretting sores of the mouth, and sinewous ulcers, being dissolved, either in decoctions, or distilled waters convenient tor the kinde of sore.

As for Vnguentum Apostolorum, Vnguentum Apostolorum. if it be made according to Art, it is a cathereticall medicament in tender bodies; [Page 235]but onely a mundificative in those who have a firme and so­lid constitution of body.

It falleth out many times, How hard and stubborne proud flesh is to be abated. that the superfluous flesh is so hard and compact, that it contemneth all cathereticall me­dicament, and cannot be abated by them. In this course we are to have recourse to those medicaments which are called [...], or Putrefacientia, or rotting the part; and to those which are named [...], or Crustam inducentia, which leave an eschar or crust after they are applied.

As for the Escharoticall medicaments, [...] which are called Exedentia, or eating medicines, seeing they corrupt the naturall heat, they must be hot above the third degree, and have a thick, viscous, and terrestriall substance; wherefore by reason of their heat in the fourth degree, they burne the part, and by reason of their thick and terrestriall substance, the heat is kept durable and permanent. And we see that Pepper, Onyons, and such like, although they be hot above the third degree, yet they are not caustick; and the reason is, because although they inflame, yet because their heat is placed in a thin and subtill substance, it is more easily dissol­ved, and at last overcome by the naturall heat of our bodies.

So when a Caustick is applied, notable paine is caused: Why caustick medicaments are painfull. First, by reason of their extraordinary and exceeding great heat.

Secondly, because by reason of their terrestriall substance, they are long in piercing thorow the part.

Of these medicaments two are most used: the Lapis infer­nalis, Lapis infernalis. and the white Caustick. I meane not to trouble you with the setting downe of their preparations, because they are sufficiently knowne unto all who have profited any thing in the study and practice of Chirurgerie.

Of these two, the Lapis infernalis is most effectuall, & wor­keth most speedily; wherefore it is most fit for making of fontanels, where it may be conveniently applyed to the up­per part of the member, and be hindered from spreading: The white Caustick. but if a caustick medicament be to be applied to a depen­ding [Page 236]part, and where there is feare of running, then the white Caustick is most convenient. Besides these, two other escharoticall medicaments I will commend unto you.

Mercurie sub­limate.The first is Mercurie sublimate, mingled with Roman Vitrioll calcined, untill it become red, and the true Terra sigillata.

Turbith mine­rall unwashed.The second, the Turbith minerall mingled with these same; but whilst it is white and not washed. These doe work more gently, if they be mingled with any narcoticall or anodine unguent, than when they are applyed to any fore without mixture. But the Turbith minerall far excee­deth the Mercurie sublimate, because it is more familiar to nature, & doth not cause such paine; besides, it is not so vo­latil and piercing as the sublimate is, which in tender bo­dies assaulting the heart it selfe, doth cause sharp diaries, al­though they be but symptomaticall.

Of the nature of Septicall medicaments.For the suppressing of rebellious excressing flesh in ulcers, the second meanes I appointed those to bee which are cal­led [...], or putrifacentia, corrupting medicaments. These are not so hot as those medicaments which procure an eschar, or crust, they have a more thin substance, and subtill, and have not so much terrestreitie, or astriction. These doe more easily pierce, and so cause not so great paine: the paine which these medicaments cause is pungitive, as if needles did prick being made red hot, and it quickly cea­seth. And as caustick medicaments leave the part corrupted in manner of a crust, so these leave that which they corrupt soft, Septick Medi­caments. moyst, and of a blackish colour. If you will require medicaments moyst, endued with such a facultie, have re­course to the oyle of Vitriol, the oyle of Sulphur, Aqua fortis, and Aqua regis. But if you will have solid and hard medicaments, then call to aid all sorts of Arsenick, as the white, yellow, and red, passing under the names of Rats-bane, Orpiment, and Roses-ager.

Septick Vege­tables.As for the Septick Vegetables, because they rather mor­tifie the inward parts, if they bee ignorantly or maliciously [Page 237]ministred, then abate proud flesh in ulcers, as Dryopteris, the Ferne of the Oake, and Aconitum, or Leopards-bane, and such like, I will leave them to the consideration of the Italian and Spanish poysoners.

Whether su­perfluous flesh may not be ta­ken away by instruments.But being appointed to read a Chirurgicall Lecture, and having onely made mention of abating of superfluous flesh in ulcers, by the application of topicall medicaments, you may demand of mee whether this may not bee effected by Chirurgicall instruments, as actuall cauteries, and incision-knives and razors. Truly hitherto I have deferred the men­tion of this kinde of curing, because God of his bountie in these later times hath in all faculties revealed many things which were kept from our fore-fathers. If a patient reso­lute offer himselfe to a skilfull Chirurgeon to be cured, let the Chirurgeon, When instru­ments are not to be used. in Gods name, in extremities use iron and steele: yet let me advise him not to bee too forward in three cases. I. If the partie be of a tender constitution, and unwilling for if a Chirurgeon do altogether urge these ex­tremities, he may lose his patient, who is prompt to hearken to the Syrenian speeches of deluding Knaves and Queanes. II. If you cannot handsomely come to the part, as if the ulcer be sinuous. III. If the superfluous flesh require not onely abating, but drying also, it being marvellous moyst, then the medicament is better than the instrument, because it drieth more powerfully.

Now to end this Lecture, I will deliver unto you a medi­cament of famous Fallopius, which is effectuall both in corre­cting of stubborne superfluous flesh, and in curing of Can­cers: the description of it is this: ℞ Arsen. cristallin. De ulcerib. c. 18 & Citri [...] an. ʒss. Aristol. rot. Aerugin. an. ʒj. Opii, ℈ij. Axung. porcin. ℥jss. Misc. Ut fiat unguentum. One thing I had al­most let passe, to wit, the description of cathereticall lint; use this of Fallopius his description: ℞ Aq. Plantag. Ros. Ibid. Solani an. ℥iiij. Opii, ℈j. Medullapanis, ℥ij. Mercur. ssubli­mat. ℈ iiij. super porphyritidem triti. Omnia haec commixta bulliant ad consumptionem medietatis: deinde colentur per [Page 238] pannum crassi [...]sculum. Fila excerpta bulliant aliquandin in hoc liquore, postea eximantur, exprimantur, siccentur ac ser­ventur ad usum. So much then concerning abating of su­perfluous flesh in ulcers.

LECT. XX. Of the scaling of corrupt bones.

Having in my last Lecture set downe the fountaines from whence all the accidents of ulcers doe spring, and having discoursed of the manner of curing of an ulcer, wherein there is excrescense of superfluous flesh, which was set downe to be the prime accident flowing from things ac­cording to nature, I must be carried to the second accident, proceeding from things according to nature, which is the cariositie of the bone.

Now seeing the bones are the stayes and props of the body, appointed not onely for locall motion; but for the parts also which further this action, as muscules, veines, nerves, arteries, I am with the greater care to set downe the curation of an ulcer, with the cariositie of a bone, seeing so many things of importance doe depend upon the curation of such an ulcer. In running over the whole course of Chi­rurgerie, I have resolved upon this first triall, to set downe onely the generall practices, which they who are judicious may apply to all persons and parts in speciall. In handling of this accident, I will set downe these foure points. I. The causes which procure the cariositie of the bones. II. The signes of a corrupt bone. III. The prognosticks or an ul­cer, wherein there is a cariositie of the bone: And IIII. Of the meanes which are to be used for removing of this ac­cident.

The causes of the corruption of the bones.Now the causes which procure the corruption of the bones, are either externall, or internall. [Page 239]The externall causes are two, to wit, too great cold, 1. Externall. and too great heat: for as too great cold doth quench the na­turall heat of the bone; so immoderate heat, by discussing the naturall humiditie, drieth and corrupteth the bones. 2. The inter­nall.

The internall causes which most frequently produce this accident, are in number three. The first is a glutinous and superfluous humiditie, first softning, and then corrup­ting of the bone, which oftentimes doth cause a distortion of the member, and a protuberance of the bone, which I have sundrie times seene, and have noted not to have pro­ceeded from any venereall cause. Such an humor seized up­on one, whose name was Iames Wilkinson, who dwelt neere to me when I practised in the citie of Chester, and caused a bending outward of both the shin-bones, or Ossa tibia: this happened to him when he was above sixtie yeares old: neither did this accident either cause nocturnall or diurnall paine, or hinder his going. Before this did befall him, hee had a great evacuation of bloud (by reason of the rupture of a vessell in his left kidney) together with his urine, of the which I cured him by the decoction of some of the My­robalans.

II The second inward cause of the cariositie of bones, is a sharp and maligne matter, which by touching doth corrupt the bone: this happened) most commonly in old and inve­terate ulcers: the Periostium being once croded by the acrimony of the Sanies, it presently corrupteth the bone. It is no marvell that a sharp humor is able to corrupt bones in other parts of the body, when wee see the teeth to bee hol­lowed by a sharp rheume, which a file of tempered steele doth with some difficultie rase.

III The third inward cause is an hidden and strange qualifie of the humor, adverse to the bones, seizing not onely upon some particular bones, but upon some parts also of these bones: for if it did with any manifest qualitie corrupt the bones, it would first have eroded the flesh: this being most subject to the impression of any fretting humor. But the [Page 240]bones verie often are found to be carious, when the parts covering the bones, as the Cuticula cutis, and Membrana carnosa are found whole. So when Nodes invade the Citi­zens of Naples, they appeare most commonly in the Os frontis, or in the Ʋlna, or Tibia, and that betweene the joynts: Who is able to give a demonstrative reason of this invasion? Hee undoubtedly who is able to shew why the Loadstone draweth Iron, and the Amber and Jet Chaffe.

The signes of the corruption of the bones.The signes discovering the cariositie of a bone, are either sensuall, or intellectuall.

The sensuall are in number five.

I. Is if the bone appeare black and fretted: 1. Sensuall. Blacknesse is caused by the corruption of the naturall temperature, by the which it is kept alwayes white with a ruddy glimps, or of an horse-flesh colour almost. Cariositie is caused by the acrimony of humor fretting the substance of the bone.

II. Is, when the bone being felt with a probe, doth not appeare smooth, but rugged.

III. Is, if the probe slip not being guided into the bone; for then the Periostium must bee gone, and so the bone ei­ther more or lesse corrupted, partly by reason of the aire, partly by reason of the quittor settling upon the bone.

IV. Is, if the flesh ulcerate above the bone appeare soft and spungeous, or of a livid colour, it is to be doubted that the bone is corrupted: for when the bone is carious, the flesh is made soft and corrupt, so that any one may thrust a probe thorow it, without any great annoyance to the partie.

V. Is this: if a tent or pledget reaching to the bone stink the next day when it is taken out, there is just occasion offe­red to suspect that the bone is carious.

2. Intellectuall.The intellectuall signes are in number foure.

I I. Is, if more quittor doth flow from the ulcer, than the bignesse of it seemeth to afford.

II II. Is, if thin and stinking sanies doth flow from the the sore, it is probable that the bone is foule.

III. III If an ulcer admit skinning, and often breake up a­gaine, it may not without cause bee doubted that the bone is foule: for an humor still flowing from the corrupt bone, doth cause a new inflammation, whereby the skin of a new is broken.

IV IV. Is this. If an ulcer hath continued a long time, and is rebellious to proper medicaments, it may be thought that the bone is carious being much moystened, and so made soft by the quittor: and therefore must be scaled.

As for the Prognosticks: Aphor. 45. sect. 6. Prognoses. 1. Of such ulcers as are accom­panied with cariositie of the bone, receive these.

I. No ulcer accompanied with the cariositie of the bone is of easie curation: for it hath a malignitie annexed to the solution of unitie.

II II. If there happen a cariositie passing the first table in either of the bones above the eye-browes, it will bee an hard matter to cicatrize it: If this be a true Aphorisme in wounds dividing these parts, how much more true in ul­cers: those ondy causing a solution of unitie by an exter­nall cause; but these eroding the parts by an internall hu­mour: which for the most part is still supplyed by some no­table distemperature of some noble part.

III III. Shall be this: If any of the Vertebra's of the Spina prove foule, shun the cure: for first the substance of the Vertebrae being hollow, they will hardly scale: Secondly, it is an hard matter to come to apply a medicament unto them, by reason of the muscules placed above them. Thirdly, because it is an hard matter to shun the paires of sinewes, which spring from the transverse processes of them.

IV Let this be the fourth: If in ulcers of the brest, the Ster­num or ribs be foule, bee not too forward to meddle with them; for the acrimony of the quittor may easily corrode and pierce thorow the entercost all muscules, and the Pleara, and so lay open to the aire the vitall parts, which ere it be long, must cause an extinction of the naturall heat, and so death it selfe.

The fifth shall be this Ulcers in the great joynts, as the elbowes, knees, or ankles, wherein there is a cariositie of the bones, with losse of the cartilages, are for the most part uncurable, because the paine in the joynts is great, depri­ving the diseased persons of their naturall rest and sleepe, and so of good digestion and concoction of their food: be­sides this, they seldome fall out alone, but bring with them a Marasmu [...], or extenuation of the body.

How the [...]tio­ [...] o [...] a bone [...] is to be cured.Having set downe the causes, signes, and presages of the cariositie of a bone, I am to shew the way how the cariosi­tie is to be removed. To performe this taske, two things are to be done: First of all, the bone is to be laid bare, and no lesse of it than is to be sc [...]l [...]: Secondly, the scaling of it is to be procured by conv [...] meanes.

How the bone is to bee laid bare.The discovering of the bone is to bee procured three manner of wayes; to wit, by Incision, Exesion, or Dila­tation.

As tor Incision: [...] By incision. we are not to use it where the bones lye deepe, and have muscules, tendons, veines and arteries above them, as in the thighs & armes chiefly to the inner parts. Se­condly, although the bones lye not deepe, if they have many tendons above them, we cannot use Incision safely: such ate the bones of the Metacarpium, or the upper distance be­tweene the wrist and fingers, and the bones of the Metape­dium or Metatarsus, which are articulate with the toes.

2. By exesion.Exesion is performed by potentiall cauteries; as Lapis infernalis, the white Caustick, the powders set downe by me, when I discoursed of Fistula's and cancerous ulcers.

Where poten­tiall cauteries are not to be used.These are not to be used where many tendons or nerves are, lest they deprive some parts of their motion, and cause convulsions, by reason of the great paine which they, pro­cure, as also symptomaticall fevers. Potentiall cauteries are most convenient, when there is cariositie in the Cranium, the Ulna, or Tibia.

3. Dilatation.Dilatation, or enlarging of a narrow sore, by stretch­ing out the circumference of it, is performed by such things [Page 243]as swell, when they have imbibed any moysture, as the roots of Gentian, the pith of the Eldar, and spunges brought close together, either by threed, or the Melilot Emplaster.

When this is convenient.These are fit to be used in ulcers which possesse the back of the hand, or the instep of the foot. The bone being by some of these meanes laid bare, I am to shew you how the bone is to be scaled.

How the bone is to be scaled.This is to bee performed three manner of wayes, to wit, by medicaments, instruments, or actuall cauterie.

1. Desquama­torie medica­ments.The medicaments which procure the scaling of a bone ought to be verie drying, and of a subtill and thin substance: for the found bone, being assisted and strengthened by such drying medicaments, sendeth forth of it selfe flesh, which being increased, separateth the corrupt bone from the sound.

Degrees of de­squamatorie medicaments.These Desquamatorie medicaments are of three degrees. For some are mild, as the root of Peucedanum, or Sow­fennill, Aristolochia rotunda, the root of Iris, and Myrrh: these will serve if the cariositie of the bone bee but su­perficiall, I and the constitution of the partie soft and tractable.

II Some againe are yet more drying and strong, as that me­dicament of Avicenna, which is composed of equall parts of Aristolochia rotunda, Iris, Myrrh, Aloe, the rind of the plant Opopanax, whereout the gumme issueth, the Pumick stone calcined, the refuse of brasse melted, and the barke of the Pine-tree. All these being beat to powder may bee ap­plyed alone, or mingled with honey. Of this nature also are Aqua vitae, and the root of Dracontium or Dragons. De ulcerib. c. 22. Fallo­pius hath two medicaments to this purpose: the first is this, ℞ Rad. Peucedani, Indis, an. ℥j. Euphorb. ℈j fiat ex omni­bus pulvis: qui excipiatur pasta panis molli, atque ossi cor­rupto applicetur. The second is this: ℞ Rad. Peucedan. A­ristol. rotund. Opopanac. Enphorb. an. ʒss. Terebinthiae ℥j. Cera ℥ss. Aceti ʒj. fiat cerat. ex p. a. These and such me­dicaments are to bee used, when the cariositie is somewhat [Page 244]deepe, and the partie of reasonable firme constitution of body.

III Lastly, some are strongest of all, as Euphorbium beat to powder, Aqua vitae having the tincture of Euphorbium, the oyle of Cloves, or Petroleum wherein some Camphir is dis­solved, Aqua fortis, Aqua regis, the oyle of Sulphur, and the oyle of Vitriol, and Roman Vitriol calcined. These are to be used when the cariositie is deepe, and the constitution of the diseased partie stubborne and strong. When these medicaments are applyed, the fleshie parts adjacent must be verie well defended, otherwayes paine and inflammation will be caused. If the sores be well dressed, and these medi­caments judiciously applyed, the bones will scale within the space of fortie dayes.

II Sometimes the cariositie of the bone is verie deepe, so that a long time would bee required for the scaling of it: The scaling of the bones by instruments. wherefore in this case we must have recourse to instruments: the chiefest of these instruments are the Mallet, and Chee­sels, the signe of the cariositie removed. and Raspatories: First then, the corrupt part of the bone is to be knocked off with the Mallet and Cheesell un­till you come to the sound bone; which you shall know if the bone bleed, and appeare white and firme, according to Celsus. Lib. 8. c. 2. What mallet best. Secondly, the bone is to bee made even with the Raspatories and smoothed. In this case a leaden Mallet is best; for it is weightie, and causeth a lesser noyse: this be­ing done, some of the aforenamed medicaments must bee applyed according to the constitution of the partie; How ulcers of the head, wher­in both the ta­bles are cari­ous ought to be handled. for by it you must be led.

In ulcers of the head it often falleth out, that both the ta­bles of the soul are so [...]le, so that you shall be enforced to re­move a great peece of the C [...]anium: here you must use the III Trepan & head-saw, the use wherofshall be delivered, when I shall set downe the curation of the wounds of the head. How bones corrupt are to be scaled by the actuall cau­ [...].

The third way to scale bones, I named to bee the actuall cauterie: Of it I will set downe three documents: The first shall be, when it is to be applied: The second shall di­rect [Page 245]where it shall be applyed: The third shall teach, how the sore is to be dressed after the application.

As for the first: When it is to be applyed. It is to be applyed when superfluous hu­miditie floweth to the bone; this you may conjecture; First, by the moyst and cold constitution of the body of the person affected: I the signes of such a constitution I delive­red unto you, when I discoursed of a waterish tumor: whi­ther I remit you.

II Secondly, if after the application of your desquamatorie medicaments, the bone still appeareth moyst and soft, not changing its colour.

The second document shall be, where it is to be applyed: Where it is to be applied. you may apply it safely to the Ulna and Tibia laid bare.

I Secondly, you may use the actuall cauterie in those pla­ces, where dilatation onely is permitted, and not incision, II or potentiall cauterie, as in the back of the hand, and instep of the foot: but this operation you must doe thorow a pipe of white iron, to save the circumjacent parts from burning.

III Thirdly, you may apply the actuall cauterie to the joynts, if the cartilages bee foule, and way be made. This practice Ambrose Parrey used when hee had dismembred one in the joynt of the elbow: the dismembred partie found great ease and comfort by the application of it: See the Histo­rie, Lib. xj. cap. Xxv. What formes of cauteries you are to use, the figure of the ulcer will shew you. When the actuall cauterie is applyed, you are to bee acquainted with the manner of dressing of the bone, which was the third document.

How this is to be done, 3. How the bone is to be dressed after cauterization. Guido a Cauliaco teach you in his owne words: I (quoth hee) after the application of the cauterie, apply for the space of three dayes oyle of Ro­ses tempered with the white of an egge, & for three other, it mingled with the yolk of an egge: and afterward But­ter with. Mel rosatum, and ever above these applications some mundificative untill the bone scale. Afterwards, I in­carnate [Page 246]and consolidate the part with Avicens medica­ment, which I delivered unto you amongst the medica­ments exfoliative of the second degree. Fallopius counsel­leth after cauterization to use pledgets moystned in Rose­water and the white of an Egge, to hinder inflammation for some few dressings: then to apply to the bone the me­dicaments exfoliative.

Where the a­ctuall cauterie is not to bee used.Beware of the use of the actuall cauterie, if the Scull, or any of the Vertebrae of the back be foule, by reason of the braine contained in the first, and the Spinalis medulla con­tained in the second; which being inflamed by the heat of the actuall cauterie, will bring alienation of minde, and con­vulsions.

LECT. XXI. Of a discoloured and varicous Ʋlcer.

THe two last differences of ulcers taken from things ac­cording to nature, were said to bee an ulcer, wherein the naturall colour is altered, and an ulcer varicous. First then I will discourse of the ulcer, wherein the colour is al­tered, and then of an ulcer varicous.

[...] An ulcer ha­ving the co­lour of the part altered. As for an ulcer having the skin adjacent, and the sub­stance of the part altered. The unnaturall colours which possesse the part altered are most commonly foure; the red, yellow, livid, and black colours.

The red colour proceedeth alwayes from heat, I. The red co­lour. causing, an inflammation.

