Book 13: Of Ulcers, Fistulas, And Hemorrhoids.

Original writing

Table of Contents

I. Of the Nature, Causes, and Differences of Ulcers.

Having already handled and treated of the nature, differences, causes, signs and cure of flesh and blood wounds, reason and order seem to require that we now speak of ulcers, taking our beginning from the ambiguity of the name. For according to Hippocrates, the name of ulcer most generally taken may signify all or any solution of continuity; in which sense it is read, that all pain is an ulcer. Generally for a wound, an ulcer properly so called as appears by his book De Ulceribus. Properly, as when he says, it is a sign of death when an ulcer is dried up through an atrophy or defect of nourishment. We have here determined to speak of an ulcer in this last and proper signification. And according thereto we define an ulcer to be the solution of continuity in a soft part, and that not bloody, but sordid and unpure, flowing with quitture, sanies, or any such like corruption associated with one or more affects against nature, which hinder the healing and agglutination thereof, or that we may give it you in a fewer words According to Galen’s opinion; an ulcer is a solution of continuity, caused by erosion. The causes of ulcers are either internal or external. The internal are through the default of humors peccant in quality rather than in quantity, or else in both, and so making erosion in the skin and softer parts of their acrimony and malignancy. Now, these things happen either by naughty or irregular diet or by the ill disposition of the entrails sending forth and emptying into the habit of the body this their ill disposure. The external causes are: the excess of cold seizing upon any part, especially more remote from the fountain of heat, whence follows pain, whereunto succeeds an attraction of humors and spirits into the part, and the corruption of these so drawn thither by reason of the debility or extinction of the native heat in that part, whence lastly ulceration proceeds. in this number of external causes may be ranged, a stroke, contusion, the application of sharp and acrid medicines, as caustics, burns; as also impure contagion, as appears by the virulent ulcers acquired by the filthy copulation, or to familiar conversation of such as have the French disease. How many and what the differences of ulcers are, you may see here described in this following scheme. A table of the differences of ulcers. An ulcer is an impure solution of continuity in a soft part, flowing with filth and matter or other corruption whereof there are two chief differences for one
  • is simple and solitary, without complication of any affect against nature. And this varies in differences either or his compound and many various ways complicated –
    • proper which are usually drawn from three things, to wit:
      • Figure whence one ulcer is called
        • round or circular,
        • sinuous and variously spread
        • right or oblique
        • cornered as triangular or proper, which are usually drawn from things to wit quantity, and that either according to their length, whence an ulcer is long, short in different breadth, whence an ulcer is broad, narrow, indifferent profundity, whence an ulcer is deep, superficially indifferent equality or inequality, which consists in those differences of dimensions where we last treated, I say, in length, breadth and profundity wherein they are either alike or of the same manner or else unlike and so of a different matter, or common and accidental. And these drawn either from their time whence an ulcer is termed new old of sort or long cure and duration from their appearance, whence one is called an apparent ulcer, another, a hidden and a cold ulcer from their manner of generation, as if it be made by a heavy bruising, cutting, pricking or corroding thing once a cut, torn and mixed ulcer from their sight, whether an ulcer before behind, above, below in the head, tassel or belly of a muscle from that part it seizes upon whence an ulcer in the flesh and skin, or feeding upon the crystals or bones such as those of thenose, the palate of the mouth and ears from other common accidents whence it to levy an ulcer that is such an ulcer is itself is had a curonian which needs the hand in art of Chiron aching caress which resembles a cancer with the cause. Whence an ulcer is Kharkov mimic Catterick or bend in it? That is with a cargo kimia or depletion of ill humors. It could tar or poison cherishes or feeds distemper, whether simple or compound whence an ulcer is hot, cold, dry, moist, mixed with the disease as from smelling or humor or tumor. Whence a flagman is erysipelas, a domestic scourges cancerous ulcer solution of continuity or any other disc commodity whence a rough callus fistulas, cavernous sinuous ulcer with luxation fracture, etc. with the symptom them whence a corroding eating painful, sordid and virulent ulcer with the cause and disease with the cause and symptom with the disease and symptom with the cause. Disease and symptom examples whereof may be taken from that. We have formerly delivered

II. Of The Signs Of Ulcers.

There are various signs of ulcers according to their differences. For it is the sign of a putrid ulcer if it exhale and noisome, grievous, stinking and carrion like vapor together with filthy matter. An eating ulcer is known by the eating in, hollowness and wearing away of the part wherein it resides, together with the adjoining parts. A sordid ulcer may be known by the grossness and vascidity of the excrements it sends forth, and by the loose and spongy softness, or the crusted inequality of the flesh which grows over it. A cavernous ulcer, by the straightness of the orifice, and largeness and deepness of the windings within. A fistulous ulcer, if to the last mentioned signs, there accrue a callous hardness of the lips or sides of the ulcer. A cancerous ulcer is horrible to behold, with the lips turned black, hard and swollen, flowing with virulent and stinking corruption, and sometimes also with bloody matter, together with the swelling and lifting up of the adjacent veins. An untemperate or as they term it, a distempered ulcer, is such as is nourished by some great distemper, whether hot or cold, moist or dry, or compounded of these. An ill natured or malign ulcer is known by the difficulty of curing and rebellious contumacy to remedies appointed according to art and reason. We know a catarrhous ulcer, if the matter which feeds it flow to it from some varices thereunto adjoining, or dilated, swollen and broken veins, or from some entrail, or from the whole body being ill affected. An aposthumous ulcer is perceived by the presence of any tumor against nature, whose kind may be found out by sight and handling. Telephian ulcers are such aa affected Telephus, and Chironian (in whose cure Chiron excelled) are ulcers which may be known by their magnitude not much putrid, and consequently not sending forth any ill smell, not eating, not tormenting with pain, but having their lips swollen and hard and therefore ill to be healed. For although they may be sometimes cicatrized, yet it being but slender may easily be broken, and the ulcer renewed. They are almost like an ulcerated cancer, but that they are accompanied with swellings in the adjacent parts. They are also worse than these which are termed Cacoethe, that is, ill natured or maligne; whence it is that Fernelius thought they had a hidden cause of malignitie, besides the common default of the humor, and that such as can scarce be driven away; such commonly are left after the plague. Wherefore Galen thinks such to be malign as will not suppurate or yield any quitture.

III. Of the prognostics of ulcers.

The bone must necessarily scaill, and hollow scarres be left by maligne Vlcers of a yeares continuance or longer, and rebellious to medicines fitly * applyed. The bone must scaill by reason of the continuall affluxe, and wearing by the acrimony of the humour, which looses the composure and glue by which the parts thereof are joyned together. But the scars must become hollow, for that the bone (whence all the flesh takes its first originall) or some portion thereof, being taken from under the flesh, as the foundation thereof, so much of the bulcke of the flesh must necessarily sinke downe, as the magnitude of the portion of the wasted bone comes unto.
You may know that death is at hand, when the Vlcers that arise in or before diseases, are sudainly either livid or dryed, or pale and withered. For such drinesse * sheweth the defect of nature, which is not able to send the familiar and accustomed nutriment to the part ulcerated. But the livid or pale colour is not onely an argument of the overabundance of choler and melancholy, but also of the extinction of the native heate. In Vlcers where tumors appeare, the patients suffer no convulsions, neither are franticke; for the tumor being in the habite of the body possessed with an Ulcer, argues that the nervous parts and their originall are free from the noxious humors. But these tumors suddenly vanishing and without manifest cause, as without application of a discussing medicine, or bleeding, those who have them on their backs have convulsions and distensions, for that the spine of the backe is almost wholly nervous; but such as have them on their fore parts, become eyther franticke, or have a sharpe paine of their side, or pleurisie, or else a dysentery if the tumors be reddish; for the forepart of the body is replenished and overspread with many and large vessells, into whose passages the morbificke matter being translated, is presently carryed to these parts which are the seats of such diseases.
Soft and loose tumors in Vlcers are good, for they shew a mildnesse and gentlenesse * of the humors, but crude and hard swellings are naught; for all digestion in some measure resembles elixation. Vlcers which are smooth and shining are ill, for they shew that there resides an humour maligne by its acrimony, which frets asunder the roots of the haires, and depraves the naturall construction of the pores of the skin; whence it is that such as are troubled with Quartaine agues, the Leprosie or *Lues venerea, have their haire fall off.
A livid flesh is ill in Vlcers which cause a rottennesse or corruption of the bones lying under the flesh; for it is an argument of the dying heare and corruption of the bone, whence the flesh hath its originall and integrity.
These Vlcers which happen by occasion of any disease, as a Dropsy, are hard to be * cured; as also those whereinto a varix or swollne vessell continually casts in matter; which a present distemper •oments; which have swollne, hard and callous lips; and such as are circular or round. An Hypersarcosis, or fleshy excrescence usually happens to Vlcers not diligently mundified; and if they possesse the armes or Legs they cause a Phlegmon or some other tumor in the groines, chiefly if the body bee full of ill humors, as Avicen hath noted. For these parts by reason of their rarity and weakenesse are fit and subject to defluxions. Albucrasis writes that for nine causes Vlcers are difficultly replenished with flesh and cicatrized. The first for want of * blood, in a bloodlesse body; the second by reason of ill humors and the impurity of the blood; the third by the unfit application of unconvenient medicines; the fourth by reason of the sordidnesse of the Vlcer; the fifth by the putrifaction of the soft and carionlike flesh encompassing the Vlcer; the sixth when they take their originall from a common cause which every where •ages with fury, such as are those which are left by the pestilence; the seaventh by reason of the callous hardnesse of the lips of the Vlcer. The eighth when the heavens and aire are of such condition as ministers fuell to the continuance of the Vlcer, as at Sarogoza in Aragon; the ninth when the bones which lye under it are waisted by rottennesse.
An Vlcer that casts forth white, smooth, equall quitture, and little or no stinking, is easily healed; for it argues the victory of the native heate, and the integrity of the solid parts. We terme that smooth quitture which is absolutely concocted, neither * yeelds any asperity to the touch, whereby we might suspect that as yet any portion of the humor remaines crude; we call that equall wherein you can note no diversity of parts; and white not that which is perfectly so, but that which is of an ash colour, as Galen observes. But it is ill, if when the cure is indifferently forward, a fluxe * of blood suddainly breake forth in those Vlcers which beate strongly by reason of the great inflammation adjoyned therewith. For as Hippocrates observes, an effusion * of blood happening upon a strong pulsation in Vlcers is evill; for the blood breaking out of an Artery cannot be stayed but by force; and also this blood is so furious by reason of the heate and inflammation the nourishers of this Vlcer, that it breakes its receptacles, and hence ensues the extinction of the native heate, whence the defect of suppuration and a Gangreene ensues. Now for that there flowes two * sorts of excrements from maligne Vlcers, the more thinne is tearmed Ichor or sanies, but the more grosse is named sordes; that is virulent and flowes from pricked nerves, and the Periostia when they are evill affected; but the other usually flowes from the Vlcers of the joynts, and it is the worser if it be blacke, reddish, ash-coloured, if muddy or unaequall like wine Lees, if it stinke. Sanies is like the water wherein flesh hath beene washed, it argues the preternaturall heate of the part, but when it is pale coloured, it is said to shew the extinction of the heate.

