The Compleat Surgeon Part 24

_What is an Ulcer?_

An Ulcer is a Rupture of the Natural Union of the Parts made a long while ago, which is maintain'd by the _Sanies_ that runs out of its Cavity; or an Ulcer takes its Rise from a Wound that cou'd not be well cur'd in its proper time, by reason of the ill quality of its _Pus_ or corrupt Matter.

_What difference is there between a Wound and an Ulcer?_

It is this, that a Wound always proceeds from an external Cause, and an Ulcer from an internal, such as Humours that fall upon a Part; or else a Wound in growing inveterate degenerates into an Ulcer.

_Whence is the difference of Ulcers deriv'd?_

It is taken from the Causes that produce 'em, and the Symptoms or Accidents with which they are accompany'd. Thus upon Account of their Causes they are call'd Benign or Malignant, Great, Little, Dangerous, or Mortal; and by reason of their Accidents, they are term'd Putrid, Corrosive, Cavernous, Fistulous, Cancerous, _&c._ {165}

_Do Ulcers always proceed from external Causes, or from an outward Wound degenerated?_

No they sometimes also derive their Origine from internal Causes, as the Acrimony of Humours, or their Malignant Quality; the Retention of a Splint of a Bone, and other things of the like Nature. These Ulcers are commonly call'd Primitive, and the others Degenerate.

_What are Putrid, Corrosive, Cavernous, Fistulous and Cancerous Ulcers?_

The Putrid Ulcer is that wherein the Flesh is soft and scabby, the _Pus_ and _Ichor_ being viscous, stinking, and of a cadaverous smell.

The Corrosive Ulcer is that which by the Acrimony and Malignity of its _Sanies_, corrodes, makes hollow, corrupts and mortifies the Flesh.

The Cavernous Ulcer is that the Entrance of which is streight and the bottom broad wherein there are many Holes fill'd with malignant _Sanies_, without any callosity or hardness in its sides.

The Fistulous Ulcer is that which hath long, streight, and deep Holes, with much hardness in its sides; the _Sanies_ whereof is sometimes virulent, and sometimes not.

The Cancerous Ulcer is large, having its Lips bloated, hard, and knotty, of a brown Colour, with thick Veins round about, full of a livid and blackish sort of Blood. In the bottom are divers round Cavities, which stink extremely, by reason of the ill Quality of the _Sanies_ that runs out from thence.

_Are there no other kinds of Ulcers?_ {166}

Yes, there are also Verminous, _Chironian_, _Telephian_, Pocky, s...o...b..tick, and others, which have much affinity with, and may well be reckon'd among the five Kinds already specify'd.

_What are the means to be us'd in the curing of Ulcers?_

Ulcers ought to be well mundify'd, dry'd and cicatriz'd; but with respect to the several Causes and Accidents that render 'em obstinate, and difficult to be cur'd, it is also requisite to make use of internal Medicines, which may restrain and consume 'em. If their sides grow callous, they are to be scarify'd, in order to bring 'em to Suppuration; and if there be any Excrescences, they must be eaten away with corroding Powders, such as that of Allom; or by the Infernal Cautery.

_What are the Remedies proper to cleanse and dry up Ulcers?_

To this Purpose divers sorts of Liquors may be us'd, as also Powders and Plaisters: The Liquors are usually made of Briony-Roots, the greater Celandine, Lime, and Yellow Water; a Tincture of Myrrh, Aloes and Saffron, and Whey, whereto is added _Saccharum Saturni_; so that the Ulcers may be wash'd or bath'd with these Liquors; and very good Injections may be compounded of 'em.

The Powders are those of Worm-eaten-Oak, Allom, and Cinoper, the last of these being us'd by burning it, to cause the Fume to be convey'd to the Ulcer thro' a Funnel. The Country People often make use of Potter's-Earth to dry up their Ulcers, with good {167} Success; but then they must must be of a Malignant Nature.

The Plaisters are _Emplastrum de Betonica_, _Diasulphuris_, _Dessiccativum Rubrum_, and others; and the Ointments are such as these;

Take three Yolks of Egg, half an Ounce of Honey, and a Gla.s.s of Wine, and make thereof a mundifying Ointment, according to Art: Otherwise,

Take Lime well wash'd and dry'd several times, let it be mingled with the Oil of Line and _Bolus_, and it will make an excellent Ointment to mundifie and dry; a little _Mercury Precipitate_ may be intermixt (if you please) to augment the drying Quality; and _Mercurius Dulcis_ may be added in the Injections.

For Ulcers in the Legs, and Cancerous Ulcers, take Plantain-Water and Allom-Water, or else Spirit of Wine, _Unguentum aegyptiac.u.m_, and Treacle; or else an Extract of the Roots of round Birth-Wort made in the Spirit of Wine. Gun-Powder alone dissolv'd in Wine, is of singular Use to wash the Ulcers, and afterwards to wet the Pledgers which are to be apply'd to 'em.

But here are two particular and specifick Medicines to mollifie a Cancer.