The efficient causes of it.The externall efficient causes of it are superfluous hot garments, too thick boulsters, rowlers made of wooll, or of hard and stubborne linnen-cloth, the hot season of the yeare, too strait ligature, the use of hot meats and drinks, surfetting, venerie, troubling the masse of bloud, extraor­dinarie motion of the part, perspiration hindred by reason [Page 247]of the suffocation of the part, or incuneation of the humor, and solemne evacuations suppressed, as of the flowing of bloud from the hemorrhoidicall veines in men, or the men­struous bloud from the veines of the matrix in women, by the error of the Chirurgeon, applying things actually and potentially cold.

The materiall cause. The materiall cause of this colour is bloud offending: How bloud may offend.Now the bloud may offend two manner of wayes, to wit, in qualitie, if it be too hot or fervid; or in quantitie, if the body be plethorick. The curation.In removing then this red colour, one of the symptomes of inflammation, our first care must bee to remove the externall efficient causes.

The diet must be moystning and cooling, The diet. untill this acci­dent be removed: wherefore broths made of Chickens, or Veale, wherein Sorrell, the sowre three-leaved Grasse, or Allejujah, Endive, Succorie, Purselaine, Lettuce, and such like have beene boyled, are verie convenient. If the disea­sed partie delight in roasted meat, let him use for his sauce, sippets with the juyces of the common and wood Sorrell, with a little vinegar and Sugar.

The season of the yeare.If the season of the yeare be extreme hot, let the roome wherein he remaineth be hung with sheets, which must bee still moystned with spring-water: In this case it is good to garnish the windowes with the Meddow-sweet, called in Latine Regina prati, and Gaule called Myrtus Brabantica.

Of the gar­ments. Rowlers.Let his cloaths bee neither heavie, nor heating: Let the rowlers be of soft linnen-cloth, and moystned in Rose, Eldar Vinegar, and faire Spring-water, taking two parts of the water, and one of the Vinegar: Rowling. Let the rowling be somewhat slack, onely to keepe the locall medicaments to the ulcer; for strait ligure doth cause paine, paine at­traction of humors, and the attraction of hot humors in­flammation. Venerie. Violent mo­tion. Suppression of solemne eva­cuations. The partie must abstaine from sacrificing to the Cyprian Dame: yea, hee must abandon everie violent motion. If this symptome be caused by reason of the sup­pression of any solemne evacuations, as the staying of the [Page 248]menstruall courses in women, or the suppressing of the He­morrhodes in men, the accustomed flowing of these are to be pro [...]ed againe.

How the men­struall courses are to be pro­cured.The menstruall courses are to bee brought downe; first, by opening of the Sap [...]ena in what foot it is most conspicu­ous; and secondly, by exhibiting the powder of steele, ei­ther in forme of Lozenges, or of an Electuarie or in infu­sion in whi [...]e wine.

How the He­morthodes are to be opened.The Hemorrhodes must be opened by application of the Leeches, and ministration of Aloeticall medicaments. That medicament, which by Paracelsus is called Elixir proprieta­tis, and by others Pilulae pestilentiales Arabum; composed of Aloe, Myrrh, and Saffron, are excellent. These may be taken sundrie mornings together. But seeing these things are at large set downe by those who have written of the practice of Physicke, I have onely pointed at the best indi­cations, which serve for the curing of these griefes, and the rather because the sp [...]lation of them doth belong to an­other Facultie and Art, to wit, Physick.

How the mate­riall cause i [...] to be dealt with­all.If the materiall cause of this symptome, which is bloud, offend in qualitie, being too hot, then it is to be cooled by a refrigerating diet, which I at large set downe, when I dis­coursed of a phlegmon, to the which place I remit you. If in quantitie it offend, first Phlebotomie, or opening of a veine is to be used, and bloud drawne, as the age, constitu­tion of the partie, and nature of the griefe shall require. Se­condly, the part it selfe is to be scarified, and other Vento­ses or Leeches to be applyed, that the bloud may issue out plentifully to discharge the part.

Of the livid colour. Its causes. A livid, or leady colour in an ulcer followeth. Two cau­ses produce a livid colour in ulcers: the first is black bloud impacted in the part: The second is externall cold, or de­fect of the naturall heat.

How lividitie from black bloud is to be cured.This livid colour doth happen most frequently by rea­son of black and corrupt bloud setled in the part, for as a bright red colour under white, causeth a lively blue, or azure [Page 249]colour, as we may see in the veines of sound and healthfull persons; so black under white causeth a livid, or a leady co­lour. This accident is to be removed by scatification, and application of the Cupping-glasses, Hornes, or Leeches. Afterward the scarifications are to be somented with Oxy­mel dissolved in Cardum Benedictus water.

How lividitie from cold is to be cured.If the lividitie proceed from cold, you shall perceive it by the cold constitution and temperature of the part. In this case you are to apply such locall medicaments as are able to reduce the naturall heat and complexion. Fallopius in his Treatise de tumoribus, c. 26. de Gaugraena, affordeth a nota­ble one, and parible, which is this: Take an ordinarie Tur­nep, and a Rettish-root of reasonable bignesse, grate or scrape these two, and adde to them of the powder of Mu­stard-seed one ounce, of the powder of Cloves three drams, of the oyle of Lin-seed, and Wall-nuts verie old, so much as is sufficient, and make a pultice, which apply warme; he calleth this cataplasme, Medicamentum optimum & divinum, A most excellent and divine medicament; with the which he affirmeth himselfe to have cured many: so that you need not to doubt of the efficacie and certaintie of it: and the ingredients seeme to promise no lesse.

Of a black co­lourThe last unn [...]rall colour is a black colour: this may proceed either [...] heat or cold. If it hath proceeded from heat, then an inflammation went before; if from cold, then lividitie did precede. The first betokeneth adustion; but imperfect: so we see wood, before it be perfectly bur­ned, and incinerate, or turned to ashes, to become black. And in a Carbuncle, the lower part is of a dark [...]ed, the mid­dlemost black, and in the top there is a white pustule, the heat beginning the adustion in the lowermost, increasing it ill the middlemost, and perfecting the adustion in the top: for it is the propertie of fire or heat to mount up, and to be most effectuall aloft. If before blacknesse lividitie did ap­peare, it is to be feared, that the part beginneth to be mor­tified at the least, if any feeling or heat remaine: If these [Page 250]cannot be perceived, then you may boldly say, that a Spa­celus or Mortification hath possessed the part.

How this acci­dent is to be removed.In both these cases, first, the parts are profoundly to bee scarified: Secondly, they are to bee fomented with the de­coction of Worme-wood, the lesser Centorie, Scordium, Carduus Benedictus, the flowers of Camomil, Melilot, and tops of Dill boyled in a gentle Lixivium. Thirdly, fill the incisions of the scarifications with some of the medica­ment following using a feather: ℞ Oxymell. simpl. ℥ij. Vu­guent. Aegypt. ʒiij. Spirit. vini, ʒij. Miseeautur. Fourthly, this cataplasme is to be applyed warme: ℞ Farin. fab. hord. & erobi, an. ℥iiij. Lixiviimitioris, lb. iiij. coq. haec ad cata­plasmat. consistentiam: tunc adde Oxymell. simpl. ℥ij. Vn­guent. Aegyptiaci, ℥j. Omnia probe misceantur. Continue the use of this medicament, untill the parts bee brought to their naturall temperature and colour: then proceed as hath beene set downe, when I spake of the curing of a com­pound ulcer.

Of Varices.Having set downe the methodicall curations of the three first accidents taken from things according to nature; to wit, of abating superfluous flesh, removing of the cariositie of the bone, and reducing the naturall colour to the parts, I am to shew how the fourth accident Va [...]s, or the tume­faction of the veines, by reason of supernuous grosse bloud are to be cured.

Its names.This accident is called in Latine Varix, from the simili­tude and likenesse which it hath with the protuberances which are seene in trees above the bark, called Varices: ac­cording to Avenzoar, lib. 2. tract. 7. c. 25 Albucasis Chirurg. part. 2. c. 93. calleth this affection Vitis, or the Vine, because these passe alongst the parts by windings, as the vine doth: In Greeke it is called [...], or as it is found in Pollux [...]. It is called by Hippocrates [...], and by Aristot. 3. de histor. animal. 11. and in sundrie other places.

The descrip­tion.This affection may thus be described: A varix is a dila­tation of a veine causing a tumefaction of it, with win­dings [Page 251]and tortuositie arising in one or more parts of the bo­die. It is called the dilatation of a veine, because the dila­tation of the arterie is called [...]. This particle (cau­sing a tumifaction) is added, to exclude veines, which are naturally big. Galen de Method. medend. lib. 14. c. 13. numereth this affection amongst the diseases which pro­ceed from the quantitie encreased. It may bee accounted a disease, because the actions of the parts which it possesseth are hindred; for if it possesse the legs, they become exte­nuate, and by reason of the heavinesse of the humor, they become flow in motion. If this affection invade the stones, the partie becommeth barren.

Its causes.The causes of it are either internall or externall. Accor­ding to Aristotle, the materiall cause is bloud, The materiall. being im­pregnate with spirit, hee doth affirme it to proceed from bloud, Lib. 3. de histor. animal. c. 19. Aristotles opi­nion. where he noteth that women are not troubled with varices; because they turne out their superfluous bloud by their naturall fluxes, and that they are lesse troubled with the hemorrhods in like manner. And although this doth prove true in most women, yet there may bee sundrie women found, who both have vari­ces, and are subject to the hemorrhods. Hee thinketh that the bloud in the varices is full of spirits; and therefore pro­nounceth, Sect. 6. problem. 3. & Sect. 4. problem. 21. that they who have their testicles varicous are barren, because the spirits of generation passe to the varices, and so leave the seed unfruitfull, being deprived of spirits. Galen and Hip­pocrates his opinion. But Hippo­crat. 3. de articul. text. 4. & 6. aphor. 21. & Galen. 4. de compos. medicament. 2 ^• gnrā, thinke that the materiall cause of varices, to bee grosse and flatuous melancholy bloud: yea, both Galen and Avicen are of the opinion, that the vatices may sometimes be caused of laudable bloud, onely offending in quantitie, and dilating the coats of the veines.

The antece­dent causes.The antecedent causes are in number foure.

I. Is a melancholy and pituitous temperature: so they who have a bad spleene, are most subject to this disease.

II. An hairie and an hard habit of the body.

III. The masculine sex: for women are not so fre­quently troubled with this affection, because monethly they discharge all superfluous bloud, if they bee healthfull: as hath beene said out of Aristot. 3. de histor. animal. c. 11. & sect. 10 probl. 29.

IV. Either ripe or old age: for according to Hippoc. in Coac. praenot. they happen not before the fourteenth yeare of the age, in the legs; although even children may have varices in the testicles. Why Eunuchs are not troubled with the varices, Arist. sect. 10. probl. 29. yeeldeth a reason; be­cause they are deprived of seed and spirits. Avicen doth adde to these sharp diseases going before: for in these the thinnest part of the humors being spent by sweat, insensible perspiration, and discussion procured by Art, the thicker part being turned to some particular places, may procure the varices.

The primitive causes.The primitive causes are these.

I. A thick and impure aire; because it doth weaken the legs, and maketh them the more apt to receive superfluous humors. And for this cause Hippocrates affirmeth, that men who dwell in the Westerne parts, are frequently troubled with this affection, and ulcers in the legs.

II. Immoderate exercise: so we may see Foot-men and Porters often to have varices.

III. Long standing: according to Averr. 6. collect. 2. From hence Iuvenal saith; Fiet varicosus aruspex: He shall become a varicous Sooth-sayer: for they who tooke upon them to finde out future contingents by the flying of birds, were enforced often to stand along time.

IV. Thick wine and grosse food: such are old flesh sal­ted, or smoaked, pease and beanes.

The presages.As for the presages, let this be the first:

I. If varices appeare in those who are mad, by reason of the melancholy humor, the griefe ceaseth.

II. The varices mitigate gibbosities, or bunchings in [Page 253]any part of the body: for the humor which causeth them, is by these meanes averted from maintaining of them.

III. The varices appearing either in the right or left testicle, help a squeeking voyce; the humor being turned from the brest to the testicles, according to Hippocrates, in the 5. Sect. of his Epidemicks. This may happen for two causes. I. By reason of the content which is betweene the spirituall and genitall members. II. Because baldnesse, stut­ting, lisping, and a squeeking voyce, according to Hippo­crates in the same booke, are melancholy affections.

IV. They who never become bald, have not large vari­ces. And againe, if in those persons who are bald, large va­rices appeare, haire will grow againe, Hippoc. 6. aphor. 34. & Arist. 3. de histor. animal. 11. But you must understand this of the varices of the testicles, called Hernia varicosa. The cause of this is the consent of the braine, and of the genitall members, which is so great according to Avenzoar, lib. 2. tract. 3. c. 1. that castration doth impaire both wit and courage. Then humours melancholike being gathered in the testicles, vapors ascend to the head, which afford suf­ficient matter for producing of the haire. And in women their courses being stopped, vapors ascend to the chin, from whence a beard doth bud out. As Hippoc. 6. Epidem. sect. 8. doth report of Pha [...]tusa the wife of Pythe [...], who got a beard by reason of her husbands absence from her.

V. Varices caused by reason of some griefe of the spleen, are not to bee cured, lest the diseased partie fall into some melancholy disease, according to Avicen 22.3. tract. 2 c. 8. for seeing the matter is lodged in the spleene, and the vari­ces of the legs are stopped by curation, the humor must bee turned to some other parts.

VI. The varices are hardly cured by medicaments, ac­cording to Avenzoar, lib. 2. tract. 2. c. 2 [...]. Although they may bee cured by Chirurgerie without danger of life, ac­cording to Celsus, lib. 7. c. 22. This is true, if the varices bee caused of too copious laudable bloud, otherwayes not for [Page 254]the reason before assigned. The curation. The curation, which is the last point, is performed by two indicutions, to wit, by dischar­ging the body of the thick and melancholick humors, and taking away the tumified veines.

The first is performed by appointing a convenient order of diet, and the administration of fit medicaments.

The second is performed by Chirurgerie.

The diet.As for the diet, grosse, tough, and flatuous meats are to be shunned; as Beefe, Goats-flesh, Venison, Oysters, Fishes fed in muddie waters, old Cheese, Beanes and Pease, Let­tice, Coll-wort, Cabbage, and all those things which Galen doth forbid in melancholy diseases, 3. de loc. affect. c. 7.

As for Phlebotomie, Phlebotomie. the liver or median is to be opened in the arme directly opposite to that leg wherein the hae­morrhods are, or Leeches are to be applied to the haemor­rhodicall veines, chiefly if bloud was wont to issue from them.

As for purging, Purgation. Lenitives mixed with those which purge grosse humors are often to be ministred: Take this for a patterne, ℞ electuar. lenitiv. ʒvj. pulv. sancti ʒj. syrup. de cichor. cumrhab. ℥j. misc. ut fiatpotio.

The chirurgi­call curation.The Chirurgicall curation of the varices is perfor­med by two meanes, ustion, and exsection; ustion is to be used when the varix is straight, and not much tumified.

The manner of ustion is this: Vstion. Incise the skin untill you come to the veine, and separare it from the parts adjacent, then shunning the brims of the wound, cauterize the coat of the veine: foure inches from this ustion doe the like, and so still untill you come to the end of the varix. This being done, dresse these ustions as you use to dresse parts burned.

Excision is to be used when the varix is crooked, Excision. and hath windings, according to Celsus: but in my judgement a straight varix is better cured by excision than that which hath windings and creeks, because it is more easily sepa­rate, and will admit a more beautifull cicatrix: whereas in cutting the other there must be horrible paine, and an ugly cicatrix must be left.

The manner of excision is this: Excision. you are to begin at what end of the varix you will, and to separate the veine from the adjacent parts, untill you come to the other end, then binde the veine hard at each end, and cut off what re­maineth betweene the two ligatures: this being done, the brims of the wound are to be brought together, and to be healed with glutinative medicaments. Plutarch in the life of Marius writeth, that he having this griefe in both his legs, submitted himselfe to this manner of cure; and when he had put forth one, did constantly endure the excision of the varix in it, that no man should have doubted of his va­lour: but when the Chirurgeon would have done the like in the other leg, Marius answered flatly, that he meaned not to buy beauty with such paine: it is not to be thought that any in this our tender age will admit either of these two operations.

The Auchors way of curing.If a varicous ulcer be offered unto you, which contem­neth ordinary meanes, my counsell is, that you take up the varix above and below, as you doe the veines of the temples in inflammation of the eyes, and open it betweene the deli­gations, that the bloud may be discharged out of it. This operation any one will admit, if he be not too tender.

LECT. XXII. Of a verminous and lowsie ulcer.

IN my last Lecture having delivered unto you the two last differences taken from things according unto na­ture, yet changed from the naturall constitution, to wit, of a discoloured and varicous ulcer; now I am to set downe the differences of ulcers taken from things aliene to nature, and strangers. These are two; wormes, and lice; from the first, an ulcer is called verminous; from the second, lowsie. How the wormes are called. The wormes which breed in ulcers may more fitly be called [Page 256]Maggots, in Latine Termetes and Galbae, as those of the guts are called [...] in Greek, or Lumbrici in Latine; as we sinde set downe in a learned Epistle of Alexander Tral­lianus intituled [...], de lumbricis, of wormes in the belly, translated by that famous and learned Physician Hie­rony [...]us Mercurialis, which hee annexed to his Treatise written of the diseases of children.

Their genera­tion.They are ingendred of putrid humors, in uncleane and sordid ulcers negligently dressed, but most frequently in hol­low, deepe, and sinewous ulcers: for in such the quittor is longest lodged, and the putridinall heat is greater. And for this cause they are seene often in ulcers of the eares, for the quittor is there long detained by reason of the win­dings and labyrinths of the care.

The materiall cause.The matericall cause of these maggots for the most part is a pituitous excrement, as Paul. Aeginet. witnesseth, lib. 4. cap. 17.

The efficient.The efficient cause is heat, and that of two sorts: The one is extraneous, and putrifactive, causing corruption of the humors.

The other is naturall: Seeing, according to the Philoso­pher, lib. 3. de generat. animal. cap. 2. nothing can be produ­ced of putrefaction onely, unlesse concoction put to its hel­ping hand. Then in a verminous ulcer which is preternatu­rall, there is putrefaction, heat, and the ulcer it selfe, besides the wormes the effects of the first two.

The signes.As for the signes, they are three: The first is the sense of sight, I for oftentimes they are seene if either the cavity of the ulcer be ample, or that they are voided with the quittor.

II The second is the motion of them felt by the Patient: their motion is called Motus undosus, like unto the waves of the sea, contracting and extending it selfe.

III The third is a pinching paine now and then: for living they must be fed, and their feeding must of necessity cause more or lesse paine.

IV The fourth signe is horrible stink, by reason of the great putrefaction.

Against the use of instruments.When you goe about to cure such an ulcer, attempt not the taking out of the maggots with any instrument, for your labour will be fruitlesse, and the paine of the Patient great: and grant that you take many away with your in­strument, yet you must leave the putredinall heat, and the corrupt humor, for the breeding of more.

Against the use of the actuall cautery.I wonder that even great Authors make mention of the application of the actuall cautery in this case: they might bee borne withall, if these ulcers were plaine, and shallow; for so the superfluous humidity might be dryed, and putrefaction removed: but they with an unanimous consent confesse, that these maggots are most commonly bred in sinewous and hollow ulcers, (as hath beene said) and most frequently in the Summer time, and Southerly winds blowing; and so a great heat would be induced, and the Pa­tient put to great paine, if they could reach to the cavity of the ulcer, which cannot be.

The curation.These wormes then must first be killed, and then they will issue out of the ulcer without any difficulty.

The medica­ments.Those things which kill these wormes, doe it either of a manifest, or hidden quality.

From a mani­fest quality.They which kill them by their manifest quality must be bitter, such are Worme-wood, Southerne-wood, Calamint, Aloe, the Ferne, Buls-gall, the Meale of Lupines, the Leaves of the Peach tree, Capers, the Roots or distilled Water of the Roots of the Couch-grasse, called Gramen canarium, Horehound, Scordium, Mugwort, Centorie the lesser, Mints. Of these you may make decoctions, whereof you may finde sundry descriptions in the monuments of those who have written of this subject. Ambrose Parrey, lib. 12. cap. 8. setteth downe this medicament: ℞ absynth. centaur. minor. & marrhub. an. m. 1. decoq. in lib. 1. aq. font. ad lib. ss decoct. coletur: In quo dissolve aloes ℥ss. unguent. Aegyptiac. ʒiij. he putteth in the decoction ℥ij. of Aloe, and ℥j. of Aegyptiacum: but who may not perceive the quantity of these to be too great? This of Riolan the father, in hi [...] [Page 258]Chirurgerie, de ulcerib. cap. 8. is excellent: ℞ Ellebor. alb. rad. cappar. gentian. dictamni, alb. an. ʒij. cen [...]aur. minor. scord. absynth. marrhub. calaminth. an. man. ss decoq. in suf­ciente quantitate aquae font. ac coletur decoctum. In lib. 1. co­laturae dissolve mellis ℥ij. Aegyptiaci ℥j. Above the ulcer he adviseth to lay Ʋnguentum Apostolorum. If a tent may reach to the bottome, use this commended by Fallopius in his Treatise de ulceribus cap. 21. ascribed to Archigenes, as al­so Ambrose Parrey, in the place afore named: ℞ cerussae po­l [...]montan. an. ℥ss. picis liquid. q. s. ut fiat linimentum: Pellamountain. This cannot chuse but be effectuall, for the faculty of Tarre is knowne even to hunts-men and shepherds.