IV. Of The General Cure Of Ulcers.

An Vlcer is eyther simple or compound. A simple Vlcer, as an Vlcer hath one and that a simple indication, that is, exsiccation; and that more than in a * wound, by how much an Vlcer is moister than a wound. There are many indications proposed for the cure of a compound Vlcer, in respect of wch Galen would have us to keepe this order, that wee have the first regard of the most urgent, then * of the cause, then of that, which unlesse it be taken away, the Vlcer cannot be healed. By giving you an example you may easily understand the meaning hereof. Imagine on the inside of the Leg a little above the ancle, an Vlcer very painefull, hollow, putride, associated with the rottennesse of the bone, circular, having hard and swolne Lips, and engirt with the inflammation and varices of the neighbouring parts. If you take this to cure before you doe any thing about the Vlcer, unlesse you bee called upon by that which urges, as by vehemency of paine, you must first use generall meanes by calling and advising with a Physition; For in Galens opinion, if the * whole body require a preparation, then must that be done in the first place; for in some Vlcers purgation onely will bee sufficient; in some bloodletting; others are better by using both meanes, which is as the cause of the Vlcer proceedes from a repletion or illnesse of humors. Now by these meanes having taken away the cause of the Vlcer, you must come to the particular cure thereof, beginning with that which is most urgent. Wherefore you must first asswage the paine by application of things contrary to the cause thereof, as if it proceede from a Phlegmonous distemper, which hath long possest, distended and hardned the part, it must bee eased by evacuation. First, bathing it with warme water, to mollifie and relaxe the skinne, that so you may the more easily evacuate the contained humors; then shall you draw away portion of the matter causing the swelling and paine by scarrification, if the patient shall be of sufficient courage, or else by application of hose-leaches if hee be more faint hearted; and then you shall temper the heate there of by applying Vnguentum refrigerans Galeni.
To conclude, you shall attempt all things which wee have formerly delivered (in our treatise of Tumors) to take away the swelling thereof. When you have brought this to that passe you desire, you shall come to those which are such, that it cannot be taken away or healed without them, which shall be done by orderly helping the defects against nature which were conjoyned with the Vlcer, to wit, the rottennesse of the bone, which you shall helpe by actuall cauteries; and in the meane while you shall draw the Vlcer into another forme, to wit, cornered, and you shall cut away the callous hardnesse, and helpe the rottennesse. Then must you procure the falling away of the Eschar, and then provide for the scailing of the bone by the meanes formerly prescribed, lastly the mundified Vlcer must be filled with flesh.
For generating of flesh two causes must concurre, the efficient and materiall; The * efficient is, the good temper both of the whole body, as also of the Vlcerated part. For this prevailing, there will be an attraction, digestion, apposition and assimulation of the laudible juice to the part affected; verily the laudible temper is preserved by like things, but the vicious is amended by contraries. The matter to bee spent upon flesh, is laudible blood, which offends neither in quality, nor quantity. In this regeneration of the flesh there appeare two kinds of excrements, the one more thinne and humide called Sanies, the other more grosse termed Sordes. Both of these for that they are contrary to nature, doe therefore hinder the regeneration of flesh, and therefore must be taken away by applying their contraryes, as by things drying in the first degree, and more strongly or weakely detergent according to the complexion of the part and the whole body, and the plenty and quality of the excrementitious humor, and the uncleannesse of the Vlcer. For the part must bee preserved by the use of the like, but the ulcer orecome by application of things contrary thereto. After that by natures endeavour and the Chirurgions helpe the Vlcer is replete with flesh, it must be cicatrized, that is, covered with a callous skin * in stead of the true and native skin. It may be cicatrized by strewing of very drying pouders having very little or no acrimony. Thus Alume and vi•rioll being burnt and made into pouder, and thinly strewed upon the part doe quickly cicatrize the former fleshy worke. To this purpose also serve, the roote of Aristolochia, Aloes, * burnt Lead, Pomegranat pills burnt, Litharge, Tutia, and also plates of Lead besmeared with quicksilver, whose efficacy for this purpose Chirurgions sometimes finde more certaine and powerfull than any other remedies.

V. Of A Distempered Ulcer.

Before we speake of a distempered Vlcer, it is meete; least that the Chirurgion * take one distemper for another, briefly to relate the signes of each. You may know that an Vlcer is associated with a dry distemper by your sight, as if the Vlcer be as it were wrinckled, if it send forth little or no moisture; also it is knowne by touch, if it feele rough and hard. You shall correct * this distemper by humecting medicines, as fomenting it with warme water according to Galens opinion, or else with Hydraelaeum (i.) Oile and water mixt, but alwayes you must first purge, if the body shall abound with ill humors, or use Phlebotomie if the body be plethoricke; otherwise you shall draw more humors into the part than it can beare. Now you shall so long •oment it, untill the flesh which is about it begin to looke red, waxe soft and moist, and the part it selfe be a little swollne. If you proceede further, you will resolve all the humor which you have drawne thither, and so your labour is in vaine. After the •omentation apply such a remedy to the ulcerated part.
℞. cremoris hordei ℥ij. fol. malva in aq. coct. ℥j. pingued. porci ℥iss. mellis com. ℥ss. mis•e in mortario & fiat unguentum.
You shall know a moist distemper associates the Vlcer by the plenty of the excrementitious * humor, which the Vlcer sends forth; by the spongie and fungous softnesse and growth of the flesh about it. You shall amend this by drying remedies, such as these are, which we terme sarcoticks, having alwayes regard to the plenty of the humour, the proper temper of the part, and other indications formerly mentioned. Amongst other remedies Galen much commends Alume water, for it dries, * clenses and corroborates the affected part. Also this ensuing fomentation may be applyed to good purpose. {rum} rosar. rub. absinth. beton. tapsi barbati, an. m. j. gallarum, nucum cupressi, an. ʒij. aluminis rochae ʒj. fiat decoctio in vino ansiero, instituatur fotus; Then let Empl. de cerussa or De minio be applyed to the Vlcer. Also I have found by experience that the pouder of burnt alome lightly strewed upon the Vlcer is very effectuall in this case. You shall know that an hot distemper associates the Vlcer by * rednesse, or yellownesse thereof, by the heate manifest to your touch, and the propriety of the paine. Then must you have recourse to refrigerating things, such as •ng. Rosatum Mes. Refrigerans Gal. Populeon; stoopes and cloathed dipped in plantaine water, Night-shade water, or Oxycrate. I have oft found by experience that scarrification, or Leaches being applyed, did more conduce than any other remedy. For so the chafed blood, which by that meanes is apt to corrupt, is drawne away, and the part its selfe is also freed of that burden.
We know a cold distemper by the whitish or pale colour, by the touch of the Chirurgion, * and speach of the patient complaining of the coldnesse of the ulcerated part. You shall correct this by applying and putting bottles filled with water about the part, or else Swines bladders halfe filled with the following decoction.
{rum} origani, pulegij, chamaem. meliloti, an. m. j. absinth. majoranae, salviae, rorismar. an. m ss. fiat decoctio in vino generoso, addendo aquae vitae quod sufficit. Also the Vlcer may conveniently bee fomented with spunges dipped in the same decoction, and let there be applyed thereto Empl. Oxycroccum; emp. de meliloto; de Vigo cum mercuris, and sine mercurio. But if a mixt and compound distemper be joyned to the Vlcer, the medicines must in like manner be mixt & composed. The residue of the Chirurgions care and paines must be spent upon the proper and peculiar cure of the Vlcer, as it is an Vlcer; which we said in the former Chapter was conteined in detersion, regenerating flesh and cicatrization thereof.