Take _Saccharum Saturni_, Camphire, and Soot; let 'em be incorporated with the Juice of House-Leek and Plantain, in a Leaden-Mortar; then make a Liniment thereof, and cover the Part affected as lightly as is possible to be done, as with a simple Canva.s.s-Cloth, or a Sheet of Cap-Paper: Or else, {168}

Take the destill'd Water of rotten Apples, and mingle it with the Extract of the Roots of round Birth-Wort made in Spirit of Wine; reserving this Liquor to wash the Part, and to make Injections.

CHAP. VIII.

_Of Venereal Diseases._

_Of the _Chaude-p.i.s.se_ or _Gonorrhaea_._

The Signs of this Disease are a painful Distention of the _p.e.n.i.s_ or Yard, and a scalding Pain in making Water, the Urine being pale, whitish, and full of Filaments or little Threads: Sometimes the t.e.s.t.i.c.l.es are swell'd as well as the _Glans_ and _Praeputium_; and sometimes there is a Flux of a kind of Matter yellowish, Greenish, _&c._

If there be a great Inflammation in the Yard, endeavours must be us'd to allay it by letting Blood; and afterward the Patient may take a cooling and diuretick Diet-Drink, as also Emulsions made with cold Seeds in Whey. A very good Decoction may be prepar'd in all places, and without any trouble, by putting a Dram of _Sal Prunella_ into every Quart of Water, whereof the Patient is to drink as often as he can: This Decoction is very cooling and diuretick; and the use of it ought to be continu'd till the Inflammation be a.s.swag'd. Then some gentle {169} Purges are to be prescrib'd in the beginning; such as an Ounce of _Ca.s.sia_, and as much _Manna_, infus'd in two Gla.s.ses of Whey, which are to be taken one or two Hours one after another.

Afterward the Patient must be often purg'd with twelve Grains of Scammony, and fifteen Grains of _Mercurius Dulcis_; and these Purgations must be continu'd, till it appears that the Fluxes are neither yellowish nor greenish, nor of any other bad Colour. When they are become White, and grown Thready, they may be stopt with Astringents: Amber and dry'd Bones beaten to Powder, eighteen Grains of each, with one Grain of _Laudanum_, the Composition being taken in Conserve of Roses, are very good for this Purpose. _Crocus Martis Astringens_, or else its Extract, taken from half a Dram to a whole Dram, in like manner performs the same Operation. As soon as the _Gonorrhaea_ is stopt, to be certain of a perfect Cure, a Dram of the _Mercurial Panacaea_ is to be taken, from fifteen to twenty Grains at a time, in Conserve of Roses. In the mean while, if a small Salivation shou'd happen, it must be let alone for the present, since it may be stopt at pleasure by the Purgations. When it is requisite to restrain the _Gonorrhaea_, _Mercury_ must not be given any longer, in regard that it is a Dissolvent, which is only good when the Glandules of the Groin or t.e.s.t.i.c.l.es are swell'd, or else when it is expedient to set the _Chaude-p.i.s.se_ a running, after it hath been too suddenly stopt. At the same time that the Astringents are taken with the Mouth, {170} Injections also are to be made into the Yard; such as are prepar'd with _Lapis Medicamentosus_, of which one Dram is put into eight Ounces of Plantane-Water. All Astringents that are not Causticks, are proper for the Syringe.

_Of Shankers._

They are round Ulcers, and hollow in the middle, which appear upon the _Glans_ and the _Praeputium_. To cure 'em, they must be touch'd with the _Lapis Infernalis_, and brought to Suppuration by the means of red Precipitate mixt with the Ointment of _Andreas Crucius_. _Oleum Mercurii_ laid on a Pledget or Bolster, is very efficacious to open s.k.a.n.kers, and consume their Flesh. The Patient must be well purg'd with _Mercurius Dulcis_ and Scammony, taking twelve or fifteen Grains of each in Conserve of Roses; and after these Purgations are sufficiently reiterated, he may take the _Mercurial Panacaea's_. It is an excellent Remedy for all sorts of Pocky Distempers not yet consummated, or arriv'd at the greatest height of Malignity.

_Of _Bubo_'s._

_Bubo's_ are gross Tumours or Abcesses that arise in the Groin, the perfect Maturity of which is not to be waited for in order to open 'em; because it is to be fear'd lest the corrupt Matter remaining therein too long, might be convey'd into the Blood by the Circulation, and so produce the grand Pox: Therefore it is {171} necessary to open 'em betimes with a Lancet, or else with a Train of potential Cauteries, if they are too hard. They ought to be Suppurated for a considerable time: The Patient must be well purg'd with Scammony and _Mercurius Dulcis_: He must also take the _Mercurial Panacaea's_.