Medicaments killing wormes from a hidden quality. [...] Minerals.As for those medicaments which kill wormes from a hid­den quality in ulcers; they are taken either from Minerals, or Vegetables.

Amongst the minerals, all waters indued with the qua­lities of Mercurie or Antimonie are effectuall: wherefore you may use Aqua aluminis magistralis of Fallopius, set downe by him in his Treatise of the French-pox thus; Cap. 93. ℞ aq. plantag. & ros. an. lib. 1. alum. & Mercur. sublimat. an. ʒij. pulverizat. Aqua alu [...]in [...] magistralis. These are to be mingled together, and be­ing put into a separating glasse, the halfe of the water is to be breathed away: Pallopius counselleth the glasse to be set upon a gridiron, and coales to be put under: but the safest way is to have this done in a pan, with some sand set upon a little furnace. After that the halfe is breathed away, the separating glasse is to stand five dayes, and then the cleare water is to be powred off, and kept for use.

The use of it.It is not to be used alone, but mingled sometimes with a double, sometimes triple, sometimes quadruple quantity of Rose, Plantane, or Night-shade-water. The ablutions of Crocus metallorum precipitate, and the Turbith minerall, are effectuall: Vitriols of all sorts, dissolved in faire Spring-water, and having some Camphire added, are very good: for they not onely kill the wormes, but powerfully cor­rect the putrefaction in ulcers.

Amongst the vegetables which kill wormes, Vegetables. by a hidden and unknowne quality, the Tabacco doth carrie away the bell, and not onely the juyce of the greene, but the deco­ctions of the dry also, doe effect this, being applied to the ulcers by injection, or moistening the tents or pledgets with the same. Seeing you may finde this medicament, whose faculty and operation are certaine, I will not trouble you by setting downe a rabblement of uncertaine toyes: unguen­tum de Paeto, having some Mercurie precipitate mingled with it, is excellent in such ulcers.

Of wormes in the belly.Seeing wormes in the belly, by eresion, cause ulcers in the guts; in so much that wormes have often come out at the navell and groynes, whereof you may reade memorable histories set downe by Schenkius in his third booke Pag. 407. titul. de lumbricis, it will not be a thing impertinent to discourse briefly of them, seeing they often trouble chil­dren, and procure sometimes death.

Their names.These wormes are called in Creek [...], and [...], f [...]rae, because they cruelly torment the body; in Latine Lum­brici.

Their efficient cause.The efficient cause is the temperate heat of the guts, for the intemperate heat rather doth burne the humors, than produce any thing of them.

The materiall cause.The materiall cause, is the inconcocted part of the Chy­lus, sent away to the small guts from the stomack, and left undrawne by the mesaraicall veines to the liver, there to re­ceive the forme of bloud. This part of the Chylus being crude, and left in the intestines, mixed with the pituitous humor, is elaborate by the temperate heat of the guts, and the forme which lay hid in this matter before, is brought forth afterward by this heat: and according to the di­versity of the latent formes, sundry sorts of wormes are bred. In the aforenamed title of Schenkius, you may reade of the stupendious figures of wormes, set downe by lear­ned and famous men, in their monuments, who have seene them.

[...]he differen­ces swormes.As for the differences of them: they are either ordina­ry, or extraordinary.

Of the ordinary there are three sorts: [...]. Ordinary. The first is Tere­tes, the round ones, not unlike to the earth wormes in fi­gure, but in colour different: for they are whitish.

The second are called Ascarides: these are like unto the wormes which grow in cheeses, and maggots in flesh: they are for the most part bred in the Intestinum rectum.

The third kinde is called Lumbricus latus, Taenia, the broad worme; and Taenia, which in Greek is called a swadling band, by reason of its figure, for it is broad and long, and it hath sundry joynts. This worme will be of a strange length. Plin. lib. 11. nat. histor. cap. 33. affirmeth that some have beene thirty foot in length. Conciliator. diff. 101. saith, one avoided such a one fifteene foot in length. Alexand. Benedictus, in prooem. lib. 21. practica, saith he saw the like. If you desire greater variety of such histories, peruse Schen­kius his observations, Lib. 3. pag. 411. I my selfe when I was in the Newrie, a towne in the North part of Ireland, being desired to visit a young man who had a Fistula in Pe­rinaeo, and whose body was exceedingly extenuate; when I had ministred a dose of 2. gr. of Mercur. vitae to him, he a­voided such a worme, tucked like a [...]rabtree cudgell, about the thicknesse of a childes finger, and fifteen foot in length, he kept it in a little pewter basin for my comming: when he was in voiding of it he was in great feare, thinking that his guts came out.

The signes. Of round [...]mes.As for the signes of wormes: You shall know any one to be troubled with round wormes by these signes: The party fi [...]deth gnawing, and pinching paine in the belly, hath gnashing of the teeth, chiefly in the sleep; is troubled with a dry and continuall cough, the nosthrils itch, where­fore children having them, are still picking their nose; the face is evill coloured, the cheeks are sometimes of a red, sometimes of a livid colour; the eyes are hollow, the mouth is waterish, the breath is strong, there is a desire to vomit, [Page 261]the hicket oftentimes, hunger, paine, and heavinesse of the head, drowsinesse, convulsions, starting in the sleepe, stret­ching of the belly; but an extenuation of the rest of the body; horrible dreames, loosenesse of the belly, ugly and stinking [...]crements doe fall out. This is holden for an ex­periment, if water be powred upon the stomack in the mor­ning, the party being fasting, he or she shall finde a drawing on of the belly, by reason of the shrinking of the wormes, shunning cold. All these fignes are not found in every per­son, but some in sundry.

Of Ascarides.If Ascarides, or small wormes, be bred in the Intestinum rectum, a horrible itch troubleth the party, and they are of­ten seene in the excrements.

Of Tania. If Tania, or the long broad worme be in the guts, the party hath an insatiable appetite, the body consumeth, and some substance doth come from it like to the seed [...] of a cu­cumber. The falling ficknesse oftentimes proceedeth from the round wormes, but seldome from the broad, and the Ascarides.

The predicti­ous.Let us now come to the presages which the diversity of wormes afford.

I. The Ascarides, if they be small, they are of all sorts lesse dangerous, for they are farthest from the noble parts, and are most easily killed, by clysters, or injections of bitter things. It is otherwise if they be big, for then they are in­gendred of a worse matter.

II. The Tania is of all others the worst, because it is biggest, and hardest to be killed.

III. The bigger are worse than the lesser, and many more dangerous than few, and the red are worse than the white.

IV. If in the beginning of sharpe diseases round wormes come out alive, they betoken pestilent diseases.

V. It is good if round wormes come out, either when the crisis is at hand, or in the declination of the disease.

VI. If in persons not sick, wormes come out either at [Page 262]the mouth or nose, it betokeneth no harme, because this they doe for lack of food.

VII. If this happen in sick persons, it is an ill signe, for it argueth the malignity of the matter, which the wormes labour to shun.

VIII. If wormes expelled seeme to be be sprinkled with bloud, it is an ill signe, for it sheweth the guts to be ill af­fected.

The curation.As for the curation, it is performed by two indications; the first is by killing of them; the second by expelling of them killed.

Medicaments that kill wormes.They are killed either by internall medicaments, or exter­nall applications.

The internall medicaments are either simple or com­pound; the simple are either Vegetables, or Minerals, or Animals.

The most powerfull amongst the simple vegetables are these: Corallina, the dose of it is ʒj. The seeds of Tansie, and the common worme-seed, the dose of them is ʒj. the juyce of Vervine; give a spoonefull, the juyce of Scordium, Wormewood, the lesser Centorie, Carduus benedictus, or Beere or Ale brewed with these, Garlike, the roots of grasse.

As for compound medicaments, let this be the first: ℞ corallin. lumbric. terrest. nasura corun cervi, semin. santonici, & tanaceti an. ʒj. rad. dictamnialbi, rhabarb. agaric. tro­chiscat. an. ℈ ij. fiat ex omnibus pulvis: dos. ʒj. The second shall be that medicament, which Quacksalvers in Germanie, call Panis vitae, the composition is this: ℞ mustacei ℥ iiij. semin. santonici ʒ v. mellis puri q. s. ut fiat pasta: dos. ℥ss. ad ℥j.

The medicaments taken from minerals: Mercur. crudus, dos. ℈ij. Mercur. dulcis, dos. a. gr. iiij. ad 20. secund. ratio­nem, atatis & virium, Mercur. vita, cujus dos. a.gr. ss. ad gr. ij. vitrum antimon [...]i, crocus metallorum, inpulvere vel infusione.

As for externall applications receive these as patternes:

• I. ℞ aloes hepat. ʒij. fellis taurini ℥iiij. absynthii contus. ℥iiss. fiat cataplasma applicandum umbilico.
• II. ℞ farin. lupin. ℥j. myrrh. aloes an. ʒj. pulp. colocynth. ℈iiij. croci ℈j. fell. boum ℥iss. aceti acerrimi ℥ss. mese. Ap­plicetur cuminum pultum cum felle tauri, quod commendat. Sebastian. Austrius lib. demorb. infant. morb. 42.

The death of Herod by wormes is extraordinary, Act. 12. which is set downe by Saint Luke, undoubtedly to shew what sub­jects may offer to honour their Princes, and what Princes ought to assume unto themselves of right. Herod having begun to persecute the Church, caused Saint Iames to be killed, and Saint Peter to be laid up in prison. After he had done this, the third yeere of his raigne (as witnesseth Iose­phus antiquit. lib. 19. cap. 7.) he went to Caesarea to keep some playes in honour of Casar. The second day of his playes, when he had given an answer to the Tyrians and Si­donians, who sued after his favour, he being offended with them: the people cryed out, The voyce of God, and not of man. O Herod, why diddest thou accept of this grosse flattery? Had it not beene sufficient to thee to have assu­med subordinate Majestie, and truth in thy declamation, which was (I make no doubt) in some points of it failing? Loe, whom prosperity could not bring to the consideration of his carriage, Gods visitation did. Wormes, not presented to view of men, begun inwardly to torment him, and eat up his intrailes; which caused him to burst out into these lamentable speeches; En ego ille &c. Behold, Iose [...]h [...]a [...] lib. 18. cap. 13. I whom you called God, am by fatall necessity commanded to leave life, it proving you to be liars, and I, whom you saluted as immortall, am violently drawne to death. Being horribly tormented, he died the fifth day, although the people put on sackcloth, and made supplication for him. So much Io­sephus. O that Christian Princes would not so much labour to delight the eares of the people by eloquent speeches, as to administer justice. And although they think themselves [Page 264]secure enough from such a judgement in this life as befell this tyrant: yet let them not doubt, but that there must be an accompt made after death, where every debt must be paid with interest. I have delivered unto you what I thought fit concerning a verminous ulcer, now I will in few words deliver the doctrine of a lowsie ulcer. A lowsie ulcer.

The efficient muse.The efficient cause of lice, is the naturall temperate heat, mixed and concurring with the heat putrefactive.

The materiall cause, is the excrements of the third con­coction, or assimilation, which are hot; but not sharpe, or maligne. This is the opinion of Galen lib. 1. de compos. me­dicam. secund. loca cap. 7. and Avicen. lib. 4. fen. 7. tractat. 5. cap. 26. That you may the better understand this opinion, you must understand, that when bloud is turned to the nou­rishment of the parts, divers excrements are produced: of the which, some are discharged by insensible perspiration, some by sweat, some cleave without to the skin, as the mor­phew, and the filth which cleaveth to the soles of the feet, called Strigmenta; and scales in the head and other parts: some stay within the Cuticula; and these are either sharpe, and of a maligne quality; and these cause shedding of the haire, or they are destitute of both these qualities, and they produce lice.

The differen­ces of the lice.The differences of these lice are two: For some are most commonly without the Cuticula, and some within the Cu­ticula; of those that are without, some are familiar, as the common sort; some are called [...], feri, wilde and cruell ones.

The ordinary.As for the ordinary and familiar, most commonly in boyes and girles, they swarme in ulcers in the neck below the fu­ture Lambdoides: but sometimes, and in some persons, they possesse the distance between the Cuticula and the Cu­tis, divelling and separating the one from the other. If one will know what store of these moveables may issue out of the Cuticula one person, let him reade Amatus Lufitanus cent. 3. curat. 58. & schol. ad curatione [...] ea [...]de [...], where he [Page 265]reporteth, that one of good note in Lisbon called Tabora, was so troubled with them, that two Negroes had e­nough to doe to discharge him of them, and to carry them to the sea; and that at the last they procured his death.

The [...], or feri, the crab-lice, Crab-lice. are most commonly en­gendred in the arme-pits, and in the forrests of Ʋenus in na­stie men and women.

Those which are alwayes found under the Cuticula, are called Syrones, unknowne to the Grecian Physicians: Syrones. they draw a trench, as Moles doe in the earth, under the Cuticu­la [...], leaving watery pustules behinde them, as they march: their seat (when they rest) is easily discerned at the end of the trench, where when the Cuticula is opened, they may with the point of a sharp pin or needle be taken out: they resemble nits in cheese, and if you place them upon the co­ver of a booke of blacke leather, in the Sunne, they will passe alongst the cover with a marvellous agility; as often I have made triall my selfe.

The Prognosticks.As for the Prognosticks. I. They who are troubled with any kinde of lice are nastie persons.

II. In a Hectick fever, they shew that one is entred into the third degree of it, and so is uncurable.

III. In persons not diseased if they abound, you may ad­vise them to keepe their hands from their mouth, and to la­bour to be cleanly.

When the lice swarme over the whole body, the disease is called [...], à pediculis, from lice.

The curation.Three intentions are required for the curation of them: Phlebotomie, Purgation, and locall applications.

As for Phlebotomie, the sex, age, Phlebotomie. constitution of the party, and strength, with the rest of the indications are to be observed.

When you purge, use rather minerals than vegetables, Purgation. because they more strongly evacuate, and are of a more sub­till, durable, and penetrating faculty. These same will serve to hinder the increase of these, which I set downe as power­full to kill wormes.

Locall medica­ments.As for locall applications, Amatus Lusitanus in the place afore-named, affordeth two: The one is a medicate vine­gar; the other a liniment: The description of the vine­gar it this: ℞ Lupin. amar. pug. iij. Staphisagriae pug. ij. Let these be boyled in a sufficient quantitie of vinegar, with it moysten the whole body: The liniment is thus made: ℞ Staphisagr. part. 2. Sandarach. Grac. part. 1. Salis petrae partem dimidiam, postquam ista fuere infusa in Oleo Raphani­no, part. 2. & Aceti acorrimi, part. 3. fiat linimentum, quod illinatur toti corpori. Lib. 3. c. 3. Paulus Aegiueta affirmeth, that hee found good successe in the application of oyle and vinegar.

As for the Crab-lice, the waiting-maids of Venus rest contented with the application of an unguent made of sweet Sope and Quick-silver. If any one bee desirous to know more of the mysterie of these movables, I will advise him to repaire to the Pilgrims of the tribe of Gad, in the Summer time to be found by Coleman hedge, and thorow­out the whole yeare in Batne-Elmes barne. If any be desi­rous to read a learned and philosophicall discourse of this subject, let them have a recourse to Minadous, lib. 2. c. 9. de turpitudinibus.

LECT. XXIII. Of Ʋlcers of the Hairie Scalp.

SEeing I have set downe the generall doctrine of ulcers, sufficient to instruct any one how everie ulcer in particu­lar parts is to be cured; yet seeing some ulcers in these parts require some speciall considerations, I will run thorow them to shut up the Lectures of this yeare: Neverthelesse, I meane not to omit any thing which shall seeme materiall. I will begin at the ulcers of the head, partly because some are uncurable of them, & that it is necessarie that you know which be such; partly because it were a foule shame, that [Page 267]women should goe beyond a Chirurgeon in this businesse, who confidently take upon them the curation of these ulcers.

Differences of ulcers of the head.The ulcers of the head are of two sorts: for some are moyst, and some are dry.

The nature of these griefes and names.The moyst are two, Achor and Favus. These dispositi­ons of the head are called by the Arabians Sahafati, by A­vicen. 7.4. tract. 3. c. 1. Serap. lib. 1. tract. 1. c. 3. Aven­zoar, lib. 1. tract. 1. c. 7. and they are nothing else but small ulcerate tumors of the whole skin of the head, caused of sharp excrementitious humors. All small tumors, in Latine Tubercula, by the Arabians are called Bothor. So then as the Cuticula, or the scarfe skin, is the seat of Pthiriasis or the lowsie maladie, so the place of these griefes is the whole skin, both the Cuticula, and the Cutis.

The materiall causes. The divers kindes of sharp humors.The materiall cause is a sharp excrementitious humor.

Now sharp humors are of two sorts: for some are sharp of their owne nature, as choler: and some by accident. By accident, humors may become sharp two manner of wayes. First, by exustion and putrefaction, as Bilis atra, and melancholy not naturall excrementitious. Secondly, by ad­mistion of a sharp humor. These ulcerous tumors of the head may bee caused, not onely of simple sharp humors of their owne nature, but also of humors made sharp by ac­cident.

The Chymists opinion con­cerning the material cause.The Chymists will have the salt of Vitriol to be the ma­teriall cause of these ulcers. See Ioan. Faber Chirurgia Spa­gyrica, c. xv. Achor so called according to Alex. Trallia­nus, lib. 1. c. 8. because from it a sanious quittor called [...] doth flow. Galen in his booke of tumors thus discourseth of it: Achor also is a small ulcer in the skin of the head, Achor, what it is. you may thinke that it is caused of salt and nitrous phlegme, out of it floweth a sanious matter, which is not altogether wa­terish, nor so viscous and thick as honey, which appeareth in those ulcers which are called Favi; for in these there is a certaine tumor, and sundry holes, out of which floweth a [Page 268]matter like unto honey. He also in his Lib. 1. de co [...]pos. Pharmacorum secund. loc. affirmeth the holes in this tumor to bee lesse than are those which are called [...]avi, and that out of them floweth a thin humor with some clamminesse. Oribas. lib. 4. ad Eunap. c. 4. thus speaketh: Achor is sea­ted in the skin of the head, and hath but small holes, out of which a thin and reasonable viscous Sanies doth flow. That affection which is called Favus is like to this; but it hath greater holes, which containe a matter like to honey. Trallianus lib. 1. c. 9. subscribeth to these in these words: Wee must know also that Cerion, (which is Favus in La­tine) is a griefe like to Achor, yet differing in bignesse: for the holes out of the which the humor issueth, represent the honey-comb: wherefore by Ancients it was called [...]. The like hath Paulus Aegineta, lib. 3. c. 3.

The differen­ces betweene Achor and Fa­vus.So that Achor differeth in three points from Favus: for first, in it the tumor is lesser: secondly, in it the holes are lesser: and thirdly, the holes in Favus are conspicuous; but in Achor not. Aetius lib. 6. c. 68. hath these words: Achor is seated in the skin of the head, and hath but small holes, out of which a thin and viscous Sanies doth flow. The griefe called [...], or Favus, is like to this, wherein there are large holes, out of which issueth a matter thick, like un­to that which is contained in honey-combs: wherefore it is called [...]. Favus, what it is. As for Favus, or [...] in Greeke, Actuar. lib. 2. de dignose. morb. c. 5. thus describeth it: Small ulcers arise in the head thick, and red like little dugs, of the which, that which is called [...] hath but small holes, which sen­deth out a clammie Sanies; but [...] or Favus hath greater holes, which containe an humor like to honey.

Out of these passages, which have beene alleaged out of these ancient and learned Authors, these descriptions of these two ulcers may be gathered: Achor. Achor is an ulcerous tu­mor of the skin of the head, red and dug-like, having small holes, Favus. out of which issueth a thin and viscous Sanies. Favus is the like ulcer, yet wherein the holes are larger, containing [Page 269]an humor in thicknesse resembling honey, from whence it hath its name.

The primitive causes.The primitive causes are in number two: corrupt nou­rishment, and contagion: of the first I have discoursed here­tofore, of the second there is no doubt to bee made: for it may be daily seene, that these griefes are communicate by contract and frequent conversation.

The materiall cause.The materiall cause is a sharp and fretting humor, vi­scous in both these ulcers yet thinner in Achor, than it is in that which is called Favus. Galen and Aegineta in the places afore-cited, affirme it to be a salt and nitrous flegme. The Chymists affirme them to proceed from the salt of the vi­triol of the lesser world, or man.

The conjunct cause.The cause conjunct is the same humor impacted in the skin of the head.

The signes of these two are these: First, Signes. in both these tumors there is an itching, and a tumor. Secondly, holes appeare in both, but in Achor lesser, in Favus greater. And although Lice are often seene in both, yet it is proper for Favus to have scales.

The presages.As for the Prognosticks, receive these.

I. Young persons are most subject to these griefes, and amongst these children most frequently: The causes of this may be two. First, because they may have received many im­purities in the mothers womb, which when they are come to the light, the naturall heat increasing, they lat our to ex­pell; or it may happen by reason of the corrupt milke of the Nurse, who useth an ill diet.

II. These ulcers, if they have continued long, and have much altered and corroded the skin, when they are cured, they leave behinde them baldnesse of the parts affected.

III. These griefes free children from the falling-sick­nesse, according to Hippocrates, Lib. de sacro morbo, and Avicer. 1.3. c. de Epilepsia. For the humor which might cause this disease, is sent from the inner to the outer parts.