VI. Of An Ulcer With Pain.

There oft times so great paine accompanieth Vlcers, that it calls thereto the counsell of the Physition. Wherefore if it proceede from any distemper, it shall be taken away by remedies proper against that distemper, such as we mentioned in the former Chapter. But if it doe not so cease, wee must goe on to Narcoticks. Such are cataplasmes of the leaves of Mandrakes, water lillies, Hen-bane, Nightshade, Hemlocke, the seeds of Poppy and Oyles of the same; to which also may be added Opium, Populeon, and other things of like faculties. But if a maligne * acrimonie and virulency of an humour corroding and eating the flesh lying under it and the lips about it, cause and make the paine, you shall neither asswage it by anodynes, nor Narcoticks; for by application of gentle medicins it will become worse and worse. Wherefore you must betake you to Cathaereticks; For strong medicines * are fittest for strong diseases. Wherefore let a pledget dipped in strong and more than ordinarily powerfull Aegyptiacum, or in a little oyle of Vitrioll, be applyed to the Vlcer; for these have power to tame this raging paine, and virulent humors. In the meane season let refrigerating things be put about the Vlcer, least the vehemency of acrid medicines cause a defluxion.

VII. Of Ulcers With Overgrowing Or Proudness Of Flesh.

ULcers have oft times proud or overgrowing flesh in them, either by the negligence of the Chirurgion, or fault of the patient. Against this, * drying and gently eating or consuming medicines must be applyed; such as are Galls, cortex thuris, Aloes, T•tia, Antimony, Pompholix, Vitrioll, Lead, all of them burnt and washt if neede require. Of these pouders you may also make ointments with a little oyle and waxe; but if the proud flesh, as that which is hard and dense yeeld not to these remedies, we must come to causticks, or else to iron, so to cut it off. For in Galens opinion, the taking away of proud flesh is no worke of nature, (as the generating, restoring and agglutinating of the flesh is) but * it is performed by medicines which dry vehemently, or else by the hand of the Chirurgion; wherefore amongst the remedies fit for this operation, the pouder of mercury with some small quantity of burnt Alume, or burnt Vitrioll alone, seeme very effectuall to me. Now for the hard and callous lips of the Vlcer, they must bee * mollyfied with medicines which have such a faculty, as with Calves, Goose, Capons or Ducks grease, the oiles of Lillies, sweet Almonds, Wormes, Whelpes, Oesipus, the mucilages of Marsh-mallowes, Lineseede, faenugreeke seede, Gum Ammoniacum, Galbanum, Bdellium, of which being mixed may be made Emplaisters, unguents, and liniments, or you shall use Empl. Diachylon, or de Mucaginibus, De Vigo cum mercurio. To conclude, after we have for some few dayes used such like remedies, you may apply to the Vlcer a plate of Lead rubbed over with Quick silver; for this is very effectual to smooth an Vlcer and depresse the lips; if you shall prevaile nothing by this meanes, you must come to the causticks, by which if you still prevaile nothing, for that the lips of the Vlcer are so callous that the caustickes cannot peirce into them, you must cleave them with a gentle scarification, or else cut them to the quicke, so to make way, or as it were open a window for the medicine to enter in, according to Galen. Neither in the interim must you omit Hippocrates his advice, which is, that by the same * operation we reduce the ulcer if round, into another figure, to wit, long or triangular.

VIII. Of An Ulcer Putrid And Breeding Worms.

WOrmes are divers times bred in ulcers, whence they are called wormie ulcers; the cause hereof is the too great excrementitious humidity prepared * to putrefie by unnaturall and immoderate heate. Which happens, either for that the ulcer is neglected, or else by reason of the distemper and depraved humors of all the body, or the affected part; or else for that the excrementitious humor collected in the ulcer, hath not open and free passage forth; as it happens to the ulcers of the eares, nose, fundament, necke of the wombe, and lastly to all sinuous and cuniculous ulcers. Yet it doth not necessarily follow that all putrid ulcers must have wormes in them; as you may perceive by the definition of a putride ulcer which we gave you before. For the cure of such ulcers after generall meanes, the wormes must first be taken forth, then the excrementitious humor must be drawne away, whence they take their originall. Therefore you shall foment the ulcer with the ensuing decoction, which is of force to kill them; for if any labour to take forth all that are quicke he will be much deceived; for they oft times doe so tenaciously adhere to the ulcerated part, that you cannot plucke them away without much force and paine. ℞. absinth. centaur. majoris, marrub ij, an. M. j. fiat decoctio ad lb. ss. in qu• dissolve*aloes ℥ss. unguenti agyptia•i ℥j. Let the ulcer be fomented and washed with this medicine, and let pledgets dipped herein be put into the ulcer; or else if the ulcer be cuniculous or full of windings, make injection therewith which may goe into all parts thereof. Archigenes much commends this following medicine. ℞. Cerusae, poli j montani, an.* ℥ss. picis navalis liquidae quantum sufficit, misce in mortario pro linimento. If the putrefaction be such that these medicines will not suffice for the amendment thereof, you must come to more powerfull, or to cauteries also, or hot Irons, or to section; yet you must still beginne with the more gentle, such as this of Galens description. ℞. cerae. ℥ij. cerusae ℥j. olei ros. ℥ij. salis amnon. ℥ss squam. aris ʒij. thur. alum. •rug. malicor. calcis vivae, an. ʒj. fiat emplastrum. Or ℞. terebinth. lotae ℥ij. cer• albae ℥ss liquefiant simul addendo sublimati, ʒss. salis torrefacti, & vitrioli calcinati, an. ℥j. fiat mundificativum. Or you must use our Aegyptiacum alone, which hath Sublimate entring into the composition thereof; but in the interim the circuit of the Vlcer must be defended with refrigerating, and defensative things for feare of paine.

IX. Of a Sordid Ulcer.

A Sordide Vlcer after the cure of the body in generall, shall be healed with detergent medicines; the indication being drawne from the grosse and tough excrement, which with the excrementious Sanies, as it were besieging, and blocking up the ulcerated parts, weakens and as it were dulls the force of medicines though powerfull, which causeth us to beginne the cure with fomentations and lotions as thus.
℞. Lixivij com. lb. j. absinth. marr•…. appij. centaur. utriusque, hypericonis, an. M. ss.*coquantur, colaturae, quae sufficiat, adde mellis rosati ℥j. ungunti aegyptiaci ℥ss. fiat fo•us. Then use the following detersive medicine: ℞. succi appij, & plantag. an. ℥ij. mellis com. ℥j. terebinth. ℥iss. pul. •reos Florent. & aloes. an. ℥ss. fiat medicamentum.
The Chirurgion must wel consider, at how many dressings he shall be able to wash away the grosse sordes or filth sticking close to the Vlcer, and dry up the excrementitious sanies. For oft times these things may be done at one dressing; but in others who have more quicke sense or feeling, not so soone. But when the Vlcer is freed of such grosse Sordes or filth, you must forbeare to use more acride things for feare of paine, defluxion, inflammation, and erosion, whereby the Vlcer would become more hollow. Wherefore then we shall bee content to apply remedies which dry and cleanse without acrimony, that wee may so helpe natures endeavours in generating * flesh. Such remedies are the pouders of Aloes, Mastich, Myrrhe, Orris, Litharge, Antimony, roots of Gentian, Barly flower, and the like, which being strewed upon the Vlcer, you shall cover it with Lint, and put over that a plate of Lead, rubbed over with quicksilver; and you shall put on these detersives and desiccatives more or lesse strong, as you shall finde it requisite and necessary. For the too plentifull * use of drying and detersive things, doth in time hollow the Vlcers, whereby it comes to passe that in short time in like sort, a greater quantity of Sanies flowes from the Vlcer, the proper substance of the flesh being dissolved by the force or acrimony of the detersive medicine; as also the proper alimentary humor, which flowed to the part, being in like sort, a greater quantity of Sanies flowed from the Vlcer, the proper substance of the flesh being dissolved by the force or acrimony of the detersive medicine, as also the proper alimentary humor, which flowed to the part, being in like sort defiled: which thing beguiles the unskilfull Chirurgion. For by how much he sees the Vlcer flow more plentifully with sanies, he endeavours by so much the more to exhaust and dry up with more acrid medicines these humidities as if they were excrementitious; But Galen hath long agoe admonished us to take heede hereof, setting forth a History of a certaine Empericke who dressing a sordide Vlcer with a greene, acrid and eating medicine, dissolved the flesh, and so consequently made the Vlcer more hollow, and caused more paine and defluxion; whereby it happened that continually adding more acrid medicines, hee continually by his ignorance and unskilfulnesse increased the colliquation of the flesh, the largenesse of the ulcer and excrementitious humidity. Wherefore wee * must take speciall care, whether the sordide Vlcer grow each day worse, by its proper fault and the impurity of the whole body besides, or else by the colliquation of the flesh and corruption of the benigne and alimentary humor sent thither for the nutrition of the part, by the too frequent and unskilfull use of too acrid a medicine. You may conjecture this by the increase of the paine without reason, and by * the heate and rednesse of the lips of the Vlcer. Therefore you must principally have regard to this, that you give each of your patients his fit measure, that is, a convenient and agreeable medicine to each of their strengths, taking indication from the strength, distemper, and consistence of the whole body and affected part; for there is a great deale of difference whether you apply a medicine to a plowman or labourer, or to an Eunuch and woman, or whether to the Legge, or eyes. For these medicines which to a dense and hard body and part are onely detergent and drying, the same are to delicate and tender bodies and parts cathaereticke and eating, by colliquation of the flesh, and corruption of the nourishment, making an increase of Sordes or filth; on the contrary those things which doe laudibly and sufficiently clense the flesh in a soft body and dry up the sanies, these same things applyed to a hard body encrease the sordes and sanies by suffering them to breed, neither are they of sufficient power to wash away the tenacious impurity of a dense body. Wherefore the skilfull Chirurgion will see when he must be take himselfe from too strongly cleansing and eating medicines, to these which are more milde.