_Of the Pox._

This loathsome Disease begins sometimes with a virulent _Gonorrhaea_, and a weariness or faintness at the same time seizeth on all the Members of the Body: It is usually accompany'd with Salivation and the Head-ach, which grows more violent at Night: p.r.i.c.king Pains are also felt in the Arms and Legs, the Palate of the Mouth being sometimes ulcerated. If it be an inveterate Pox, the Bones are corrupted, and _Exostoses_ happen therein; divers Spots with dry, round and red Pustules appear in the Skin; and the Cartilages or Gristles of the Nose are sometimes eaten up. But when this Disease is come to its greatest height of Malignity, the Hair falls off; the Gums are ulcerated; the Teeth are loose, and drop out; the whole Body is dry'd up; the Eyes are livid; the Ears tingle; the Nose become stinking; the Almonds of the Ears swell; the _Uvula_ or Palate is down; Ulcers break out in the Privy-Parts; Bubo's arise in the Groin; as also Warts in the _Glans_ and _Praeputium_; and _Condyloma's_ in the _a.n.u.s_.

Indeed the Pox may be easily cur'd in the beginning; but when it hath taken deep Root {172} by a long Continuance, it is not extirpated without much difficulty, more especially if it be accompany'd with Ulcers, _Caries_, and _Exostoses_; the Person afflicted with it being of an ill Const.i.tution, and his Voice grown hoa.r.s.e.

The Spring and Summer are the proper Seasons of the Year for undertaking the Cure of this Disease: In order to which, it is necessary that the Patient begin with a regular Diet, lodging in a warm place, and taking such Aliments as yield a good Juice; as Jelly-broath made with boil'd Fowl: Let him drink Sudorifick Decoctions, prepar'd with the Wood of _Guayac.u.m_, _China_-Root, and _Sarsaparella_, and let him abstain from eating any thing that is high season'd: Let him take Clysters to keep his Body open; sometimes also he may be let Blood, and purg'd with half a Dram of Jalap, and fifteen Grains of _Mercurius Dulcis_. The Purgations may be re-iterated as often as it shall be judg'd convenient; and then the Patient may be bath'd for nine or ten Days, every Morning and Evening; during which time he may take volatile Salt of Vipers, the Dose being from six to sixteen Grains; or else Viper's-Grease from half a Dram to a whole Dram in Conserve of Roses.

Afterward it will be necessary to proceed to Fluxing, which is caus'd by the means of Frictions with _Vuguentum Mercurii_, which is made of crude _Mercury_ stirr'd about in a Mortar with Turpentine, and then the whole mingled with Hog's-Grease, one part of _Mercury_ being usually put into two parts of Hog's-Grease. The Rubbing is begun at the Sole of the Feet, {173} by a long Continuance, it is not extirpated without ascending to the Legs, and the inside of the Thighs; but the Back-Bone must not be rubb'd at all; When the Persons are tender, or of a weak Const.i.tution, a single Friction may be sometimes sufficient. Thus the Patient must be rubb'd at the Fire, after he hath taken a good Mess of Broath; but I would not advise it to be done with more than one or two Drams of _Mercury_ at a time, without reckoning the Grease. Then the Patient must be dress'd with a Pair of Linnen-Drawers or Pantaloons, and laid in his Bed, where his Mouth may be lookt into from time to time, to see whether the _Mercury_ hath taken effect; which may be easily known, by reason that his Tongue, Gums, and Palate swell and grow thick, his Head akes, his Breath is strong, his Face red, and he can scarce swallow his Spittle; or else he begins to Salivate.

If none of these Signs appear, the Rubbing must be begun again in the Morning and Evening; then if no Salivation be perceiv'd, for sometimes four or five Frictions are made successively, a little _Mercurial Panacaea_ may be taken inwardly, to promote it. During the Frictions, the Patient is to be nourish'd with Eggs, Broaths, and Gellies; he must also keep his Bed in a warm Room, and never rise till it shall be thought fit to stop the Salivation, which continues twenty or twenty five Days; or rather till it becomes Laudable; that is to say, till it be no longer stinking, nor colour'd, but clear and fluid.

If a Looseness shou'd happen during the Salivation, it wou'd cease, so that to renew it, {174} the Looseness may be stay'd with Clysters made of Milk and the Yolks of Eggs; and in case the Salivation shou'd not begin afresh, it must be excited with a slight Friction: But if it shoul'd be too violent, it may be diminish'd by some gentle Purge, or with four or five Grains of _Aurum Fulminans_, taken in Conserve of Roses.

Three or four Pints of Rheum are commonly salivated every Day in a Bason made for that purpose, which the Patient holds in his Bed near his Mouth, so as the Spittle may run into it. But if the Fluxing shou'd not cease of it self at the time when it ought, he must be purg'd to put a stop thereto.

If any Ulcers remain in his Mouth, to dry 'em up, Gargarisms are to be often us'd, which are made of Barley-Water, Honey of Roses, or luke-warm Wine.

The Warts are cur'd by binding 'em, if a Ligature be possible, or else they may be consum'd with Causticks, such as the Powder of Savine, or _Aqua-fortis_, by corroding the neighbouring Parts; sometimes they are cut, left to bleed for a while, and bath'd with warm Wine.

When the Patient begins to rise, he must be purg'd, his Linnen, Bed, and Chamber being chang'd; and afterward his Strength is to be recruited with good Victuals, and generous Wine. If he were too much weaken'd, let him take Cow's-Milk with _Saccharum Rosatum_.