IV. If these griefes be hereditarie, they hardly can bee [Page 270]cured: seeing this is true in all other maladies, how much more certaine, when to the humor a malignitie is joyned, as in these, as all must confesse.

The Indicati­on. of curing.The meanes which are appoynted for the curation of these griefes, are of two sorts, Physicall and Chirurgicall.

The Physicall are three; 1. Physicall. A convenient order of Diet, Phlebotomie, and Purgation.

As for the Diet, Dieteticall. that is most fit, which was set downe in the Lecture delivered concerning the curation of Leprosi­tie: for by some this is accompted a particular Leprosie. All surfetting, strong and sweet wines, sharp, and salt, and fried meats are to be shunned; and such as afford a grosse and impure juyce, as hard Egges, Fishes living in muddie wa­ters: Purselane, according to Avenzear, exceedingly fur­thereth these griefes.

As for Phlebotomie, Phlebotomie. two indications may induce you to use this: First, a Plethora of the whole body: Secondly, much corrupt bloud settled in the vessels of the head. If there be a fulnes in the whole body, then it is fit to open the Medians of both the armes: it skilleth not much at which you begin: Let some daies passe between the opening of the one and the other: Let the strength, age, time of the yeare, and the like circumstances shew you, what quantitie of bloud is to be drawne. If much impure bloud bee conge­sted in the head, open the Cephalica, the veines under the tongue, the Vena frontis, yea and the arteries of the tem­ples; for they powerfully derive corrupt bloud and foule spirits from the head.

Purgation. Generall.As for Purgation: If this must be generall, then no me­dicament is better than Confectio Hamech, or Hiera Diaco­locynthides, with the syrup of Rose solutive with Agarick in Betonie, Eye-bright, Strawberrie, Cowslip, or water of the black Cherries. Receive this description as a patterne: ℞ Confect. Hamech, aut Hier. Diacolocynt. ʒiiij. Pulv. sancti ℈ij. Pulv. Holland. ℈j. Syrup. ros. solut. cum Agari­co ℥j. Aq. praedict. ℥iij. Mise. ut fiat petio. If the partie af­fect [Page 271]pils, these or such like you shall finde verie effectuall: ℞ Pilul. aurear. & aggregat. an. ℈j. Trochiscor. alhand. pultorumgr. vij. spirit. Vitriol. gutt. 5. Formentur pilul. ʒj. quae de [...]ureatur. These purgative medicaments are to bee ministred once everie weeke, untill the pa [...]e be cured.

If you goe about particularly to purge the head, Particular. use Sternutatories made of white Hellebore, and the best and strongest Tobacco, with a little of the powder of the seeds of sweet Marjerome and Lavender; or use Gargarismes: This water drawne by a quill into the nostrils, which I will set downe, is verie effectuall: ℞ Pulv.Lap. magnet. amp; ca­lamin. an. ʒij. Virid. aeris & Euphorb. an. gr. vj. Lap. haema­tit. ʒj. Succini albi ʒss. Aq. major. ℥j. Misceantur. Let this medicament be kept in a glasse, and drawne into the nostrils everie morning, or everie other morning, as the patient is able to endure.

Chirurgicall meanes.The Chirurgicall meanes are the artificiall dressings of the ulcers with locall medicaments. To attaine to this, two things are to be noted: The first is, what medicaments are to be applyed: The second is, how they are to be applyed. As for the qualities of the medicaments, they ought to bee astringent and repelling: when I discoursed of tumors, I set downe an ample catalogue of them, whither I send you, because I hare idle repetitions.

How persons of ripe age are to be dressed.But seeing some magistrall compositions are required in the curation of these griefes, which often prove verie obsti­nate and stubborne, I will not leave you unfurnished, but will deliver unto you some which are verie effectuall. Compound unguents. The first is this of mine owne: ℞ Butyri recent. lb. ss. Axung. porc. ℥iiij. ol. Scorpion. ℥ij. Sulphur. vivi, Helleb. alb. & ni­gri, Rad. Enul. pulveriz. an. ℥ss. Calcis viva ʒiij. Mercur. crudi ℥jss. Misc. ut fiat linimentum. The second is that of Gordonius, described by Rinodaus, Dispensator. medic. lib. 5. sect. 1. thus: ℞ Elleb. alb. & nigr. Sulphur. viv. Auripig. Litharg. Calc. viv. Alum. Gallar. Fulig. Ciner. Clavellat. an. ℥ss. Mercur. & virid. ar. an. ʒij. pulveriz. and pulv. [Page 272]coq. in Succ. Borrag. Scabios, Fumar. Oxylap. & Aceti, an. ℥iij. ad Succorum consumpt. deind. addantur Ol. veter. lb. j. Piccis liquid. ℥ss. Cer. liquat. q. s. ut siat linimentum. I have made triall of it, and have found it effectuall. If you but consider the ingredients, you cannot but allow of it. The Author commendeth it in a scald head, all manner of scabs, and in Mulum mortuum it selfe.

The artificiall dressing. The pulling out of the haire.When you are to apply these unguents, which was the second point of the Chirurgicall meanes: First, you are to marke whether the roots of the haires be corrupt or no; for if the roots be corrupt, they must be pulled out: you shall know this by pulling out of a few, and observing the roots: for if the roots be thicker than ordinarie, & moyst, you may in be assured that they are corrupt: they are to be pulled out children, that you may the better apply your Topicks: In aged persons not onely to this end; but to open the skin al­so, and to make it more perspirable, that the corrupt hu­mors may be the more easily corrected and spent.

Pulling out of the haires.The haires are readily pulled out, by application of an Emplaster of red wax newly made, drawne upon lether, and lying to the ulcers twelve houres. Secondly, above the un­guents you are to apply Sparadrops made onely of wax, to save the unguents, and keepe them to the sores without much waste. Thirdly, you are to foment the sores with red wine, or Tanners woose, wherein Pomegranate flowers and rindes, Myrtill-berries, and Sumach, with red Rose-leaves dried, have beene infused in a pot set by the fire side, before you use the unguents.

How children are to be hand­led.If children be offered to you to be cured, you must have a care that you use gentle medicaments to them, and that their caps bee so tied to their heads, that they cannot pull them off. For children receive these Topicks: the first shall be that of Minadous, in his Treatise De turpitudinibus, li. 2. c. 10. which he learned of a woman, who professed the cu­rarion of these griefes: Of the Ma­stickt ee. ℞ Sulphur. vivi. Litharg. Argent. pulverizat. an. ℥j. cum aceteros. teranturac levigentur, tuus [Page 273]adde Terrae l [...]ae pulv. ℥ss. Succi Plantag. & Limon. an. ℥j. Ol. Lentiscin. & Myrtini. an. ℥j. Misc. ut fiat linimentum. If the ulcers in children prove obstinate, use this of mine: ℞ Pomati, ungnent. Popul. & Vng. albi caphurat. an. ℥j. Ol. de vitell. ovorum ℥ss. Ol. Scorpion. ʒij. Mercur. crudi ℥ss. Misc. in unguentum. You may adde ʒjss. of Alome calcined and beat to powder, if you will have it stronger. These ul­cers are to be dressed once in 24. houres, and towards the night: for then the medicaments will prove most effectu­all. If these ulcers be verie moyst, and apt to bee enflamed, by the application of an unguent, then you are to use a me­dicament made of the abstersive powders, which the Anci­ents called Smegmata contempered with Oxymel simplex: such are the Ellebores, Sulphur vivum, S [...]aphesager, the Pu­mick-stone, Cuttle-bones, the roots of Iris, and Aristolo­chia rotunda, and Barley-meale: these being beat to pow­der, and by the admixtion of Oxymel simplex brought to the consistence of a liquid Electuarie, must bee applyed to these ulcers, and above the medicament a cap of Ivie-leaves sowed together be set.

Having spoken sufficiently of the two kindes of moyst ulcers, which are found in the head, Achor and Favus, it is time that wee reason of the dry ulcer of the head, which properly is called Tinea.

Of Tinea.This is a crustie ulcer, fretting the skin like a Moth (from whence it hath its denomination) without any great store of moysture, corrupting the roots of the haire, and sending out of the skin a dry filth which stinketh: Videatur Hieron. Mercurial. c. 14. de morb. cutan. But Petrus Ioan. Faber, in his Chirurgia Spagyrica, thus describeth it, c. 15. de Ti­nea: It is a peculiar phagedaenicall and cancerous ulcer of the head, caused of the salt of the Vitrioll of the body of man, which fretteth the skin, and produceth scales, sometimes white, and sometimes yellow. The materiall cause, and the manner of the generation of it, hee thus prosecuteth. The Vitrioll in the great would, while it is [Page 274]calcined in the fire, it is coagulate into a masse; either white, if the calcination be but moderace; or yellow, if the fire bee increased. So in the little world (hee meaneth the body of man) the Vitrioll, when it is seperated from the Balsome of the body, it marcheth towards the skin of the head, which it corrodeth, and above it produceth a crustie and scaly substance. Thus he: and I protest verie probably.

The materiall cause.And if it bee true which Galen and Aegineta affirme of the materiall cause of Achor and Favus, that it is a sharp ni­trous flegme, as hath beene said, it may verie probably bee affirmed, that the materiall cause of Tinea is Phlegma vi­triolatum, Flegme endued with V [...]rioll, yet grosser than that which is the cause of Achor and Favus. Cap. de Tinea. Avicen, Mer­curialis, and the rigid Galenists affirme the melancholy hu­mor to be the materiall cause, accompanied with some sharp humiditie, which pricking the expulsive facultie, moveth it to drive out the humor to the skin of the head, and so to cause this ulcer: but this opinion carrieth no shew of truth: for first, this griefe most commonly seizeth upon phlegma­tick persons: secondly, it cannot be apprehended, how me­lancholy, either by the admixtion of any humor, or by any degree of heat in the body of man, being of it selfe black, can produce such a coloured ulcer▪ to wit, white or yel­lowish.

Primitive causes.The primitive causes are foure; Errors committed in the things not naturall, Hereditie, the corrupt Milk where­with children are fed, and Contagion or Infection.

The signes are dry crustie scales most commonly white, sometimes yellowish, or of an ash-colour, or greenish, ne­ver black altogether.

As for the presages: let this be the first.

I. This ulcer is hard to bee cured, because it is maligne and venomous.

II. Inveterate ulcers of this kinde are more maligne, and harder to be cured, than those which have but lately in­vaded any person.

III. When they are cured, they often leave behinde them Alopecia, or Ophiasis.

IV. Sometimes they end into the Leprositie, and pedi­cular or lowsie disease.

V. If in a Tinea the skin be hard, or of a shelly substance, and send out many scales, and the haire fall by reason of the corruption of the roots of them, it is of all others most hard to be cured.

VI. If this ulcer being once cured, returne, pronounce it to be of hard curation: for there must be some seed of this maligne malady firmely impressed in the braine.

The curation.In the curation of this griefe, two indications offer themselves: The first is the removing of the causes; but seeing the causes are either primitive or conjunct: The pri­mitive causes are removed, by rightly ordring those things which are called Res [...] naturales: The cause conjunct is taken by purgation and phlebotomie. As for Phlebotomie and purgation, although that may suffice which I have deli­vered in setting downe the healing of Tinea and Favus, yet let the insinuate this unto you, that it is expedient that once a quarter you open the Cephalica, two dayes before the full of the Moone, and that for purgation you call Mercu­riall medicaments to aid, when Veget [...]s will not serve. Parrey is of the opinion, Lib. 16. c. 2. de Tinea. that the meanes which are used in curing of the French Pox, are effectuall in curing this griefe: Use these then, Mercurius sublimatus dulcis, Tur­bith minerall, Mercurie precipitate dulcified, Mercurie coa­gulate, and fixed by gold and silver.

The applica­tion of the Fo­picks.The second Indication is the curation of the ulcer it selfe by locall meanes.

Things to be noted before the application of lo [...]ll medi­caments.But before you goe about to apply any locall medica­ments, observe these passages: First, that you meddle not with tender children, if they have a maligne Tinea, un­till they bee able to abide sharp medicaments; for you shall vex both them and their parents, and so shall procure a dimission to your selves. The meane time you may use a li­niment [...] [Page 278]espying things which might hurt the body, The excellen­cie of the hearing. that we may prevent and shun them: yet the hearing excelleth it, for it is Disciplinae sensus, the Sense of learning, according to Ari­stode, and the entertainer of faith: for faith is bred by hea­ring, according to the Apostle. And as the sight furthe­reth invention, so by die hearing, things invented are communicated to others. Besides, by hearing, the pertur­bations of the minde, as anger, envie, wondering and such like, are most stirred up.

The causes.The causes of the ulcers of the eares, are either antece­dent, or conjunct.

The antecedent is either externall, or internall.

The externall causes are two; Externall. to wit, a blow, or a fall: for by reason of either of both these the parts may be con­tused, and from hence quittor bred, which being stayed long within the cavities of the eare, and having the eare-wax, and other sharp excrements of the braine, mingled with it, may erode the parts.

The internall cause is a sharp humor sent from the braine to the cavity of the eare, Internall. which first of all causeth aposte­mation.

As for the Prognosticks, [...]ciages. let this be the first: These ulcers are not to be neglected; for if the curation be prolonged, deafenesse may ensue.

II. If greater plenty of matter issue out of the eare than the part of its owne selfe is likely to afford, then you may pronounce that the greatest part of it is sent from the braine ill affected.

III. If before matter issue out of the eare, the party feele pulsation, and great paine, you may pronounce that a Phlegmon hath invaded the part.

The differen­ces.These ulcers are either without any excrescence of flesh, or they have excrescence.

The curation.In the curation of ulcers of the eares, it is requisite that ever before the application of any locall medicaments the head be purged by cephalicall pils. Purgation. Receive a description of [Page 279]those which are very effectual. ℞ pilul. aggregatar. & an. rear. an. ℈j. trochiscor. Alhandal. & diacrid. an. ℈ss. spirit. vitriol. q. s. ut formetur nassula. Ex hoc massa efformentur pi­lul. iiij. deglutiat. duat hor. 5. Matur. sequente dio sumat toti­dem. Exactis 4. horis à sumptione pilularum capiat [...] sculum sine pane, prandeat autem hora consueta.

Application of locall meanes.In the application of locall medicaments, these five points are to be observed, according to Petrus à Largelata Medi­cus Bononiensis. [...]. 5. tract. 9. c. 9

• I. Let no sharp medicament be put into the eare before the body be well purged, lest we procure a fever, and cause an attraction of humors.
• II. Let all medicaments which are powred into the eares be neither too hot, nor too cold; for they being (for the greatest part) framed of spermatick parts, they can hardly endure any excesse in heat or cold.
• III. Let all the medicaments which are to be powred into the eare be of a liquid substance, that they may enter the deeper.
• IV. After the party is dressed, let him or her lie upon the sound eare, the ill affected eare being stopped with cotton or wooll for a good space of time.
• V. Let not fattie medicaments be either powred, or injected into the eare, for it is composed of spermatick parts, and such things will cause a sordid ulcer.

The locall medicaments which are fit to be applied to ul­cers of the eares, wherein there is no superfluous flesh, are these: Trochisci Andronii in aceto sambucino dissoluti: Haec autem est corum descriptie: ℞ [...]la [...]st. vitri [...]l. aristol. gallar. an. ʒij. alum. mirrh. sali [...] Ammon. an ʒj. Excipiantur om­nia melicrate & fiant trochisci. If you boile Crocus Martis in strong wine vineges, nutill both come to the consistence of a liniment, it is a good medicine. The Sanative syrup made of the vulnerarie plants, as, Selfe-heale, our Ladies-Mantle, Avens sanicle, Salamons-seale, Plantane, Horse-taile, Yarrow, Knotgrasse is very effectuall, not onely in ulcers of [Page 280]the eares, but in all hollow ulcers in like manner, if Balau­stia, Pomegranate-pils, Sumach, Mirtle-berries, and red Rose-leaves be added. These medicaments are sure, and such as you may trust into. In the winter time, if you boyle a sufficient quantity of dry Tabacco in strong Ale, and boyle the decoction strained, you shall have an effectuall me­dicine, chiefly if the ulcer be foule, and have wormes, which you may conjecture by intolerable itching, which they will cause by their motion. If these ulcers afford great store of quittor, they must be dressed every foure and twen­tieth houre; but if they yeeld but little matter, it will be sufficient to dresse them once in two dayes.

The curation of the ulcer of the eare with excrescence of flesh.If falleth out sometimes, that if ulcers in the eares conti­nue long, that superfluous flesh doth so increase in them, that it filleth up all the cavities of the eare, and causeth deafenesse. This happened to a gentlewoman of the race of the Fittons in Chester, when I practised Phisick and Chi­rugerie there.

An experiment of the Authors.I thus cured her: First, I ministred unto her Cephalick­pils.

This being done, I consumed the spungeous flesh by of­ten application of the Fistula-powder, so that it did not not touch any part in the circumference. This powder I set downe in that Lecture, wherein was set downe the metho­dicall cure of a Fistula.

Thirdly, I made in jection into the eare, made of two oun­ces of white Wine, one dramme of Aegyptiacum, and halfe an ounce of Mel rosatum.

Last of all, I healed, and cicatrized it with my vulnerarie syrup dissolved in Plantane-water.

If such an accident come to your hands, proceed thus me­thodically, and you shall undoubtedly bring to passe that which you shall goe about. So much I thought good to de­liver unto you concerning the dignotion, and curation of ulcers of the eares, which often prove troublesome to the Patient and Chirurgeon, and loathsome to others, who ap­proach [Page 281]to the party grieved, by reason of the evill smell, which the ulcer sometimes sendeth forth.

Of ulcers of the eyes.Now I will come to the ulcers of the eyes, which ought exquisitely to be handled, seeing the sense of sight, the in­strument whereof is the eye, is so pleasing and necessary to all persons. Of all the ulcers of the eye, Fistula lachrymalis, or Aegylops, first doth offer it selfe, but seeing I amply dis­coursed of it, when I delivered the doctrine of Fistula's, I will remit you to that Lecture.

Three points of the generall doctrine.In this my discourse of the other ulcers of the eyes, I will first set downe the generall doctrine of them, and then de­scend to the particular handling of each one of them.

In the generall doctrine, I will deliver three things: to wit, their causes; secondly, their prognosticks; and third­ly, the indications of curing of them.

The causes, are either externall, or primitive, or inter­nall.

The externall causes are two; to wit, a blow, or a contu­sion by reason of a fall.

The internall causes are sharp and eroding humors.

I As for the Prognosticks, let this be the first: Ulcers of the eyes in persons of an ill habit of body, seldome end without leaving some scar, or infirmity.

II II. For this cause be wary what you promise, for boun­tifull promise can hardly be called back, and the Patients, being for the most part carefull of the comelinesse of their parts, will undoubtedly expect the performance of them.

III III. If children, or disordered persons, be presented to you to be cured of ulcers in the eyes, ever pronounce that the cure will prove difficult and hard.

The methodicall generall intentions of curing these griefes, are in number foure; Good order of diet, Phlebo­tomie, Purgation, and the application of the Seton or Fon­tanell for revulsion and derivation.

The manner of curing these three ulcers in particular.Having dispatched the three points which the generall doctrine of ulcers doth containe, I am come to set downe [Page 282]how each one of these ulcers in particular is to be cured.

As for the differences of them, they are either milde, or maligne. The milde are either of the Adnata, or Conjuncti­va, or Cornea, or uvea. The ulcers of Conjunctiva most com­monly proceed from Ophthalmia.

Of it then I will speak, beause it most frequently seizeth upon the eye: Ophthalmia what it is. [...] in Greek, but Lippitudo in Latine, according to Galen 4. de medicam. local. cap. 4. is an inflam­mation of that tunicle of the eye which is called Adnata.

The differen­ces of it.There be two kindes of it: One properly so called, pro­ceeding from inward causes.

The other proceeding from externall causes, which pro­perly is called [...], or Perturbatio.

Againe, Ophthalmia vera is either more milde, when on­ly the Conjunctiva is inflamed or vehement, when as the eye-lid besides is red, turned up, and somewhat ulcerate.

How it is bred.This griefe is thus bred, according to Cassius Medicus 66. probl. medic. When humors are impacted in the eye, they stop the passages, and keepe in the heat: the heat kept in, burneth when it cannot breathe thorow, and inflameth the humors; and these inflamed, cause Ophthalmia, and hinder the sight; for the Conjunctiva being inflamed, great pain and heat are felt in the eye. These draw humors into the eye: the humors attracted being dispersed thorow the eye, trou­ble the humors and spirits; and these being troubled, of a ne­cessity hinder the sight. The eyes are subject to these affe­ctions, according to Arist. probl. 7. sect. ultim. & Alex. 1. probl. 35. because they are moist, and [...], very passable.

The causes of Ophthalmia ve­ra conjunct.All sorts of humors may cause a true Ophthalmia, but sundry wayes; for hot humors, as bloud and choler, of themselves cause great inflammations; but small inflamma­tions may be caused of cold humors mixed with hot.

The primitive causes are the heat of the Sunne, Primitive. paine of the head, a burning fever, dust, smoake, great cold binding the part, blowes upon the head, blustering winds, ebriety, venery, and according to Paulus, oyle. It bringeth an Oph­thalmia, [Page 283]because it cleaveth fast to the tunicles, and so stop­peth the pores, and to the heat is kept in, and inflameth the eye.