X. Of A Virulent, Eating And Malign Ulcer Which Is Termed Cacoethes, And Of A Chironian Ulcer.

Virulent and eating Vlcers differ not unlesse in magis and minus, for we tearme * it a virulent Vlcer which sends forth a virulent sanies, which is properly called Virus. This Virus, or virulency, when it becomes more maligne, gnawes and feeds upon the parts which lye under, and are adjoyning to the Vlcer, and makes an eating Vlcer. Such Vlcers are by Galen called Dysepulotica, that is, * difficultly to be cicatrized; for, saith he, it happens that the Vlcer is Dysepuloticke, either for that the part affected may be vitiated either in the habit or temper thereof, so that it may corrupt the humor which flowes thither; such an Vlcer is by a particular name tearmed Cacoethes; or for that by reason of the evill quality of the blood flowing thither and eating the part, the part affected being too moist cannot * heale up. He further addes that a Chironian Vlcer is farre more maligne than these Vlcers which are tearmed Cacoethe.
For the cure; by reason that all these Vlcers have a large extent, for some are more maligne and ill to be cicatrized than othersome; it is also necessary to have divers medicines ready and at hand distinct both in their faculties and the degrees thereof; so that it is no marvaile if they oft faile of their purpose, who with the same medicine dresse and thinke they shall heale all maligne Vlcers. This following medicine described by Asclepiades is much commended by Galen.


℞. squamae aeris, aeruginis rasae, an. ℥j. cera lb. ss. resinae laricis. ℥jss. quae liquari possunt*aridis affundantur, and make an emplaister to bee laid onely upon the Vlcer; for you must lay a defensative about the Vlcer for feare of inflammation. But Galen saith, that the following Epuloticke of Primion excells the rest, as that which to desperate Vlcers, (which many have taken in hand and left as uncurable,) was of certaine and approoved use.


℞ soreos ℥iij aluminis scissilis, calcis viuae, an ℥ij. thuris, gallarum, an. ℥iiij. cerae, lb. j *& ℥iij. sevi vitulini lb. j. & ℥vij. olei veteris quantum sufficit, fiat emplastrum.

XI. Advertisement To The Young Surgeon Touching The Distance Of Times Wherein Malign Ulcers Are To Be Dressed.

TO shew the use of Asclepiades his medicine described in the former Chapter, * and convince the errour of these Chirurgions, who thinke they doe well for their patients, if they twise or thrice on a day dresse maligne Vlcers, I have heere thought good to digresse a little from my purpose and to interpose Galens authority. Rightly (saith Galen) hath Asclepiades added these words to the formerly described medicine: And loose this after three dayes, and foment the Vlcer, and fasten the same emplaister being washed, and apply it againe; for unlesse the medicine adhere long to the skin, it will doe no good. Which thing notwithstanding many Physitions have beene ignorant of, thinking if they wiped away the Sanies from the Vlcer thrice on a day, they should doe better than those who did the save but twice a day. But those who dresse it but once a day, are reprooved by the patients as negligent. But they are much mistaken; for you must remember, as we have delivered in most of our writings, that the qualities of all neighbouring bodies do mutuall actuate and affect each other in some degree, although the one thereof bee much more powerfull; for by this reason in space of time they become somewhat alike, though they otherwise differ much; But when the quality of the medicine shall bee like in species to the body to bee cured, there followes the better successe. Wherefore he which moved by these reasons first appointed to use the emplaster formerly applyed, is worthy of commendations; and we ought to follow him much the rather, seeing that which he found out by reason, is approoved by experience. Neither did he unadvisedly command to foment the wound every third day, that is, at every dressing; for seeing it is a powerfull medicine, therefore it stands in neede of mitigation. Thus much Galen, whose opinion grounded * on reason, he can againe confirme with another reason. It is already sufficiently knowne, that medicines can doe nothing in us unlesse by the force of the native heate, which stirres up the faculty of the medicine to operation. But in Vlcers which are absolutely maligne, the native heate of the affected part is very languid, being broken and debilitated by the presence of the preternaturall heate; so that it stands in need of a great space of time to actuate the vertue and faculty of the medicine. Wherefore, if in that time, when as the native heate hath much moved and stirred up the faculty of the medicine, the ulcer be loosed or opened, and that emplaister cast away which was layd upon the part, and a fresh one layd in steede thereof; the heate implanted in the part is either dissipated by the contact of the ayre, or is weakned and driven in; and that endeavour which was made by the emplaister was to no purpose, being as it were stopped in the midst of the course. But a new emplaister being layd on, the heate of the part must undergoe a new labour, so to stirre up the faculty to bring it to act.


For all medicines are, what they are, in faculty. Equall to this is their errour, who by too oft renewing their emplaisters on the same day, doe too powerfully * clense; for so they doe not onely take away the excrementitious humors, both Sordes and Sanies, but also the alimentary juice; to wit, the Rob, Cambium, and Gluten, which are the next matter for procreating of laudible flesh. Wherefore it is not good to dresse Vlcers so often in one day, and to loose them to apply new emplaisters, unlesse some grievous symptome (as paine) force us to doe it, which requires to be asswaged and mittigated by the often changing and renewing of Anodyne medicines.

XII. How To Bind Up Ulcers.

For the binding up of Vlcers, you must alwayes beginne your bandage at the Vlcer. Now the Rowler must be so large that it may not onely cover * and comprehend the Vlcer, but also some portion of the adjacent parts above and below; and let it presse the Vlcer with that moderation, that it may only presse out the excrementitious humors. For so the ulcer wil become dry, and consequently more neere to healing, as it is observed by Hippocrates. Let this be the measure of your binding, that it be neither too straite for hence would ensue * paine and defluxion; nor too laxe, for such is of no use. You may moysten your boulsters and Rowlers in oxycrate or in red and astringent wine, especially in Summer; when you have bound it up the part must be kept quiet. For according to Hippocrates, those who have an ulcer in the legge, ought neither to stand, nor sit, but to lye on a bed. Wherefore when the legges are ulcerated the armes must be exercised, by handling, lifting up and casting downe of divers things. But on the contrary if * the armes be ulcerated, the legges must be exercised with walking, or frictions from above downewards, if the patient cannotendure to walke. So the humors and spirits which with more violence and greater plenty runne downe to the part affected, may be drawne backe and diverted.

XIII. Of The Cure Of Particular Ulcers, And First Of Those Of The Eyes.

FOr that (in Galens opinion) the diverse indication in curing diseases is drawne from the condition of the part, to wit, the temper, complexion, site, sigure, * use, dull or quicke sense; Therefore having breefely handled the generall cure both of simple and compound and implicite ulcers, I thinke it fit to treate of them now as they are distinguished by the parts, beginning with these of the eyes. These according to Celsus, are sometimes caused by pustules, or a sharpe defluxion which frets or eates in sunder the coates thereof, or else by a stroake.
Paulus sets downe these differences of the ulcers of the eyes; If (saith he) a small, little and hollow ulcer be upon the horny coate, it is by the Greekes termed Botryon;* but if it be broader and lesse deepe, it is termed Caloma; about the circle of the Iris or Rainebow, it is called Argemon. If it be crusty and sordid, it is termed Epicauma.* These in generall require the same cure as the former, that is, to bee mundified, incarnated, dryed and cicatrized; but the part affected indicates more gentle medicines. Wherefore having purged the patient and taken some blood both from his arme, as also from his veines and temporall Arteries, and bathed him if it be needfull; to divert the defluxion you shall to his shoulders apply cupping glasses with scarrification; or else bread newly drawne out of the oven, and sprinkled with aqua vitae or some good wine shall be applyed to the originall of the spinall marrow. But you shall apply to the forehead and temples an astringent emplaister made of emplastrum contra rupturam, ung. Comitissae, and Resiccativum rubrum mixed together. But this ensuing Collyrium described by Celsus and approved by Hollerius, shall be dropped into the eye. ℞. aeris usti, cadmiae ustae & lotae, an. ℥j. ex aqua •ingatur collyrium quod liquore ovi dissolvatur. But in the meane time you must diligently observe whether you put the * eye to any great paine. Wherefore now and then by putting anodyne medicines thereto, it will be good to comfort it. Also you may make collyria of the decoction of Plantaine, faenugreeke, wormewood, with a little quantity of Sugar Candy, tutia, gumme tragacanth, myrrhe and vitrioll dissolved therein. When the ulcer i• mundifyed, the following sarcoticke will be of good use.
℞. sarcocollae in lacte muliebri nutritae, ʒiij. pul. diaireos simplicis, gum. arabici, tragacanth.*an. ʒss. mucilaginis faenugraeci quantum sufficit ut inde fiat collyrium. But you must note that for moyst Vlcers, powders are more convenient than Collyria.
When the ulcer is playned or filled with its proper flesh, it may bee cicatrized with the following collyrium. ℞. tutiae, cadmiae ut decet praeparatae, cerusae, antimonij, olibani, an. ʒss. myrrhae, sarcocollae, sanguinis Draconis, aloes, opij, an. ℈ss. cum aqua planta.*ginis fiat collyrium; or the powder onely may be conveniently strewed thereon.
Celsus hath noted that the cicatrizing of the eyes is incident to two dangers, that is, * least they be too hollow, or else too thick. If too hollow, they must be filled by the following remedy, ℞. Papaveris lachrimae, ʒss. sagapeni, opopanacis, an. ʒss. aruginis ʒj. *cumini ʒiij. piperis ʒij. cadmiae lotae & cerusa, an. ʒiss. cum aqua pluviali fiat collirium. But if the scars be thicke or grosse, the following remedy will extenuate them. ℞ cinamom. acaciae, an. ʒss. cadmiae elotae, croci, myrrhae, papaveris lachrymae, gum. arabici, an. ʒj. piperis albi, thuris, an. ℥iss. aris combusti, ʒiij. cum aqua pluviali fiat collyrium. But * if the scarre be upon the cornea or horny coate, so that it cover the pupilla or sight, the sight will be intercepted by the densenesse of the membrane. Here you must also observe, that the scarres that are on the Cornea are white, but these on the Adnata are red, because this is spred over with more little veines than that.

XIV. Of The Ozaena And Ulcers Of The Nose.

He Ozaena is a deepe and stinking Vlcer in the inside of the nose, sending forth many crusty and stinking excrements. Celsus saith that such ulcers * can scarsely be healed. It is caused (as Galen saith) by the distillation of acride and putride humors from the head into the nosethrills about the mammillary processes. For the cure, the patient must eate sparingly, and his meate must neither be sharpe nor strong; the humor being prepared must be purged; the head dryed and strengthened, that so it may neither admit the excrementitious humors, nor send them downe; then must we come to the part affected with the Vlcer. The Vlcer must be dryed with a repelling medicine, such as is the juice of Pomegranats boyled to the halfe in a brasse vessell; the powder of Calamint, Cresses, white Hellebore, the juyce of Cresses with Alume and other things which you may reade in Celsus.
Galen out of Archigenes wishes, to draw up into the nosethrills the juyce of Calamint, or that the Calamint it selfe being dryed, and made into powder, may bee blowne with a quill into the nose. Others use this following powder. ℞. ros. Rub. mint. calam. arom. rad. angelica, gentian, macis, caryop. an. ʒss. camph. ambrae, an. gr. iiij. mosch. gr. vj. fiat pulvis subtilissimus. Manardus writes that the Vrine of an Asse, though a nasty * medicine, is an excellent remedy in this affect. But if the inveterate and contumacious evill doe not yeeld to these remedies, then you must have recourse to Coprose, Verdigreece, sal ammoniacum, and Alume with Vinegar. It divers times happens that the Vlcer spreading on, comes to take hold of the Ossa ethmoidea or sive-like bones; in which case you must not forcibly plucke them out; but referre the whole businesse * to nature, and expect when they shall come away of themselves, making in the meane while injections into the nosethrils of aqua vitae, wherein Cephalicke pouders have beene steeped for the greater drying.

XV. Of The Ulcers Of The Mouth.

OF this tribe are the Aphthae, Vlcers familliar to little children, according to Hippocrates. They oft times beginne at the gums, and by the palate of * the mouth creepe into the uvula, throtle, and over all the mouth, as Celsus saith. Galen makes two kinds of Aphtha’s; the one of easie cure, such as that which usually troubles children by reason of the acrimony of the nurses milke; the other is maligne by reason of an affluxe of an evill humor (that is, venenate and maligne) into the mouth.
For the cure, it shall be good to abstaine from all acride things, and if it be a sucking * child, it will not be amisse to temper the nurses milke with refrigerating meates, bathing the whole body, and fomenting the dugges with warme water; for all the members in children are most tender, and as it were mucous, and their mouths are unaccustomed to meates and drinkes. For topicke medicines, you must make choise of such which may quickely and readily worke the effect; for heere the condition of the affected part is such, that they cannot long remaine and adheere thereto. Therefore if the Vlcer be maligne, it must be lightly touched with aqua fortis which hath beene used in separating mettalls and which besides is tempered with sixe parts of common water. You may for the same purpose use the oyles of Vitrioll, Sulphur, Antimony, Mercury water and the like.
Aetius wishes you to touch and correct such Vlcers with a locke of wooll dipped in scalding oyle, and so fastened to the end of a probe, untill they waxe white and become smooth or plaine. For so their eating and spreading force will at length be bridled, and laudible flesh grow up in place of that which is eaten. After such burning it will be good to wash the mouth with the following gargarisme, which also of its selfe alone will serve to cure Aphtha’s, which are not maligne. *
℞. hordei integri p. j. plantag. ceterach, pilosellae, agrimonia, an. M. j. fiat decoctio ad lb. j. in qua dissolve mellis rosati ℥j. diamoron, ℥ss. fiat gargarisma. You may also make other gargles, of Pomegranate pills, Balausties, Sumach, Berberies, red roses being * boyled, and dissolving in the strayned liquor Diamoro• and Dianucum with a little Alume. For Galen writes, that simple Vlcers of the mouth are healed with things which dry with moderation; now Diamoron and Dianucum are such. But others * stand in neede of strong medicines, with such like. If the palate be seazed upon, we must use the more diligence and care; for there is danger, least being the part is hot and moyst, the bone which lyes under which is rare and humide, may bee corrupted by the contagion and fall away, and the voyce or speech be spoyled. If the Vlcer be pockie, omitting the common remedyes of Vlcers, you must speedily be•ake your selfe to the proper antidote of that disease, to wit, quick-silver.
Fistulous Vlcers often take hold on the Gummes, whence the roote of the next tooth becomes rotten, and so farre that the acrimonie of the Sanies oft times makes its selfe a passage forth on the outside under the chinne; which thing puts many into * a false conceite of the scrophulae or Kings evill, and consequently of an uncurable disease. In such a case Aetius, and Celsus counsell is, to take out the rotten tooth, for so the Fistula will be taken away, the Gum pressing and thrusting its selfe into the place of the tooth which was taken forth; and so the cause nourishing the putrefaction being taken away, (that is, the tooth) the rest of the cure will be more easy. The Vlcers of the tongue may be cured by the same remedies by which the rest of the mouth; yet those which breede on the side thereof endure very long, and you must looke whether or no there be not some sharpe tooth over against it, which will not suffer the Vlcer in that place to heale; which if there be, then must you take it away with a file.

XVI. Of The Ulcers Of The Ears.

ULcers are bred in the auditory passage both by an externall cause, as a stroake, or fall, as also by an internall, as an abscesse there generated. They * oft times flow with much matter, not there generated, for such Vlcers are usually but small and besides in a spermaticke part, but for that the braine doth that way disburden its selfe.
For the cure, the cheefe regard must be had of the antecedent cause, which feedes * the Vlcer, and it must be diverted by purging medicines, Masticatories and Errhines. This is the forme of a Masticatory. {rum}. Mastic. ʒj. staphisagr. & pyreth. an. ℈j. cinam.*& caryoph. an. ʒss. fiant Masticatoria, utatur manè & vesperi. But this is the forme of an Errhine. {rum} succi betonic. mercurial: & melissa, an ℥ss. vini albi ℥j, misce & frequenter*naribus attrahatur. For topicke medicines we must shunne all fatty and oyly things, as Galen sets downe in Method. medendi, where he findes fault with a certaine follower of Thessalus who by using Tetrapharmacum, made the Vlcer in the eare grow each day more filthy than other, which Galen healed with the Trochisces of Andronius dissolved in Vinegar, whose composure is as followeth. {rum} balaust. ʒij, alumin.* ʒj. atrament. sutor. ʒij, myrrhae. ʒj, thur. aristoloch. gallarum, an. ʒij, salis Ammon. ʒj, excipiantur omnia melicrato, & •…t trochisci. Galen in the same place witnesseth, that he hath healed inveterate Vlcers and of two yeares old of this kind, with the scailes of Iron made into powder, and then boyled in sharpe Vinegar untill it acquired the * consistence of Honey: Moreover an Oxes gall dissolved in strong Vinegar, and dropped in warme, amends and dryes up the putrefaction wherewith these Vlcers flow. Also the scailes of Iron made into powder boyled in sharpe Vinegar, dryed and strewed upon them. But if the straitnesse of the passages should not give leave to the matter contained in the windings of the eares to passe forth, then must it bee drawne out with an Instrument thereupon called a Pyoulcos, or matter-drawer, * whereof this is the figure.