Why in hot re­gions the inha­bitāts are more frequently troubled with these inflam­mations. Hippocrat. lib. de aer, aquis & locis, writeth, that they which inhabit the South, and hot regions, are easily assaul­ted by such diseases, and easily cured: and by the contrary, that they who dwell in the Northerne parts are not so easi­ly tainted with this griefe, but are more hardly cured: A­vicen yeeldeth the reasons for this, saying, that they who dwell under a hot climate, have their heads full of vapours and humors, which being resolved by the hot aire, fall to the eyes, and being there stayed, cause an inflammation, which afterward is easily cured. First, because their bodies are more perspirable. Secondly, because they have still a loose belly. But in cold regions, although they have plen­ty of humors in their heads, yet they are congealed, and doe not so promptly flow to the eyes; but if they come to the eyes, and be there impacted, they cannot so readily be dis­cussed, by reason of the thicknesse of the skin, and constri­ction of the pores. So inflammations of the eyes happen more frequently in the Summer to those who have their heads stuffed with vapors and humors, the heat colliquating them, and turning them to the eyes. In like manner in those diseases wherein there is an ebullition of the bloud, Oph­thalmiae are forerunners, as in the small pox, measles, and sometimes the plague, hot and sharp vapours being carried up to the head.

The generall signes of a true Ophthalmia.As for the signes of an Ophthalmia; they are generall, or particular.

The generall are these: according to Galen. 4. de medio. loc. 4. & lib. de totius morbi temporib. & Rhazes lib. 9. ad Almans. a swelling of the eie, a rednesse of it, paine somtimes pricking, sometimes corrosive, sometimes tensive, flowing of teares.

The particu­lar.The particular signes of a true Ophthalmia are these: a great tumor and paine, horrible heat, turning up of the eye­lids, shew a great inflammation.

These accidents, in a more remisse degree, shew a milder Ophthalmia: Signes of the parts sending. if the humor proceed from the stomack, then the party will desire to vomit: if from the head, the head­ach, vexeth: and seeing the humor may be sent both from the vessels within, and without the Cranium, if the veines of the forehead, and the rest of the face be full, if the arteries of the temples beat, and if the eye-lids be heavy, then the humor commeth from the vessels without the Cranium; but if none of these symptomes appeare, and yet the party often neezeth, and findeth itching in the nose, the humor or vapour is sent by vessels within the Cranium.

Signes of the humors sent.Signes of the humors sent are these: If bloud be it, the eyes and face will be red, the veines will be full, the paine will be gravative, the matter that floweth will not be very sharp. If it be a vapour or flatuofity, there will be a finging in the eares, and a tensive paine. If it be pituitous bloud, the tumor will not be very red, but whitish, lesse heat and meane, great heavinesse of the eye and eye-lids; the eye-lids in the night time will be glued together. Why in an Ophthalmia the eyes cleave to­gether in the night time.

This happeneth for three causes: First, because in the day time the eye is still in motion, and suffereth not the hu­mor to cleave to the eye-lids.

Secondly, because moisture is multiplied in the night time.

Thirdly, because the humor doth concoct in the night time, groweth thick, and so is more apt to cleave to the eye-lids, they then being immoveable. If choler be the cause, there will be but little rednesse mingled with yellow­nesse, the humor which runneth from the eyes will be thin, the paine will be pinching. If flatuosity or a vapour, then none of these signes will appeare, yet the eye will be some­what swelled, and a noise will be noted in the eares, and no humidity flow from it.

The predicti­ons.As for the predictions: I. An inflammation comming of externall causes, is more easily cured than that which com­meth of an inward.

II. When a continuall paine of the head is joyned with Ophthalmia, and coutinueth long, blindnesse most common­ly ensueth.

III. If in an inflammation of the eye, the humor which floweth from it be thick, it will not long continue: for it betokeneth the benignity of the humor, and strength of nature.

IV. If a milde sever, or a lask, 6. Aph. 17. seize upon one troubled with Ophthalmia, it ceaseth within a short time, the humor being discussed by the first, and revelled by the second.

[...] If the tumor of the eye be great, the paine vehement, and the matter which floweth from the eye be copious and thin, the Ophthalmia is like to continue long; but short if signes contrary to these appeare. Thus much then concer­ning the causes, signes, and prognosticks of an Ophthalmia vera shall suffice.

Ophthalmia spu­ria, what it is.Now it remaineth, that we speak a word or two of Ophthalmia spuria, a bastard Ophthalmia: This is caused onely by externall meanes, whereof we have spoken suffici­ently before, when we set downe the primitive causes of Ophthalmia vera. And if the accidents, as inflammation, rednesse, and the like, be but moderate, it will easily cease, and without great difficulty, by removing the extrinsecall causes, and applying cooling waters, as Rose-water, or Plan­tane-water, with Camphire.

The curation of Ophthalmia vera.In the curation of Ophthalmia vera, some precepts are to be observed before the application of locall medicaments.

Precepts be­fore the appli­cation of To­picks.I. The party must eat and drink sparingly, abstaine from venerie, and keep the body soluble.

II. Let the party be kept in a dark roome, and let the sleep be moderate; because immoderate sleep draweth va­pours to the head.

III. Let the objects, which the party beholdeth, be greene, blew, or black.

IV. Let anger, serious cogitations, and motion bee shunned.

V. If the haire be too long and heavie, let be polled.

VI. Let the drink be small Beere, or Barley-water, wherein have beene boiled Fennell-seeds, Coriander-seeds, and eye-bright.

VII. Let meats salt, vaporours, sharp, and hard of di­gestion be shunned.

VIII. If the party be strong, open first the Median, then the Cephalica, then the Vena frontis, and those behinde the eares, and in the temples, if the inflammation be great: if circumstances will not admit Phlebotomie, apply Ven­toses to the shoulders, and thighes; and Fructions an [...] [...] ­gatures to the armes and legs.

IX. Purge according to the humor offending, as choler with Pilulae cochiae, or electuar. de succo ros. flegme with Diaturbith cum agarico, or Diaphanicum, or Diacartha­mum.

X. If you use fomentations, Fomentation. these five things are to be observed:

• 1. That the body be cleane, otherwise the matter (be­ing scattered by fomentation) will run to the eyes.
• 2. The matter must be discharged into the eye, and not in motion.
• 3. That it be used when the matter is thick, for it atte­nuateth it.
• 4. That it be used in the declination of the griefe.
• 5. No astringent fomentations are to be used; for they wedge in the humor, and exasperate the griefe.

XI. To stay the fluxion, you are to apply a strong de­fensive to the forehead and temples.

Opiaticall me­dicaments.XII. Opiaticall medicaments not well corrected, are not to be used; for if they be but weak, the may procure a little ease for the time, but the fluxion and pain will returne more fiercely: if they be strong, they may cause inevitable blindnesse, by hindering of the influence of the visive spirit.

The locall me­dicaments.The locall medicaments must have three qualities; for they must be somewhat astringent, cooling, and anodine; [Page 287]such are the water of the white of an egge, the mucilage of Fenugreek, and Quince-seeds drawne with Rose and Plan­tane-water, with a little Saffron; Trochiset albi Rhasis sine opio (unlesse the paine be very great) dissolved in Violet, or Succorie, or Eye-bright-water. What I have spoken, I would have you to understand it of an ordinary Ophthol­mia.

The venereall Ophthalmia.If you perceive it to be venereall, or a symptome of the great Pox; then you must cure the griefe, and then the ac­cident will cease: If after the using of these meanes, the [...]hthalmia prove rebellious, you must blister the neck.

The use of the Seton.If this will not serve, you must apply the Seton, or make a Fontanell in the neck or arme; but the Seton is most effe­ctuall: for first, by reason of the great paine which it brin­geth, it maketh a stronger revulsion: Secondly, it dischar­geth the humor more plentifully, it having two orifices, but the Fontanell onely one.

LECT. XXV. Of the rest of the ulcers of the eyes.

NOw order requireth, that I should set downe the do­ctrine touching the ulcers of Cornea.

Superficiarie ulcers of Cor­nea.These are either superficiall, or deep, corroding the sub­stance of the Cornea.

I The superficiall are foure, whereof the first is called [...], which signifieth a troubling of the aire: and it is a very thin, and superficiary exulceration, of a bluish colour, resembling a dark aire, and possessing the greatest part of the black of the eye: the Latines call it Caligo, a mist in English.

II The second is called [...], in Laine Nubocula, this is deeper than Achlis or Caligo, yet narrower, and whiter.

III The third is called [...]; it is an ulcer which groweth [Page 288]about the circle Iris, possessing part of the white, and part of the black of the eye: without the▪ Iris it appeareth red, but within the Iris white.

IV The fourth superficiary ulcer is called by Aetius [...] this is a superficiary ulcer also, which maketh the Cor­nea rugged by erosion, and to be of an ash-colour, resem­bling a lock of wooll, for the which cause it is called of Avi­cen, the woolly ulcer.

The three kindes of dee­per ulcers of Cornea.Of the deeper ulcers of Cornea there are three sorts:

The first is called [...]; and it is an ulcer of the Cornea▪ hollow, narrow, without filth, like to a round p [...] ­cture: in Latine it is called Fossula; 1 for [...] in Greek doth fignifie Fovea, a pit.

2 The second is called in Greek [...], and it differeth from [...], in that it is wider, although not so deep.

3 The third, of the deeper ulcers of the Cornea, is called [...] by Aetius; by Scribouius, Largus ustio; and by others inustio; and it is an impure, and crustie ulcer of Cornea, tho­row which sometimes the humors of the eye come out, when it is made cleane, by cleansing medicaments applied.

These ulcers of the Cornea of the eye, Prognosticks. whether they be superficiarie or deepe, are not to be slighted, but carefully to be dressed: but those especially which have deeply sei­zed upon the substance of the membrane, lest they corrode thorow the whole membrane, and so the humors issuing out, the eye sink, and both deformity, and inevitable blindnesse ensue.

The materiall cause of these ulcers.For the materiall cause of these ulcers is a salt and nitrous humor, as Paulus Aegineta speaketh, Lib. 3. c. 22.

The falling downe of uvea.It the Cornea be quite thorow corroded, then the uvea fal­leth downe: this disease of uvea is called [...], uvea procidentia.

Foure kindes of it.Of this disease there are foure kindes:

I If it fall out but very little, it is called [...], caput musca, the head of a flie, and of Avicen, Formiculis, like the head of a pismire.

II If it fall downe yet more, and equall a grape in bignesse, it is called [...], uvea, or uvatio.

III If it fall downe yet further, and hang out like a little ap­ple, it is called [...], m [...]lum, the apple-like rupture.

IV But if the uvea fall downe and grow hard, brawnie, and flat, it is called [...], clavus, the naile-like rupture. All these foure kinds of the rupture of uvea for the most part are un­curable: Predictions. only the apple-like, and grape-like rupture, if the roots be small, and the party be of a good constitution, may be by binding cured, to takeaway and mitigate the defor­mity of the eye. For if the sight be taken away before by these breaches of uvea, the deligations will not restore the sight, which must be intimate to the party before you goe about these operations, that he think not himselfe deluded, having hoped for the recovery of his sight, as the reward of his patience, in enduring the manuall operations.

The alteration of the body.Seeing all ulcers of the eyes argue a cacochymicall body, for they are caused of sharp and corroding humors, the con­stitution of the body must be altered, not suddenly, by labo­ring to remove the whole cause at once; but [...], and that is according to Galen. li. 9. meth. medend. when by little and little that is discharged which is faulty, that that which is good may succeed in its place. Wherefore you are to shun all strong catharticall meanes, lest they procure vomiting, which is very prejudiciall to weak eyes, such as are those which are ulcerate. The body having beene gently purged, nature very often doth correct the refidue of the humor, by turning that part which is benigne into nourishment, and expelling that which is superfluous, by stoole, urine, and sweat. Those twelve observations which I set downe in the deliverie of the curation of Ophthalmia vera, I commend unto you in the curing of the ulcers of the eyes also, which need not any repetition.

Locall medica­ments.To set downe all the locall medicaments, which are deli­vered by the Ancients in curing ulcers of the eyes, were a fruitlesse labour.

Neverthelesse, I will furnish you with a few approved medicaments. To superficiall ulcers of Cor­nea. Then in superficiall ulcers of Cornea, use These: I. ℞ su [...]xi tu [...]. fanicul. chelidon. [...]uphragia an. ℥ij. vini albi poten [...]i [...] ℥iij. sa [...]chat. cordi ʒiij. aloes, sarcocoll. an. ʒ [...]. fellis capan. ʒij. Distill these, and use the water.

II. ℞ [...]q. chelidon. & rutae an. ℥iss. aq. ros. ℥j. croci me­tall. ʒj. fiat infusio.

III. ℞ succi saenicul. ruta an. ℥iij. mell. vptimi ℥ij. expo­nantur soli inclusa vitro stricti orificii probe obturato per men­sem tempore astive. Vtemdum ho [...] medicamento abjectis foe­civus.

IV. ℞ axung. porci aq. ros. ubluta ʒij. caphura ℈ss. turiae praepurar. gr. x. al [...]s pulv. ℈j. sacchars candi gr. xvj. fiat col­lyrium.

For deepe ul­cers.In deepe ulcers of Cornea tunica use this of H [...]urni [...], which he bought at a deate rate, and which he hath set downe method. ad praxin, lib. 1. pag. 106. ℞ [...]laminar. ter. usti ac bis in vini aceto extincti ℈j. myrrhae, plumbi usti ac le­ti an ℈ss. croci gr. v. opi [...] gr. ij. aeris ust [...] ℈ iiij. decocti fanu­graeci ℥j. terantur omnia supor lapidom pictorum ac fiat colly­rium. Having first made clean the eyes with a spunge dipped in the mucilage of Fenugreek and Linseed, dresse the ulce­rate eyes twice in the forenoone, and so often in the after­noone.

Collyrium de plumbo described by Rinodaeus, set downe by him in Dispensatorio medico lib. 5. cap. 11. de collyriis, is an effectuall medicament. ℞ plumb [...] ust [...], antimon. turiae lotae, ae­ris usts, gumm [...] Arabici, tragacanthi an. ℥j. opii ʒss. fiat ex omuib ut pulvis ex quo cum aqua resacea formentur trochises: dissolve one of them in Plantane and Purselane water, and dresse with this medicament the eye. Purging of the body. When you are a dressing the ulcers of the eyes, minister once a week a pur­ging medicament. If you use Pil [...], minister (according to the advice of the Arabiane) Pilula alephanginae, or Pilula lucis majores & minores, or de agari [...], minister a dram made up into foure Pils, which are to be covered with silver [Page 291]foile: or use this pill; ℞ Spcoier. hier. ℥ss. Diacridii ʒij. Trochiscor. Alhaxdal. ʒv. Cum Syrupo Augustano fiat massa. One pill of this composition weighing twenty graines, will purge sufficiently. If the partie cannot swallow pils, mini­ster to him this potion: ℞ carieostin. & Electuar. lenitiv. an. ʒiij. Pulv. sancti ℈ij. Fulv. Holland. ℈j. Syrup. ros. solu­tiv. cum Agarico ʒvj. aq. Beton. Faenicul. aut Euphrag. ℥iij. Misc. ut fiat poti [...].

The ordinati­on of the things not na­turall.To these medicaments both inward and outward, the, right use of those things which are called Non naturales must be joyned, or else the curation will be protracted and prolonged.

The Aire.The Aire then must bee temperate in its first qualities, as being neither too hot, nor too cold, too moyst, or too dry. It is not good to abide in the heat of the Sun, nor the beames of the Moone, or any open aire: the partie is to shun Southerne and northerne winds: for the Southerne wind, according to Hippocrates, troubleth the sight, aphor. sect 3. cau­seth hardnesse of hearing, an heavie head, dull senses, a lazie body, because it begetteth grosse spirits. And the Nor­therne wind is verie sharp, and therefore it stingeth and pricketh the eyes: neither must the aire be too lightsome; for it scattereth the spirits.

The bread must be made of cleane wheat, Bread. well-leavened, and somewhat salted, wherein may bee put Fennill, Anise, and Coriander seeds: for unleavened bread is accompted hurtfull to the eyes.

As for flesh-meats these are good: Flesh. Chicken, Capon, Hen, Partridge, Phesant, Pigeons. Larks, the Pie, the Swallow, and the Goose-flesh are accompted good for the sight.

As for fish, Trouts, Rochets, Pearches, and Pickerels, Fish. of fresh-water fish may for varietie of diet bee admitted: of salt-water fishes, Whiting-mops, and the Smelts are ac­compted the best. Baked and fried meats, strong spices, as Pepper, Ginger, Mustard, and the roots of the Horse-rettish are not to be used. To meats minister this composition in [Page 292]stead of salt: ℞ Euphragiae, Semin. Faenicul. an. ʒj. Cinamo­mi & Macis, an. ℈j. Salis communis ℥j. fiat ex omnibus pul­vis. All bulbous roots, as Onions and Garlick; and P [...]lses, as Pease and Beanes, are to bee rejected; as also moyst and [...]w fruits: Stewed Prunes, and Peares, or Quinces preser­ved, are permitted after meat, to stay the ascending of va­pors to the head, and the Marmalade of Quinces, with some Anise-seeds, Fennill-seeds, and Coriander-seeds Comfits.

As for drink, Drinke. no liquor is more convenient than six shil­lings Beere, neither too new, nor too stale, having had a bag of boulting-cloth hung in it, filled with Eye-bright, Fen­nill-seeds, Betony, Rosemarie, sweet Marjerome and Sage.

If the partie hath beene accustomed to wine, Wine. let him use some small wine, not sharp or vaporous, wherewith some good spring-water must be mingled, and Borrage-flowers, and Burnet-leaves are to be put into the cup: and this will serve for two purposes: for the colour will comfort the eyes, and the herbs by their propertie will represse the va­porousnesse of the wine. The lesse one doth drink the bet­ter will the Patient be, and the sooner cured. A small kinde of Meath made after this manner will not be amisse: ℞ Aq. font. lb. xv. Mellis optimi lb. j. Faenienl. Euphrag. an. man. j. Macis ʒj. Coq. adtertiae partis consumptionem semper spu­mam auferendo, Sleeping and watching. actandem colando. Immoderate sleepe fil­leth the head full of vapors, and immoderate watching doth spend the spirits, coole the braine, and hinder the sight. It is good to goe to bed three or foure houres after supper, and to rise early, and to walk softly up and downe the chamber, to comb the head, Exercises. pick the eares, and to emptie the excre­ments. Much reading is not good, especially after meales, and weeping is verie hurtfull.

The body must still be kept soluble with lenitive clysters of Diacathol. the syrup of Althaea, Solublenesse. and the oyle of Lilies dissolved in the ordinarie decoction appointed for clysters. Take this for a parterne: ℞ Diacathol. ℥jss. Syrupi de Al­thea ℥ij. ol. Lil. albor. ℥ij. Decoct. communis pro clysterib. [Page 293]℥viij. Misc. ut fiat clyster. If the partie will not admit a cly­ster, then minister halfe an ounce of Electuar. lenitivum, in seven spoonfuls of broth made of a Chicken. After meales use this or the like digestive powder: ℞ Semin. Faenicul. & Coriand. Saccharo semel incrustatorum, an. ℥j. Cort. Citri, & Myrobalan. Kebul. condit. an. ʒiij. Euphrag. siccat. ʒij. Ma­cis ʒj. Sacchari rosat. Tabellat. ʒjss. fiat ex omnibus pulvis. Dos. cochl. 1 à singulis pastibus.

Hitherto I have delivered unto you the differences of milde ulcers; Of maligne ulcers of the eyes. now I will speake of the divers kindes of ma­ligne ulcers of the eyes. These are either not contagious, or contagious. The not contagious are two; Noma, and Ʋlcera cancrosa. The contagious are three; Carbuncu­losa, Venerca, Morbillosa. Of these in order I will discourse briefly.

Noma, or Ʋlcera depascentia are maligne ulcers, Noma. which sometimes begin at the corners of the eyes, sometimes at the white, and sometimes seize upon the hornie membrane. In corrupt bodies they fret exceedingly, and goe forward in such sort, that oftentimes they consume the parts adja­cent, as the muscules and lids of the eye: Signes. from them flow­eth a stinking slimie matter: the paine is grievous, and the diseased partie hath an accidentall fever.

This ulcer is dangerous, Prognosticks. and seldome cured without deformitie and losse of the sight: wherefore my counsell is, that you fore-tell the danger, if such ulcers bee offered to you to be cured.

The locall me­dicaments.Onely I will acquaint you with some locall meanes, ha­ving spoken sufficiently of the generall intentions. Apply then to the ulcer the juyce of Plantane. Horse-taile, Knot-grasse, Night-shade, and Yarrow clarified with Honey, and the whites of Egges: Dresse these ulcers morning and eve­ning, dropping a few drops into the affected eye, covering the eye with a cataplasme made of Ʋngn [...]um ros [...]t [...], the pulp of a Quince boyled, and some [...]y [...]e of P [...]pp [...]es. If these ulcers prove verie maligne and corroding, you may [Page 294]correct them by instilling some oyle of Vitriol, or Sulphur, mingled with Plantane-water, taking onely the fourth part of it. To asswage the paine use this cataplasme: ℞ Mala Cydonia numero 2. Sedi major. et Solani hortens. ana man. ij. coq. in s. q. Lact. muliebr. vacc. capr. aut asinae, adda­tis Croci ℈j. ac fiat cataplasma.

A cancerous ulcer. Vlcus cancrosum, a cancerous ulcer followeth, which the Chymists pronounce to be caused of an Arsenicall salt, and it is like to be so: for in this ulcer, besides corrosion, there is a septick or putrefactive qualitie. It beginneth in the black of the eye.

The signes.In it the black and white of the eye are reddish, lines seeme to be sent from the black to the temples: the Patient refuseth food, by reason of the exceeding great paine, a thin darkish and sharp humor floweth from it, and it is exasperate, by reason of the application of sharp medica­ments.

You an onely promise a palliative cure of this maligne ulcer, Prediction. by the application of anodine meanes, after you have used the generall indications before specified. Paulus Aegi­net. lib. 3. c. 22. affirmeth it to bee an uncurable evill. Hee counselleth to feed the Patient with milk, panado's, and other meats of a good juyce, and of an easie concoction.

Locall meanes.Milde eye-salves are also to be applyed, as this: ℞ Muci­lag. Semin. Cydon. et Palicur. Aq. ros. extract. ℥j. Trochisc. albor. Rhas. cum opio ʒj. fiat collyrium quod tepidum applice­tur. Renovetur mane et vesperi. Desuper applicetur hoc ca­taplsama. ℞ Pome cocta num. 3. Cassiae recent. extract. ℥ss. Croci ℈j. Lactis mulieb. ℥j. Albumen ovi unius: fiat cata­plasma. So much then concerning the handling of maligne ulcers of the eyes, Maligne ulcers proceeding of contagious dis­eases. wherein there is no contagion.

Ulcers which are caused of contagious diseases follow, as the Small Pox, the French Pox, and the Plague: If you feare that the Small Pox are like to cause ulcers in the eyes, I which you shall conjecture if there was an inflammation in the eyes, Of ulcers cau­sed of the Small Pox. before any did appeare in the body; if the par­tie [Page 295]feele paine in the eyes, and cannot open the eye-lids, then are you to apply gentle fomentations to the eyes, Topicks. as the brest-milk of a sound woman, having a little Saffron mingled with it; or the Mucilage of Fenugreeke, Lin-seed, and Quince-seeds, drawne with Rose-water, having some Saffron added to it. You shall not need to looke for any other medicaments in these ulcers.

Venereall ul­cers.If the ulcers be venereall, caused of the great Pox: then with all expedition are you to goe about the curation of the maine griefe, lest blindnesse quickly ensue, and then to labour to cure the ulcers of the eyes, which are but onely symptomes of the disease. Rinod. in dispensat. med. lib. 5. c. 11. it setteth downe an excellent eye-salve for this purpose, ascribed to Lanfranck by the Neotericks, which hee could not finde in the works of Lanfranck (as hee confesseth) so that by all likelyhood it is a magistrall receit. The descrip­tion of it is this: ℞ Vini albi lb. j. aq. Plantag. & rosarum an. ℥iij. Auripigment. ʒij. Virid. ar. ʒj. Aloes, Myrrh. an. ℈ij. Terrantur ista subtilosmè, & fiat collyrium.

Of the ulcer caused of a pe­stilentiall Carbo.I will adde a little of the ulcer of the eye, caused of a pestilentiall Carbo, or Anthrax, and so end. In this case, first there ariseth a small tumor in the eye, hot, hard, pain­full, and contagious, caused of a thick, burned, and veno­mous humor: It is hot, the unnaturall heat causing an ebul­lition of the humor: It is hard, because the heat burneth the humor: It is contagious, by reason of the venomous humor which causeth it: when it yeeldeth matter it stin­keth, by reason of the putrefaction of it.

The symp­tomes.It is accompanied with watching, drought, internall heat, raving, and the urine is sometimes of a firie colour, sometimes thick and troubled.

The curing of it.If these symptomes appeare, then are you first of all to minister such Antidotes as are fit for a pestilentiall fever, as Th [...]riaca Andromachi, Antid [...]m de sangui [...]ibus, Electua­rium de ovo, and such like, to tame the venenositie of the matter, and then to proceed to the curing of it. If you per­ceive [...] [Page 298]call the capitall instrument, the gibbous or arched part be­ing blunt, and having a back; but the belly being as sharp a a razor: when you have compassed all the part united, ha­ving turned the back of the instrument towards the eye lid, cunningly seperate the parts united, neither offending the eye-lid, nor any tunicle of the eye. But if either of these must bee touched, it is best that the eye lid suffer, than any tunicle: for it may more securely suffer the injurie. When this operation is performed, if you be not vigilant in kee­ping the parts seperate asunder, they will easily unite againe. as Celsus noteth.

In setting downe the operation, Celsus calleth the instru­ment Specillum: Specillum. As for that instrument which goeth com­monly amongst the Ancients, under the name of Specillum: It did absolutely represent your ordinarie Spathula's, being on the one end narrow and round, to serve for a probe, en­ding in a round small button, to hinder it from offending, when you are to trie the depth of an ulcer, or wound, and on the other broad and flat, to spread your unguents: of the broadest end Galen speaketh, Method. 13. c. 5. where hee adviseth to besprinkle an ulcer with the powders, using lato Specilli mucrone, the broad end of the Specillum, or Spathula.

A note.One thing is to: be noted, that if (you feare that in put­ting in of the instrument into the eye, to comprehend the parts united) you feare to hurt any part with the point, then it is requisite to arme it with a little wax, that it may bee like the end of a probe.

The locall me­dicaments.To the parts thus seperated, apply a Collyrium made of Plantane-water, and Tochisci albi Rhasis sine opio: dissol­ving in an ounce of the water, a dram of the Trochisces. Keepe the parts asunder with small dosils of lint put be­tweene the parts disjoyned, laying upon the eye a couple of boulsters crosse-wayes, moystened with the afore-named medicament, and then rouling it up: Dresse the eye mor­ning and evening, to hinder unition, and hasten the [Page 299]cure, untill the incised parts be cicatrized, and no feare left of cleaving together againe of those parts, which by manu­all operation were severed.

LECT. XXVI. Of Ozaena.

HAving set downe the ulcers which ordinarily possesse the eares and eyes, I must not let those passe which sometimes trouble the instruments of the other two senses, to wit, smelling and tasting, which are the nose and the mouth. Of all the ulcers of the nose, I will onely speake of Ozaena, omitting the rest; because they require no singular consideration: for the generall indications of curing of ul­cers, will serve to lead any man to the curation of these.

The Etymon.Ozaena hath its denomination from [...], which ac­cording to Celsus, lib. 3. c. 11. is Foetor oris, the stinking of the breath.

What it is.Of it Galen, de comp. medicam. sec. loc. lib. 3. c. 3. so discourseth: Polypodes are bred in the nostrils, which are tumors unnaturall: but Ozaenae are a kinde of ulcers, &c. First of all, I will speake of the Ozaenae, which are produ­ced of the influxion of sharp, and putrid, or rotten humors. These humors, if they be onely sharp, they produce ulcers hard to bee cured; but not of a grievous smell: Out of Galen then you may gather, that Polypodes are onely tu­mors in the nose, but Ozaenae are ulcers. Secondly, The differen­ces of Ozaenae. that there are two sorts of Ozaenae; the one is of these which erode, being caused of the influxion only of sharp humors, but stink not. The other is of these which smell grievously, and are caused not onely of sharp humors, as the former; but such also as have putrefaction annexed to the erosion. Actuar. lib. 2. [...] c. 10. so speaketh of this kinde of ul­cer. Ozaena doth manifest it selfe by its verie name, which [...] [Page 302]corrupt and evill juyce. Secondly, that he use great mode­ration in the use of wholsome and convenient food.

How fasting is profitable.Fasting often in this case is verie requisite: First, be­cause it drieth the habit of the body: Secondly, because it furthereth concoction: Thirdly, because by fasting those vapors are digested, which otherwayes would mount up to the head. And although in the beginning, while the body is fraughted with sharp humors, the sore may bee exaspera­ted by fasting: yet after that the body is cleane, and dis­charged of such humors, by frequent evacuations, you shall finde the commoditie of fasting: howsoever, the dinner must not be riotous, and the supper verie spare.

The second Physicall meane is Phlebotomie: Phlebotomie. If the bo­dy bee plethorick: First, open the Cephalica of the right arme in the Spring and Summer; but of the left, in the Har­vest and Winter: Then three or foure dayes afterward open the veines under the tongue, which will serve for deriva­tion of the humor, as the former did for revulsion of the same.

The commodi­ties of it.This must much further the curation: For first, Phle­botomie impaireth the quantitie of the humors contai­ned in the masse of the bloud: Secondly, it maketh way for the receiving of better bloud into the vessels, which of a necessitie must ensue after the appointing of a conveni­ent diet, and exquisite purging of the body, which imme­diately after Phlebotomie is to be performed.

The third Physicall meane appointed for the curation of an Ozaena, Purgation. was said to be purging of the body by cathar­ticall medicaments: for vomitive medicaments are not so convenient as the catharticall, in the diseases of the head, unlesse the stomack bee foule, and pestered with raw and corrupt humors, which require a long time for concoction: Vomitions (as is confessed by all Practisers) send up vapors to the head.

Their kindes.These purging medicaments are of two sorts: for they are either vegetable, or minerall.

The vegetable purgatives.As for the vegetable medicaments, they must bee of the strongest, which are appointed for disburdening of the head of ill humors: such are Agarick, Turpetum, Coloquint, Scammonie, the black Ellebore. But seeing the purgative simples are seldome ministred alone, I will shew unto you what compounded medicaments are fittest to bee used in this case. The compounded purgative medicaments are ei­ther Pils or Potions.

As for the Pils: Pils. If the humors be mixed then use E [...] ­tractum Panchimagogic [...] of Paracalsus, or the Pilula e [...] ­tracta R [...]u [...]; of them minister halfe a dram for a dose: Let the Patient use this medicament twice a weeke. If cho­le [...] and flegme corrupted be the materiall cause of the ulcer, then minister the pils called Sine quibus esse no [...]. If thick and gorsse humors be the cause, ministe 1 Pilula a [...]a, & coc­tia. It corrupt flegme be the cause, minister Pilulo de A­garito. Of these pils minister one dram for a dose: let the number of the pils bee according to the swallowing of the Patient.

If the Patients bee hard to be moved to the stoole, you may acuate, and make the pils more effectuall, by adding to everie dose of the pils some graines of the Trochisces of A [...]andal, and three graines of Dacrydium.

If the partie cannot swallow pils, Potions. then you are to mini­ster potions. The Electuaries most fit for this purpose, are Diacatholicum, Caricosti [...]m, Diaph [...]icum, Elect [...]ar [...]um de succo rosarum, Confectio Hamech, Diac [...]rhamum. Of these Electuaries, and convenient syrups, and distilled wa­ters, or decoctions, you may make potions fitting the con­stitutions of the parties grieved.

For one of a cholerick constitution minister such a po­tion: ℞ Caricos [...]i [...]. & El [...]tu [...]. de s [...]c [...] res. an. ʒiij. Sy­rup. de C [...]bor. cum [...] ℥j. aq. Endivia ℥iij. Misc. ne fiat potio.

If the partie be of a phleg [...] constitution, minister this potion: ℞ Diaph [...]. & Di [...], an. ʒiij. Syrupi [Page 304]ros. solut. cum Agarico ℥j. aq. Beton. ℥iij. Misc. ut fiat potio.

If the diseased person be of a melancholy temperature, then minister this potion: ℞ Confect. Hamech ʒiiij. Dia­cartham. ʒiij. Syrupi Augustani ℥j. aquae Fumariae ℥iij. Misc. ut fiat potio.

Thus you may purge the body with vegetable medica­ments, if the body of the diseased partie be weake, or if you feare the use of minerals. But let me insinuate so much un­to you, that the minerall medicaments, if they be well pre­pared, are most effectuall, and if they be ministred by a skil­full Practiser, howsoever they are sleighted and despised by those, who glorie of the denomination of Galenists, a­mongst whom some may bee found, whose skill is inferior to the envie of an understanding man.

Minerall me­dicaments.The minerall medicaments are more subtill and piercing than the vegetables, and sooner alter the complexion of the partie unto whom they are ministred. These medi­caments are most commonly taken from Antimonie and Mercurie.

The Antimonie which purgeth most by stoole is excel­lent. Antimonie. The Sulphur of Antimony drawne by Art from the recrements of the Regulus is good; as also the Regulus it selfe calcined and fixed with Sal-peter, and brought to a white powder. The glasse of it, and Crocus metallorum, are not so convenient and secure, because they procure strong vomitions.

There bee divers preparations of Mercurie which are verie effectuall; Mercurie. as Mercurie precipitate, with Aqua fortis, the oyle of Vitrioll, or Sulphur, with Gold or Silver, or precipitate alone, without the addition of any thing. There is none of any note amongst you, who is not able by one preparation or another of Mercurie, to procure salivation.

These Mercuriall medicaments are effectuall, as well in an Ozaena which is a primarie disease, or of it selfe, as in [Page 305]that which is a symptome of the French Pox. You have heard what diet is most convenient, and what internall me­dicaments are most effectuall in curing of an Ozaena: The last point which I propounded unto my selfe to attaine to the curation of this ulcer, was the right use of the exter­nall medicaments.

The externall medicaments.These are in number two; to wit, the locall medica­ments, and the actuall cauterie.

As for the locall medicaments, they are either waters, or decoctions, or unguents: But before you apply any medi­caments to mundifie, incarnate, or cicatrize, you must labour to remove the crustie substance, How the crustie substance is to be removed. which doth fix it selfe in the fore-part of the Ethmoides, or Os Cribriforme: and that for two causes: First, because the braine is hindred from discharging of the residue of the maligne humor, which causeth the ulcer, and so the curation is protracted: Se­condly, because the medicaments cannot touch the affected parts, and so no alteration can be procured.

For the removing of the crustie substance, I commend unto you two medicaments:

The first is this: ℞ Ol. A mygdalarum dulcium ℥j. Sper­mat. Ceti ʒij. exquisitè misceantur:

The second is this: ℞ Axung. Vrsi ℥j. Pinguedin. Taxi ℥ss. ol. Semin. lin. ʒiij. Mise.

The manner of the applying of these medi­caments.You must thus dresse the Patient: Turne his face up­ward, and let his head be bent backwards, then morning and evening with three feathers tied together, drop still some of these medicaments warmed in a Sawcer, into the nose, and let the partie grieved stil draw in his breath, untill hee feele the taste of them in his mouth.

When you have perceived that the crust is soft, morning and evening let him snuffe up into his nostrils some of this sternutatorie powder: ℞ Ellebor. albi, Nigilla, Tabacc. an. ℈j. Rorismar. Salv. an. ℈ij. Moschi gr. ij. fiat pulvis subtilis. Let him snuffe a little up into his nose everie mor­ning, after you have moystened the crust with some of the [Page 306]medicaments set downe before. When part of the crustie substance is falne out, dresse it still after this same manner, untill all the crust is spent: The medica­ment, to be applyed. then proceed to the application of the medicaments named by name.

Use these waters.

I. Waters.First, the preheminence shall bee given to Aqua alumini [...] magistralis of Fallopius allayed with Plantane, or white Rose-water.

The second shall bee this: ℞ Aq. Plantag. Card. Bene­dict. Caras. nigror. & fragor. an. ℥iii. Spirit. Vitriol. ℈i. Misc.

The third shall be this: ℞ Aq. aurifabror. & gemmar. quer­cus an. ℥iiij. Alum. ʒij. Exquisitè misceantur & depurentur.

The fourth shall be this: ℞ Aq. Alum. & Plantagin. an. ℥iiii. Mercur. dulcis ʒii. Digerantur in cinerib. calidis per her. 2.

[...]I. Decocti­ons.As for Decoctions, I commend unto you these:

I. ℞ Flor. ros. rub. pug. ii. Balanstior. ʒss. rad. Tormen­till. ʒi. fol. Plantag. Polygon. & Vinca pervinc. an. pug. 1. Boile these in six ounces of spring-water, untill the halfe be consumed; straine then the three ounces remaining, and dissolve in them one ounce of Melrosatum.

II. ℞ Rhois Coriar. lb. ss. Alumin. ʒii. coq. ista ac cla­rificextur albumine ovi unius, ac colentur. Colaturae adde mel­lis rosat. Syrup. Myrtill. & deros. rub. sicc. an. ℥i. I will not trouble you with great varietie, as I might out of the mo­numents of the Ancients; seeing these will suffice, or else none.

The manner of using of wa­ters and deco­ctions.The waters and decoctions you must inject by a fyringe warm, to make your topicks answerable to the ayre, which is drawn by the nostrils in the first qualities, to wit, moyst and hot: moyst, I say, actu, but potentia, drying; seeing ul­cers require such medicaments: seeing both waters and de­coctions being applyed, do quickly evaporate, and leave the part affected dry, and thirsting for other topicks.

The unguents.The unguents shall offer themselves; I will not super­erogate [Page 307]in this point, but will only deliver unto you such as shall bee effectuall; and what is deficient in number, shall be supplyed by efficacy. Receive this as the first, out of Da­niel Sennert. med. pract. lib. 1. part. 3. sect. 4. c. 1. ℞ plumb. usti, lithargyr. an. ℈ i. ceruss. bol. Armen. balaust. an. ℈ ss. ol. ros. myrtin. an. ʒ ss. cerae alb. ℈ i. Ducantur ista in mor­tario plumbco, donec acquirant unguenti confistentiam. The second shall be this: ℞ unguent. de tutia, & unguent. albi caphurati, an. ℥ i. ol. myrtill. et cydon. an. ʒ ii. Mercur. dulcis ʒ i. ss. pulverizati. Misceantur. These ulcers are to be dres­sed twice a day, morning and evening.

Cancerous ulcers.Cancerous ulcers also seaze upon this part. This griefe hastened the end of that famous Mathematician, Mr. Ha­riot, with whom I was acquainted but a short time before his death; whom at one time, together with Mr. Hughes, who wrote of the Globes, Mr. Warner, and Mr. Turperley, the Noble Earle of Northumberland, the favourer of all good learning, and Mecaenas of learned men, maintained while he was in the Tower, for their worth and various li­terature. But seeing those documents, which I delivered for the curation of cancers already, may suffice, I will only set down the description of an effectuall water in this griefe, which is this: A water fo [...] cancer in the nose. ℞ spermat. ranar. et limacum, an. lb ii. gem­mar. quercus, et hederae terrest. an. ℥ iiii. Extilletur aqua è stillatorio communi, unde prolici solet aquarosacea in recipi­ens, cui immissae sint caphurae calcinatae ʒ ii. Inject this water into the nose, and lay to the sores either double clouts, or lint moystned in this water, as you shall think most fit, morning and evening.

The applica­tion of the actuall cau­terie.It resteth only now that I speak a little of the applicati­on on of the actuall cautery, which was sayd to bee the second externall meane in the curing of an Ozaena: this meane is only used when the sore is rebellious to powerfull ordinary meanes; which hapneth either by reason of malignity, or too much, or superfluous humidity: When it is to be applyed. for according to Hip­pocrates [Page 308]aphor. lib. 1. aphor. 6. Against extreme griefes, ex­treme remedies are best.

The uses of it.The actuall cautery is applyed for two purposes:

First, to cause an eschar by impressing of it upon the ul­cer.

Secondly, it is used only to dry the ulcer, by often apply­ing of it, still desisting before the party feele any paine, by reason of extreme heat.

The pipes.If you meane to procure an eschar, both the ends of the pipe by the which the cautery is carried, must be open; but if you intend desiccation, the end which you apply to the ulcer, must be shut.

If you have procured an eschar, the fall of it is to be procured as I did shew in removing of the crust: this being done, proceed in curing of the ulcer as hath been taught.

If only you have caused desiccation by iteration of the application of the actuall cautery, the manner of curing is not to be altered.

LECT. XXVII. Of the ulcers of the mouth.

NOw am I to discourse of such ulcers as befall the in­strument of taste, which is the mouth.

The limits of the mouth.It beginneth at the lips, and reacheth to the beginning of the wind-pipe, and the Gula, or mouth of the stomack.

The uses of it.It hath foure uses: I. It serveth for breathing, it sending fresh aire unto the lungs, and discharging fuliginous vapors sent from the heart by the Arteria venosa.

II. It receiveth the food, and having prepared it by the chewing of the teeth, and the mandible, it sendeth it to the stomack there to be chylified.

III. It serveth for speaking: the externall and internall parts of it serving for the framing of the voyce.

IV. It serveth for the discharging of the excrements of the braine, by spitting out of the excrements of the lungs by expectoration, and of the excrements of the stomack by vomiting.

Seeing then the uses of it are so manifold and necessary, it behoveth me to discover such diseases (belonging to our purpose) as deprive us of one or more of these commodities which it affordeth to us. But seeing some of the parts of it are externall, as the lips; and some internall, as the teeth, gums, roofe, the tongue, the almonds, the uvula: I will onely meddle with the ulcers of the lips, roofe, tongue, almonds, uvula, and the ulcers of it beyond the uvula, as onely being proper to my intention.

Of the ulcers of the lips.I will begin first with the ulcers of the lips: how hurtfull the ulcers of the lips are, you may gather from the commo­dities, which they (being sound) afford to man.

The commodi­ties of the lips.The lips afford a sixfold commodity to the life of man:

• I. They serve for the convenience of eating and drink­ing, for they keepe in the meat untill it be chewed.
• II. They beautifie the face if they be well fashioned.
• III. They keep in the spittle of the mouth.
• IV. They keep the teeth and gums from externall in­juries.
• V. They serve for the framing of the speech.
• VI. They serve for kissing, the earnest penny of lust.

And although the benefits which doe redound unto us by the lips, being well affected, may be hindered by sundry meanes: yet I will touch onely but two sorts of solution of unity befalling to the lips, as proper to the subject which I have in hand, which are the chaps of the lips, and the ulcers of the same.