XVII. Of The Ulcers Of The Windpipe, Weazon, Stomach And Guts.

THese parts are ulcerated either by an externall cause as an acride medicine, or poyson swallowed downe; or by an internall cause, as a maligne * fretting humor which may equall the force of poyson generated in the body, and restrained in these parts. If the paine be encreased by swallowing or breathing, it is the signe of an Vlcer in the weazon, or windepipe joyning thereto; But the paine is most sensibly felt when as that which is swallowed is either * soure or acride, or the ayre breathed in, is more hot or cold than ordinary. But if the cause of paine lye fastened in the stomacke, more greevous symptomes urge; for sometimes they swound, have a nauseous disposition and vomiting, convulsions, gnawings, and paine almost intollerable, and the coldnesse of the extreame parts; all which when present at once, few scape unlesse such as are young, and have very strong bodyes. The same affect may befall the whole stomacke, but because both for the bitternesse of paine, and greatnesse of danger, that Vlcer is farre more greevous which takes hold of the mouth of the Ventricle, honoured by the Ancients with the name of the heart; therefore Physitions doe not make so great a reckoning of that * which happens in the lower part of the stomacke. Now we know that the Guts are ulcerated if Pus, or much purulent matter come forth by stoole; if blood come that way with much griping; for by the Pus staying and as it were gathered together in that place, there is as it were a certaine continuall Tenesmus, or desire to goe to stoole. Now all such Vlcers are cured by meates and drinkes, rather than by medicines, according to Galen. Therefore you must make choyse of all such meates and drinkes * as are gentle, and have a lenitive faculty, shunning acride things; for Tutia, Lytharge, Ceruse, Verdigreece and the like, have no place heere, as they have in other Vlcers. But when as the Vlcer shall be in the Gullet or Weazon, you must have a care that * such things may have some viscidity or toughnesse, and be swallowed by little, and little, and at diverse times; otherwise they will not m••h availe, because they cannot make any stay, in these commune wayes of breath and meat; therefore they presently slip downe and flow away; wherefore all such things shall be used in forme of an *Eglegma, to be taken lying on the backe, and swallowed downe by little and little, opening the muscles of the throate, least the medicine passing downe sodainely and in great quantity, cause a cough, a thing exceeding hurtfull to these kinds of Vlcers. When they must be clensed, you shall have crude honey, which hath a singular faculty, above all other detergent things, in these kind of Vlcers. But when they can conveniently swallow, you shall mixe Gumme Tragacanth dissolved in some astringent decoction. In Vlcers of the stomacke all acride things (as I have formerly advised) * must be shunned, as those which may cause paine, inflammation and vomite, and besides hinder the digestion of the meate. Therefore let them frequently use a ptisan, and sugered gellyes wherein Gumme Tragacanth, and bole Armenicke have beene put, the decoction of Prunes, Dates, Figges, Raisons, Honey, Cowes milke boyled with the yoalkes of egges, and a little common honey. When they are to be agglutinated, it will be convenient to make use of austere, astringent, and agglutinative things which want all acrimony, and ungratefull taste, such as are Hypocistis, Pomegranate flowres and pills, terra sigillata, sumach, acacia a decoction of quinces, the Lentiske wood, the tops of Vines, of brambles, myrtles, made in astringent wine, unlesse there be feare of inflammation. Their drinke shall be Hydromel water with Sugar, syrupe of Violets and Iujubes. Honey mixed with other medicines is a very * fitting remedy for Vlcers of the guts and other parts more remote from the stomacke; for if you shall use astringent medicines alone of themselves, they will sticke to the stomacke; neither will they carry their strength any further; but honey mixed with them, besides that it distributes them to the rest of the body, and helpes them forwards to the affected parts; also clenses the Vlcers themselves. Here also Asses milke may with good successe be used in stead of Goates or Cowes milke. The use of a valnerary potion is almost commendable, if so bee that it bee made of such hearbes and simples, as by a certaine tacite familiartiy have respect to the parts affected. But the Vlcers of the Guts have this difference amongst themselves, that if the greater guts be affected, you may heale them with a Glyster and injections, made also sharpe to correct the putrefaction; such as are those which are made of Barly * water, or wine with Aegyptiacum. But if the small guts be ulcerated, they must bee rather healed by potions and other things taken at the mouth, for that (as Galen saith) these things which are put up into the body by the Fundament, doe not commonly ascend, to the small or slender guts, but such as are taken at the mouth cannot come unlesse with the losse of their faculty, so farre as the great guts.

XVIII. Of The Ulcers Of The Kidneys And Bladder.

ULcers are caused in the Kidnyes and Bladder, either by the use of acride meates, drinkes, or medicines, as Cantharides; or else by the collection of an acride humor bred in that place, sent or falne thither; or else by the rupture * of some vessell, or an abscesse broken and degenerated into an Vlcer, as it sometimes comes to passe. They are discerned by their site, for the paine and heavinesse of Vlcers of the Reines comes to the Loynes, and the Pus or matter is evacuated well and * throughly mixed with the Vrine. Neither doth the Pus which flowes from the renies stinke so ill, as that which is cast * forth of the bladder; the reason is, for that the bladder being a bloodlesse, fleshlesse & membranous part hath not such power to resist putrefaction; that pus which flowes * from the Kidneyes never flowes without water; and although by long keeping in an Vrinall, it at length subsides or falls to the bottome, and may be seene separated; yet when it is first made, you may see it perfectly mixed with the Vrine; but that Pus wch* flowes from the bladder is oft times made alone without Vrine; & usually it comes to passe that the Pus, or matter which flowes from the ulcerated Kidnyes, hath in it certaine caruncles, or as it were haires, according to the rule of Hippocrates. Those who in a thicke Vrine have little ca•uncles, and as it were haires come forth together therewith, they come from their Kidnyes; but on the contrarie those who have certaine bran-like scailes come from them in a thicke Vrine, their bladder is scabby or troubled with a scabby Vlcer. For the cure; it is expedient that the belly be soluble either by nature; or Art and * the use of mollifying Glysters. And it is good to vomit sometimes, so to draw backe the humors by whose confluxe into the affected part the Vlcer might bee seed and made more sordide and filthy. You must beware of strong purgations, least the humors * being moved and too much agitated, the matter fit to nourish the Vlcer may fall downe upon the Kidnyes or bladder. The ensuing potion is very effectuall to mundifie those kind of Vlcers. ℞. Hordei integri, M. ij. glycyrrhizae ras. & contus. ℥ss. rad. acetosae & petrosel. an.* ʒvj. fiat decoctio ad lb. j. in colatura dissolve mellis dispum. ℥ij. Let him take every morning the quantity of foure Ounces. Gordonius exceedingly commends the following Trochisces. ℞. quator sem. frig. maj. mundatorum, sem. papaveris albi, sem. malvae, portul. cydon. baccarum myrti, tragacanth. gum. arab. nucum pinearum mund.*pistach. glycyrrhizae mund. •ucaginis sem. psilij, amygd. dulc. hordei mund, an. ʒij. bol. armeni, sang. drac•spodij, rosarum, myrrhae an. ℥ss. excipiantur hydromelite, & fingantur trochisci singuli ponderis ʒij. Let him take one thereof in the morning dissolved in Barly water or Goates milke. Galen bids to mixe honey and diureticke things with medicines made for the Vlcers of the Reines and bladder, for that they gently move * Vrine, and are as vehicles to carry the medicines to the part affected. Vlcers of the bladder are either in the bottome thereof, or at the necke and urinary passage. If they be in the bottome, the paine is almost continuall; if in the necke, the paine * then prickes and is most terrible when they make water and presently after. The Vlcer which is is the bottome sends forth certaine scaly or skinny excrements together with the Vrine; but that which is in the necke, causes almost a continuall Tentigo. Those which are in the bottome are for the most part incurable, both by reason of the bloodlesse and nervous nature of the part, as also for that the Vlcer is * continually chased and troubled by the acrimony of the Vrine, so that it can hardly be cicatrized. For even after making of water some reliques of the Vrine alwayes remaine in the bottome of the bladder, which could not therefore passe forth together with the rest of the Vrine, for that for the passing forth of the Vrine, the bladder being distended before, falls and is complicated in its selfe. Vlcers of the bladder are healed with the same medicines as those of the reines are; but these not onely taken by the mouth but also injected by the urinary passage. These injections may be made of Gordonius his Trochisces formerly prescribed, being dissolved in some convenient liquor; but because Vlcers of the bladder cause greater and more sharpe paine than those of the Kidnyes, therefore the Chirurgion must bee more diligent in using Anodynes. For this purpose, I have often by experience found, that the oyle of hen-bane made by expression gives certaine helpe. Hee shall doe the same with Caraplasmes and liniments applyed to the parts about the Pecten and all the lower belly and perinaeum, as also by casting in of Glisters. If that they stinke, it will not be amisse to make injection of a little Aegyptiacum dissolved in wine, plaintaine * or rose water. For I have often used this remedy in such a case with very prosperous successe.