The chaps of the lips. Fissura labiorum, or the chaps of the lips, proceed from a salt, sharp, & drying humor, which causeth these narrow, but [Page 310]long small ulcers, Their cause materiall. which are hot and painfull, chiefly when the party speaketh, eateth, or laugheth.

These chaps, [...]ictions. although they may without any great diffi­culty be cured in persons of a laudable constitution, yet in cacochymicall bodies they will give you somewhat to doe: in so much that the Patient will wonder and fret, that such toyes and trifles cannot more speedily be cured; for so they terme such griefes, considering not the quality, but quanti­ty of the griefe.

The curation of these.For the curation of these, I will commend unto you two medicaments of my owne, which I familiarly use: The first is this: ℞ cer. flav. ℥ij. ol. ros. mell. & axung. porc. in aq. ros. lot. an. ʒiij. litharg. argenti, myrrhae, zinzib. pulv. an. ʒj. fiat linimentum s. a. First, moisten the part with the parties owne spittle, and then anoint the part affected with the li­niment: it is effectuall, not onely in chaps of the lips, but in other chinks of Fissurae in what part of the body soever they be; and it cureth speedily.

The second is a Pomatum, the description wherof is this: ℞ Pomae numero 3. quibus infige cariophyll. ℥ss. styrat. cala­mit. ʒiij. benzoini ʒij. labdan. ʒiss. calam. aromat. cinamom. an. ʒj. axung. porc. lib. ij. aq. lavendul. & ros. an. ℥iiij. Moschi, civetae an. gr. iss. Indantur ista vasi terreo satis am­plo, ac calore B. N. evaporentur aquae, & colatur pomatum, quod in vase puro servetur. You may conjecture the efficacie of this medicament by the ingredients.

Vlcers of the lips.As for the ulcers of the lips, they are either milde, or ma­ligne.

For the milde.As for the milde ulcers, this ointment described by R [...]o­daus, Antidot. lib. 5. sect. 1. cap. 11. which he calleth Vn­guentum de minio, or Vnguentum rubrum caphuratum, is ve­ry effectuall: compos. haec est: ℞ minii triti ℥iij. lithar. argent. ℥ij. cerussae ℥iss. tut. ʒiij. caphur. ʒij. ol. ros. lib. j. cer. albi, ℥iij. fia [...]ung. ut [...]rsprascribit. This unguent is effectuall a­gainst even old and inveterate ulcers, in what part soever of the body they be.

For the ma­ligne.If you perceive an ulcer of the lip to be maligne or can­cerous, which you may conjecture if the colour be livid, or blackish, if the brims be hard, if the heat and paine exceed the quantity of the ulcer, and if it yeeld a sanious and ill smelling quittor; then are you to looke about, and to espy which are the most powerfull medicaments.

When I discoursed of a Cancer, a Nome, and a Phagedae­nicall ulcer, I delivered unto you choise of locall medica­ments: for such ulcers, if they happen to invade the lips, at this time I will onely deliver unto you a description of a di­stilled water, and of a magistrall unguent.

The water is thus to be made: ℞ fol. plantag. solani hor­tens. veronic. sempervivi major. & minor. an. man. iij. albu­mina ovorum conquassata num [...]ro xij. alumin. contus. lib. ss. caphur. ʒiss. Extuletur aq. calore balnei: fomentetur cancr [...] ­su [...], aut malignum [...]lc [...] hac aqua, quae & facici ruborem tol­lit. The description of the unguent is this: ℞ plumbi ʒiij. fundatur in crucibulo, eique addatur Mercur. ʒiss. postquam refrixit man. in pulverem vertatur massa, cui adde unguenti de tutia ʒvj. terebinthin. ʒij. terebinthin. ʒj. ol. myrtil. ʒiss. fiat unguen­tum quod ulceri post fotū applicetur. Deligetur ulcus singulis diebus quoties opus est. If you find the ulcer to be rebellious, and not to yeeld to these very convenient and effectuall meanes, then are you to apply such medicaments as I have set downe for the curation of Nome, Phagedaena, and Can­cer, when I discoursed of them, whither I remit you, to shun tedious and fruitlesse repetition.

The ulcers of the Palatum.To the ulcers of the lips, the ulcers of the Palatum, the roofe of the mouth must be annexed: It is rawted, that the aire being repercussed, the voyce should be the sharper: it is wrinkled and rough where it covereth the bone, Its figure. that it might the more firmely cleave to it, and the better stay the meat whilest it is in chewing.

The instru­ment of ta­sting.Now seeing all the internall parts of the month are in­ducd with the sense of tasting, but chiefly the membrane [Page 312]which covereth the tongue, The instru­ment of fee­ling. and have the exquisite sense of feeling, by reason of the nervous fibres, whereof they have great store, you are to have a care that your locall ap­plications be not distastfull and loathsome, seeing the parts will abhorre them. If then the wrinkled skin, which cove­reth the Os palati, be ulcerate: first, touch it with Aqua Fallopii, allaied with Plantane-water, if it be foule; or with this: ℞ aq. plantag. card. bonedict. & spermat. ranar. an. ℥iij. melius ros. ℥ij. ol. sulphur. aut vitriol. ℈j. Misc. Having touched the ulcer with either of these waters war­med sufficiently, apply this medicament: ℞ syrup. è ros. rub. siccat. è baccis myrts, & de succo granatorum an. ℥j. ol. vitriol. ℈ss. Misc. Seeing the part is moist, and will not admit any deligation, you are to dresse it the more often. If you perceive the Os palati to be bare, then mingle some of this powder following, mingled with these syrups: ℞ far. hord. rad. irid symphyti, tormentill. an. ℥ss. mastiches, boracis, sarco­coll. an. ℥ss. fiat ex omnib us pulvis. If the rough skin unite, as I have often seene, then have you obtained your desire.

What is to be done when Os palati falleth out.If a small peece of the Os palati fall out, using these incar­native using these incar­native meanes, and keeping the brims of the ulcer raw, you may bring them together; but if a large peece of the bone come away, there is no hope of unition. In this case, you are to cause the party to weare a plate of silver to supply the defect of the bone, that his speech bewray not the losse of it.

The third internall part of the mouth, which useth to be ulcerate, Of the go­vernment of the tongue. is the tongue. The tongues of Angels are not able to expresse what benefits doe redound unto man by the right ordering of the tongue, and what harmes and incon­veniences againe, when we give it free reines to lash out. The frequent exhortations set downe in the holy Scripture to the first, and dehortations from the second, may make us wary in our discourses & conferences. It is that part of the body by the which God is chiefly glorified; by it we praise [Page 313]and magnifie him, as godlesse persons blaspheme him with it we confesse our sins, by the which we provoked him to anger; and againe, we powre out our prayers with the tongue to obtaine remission for them.

The uses of it.The tongue affordeth foure benefits to the body. I. It is the instrument of tasting, by the benefit of the membrane wherewith it is covered.

II. It uttereth the speech, by the which we communi­cate our wants to others, and implore aid in time of di­stresse.

III. It helpeth chewing, by gathering of the meat toge­ther, and tossing it to and fro, it turneth also the meat downe to the stomack.

IV. It serveth for licking. To omit that in our infancie we could not suck without it: so we see, that if the fraenum of it come too neere to the tip of it, the sucking is hindred, and it must be cut. The children who have this infirmity, are said to be tongue tied. The flesh of it is spungeous, How mild sores of the tongue are cu­red. that it might receive the qualities of the sapors, and the more accurately judge of them.

If the sores of this part be but ordinary and milde, this medicament will serve if it be often washed with it: ℞ hord. mundat. ℥iij. rad alth. ℥ij. liquirit. ℥iss. Bulliant ista in lib. vj. aq. font. ad mediat ac coletur decoctum, cui admisce syrup. viol. tussil [...]g. & scabiosae an ℥jss. ac serva in mundo vase ad usum.

Of maligne ulcers of the tongue.It falleth out sometimes, that sores in this member prove maligne and very fretting, causing one of those ulcers which are called, [...] and [...] as it happened to the late Lord Mayor of London, Ralph Freeman. Hee lacked neither Physitians nor Physicke, yet old age, weaknesse, and the malignitie of the sore hindred the procuring of his health, which his Physitians and Chirurgeans aimed at and wished for. The ulcer was so corrosive, that it fretted asunder the veines and arteries of the tongue, on that side [Page 314]which it possessed, and caused a great flux of blood, which exceedingly weakned him, for that present causing a strong syncope, so that afterward nature could not recol­lect her selfe. When such griefes befall great personages, their case is worse than that of the poorest in the like infir­mities, because Physitians and Chirurgians are not per­mitted to use the like libertie in the application of medica­ments to the one, as to the other. If the like case fall out hereafter at any time, I advise you so to use medicaments borrowed of the vegetables, as that you contemne not the minerals: What hurt I pray you can come from the use of Merc. dulcis, and Merc. praecipitat with gold: None I assure you: for these medicaments are familiar to nature, and are true balsams for maligne sores.

Quest. But you may aske what was the reason that these medi­caments were not used?

Answer. I answer, because there was no mention made of these medicaments at the first, and it was too late to minister them at the last, nature being surprised; for this only would have made the medicaments odious, and the Physitian, (who should have advised this course) obnoxious to calum­nie and reproach.

Of ulcers of the Vvula.Now time admonisheth mee to come to the ulcers of the Uvula, or gargarion.

Of mild ones.If they be milde and ordinarie, the former medicaments set downe for the curation of the tongue will suffice.

Of fretting ulcers.But if it be a fretting ulcer, first you are to admonish the patient of some accidents, which may ensue: and those are two in number.

The first is, Prognosticks. that if the Uvula bee wholly fretted away, the party shall hardly be able to speak clearely and distinct­ly. Howbeit both Bauhinus in his Theatr. anatomicum, and Guillelmus Fabricius Hildanus cent. 2. observ. 21. doe affirme that in some they observed it to have beene lost, not leaving any defect in their speech.

The second accident is, the danger of pthisis, or cough of the lungs, for this is to be feared, seeing the member which did hinder the roushing in of the cold ayre into the lungs, and put back from the breast humors distilling from the head, is wholly taken away. Having acquainted the pa­tient with prognosticks, proceed to the curation.

The curation.This is performed either by the application of conveni­ent medicaments, or else by cutting it away.

1 By medica­ments.As for the medicaments, use first this gargarisme: ℞ fol. plantag. veronic. et sigill. Salom. an. man. 1. scord. orig. centaur. minor. an. man. ss. Bulliant ista in lib. 2. aq. font. ad consumpt. lib. 1. & coletur decoctam, in quo dissolve oxymellis simplicis ℥iij. Then touch the sore morning and evening with this liniment: ℞ ung. Aegypt. ℥ss. alum. pulv. ʒss. mell. ros. ℥ss. Misc. applicetur mane & vesperi.

If it proceed from a veneriall cause, use this topick twice a day: ℞ aq. card. benedict. & plantag. an. ℥ vi. aq. fort. ʒi. Misc. you may also use the blue water, which you may buy for three-pence a pinte after the silver is separate, after so­lution, and hath no other mettall in it, but a little of Ʋenus. If these meanes will not prevaile, then you must wholly cut it away.

But according to Valescus de Taranta, Lib. 3. cap. 3. you must ob­serve these five things before you goe about this operation.

• 1. You must purge the bodie well.
• 2. No humor must be in flowing to the part.
• 3. You must not attempt this operation as long as there is hope that other medicaments will prevaile.
• 4. Goe not about this operation, unlesse it bee small a­bout the root, for if it be thick, and red, or blue, such a flux of blood may ensue, as will strangle the partie, and cause fainting.
• 5. Marke how much of a necessitie must be cut off, for a little remaining will both further the speech, and repell the cold ayre from the lungs. If after the cutting of it off, a [Page 316]flux of blood ensue, either apply astring or else cauterize it with the Uvula spoone made hot.

Vlcers of the almonds.If the Tonsillae or almonds be ulcerate by reason of the influxion of sharp humors, which your eyes can discerne, the tongue being pressed downe by your spathula, carry in mind these prognosticks.

The Progno­sticks.I. If the ulcers be without a fever, they are the more safe.

II. If these ulcers happen in the summer, they sooner spred.

III. If these almonds become scirrhous they are hardly or never cured.

IV. These ulcers as all other ulcers of the mouth, require stronger desiccatives than the ulcers of the externall parts; First, to hinder them from spreading. Secondly, because they are still kept moist with the spittle.

For the curation of these ulcers, I will deliver unto you two locall medicaments: The first is the decoction of the root of the devils bit to be used in steed of a gargarisme. The second is a liniment to bee applyed after gargarization tryed by Seanertus, and set downe medicin. pract. li. 2. c. 22. ℞ centaur. minor. rad. irid. stercor. canini. an ℥ cum melle de­spumato fiat electuarium. As for the facultie of a white dogs turd read Galen. li. 10. de simpl. med. facult, c. de sterc [...]re canino.

Vlcers of the throat.If the throat beyond the Uvula be ulcerated, use this wa­ter instead of a gargarisme as a certaine experiment. ℞ aq. plantag. li. 1. ros. rub. flor. arantior. an. ℥ j. pulv. Mer. subli. ʒij. digerantur in arena per horā quadrantem ac coletur aqua, The curation. quae in vase vitreo servetur ad usam. If by reason of these ulcers the partie cannot swallow any solid meat, minister to the patient mercurius duleis for foure mornings together, and you shall perceive a wonderfull effect. Give it in new milke.

Lect. XXVIII. Of the ulcers of the lungs.

SEeing the lungs very often become ulcerate, a solution of unitie in the substance of them, or an apertion of the vessels of them which are the branches of vena arteri­osa, and arteria venosa, being caused by a wound: I must not let such ulcers to slip untouched.

The cause of the ulcers of the lungs after a wound.The causes of ulcers of the lungs after a wound inflicted may be assigned two: to wit, a solution of unitie in the sub­stance, and vessels of the lungs, and the effusion of blood into the h [...]llownesse of the breast, you shall discerne the lungs to be wounded,

Signes of the lungs wounded.I. First, if frothie blood issue out of the wound, and mouth by coughing, which shew some of the vessels to bee wounded, and opened.

II. Secondly, difficultie of breathing troubleth the party wounded.

III. Thirdly, the paine of the sides is grievous, which he felt not before.

IV. Fourthly, it is more easie for the patient to lie upon the wounded, than the whole side: So that often hee can speak readily so lying, but being turned upon his sound side. he can but with paine and difficultie speake.

Signes of blood poured out into the capa­citie of the breast.You shall perceive and gather blood to have beene pou­red out into the capacitie of the breast by these signes.

I. First, if a heavie weight seeme to presse downe the midriffe.

II. Secondly if the partie breath with great difficultie.

III. Thirdly, if the fever increase.

IV. Fourthly, if the wounded partie void blood at the mouth.

V. Fifthly, if the breath of the partie stinke after a while, for that betokeneth the blood to bee turned into quittour.

VI. Sixtly, the wounded person can onely lie upon the back.

VII. Seventhly, the partie hath a desire to vomit, and striveth to rise, from whence ensueth fainting; for noy­some vapours arising from the clotted blood turned into quittour assault the heart, and weaken it exceedingly, and dissolve the facultie of the stomack.

Whether after a wound of the lungs an ulcer will ensue.After that the wound is inflicted, and that you have dres­sed it so long a time as you have required in former times for healing of a penetrating wound of the breast, (which will be shorter in the summer, than in the winter: for heat helpeth digestion) you may feare than a fistula at the least, or a putrid ulcer of the lungs will ensue: chiefly if a thinne sanies, and not a laudable quittour doe flow out, farre in quantitie exceeding the bignesse of the wound.

Why wounds of the lungs send out much quittour.Why in wounds of the lungs, so much quittour every day is sent out these are the causes.

I. The vicinitie and neerenesse of the heart, which be­ing the welspring of the vitall blood, I doth send too much of it to the part affected: And when as it cannot make use of all of it by reason of weaknesse, it turning the remainder by its naturall heat into quittour, dischargeth it by the ori­fice of the wound.

II II. Because the sound parts send unto the diseased blood and spirits without meane or measure.

III III. Because the lungs draw more nourishment to themselves by their motion, heat, and paine, than they are able to digest.

IV IV. Because the ulcer like a devouring wolfe by its ma­lignitie and filth, presently corrupteth the blood sent for nourishment unto the lungs, turning the greatest part into quittour, and defrauding the part affected of mainte­nance: from whence ensueth the extenuation of the whole bodie.

The progno­sticks.Now that you may the better foresee and foretell to the patients the events of such ulcers, I would have you to mark these prognosticks which I shall deliver unto you.

1. All ulcers of the lungs are hardly, or with great diffi­cultie cured, and that for foure causes.

1. Because the musculs of the breast, lungs and heart, are in perpetuall motion: now motion hindereth consolidati­on, as all by experience know.

2. Because the lungs are onely environed by the Pleura, the skin inwardly investing the ribs, which is endued but by small store of blood, and being a spermatick part, to wit, a membrane, is not easily united; and that onely by the second intention.

3. Because locall meanes cannot be kept to these ulcers, by rowling, bowlstering, and emplastering, as they may to the ulcers of the externall parts.

4. Because the orifice of the ulcer is not most commonly in a depending part; but either parallel, or higher than the ulcer. How hard a matter it is for quittour to ascend, I leave it to your consideration.

5. If the partie pine not away, if hee expectorate easily, if he fleepe reasonable well, if he digest his meat, if his stools be orderly, if the quittour bee indifferent good, you may conceive some hope of the cure.

6. But if the diseased parties breath smell ill, if he con­sume, if the quittour which floweth from the ulcer stink, if he hath a grievous cough, and difficultie of breathing, if a lingring putrid fever troubling him chiefly toward night, and hindering his sleep, follow him, if his appetite decay, and the concoction of the aliments be empaired; if a rotten peece of the liver, or of the branches of the wind be throwen out at the mouth, if he have a whistling voice as if he spake thorow a cane, his case is desperate.

7. If his haire fall, which happeneth by reason of the want, and corruption of the nourishment: if the nailes [Page 320]grow crooked, the flesh of the tops of the fingers being spent, if the cheekes grow to bee of a leady colour; but when after meat they seem ruddy, vapours mounting thi­ther, if the feet begin to swell, the naturall heat being spent, if lice multiply by reason of the corruption of the hu­mours, you may pronounce, that a diarrhea or humorall flux ensuing, the party shall depart.

VIII. Although some have lived many yeeres who have had an ulcer of the lungs, Lib. 3. sen. 10. tract. 5. c. 18. as Avicen reporteth, that he saw a woman who lived twenty three yeeres, or thereabout, with an ulcer of the lungs. And as Matth. de Gradil. in 9. Rhas. c. 54. affirmeth, that he saw a woman who still was busied about the fire, who lived twenty eight yeeres; yet bee not you too forward to take in hand such persons as have ulcerate lungs: for the curation is uncertaine, and that for foure causes.

Why the cura­tion of the ul­cers of the lungs is un­certain.I. By reason of symptomes which ensue, as are a lingring fever, and consumption of the body.

II. Because the quittour which is contained in the spongious substance of the lungs, cannot be voyded by ex­pectoration without coughing; which doth much trouble the lungs, and exasperate the griefe.

III. Because the medicaments which are ministred to cure these ulcers, cannot come to the lungs in their full force.

IV. Because the fever and consumption of the body re­quire those things which are moystning, but the ulcer those things which mundifie, and dry.

If it chance that by Art and good luck you cure an ulcer of the lungs, charge the party that hee walk circumspectly in the course of the residue of his life; for many times when the ulcer hath seemed to have been cured, yet the cicatrix being removed by the ill carriage of the patient, the ulcer hath gotten footing, and been the cause of un­timely death, as Galen witnesseth, 4. de loc. affect. c. 5.

The indicati­ons of curing.When you go about to cure such ulcers, you are to pro­pose three indications curative to your selve.

The first is, the appointing of a convenient diet.

The second is, the ministring of fit pectorall decocti­ons.

The third is, the artificiall dressing of the ulcer.

The di [...] ▪As for the diet: the party having an ulcer of the lungs, must eat meat of an easie concoction, because nature is much weakned; of good juyce, lest putrifaction bee encreased; and lastly, of much nourishment, because the body in this griefe is most commonly much extenuate: only I will briefly touch some kindes of food which are endued with these qualities.

The first that offereth it selfe is Milk, Milk. for it nourisheth the body, it affordeth matter to blood, it correcteth the a­crimony of corrupt humors; with the wheyiest part it mun­difieth the ulcer, with the cruddy part it consolidateth, and with the buttery part it moystneth, and stayeth the desicca­tion of the body. Womans milk is most familiar: By the sucking of a womans breast I saw a Welch Gentlewoman called Mrs. Price, recovered of a P [...]hisis, who could not turne her selfe in her bed, by reason of weaknesse, and could not take any other food. Asses milk is thinner and more wheyish, and so more apt to mundifie. Goats and Cowes milk obtain a meane between these two.

But lest it corrupt in the stomack, you are to dissolve some sugar or hony in it.

You are to minister it only when the stomack is empty, and no other meat is to bee taken before it bee digested; o­therwise it will crud, become sowre, and be corrupted.

So much of it is to be given, as the stomack of the party can well digest: wherefore first prescribe the lesser quantity, and ascend to a greater.

Abstaine from appointing of it, If the party be feverish, have the headach, and be troubled with flatuosity.

Snailes, Crabs.Snailes and Crabbes are much commended in this griefe; neverthelesse, seeing they are of a thick, terrestriall, and sli­my substance, and afford a corrupt and excrementitious juyce, it may be doubted whether they be good or no: to omit that they are of hard digestion; the broth of them boyled in milk, and sweetned with sugar, and mingled with other brothes, may be good; for so the nourishment will be the more solid.