XIX. Of The Ulcers Of The Womb.

ULcers are bred in the wombe either by the confluxe of an acride, or biting humor, fretting the coates thereof, or by a tumor against nature degenerating into an Absesse, or by a difficult and hard labour; * they are knowne by paine at the perinaeum, and the effluxe of Pus and San•es by the privity All of them in the opinion of Avicen are either putride, when as the Sanies breaking forth is of a stinking smell, and in colour resembles * the water wherein flesh hath beene washed; or else sordide, when as they flow with many virulent and crude humors; or else are eating or spreading Vlcers, when as they cast forth blacke Sanies, and have pulsation joyned with much paine. Besides they differ amongst themselves in site, for either they possesse the necke and are known by the sight, by putting in a speculum; or else are in the bottome, and are manifested by the condition of the more liquid and serous excrements, and the site of the paine. They are cured with the same remedies wherewith the ulcers of the mouth to wit, with aqua fortis, the oyle of Vitrioll and antimony, and other things made * somewhat more milde, and corrected with that moderation, that the ulcerated parts of the wombe may bee safely touched with them; it is requisite that the remedies which are applyed to the Vlcers of the wombe, doe in a moment that which is expected of them, for they cannot long adhere or sticke in the wombe, as neither to the mouth. Galen saith that very drying medicines are exceeding fit for the Vlcers of the wombe, that so the putrefaction may be hindred or restrained, whereto this * part as being hot and moyst is very subject; besides that the whole body unto this part as unto a sinke sends downe its excrements. If an ulcer take hold of the bottome of the wombe, it shall be cleansed and the part also strengthened by making this following injection. ℞ hordei integri p. ij. guajaci. ℥j. rad. Ireos. ℥ss. absinth. plant. centaur. utriusque, an. M. j fiat decoct. in aqua fabrorum ad lb. ij. in quibus dissolve mellis vosati, &*syrupi de absinthio, an. ℥iij. fiat injectio. For amending the stinking smell I have often had certaine experience of this ensuing remedy. ℞. vinirub. lb. j. unguent. agyptiaci ℥ij. bulliant parum. Thus the putrifaction may be corrected and the painefull maliciousnesse * of the humor abated. Vlcers when they are clensed must presently be cicatrized; that may be done with Alume water, the water of plantaine wherein a little vitrioll or Alume have beene dissolved. Lastly, if remedies nothing availing, the Vlcer turne into a Cancer, it must be dressed with anodynes and remedies proper for a Cancer, which you may finde set downe in the proper treatise of Cancers. The cure of Vlcers of the fundament was to bee joyned to the cure of these of the wombe; but I have thought good to referre it to the treatise of Fistula’s, as I doe the cure of these of the vrinary passage to the Treatise of the Lues venerea.

XX. Of The Varices And Their Cure By Cutting.

A Varix is the dilatation of a Veine, some whiles of one and that a simple branch, otherwhiles of many. Every Varix is either straight or crooked, * and as it were infolded into certaine windings within its selfe. Many parts of the body are subject to Varices, as the temples, the region of the belly under the Navill, the testicles, wombe, fundament, but principally the thighes and legges. The matter of them is usually melancholy blood, for Varices often grow in men of a malancholy temper, and which usually feed on * grosse meates, or such as breed grosse and melancholy humors. Also women with child, are commonly troubled with them, by reason of the heaping together of their suppressed menstruall evacuation. The precedent causes are a vehement concussion of the body, leaping, running, a painefull journey on foote, a fall, the carrying of a * heavy burden, torture or Racking. This kind of disease gives manifest signes thereof * by the largenesse, thicknesse, swelling and colour of the Veines. It is best not to meddle with such as are inveterate; for of such being cured there * is to be feared a refluxe of the melancholy blood to the noble parts, whence there may be imminent danger of maligne Vlcers, a Cancer, Madnesse or suffocation. When as many Varices and diversly implicite are in the legges, they often swell with congealed and dryed blood, and cause paine which is increased by going and compression. Such like Varices are to be opened by dividing the veine with a Lancet, and then the blood must be pressed out, and evacuated by pressing it upwards * and downewards; which I have oft times done, and that with happy successe to the patients, whom I have made to rest for some few dayes, and have applyed convenient medicines. A Varix is often cut in the inside of the legge a little below the knee, in which place commonly the originall thereof is seene. He which goes about to intercept a Varix downewards from the first originall and as it were fountaine thereof, makes the cure far more difficult. For hence it is divided as it were into many rivelets, all which the Chirurgion is forced to follow. A Varix is therefore cut or taken away so to intercept the passage of the blood and * humors mixed together therewith, flowing to an Vlcer seated beneath; or else least that by the too great quantitie of blood, the vessell should be broken, and death bee occasioned by a haemorrhagie proceeding from thence. Now this is the manner of cutting it. Let the patient lye upon his backe on a bench or table, then make a ligature * upon the legge in two places the distance of some foure fingers each from other, wherein the excision may be made, for so the Veine will swell up and come more in sight, and besides you may also marke it with inke; then taking the skin up betweene your fingers cut it longwayes according as you have marked it, then free the bared veine from the adjacent bodies; and put thereunder a blunt pointed needle (least you pricke the veine) thred with a strong double thred, and so binde it fast; and then let it be opened with a Lancet, in the middle under the Ligature just as you open a veine, and draw as much therehence as shall be fit. Then straight make a Ligature in the lower part of the forementioned Veine, and then cut away as much of the sayd Veine as is convenient betweene the Ligatures, and so let the ends thereof withdraw themselves into the flesh above and below; let these ligatures alone untill such time as they fall away of themselves. The operation being performed, let an astringent medicine be applyed to the wound and the neighbouring parts; neither must you stirre the wound any more for the space of three dayes. Then doe all other things as are fit to be done to other such affects.

XXI. Of Fistulas.

A Fistula is a sinuous, white, narrow, callous and not seldome unperceivable Vlcer. It tooke its denomination from the similitude of a reeden * (Fistula) that is, a pipe, like whose hollownes it is. A Fistula is bred in sundry parts of the body, and commonly followes upon Abscesses or Vlcers not well cured. A Callous is a certaine fleshy substance, white, solid, or dense and hard, dry and * without paine, generated by heaping up of dryed excrementitious phlegme, or else adult melancholy, encompassing the circuite of the Vlcer, and substituting its selfe into the place of laudible flesh. The Sinus or cavity of a Fistula is sometimes dry, and * otherwhile drops with continuall moisture: sometimes the dropping of the matter sodainly ceases, and the orifice thereof is shut up, that so it may deceive both the Chirurgion and the Patient with a false shew of an absolute cure; for within a while after it will open againe and run as formerly it did. Some Fistula’s are bred by the corruption of a bone, others of a nerve, others of membranes, and others of other parts of the body. Some run straight in, others and that the greater part, have turnings and windings; some have one, others have more orifices and windings; some are at the Ioynts, others penetrate into some capaoity of the body, as into the chest, belly, guts, womb bladder; some are easily, others difficultly cured, and some wholly uncurable. There are divers signes of Fistula’s according to the variety * of the parts they possesse; for if that which you touch with the end of your probe make resistance, and resound, then you may know that it is come to the bone; and then if the end of the probe slip up and downe as on a smooth and polite superficies, it is a signe that the bone is yet sound; but if it stop and stay in any place as in a rough way, then know that the bone is eaten, rough and perished; sometimes the bone lies bare, and then you neede not use the probe. Besides also it is a signe that * the bone is affected, if there be a purulent efflux of an unctuous or oily matter, not much unlike that marrow wherewith the bone is nourished. For every excrement shewes the condition of the nourishment of the part whence it is sent; in a Fistula which penetrates to a Nerve, the patient is troubled with a pricking paine, especially when you come to search it with a probe, especially if the matter which flowes downe be more acrid. Oft times if it be cold, the member is stupified the motion * being weakned; besides also the matter which flowes from thence is more subtle, and somewhat like unto that which flowes from the bones, yet not oily nor fat, but sanious and viscous resembling the condition of the alimentary humor of the Nerves. The same usually appeares and happens in Fistula’s which penetrate to the Tendons and those membranes which involve the muscles. If the Fistula bee within the flesh, the matter flowing thence is more thicke and plentifull, smooth, white and equall. If it descend into the Veines or Arteries, the same happen as in those of the Nerves; but that there is no such great paine in searching with your probe, nor no offence or impediment in the use of any member: yet if the matter of the Fistulous Vlcer be so acrid, as that it corrode the vessells, blood will flow forth; and that more thicke if it be from a veine, but more subtle and with some murmuring if from an Artery. Old Fistula’s and such as have run for many yeares, if suddainly * shut up, cause death, especially in an ancient and weake body.