Pectorall de­coctions.As for pectorall decoctions, I will not trouble you with any great variety of them; only I will set down a few; but the paucity shall be recompenced with the efficacy.

I. ℞ rad▪ enul. ℥ ij. scob. guaiaci lb. ss hyssopi, marrhub. albi, an. man. ij. polypod. liquirit. an. ℥ i ss ficuum incisar. passul. major. exacinat. an. ℥ iij. Infundantur infundenda per noctem in aqu. font. fervent. lb xviij. deinde additis reliquis coq. ad consumpt. lb vi. ac coletur decoctum, quod clarificetur additis sacchari & mellis an. ℥ ij. croci ʒ i. atque iterum cole­tur: utatur aeger hoc decocto loco consueti potus.

II. ℞ rad. chin. ℥ iiij. symphiti, tormentill. irid. an. ℥ i. capill. vener. tussilag. scabios. marrhub. albi. hyssopi, an. man. i. flor. viol. borag. buglos. an. pug. i. flor. herbae paralays. pug. ij. flor. alth. pug. i ss. caricar. ping. ℥ iij. liquirit. ℥ ij. semin. co­riand. anis. an. ʒ vi. Infundantur ista ut superiora in pari quantitate aquae, ac decoq. ad consumpt. lb vi. ac coletur deco­tium, quo utendum loco consueti potus.

Every morning the patient is to take halfe a pinte of ei­ther of these decoctions warm, and to eat a lozenge of saccharum rosatum tabellatum, or two drammes of the con­serve of red roses, being a twelve-moneth old.

The artificiall dressing.Now I am come to the artificiall dressing of ulcers of the breast.

The medicaments which are fittest for dressing, are In­jections by a large syringe.

As for the simples whereof the injections are made, Injections. they must not bee of bitter things, as Wormwood, the lesser [Page 323]Centory, or Carduusbenedictus; for as judicious and dili­gent Ambros. Paraeus noteth, Chirurg. lib. 9. c. 31. these bitter things being injected, are first drawn in by the spon­gious substance of the lungs, and from thence are sent by the trachea arteria, to the throat; where such a bitternesse is felt, that it causeth a desire to vomit; so that they rather hurt than profit.

These injections are either abstersive or consolidative.

Abste [...]s [...] inject [...].Of abstersive injections I will set down a few, as a pat­tern, by the which you may make others.

I. ℞ marrub. alb. hyssopi, scabios. an. man. ss. c [...]qu. in lb iij. aqu. font. ad medietat. consumptionem, ac coletur de­coctum; quod postea clarificetur addit. mell. lb ss. atque ite­rum coletur.

II. ℞ aqu. hord. lb i. mellis ros. ℥ ij. sacchari rubri ℥ iij. Mise. bubiant 3 aut 4 ebullionibus ut injectio clarificetur, quae postea coletur.

If you perceive that the ulcer is sordid, and affordeth much matter, you may adde either of ungnentum Aegypti­acum, or the oyle of Sulphur, or Vitrioll, so much as you shall finde fit to cleanse the ulcer.

When you perceive that the ulcer is sufficiently mundi­fied; which you may gather, if laudable quittour flow, The consolida­tion. and in no great quantity; then hasten to consolidate the ulcer: I will in this case furnish you also with effectuall topicks, and but a few: the first shall be this:

℞ decoct. pectoral. ℥ iiij. syrupi è ros. rub. sicc. ℥ i ss. fiat injectio. Consolidative medicament [...].

II. ℞ hed. terrest. flor. & fol. symphit. sanicul. plantag. polygon. millefol. vinc. pervinc. Equiseti, hyper. eupat. beton. valerian. an. man. ij. limaces numero 40. cancros fluviatil. numero 10. Addita aqu. pluviali: instituatur distillatio in alembico, ut extilletur aqua. ℞ aqu. hujus lb ss. syrup. myr­till. & è ros. rub. siccat. an. ℥ i. ss. syrupi granat. ℥ i. Misc. ut fiat injectio.

The manner of dressing.These injections must bee warmed when they are to bee used. Into the orifice which is in the breast somewhat must be put to keep it open: this then is to be performed either by a tent, or a pipe made either of gold or silver.

The materials of the tents are three; Tents. lint, fine tow, and a sponge. Lint is altogether unapt, for it is apt to fall a­sunder after that it is made up into a tent: if therefore a p [...]cce of it part and rest upon the diaphragma, it must pu­trify there, and send noysome sents unto the heart, which cannot but bring faintings, and at the last shorten the life.

Good tow then is better than it, because it cleaveth fast together; but the spunge is best of all, because it doth not only cohere firmly, but draweth also strongly the quittour, and doth imbibe it.

It is good so to forme the tents, that the outer end being broader than the inner, it may bee stayed from slipping in: it is not amisse to halter them with thred for this same pur­pose.

The use of a pipe.A pipe is best of all; it must be of thicknesse proportio­nate to the orifice, having two stayes to hinder the slipping in of it into the cavity of the breast; and sundry holes some­what large about the end, to give way to the quittour. It must also be somewhat arched, lest the lungs butting against it, should suffer any hurt. The outer hollownesse of it is to be stopped with a sponge dipped in aqua vitae and wine min­gled together, and warmed, and wrung. Above the tents and the pipe apply emplastrum de minio, or diachalcithes.

If the ulcer runne much, it must bee dressed twice a day; but if it runne little, once dressing will serve.

You may demand of me, Quest. when the tents and pipe are to be left?

I answer, when the ulcer yeeldeth but a small deale of quittour, Answ. and that good; and seemeth to bee almost dry: for siccum est sano proximum, that which is dry commeth [Page 325]neere to that which is whole.

If you keepe the orifice of the breast too long open, it will fistulate.

What course is to bee taken if the body grow leane.It falleth out many times, that in ulcers of the breast, the diseased person groweth leane. In this case you are to per­mit the party to drink some Almond milk made of chicken broth, wherein have been boyled Pompion, Cucumber, and Muskmelon seeds, with Mallow roots, Cowslip flow­ers, Succory flowers, and Marigold flowers, between meales, and in the night time after two a clock; or mini­ster a dramme and a halfe of this powder which I will set down, every morning and evening, in six ounces of one of the pectorall decoctions, which I described in the begin­ning of this Lecture.

The description of the powder is this: ℞ semin. papav. albi ʒ i ss. gu [...]i tragac [...]th. far. [...]robi an. ʒ ij ss. semin. alth. portul. cucum. melon. pepon. pla [...]tag. hyoscyam. alb. an. ʒ iij. coral. rub. praparat. perla [...]. pr [...]parat. succini albi praeparat. an. ʒ i ss. liquirit. ʒ iiij. sacchari r [...]sat. tab [...]llat. ad pondus [...]mnium: fiat pulvis.

If these courses being used faithfully, do not prevaile, acquaint the diseased parties friends with the dangerous estate wherein he is; for no other medicaments are like to prevaile.

Lect. XXIX. Of the ulers of the backe, the abdomen, and joynts.

NOw I am, according to my promise, to deliver the last Lecture appointed for this yeere, and withall to shut up this Treatise of Vlcers; that when I shall ascend to this place againe, I may begin to handle a new subject, which will bee of wounds. And although one might rest contented with that which hath been already delivered concerning ulcers; yet that none may justly say, that any thing absolutely necessary, hath been omitted, and to fur­ther the practice of those which are not so well versed in the curing of all particular ulcers, I will briefly set down some notes concerning the ulcers of the back, the abdomen, or lower belly, and of the joynts.

Vlcers of the back. Vlcera dorsi, or ulcers of the back, most commonly fall out after [...], or cedematous phlegmons, wherein morbi acuti ex decidentia end.

Now that you may the better understand what I meane, I must digresse a little, and briefly shew you what diseases are termed morbi acuti, and how many kindes of them there are.

Which are to be accompted sharp diseases. Three kindes. Morbi acuti, or sharp diseases, are properly called such as with great expedition, force, and danger, go on to their status and extremity of the symptomes, as may be gathered out of Galen 2. aphor. 19. & 23.

Now there be three kindes of these morbi acuti, or sharp diseases; for they are either peracuti, very sharp, or acuti simpliciter, simply sharp, or acuti ex decidentia, or sharp diseases ending into other griefes.

Peracuti end at the furthest the seventh day, and they are of two sorts, exquisitè peracuti or perperacuti, or exqui­sitely very sharp, which end the fourth day, and non exquisi­tè peracuti, which are not exquisitely very sharp, which continue till the seventh day.

Now the simpliciter acmi in like manner are of two kinds: for they are either exactly so, and end for the most part the fourteenth day, or not exactly so, which may conti­nue till the twentieth day. You may, and (I make no doubt) doe see examples of these in burning and pestilentiall fevers almost every week. Last of all are acuti [...], ex decedentia, which may bee prolonged to the fortieth day: Diseases which continue longer than fortie dayes are called morbi chronici, or di [...]ur [...]i, long or lingring diseases. Some of these chronicall diseases may end in sixtie, some in eigh­tie, some in an hundred, some in two hundred dayes: some may continue a whole yeere, some seven yeeres, some twice seven yeeres.

I saw a Scottishman whose surname was Iohnson, Histor. 1. a sadler by profession, who followed the Court in Queene Eliza­beths reigne, who was troubled twelve yeeres with a quar­tan ague without intermission: neither can I affirme that it left him during his life time.

I being in the Ile of Shepey in Minster street curing one Clover an aged man, II. whom I dismembred, there was a girle brought to mee, of seven yeares of age, which for the space of six yeeres was grievously tormented with an exquisite quartan. The lifes of these personages may be well termed living deaths. Some of these lingring diseases againe con­tinue in boyes untill the fourteenth yeere of their age, and in maids untill their courses flow: as the falling sick­nesse.

Apostemes and ulcers of the back.Now to come to apostemes of the back, which leave ulcers after they are brought to suppuration and opened; They are for the most part criticall translations of humors, [Page 328]sent in morbis acutis ex decidentia, sharp diseases which continue untill the fortieth day, or on chronicall diseases the continuance of which is uncertaine, sent from the inner either noble or ministeriall parts from within outward, the Physitians say this to be done, per diadosin: whereas if noxious humors be turned from without inward, as in pe­stilentiall and veneriall buboes, they affirme this to be done per metastasin.

Criticall en­ding of griefs.Criticall ending of griefs, are either performed by ex­cretion or translation of the griefe.

By excretion nature doth expell the peccant matter sun­dry wayes, I as by vomit, siege, sweating, bleeding at the nose, the flowing of the menstruous course, and the apertion of the hemorrhoidicall veines, as you may observe everie day in termination and ending of sharp fevers.

II. In translation, the peccant matter is not altogether discharged out of the bodie; II but it sent from the part affe­cted unto another part by provident nature.

But seeing the humor may be sent from the outward parts to the inward, and from the inner parts to the outward, this last translation is most secure; for if this first be done in maligne and contagious diseases, as in the Pox and Plague, all understanding practisers pronounce either death, or protraction of the cure.

When therefore these apostemes appeare either in the back, or one of the great joynts, which afterward degene­rate into ulcers, the motion of the matter by nature is lau­dable doing it by translation, seeing she cannot by excre­tion, partly by reason of the weaknesse of the principall parts, or by the plenty, or hard concoction of the hu­mor.

But this is the miserie, that the friends or kinsfolks of such a diseased person thinke him or her to bee altogether safe and secure, when they see them eased by the transla­tion of the humor, and therefore to spare charges call not [Page 329]for skilfull Physitians, and Chirurgeans, by whose skill and diligence the motion of nature might be furthered. And so it falleth out many times, partly by reason of the thicknesse of the skin, as in the back, or by reason of the thicknesse of the skin, & compactnesse of the membranes as in the joynts, that the vertebrae of the back are corrupted, & the cartil­lage, and tendons of the joynts before remedie is sought for.

But that you may meet with these hide bound patients, and keepe your selves from incurring danger or discredit, marke these prognosticks which I will deliver unto you.

The progno­sticks of the ulcers of the back.1. If after inquisition you find that a tumor in the back continued a long time before it did break of it selfe, or was opened, suspect the ulcer to bee of hard curation: for it is likely that the vertebrae of the back are foule.

2. If the vertebrae bee foule, which you may easily find out, by your finger or probe, the case is desperate: wherefore take heed that you promise not curation.

3. If in ulcers of the back you see the parties body day by day to become more and more extenuate, advertise the parties friends of the danger: for it is an evident argument that the principall parts are weakned, and cannot wholly discharge the humor which offendeth.

Why ulcers in the upper part of the Spina are of easier cura­tion, than those of the lower.4. Ulcers in the upper part of the Spina dorsi are more easily cured, than those in the loynes: Because the abdomen or lower belly sendeth out more superfluities than the tho­rax or the breast, which is the middle cavitie. Secondly, because they are neerer to the heart, the sunne of the lit­tle world, who by his heat it able to consume much super­fluous humiditie.

I think it will not bee unpleasant to you to heare mee confirme that which I have delivered unto you in my last prognostick, Histories. by true relation of the events which befell mee when I practised in Wales in the like griefes: seeing exam­ples leave a deeper impression in the mind, than precepts, and leade best to the curation of externall griefes.

In Denbigh towne there was one Richard Pryce an Ha­berdasher, sonne to Iohn Pryce, who kept the principall Inne of the towne, who after hee had beene troubled with a chronicall diseases, felt in his back a little below the shoul­ders blades, a tumor still increasing in the outward parts, as he was eased in the inward, untill at the last it grew to the bignesse of a penny loafe. I having beene called unto it by opening of the Aposteme, & using methodicall indications, cured the Patient. This man (as I heare) having given over his trade, still keepeth the Inne which his father did.

In this same Towne about the same time, a lustie young man, whose sirname was Owin, whose father was a retainer to Sir Iohn Salisburie, had the like tumor in the Vertebrae of the loines, after a lingring griefe: I having been entrea­ted by the truly worshipfull, Sir Iohn Salisburie, (who had not an ordinarie skill in the knowledge of the plants, and in performing chirurgicall cures) tooke a view of the young Gentle-man. After mature deliberation, I told Sir Iohn and the young mans friends, that there was much quittor in the tumor, which must be discharged; and that the event of the curation would be uncertaine, if the matter were let out, for the reasons above specified. At the entreatie of Sir Iohn Salisburie & the young mans parents & friends, I ope­ned the Aposteme which was in the Vertebrae of the loines: And although no meanes were omitted, which seemed unto us effectuall, for the recoverie of the young mans health, and that the Vertebrae of the loines were not foule; yet hee fell into a Marasmus, or extenuation of the body, being other­wayes a proper and valiant young Gentle-man; and so en­ded his life before age called for his dissolution, to the great griefe of his parents, having no other sonne but him, and the commiseration of the worthy Knight. I have delivered unto you my observations in this griefe, whereof I hope you will make good use: you having occcasion ministred to be warie, by the examples of others, which is no meane benefit.

How the Ha­berdasher was cured.How I performed the curation of the first Patients, now I will declare unto you: First, I purged his body with a gen­tle medicament: It was this; ℞ Electuar. lenitiv. ʒiiij. E­lectuar. de succo ros. ʒij. Syrup. ros. solutivi cum Agarico ℥j. aq. Cichor. ℥iij. Misc. ut fiat p [...]tio. Secondly, I applyed the Lapis infernalis to the depending part of the tumor: Thirdly, I opened the Aposteme, making but a small orifice thorow the eschar. Fourthly, everie day I dressed the sore, still suffering a little of the quittor to flow out, untill all was discharged. Fifthly, I used a mundifying injection, un­till I perceived the sore to bee cleane, not stinking, and to afford both laudable, and small store of laudable quittor. Sixthly, I used a consolidative injection, and boulsters somewhat thick, to compresse the sore.

The descripti­on of the inje­ctions.The mundifying injection was this: ℞ Vini albi lb. j. mel­lis rosati ℥iij. Ʋngi [...]en [...]. Aegyptiaci ℥ ss. [...]isc. ut fiat inje­cti [...] usurpand [...] calid [...]. The consolidative injection was this: ℞ aq. Plantag. ℥iiij. Syrupi [...]yr [...]i [...]i & è ros. rub. sie­cat. a [...]. ℥ ss. Trachisc. albor. Rhos. sine [...]pio ʒij. Misc. ut fiat injectio applicanda item calida: All such injections must be warmed; for cold, as Hippocrates witnesseth, is hurtfull to the Spinalis medulla. The Emplaster which I used was Diachylon cum gummis. By these meanes I cured the partie in three weekes space.

Of the ulcers of the Abdo­men.Now the ulcers of the Abdomen, or of the lower belly, doe offer themselves onely to bee but compendiously tou­ched. Seeing there are three parts of it, Regio epigastrica, [...]ilicalis, and hypogastrica, the upper, the umbilicall, and lower region: I am to shew unto you what parts in these regions most commonly suffer ulceration.

1. Of an ulcer penetrating of the stomack.I saw the stomack of one Mistresse F [...]r [...]e, together with the muscules perforate by the erosion of a sharp humor, in the Howlt, a towne distant from Chester five miles: the meat, drinke, and chylus came thorow the perforation: the ulcer also smelled strongly. I being unwilling to deale with [Page 332]her, prescribed some locall meanes, which wrought but small effect; for she died of a Marasmus, or extenuation of the body, within a short time: the ulcer hindering the chy­lification of the aliment, and so defrauding the body of nourishment. My opinion was then, and now is, that ul­cers penetrating into the cavitie of the stomack are mortall, although wounds of this kinde bee sometimes cured: for in the second there is but a bare solution of continuitie; but in the former there is a solution of continuitie, having an­nexed to it the sharpnes & malignitie of the matter. Here in London, 2. Of an ulcer of the liver. in the Inne a little above Fleet-conduit, one Richard, who wa Tapster of the Inne, had for a long time a great paine in the right side of the epigastricall region of the Abdomen: in progresse of time there appeared a great hard tumor, causing a sharp fever: at last the Phlegmon brea­king of it selfe, sent out great store of quittor. I then being lodged within the signe of the Naked Boy, a little below the Conduit, and being of his familiar acquaintance, was sent for, finding him in a strong fever, and having difficultie of breathing, the tumor of the liver hindring the free mo­tion of the Septum transversum, the instrument of naturall respiration, I pronounced his griefe to be mortall, and so it fell out: for although no rationall meanes were omitted, fit to have recovered the partie, if the griefe had beene cu­rable, yet the partie died. It were but a fruitlesse labour to set downe the medicaments which were used, seeing they prevailed not.

This historie I thought good to set downe, that you may imagine what the event is like to be, if you be called to the like griefe.

Of an ulcer of the navell.If falleth out sometime, that superfluous flesh groweth above the navell, if it be slackly bound, and be left some­what long, which doth become ulcerate: This I saw once in Tavestock, a towne in the West Countrey, in Devon­shire, in a childe of Master Moones, a Draper of that towne. [Page 333]I having beene called to the cure, first bound off the navell by a strong ligature, afterwards I cured it by the application of Vnguentum de cerussa.

A penetrating ulcer of the groine.In the groine after a Phlemone of it opened, oftentimes an ulcer is left penetrating thorow the oblique and trans­vers muscules of the Abdomen: If you perceive such an ulcer, pronounce it to be not of easie curation, chiefly if it fall out to be after a venereall Bubo: For first, there is mor­bus cum causa, a griefe having the cause annexed: Secondly, it corrupteth the Fibres of the muscules: Thirdly, it cor­rupteth sometimes the Vertebrae of the loines, in which case all medicaments are fruitlesse, because the griefe is mortall: This happened to a young woman, An Historie. who dwelt with the Lady Lucie, whom Master Napkin dressed, and opened after her death. Both M. Doctor Gifford and I were called to view the sore sundrie times; and although means were used for her recoverie, yet they did not prevaile; so that shee died of a Marasmus, the body becomming ex­tremely extenuate; although she seemed to bee of a firme and thick habit of body, when the tumor first appeared. If any such tumors come to your hands, after they are brought to maturation, use the generall meanes prescribed for the curation of Lues venerea, lest the like event happen to you.

Of ulcers of the joynts.I will touch briefly the curation of ulcers of the joynts, which differeth but verie little from the curation of ulcers in other parts, saving that they require medicaments of more desiccation without any sharpnesse, and more power­full anodine cataplasmes for asswaging of paine; which is an inseparable accident of ulcers, seizing upon these parts.

The Topicks.Apply then to the sore Desiccativum rubeum, and anoynt the brims with this liniment: ℞ Ʋnguent. popul. & albi Caphuratian. ℥j. Ol. Cydonit. & Papaverin. an. ℥ ss. Misc. ac fiat liniment. ex arte. Before you apply your medica­ments, [Page 334]foment the part with a fomentation made of Su­mach, Pomegranate pils and flowers, red Roses dryed, and Myrtle-berries infused in astringent red wine, being put in­to a long and narrow galley pot, and set in a warm place, or in a posnet having in it boyling water.

In curing of these ulcers often purging is required, to stay the flowing of sharp humors; but seeing everie purga­tive medicament is not of like efficacie, I will set downe one as a patterne, after the which you may frame others: ℞ Caricostin. & Elect. de succo ros. an. ʒiij. Syrup. ros. solut. cum Agaric. ℥j. aq. Cichor. ℥iij. Misc. ut fiat potio: You may either detract from the quantitie of the purging Ele­ctuaries, or adde to them what you shall think fit, after you have diligently considered the strength of the partie: with this I will end the Lectures for this present, and finish the Tractation of Ulcers. When God shall permit mee to ascend againe into this seat, I will begin the Lectures of wounds.