XXII. Of The Cure Of Fistulas.

FOr the cure; in the first place it will be expedient to search the Fistula; & that * either with a waxe size, a probe of lead, gold or silver, to find out the depth and windings or corners thereof. But if the Fistula be hollowed with two or more orifices, and those cuniculous, so that you cannot possibly and certainly search or finde them all out with your probe; then must you cast an injection into some one of these holes, and so observe the places where it comes forth, for so you may learne how many, and how deepe or superficiary cavities there be; then by making incisions you must lay open and cut away the callous parts. You must make incisions with an incision knife or razour, or else apply actuall or potentiall cauteries; for nature cannot unlesse the Callous substance bee first taken away, restore or generate flesh or agglutinate the distant bodies. For hard things cannot grow together, unlesse by the interposition of glue, such as is laudible blood; but a callous body on all sides possessing the surface of the ulcerated flesh, hinders the flowing of the blood out of the capillary veines for the restoring of the lost substance and uniting of the disjoyned parts. If you at any time make causticke injections into the * Fistula, you must presently stop the orifice thereof, that so they may have time to worke the effect, for which they are intended. Which thing we may conjecture by the tumor of the part, the digesture of the flowing matter, and its lesser quantity. Then you must hasten the falling away of the Eschar, and then the Vlcer must be dressed like other Vlcers. But oft times the Callous which possesses the sinuous cavity of a Fistula, overcome by the power of acrid and escharoticke medicines comes * whole forth, and falls out like a pipe, and so leaves a pure Vlcer underneath it. Which I observed in a certaine Gentleman, when I had washed with strong Aegyptiacum divers times a Fistulous Vlcer in his thigh shot through with a bullet; then presently by putting in my Balsame formerly described, he grew well in a short time. Fistula’s which are neare great vessells, Nerves or principall intrailes, must not bee medled with, unlesse with great caution. When a Fistula proceeds by the fault of a * corrupt bone, it is to be considered whether that fault in your bone be superficiary, or deeper in, or whether it is wholly rotten and perished. For if the default be superficiary it may easily be taken away with a desquammatory Treapan; but if it penetrate even to the marrow, it must be taken forth with cutting mullets, first having made way with a Terebellum. But if the bone be quite rotten and perished, it must bee wholly taken away, which may be fitly done, in the joynts of the fingers, the radius of the Cubite and Legge; but no such thing may be attempted in the socket of the Huckle bone, the head of the Thigh bone, or any of the Rack bones when they are mortified, neither in those Fistula’s, which are of their owne nature uncurable; but you shall thinke you have discharged your duty and done sufficiently for the Patient, if you leave it with a prognosticke. Of this nature are Fistula’s which penetrate * even to the bowells, which come into the parts orespread with large vessells or Nerves, which happen to effeminate and tender persons, who had rather dye by much, than to suffer the paine and torment of the operation. Like caution must bee used, when by the cutting of a Fistula there is feare of greater danger, as of convulsion if the disease be in a nervous part. In these and the like cases the Chirurgion shall not set upon the perfect cure of the disease, but shall thinke it better to prevent by all * meanes possible that the disease by fresh supplies become no worse, which may bee done if he prevent the falling downe of any new defluxion into the part; if by an artificial diet hee have a care that excrementitious humors be not too plentifully generated in the body; or so order it, that being generated they may be evacuated at certaine times, or else diverted from the more noble to the base parts. But in the meane space it shall be requisite to waist the faulty flesh, which growes up more than is fitting in the Vlcer, and to clense the sordes or filth, with medicines, which may doe it without biting or acrimony and putrefaction.

XXIII. Of The Fistulas In The Fundament.

FIstula’s in the Fundament are bred of the same causes as other kinds of * Fistula’s are; to wit, of a wound or abscesse not well cured, or of a haemorrhoide which is suppurated. Such as are occult, may be knowne by dropping * downe of the sanious and purulent humor by the Fundament and the paine of the adjacent parts. But such as are manifest by the helpe of your probe you may finde whither they goe and how farre they reach. For this purpose the Chirurgion shall put his finger into the Fundament of the patient, and then put a Leaden probe into the orifice of the Fistula, which if it come to the finger without interposition of any medium, it is a signe it penetrats into the capacity of the Gut. Besides also then there flowes not onely by the fundament but also by the orifice which the maligne humor hath opened by its acrimony, much matter, somewhiles sanious, and oft times also breeding Wormes. Fistula’s may be judged cuniculous, and running into many turnings and windings, if the probe doe not enter farre in, and yet not withstanding more matter flowes therehence than reason requires should proceede from so small an Vlcer.
You may in the o•ifices of all Fistula’s, perceive a certaine callous wart, which the common Chirurgions tearme a Hens arse. Many symptomes accompany Fistula’s * which are in the Fundament, as a Tenesmus, strangury & falling downe of the Fundament. If the Fustula must be cured by manuall operation, let the patient lye so upon his backe, that lifting up his legges, his thighs may presse his belly, then let the Chirurgion, having his naile pared, put his finger besmeared with some oyntment * into the patients Fundament; then let him thrust in at the orifice of the Fistula a thick Leaden needle drawing after it a thread consisting of thread and horse haires woven together, and then with his finger taking hold thereof and somewhat crooking it, draw it forth at the Fundament, together with the end of the thread. Then let him knit the two ends of the thread with a draw or loose knot, that so hee may straiten them at his pleasure. But before you bind them you shall draw the thread some-what roughly towards you as though you meant to saw the flesh therein conteined, that you may by this meanes cut the Fistula without any feare of an Haemorrhagye, or flux of blood.
It sometimes happens that such Fistula’s penetrate not into the Gut; so that the finger by interposition of some callous body cannot meete with the needle or probe. Then it is convenient to put in a hollow iron or silver probe so through the cavity thereof to thrust a sharp pointed needle, and that by pricking and cutting may destroy the callous; which thing you cannot performe with the formerly described leaden probe, which hath a blunt point, unlesse with great paine.

The description of a hollow Silver probe to be used with a needle, as also a Leaden probe.

A. Shewes the Needle.
B. The hollow probe.
C. The needle with the probe.
D. The Leaden needle drawing a thread after it.

 
The Callus being waisted, the Fistula shall be bound as wee formerly mentioned That which is superficiary needs no binding, onely it must be cut with a croked scalprum, and the Callus being consumed, the rest of the cure must bee performed after the manner of other Vlcers. But you must note, that if any parcell of the Callous body remaine untoucht by the medicine or instrument, the Fistula reviving againe will cause a relapse.

XXIV. Of Hemorrhoids.

Haemorrhoides, as the word usually taken, are tumors at the extremities * of the veines encompassing the Fundament, caused by the defluxion of an humor commonly melancholicke, and representing a certaine kind of Varices. Some of these run at an hole being opened, which sometimes in space of time * contracts a Callus; others onely swell, and cast forth no moisture; some are manifest; others lye onely hidde within. Those which runne, commonly cast forth blood mixed with yellowish serous moisture, which stimulates the blood to breake forth, and by its acrimony opens the mouthes of the veines. But such as do not run, are eyther like blisters, such as happen in burnes, and by practitioners are usually called vesicales, and are caused by the defluxion of a phlegmaticke and serous humor; or else represent a Grape, whence they are called Vvales, generated by the afflux of blood laudible in qualitie, but overaboundant in quantiry; or else they expresse the manner of a disease, whence they are termed morales, proceeding from the suppression of melancholicke blood; or else they represent warts, whence they are stiled Verrucales, enjoying the same materiall cause of the generation as the morales doe.
This affect is cause of many accidents in men; for the perpetuall effluxe of blood * extinguisheth the vivide and lively colour of the face, calls on a dropsie, overthrowes the strength of the whole body. The fluxe of Haemorrhoides is commonly every moneth, sometimes onely foure times in a yeare. Great paine, inflammation, an Abscesse which may at length end in a Fistula, unlesse it be resisted by convenient remedies, doe oft times forerunne the evacuation of the Haemorrhoides. But if the Haemorrhoides flow in a moderate quantity, if the patients brooke it well, they ought not to be stayed, for that they free the patients from the feare of imminent evills, as melancholy, leprosie, strangury and the like. Besides, if they bee stopped without a * cause, they by their refluxe into the Lungs cause their inflammation, or else breake the vessells thereof, and by flowing to the Liver cause a dropsie by the suffocation of the native heate; they cause a dropsie and universall leanenesse on the contrary, if they flow immoderately, by refrigerating the Liver by losse of too much blood; wherefore when as they flow too immoderately, they must be stayed with a pledget of hares downe dipped in the ensuing medicine.

℞. pul. aloes, thuris, balaust. sang draconis,*an. ℥ss. incorporentur simul cum ovi albumine, fiat medicamentum ad usum.

When they are stretched out and swollne without bleeding, it is convenient to beate an Onion roasted in the embers with an Oxes gall, and apply this medicine to the swolne places, and renew it every five houres. This kind of remedy is very prevalent * for internall Haemorrhoides; but such as are manifest may be opened with horsleaches, or a Lancet. The juyce or masse of the hearbe called commonly Dead nettle or Arkeangell, applyed to the swolne Haemorrhoides opens them, and makes the congealed blood flow there hence. The Fungus and Thymus being diseases about the fundament are cured by the same remedy. If acrimony heate and paine doe too cruelly afflict the patient, you must make him enter into a bath, and presently after apply to the ulcers (if any such be) this following remedy.

℞. Olei ros. ℥iiij. cerusae ℥j. Litharg. ℥ss cerae novae, ʒvj. opij ℈j. fiaet unguent. secundum artem. Or else. ℞ thur is, myrrhae, croci, an. ʒj. opij ℈j. fiat unguentum cum oleo rosarum & mucagine sem. psilij, addendo vitellum unius ovt. You may easily prosequute the residue of the cure according to the generall rules of Art.